The truth about living with Rheumatoid Arthritis

#seronegative rheumatoid arthritis

Rheumatoid Arthritis, and depression and side effects and co morbidities

controlI’m sorry, I have been MIA lately.  Truth?  The last few months have really taken their toll – liver problems, kidney problems, staph infections, bizarre skin rashes, eyes sight problems (the very real possibility that I could go blind), tapering prednisone yet again and of course the unrelenting, severe pain in every joint.

I know you all understand…but depression got the better of me for a while.  I have missed you all – and posting here is something I should not have stopped doing.  Writing soothes my soul and helps me deal with all of the above.  I guess I was loathe to write about depression…but now I realise its kinda dishonest to skip that part of this delightful disease.  Like hiding part of me.  As if I am ashamed.

Well, I am not ashamed.  Depression is no more anything to be ashamed of than having Rheumatoid Arthritis itself. But it’s not easy to express yourself when your brain is confused and you’ve lost your way.  I will write more about it, because I believe it’s an important part of my story, and it’s time I had the guts to tackle it.  But briefly, what have I been doing to get back on top of things?

I have been spending more time with my psychologist and I have adjusted my medications. Tapering prednisone causes mood problems for me.  And methotrexate causes severe depression.  The kind that creeps up on you…slowly, insidiously.  And one day you realise that you are not yourself at all, that you are having crazy thoughts and you are no longer driving the bus.

I stopped all my medications for a few weeks, except prednisone.  Physically it was fairly horrendous.  The pain was as you would expect.  Which didn’t help my mood.  But I was depressed because of pain and disability…a very different thing.

Medication induced depression feels different to me.  And I recognise it now, having been down that road a few times already, if not always which medication is causing it.  It takes trial and error.  But the main culprit is methotrexate and now, for real this time, I will never take that drug again.  I stopped it three weeks ago, and now I am getting back to ‘myself’.  I am feeling more normal, more in control of my disease, in fact I’m feeling downright defiant!

Much more like me J

I have even booked an impulsive and rather irresponsible holiday with my kids.  Just me, and the kids.  I live in Canberra.  We are flying to Brisbane (2 hour flight) then I am picking up a car and driving a further hour north to the Sunshine Coast.  It will be much warmer there than here.  There will be a beach.  And there will be a pool with a huge spa.  All I need to do is get through that flight, and car trip.

I admit I am nervous.  I have never done this without the support of an able bodied adult. Someone to take the wheel if I have a full body mega flare.  I am anxious…and last night I felt absolute panic about whether I can, in fact, physically do this.  What if I DO have a full body mega flare?  Several of my joints ‘flare’ every day.  I am always in pain somewhere…but which individual joints are flaring makes a radical difference to my capabilities. I can adapt, find a way.  If ALL my joints are flaring (hands, elbows, shoulders, hips, spine, neck, knees, ankles, ribs, jaw) I can’t ‘save’ one joint by putting more pressure on a ‘good’ joint.  I can’t do much of anything at all.

Since I have tapered below 12mg of prednisone, I have been needing to take round the clock slow release oxycodone (Targin) and short release oxycodone (endone) for break-through pain.  There is always break-through pain.  I am at 9mgs of prednisone now, and I need to taper off.  Slowly. There is no choice.  Prednisone has caused cataracts and glaucoma and I don’t want to go blind.  So the only option is stronger-than-morphine opioid medications.

I can’t take these drugs when I need to drive a car for 100kms on unfamiliar roads.

I can take all of them as soon as I get there.

So I need to have a mild to moderate day on the two days that we are travelling to and from.  I am trusting the gods to sort out this out for me, because I am an optimist by nature.  And if the gods let me down, I am trusting myself to figure something out, because I am capable, and resourceful and I fervently believe there is always a way.

