Month: March 2014

Methotrexate

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I had my med management appt at the rheumy the other day and I had done my research.  I was ready for an aggressive approach advocated by research for people recently diagnosed, only Dr. B was having none of that.  She wanted to do the monomodal approach using the old standby Methotrexate.  I asked which was more effective, MTX or one of the new biologics?  She answered, “well, of course the biologics are, but they are only for people with moderate to severe disease states and for whom MTX did not work or stopped working.”  I said, “you mean, the insurance won’t let you?” She answered, “yes, they have to try the cheap and tried and true drugs first.”  So, there you have it.  Blue Cross/Blue Shield has predetermined my treatment because MTX is cheap and has a generic form and the biologics are new and cutting edge and don’t have generic forms and so I have to wait until I am pretty bad off to get one of them.  I am trying to stay super positive though, and so I am going with gratitude that I am not bad off enough to rate a biologic yet and may never be if MTX puts me into remission and keeps me there.

Dr. B told me that MTX does not have a lot of side effects, the Internet told a different story, so holding my 4 pills plus a folic acid pill in my hand last night I did have pause thinking of the most noxious of side effects like nausea, dizziness, hair loss, stomach pain, extreme fatigue, and so on, that I could experience.  I was alone and I wondered what would happen if I had some awful reaction or got really sick.  But, I was tired, and so I swallowed them and went to bed.

Well, guess what?  I slept like a nice rock.  I remembered to take my nighttime 800 Motrin, so I awoke with less foot pain and even my hands were not too stiff.  I had diarrhea almost immediately after waking, but that was it.  The rest of the day was, frankly– the best day of this past week.  I felt pretty good all day long. So, I feel pretty victorious, like I kicked butt or something.  I am not sure what this means:  I got a bad batch, I’m a badass, I am not affected by this drug like other people are, it’s going to work great, it’s not going to work great, who knows… but I am thankful that I did not have bad side effects today.  I only take it once a week, so I won’t take another dose until next weekend, and Dr. B says I won’t really notice improvements until after like 6 weeks, so it’s a slow drug.  I hope the side effects don’t take that long to show up.

I’m off to bed now.  Everything I read says I need my rest.  I’m feeling positive and hopeful tonight. 🙂

Oil Pulling– Yep, I tried it!

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So, if you’ve not been hiding under a rock lately [translation you have been lurking about on Facebook or Twitter or Pinterest], you’ve most likely heard about oil pulling.  If you’re a quasi-hippy, like me, then you were intrigued by this sorcery and wanted to know more.  Anything that mentions coconut oil, frankly, has me at hello, so I proceeded to do some research using what else, but Google, the company that now owns all our thoughts.  I found these instructions:

So, it’s basically three steps:  1. choose 2. swish 3. spit

Choose an oil that is organic, coconut is nice because it melts slowly in your mouth and has a pleasant smell and taste, but you can also use sunflower or sesame.  Take about one tablespoon [I used more like a teaspoon and a half] into your mouth and then just let it sit there or swoosh it around for about 20 minutes [that feels a bit excessive, more on that later].  Then, after it has had a chance to pull all of the toxins out of your mouth [they are like little hidden terrorists], you just spit.  Yes, spit that stuff out- it’s full of terrorists.  Don’t spit into the sink because it will clog your pipes up– of course, if you swallow, it might open your pipes up [giggle].

Like other folk remedies that have stood the test of time [this is ancient Ayurvedic], oil pulling is supposed to ameliorate a wide range of ailments.  I will only list a few that stood out for me: clearing up the skin, Gingivitis, whitening the teeth, reduction of systemic inflammation so it could help with RA, relief from sinus congestion, better quality sleep, improving the immune system, balancing the bacteria in the mouth, and on and on.

Huffington Post even weighed in with an article, and of course, Snopes debunked the majority of the benefits [but they cannot debunk the ones associated with the mouth and dental health benefits]!  It doesn’t matter when you do it, but some sites claim that on an empty stomach first thing in the morning is best, so you can do it while in the shower.  Afterward, you do your normal tooth brushing, flossing, pik routine and, voila[!], your teeth feel super smooth and they are whiter to boot!

