Weighing the risks 

Posted on by SingleRheum

Well here I am, roughly 20 months since diagnosis with RD and more or less no further forward.  Although I can now quote some really fancy medical terms! Most of my joints are now affected in some way, my mobility is very limited and the fatigue is a constant companion. Having tried all the basic DMARDs, Methotrexate (damaged liver), Sulfasalazine (no effect), Hydroxychloriquine (no effect) and Leflunomide (horrid side effects) it’s come time to move on to the biologic medication.  

My rheumatologist and I have decided to start on Humira (Adalimumab) which means fortnightly self injections using a click-pen delivery system. I’m just waiting for an appointment to go through the logistics of delivery, storage etc and then it’s a go. I can’t wait. 

One of the reasons this medication and others like it are not offered until other drugs have failed is the cost. According to the most recent information I can find online, Humira costs the NHS £352 per injection. With 52 weeks in the year that’s over £18,000 per year. Shocking isn’t it? I’ve only become conscious of medication costs since chatting with my lovely RD friends in the US, it’s a horrid reality for them every time they so much as call a doctor. So I’m very grateful for the NHS right now, believe me. 

So what is a biologic, why is it so special? They are actually genetically engineered proteins derived from human genes. All very modern medicine!In simple terms they target specific areas of the immune system, Humira in particular blocks a chemical reactor that causes inflammation called TNF. Biologics are only prescribed for moderate to severe RD, and have revolutionised treatment  over the past 20 years or so. This more aggressive treatment can help reduce the chances of long term disability and have changed many people’s lives.  I’m hoping this will be my ‘magic’ and allow me to enjoy a better quality of life, which is why I’m prepared to take the risks associated with biologics. 

They can read as very scary. Even on Humira’s own website, the first thing you see is a warning.  Firstly that serious infections can occur whilst on Humira and some people have died.  Secondly that there is an increased risk of some cancers. According to the Journal of the American Medical  Association the risk increases three-fold the chances of  Lymphoma, skin cancer and a specific type of T-cell Lymphoma that commonly results in death. Plus of course the full range of more ‘normal’ side effects. Definitely not to be taken lightly. 

So why take this risk? Two things:

  • Firstly I would really like some proper quality of life back. To be able to get out and about more, not have to cancel arrangements because I’m too ill or too fatigued. I love my friends, I’d like to see them more often. Believe me fatigue is incredibly debilitating, unless you’ve had to sit down exhausted after something as normal as taking a shower you have no concept of just how awful it makes you feel. 
  • Secondly I’d like to slow the progression of my RD and hopefully keep my joints working to some degree. My RA hasn’t been controlled at all yet and whilst my joints haven’t become obviously deformed they is ongoing damage occurring which causes incredible pain. 

So yes, I’m excited. I know some people who refuse biologics because of the risks, and that’s absolutely their right. However for me there’s no alternative but to say a heartfelt yes please. If I can lessen my pain and swelling, and hopefully reduce some of my other RD symptoms like night sweats and  hot flashes, AND get some energy back then I’ve got to grab that chance with both hands! Maybe my dream of returning to work of some kind could even become a reality! 

As with most RD drugs I won’t know for around ten weeks if this is working for me, so it’s not an overnight fix. And I’m fully aware it may not work for me, I have to keep that firmly in my mind too – not negativity but reality. My rheumatologist has already said if this doesn’t work she will try another biologic which is delivered by weekly infusions, so this isn’t the end of the line by any means. 

I’ll obviously post here as soon as I know more and receive my doses, in the meantime you’ll still find me napping 😉

(As always please do not consider this post in any way medical advice, any errors are my own!) 

When less becomes more

Posted on by SingleRheum

I realised this week that I’ve been blogging about RD for over a year! So much has happened in that time, the blog I wrote this week last year, Living in Limbo, was about finding myself homeless, things were certainly very up in the air and nothing felt solid or stable.

I’m very grateful to have had some amazing support since then, I’m settled in my little bungalow with my cats and feel on a much more even keel. Constant change is unsettling, especially when it’s not because of choices we’ve made.

