I have had a bit of a tidy-up of my blogroll. I’ve removed most of the blogs of people who haven’t posted for over a year – but if you’re someone who just posts really infrequently but still has a ‘living’ blog, and you’re miffed that you’re not on there any more, just drop me a note and I’ll put you back on! :-)
I have also added a few ‘new’ blogs – not new at all really, but new to me, in particular a couple about other forms of arthritis than RA. And I have finally got around to adding Carla, who should have been added AGES ago – sorry Carla, but at least I got there in the end!
Want to recommend a blog that’s not on here? I’d be delighted to hear from you. It might take me a while to get round to adding it, but I will do so … one day!
Tags: RA, Rheumatoid arthritis, shoulder, shoulder injection, tendon, tendonopathy
Well, I’ve had my second shoulder injection. It was a week or so ago now, and it’s definitely working. Things aren’t perfect, but they’re a heck of a lot better than they have been.
This was an injection into the tendon, not the joint, guided by an ultrasound scan so they could see exactly where the steroid injection needed to go.
The advice in advance with this one was don’t drive and do rest for 48 hours, so hubby kindly took me into the hospital on his day off. We decided to go a whole hour early in case of parking difficulties, so of course we parked with ease! But when we came out an hour later, it was heaving and I was really glad we’d made the decision to go early.
I don’t know why they bothered sending out instructions in the letter to wear loose and washable clothing, since it turned out I had to take off the top half and put a gown on anyway, because my bra strap was in the way! That was only mildly embarrassing, when the gown flapped about because the nurse couldn’t find the tabs to do it up!
Then I sat down facing the radiologist and the screen, as instructed, and he scanned the shoulder with ultrasound. He confirmed the tendon was indeed inflamed, pretty much exactly where I thought it was, but happily not torn. Then he got me to put my arm in an incredibly uncomfortable position and keep it there, and took out a scarily huge needle. ‘Focus on something else, Polly’ I told myself as it came towards me.
‘Just a little scratch,’ said the doctor, cheerfully.
It was more than a little scratch but not madly painful. ‘Don’t think about the BIG, SCARY NEEDLE Polly’ I said to myself, ‘ la, la, la, think of little gambolling lambs and mountain streams. La, la, la …’
‘Look,’ said the doctor cheerfully, ‘You can see the needle on the screen!’
Mmm, thanks mate, just what I wanted! And sure enough, there it was, a long, straight stiletto floating about in the various incomprehensible (to me) wavy lines of the ultrasound. Actually it was quite fascinating to watch – for a bit. Then it started to jigger about alarmingly, and whether it really was jiggering about inside me, or whether I just thought it was and it caused me to tense up, I don’t know, but suddenly it was really, really painful. I must have made a that’s really, really painful face because the doctor realised it was hurting and said he’d stop for a bit.
Now I don’t know about you, but when I have a ruddy great needle in part of my anatomy I’d rather just press on, so to speak, and get the job done, especially if the alternative is to sit and rest for a minute with the needle still stuck inside me – so I said no, it was fine, and he carried on. Actually the pain did diminish, so perhaps I had just tensed up for a bit.
While this was going on another doctor came into the room and apologised for having been absent. ‘No worries,’ said the radiologist, ‘you haven’t missed anything. It’s just a shoulder. Boring.’
I gave a little involuntary chuckle, which went straight over the doc’s head but the nurse quickly added, ‘Not that we’re saying you’re boring!’
At that the radiologist did have the grace to look mildly embarrassed, and he said, ‘Oh believe me – it’s good to be boring! We do hundreds of these procedures so I know exactly what I’m doing. You don’t want something rare!’
Well, that was fair enough I thought.
‘By the way,’ I said, ‘when the instructions say “rest for 48 hours,” what exactly does that mean?’
‘Whatever you want it to mean,’ said doc with a kindly smile. ‘There’s no scientific basis to it. Just see how you feel and what you feel like doing.’ So I did. They day after the injection it didn’t hurt much so long as I did nothing but veg about and be a couch potato, but it did hurt if I did ANYTHING with it. So I didn’t do anything with it. I watched an entire season of Dollhouse (thanks Maggie) and let hubby wait on me when he got home! The following day I thought, ‘I’m fine – I’ll go into work’ so I did.
MISTAKE! Two hours at work and my shoulder was in a lot of pain – so I went home again. (Advantage of being the boss!) By the next day it really was much better and it’s continued getting better and better so far – so flippers crossed that will continue!
Tags: Christmas, cookery, cooking, eggs, German Christmas biscuits, zimstern
Health warning: This post has nothing to do with health.
