Please watch #Unrest

Some of you may know I have Myalgic Encephalomyelitis, or ME/CFS. Many of you will have no idea of what that actually means beyond “being tired” which is so far from the truth. For too long the medical profession & the media have treated ME/CFS as a joke, a mental illness, or fakery. It is none of the above, and the mindset is insulting to every single one of us.

It affects waking & sleeping. It affects cognitive thinking and speech, memory, writing and listening. It causes seizures and myoclonic jerks. Clumsiness. Bowel problems. Joint pain. Muscle pain. Exercise intolerance and PEM (Post Exertional Malaise) which can last for weeks or months. Flu like symptoms. It affects every minute of waking life every single day.

In the face of ignorance and incompetence from those with whom she sought help, Jen did what many of us do. She went online and found a tribe. Somewhere where we are heard, seen and understood. Where we are validated.

She then went much further, eventually creating and filming Unrest. This is her story, but it’s also our story. Thankfully I’ve never been as severe as Jen, I pray I never am.

But I have periods of days when I am invisible, when no-one sees me. I don’t get dressed or leave the house. When I wake from an 18 hour sleep then have a three hour nap. When holding a conversation is impossible. When simply sitting up is just too hard, let alone leaving the bed or sofa. I am too often one of the #millionsmissing

Please watch #Unrest – it’s now on Netflix. The link to the trailer is below. Yes it’s hard viewing. But it will open your eyes to the reality of the lives of millions with ME.

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NYE 2017 – Reflections

I was trying to find a theme or quote that represented what 2017 has meant for me to use as a starting point, but nothing seemed quite the right thing. I know New Years Eve tends to bring us bloggers out of the woodwork, I think it’s the creative urge to somehow capture where we’ve been, and perhaps plot where we want to go. Combined with the creative muse that won’t let us know what the next sentence is until we write it.

My year has above all been a catalyst for change, and wending through it has been a series of lessons I hope I’ve learned from. I think I’m a better person than I was twelve months ago, and I hope in twelve months time I can say the same again and mean it as fully as I do now. There’s a lovely aboriginal proverb that says “”We are all visitors to this time, this place. We are just passing through. Our purpose here is to observe, to learn, to grow, to love… And then we return home.”

I have, with the support of some wonderful people, finally discovered the real Joy of Now. Not the superficial trimmings of mindfulness that is pushed by mainstream media, but the real living in the moment stuff. It’s mind altering. Life changing. And it’s so amazing! But I wouldn’t have been ready for this had it happened earlier in my life, I firmly believe that we have to become open and ready to welcome in the new and let go of the old, and do this with with self love and self compassion. Even when it’s as challenging as f*ck. Which it often is.

So how did I get here? I am forever grateful to Demi Schneider my wonderful therapist, who helped me become ready to open these doors almost two years ago now by teaching me how to love myself fully. To Ruby Wax whose fabulous book “A Mindfulness Guide for the Frazzled” gave my logical brain the understanding it needed of what was going on in my head and how to start rewiring those neural pathways. To the wonderful Calm app which helped me start meditating and sleeping again. To the beautiful Essia for leading me to The Now Project. And to Adrian from the Now Project who held my hand (literally & metaphorically) through one of the darkest hours of my life. And to the whole Now Project Team for just being here.

Does that give you a glimpse of how it all fits? How what seems random and disparate is beautifully interconnected. The Universe guides us to where we need to be even when we have no clue what we need. We can’t rush it, things will happen when they are supposed to. All we need do is live, right now.

For those that don’t know I was diagnosed with a serious lung condition in June, which at the time was believed to be terminal. It wasn’t a shock to me as I’d been expecting it for months, but even so it was definitely one of life’s “oh shit” moments. Thankfully I already had mindfulness and meditation in my life, without either I know I would have spiralled back into severe depression.

And here’s where synchronicity comes in. I attended my first retreat with the Now Project the day after I had this news. (See, I did have a point!) That evening during our informal meet and greet we were asked what we hoped to get from this weekend. As I listened to the others share a voice in my head (mine, of course) suddenly shouted “Nothing, I’m going to die, you can’t help me” In that moment everyone and everything else seemed trivial. Knowing I was about to either sob or scream I quietly left the room.

I went outside and sat under a beautiful willow, looking over the fields in front of the house. And I sobbed my heart out. Until gradually I realised I was watching the midges dance in the twilight. Above them Swifts circled and dove, catching their evening supper. And I found a measure of peace, my feet bare against the grass, grounded in nature.