And I plan to document it. Show the world all the things that need to be taken account for a person with a chronic illness, for just for a few days away.  Like making sure there is a microwave for heat packs. That there is a fridge for Enbrel.  That the beds are comfortable…no camping or two star ‘roughing it’ for me.  The 7 or 8 daily medications, plus the 2 or 3 others incase of incidentals, like nausea or severe indigestion caused by meds, or the eyedrops that I need to take daily to protect my vision.  All the little ‘extras’ things I need to pack…incase.

The sheer courage that it takes to leave the comforts of home where you are ‘safe’ and take a chance because sometimes the soul needs to travel, to find warmth, to find sun.  To try to give my kids something a little more normal.  To give them some good memories.  To give ourselves a challenge and prove we can do it, even if it’s not the way we used to do it.

Wish me luck.  Pain free is too much to hope for…but pain control is possible 🙂  I wish the same to all of you!

Rheumatoid arthritis and eyes…uveitis, iritis, cataracts and glaucoma

uveitis and rheumatoid arthritis

http://www.insighteyespecialists.com/patient-education/iritis/

I’ve been very quiet of late because I have been struggling.  I haven’t wanted to write a really ‘negative’ post, but it’s not really negative. Its reality. Its truth.  I suppose it wouldn’t be honest for me to not admit that over the last few weeks/months the hits have kept coming.  And they have knocked me down.  And I have been experiencing bouts of depression and loneliness that I can’t just ‘mind of matter’ and wish away. No amount of positive thinking or optimism is enough right now. In all seriousness, the surprising thing is not that I am now experiencing this depression, but much more that I have gotten through the last few years largely escaping it.

I hate to admit that I am not coping.  But I am not.  I don’t know if the pain is worse now, or if my pain tolerance has fallen.  Does it matter?  The end result is the same.

One thing I am very sure about is that my depression is secondary to pain.  When the pain is under control, there is no depression.  In the beginning I remember doctor after doctor, person after person, telling me I was just depressed. Doctors, because my bloodwork was clear.  People, because I looked just fine.

All.  Wrong.  In my case.

I know there are people who suffer aches and pains as a result of depression.  It’s a physical manifestation of their depression, and the pain is very real. But this is not so in my case.  I log my  moods and I log my pain.  If I overlay one over the other, surprise, surprise.  When the pain has been bad for many days, depression starts to set in.

Now depression has made itself a little home here next to me on the couch…not that I invited it.  Because I have received the blow that all my doctors have been warning me was coming.

I have to get off prednisone.

I know that everyone has a love/hate relationship with prednisone.  But I have loved more than hated, because it’s the only thing drug that really helps, the only thing that keeps me moving.  While I am in daily pain still, when I am taking 15mg of prednisone daily, usually the pain is manageable.  I can walk.  I can take care of my kids.  I can go to the gym sometimes.  I can look normal.

I still have the mega flares, where I spend a few days in agony and unable to move.  But they aren’t every day.  Life is far from ideal…but it’s comparatively liveable.

My doctors have been telling me for years that I need to get off prednisone, because it will cause me more trouble in the long run. The usual worry is bone density, but for me it’s my eyes.  I have uveitis again, plus cataracts and increased eye pressure from the prednisone.  My opthamologist told me I have to get my dose down to about 7.5mg, or risk losing my eyesight.

So my time is up!

I live on my couch now, and am taking oxycodone and ms contin (morphine) around the clock to deal with the pain.  This is not living.

I have steroid eye drops for my eyes (irony). They are improving. I go back in a few weeks to get another check.  Perhaps if they are OK, I can go back on prednisone.  I doubt it.

I am still taking Enbrel, methotrexate, Naprosyn and plaquenil.  Not helping.  I am switching to a new NSAID – arcoxia.  It is expensive.  But worth every cent if it works.

Last visit my rheumy said she will switch me to Humira in 8 weeks if there is no improvement on Enbrel. She doesn’t think there will be.

So I wait. And wonder.  Has anyone else had eye inflammation, uveitis, iritis?  Or complications from prednisone use, like cataracts and/or glaucoma?  Let me know how you’re dealing with it, or how it all turned out.