I’d say my key word for the past twelve months has been ‘acceptance’. It’s been a long process but it’s definitely the fulcrum around which my improving mental health resolves… I can feel a whole separate blog there 🙂

It’s often the simple things that can resonate with us the most. A conversation with my psychotherapist a few months ago is a great example, I’d been telling her how I kept looking ahead and just seeing no end, no way out of feeling ill and frustrated and trapped and out of control. She said

‘everything changes – from your pain levels to the weather’

and although it didn’t help immediately as I was having a low day it stuck in my mind, and she’s absolutely right.

Things do change, they will change again, the trick I’ve since found is to try to live more in the moment, enjoy each hour, each day, each small success – looking ahead is actually counter productive, especially when it feels bleak.

Depression is horrid, I’ve had it for over four years now, and of course it’s often common for people to start suffering post diagnosis, which is hardly surprising. But I honestly believe with a combination of meds and talking therapies it’s absolutely possible to enjoy better days!

The second simple thing that resonated was even more basic, but I strongly believe it’s worth sharing.

Change that ‘why me? ‘ to ‘why not me?’

I know it sounds really simplistic but just churn it over for a while. Think about what it actually means. “Why me” implies some cosmic force has said ahh yes you, you need RD! Isn’t it much more likely that it is just down to a random combination of genetics and environment? The simple fact is that it’s not personal!

RA has literally turned my life upside down this past year, I first lost my health, then consequently my home, my job, etc etc BUT…. It has over the same period made me completely reassess my priorities, my way of life, and I’m now starting to work out what it is I really want.

I’m not there yet and wouldn’t pretend to be, but boy it feels good to have had the breathing space. I’ve been forced to step off the treadmill, to stop, take my time, breathe! And the ‘worst’ happened and you know what? Not only have I survived but there is still joy in my life, and in being alive, I’ve just have to look a little harder and in different places. Meditation has helped hugely. I’m more grounded, I’m more peaceful, my life is simpler and calmer, and this enables me to focus on self care and my hope that I will be able to return to some kind of contributing employment in the future.

Yes, of course RA limits what I can do and when – it probably always will, but I will not let it limit who I want to be. You too will find a way, I promise 💙

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Gut Instinct? Mine says no…

Posted on by SingleRheum

I was browsing through my phone media, pondering a blog today on fatigue, and then this article popped up in front of my eyes.

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Link is at the bottom of the page.

To those not familiar with the RA or indeed the autoimmune world this is one of those areas that immediately provokes lively conversation, and often dissenting views. It’s a marmite issue if you will 🙂

Leaky gut is a term that’s been floating around for years, often touted by people who think gluten is evil, we should refuse all meds, and we should probably all live on organic mung beans. Served in knitted yoghurt pots. It’s a nonsense term as of course the gut ‘leaks’, it’s designed to. How else would we absorb goodness/drugs etc into our bodies?!

I’m being slightly flippant here but you can probably guess which side of the fence I fall on. My rheumatologist tells me diet is irrelevant. My personal experience tells me so. My GP agrees – standard advice is that a healthy balanced diet is best, do not exclude food groups unless you have a medically diagnosed allergy, as it causes more harm than good.

There is no scientific evidence to prove diet affects RA in any way.  Yet. I do keep an open mind. Honestly! However….

I’m still very dubious. I just don’t believe the answer is this simple. Bearing in mind this research has been targeted to ‘prove’ a theory already held by the researchers (and of course this is common practice), it is still full of its, coulds, shoulds, mights and maybes.

So is it possible those of us with RA have gut problems? Absolutely,  it’s actually incredibly common.  But my logical head tells me there has to be more to it, it’s not as simple as “which came first RA or Bacteria”?!

But this research comes nowhere near to explaining the following –

Why some families have clusters of Autoimmune conditions whilst others have sole sufferers?

Why some suffer from JIA almost from the birth and others don’t show symptoms until they are 40-50 yrs old?

It doesn’t explain the huge prevalence of woman over men with autoimmune.

It doesn’t explain why some patients with autoimmune commonly have more than one condition diagnosed.

It doesn’t explain why some patients who eat “clean” diets still suffer symptoms.

And some don’t.

I absolutely believe the “gut”, gallbladder, liver, pancreas etc may well be involved. We have a complicated system that relies on food of many different types to stay balanced and healthy. I along with millions of others suffer IBS alongside RD, but so do many without it.