Of course when someone came to see if I was okay I melted again. And Adrian, a complete stranger to me, sat with me for nearly an hour. Holding my hands. Bringing me back to my breath continually. And that is when I finally understood that we only ever have Now. None of us are guaranteed tomorrow. Nothing else is real. Catalyst.

I’m incredibly grateful to say that further testing has (at least for now) ruled out any significant impact on my life expectancy. I have Interstitial Lung Disease caused by RA, which in turn causes a lot of breathing issues, but they are manageable by moving slowly. I’ve also been formally diagnosed with ME this year, so fatigue impacts my pace too. And that helps me continue to live in the moment.

So in simple terms facing my own mortality brought me deep joy. I know I’m not the first or last to say this. And others will walk different paths. The one thing we’ll have in common is that realisation of just how essential it is to live Now. Not today or next week or next year – they don’t exist. When we combine that with real love for ourselves exactly as we are we become invincible. Even death holds no fear because it’s just another step towards enlightenment.

It’s quarter to midnight on New Years Eve 2017, the moon is bright and full. I have candles burning gently and the enchanting music of Deva Prema playing in the background. All is well right Now.

Wishing you all a blessed 2018.
Dee 💙

Excuse me, I’m Dormant…

I sort of feel I should start by apologising for being so quiet recently, especially with blogging, but the spoons have been really low for a couple of months. I feel the balance is tipping towards more ‘bad’ days than ‘good’. I dislike using those terms as they feel like I’m judging, I’ve hit the trusty thesaurus, how do dormant days and wakeful days sound?

The definition of dormant seems particularly apt – adjective: dormant (of an animal) having normal physical functions suspended or slowed down for a period of time; in or as if in a deep sleep

That accurately sums up about 40% of my time. Maybe more. At the moment I feel like I’ve hit a medical stalemate – another great word – any position or situation in which no action can be taken or progress made.

I saw my GP (who is fab) on Friday, we ran through a few symptoms where her answers were, not unreasonably, that there’s nothing that can be done. Of course if a,b, or c get worse let her know, if not do my best to continue to live around them. She has the option to refer me back into the hospital Fatigue Management team so to keep that in mind for the future.

FYI I’m not being ignored, I have ongoing support from Thoracic (lungs), Rheumatology (joints & lungs), and Orthopaedics (spinal surgery, sciatica) as well as my GP.

But none of these stop me doing this. Sleeping for 16, 18, 20 hours at a time. I track my sleep now because I’m not sure people believe me, but I’m genuinely out for the count, I don’t wake to pee, drink or eat, and a bomb could go off without me stirring. Usually after a sleep like this I wake but can barely move, it takes everything I have to stay upright just to make a coffee and maybe toast. It’s like the worst flu feeling quadrupled. I literally stagger to the kitchen and back, almost on my knees.

And every time within two hours I’m passing out again. I use passing out deliberately because that’s exactly what it feels like, it’s almost as if I can feel my body shutting down, to quote the Borg “resistance is futile”. I spend approx two to three days a week like this.

To be clear here I’ve been diagnosed with RA, Fibromyalgia, ME/CFS, and RA-ILD (Interstitial Lung Disease). All of which will be contributing to this dreadful fatigue, though my suspicion is this is much more ME than the others. I’ve attended pain management sessions and fatigue management sessions which mostly revolve around pacing and CBT. Unfortunately as anyone with ME knows the use of CBT as a tool to improve fatigue has been totally discredited. And pacing just doesn’t work.

Pacing is actually a very simple technique. One monitors one’s activity and fatigue levels for a few weeks on a chart, then you calculate an energy ‘baseline’. So let’s say the average day allows you three hours of low activity. You plan around this and you slowly work on building up. Sadly this model assumes a number of modes of behaviour are manageble for the patient – such as getting up at the same time every day, sleeping for the requisite number of hours per night, ceasing to nap during the day, and that after sleep one feels refreshed.

None of this applies in my case. When I mentioned to the fatigue team that I can spend two or three days a week sleeping (dormant) they told me this “wasn’t usual” for ME. I thank the stars for the Internet, there is a lively community online who very quickly taught me I’m not alone, and I’m definitely not an aberration. In fact I’m fortunate, there are people with ME who’ve not left their beds for years.