So, I have done this like 3 times and here is my personal review.  I used coconut oil and I don’t mind the solid to liquid thing like some, but I felt that a little over a tsp. was a plenty and 20 minutes seemed like an eternity.  I could only make it like maybe 5 minutes before spitting.  Some people have said it was sort of comforting and nice to hold the oil in your mouth while lying in bed or doing your morning business.  I did not find that to be the case.  It was, well, a neutral experience for the most part.  I did not find it particularly pleasant or noxious, although I did have some problems holding it in my mouth.  It was either dripping out the side onto the screen of my cell phone while I playing Candy Crush in the bathroom whiling away my 5 minutes, or I was tempted to swallow it because it tasted kind of good and it felt like it was growing in volume, the way your spit seems to flood in when you’re at the dentist and you cannot yet spit.  After brushing and flossing, I did notice that my teeth were whiter, and not just from the regular brushing.  They are noticeably whiter and they stay that way all day.  It’s like they are coated with that oil for a while, so your coffee wants to stain your teeth, but it can’t get a grip on the enamel because it’s all slick from oil.  Fabulous!

I am not sure about the congestion thing, but this morning after oil pulling, I did cough a lot and now I do feel like my lungs and nasal congestion is clearer.  That could totally be a placebo effect, but I’ll take it.  If you have pulled oil and would like to weigh in, leave a comment about what you thought of it or what it did for you.  I keep the coconut oil around for my skin and cooking anyhow, so why not?  I love the whiter teeth and the way my mouth feels after.

Clumsy Hands and Broken Feet- A Diagnosis

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This week I had the wind knocked out of my sails.  I was diagnosed with RA.  Rheumatoid Arthritis is an autoimmune version of arthritis where your body attacks the synovial lining/cavity of your joints and sometimes other organ systems like your eyes, lungs, vascular system, and heart.  It manifests as pain that usually begins in your hands and your feet-exactly where mine started abruptly this past fall.  I may have had RA for a while, but something triggered it prior to November.  I suspect a teeth cleaning that left me with swollen sore gums for weeks.

I already have one autoimmune disease- Hashimoto’s Disease [autoimmune hypothyroidism]- I wonder if there is a limit, like how many AI diseases can you get at one time?  I hope there’s a limit.  I found out I had Hashimoto’s when I was in my late 20’s.  I’m in good company, ie… there is a genetic predisposition, since both my sisters and my Mom have it and my late maternal grandmother did as well.  I am cool with this; I have it on lock.  I know this disease inside out, I self-titrate my natural thyroid [Armour], and I ignore well-meaning practitioners who tell me that my TSH is too low while disregarding other key blood markers and my physical well-being and self-awareness.  I am not afraid of Hashimoto’s.

My Grandfather suffered from Dermatomyositis [another AI disorder].  My sister has RA.  Yeah, that should have been a clue when my joints caught fire.  But, it wasn’t.  That was her disease; and one that I never planned on claiming.  I did not have RA- I like to hike, I’m active, and I always have at least 2 jobs.   I climbed a mountain in only average shape [for a 49-year-old] in April.  I run on my treadmill even when my knees and feet hurt. I don’t like to take drugs of any kind and I do like to eat clean [although I struggle with a love affair with sugar that I am seriously trying to end]. I had just lost more than 40 pounds and I was feeling great.  I was excited to turn 50!  RA was an image in my mind that did not fit with the image I have of myself.  So, when Dr. Belhorn said she was positive that I have it, she might as well have punched me right in the gut.  When I got into my car after that appointment, I did not have the key turned in the ignition before I was sobbing.  My denial had been so complete that I had an explanation for each puzzle piece.  My knees were stressed from the Zumba, my joints hurt because I was allergic to wheat and all of this was related to my skin rashes and eczema.  I even thought I might have lupus or psoriatic arthritis, maybe reactive arthritis, but I was pretty sure it wasn’t RA.

When you google RA images, you see this awful picture of a hand that might belong to the cannibalistic witch who locked Hansel up in a cage.  I can imagine that gnarled hand reaching in to retrieve the bones he would hand her when she tried to determine his fitness/fatness for cooking.  I know that it is not a death sentence, not directly, but it feels like a sentence of some sort– a sentence of having to put toxins into my body to prevent deformity and disability; a sentence of having to take handfuls of pills that make sick, a sentence of being tied to doctors [who belong to a profession I collectively mistrust].   So, I am researching and finding that there are a lot of weedy paths that you can get lost on and lots of scammers looking for an easy mark.  It’s hard to know whether to trust the doctors and researchers because to hammer-wielding people, everything looks like a nail.  I am not even sure if that analogy makes sense here, but I keep seeing clinicians holding hammers as I do this research.  I know that a plant-based diet, low in sugar and red meat that limits grains and sugar is optimal.  I know that fish oil, especially Krill oil helps.  I know that I need to stop being so angry because inflammation is a factor of seething anger, but I don’t know exactly how to let go of the anger that I have.  It’s a simmering, chronic anger that bubbles up when I sense injustice- real or imagined.  It’s an anger that is as self-indulgent as I believe depression or boredom to be.  It’s well hidden and most people who not have any clue that it’s there.  Perhaps some more therapy is in order, but I digress.

