Tags: arthritis, flare, joint damage, joint pain, pain, RA, rheumatoid, Rheumatoid arthritis, rheumatoid arthritis (RA)
Yay – the swelling has pretty much all gone and so has the inflammation – I have pretty much full ‘bendability’ back in my left knee – woohoo … but yes, I’m still being careful! Of course if you have an injury, swelling and inflammation happens for a reason – to take more blood to the area to repair the injury, and to stop you moving it in ways that are going to cause the injury to worsen. Now in RA, given that it’s those helpful wee blood-cells that are actually doing the attacking and causing the injury, it kind of confuses things a bit, but nevertheless the swelling DOES stop you moving the joint in ways that are likely to cause more injury … and when the swelling’s gone, so is that warning and protecting system. And one thing hasn’t gone yet … the pain! Luckily the pain isn’t there all the time for me, which is great – I’m very, VERY glad about that – but it does mean that while I’m sitting at my desk pain-free and want to leap up and get a cup of coffee, it’s rather important to remember not to leap unless I want to end up an embarrassing heap on the floor!
No doubt about it, this flare is definitely nearly over … but not quite. I was chatting to a friend on the phone the other night, someone who knows me distressingly well, and when I said that she said, ‘Well just don’t go and do anything stupid … like you usually do.’ Now I could have said something (quite a lot actually) about pots and kettles here (Maggie, if you’re reading this you know who I’m talking about!), but I have to admit she has a valid point, so … although today is the first day where I’m not using my stick AND the first day where (so far) I haven’t got my Physicool bandage on (but it’s with me in case I need it), I will still only be working a half-day. And just to make absolutely sure about that, I haven’t brought lunch in with me, so I’ll have to go home if I want to eat … or walk down the road to the shops, which I’m not up to doing yet – especially in icy fog!
I’ve been doing half-days all week and no doubt would have recovered slightly faster if I hadn’t worked at all, but that’s the thing about being self-employed – no work, no pay… and you let your clients down and you get a bad reputation and then you’ve got no business, so here I am! Thankfully this week we haven’t been that busy, but next week looks like a corker so I must be super-careful not to do anything stupid and make sure I’m fine for then.
Tags: arthritis, methotrexate, MTX, RA, Rheumatoid arthritis
Hmm, how many times have I read posts about self-injecting drugs and breathed a sigh of relief that I don’t have to do that? Too many to count. Well, that time has ended, my friends – I will be injecting my MTX in three weeks’ time, after my ‘education appointment’ with the hospital. Mind you, I gather from a small amount of on-line research that this is a very easy subcutaneous (under the skin) injection; not the sort of nasty intra-muscular injection that biologics users have to endure. It seems to be a simple (?!) question of using something like an epi-pen to squirt the MTX in with, but I will find out more when I go and get educated. Here’s hoping I get the sweet nurse I’ve been speaking to on the (yes, actually helpful) helpline, and not the bored and horrid nurse I’ve never liked from day one. We shall see. Either way I will endeavour to be a good girl, listen hard, take it all in and get it right first time. (Not getting it right first time could be messy!)
The reason I’m moving to this course is that I sometimes get stomach problems that may or may not be from the MTX and that many people who take the dose orally don’t get the full benefit as some of it is digested, rather than moving on to the bits it needs to go to in order to work. By injecting, I can keep to the same dose, rather than increasing and risking the side effects that go with that, but hopefully get more benefit from the dose as all of it will go straight to where it’s supposed to go. That’s the theory, anyway. Apparently there are no other advantages or disadvantages of injecting – other than the obvious mild unpleasantness I’m assuming for the injecting!