I can sleep four hours or twenty, I never wake feeling refreshed. I can’t choose to not nap when I can be awake and say, reading one minute and the next it’s six hours later. Yes, my internal nap monitor is screwed too, it’s never just twenty minutes! I can’t work to a normal “sleep pattern”, when I’m dormant I not only sleep through alarms, I’ve slept through my cleaner coming and going, and a few weeks ago just crashed on the sofa whilst a friend was building me a walk in closet, thankfully he understood as his mum has ME so he finished quietly and tiptoed away. Bless him.

But I think these examples clearly show this is not down to me giving in or not trying. I don’t see anywhere to go from here clinically. So my only realistic option is to continue to flex and enjoy my Awake around my Dormant.

Yes this makes planning difficult. There are hospital appointments I’ve had to reschedule, blood tests I’ve missed. More important to my sense of engagement with life is the birthdays, the weddings, the lunches and the family events I’ve missed. It’s been a long time since I’ve felt guilty for these, I know now I have to listen to my body, but it still saddens me to have to cancel.

Is this difficult to live with? Yes of course, saying otherwise would be disingenuous. I think anyone faced with the reality of losing maybe three or four days a week, every week, for the rest of their life would be floored. I think the blessing here for me is that this hasn’t been a sudden notification, it’s happened gradually over the past few years and whilst I’ve railed and wept I’ve also become accustomed to these limitations being my life.

It’s just that this conversation on Friday finally drove home that this is here to stay. There is no magic pill or potion, therapy or faith that will make this change. Stalemate.

And so comes acceptance. So I will continue to try to see my dormant days as necessary recharging, to allow my wakeful days to happen. I will continue to try every day to find both gratitude and joy in my world. I will continue to use my toolbox containing items as random as meditation and tramadol, heating pads, mindfulness and antidepressants. And I will continue to find my joy in the smallest and often unlikeliest of places. Eyes wide open.

Namaste 🕉️

RA & Lung Disease, or my struggle for breath

Firstly my apologies for sneaking in a wildcard at the end of RA Blog Week, but I’ve been suffering badly with fatigue which is unfortunately not conducive to blogging!

It’s been a long year already, and it’s left me a little tired. Let me take you back almost 12 months….

October 1st last year I started coughing. An irritating dry cough that was constantly annoying. By the beginning of December my GP ordered a chest xray ‘just to cover all bases’ and prescribed a steroid inhaler to help with the cough, which we thought might be Bronchitis.

Around Xmas I started getting breathless on exertion, and over the next few weeks this got worse. My xray came back showing ‘some scarring’. I’ll cut a long story a little shorter here but over the next few months I had a number of attempts at spirometry tests which failed as I coughed too much, though they did indicate a restrictive breathing pattern. At this point I was referred into the hospital, and after more detailed HRCT scans, Fleuroscopy, a bout of pneumonia and extensive lung function tests it became apparent that the RA has attacked my lungs.

In the last meeting with my thoracic consultant I got to see the scans, including a short “video” of my lungs breathing. It’s fascinating to see, you know me and wanting the fine detail! What it’s also shown is that on top of the lung damage – which is very likely from the RA – my right hemidiagphram is significantly elevated, though still thankfully working. The diaphragm is essentially the muscle that moves your lungs when your brain says breathe.

I’m saying it looks like RA damage because the jury is still out, there’s still a small chance it could be pulmonary fibrosis and not interstitial lung disease – further tests will keep an eye on progression of the lung damage and help identify the cause.

But essentially parts of my lungs have become inflamed, and then hardened, reducing my lung capacity and making it harder to breathe. On top of that the raised hemidiagphram is squashing the bottom of my right lung which just increases the breathlessness. We don’t know why that’s elevated so investigation is needed there too.

There is no fix, no cure. Lung tissue can’t be repaired. At the moment my consultant doesn’t feel this will significantly shorten my life, but we all know life don’t come with guarantees. I’m not being negative here, just sharing the facts as they’ve been put to me.

Unfortunately whether I live another four years or forty, I will have to live with this constant breathlessness. It was particularly difficult the first few days here in Cyprus as my lungs struggled with the hot air, making breathing incredibly hard even on mild exertion. This has now eased somewhat, hopefully in part due to the new inhaler I’m on.

But daily life has become that much harder. What makes me breathless? Making a coffee. Having a shower. Getting dressed. Turning over in bed. Walking short distances on crutches. Cooking. Basically everything. I’m also increasingly tired, probably due to low oxygen saturation levels which are being monitored, but on top of ME/CFS this has been a big drain on my already limited energy. I’m slowly learning to take pacing activity to the nth degree, quite literally tiny baby steps.