Why do I do it? Every year at round about this time, fooled by a mixture of Christmas Spirit and the Great British Bake-Off perhaps, I make the same mistake: I believe I can cook … or at very least bake. I’m sure I used to be able to bake, once, a long, long time ago, before hubby, before RA, before old age … well OK, middle age, but I’m feeling old right now. Maybe I’m just imaging it though. I know I did some nice scones … once …
Anyway, my one cook-athon of the year is New Year’s Eve and I fancied making some biscuits as well as my usual main meal.
This year I’d carefully ruled out all the things I knew I couldn’t tackle on the cooking front – out went anything to do with melting sugar (after several burned saucepans and unbelievable pongs over previous years); out went anything to do with melting chocolate, (after several attempts at mousses that turned into gritty messes). But this recipe, courtesy of The Telegraph, looked simple enough.
Even though it looked simple, I thought I’d better try it out in advance.
I think I was mistaking brevity for simplicity. The brevity, I soon realised, was due to the fact that the recipe was written for people who know how to cook. How silly of me to think I was one of them. Mind you, I probably didn’t help myself because I was using our new food processor.
You start off in this recipe by making a meringue mixture. I’ve done that before. I’m sure I have. Heck, I make Snowqueen every year*. But I’ve always used a hand whisk.** This time I wanted to try out the new toy. It has a main bowl, a midi bowl and a mini bowl. Knowing how eggs fluff up when they’re whisked, I thought I’d use the main bowl. Hah! Other people’s eggs might fluff up – mine sat there for five minutes looking, well, runny – just like they had five minutes before straight out of the egg. Funny, I thought, it’s really not whisking very fast at all. I thought it would go much faster than that.
‘ Doesn’t sound well,’ commented Hubby, from his perch in front of the telly.
I gave it some thought and decided that it clearly wasn’t working in the main bowl, so perhaps I should try the midi bowl. I put the midi bowl on the kitchen counter, took the main bowl carefully off the food processor and tipped the egg into the midi bowl.
At this point it would have helped, really helped quite a lot, if I had remembered that there was a hole in the middle of the bowls for the motor to go through.
I didn’t quite have egg on my face, but I did have it all over the kitchen counter, on the glass counter saver (which didn’t save the counter) and dripping onto the floor, which hubby had only washed a few hours before.
Taking a few deep breaths and staying calm, so calm that hubby doesn’t actually even know about this bit, and won’t until he reads the blog, I decided there was still about an egg’s worth left in the bowl, so got another egg out of the fridge, added the white to the midi bowl and plugged the whole lot into the food processor Or at least that’s what I thought I’d done. It went whir, whir and nothing moved. At this point I dragged hubby away from Warehouse 13 to come and investigate. We stood scratching our heads and trying to make the various bits of whisk look like the whisk in the instruction book, which, as is the way of these things, is nearly all picture with very few words. After much head scratching and some hilarious attempts at combining the bits, I realised that a key component was still attached to the main bowl whisk, now sitting in the sink.
So I whisked the eggs into soft peaks. They made beautiful soft peaks. Then I added the sugar. Well, it doesn’t tell you in the Telegraph recipe that you have to add it a bit at a time, because it’s written for people that can cook. If you don’t add it a bit a time, the whole lot collapses into a runny mess.
It collapsed into a runny mess.
‘You’d better see if Delia has a fix,’ suggested hubby. I knew there were no fixes when a whisked egg has un-whisked itself, but I thought I’d have a look anyway. Basically her advice boiled down to ‘Don’t under-whisk the eggs – but don’t over-whisk them either or they’ll all collapse. And add the sugar an ounce a time, whisking all the time.’
Nothing else for it but to start again. Hubby, supportive and sympathetic, suggested I stopped and had a coffee first, but no, I knew better, I wanted to carry on.
So, more eggs, this time into the bowl without mishap, more nice soft peaks.
‘Make sure you can turn the bowl upside down and the eggs don’t fall out,’ says Delia. So I did that. Only I’d forgotten that the whisk was in bits and a bit fell off when I turned the bowl upside down. I made a grab for it. It was HOT. I managed not to screech so hubby doesn’t know about that bit yet either. Still, things were looking up; the eggs looked lovely. Woohoo.
I started to add the sugar a little bit at a time. I was really careful. Really, really careful. Itty-bit at a time – whisk, whisk, whisk – another itty bit. I kept checking. It looked lovely. Glossy, peaky, beautiful … I kept adding sugar, I kept whisking …
Can you see what’s coming? I was being so careful that I’d completely forgotten the ‘don’t over-whisk them or they’ll collapse’ bit.
It collapsed into a runny mess.