In October I had my teeth cleaned.  It wasn’t remarkable in any way and I have them cleaned like clockwork every 6 months.  I do remember that the hygienist was a bit aggressive, there was bleeding, and my gums proceeded to hurt for weeks afterward.  I was seriously worried I might have gingivitis and I was googling away.  I followed this with gargling– salt water and sometimes hydrogen peroxide, and I switched to a gluten-free tea tree oil toothpaste.   The gum pain eventually subsided, but then the joint pains began.  I did not immediately connect the two.

November.  The first pain was in my knees.  They were a bit swollen and so tender they hurt to be touched from the outside.  I thought it was the Zumba.  It can be hard on knees.  Then my elbow was so sensitive that sometimes when I leaned on a table with it I would react in extreme pain like being hit in the elbow or shocked.  When I turned in the bed it hurt.  My hands would go numb along with my finger tips.  One day I felt like I was walking on a stone.  I said that to everyone who would listen.  “I feel like I am walking on a big rock.”  Then, my big toe swelled and I could not bend it.  I thought I had gout.  Then my fingers began to hurt.  My ring finger joint swelled so big I couldn’t wear a ring.  It ached.  My thumb and knuckle were swollen and hurting.  I found some days I could not button a shirt.  Every day, pulling up my pants after using the bathroom hurt because it required that I hook my thumb and pull upward. And the foot pain… as soon as my feet hit the floor in the morning, I am reminded that my feet are broken.  It feels like walking on bloody stumps, or on feet that someone has smashed and broken the small bones in the center, under the balls.  This pain makes me walk funny and does not subside until I manage to walk it off so to speak about halfway through the morning or by lunchtime.  By evening, it is returning once I find myself sitting and then stand again.  The stiffness is from my hips down through my knees and into my feet right through to the arches.  The foot pain is the absolute worst.

I would still not have gone to the doctor about this– again the denial– if it were not for an acute shoulder incident in February that I related to a fall in the snow [but was really most likely a shoulder flare].  When I told the GP of my other joint pains, she diagnosed a rotator cuff injury, but did some blood work.   The rheumatoid workup results led me to a referral to a rheumatologist.  Before that appointment, I researched everything but RA.  Even sitting across from Dr. Belhorn, my denial persisted and she called me on it as I cross-examined her about the discoid rash on my thigh, the possibility of lupus, Dermatitis Herpetformis, and reactive arthritis.  She said that she would highly suspect RA in someone with my symptoms and an elevated RA factor.  My factor is not subtle, though, it is almost 200 and that is indicative of only a handful of illnesses in the absence of a positive ANA.  The family history cinches it.  So, she took more blood and x-rays and pending the outcome of those results, she will advise on how aggressively to proceed.  At this point, I am hoping for Plaquenil only, but I suspect she will also recommend Methotrexate.  I am pouring over RA blogs to get a sense of what works for different folks and what kind of side effects are widely experienced.

In retrospect, I see things now that could have been clues.  I felt last year like I was losing upper body strength when I could not win an arm wrestling match.  It literally startled me as I have always been pretty strong physically. My inability to work the latch on my grandson’s car seat could have been a clue- I became more and more frustrated by this and had to ask my other grandson to do it for me [I blamed the car seat].  I had trouble with lids, I dropped things more.  One morning this fall, I dropped my coffee cup for no apparent reason.  It just fell from my hand shattering and spilling while my students rushed to help me.  I have broken a bowl and two cups, at minimum, in the last 2 months.  I fall a lot.  There are so many and they keep coming back to me.  The day I was diagnosed, I felt defeated.  My pain felt worse and I felt sorry for myself.  That was only two days ago– it feels like a week–but I am bouncing back already.  I found a cool blog:

http://www.rheumatoidarthritisguy.com/

On it, there is a page of a mosaic of all sorts of people who have RA.  They are overwhelmingly female, but they are quite diverse and they don’t look like cannibalistic witches.  They look like normal people of all ages who are doing interesting things.   That was a turning point.  I said, “okay, I can do this.”  Thanks, RA guy [& all the people who submitted their pics and profiles].  I needed that.