There have been moments when this has been very scary, but I’ve come to realise it’s almost like starting over again with a new chronic illness. Except this time I’m better prepared. I don’t need to slog through the ups and downs of adjusting mentally because I’ve been there. I’m certainly not willing to allow – or even in a place where – this can knock me down.

So, both mentally and physically I take those baby steps forward. I still meditate regularly, practice mindfulness and gratitude daily and these help keep me sane (ish!). In all seriousness without these I’d have been floored by yet another chronic health issue, but living in the now definitely reduces stress reactions. I’ve had my moments believe me, but they’ve been mostly manageable.

I think it’s important to remember that as with my first diagnosis of RA, this isn’t an end but the start of a new, slightly tougher path. And with the support of some amazing friends and family I can learn to live with this too.

Please remember as always nothing on my page is intended as medical advice and any errors are my own!

PEM – or Bed Now Please

Having just started to come out of a bad incidence of PEM I realised it’s something I’ve not specifically posted about. Yet it’s been a huge part of my life for over three years. So I’m going to try to explain in personal terms just how incredibly debilitating it is. A little background is probably necessary.

According to the NIH* “Post-Exertional Malaise (PEM) is a cardinal symptom of the illnesses referred to as Myalgic Encephalomyelitis (ME), Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS), and chronic fatigue syndrome (CFS).

A cardinal symptom is one that must be experienced by the patient to confirm diagnosis of the condition, in this case ME. Although my official diagnosis of ME wasn’t confirmed until about eighteen months ago, my GP and I are both in agreement that this has been ongoing for me since the time of my original RA diagnosis.

So, what exactly is it? And how does it differ from the fatigue experienced by patients with RA or other autoimmune conditions?

The NIH* states that “Unlike generalized fatigue, PEM is much more profound and reduces daily functioning. This symptom is characterized by a delay in the recovery of muscle strength after exertion, so it can cause patients to be bedridden for multiple consecutive days.”

And this is exactly what I’ve just been through. More recent studies into PEM recognise that the earlier criteria of ‘exercise’ was misleading and led to confusion amongst patients affecting diagnosis, ‘exertion’ is now used to provide a clearer picture, and it’s recognised that this can be mental or physical exertion, and that the physical exertion has a much lower baseline than in the standard population, as patients with ME are rarely able to exercise.

So we know PEM is profound and reduces daily functioning. But what does that look like? And how does it feel in real patient terms?

The NIH* describes it as “a worsening of ME/CFS, ME and CFS symptoms including fatigue, headaches, muscle aches, cognitive deficits, insomnia, and swollen lymph nodes. It can occur after even the simplest everyday tasks, such as walking, showering, or having a conversation.”

Seriously? Showering? Having a conversation? Actually yes, and in my experience having conversations, chatting, talking, call it what you will is incredibly draining. That doesn’t mean it can’t be enjoyed, but it does mean I’ll often pay for it later.

I’ll try and describe as clearly as I can how I was affected this weekend. I came home Sunday evening from visiting my Dad, which involves more driving than I would usually do. I want to make it clear here that I’m not blaming you Dad!! ❤️ Going to Waitrose or even popping out for lunch can have exactly the same effect. That’s the point. It doesn’t take much. And it doesn’t have to be physical. Dealing with simple paperwork for a short time can do the same thing.

So, Sunday afternoon. The first sign for me is usually yawning. Before I had ME I never thought of yawning as being a physical thing, but this can drop me to my knees. It’s like my whole body yawns with me. A couple of friends in my regular social circle will spot this a mile off now, and they’ll simply say ‘time to go home’. Apparently I suddenly look exhausted. Always attractive!

I’d say that on average within twenty minutes of this yawning starting I’ll be asleep, there is no choice, no putting it off. It’s like my whole body is simply shutting down. My head stops thinking, my muscles go heavy, and I can barely walk.

I lay down on the sofa at about six pm on Sunday, and only came to properly at about 6am this morning. So that’s 36 hours of basically being unconscious. I know I woke twice when my alarms went off to take my meds, and I know there was a third alarm I ignored so I missed a dose. I know I briefly came to and made a coffee at about 7pm on Monday, and it took everything I had to get into the kitchen and back. The rest is a blur of weird dreams involving a pub fire, going swimming in Italy and a trip to a theatre. Strange but true.