On top of that the kitchen was in an unbelievable state – it looked like it had snowed indoors. If you’ve ever cooked with icing sugar you’ll know what I mean. Even enormous cat was liberally decorated with icing.
I threw a wobbly – hubby supportive and sympathetic – ‘There, there penguin, it’ll be OK.’
‘IT WILL NOT…’ (I’m a real charmer when I get into a bad mood!) ‘ONCE IT’S GONE, IT’S GONE!’
‘Well time to stop now. Sit down and have a coffee’
‘LIKE I HAVE A CHOICE? We’ve run out of BLOODY EGGS!’
So I had a coffee – with ill grace! And hubby, bless him, quietly went and washed everything up before I even realised what he was doing!
Maybe it’ll be Snowqueen for New Year’s Eve pudding again then …
Or maybe I should stick to what I do know how to do: crochet.
* A meringue-based ice cream. I’d forgotten that I actually buy the meringues ready made from the supermarket.
** Later realised this was to whip the cream for the Snowqueen. Cream, I can do.
I have just doubled-up on my monthly methotrexate blood-test, and I shall soon be doubling up on my shoulder injection. I’d already doubled up on colds. Now if the amount of work coming in would only double up too, I’d be happy!
So, why the extra blood test? Well, I had a call yesterday from the friendly, neighbourhood rheumy nurse. ‘I’m really sorry – we need you to come in and re-do one of the blood tests. The lab have done one but sent the other one back saying the sample is contaminated! We’ve never had that one before!’ I said, ‘I expect they dropped it. That would certainly contaminate the sample!’ I mentioned to my Mum later and her immediate reaction was, ‘I expect they dropped it’ too. I can’t really see how else a sample from one of those vacuum syringe things could get contaminated!
Anyway, all went well with it today and that should be the end of that. If this sample comes back ‘contaminated’ too though I’ll start to worry!
The shoulder thing is as I mentioned before – the scan plus injection. It’s come through. It’s at the county hospital and I was having a minor panic because it says on no account can you drive after having the injection. It’s come through for a Wednesday and that’s not a good day for anyone to give me a lift – it just so happens mum’s always busy on Wednesday’s, a very dear and far too obliging friend who’s local to me who would do it any other day has her small grandson to look after that day, and … well, I can hardly ask the girls that work for me; it’s bad enough that I’ll be out of the office all afternoon! Most of my other friends are either working or not local enough … or in one case don’t drive!
However, when I finished panicking and had a proper think I realised that by astonishing coincidence, hubby had that day off – so that’s that sorted! Poor hubby – not his ideal day off, driving me home from hospital, but he’s been very sweet about it and not pointed that out at all!
I drove after the previous injection! I didn’t even think about it. Everything was fine and I just got in the car and went back to work. I’d rather not risk it this time though as it’s a lot further away than the local surgery if there was a problem!
Tags: aches, arthritis, cold, diagnosis, doctor, R.A., rhematoid arthritis, rheumatoid, Rheumatoid arthritis, rheumatoid arthritis (RA), shoulder, stiffness, tendonopathy
When I had that shoulder injection I was finding it very hard to pinpoint exactly where the pain was, but I know it was kind of ’round the back’. Well … the pain round the back has gone, the mobility is improved but not great, but now I can exactly pinpoint the pain that remains and it’s to the side/front! I still can’t lift the shoulder much above the horizontal.
I went to see my GP about it last week and she’s put me forward for a scan. I was rather hoping for another injection but she says it’s too soon as, since there has been some improvement from the one I had, it should still be working away and might start to improve the other bit too. I rather doubt that, but she’s the doc, so we shall see!
The other thing she said was that if they do the scan and can see the exact spot that is inflamed, they can do the injection there and then and be sure that it’s in just the right place. And being the NHS, by the time the scan comes through I will certainly have left enough time between injections!
So for the moment it’s a waiting game … again!
In the meantime I have my second cold of the winter, and it’s not even supposed to be winter yet. <sigh, achoooooooooooo=””> I’ve also had an unpleasant flare through most of September and the beginning of October, but that seems to be over now – phew. As usual, nothing whatsoever showed in the bloods. In fact, when I have my six-monthly rheumy appointment in December I’m expecting him to say ‘Oh, did you have a bit of a flare in July – your bloods are slightly up.’ I was 100% fine in July!
Well I’ve had the injection in my shoulder – the one I wasn’t looking forward to in this post. In fact it all went very smoothly. I phoned the GP and she was quite amenable to doing the injection and gave me an appointment for the next day.