I’m nearly there, nearly through this flare! It’s still just the knee (although it’s now the knees and legs because although I’m trying to walk well with my stick, it’s putting pressure on the other leg!) However, I finished my dose of prednisolone today so I had to call the doc and say, ‘Not there yet, what should we do?’ She’s given me a few days more of 40 mg and then tapering it down day by day to nothing. Hopefully that will do the trick. Otherwise it’s the dreaded knee injection – the one I swore I would NEVER, NEVER, EVER, EVER HAVE AGAIN! (I also swore rather embarrassingly at the poor doc when she gave it to me.)
In spite of all that swearing, if it doesn’t clear up with the general steroids, that’ll be the way to go because I need to get mobile again and I need to be able to work a full day! I didn’t work the end of last week and today I lasted about 3.5 hours, and that was pushing it. I had to push it as we’re quite busy and had tight deadlines to meet – and one of the JPs was off with a migraine last week and the other junior penguin left early today to pick up the keys to her new house. (Well, I could hardly keep her back from doing something THAT exciting, now could I? And it was only an hour before she was due to leave anyway.)
I’m also very tired – I did sleep well last night but had two terrible nights before that due to a combination of pain and hot flushes (not a misprint, my American friends: we say flushes, you say flashes). Also of course fatigue is part of the joy of RA. Ho hum …
I’m so looking forward to being mobile and awake again – I don’t think it’ll be too long now … so long as I’m sensible, pace myself and don’t try to do too much too quickly. (Easier said than done of course. Wish me luck!)
I’m also going onto injectable methotrexate, rather than oral, but more about that tomorrow.
Warning: this is not an extensive list of things to do when you have a knee flare; everyone’s different. It’s a short list of things I need to do when I have a knee flare, but usually don’t!
- Phone the the helpline AND the GP within a couple of days.
- REST IT! Don’t pretend it’ll be fine if you just ignore it. It usually isn’t!
- Use the darned stick – it’s why you’ve got one, so you can use it. Yes, even in the house! Keeping pressure off a flaring knee helps.
- Use the physicool bandage – it seems to help a lot, especially in the morning, and it feels good too.
- ask for help and accept it when it’s offered. It all helps to keep the weight off the knee and let it mend.
- Loose some weight! Easier said than done! Must ask Carla for tips!
So I’ve been doing some of this over the last few days and the knee is SLOWLY mending. It’s been a week now and I’m still hobbling but hope to be (need to be) back at work on Monday!
So here I am, five to six days into a flare and three days into my prednisolone non-taper – it’s just 40 mg for seven days and then stop. Most of me is on top of the world with all these steroids sloshing about. Hands, great; feet, great; elbow, great; right ankle, only occasional twinges. The good ol’ left knee, however, is another matter.
Wren has her dragon, some people refer to Arthur the arthritis, but for me, I’m picturing tiny little microbe-size mice nibbling away on all my joints going, ‘like the mice on the mouse organ in Bagpus only way, way smaller. ‘Hmm, not as good as cheese’, ‘No, we’ve had better than this, Charlie-Mouse’. Then of course, a la Bagpus (with apologies to all my American friends who’ve probably never heard of him or his mouse friends) they’d start the inevitable song, ‘Eat the joints, eat the joints, nom nom nom …’ And then, finally, making their way around my body, and being beaten off by the steroids (possibly in the form of Bagpus or Emily telling them to behave … or is the point where I’m really losing my mind due to lack of sleep and knee pain?) they finally reach the safety of the mouse-hole in my left knee. ‘This is it!’ ‘Yay!’ ‘Yummy-yummy!’ ‘It’s the cheese mountain …’ And they there are to stay … but hopefully not for very long.
OK, that crazy dose of whimsicality has cheered me up slightly, which is what it’s all about really!
Back to reality – I’m at work (but I don’t know for how long) sitting with a freezing Physicool bandage round my leg, in a freezing office with snow coming down outside, but i have to say the bandage really is helping! I also remembered finally to get my stick out so I’ve been using that, which does help too. I really must remember to get these things out and use them sooner in future!
