Tapering prednisone and trying to exercise again

I made it through a spin class today.  It was doable.

Yesterday I walked on the treadmill, and that was doable, but not for very long.  After five minutes I was starting to walk funny, so time to change machines.  The purpose of my trip to the gym was to see exactly what I can and can’t do right now.  Being that my inflammatory arthritis has improved on where it was, but my spinal degenerative arthritis is worse than it’s ever been.

The recumbent bike was completely comfortable. I did ten minutes on that with no problems.  The cross-trainer was a bitch, which surprised me.  Totally out. Very hard on the lower back. Who knew?

I did some body weight exercises.  Lunges are fine, but not too deep. And I need to hold onto something for balance. Squats are not good – unless they are so shallow as to be pretty much pointless.  And again,  need to hold onto something for support.  That’s fine, as long as I’m holding proper form. So I did some bridges, to work on my glutes and lower back/core area.  No problems there. I can hold a 30 second plank easily, but all of this comes with a measure of pain.

I’m used to that.  I pay the price of pain today, for a healthier, more functional body into the future.

There is of course a line, below which any real exercise is impossible. As in the kind of exercise that works up a sweat and gets your heart pumping. I’ve been below that line for several months.  But I still did stretches, and range of motion exercises.  Everything counts.  Everything helps. Everything is worth doing.

Having said that, I am very unfit and have lost a lot of strength.

Thanks to methotrexate injections its time I tried to get some of that back.

Inflammatory arthritis pain improves with exercise. It is one of the ways that doctors diagnose the difference between inflammatory or mechanical/degenerative arthritis.  The difference is very clear to me, because when I am warmed up and exercising appropriately, my joints feel at their best.

My lower spine, however, is a completely different story.  Exercise tends to cause more pain.  But I still need to do it, to strengthen the ligaments and muscles that support my spine.

I’m calling the radiofrequency ablation a complete fail.  My back pain is the same as it was, if not a little worse.  With the added joy of a torn ligament and a strange sunburned feeling on my skin.  I won’t be going back for more.  I’m not pursuing spinal surgery.  I’m going to have to live with it.

‘Living with it’ means physical therapy.  And that means strengthening the muscles in my core, to support my spine.

It means doing exercises and it means pain.  Pain for the greater good, pain for long term gain.  Or that’s the theory anyway.

I don’t feel worse for my exercise session yesterday, in fact I feel better. I felt great after my spin class.  And tomorrow I will do another session on the recumbent bike with some core exercises.

My spine tonight is pretty horrible though.  The oxycodone is managing the inflammatory pain, but not my spine.  Heat is good.  I’ll have to lie down on my heated throw soon.

I’m feeling the tapering down on prednisone.  The joint pain is never mild now, always moderate at least.  But not in every joint, all at once. The usual offenders are my hands and wrists, ankles and toes, knees, hips and shoulders.  I’m very used to that.  Although it was nice to have a little reprieve.

It’s a level of pain that I can work through, however.  And I need to get to a safer level of prednisone.  I’m at 12.5mg now.  I’m usually bedridden at 12mg.  So I still doing far better.  Injectable methotrexate is working well. Who’d have thought?

I’m going to stay here at 12.5mg for a while.  And at the equivalent of 17.5mg of methotrexate for a while.  And just see how things go.  I can increase the methotrexate up to 25mg, if I choose to.  I need to find a balance of prednisone side effects, methotrexate side effects and a functional life.

I am still taking a minimum of 60mg of oxycodone daily.  My pain doc doesn’t have a problem with that.  It’s not a high dose.  I need to live.  And the side effects of oxycodone are the most benign of all the above mentioned drugs. Regardless of what the fear mongers may say.

I am doing better. I am far from ‘normal’ or ‘remission’.  I am not even close to pain free. Never have been. But it’s all relative. I am doing far better than I was.  And this, to me, is good.

My rheumatologist seems to have forgotten I exist.  She is supposed to be arranging Actemra infusions for me.  It has been seven weeks and I haven’t heard a thing. Usually these things take 4-6 weeks.

I’m not impressed, but I’m not keen to start Actemra right now anyway.  I want to see how far I can get with methotrexate injections.  The goal is to take as little medication as possible, in the lowest dose possible, and still be able to live.  When I have reached a point where either there is no more improvement, or I have hit the side effect ceiling, I will phone rheumy for an appointment.

I’ll leave her be in the meantime.  I have no more appointments booked and I feel very strongly that she’s washed her hands of me.  Or would like to.

That’s fine.  My GP can prescribe methotrexate, prednisone, arava, plaquenil and my narcotics.  How long he will be happy to do so is anyone’s guess.  But that’s where I’m at.  One day at a time.  Grateful that I am no longer spending 22 hours out of 24 lying down.  And hopeful that the trend can stay upwards or stable.