While I was there I took the opportunity to ask her if she thought it was RA related, just out of curiosity, and because Andrew (see comments in this post) had got me wondering. In fact, it’s almost certainly not, because I have an excellent range of movement in the joint itself. I can’t lift the arm up past horizontal, but the ball will slide around in the socket any which way you like, provided it’s not my muscles/tendons having to do the work, so the joint isn’t affected.
I was a little concerned, but being a brave penguin didn’t show it, when doc picked up this huge sausage-shaped cannister and said, ‘Right, if you can just get your arm out … ‘ Yikes, I thought, surely she’s not going to inject ALL THAT! ‘Just going to put a bit of cold spray on first,’ she said, cheerfully, and I realised that was what the cannister was. Phew! The syringe was actually quite small, as was the needle, when compared to the ones that go in the knee!
In fact the injection hardly hurt at all. I can’t say the same for the shoulder a few hours later, when the fast acting anaesthetic had worn off and the steroids hadn’t kicked in yet! I had a thoroughly miserable evening and worse night, but the next morning I could brush my hair without going ‘OUCH!’ and the following night I could get my bra off. Can’t actually mange to get the damn thing ON in the mornings yet – partly because mornings are bad anyway due to general RA stiffness, and partly because on takes longer than off, giving my shoulder a chance to remember that it hurts … but I think we’re getting there.
Flippers crossed that this injection will do the trick and allow the tendon time to heal. In the meantime I’m continuing with the physio exercises to try to strengthen the muscles so it doesn’t happen again.
If the injection fails to work, we’ll be looking at surgery, and I do NOT want to go down that route if I can possibly avoid it!
Someone on the NRAS blogging site mentioned that Food Hospital, a programme on Channel 4 that aims to help people tackle their medical problems through food, was featuring someone with RA this week, so I gritted my teeth and watched it.
It’ not something I’ve ever watched before and it exceeded my expectations; however, my expectations were spectacularly low! It’s a typical ‘magazine programme’ where each week they have three or four different featured illnesses and dietary solutions, and some other features too, and they switch from one to another and back – which meant I had to watch it all and not just the RA bit!
I was pleasantly surprised to see that they had genuine hospital-based medical practitioners involved, and pleased to see that they did in fact explain the difference between rheumatoid and osteoarthritis, and had a reasonable explanation of rheumatoid.
The lady who they were helping had very severe rheumatoid arthritis and had already had a number of joints replaced. As she couldn’t exercise at all she had become quite overweight, and I did feel that they didn’t make enough of the fact that this hadn’t caused her arthritis and indeed that many people with RA are not at all overweight. (I am, of course, not one of them, but that’s another story.) I also strongly objected to the fact that they actually said that her diet contained ‘a lot of red meat and processed meats’ and then showed a picture of a counter-top (if I remember rightly) piled high with cakes, muffins, fried food etc.
I was chatting to a friend about it a couple of days later and she said, ‘Gosh, her normal diet looked awful!’ And I pointed out that there was no reason to suppose that that was her diet (apart from the red and processed meats comment). That was just a TV ploy: let’s show a pile of fattening food because we’re talking about being overweight, and of course if you’re overweight you obviously must scoff cakes and fried bacon the whole time.
Anyway, they put this lass on a high omega-3 anti-inflammatory diet, with the side benefit that she would also lose weight, and hey-presto she lost quite a bit of weight and in ten weeks her ESR (erythrocite sedimentation rate, anti-inflammatory marker) had gone down from 28 (well above normal) to 20 (just within the normal range). Good news indeed. Good enough that I’m going to be increasing my oily fish intake, as any penguin should!
However, what they neglected to mention on the telly, although if you check out their website they do tell you, is that although the ESR went down during that period there have been “no clinical changes yet, in pain or mobility”, but that is expected as this is a long-term approach.
They also say “Beth’s rheumatoid arthritis will continue to be difficult for her but with continued weight loss she should continue to see slight improvements in her condition.” So again, the emphasis seems to be on the weight, encouraging people (especially ones who don’t think too hard – the majority?) to see this as a cause of her rheumatoid arthritis.
And the final bit on the website that I’m dubious about is the sentence: “Beth lost weight on the diet which has helped her ESR level drop within normal range.” To me the way this reads is slightly misleading. I think they meant, “Beth lost weight on the diet. The diet helped her ESR levels to drop to within the normal range.” However, the way it reads suggests that weight-loss has a direct correlation with ESR reduction. I’ve never heard that, and I’ve done an internet search to look for a link between the two and can’t find anything at all. As I say, I think it’s just the way it’s written that’s misleading, rather than that they’re trying to claim there is a link, but it’s just another little irritation in what was, all things considered, not too bad a programme after all!