Guess who called me just a half-hour or so after I called them? Yes, the helpline! I immediately apologised for my rather grumpy message and the nurse then said she hadn’t actually heard it – just been passed on a note to call me. Darn – could have saved myself an apology! <Grin> So I basically told her what I’d said, only less grumpily, and she said she’d pass the info onto the registrar who I saw last, eight weeks before, and if he wanted to up the methotrexate then she’d call me back, otherwise not. She was very pleasant and not at all as brusque as I’ve made that sound – and of course she wasn’t the dreaded voice of the answer-phone message, who’s a nurse I’m not fond of! Anyway, she didn’t phone back, and that was anticipated as since the increase in MTX was only 8 weeks ago it hasn’t officially had a chance to work yet.
I thought it was interesting that the nurse didn’t offer any nursing tips – but perhaps she figured with seven years or so of arthritic knee behind me I should jolly well know what to do by now – which, frankly, is quite true! And she also said that I should call back if I found things not improving or getting worse – which I now feel much more encouraged to do than I did before after my one and only contact with the helpline seven or eight years ago, when they took two or three days to get back and then told me to see my GP!
Well I’ll give ’em that, he called very quickly… but he started off slightly fixated on the bloody helpline. I explained the problem and got, ‘Do you see the rheumatology nurse regularly?’ I said, ‘My next appointment is May.’ He said, ‘Yes, but what about the helpline?’ I said I hadn’t spoken to them this time but their usual response was, ‘Call your GP’ so, after checking my blood tests from the end of December and finding them ‘slightly elevated’ which was news to me, he agreed to a pred taper again, slightly grudgingly, ‘but please do call the helpline nurses. They are the experts in this.’
So I’m afraid I called the helpline and left the sort of message that guarantees no one will bother to call me back. Oops! It wasn’t deliberate but I’m in pain, tired, headachy and generally riled! I phoned up and got the usual, ‘There’s nobody here. I’m bored to death. You can tell by the tone of my voice, can’t you? If you really must speak to one of us please leave your telephone number, hospital number, date of birth and name and if you’re really, really lucky, someone might get back to you in the next couple of days.’ OK, OK, that’s not EXACTLY what it said, but honestly, it was ‘within 48 hours’ and I kid you not about the instantly recognizable tone of voice either! So I left a message along the lines of, ‘This is Polly Penguin, hospital number xyz, day time telephone 01234 567891, date of birth blah blah, I’m having a flare … I’ve contacted the GP and they’re giving me a pred taper but they’ve told me to contact you so I am. Good bye.’ Oh dear. Yes, I regret it now! It pays to stay on the good side of these people … but hey, I won’t hear from them I don’t suppose, and I won’t see them till May when they’ll have forgotten all about it.
If you remember my last brush with the helpline, you’ll know why I feel this way – but it MIGHT have changed since then, even if the phone message hasn’t.
Happy New Year everyone. I hope you all had good and healthy (as possible) starts to the New Year. I had a lovely Christmas and New Year – very relaxing, Christmas at Mum’s and New Year at ours with Mum and an old friend from uni… and no arthritis problems to speak of! Hurrah.
Unfortunately I can’t say the same now. I’ve been flaring since Saturday morning (it now being Tuesday morning) and last night the flare ramped up a notch from ‘flarette’ to the real thing so I’m sitting waiting for a call back from the doctor.
In the meantime, my nurse appointment that should have been 5th February has just been postponed by the hospital to 6th May – although I can always call the helpline, for what it’s worth, between times. It actually makes more sense to have it in May as that puts it slap bang between my last and next consultant appointments, and also if I see them in February and say ‘No change since you upped my methotrexate’ they’d probably just shrug and say ‘It’s barely been three months dear’, whereas in May it’ll have been six and if it’s really not working, then it’ll be clear by then.
As always the worst of it’s in my left knee but I’m also having ‘fun’ with my left elbow, right ankle (makes walking interesting!) and hands, especially at night and of course first thing in the morning. Fortunately I can still type so ‘putting beans on the table’ is not a problem yet. However, I foresee a day off in the near future to rest up the knee, as it’s impossible to do that while sitting at the desk in the office.