In my own humble and very non scientific mind I strongly believe RA, along with many other conditions is genetic in origin. It might well be triggered at any point in our lifetimes by stress or bacteria or illness or injury or pregnancy, but if that genetic marker for RA isn’t there it can’t and won’t occur.

I will, with many others, watch this space, small discoveries like this often lead to other bigger things,  and as I’ve said before I may be opinionated but I’m not closed minded ☺ I actually hope for all our sakes this leads RA research forwards.

http://individualizedmedicineblog.mayoclinic.org/discussion/microbiome-biomarker-found-that-triggers-rheumatoid-arthritis/?utm_content=bufferd6eea&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Healing begins with Love 💙

Posted on by SingleRheum

I’ve been pondering for a few weeks where to start with this blog post.  I know what I want to say, I’m just hopeful it comes across as I mean it to!

In March this year, following 18 months of chronic illness with RD, Fibromyalgia & degenerative disc disease all playing together, plus the recent death of my Mother I kind of reached a tipping point.  I’m deliberately not using the word breaking! But I’d had month after month of pain, depression, anxiety, aching, medications,  fatigue, painsomnia and nothing was really changing – I wasn’t feeling ‘better’.

It was a sink or swim moment.  I could either drift along as I was, feeling pretty miserable most days, or I could look for help.  But what? Who? Where? So I hit trusty Google and followed where it led.  And boy was the universe ready for me to reach out! I started looking at mindfulness retreats, found lots of very out there options which included raw foods and tents, which aren’t necessarily my scene!  But whilst stumbling from link to link I came across the wonderful lady who was to change my life.  There is no other way to put that, and I truly believe we were drawn together.

Demi Schneider is simply one of life’s good ‘uns, and an insightful, generous and empowering lady.  A Clinical Hypnotherapist & Psychotherapist, Metaphysical Life Coach & Author of “Beat Your Depression For Good” – she powerfully challenges and guides us to look within for our own joy. To care for and love ourselves.  To be happy!

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In simple terms what we think is all powerful. And it’s our choice! And that choice dictates how we feel, emotionally and physically.

It’s easy, rational and possible, but it takes learning, acceptance, meditation and work.  We have years of learned negative thinking patterns to turn around before we are able to allow ourselves to truly be open and actively listen to what our body is telling us. 

It’s known that the subconscious mind can’t tell the difference between imagination and reality.  So by changing our thought patterns to positive (for example repeating ‘I am calm and in control’ when feeling anxious), we physically change the chemicals our brain releases – increasing serotonin.  And when you feel better, you feel less pain. 

Does it relieve pain? A little, yes, and I’m in my early days.  Is it worth it? Absolutely, allowing peace and acceptance into our lives brings joy and happiness to our minds and our hearts, regardless of circumstances.  Loving ourselves rocks!

It’s not a magic cure, but it is a much nicer way to live, especially with chronic illness when things can seem very bleak.

Namaste 💙

All change…. & cats!

Posted on by SingleRheum

Sometimes fatigue hits me hard for a few days, this last weekend has been one of them.  I’ve slept like it’s going out of fashion since Friday, guessing it’s finally passing as I’m writing this at 5am! Feeling tired but not sleepy, but I think the exhaustion has burnt itself out for a few days, for which I’m grateful.

Annoyingly this particular blip hit half way through RA blog week, so I only completed four out of seven nominated blogs.  I may pick up on a couple of the other titles soon, as I still have ideas in my head ☺

However some great news has cheered me up today, so I am hoping my energy continues for a few days. I finally had the call I’ve been waiting for, I have an official move in date of 1st October, my bungalow is ready!!  Trying to get excited about this was hard today, it felt like I was trying to push the world uphill, but this (early) morning I’m planning and smiling, I’m really looking forward to being in my own home again, and best of all getting my beautiful cats back home with me.

If you’d have told me in June I’d be in this B&B for the homeless until October I’d probably have broken down.  Don’t get me wrong, I’m hugely grateful for the support from my local authority, they have been amazing.  But it’s been a very long summer!

Still, I made it.  I’m very much focused on the next couple of weeks now, turning this new place into a home for me and my cats.  It’s the little things I’ve missed, having my own cooking stuff around me, using the dvr, just having my own clothes & books around me.  Ohh and my bed! I cannot wait to get back into a decent bed ☺

I’ll take it one day at a time, I have this weekend before my stuff arrives out of storage on Monday to get a feel for the space and what will go where, and I’m hoping (if my hands allow) to just slowly paint one wall in the much needed wet room, I’m determined to take away that hospital look!