So that’s 36 hours lost so far. When I woke at 6am this morning I knew the worst had passed, the almost coma like feeling had gone, and my mind is awake to some small extent. Enough to slowly write this at least. But I have zero energy, and little concentration. From experience it will take another 24 hours at least before I’m able to actually get up and shower. I won’t be able to read or follow a TV plot properly, and I will probably sleep a lot today, though hopefully more refreshing sleep, not the passed out exhausted-ness of the past two days. Although it’s not an experience I’ve had I imagine I probably feel about the same as a marathon runner the day after, when everything hurts and you can barely move!

This is not a rare occurrence, it happens about once a week. I can lose from one to three days. I do pace my activities quite carefully, plan down days around days I have to be up and out, whether for medical appointments or social. I live alone so I try to get out three times a week for a couple of hours each time, usually a couple of coffees or soft drinks with friends. It’s incredibly easy to become isolated with chronic illness and it’s so very important we don’t.

So today will be a ‘sofa day’, as it happens it’s very rainy and dark outside so a perfect day for a couple of daft movies and snoozing. Then, fingers metaphorically crossed, I’ll feel human again tomorrow 😊

Footnote – it’s curious but common in #chroniclife to feel the need to validate ones symptoms and experiences, especially with something like ME which is incredibly still dismissed by some doctors. In this instance I’m actually glad I was wearing my sleep tracker, which has recorded 23 hours of sleep for yesterday. Proof!

*I have referred to and quoted from the American NIH or National Institute of Health because I find their website carries clear and up to to date articles. The full text that I’ve quoted from can be found here.

Love Is All

A very beautiful & treasured friend of mine has lost her husband suddenly & so unexpectedly. I am stunned, and I am so sorry for her and her family’s heartbreaking loss.

I just wanted to take a moment to say please hold your loved ones close. Then hold them closer.

Make the words I love you the most common ones you use, and mean it. It is not a cliché to say not a single one of us are guaranteed tomorrow.

Make your loved ones your only priority. Forget the extra shift at work, it’s so damned unimportant. Forget who put the trash out last, who cares? Hold hands, dance together, sing together, scream together, spend time with each other.

Talk about inconsequential things whilst looking at the night sky, talk about the important stuff whilst looking into their eyes. Smile in the rain, laugh in the face of storms. Time is the most precious gift we ever give to others, and it’s so fleeting.

Make your moments count, fill them with laughter, make memories. Remember this means all of those you love, not only partners and children and parents, but the family we choose for ourselves, our friends.

Don’t put off that lunch date, or keep forgetting to make that call while time slips through your hands like water. Love with all of your heart as fiercely and as loudly as you can, because when it comes down to what’s real it’s all that matters.

Love is everything. Namaste 💙

Being Positive? Stuff it! 

I’ve been thinking about language and the power of words. Mostly about the words positive & negative which crop up lots on chronic health forums. And you know what? I really dislike them. It’s the conversational equivalent of black and white, and the world just isn’t like that. 

They also imply that we choose to be positive or negative, and that just by saying “today I will be” some magic happens and we become one or other. Simply not true, if only it was that easy. 

I honestly don’t believe people are one or the other, I think we’re often both with varied shades of grey in between. And that’s fine. It’s perfectly normal to feel sad because the budgie died but happy because it’s not raining. Life does that. It’s how we cope with these moments and move on from them that define us. 

Trying to be positive is a route to failure. In the same way that trying to be negative is. Because they both focus on ‘trying’, and that’s not authentic. Either is also incredibly draining, both for ourselves and those around us. Spend half an hour with someone who constantly complains about the raw deal life has dealt them and you’ll come away drained. Spend the same amount of time with someone who is forcing themselves to be positive and look on the bright side and it’s just as draining. 

This is because they’re counting on your responses to feed their energy. Unknowing of what they’re doing they slowly bleed you dry. 

Answer? Stop ‘trying’ and just be. Stop, take a look around you, the world is a beautiful place, full of wonder. If you’ve forgotten how spend half an hour with a young child, they’ll show you the magic of sunshine and trees and dogs and laughter. 

And among these shades of grey is where you find happy. Where you’re in pain and can’t move but the cat comes for a cuddle. When your energy is so low you can’t get dressed so your friend comes to you for a coffee instead. Sunsets, birdsong, a light breeze, blooming flowers, scented candles, decent music, great coffee. All things we can notice and enjoy every single day. 

