Good news and bad news … and good news …

January 29, 2018 at 10:38 am | Posted in arthrits, arthrits, rheumatoid arthritis, fibromyalgia, joint pai, crafting, joint pai, rheumatoid arthritis, rheumatoid arthritis, rheumatoid arthritis (RA) | 8 Comments
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Well the good news is that my poor, neglected blog has been poor and neglected since RA Blog Week in September of last year because I have been really well! I’ve had the odd hip pain but only when in bed, which means I never remember to ask the doc about it because when I’m awake, I’m fine! Other than that I’ve been OK. In fact at the beginning of the month my regular 6-monthly hospital appointment was cancelled at the last minute because the doc was sick. The beleaguered receptionist rang to let me know and to apologise and was very pleasantly surprised when I said, ‘That’s fine – saves me coming in on a horrible, foggy morning and waiting around!’ ‘Oh,’ she said, ‘that’s not the reaction I’ve had so far!’ I pointed out that I felt fine and was busy at work and delighted not to have to waste all our time and she said, ‘You’re the sort of person I LIKE to ring!’ I wished her luck with the rest of the calls and that was that.

The following week I had a day off to do a textile workshop, which was great fun. (I was learning, not teaching. My last attempt at teaching was risible and should be enough to put me off teaching a workshop for probably another 10 years or so!) At the end of the day though I had TERRIBLE lower back pain – one of the worst pains I’ve ever had. I just didn’t know what to do with myself. Luckily after an early night it settled in to unpleasant but not terrible lower back pain for the next week or so. The very day after that back pain started I had my regular monthly blood test, which I thought no more about.

That week I had an email from my friend Carla emailed me to point out that my blog was woefully out of date (and other stuff, but that was definitely a significant part of the email!) Stupidly I said, ‘Oh, that’s ’cause I’m fine! Nothing to blog about!’ I should probably have touched wood, crossed flippers and said kein aiyn hara (and anything else superstitious you can think of) but I didn’t!

Now, here’s the interesting thing. (‘Yay, finally, something interesting,’ I hear you cry.) My bloods, which are never, never, NEVER up, even when I’m having a serious flare, were somewhat up the day after the back problem started. I didn’t know this until a knee flare started the following week and I limped into the doc with my stick.

‘How are you today?’ the very pleasant, if slightly odd-looking, locum doc I’d never seen before asked cheerfully!

‘Oh, fine, on the whole,’ I replied, equally cheerfully, ‘except see the stick? Well I have rheumatoid arthritis’ (knowing the chance of his having read any notes was minimal!) ‘but I normally walk find and don’t need a stick. I’m having a bad flare in my left knee …and the right one’s not perfect either.’

‘Hmmm, let’s have a look. Ah, did you know your bloods were up this month?’

‘No! That’s intriguing, they’re never up!’ And I explained that even when I flare horribly there’s normally nothing to show in the bloods, so even a slight raise, as this was, was interesting. But I didn’t connect it with the back problem, or the fact that they were up a week before the knee flare … brain not fully functioning due to a couple of poor nights’ sleep thanks to knee pain!

‘Hmm, what do you usually do when this happens?’

‘Steroids – prednisilone’.

‘Hmm,’ (his favourite word I think), ‘Well that’s not ideal!’

So I looked him straight in the eye, which was kinda hard ’cause he was an odd-looking chap, but that’s neither here nor there, and said, ‘Oh … so what is ideal then?’

Didn’t even get a hmm that time, more of an ‘Uh … uh … uh … erm…’ followed by, ‘are you on any regular medication for it?’ See, told you he wouldn’t have looked at the notes! So I explained about methotrexate and hydroxychlorquine and he said, ‘Has anyone talked to you about tweaking your methotrexate dose?’

‘Yes of course, in the 11 years I’ve had this it’s been altered many times but that doesn’t really help with a short-term flare that needs to be cleared up so that I can carry on living/working,’ or words to that effect.

‘Hmmmmm … let’s see … when did you last have steroids?’

‘Ages ago?’

‘Oh heavens yes, two-and-a-half years ago!’

‘Really, surely not that long!’

‘Hmmm… oh my mistake, one-and-a-half years ago. Oh well, in that case we can hardly say you’re overusing them. Shall we go for it then?’

‘I think we should!’ Metaphorically wiping my forehead in relief to have come to sensible conclusion.

So we went for it. But of course in my anxiety to get something proper sorted out for the knee I completely forgot about the back (or hips for that matter) again.

Six-and-a-half HOURS later I was able to pick up the steroids from the chemist and finally get some proper treatment for the knee. (Once upon a time your doc would print out the scrip, sign it and give it to you. This must have added all of 30 seconds to the consultation time. Now, presumably to ‘save time’ the prescriptions have to go to a central place, get printed, are signed by some other doc when he has the time, and then go over to the chemist. The other doctor doesn’t have time until the end of the day so you wait all day for something that needs treatment as early as possible. MADNESS!)

Anyhooo … I’m now left with a lot of questions and no one to answer them. I really, really hope I will never have back pain like that again and I just pulled a muscle and perhaps that caused an inflammatory response that got into the bloods and raised my ESR.  OR perhaps the back pain was actually referred knee pain, which can happen in that part of the back apparently. Or, perhaps, worst case, that was arthritis in the back and I’ll have another bout some time. Flippers crossed, toca medera (my Spanish teacher’s favourite phrase after madre mia!), kein aiyn hara that that won’t be the case!