I know I’ll need to pace myself with unpacking, thankfully the removal guys will put everything in the right room, so I can just work through the boxes at my leisure.  I also know I have friends I can call on for help, they have come through so amazingly for me this year, I’m incredibly fortunate. 

So, hopefully the next blog you see from me will be from my lovely old sofa in my very new home….. With these little munchkins demanding my attention  ☺

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Five things I have learned.. #RAblog week #4

Posted on by SingleRheum

Today’s #RABlog week prompt is as follows…

Five things I have learned – write about the five things you have learned about yourself, or RA. Perhaps you have learned what things like physical pain, injections, or morning fatigue are like? Perhaps you have learned new things about yourself?

RA has made some huge changes to my life over a very short space of time, so my five things learned are personal, though I suspect not unique, to me…

1. Status & money just aren’t important – I obviously don’t mean I don’t need money to live,  this is probably the hardest thing to put into words, but my priorities have changed completely.  I’ve never been about the big ego or being flash, but I worked really hard for my career and was comfortable because of that. For a long time I almost subconsciously defined myself by my work, my life was built around it.  Having to stop working in March due to RA was emotionally as well as financially frightening.  But I’ve had a lot of time to think, and I realised it just wasn’t important, my focus has changed.  I want to return to work as soon as I am able, but perhaps in something more personally rewarding & fulfilling. As I am likely to be off work for some time, at least until I hopefully find a med that controls my RA, I have almost the ‘luxury’ of rethinking what I want to do. That’s not an opportunity many get, and I intend to use it well.

2. I couldn’t survive without my friends – I’ve seen many people say they lose friends through RA, it’s easy to become isolated when you can’t always be relied on to turn up when invited.  Maybe I am just very lucky, but the people I count as my closest friends have each been a fantastic support in different ways, and a couple of people I considered acquaintances have proved to be very good friends.  Trust me when you need helping packing, cleaning and moving because you can’t bend, kneel, lift or use a hoover you find out who’s really there! I love you guys, you know who you are.

3. My GP is an absolute star – I sort of knew this already, I’ve been with her over three years and she’s always been compassionate and supportive, through both mental & physical health problems.  When I first went to her with a suspicion of RA, she listened, agreed, promptly ordered tests and has been a great liason between myself & rheumatology.  She knows me, she spots when I’m down, she asks about my support network and cares how I am feeling. No appointment is rushed, no medical topic unspoken. I would just be lost without her. 

4. When you think the world is ending, it doesn’t – this sort of links to my first post, I have lost my mobility, my energy, my income and my home.  Yes, this has exacerbated my depression & anxiety, BUT…  I’m still here! Still standing, still learning,  still enjoying the small stuff and dealing with the bad.  Things are starting to turn around a little with a new home & rheumatologist this month, however different it may be from what I was expecting from this year, I’m still living, smiling & occasionally kicking butt! Please believe me, things are never as dark as they seem.

5. People actually enjoy my writing! – I think for me, the huge positive that has come from RA is this blog.  I’ve always enjoyed writing, bits of fiction, occasional poetry and just playing with words, I love that language allows us to express ourselves, to share with others our experiences and knowledge.  However I’d spent years just writing for me.  Somehow this blog began, mainly as a way of me processing what I’ve been going through, it just helps me to write things down.  I never expected in a million years to receive some of the amazing feedback I’ve had about my blogs, I can’t tell you how magical that is for me, so thank you so much for reading  xxx

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Explain Your RA.. #RABlog week #3

Posted on by SingleRheum

Day 3 of RAblog week, our prompt is…

Explain your RA – perhaps you want to tell someone else, (doctor, sibling, child) pick a person and decide what to tell them. You might want to tell them about living with RA or what it is like to have RA? Perhaps you want to write a letter to a fictional person. You might also choose to write to a newly diagnosed person about life with RA.

I’ve been pondering this one for days, who to write to? Friend, family, doctor, rheumatologist, physiotherapist? But they all at least sort of understand.  So, a stranger then, someone who needs understanding but doesn’t have it.  Then like a light bulb moment it hit me.  To all strangers, to those who glare at us for having disabled parking, who moan about us taking benefits or think we’re addicts for wanting pain meds that are strong enough to be of use.  This is for you. 