Rheumatoid Arthritis after ten weeks of Enbrel

shoulder arthritisI saw my rheumatologist yesterday.  I have to preface this post with this:  I do love my rheumy.  She is excellent.  She is intelligent, caring and open with her opinion.  She’s happy to explain her thinking, and happy for me to ask questions.  I trust her.

But I don’t always agree with her treatment plan.  She is the expert on Rheumatoid Arthritis from a medical point of view.  But I am the expert on me.  On what I am experiencing.  The difficulties I’m facing. What my life looks like.

These things affect how I’d like my RA to be treated.

She was running very late yesterday.  I waited more than an hour.  She wanted to catch up. I understand this.

But I wanted to talk.  And to her credit, she didn’t rush me out of there.  I think I am perhaps more frustrated right now, with my disease than anything else.  Frustrated that it seems no one can see how bad things have gotten.  I’m not explaining it well enough, no matter how I try.

I am tired of waiting.

Enbrel is working a little.  Maybe 20-30%? It’s always hard to put a number on it.  Rheumy wants me to persevere.  I expected her to want me to try the full four months.  Another six shots.

But she wants me to give it ANOTHER six months, after that.  So ten months in total before she will change the treatment.

That is a very long time to wait.  I understand that I have long standing disease. I understand now that it’s considered severe.  I understand a response might take longer.  But ten months?

My understanding is that most people give a biologic 3-4 months.  Please, I’d love to hear others experiences…please comment?

She did say that good responders would have responded by now.  She said she had a patient that it took six months for Enbrel to start to work.  So OK, I understand. I’m happy to commit to six full months.

I’m not sure about ten months.  Rheumy also said I could call her if I wasn’t managing, if the pain got unbearable.

I’d just finished telling her that the pain *is* unbearable.  I’d just finished telling her that I;m not managing.  That my life consists of couch time. That I take 4 oxys and two slow release morphine every day.  That I need a friend to pick my daughter up from school.  Hmmmmm.

So then I told her I’d restarted methotrexate.  She looked alarmed and asked my why I’d stopped taking it!  Um, remember, there was this little issue with a majorly bad reaction that put me in hospital.  I had to remind her of the circumstances, and that I’d been hospitalised.

She remembered in a rush and apologised.  She then agreed that a lower dose was a good idea, however.  So that we have more treatment options down the line.  She left it up to me as to whether to stay at 5mg or try 7.5mg.  She felt methotrexate might make Enbrel work better.  Several studies support this, it was part of my reasoning also.  30% improvement from Enbrel…if I can get another 20% from methotrexate, things are looking up?

I might then be able to reduce my prednisone.

Which Rheumy wants me OFF. Stat!  I read a summary of the updated EULAR (European Union League Against Rheumatism) Guidelines for Rheumatoid Arthritis and they emphasize that only low dose corticosteroids (prednisone) should be used.  Low dose isn’t defined, but it’s usually 7.5mg or less.  And should be tapered within 6 months.  So her approach is in line with the latest guidelines.  But it’s not realistic for me.

I explained to her that I am completely useless at 10mg of prednisone.  She said I needed to get down to 7.5mg.  I said I can’t.  Flat out.  I’m sorry, but I can’t live a non-functional, miserable  life on oxycodone and morphine when I can take prednisone and function most of the time.

She wasn’t happy about the level of opioids I’ve been taking.  I told her I needed them to function.  But I don’t enjoy being doped up and zombiefied  (that’s the medical term…LOL).

So she agreed.  20mg of prednisone to get me back on my feet.  Taper down to 15mg, which is my usual dose over two weeks.  Then after another two weeks start to taper again.

I agreed, but just between you and me, I’m not going to do that.  I have done the prednisone taper four times now. Each time, it doesn’t matter how slowly I taper, somewhere between 12mg and 10mg (on Enbrel) the pain becomes too much, and life stops.