And the final bit of good news? Well, the knee is responding extremely well to the steroids! So are the hips, which is a bit concerning … if they get back again I probably need to drag myself down to the doc again, but I think you can see from this post why i try not to do that too often!

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‘I can see clearly now, the vague has gone!’

August 29, 2013 at 9:39 pm | Posted in Me | 6 Comments
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(Apologies to Johnny Nash!)

I’m on hydroxychloroquine, which means I’m supposed to have an eye test every year – but I forgot and the optician forgot to send me a reminder!

Then a vague concern that my eyesight might not be as clear as it ought to be, combined with being unable to remember when I had my last eye test made me go and check with the optician, who is handily just down the road from work.

And the outcome is – I have glasses – first time ever – for distance vision i.e. basically driving. It’s slightly concerning (to me, but not to the optician, so it must be OK really) how much clearer things are, considering I only had the vaguest inkling that I might have a problem, and especially considering that two years ago (my last eye test) I didn’t have a problem! If I look at things without the glasses they don’t appear blurred – but then I put them on and they’re suddenly incredibly clear!

I suppose these things just creep up on one – the eye-sight deteriorated pretty gradually over those two years, and it’s only a very light prescription I have now, but the difference is quite extraordinary.

I’m getting used to them – or at least I’ve now stopped having hysterics every time I catch sight of myself in a mirror or shop window!

NICE fiddles while RA burns a hole in the economy and our joints

January 30, 2010 at 12:00 pm | Posted in arthrits, rheumatoid arthritis, fibromyalgia, joint pai, Me, rheumatoid arthritis (RA) | 5 Comments
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I got my shiny new NRAS magazine through the post today. Great to see an article by Rheumatoid Arthritis Guy in there! Well done RA Guy! But there’s always something in there to get me aeriated, and the first magazine of 2010 was no exception!

Interesting also to see a two-page spread on the ‘European Fit for Work Report’. Frankly, I’m not sure there were that many surprises in there, although I was a bit surprised at the number of people who become ‘work disabled’. Apparently 40% leave work altogether within 5 years of diagnosis, which is not happy reading. However, it appears that the main reason for this is people being diagnosed and treated too late or incorrectly. The report recommended ‘new and more inclusive methods to evaluate the cost-effectiveness of treating musculo-skeletal diseases in particular; one that considers more than the up-front costs of medical expenditure and incorporates wider social and economic factors.’ No kidding. In other words, this report recommends doing exactly what NICE doesn’t do. The article goes on to say that ‘NICE in the UK has already begun such a deliberation, although no decision has been reached to date.’ No surprise there then!

Now, my honorable friends, please turn to page 12 of your NRAS magazine. Don’t have one? Not to worry – here’s the headline: ‘People on Enbrel stay in work longer’. It goes on to state that a 500-person study (the COMET study if anyone’s inclined to look it up) showed that those with active early RA were three times less likely to stop working if treated with MTX and Enbrel, rather than MTX alone. Absenteeism was also reduced by almost 50% for those on the combination therapy. But here’s the rub – NICE won’t allow anyone to start on a combination therapy like this until they have been proved unresponsive to at least two other DMARDS including methotrexate … so when does early stop being early? It takes, I would think from my own experience, at least six months to show that a DMARD is not working for you, because it can take them that long to start working. So you’re diagnosed (probably not immediately), you’re given a DMARD if you’re lucky, perhaps hydroxychloroquine, for six months; it doesn’t work. You try MTX (either on its own or in combination with HCQ) for another six months. That doesn’t work either. You’ve now been diagnosed for at least a year. Is this still early enough to count for this study? Perhaps it is. If so, fair enough. If not then are NICE ruining people’s chances of staying healthy yet again. I don’t know the answer – I just pose the question.

And finally to a little article by a brave lady called Jean Burke, who works with NICE to provide a patient viewpoint in their deliberations. Rather her than me but I am full of admiration. Apparently she was asked by a member of an appraisal committee ‘Surely a twenty percent increase in quality of life isn’t worth bothering about?’ Well, I suppose that’s why they need the patient viewpoint. If you’re reading this blog as someone with RA I imagine you’ll see it her way immediately; I know I did. She points out that if the extra 20% means she can make a cup of tea in the morning, go to work or walk to the shops then yes, it’s worth it!

So long as NICE remains in its ivory tower, untouched by all these deliberations about the socioeconomic effects of diseases and so on, I simply cannot see how the system can ever work effectively.

I’m glad nurses are more organised than consultants!

April 15, 2008 at 8:29 pm | Posted in Me, rheumatoid arthritis (RA) | Leave a comment
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OK, that may not be a general rule but it seems to apply to mine! I had my first appointment with the ‘rhuemy nurse’ today – a.k.a. Rheumatology Nurse Practitioner – a very nice lady who kindly sorted out my next consultant’s appointment (he’d forgotten), gave me a letter for my GP asking them to continue prescribing the drug I’m on (hyrdroxychloroquine) because he’d forgotten, and gave me the hospital’s own rheumatology support line number because … he’d forgotten.

Well, I suppose the important thing is that he’s good at knowing whether people have rheumatoid arthritis or not, and what to do about it – admin is for us lesser mortals.

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