So put aside the whole +/- mindset, it’s fake and unhelpful. If you’ve ever had someone cheerily say to you “remember to stay positive” you know just how unhelpful. Instead allow yourself to feel happy whenever you can instead. Right now I’m in bloody agony, my fibro is flaring and even my skin hurts. But I can still be happy, I have TV to distract me, a comfy sofa and a snuggly blanket. And one of the cats is snoring bless her! 

On balance life is good. Don’t waste it reaching for how society thinks you should be, don’t let your illness live it for you, and make sure you constantly look for the small stuff, see the magic! 

My 15 favourite links! 

I’m approaching three years into my RA journey, in fact it was around August 2014 that I started feeling ‘not quite right’, just a general unspecific feeling of malaise. The swelling and pain waited until November to join the party! 

My way of coping with anything life has thrown at me is to research the hell out of it, as a high level manager for some years I was very used to problem solving, tackling challenges, call it what you will. Strip down your issue to the core, look at its impact, find a workable solution then plan implementation. Logic & reason. 

Obviously this approach alone doesn’t work for RA or any other chronic illness, but I still find myself fascinated by researching the medical, psychological & scientific aspects of RA. Part genuine interest, partly to confirm I’m not alone. 

This is where I both thank & curse the tool that is Dr Google. It’s fabulous that so much information is at my fingertips. It’s a nightmare that so much information is at my fingertips! We all learn for ourselves that using Google can be a bad thing, you start out with a hangnail and end up with gangrene in three clicks… 😉

So I have gradually whittled out the sites that are useless, badly sourced, unreliable, trying to sell me snake oil or just plain illiterate. Conversely I have found a staple core of websites that I return to again & again, as I know they are trustworthy, reliable and present information in a clear, understandable way. 

I’ll state now for the record these are just sites I’ve personally found very useful, I’m not being bribed to mention any particular site, and none of these are alternatives to consulting a medical professional. Phewww! They are also in no particular order. 

  1. NRAS are a British charity dedicated to providing information and support for everyone, from patients to medical professionals 
  2. Arthritis Research UK  are a another British charity who invest in research and providing information for all 
  3. NHS the British National Health Service website covers all things health related, from disease to diet, providing clear and reliable advice 
  4. WebMD offers credible and in-depth medical news, features, reference material, and online community programs 
  5. NIH the National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation’s medical research agency
  6. EULAR the European League Against Rheumatoid Arthritis is a non profit organ that fosters excellence in education and research in the field of rheumatology
  7. Rheumatoid Arthritis. Net empowers patients and caregivers to take control of RA by providing a platform to learn, educate and connect with peers and healthcare professionals 
  8. RA Warrior Kelly first created her site/blog  in 2009. She believes you are the superhero you need to fight your disease, and provides a wealth of information that’s easy to understand in her blogs 
  9. Mayo Clinic more than 3,300 physicians, scientists and researchers from Mayo Clinic share their expertise to empower you on their incredibly reliable website 
  10. Drugs.com another very reliable site that offers patients clear information about medicines, pros, cons and tips for patients. (My only caveat is don’t use this site or any other over and above your doctors advice – doctors are trained to factor in risks of interactions and side effects, you aren’t)
  11. Creaky Joints is a wonderful online patient community. More than 100,000 people with all forms of arthritis and their families have been touched by CreakyJoints with meaningful support, updates and education, innovative advocacy and global research projects, and the sharing of great patient blogs from around the world 
  12. Health Central is a kind of health magazine online! It provides easily searchable information and articles about many health issues, shares blogs and invites questions for its experts
  13. RA – Facebook Groups –  I’m not going to provide a link here or name one group because where you find your tribe is personal. I originally searched for and joined a number of groups, and have gradually whittled that down to a few I use all the time. They’ve become family. Some groups will feel right and some won’t, and your right will differ from mine. Join a few, sit back and watch the posts, you’ll soon find where you feel comfortable. 
  14. The Seated View blog by Lene Anderson – my personal RA hero!! No exaggeration. If you only ever buy one book on Rheumatoid Arthritis buy hers, “Your Life with Rheumatoid Arthritis“, it’s my bible. My copy is dog eared and full of notes, and much loved. It even convinced me I was sane on days the world said otherwise. I’ve been fortunate enough to get to get to know Lene as an online friend, she’s brave, witty, clever and frankly amazing, total respect! Plus she likes cats 😊
  15. Giggles Over Tears with RA is a simply wonderful Facebook page. Donna’s sole aim is to use her poems about RA to make people laugh, a must follow! 