Dear Stranger,

I’m asking for just a few minutes, that’s all.  A few moments when you put your prejudice aside and listen.  When you allow yourself to stop judging, and hear me.  I believe it will help both of us, shared understanding certainly brings empathy and compassion. 

This time last year I started feeling tired.  Sounds so innocuous, we all have off days. By December I was tentatively diagnosed with RA, and at this point I was getting really bad inflammation and joint pain, I couldn’t move my left shoulder, or use my hands.  I had to ask people to cut up my food on occasion, just think for a moment about how helpless that might make you feel?

I was officially diagnosed with RA in March, and by this time I had done quite a lot of research, and to be honest I was scared. Really scared. I was having more & more time off work, and I was now getting joint pain all over, feet, knees, hips, elbows, shoulders, wrists, hands, lumbar spine.  On top of this the fatigue was getting worse, causing ‘brain fog’, making holding meetings or working on contracts for work almost impossible, I would lose words mid sentence, concentration on and retention of facts and numbers was just not happening.  And I was so, so tired.

I was also aware by then of the fact that RA is systemic, meaning it can attack elsewhere in the body, affecting the eyes, heart, lungs etc.  And just to top it off the first med I was prescribed increased my risk of developing lymphoma, losing my hair and liver damage.  It’s a tough disease requiring tough medicine.  I was signed off work in March, meaning I lost my income.  I live alone. 

So yes, I have had to claim benefits.  I lost my home, and I’m very fortunate the council are shortly providing me with an adapted bungalow.  Believe me no one wants to return to work more than I do, at the moment it’s just physically impossible. I can barely walk on crutches and I’m in pain 24 hours a day.  Yes, I also have a disabled parking badge.  I couldn’t function without it. 

And as far as I’m concerned that’s exactly what our benefit system is for, it’s a safety net for those, like me, who through no fault of their own need financial assistance just to live. 

RA is known as an ‘invisible illness’. Symptoms aren’t obvious from the outside. So please, can I ask that next time you see someone who looks ‘healthy’ using a blue badge, or having to  cease working and claim, you stop and think, just for a moment.  I am ill, the last thing I need is to be judged. 

Kind regards,
Denise (on behalf of all with RA).

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Managing Fatigue… #RABlog week #2

Posted on by SingleRheum

Today’s blog week prompt is this….

Managing RA fatigue – We all know that fatigue is a big part of many of our lives. How do you manage that fatigue? Perhaps you like a warm cup of tea or a hot bath. We all have our coping strategies. Describe anything you do to help with fatigue.

That seems like such a small question when in fact it’s ridiculously large, fatigue has been my own personal demon since way before diagnosis, it was the first sign I had that something was wrong, and it started this month last year.  My one year fatigue anniversary, whoop-whoop!

I need to be honest here and in the interests of ‘full disclosure’ (lol) start by saying that my GP is in the process of diagnosing me with ME/CFS, so my fatigue may be more excessive than RA fatigue alone. 

So, how do I manage fatigue? I’ve been told by doctors and rheumatologist’s that fatigue is the hardest symptom to treat.  It’s difficult to explain to anyone who hasn’t suffered with it exactly how debilitating it is.  The fatigue is the main reason I had to stop working in March, the joint pain and mobility were obviously big factors, but the fatigue was the final straw.

I could use a hundred analogies and none would suffice.  It’s like carrying a weight, walking through water, swimming against the tide, trying to move mountains. The closest I can come is that fatigue makes me feel heavy, too heavy to move or think or just stand up.  I don’t want to eat or drink or talk or write, everything seems to involve superhuman powers that I just don’t have. 

If I’m honest I’m not sure I do manage my fatigue, I’m not sure that’s even possible.  What I do is cope.  I am used to the very bad fatigue days now, I usually have two or three a week minimum, so I’m prepared.  I keep in things like cereal bars, bananas, grapes and bottled water, really easy stuff to keep me going, there is no chance of cooking! I’ve always been an avid reader, so I make sure I have books to hand, and I’ve just discovered the magic that is Netflix when one is unable to leave the sofa 🙂

I no longer worry about these days, I used to find them incredibly stressful, because I’d feel guilty, adults don’t just take pyjama days, that’s not productive!! Actually I’ve discovered it’s the most productive thing I can do.  I’ve learnt to listen to my body instead of years of conditioning to “push on through” or “not be lazy”. If I take these rest days when my fatigue flares up, I am a better and more relaxed person because of it.  It also gives me energy for later days when I can function, rather than never having a minute when I’m not exhausted. 