I am not tapering prednisone this time until I am sure I am getting a response from methotrexate and/or Enbrel. It is an exercise in torture.  Pure,  pointless torture.  It takes me out of the game, brings on depression from the pain and disability.  And we KNOW how this ends.  I taper down. I suffer.  I hold on until I can see my rheumatologist.  We up the prednisone.  The game begins anew.

No more.

My  body.  My choice.

I understand the risks. I wish the rest of the world did.  All the good options were off the table years ago.  Now it’s all about the hard choices.

I also complained about my shoulder again.  The pain in my shoulder has been somewhere between moderate and excruciating for about 2 years now.   It feels like there is a knife permanently lodge in my back.  And another at the front of the shoulder.

I keep using it because I have to.  Yes it hurts.  She told me it can’t be that severe, else I wouldn’t be able to lift my arm.

Erm…I have to lift my arm. Yes it hurts.  I also believe in ‘use it or lose it’. If I stop moving it, I will l lose that mobility. So I lift my arm.

So she agreed to order some x-rays.

The appointment felt like an uphill battle.  But as I said, she was running late.  I kept interruptin and asking for things.  She was not unsympathetic.  And all her reasoning makes sense.  And for the most part, she gave me everything I wanted.

I am just tired of waiting.  I would like to move onto the next treatment option more quickly.  But I will give it six months.  Prednisone will kick in tomorrow or the next day.  Life will return.

And I will become more objective.  I am still thankful that my rheumy got me on biological therapy at all.

So I am still grateful.  Now I need to return that favour with trust and faith in her years of experience.

Rheumatoid arthritis, Enbrel and the next set of choices

painI’ve been quiet lately again.  I think most regular readers of this blog will know why.

Enbrel isn’t working. Or not working well enough.

I’ve taken 9 shots…I will take my 10th tomorrow.

I haven’t wanted to write this post, because I don’t want to brutally, coldly, analytically look at my results so far, and admit them.  Tomorrow I see my rheumatologist.  And while I love my rheumy, seeing her always brings some anxiety. A reality check. A taking stock.  A no-holds-barred look at where I am with my rheumatoid arthritis.

I’m a very positive type of person…I’m optimistic.  To the point of denial, sometimes.  I don’t get bogged down in setbacks (usually) but as we all know, Rheumatoid Arthritis is a serious disease.  It is painful. It is debilitating.  It is disabling and life limiting.  Even the most optimistic, glass half full type person hits the wall sometimes.

And the last two weeks, I’ve hit the wall.

Why?

The pain is much worse.  On 15mg of prednisone my life (on average) looks like this.

15mg prednisone, 1000mg Naprosyn, plaquenil

2 moderate/severe pain days per week.

3 moderate pain days

2 mild pain days

2 sleepless nights, where I lie awake most of the night because of pain.

1-2 endone (oxycodone) per day.  Targin (slow release oxycodone) or ms contin (slow release oral morphine) a couple of times a week – when I really need to sleep.

Gym 5-6 times per week.

Centergy (yoga/pilates) twice per week.

Power (Pump – lifing weights to music) twice per week.

And 2 or three cardio sessions – Spin class, either 30 minutes or 45 minutes.  Or cardio machines – cross trainer or recumbent bike.

On my very best days, I even run on the treadmill.  All of this exercise *causes* pain…but the benefits it gives me (muscle strength, fitness, cardiac health, mood boost) outweigh the pain.

It’s pain I can work through.  That doesn’t mean it’s mild pain – we RA chicks are pretty tough!

I also have 1 major knock down flare per month – 3 or 4 days of being bedridden by severe pain.  Some months it’s twice.

So that’s still a life that is severely impacted by Rheumatoid Arthritis.  That’s a life spent dealing with a lot of pain.  But that is still a functional life.  A useful life.  Dare I say it, even a happy life.

So where am I now?

10mg of prednisone + Enbrel.  Naprosyn.  Plaquenil. 