Playing the RA treatment game.. 

Hi all, I’ve just realised it’s been over a month since I’ve posted, mostly due to the extreme fatigue caused by pneumonia. Oh the joy! Hoping the double dose of antibiotics has done the trick, though I read it can take months to recover 😮

Anyways, I wanted to talk about my RA.. I’ve been pretty lucky the past couple of months, apart from “remaining pain” it had been mostly dormant. But let me step back to February which was my last appointment with my rheumy. When she decided unilaterally to stop treatment. 

Her rationale was that she couldn’t see any active inflammation so therefore my joint pain must be from Fibromyalgia. I’d been on Humira (my fifth RA med)  for six months with no improvement in symptoms, and (I quote) ‘Humira works for 80% of people so it can’t be your RA, and there’s no point keeping you on very strong meds you don’t need’. There are actually so many flaws in this argument it’s ridiculous. 

🔵 Firstly her numbers are incorrect. A quick search of the Internet will tell you that:

In one study conducted in 544 patients who had failed previous DMARDs, rates of ACR20 response for Humira 40 mg every other week and weekly at 6 months were 46% and 53%, respectively, compared with 19% for placebo” Figures from RheumatoidArthritis.Net 

🔵 Secondly I know my math is rusty but even if the 80% was  actually correct, that still leaves 20% of patients who it does nothing for. Crazy I know but what if I was one of those!! 

🔵 Thirdly I’ve had RA and Fibromyalgia for over two and a half years. I know the difference. RA joint pain is unique, the closest I can come to describing it is to imagine you can see your joint, with the synovial fluid sitting there protecting it nicely. Then imagine someone replacing that synovial fluid with acid. Burning acid. Fibromyalgia doesn’t get anywhere near that specific or that painful. 

🔵 Fourthly (that sounds wrong) RA is a systemic chronic condition. Not everyone has visible swelling. And what about the stuff going on you can’t see? The 50% increase in the risk of heart disease, the ongoing damage to internal organs, tendons, eyes, increased risk of infection, narrowing of blood vessels…. 

If rheumatoid arthritis is left untreated in the long-term, it’s not an exaggeration to say that your life could be at risk as well. “Persistent inflammation can lead to a shorter lifespan,” Pisetsky says” in a medical article from EverydayHealth 

I digress a little, but I think the risks are kinda important. At my last count there are approximately thirteen different biological medications approved for treatment of RA in the US, though here in the UK we are behind with approving new treatments, which I suspect is down to cost. There are also different types of biologics that act on specific areas of the immune system, so if a TNF inhibitor like Humira  doesn’t work perhaps a T-cell inhibitor like Orencia might. Lots of possibilities there huh?! 

But – having already dismissed one rheumy and knowing there isn’t  an endless supply of them locally I talked it over with my GP and decided to “play the game”. Because that’s exactly what it feels like, that I (the patient) am having to humour my consultant in the short term to stay on her good side so I can get the meds I need long term. So I sat back and waited. As I said my RA had been behaving for the most part and I’m kinda used to the pain so I let it be. 

Week before last my fingers started swelling again (as I’m sure many of you know there is an RA rule that they will never do this on the day of an appointment!), and then last night my Carpals started up. These are the cluster of small bones on the back of your hand just before your wrist. Today I can hardly move my left hand. It sounds insane but this is exactly what I’ve been waiting for. 

So today I’ve put in a call to our rheumy advice line which will get me a call back from the nurse within 48 hours. I’m also going to get bloods done ASAP and I’m hoping my CRP and ESR will be raised – compiling evidence! 

So I guess it you could say that in the RA treatment game I’m currently a point behind but focusing on the next match. 

Love & blessings 💙

Simplifying Part Two – Vacations 

I’ve always loved to travel, even the word conjures up a wonderful jumble of images in my mind, from fictional journeys I’ve taken such as old fashioned steamer trunks and the ‘Grand Tour’ of Europe (Little Women*), bustling Caravasarai for travellers along the Old Silk Road through Syria, Persia and onwards (see Physician*), as well as times I’ve spent abroad over the years, the scent of the spice markets of Marrakech, the taste of fresh cherries in southern France, the beautiful work of artisans in Cuba, the timeless flavours of mezze in Cyprus, the Fairytale castles and landscapes of Bavaria, the majestic beauty of mountains in Austria, the cobbled streets and squares of Belgium with the obligatory Moules Frites! 