I realise this is not considered ‘normal’, but it has become mine and I’m learning to live with it.  So if you catch me in my pyjamas at 4pm, believe me I’m not being lazy, I’m giving myself the best self care that I can.

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A Day in my life… #RABlog week #1

Posted on by SingleRheum

It’s ironic that, with the first blog due today (Monday) for RA blog week, I’ve been in a flare all weekend and am now trying to type furiously at the almost final hour… 10pm is still Monday, right?

I had a lovely clear weekend planned, I was a even cat-sitting at a friends with a sofa, Internet etc, I was sorted! And then it hit, I’ve barely had the energy to take my meds, unfortunately we all know those days! So I’m literally deciding as I write, do I cover a day like today, or a slightly more ‘normal’ day?

To be honest I could sum up today in a couple of words, sleep, pain, sleep, so let’s skip that and look at a slightly more average day.  I’m not sure three word blogs are quite the thing 🙂

My first thought when I saw the topic “A Day in my Life” was how short my days generally are – at least the functioning, thinking, moving part of the day.  Someone online mentioned a three hour window recently, and it immediately resonated with me.  It takes me an hour or so to come round in the mornings, I was never an early bird but now I’ve made slow mornings an art form!

So let’s say I wake at 10am, by 11am after a coffee or two I might be ready to face the shower.  This does help ease the aches, the warm water always soothes even the sorest joints for a brief while. Then there’s getting dried (awkward when only one arm is moving properly and you can’t bend), sitting down to rest, then getting dressed, sitting down to rest (I’m not exaggerating here, the process exhausts me),  and that’s without dealing with my hair.  On a lot of days it just goes up wet, blow drying can seem just too much. 

So hopefully by 12 noon I’m in one piece and ready to face the day. I say hopefully because on worse days I’ve been known to hit this point and just stop – my body says no. 

So this is start of the ‘three hour window’,  I might go out, meet a friend for lunch or coffee, see the physio or GP or maybe go to a store for a book or a little food shopping, small things I know I can do without walking too far or wearing myself out. Some days I make four hours or so if I’m sitting chatting with friends, but five hours is my absolute max even on a very good day.  By that point I will physically droop.  I have to make sure to leave with enough energy to get home and get into bed.  Of course if a joint is really flaring this can shorten things dramatically, pain is a great incentive to get home!

It’s so, so hard to explain how doing what most people would see as a day of leisure leaves me on the floor.  I also really struggle to do two of these days in a row, so I try to plan hospital, physio and GP appointments as well as coffee or lunch on alternate days, so I get a day at home, then a day when I’m out. 

There is however a big upside to this.  Because I’ve got used to this window I have to work within, I do make sure I prioritise what I spend my time on.  So I plan around the medical appointments, so I can see friends, or family, sit somewhere with a nice view, enjoy the sunshine or just have a really good coffee while reading.  That leaves me the evenings when I’m resting for writing if I’m in the mood. I am probably more careful about how I spend my time now that at any other point in my life, and that’s got to be a good thing!

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Poem… Would I?

Posted on by SingleRheum

If today was the end of all I could be, would I be replete, looking behind me?

Was I loved so well, did I love at all, was my passion as wild as my mind can recall?

Did I run with the wind on a hot summers night, did I laugh at the storms and draw heat from the light?

Did I dive in headfirst, embracing the chill, did I swim with the tide or against for the thrill?

Did I ride with abandon, embracing my fate, or weave a path of my own, only one I could make?

Did I fly t’ward the stars, and smile with the moon, did I start life too early and leave it too soon?

Did I chase down my dreams, did I hunt where they hide, did I once try to seize them and keep them alive?

Did I love with abandon, my soul soaring free, did I sing every word as if written for me?

If today was the end of all I could be, would I be replete, looking behind me?

Was I loved so well, did I love at all, was my passion as wild as my mind can recall?

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