Tags: arthritis, flare, flare-up, joint pain, pain, R.A., rhematoid arthritis, Rheumatoid arthritis, rheumatoid arthritis (RA), rheumatology, thumb
I’ve been cruising along very nicely thank you for the last few months. I made the mistake of getting used to it I think … Great, I feel fine … let’s get on with stuff then. Well, you only live once, people to see, things to do, natural history surveys to complete, courses to go on, friends to see … Spanish to learn, embroidery competitions to enter.
Next time I see my rheumatologist, I thought, perhaps we can talk about reducing the MTX.
When will I learn?!
It started a couple of weeks ago with sudden, severe pain in my right thumb. Then it went away. I didn’t see it as a warning sign – I’d got too used to being footloose and flare free. Then it came back … and then other bits started to hurt too … ooooooooh-k, maybe this is a flare, I thought.
And it was.
Fortunately not a terrible one – one of my flare-ettes/aka fizzles, but bad enough to act as a little reminder. It’s over now … I think … but I’m back to being careful …
Well, apart from botanical drawing class an hour’s drive away on Saturday, more natural history recording on Sunday, interviewing tomorrow …
Tags: arthritis, autoimmune diseases, immune system, new scientist, placebo effect, psychology, R.A., RA, rhematoid arthritis, Rheumatoid arthritis, rheumatoid arthritis (RA), rheumatology
According to this article in the New Scientist (6 September 2012) the “the immune system has an on-off switch controlled by the mind”. On reading the article, one feels that this isn’t actually as daft as it sounds at first. The point is that, “the immune system is costly to run – so costly that a strong and sustained response could dangerously drain an animal’s energy reserves.”
Hmm, does that start to explain the fatigue felt by so many RA patients and dismissed by so many doctors? Given that RA is apparently caused by an over-active immune system, then surely a strong and sustained over the top response must be pretty fatiguing?
Anyway, back to the article … given that the immune response is energy sapping, the theory is that the immune system will only bother kicking in to fight a mild infection if it feels the reserves it will drain can be re-stocked. Apparently Siberian hamsters will fight a mild infection in the summer, when food supplies are plentiful, but won’t do much to fight it in winter conditions.
This leads to the idea that the mind has an ability to play up/down the immune response depending on whether it feels there is help available … and that leads to an explanation of why the placebo effect works. If you think you’re taking a drug to help fight an infection, say, that makes it worthwhile to put up a fight and bring in the immune system, the theory goes.
The theory has now been supported by some computer modelling, which is all explained in the article but which I won’t go into here.
It leads to some interesting questions, to my mind, about autoimmune diseases.
Being a little flippant here, does this mean that all sufferers of autoimmune diseases are optimists who are so confident that help will always be at hand, that we bring our immune systems in on the flimsiest pretexts?
Is the reason autoimmune diseases seem to have become so much more prevalent in the last few decades (so I’m told) because we’re all generally pretty healthy (until we’re not) and so the body/mind doesn’t have to question whether there are resources available?
And finally, if there’s an on/off switch in my mind, then why can’t I just turn the damn thing off and get on with life?
Tags: muscle pain, shoulder pain, tendinopathy, tendonitis
Thankfully this one will NOT be in my knee – the one in the knee was possibly the most painful experience of my life so far – but then again it was short-lived and it did cure the problem. This one, though, is going to be in my shoulder.
If you’ve been reading the blog for a while you’ll know I’ve had problems with my shoulder, which turned out to be non-RA related, for a while. I’ve had several physio sessions and a variety of exercises, but although it seemed to be getting better for a while, it suddenly got worse. It’s ‘tendinopathy’ (and that does appear to be the right spelling). It’s the chronic version of the probably more familiar (certainly more familiar to me) tendonitis; in other words it’s chronic inflammation around the tendons, in this case those that attach the rotator cuff muscles to the shoulder bone (but don’t ask me which shoulder bone because my anatomy isn’t great!)
Anyhow, since physio isn’t working, it’s an injection for me. I can’t say I’m looking forward to it, but it’ll be nice to be able to do my bra up myself again!
Thanks to the weird and wonderful workings of the NHS though, the physio has to write to my GP to ask her if she’ll give the injection; I then have to phone my GP in about a week (to give her time to receive the letter) and ask her if she’ll do it, based on the letter. I think she has the right to say no, based on nothing more than the fact that it’s the hospital physios recommending it, and it will be her budget if she does it, so she can send me back to them. I’m not sure about that, but reading between the lines I think that’s how it works.
Since the doctor is a couple of minutes down the road and the physio is a half-hour drive away, and since it hurts the shoulder to drive, I’m hoping common sense might prevail. We shall see. NHS Wonderland Part 4 coming up, I fear!