I think I need to make a list of the ‘aids’ that I can use to help when I’m having a flare, and then remember (HA!) to refer back to it so that I actually bring into the office things like the cooling spray, the stock, the neck pillow etc. etc. … none of which I have with me today of course! I’m also missing one of the junior penguins are her young daughter has flu so she’s had to take time off (quite rightly too!) to look after her … so I’m battling deadlines with 1.5 out of 3 of us down. (I’m counting myself as the 0.5!) I just hope the other ‘JP’ turns up for work today!
On the bright side, this being a Pollyanna blog, I’m mighty glad this doesn’t happen too often! My last flare was the end of September, only 3.5 months, but I know, and sympathize with, people who have to put up with this level all the time.
Here’s hoping the doc calls back SOON and gives me a pred taper (or something even better) without seeing me, like last time!
Tags: arthritis, consultant, doctor, flare, hospital, methotrexate, MTX, NHS, R.A., RA, rhematoid arthritis, rheumatoid, Rheumatoid arthritis, rheumatoid arthritis (RA), rheumatology
I’ve just had my April hospital appointment – well, it was supposed to be in April – then they moved it to June .. then they moved it to August … then they moved it to September … then they moved it to November… but this time it didn’t get cancelled. Right, I thought, I’ve seen no one at the rheumy department in 13 months, I’m going to make a LIST of things that I need to ask about, ’cause my memory’s shot. I know doctors hate lists but when you have to wait 13 months for an appointment you don’t want to forget anything, right? Right! Shame I forgot that I’d made the list then, and consequently forgot to ask about the dry mouth, although I think I covered everything else… except memory problems of course. I don’t think a rheumy clinic is going to be that interested in my forgetfulness anyway!
Everything else was more pain and stiffness in the hands and feet than previously, two nasty flares in my knees over the past year and a lump on my finger.
For the first two, my methotrexate has gone up to 20mg from 17.5mg. The nice boy (sorry, young man – I’m getting old, all the registrars look like children to me) was slightly horrified that I started off eight years ago on 5mg (or possibly 7.5mg) as they’re now much more aggressive and he said they’d never start anyone on less than 15mg so really 20mg is nothing. He also said if stomach upsets were a problem them can move me over to a self-injecting pen. I wasn’t too keen on that idea – I’ve only had two or three stomach upsets over the year that MIGHT have related to MTX and it’s possible that none of them did – I have a dodgy tummy anyway!
For the lump on the finger, he said since it was on my left middle finger and I’m left-handed it was probably just where I rested a pen. I said, ‘Who writes these days?! I almost never hold a pen! I type everything,’ to which he laughed, agreed and basically said, ‘Dunno’. It’s not painful and it’s not growing alarmingly so ‘dunno’ is fine for the moment!
The ridiculousness of the DAS score was brought home to me yet again. As the nice boy put it, ‘You might as well be amputated below the knee as far as that’s concerned’ and one of my main problems is feet! Daft! It also included a rating of how has the RA been THIS WEEK. Who gives a monkeys about this week – I haven’t seen anyway for 13 MONTHS! He took that on board too, bless him, and although I scored ‘low disease activity’ with four sore joints and pretty good thank you for this week, he accepted that my RA wasn’t under control if I’d had two bad flares this year; hence the MTX increase.
He also said if the appointments started slipping again, I should phone reception and point it out and they’d stop it happening – my faith in reception, on a score from 1 to 10 – zero. Not that I really think it’s their fault – they’re just the front line when it keeps happening and I phone up and say ‘Oy’ and they say, ‘Not our fault,’ which it’s not!
Anyway, I’ve got a nurse practitioner appointment in February – let’s see how much that gets moved – not that I need it in February – May would be more sensible, but I’m hesitant to cancel!!