4-5 days of severe pain days.  Knock down days.  Full-body-mega-flare days.  Completely-unable-to-function days.

2 days of moderate pain.

I have been to the gym three times in the last two weeks. Twice it was a total fail.  I was unable to finish the class.  The third time I just sat on a recumbent bike and made the wheels go round for 30 minutes.  I guess I just wanted to be in an environment that I enjoy. My (previously) happy place. I ignored the fact that I wasn’t really exercising as such. I just needed to be there.  Out in the real world.

I don’t sleep at night unless I have taken slow release oxycodone.

I take 4 endone daily.  2 slow release oxycodone.  Just to function on my moderate pain days.

I am not exercising. I am not writing. I am not working.  I am not functioning.  I am just covering the essentials – keeping my kids fed, and clean school uniforms available.  I am not living.

I’m not taking my kids out.  I’m not helping them with their homework.  I’m not fun to be around.  I have needed to ask a friend to pick up my daughter from school.  (My son now takes the bus).  I’m not calling my friends, because I don’t want to complain to them.  They feel neglected because I haven’t been in touch, and asked them how they are doing.

I look exactly the same on the outside.

I make small talk if I run into an acquaintance at the store.  When people ask how I am, I say “Good! And you?”

But this is the truth.  I am not living.  I am existing.  I have two friends whom I admit this to.  And, of course, my fellow arthritic chicks.  (And arthritic guys? )

So this is where I am.  It’s not a good place.  Where does it leave me?  With some tough choices.  I’ve raved on a little much, so I’ll layout my choice in my next post.  Back in a bit…

Rheumatoid Arthritis and life after four weeks of Enbrel

enbrel2It’s update time.  I know that Enbrel can take 3-4 months to work, but many people have given me personal feedback that they knew much quicker if a biological was going to work for them.

So…this isn’t my final conclusions, its an update.  How things are going after four weeks.

I believe Enbrel is helping.

I believe that on average my pain levels are reduced by about 30%.

I know that doesn’t sound like much, but it really is.

30% means that the moderate to severe pain in the morning is moderate.  And becomes mild within an hour, rather than three…or never.

30% means I am sleeping through the night most nights, instead of being woken by pain and then unable to return to sleep.  I am finding that Monday nights and Tuesday nights I tend to wake more.  I think that’s because Wednesday is Enbrel day, and its wearing off.

30% means I am down to 13mg of prednisone.  And I am still able to exercise at the gym most days.  I have tapered prednisone many, many times now.  And I am currently tapering a 1 mg every two weeks.  Nice and slow.  But regardless, I always hit 12mg and become couch bound. That’s the line.  I’m still 1mg away from there…but I believe that when I taper down to 12mg next week I will still be walking.  That is pretty amazing.  We’ll see whether I am still working out in the gym, and whether I can still lift any weight, or need to concentration on bodyweight exercises and stretching alone.  I am definitely lifting less right now, and not able to work for as long.  I am weaker and have less stamina.  So I am absolutely feeling the prednisone taper.  But each week gives Enbrel another week to build up in my system and do its thing.

30% is still a very long, long way from pain free.  I am still in pain every day…all day.  But there could still be a lot of improvement to come!

Now for the flip side of the coin – side effects.  Avid readers of this blog will know I have experienced some weird and wonderful and even life threatening side effects.  So what’s the deal with Enbrel?

A headache.

Low grade, nagging, but totally manageable, headache.  Worst on Thursdays and Fridays (post Wedneday shot).  But it does fade as the week goes on.

So I’m a fan.  Enbrel is my friend.  I am sure it is helping…and while the improvement is not spectacular, it is certainly enough to make taking the shot worthwhile.  Especially because I still have a lot of hope for more improvement.  The other benefit is that I am taking less oxycodone.  Most days I only take 10mg now…instead of 20mg or even 60mg.

Tomorrow is shot number five.  And I’m looking forward to it!