As you may have gathered for me travel is not about finding a good beach, but wandering local streets, finding tiny coffee houses populated by ancient men who seem part of the furniture, stumbling across cosy restaurants with food you remember years later, churches and mosques and town halls with amazing architecture, bustling souks with women in brightly dressed kaftans and djellaba haggling, always haggling. 

Nowadays all of that sounds quite exhausting! So how on earth do those of us with chronic illness and disability and fatigue even contemplate travelling? For me (yes, here’s the theme) it’s about simplifying. And to simplify you need to plan a little. Yes, this may take away a smidge of the spontaneity of previous journeys, but they were taken in days when I didn’t need to know where the nearest toilet was at all times and whether I could park within 20 feet of my destination! 

So, how to simplify travelling? By reducing both physical exertion and stress. I’m going to talk about holiday type travel here, but I’m sure some of these tips could apply to other journeys too. 

  • Simplify the airport. My number one tip is book assistance at the airport. It’s free and it’s the best thing ever, especially if like me you travel alone. Once you get yourself to the meeting point in the airport you can almost stop thinking. You get comfy in a wheelchair and often sail past queues at passport control and check in. I can already hear some of you saying hang on, a wheelchair?! Yes. Gatwick airport – 1.2 miles to North terminal from check in. JFK 0.7 miles. Zurich 1.27 miles. I can’t walk that far, and you really do not want to arrive at your destination in an exhausted and painful heap. Use the wheelchair. Of course if you have your own wheelchair or even mobility scooter the airline will carry these free of charge, just make sure you let them know in advance. 
  • Simplify your meds – yes, it’s a fact of chronic life that like me you’ll probably need a bag just for your meds. If you pack it carefully you’ll have no problem at security. Don’t decant into pill sorters, take them empty and do it when you arrive. Ensure every med has its box or bottle with pharmacy labels, and carry copies of prescriptions or a print out of your repeats list as back up. I’ve had my meds emptied out at security more than once, but I’ve never had them queried. If you’re carrying sharps let the airline know in advance, you may need a letter from your GP. NB – always carry on, never put meds in the hold, we’ve all heard tales of missing luggage…. 
  • Simplify your packing. It’s taken me a while to master this, but actually taking as little as possible is so freeing! Because of my fibro I tend to stick to soft jersey or linen, and I swear to you three pairs of trousers, five tops, a jacket or cardi and a scarf or two and I’m done. One of those tops will be one I can dress up a little if I do end up having an evening out (I’m usually on the bed watching TV by evening these days!). I spent years lugging clothes abroad that came back unworn, and I know I’m not alone. 
  • Simplify your accommodation! How? Check access to your room, and access to what makes your holiday enjoyable before you book. Once you know your booking is for a ground floor room, within 40 metres of the town square/beach and there are four good restaurants/bars nearby you can relax about your arrival & enjoy your stay. 
  • Simplify your decision! What are you really travelling for? Forget everyone else for a minute, what do YOU want out of this holiday? Whether it’s time to meditate daily, swim, lay on the beach every day or learn to paint make that the focus of your booking. If you have children book a holiday with a kids club or crèche facilities, if they spend half a day there while you swim/read in peace it means you have the downtime you need to save spoons for time with them in the afternoon, or vice versa. Remember this is your holiday too. 
  • Simplify your expectations. Probably the hardest lesson I’ve learned but the most important. Be kind to yourself. It’s OK not to see every tourist attraction in the area. It’s OK to have a siesta in the afternoon. It’s OK to have early nights. It’s OK to just sit and have a glass of wine while you watch the sunset. It’s OK to spend a whole morning drinking coffee and reading a good book. It’s even OK to spend a day in bed. (What!! But I’m on holiday, stuff to do, places to see! A day in bed when I’ve paid to be here?!!) Yes, it’s absolutely OK. Think about it. You’re on holiday, a vacation, a rest. If you can’t give yourself permission for a day in bed if you need it when can you? Doing this while I’ve been away in the past couple of years has been essential, I couldn’t have had the up days I enjoyed without listening to my body and taking a day or two to rest. 

I would love to hear any tips you have for simplifying your travel plans. 

The two books mentioned are both ones I’d recommend. A relaxing holiday read maybe?  

*Little Women by Louisa May Alcott 

*Physician by Noah Gordon