Side Effects

Let me be honest: I find side effects totally insulting.

Most of us with chronic illnesses take a whole lot of medications.  Most of those medications come with a long list of side effects.  As patients, we are forced to decide (more often than most people) whether the risk is worth the reward.  We must choose whether possible liver problems are worth relief from joint pain and swelling, whether mood swings are worth relief from inflammation.  Constant choices.  It’s exhausting.

I have learned to read ALL of the patient information on my medications.  I google them all and check multiple websites.  I make sure I know the rare side effects as well as the common ones.  I check for medication interactions before I take anything new.  Oh sure, I believe my doctor is smart and knows what the best treatment is for my RA and fibro, but I also believe mistakes happen.  I believe that my health care is ultimately my responsibility.  So I research, double check, triple check.  That too is exhausting.

But neither of those is why I find side effects insulting.  I hurt all the time.  I am tired beyond tired.  I am weak.  I get depressed.  So I take medication to help with those things.  Sometimes the medications help a lot, sometimes not at all.  But…all of them come with great big side effects that I must learn to live with.

So, on top of being in pain, being tired and weak, having depression, I now also: have difficulty sleeping (side effect of Welburtrin AND prednisone), have mood swings (prednisone), am a bit foggy brained for part of the day (Lyrica), have fish burps (fish oil), have occasional stomach issues (naproxen), and most fun of all, have a day or two of horrible fatigue and nausea (Methotrexate).

Those are my regular side effects from my medications.  What about the possible long term ones- hair loss, bone depletion, liver failure, kidney problems, ulcers, cancer.  Fun!

Is all that worth it?  Yes, probably.  I am not sure how I would feel without all the chemicals.  Probably horribly depressed and unable to actually move.  So yeah, the side effects are better than that life.  But here’s the thing I wonder, the thing that makes me get upset and insulted:

if scientists can figure out how to make these meds, can cure cancer, can find ways to travel to space, can do all the amazing things they can do, why in the hell can’t they make medications that don’t make us so miserable?  I know I’m asking a lot.  I really do.   But wow, those of us who have to take so many medications, so many really strong medications, have too many side effects.  It is TOO much, and I think scientists and/or drug companies should start thinking about chronic illness and chronic care in a different way.  Don’t make a pill that trades joint pain for cancer!

Ok.  Rant over.  As you might have guessed today is my post-MTX day, aka day from hell.  Day of fatigue, nausea and headaches, despite doubling my dose of folic acid.  But…I will stick with it.  Because if MTX works (in another two months, we may know!), it will likely be worth one day of hell if it gets me six days of functional.

And now I am going to bed.

Building a Team

One of the first books I read about chronic illness, You Don’t Look Sick by Joy Selak and Dr. Steven Overman, talked a bit about building a health team of doctors you feel like are really on your team.  These aren’t just doctors you go to because they were the first in the phonebook or because your insurance company made you.  They are doctors you feel have your best interests at heart and who really get what you want in your journey.  At the time that I read that, I had had exactly two doctors, both of whom I liked just fine, and I wasn’t really thinking about needing an entire team to help me.

But since then, I have had been to a few more doctors.  I have had a whole lot of conversations with various people.  I have expanded my care.  And I am realizing that I do, in fact, have a team behind me.  My team includes:

My Primary Care doc, Dr. W, who didn’t blink when I went in and said at the end of an appointment for something else, “oh and I have been really feeling awful for several months.  Very tired, weak; everything is hard to do.”  Instead, she ordered a ton of labs and promptly referred to me to an excellent rheumatologist.

Which brings me to Dr K, my rheumy.  I like her, though she isn’t warm and fuzzy.  There’s something about the way she doesn’t think you’re odd when you explain a symptom, the way she even remembers the phrasing (“my arms feel heavy”) to ask you about it later.  I also very much like that she and her staff never seem to hurry through an appointment, and yet never keep you waiting for long.

Next up, and this one seems silly probably, is the entire staff at the CDI (Center for Diagnostic Imaging) that is located within my rheumy’s building.  I have now been there for two ct’s and several xrays, and every person there is friendly, knowledgeable and helpful.  They explain everything they are doing, and truly have the patient’s best interests at heart. I will have all of my imaging done there, if I can help it.

Even though he’s an odd duck, I also have to add my shrink to the mix.  Dr. A always tells me weird stories about articles he read in journals, or books he’s read.  But he also explains his clinical outlook, and he doesn’t dole out meds like candy, the way so many other psychiatrists do.  I like that about him.

I also feel like my team is made up of some non-doctor types.  My pharmacist, Michelle, who knows me by name, remembers all of my medications and diseases, and always asks me how it’s going.  There’s my acupuncturist, the newest addition to my team, who isn’t intimidated by high levels or multiple problems.  She truly loves what she does and it has made me a believer in acupuncture, as a healing mechanism (even if it doesn’t work for me- jury is still out).   There’s Jean, the nurse at my rheumy’s office.  I have never met Jean because she’s not the nurse who helps with patients in the office, but every email and every phone call is routed through Jean, who always answers promptly and who is always supportive and helpful.   I also feel like I need to add my best friend L to my team, not just because she’s my best friend, but because she is so knowledgeable about all of the stuff I have been going through because of her own health journey; she has also been the one to encourage me to try alternative treatments and who found me my acupuncturist.  L is on my team because she gets how I feel without having any doubts, because she helps me figure out ways to feel better.  I couldn’t ask for a better friend (or team member!).

NOT on my health care team: the urologist who was so disorganized and so incredibly unhelpful at my own appointment with him and who has never called me back with test results over a month later (I got the results on my own, thank you very much).  But that reminds me, I need to find a new urologist!  *Sigh*

So far, I feel pretty good about the team I assembling.  I hadn’t thought at the beginning of this that I would need a whole team, but I really do.  Today, I am hoping to add a physical therapist to the mix, but we’ll see how I like them.  The truth is, these diseases are hard; living with chronic pain is hard.  We can’t do it alone, and we shouldn’t try.  I have been so lucky to have found a good team without too much effort, but I know it won’t always be this easy.  I know it isn’t that easy for most people.  But, I feel so strongly that it is necessary that all I can really say to people who don’t have a good team is keep trying!  It’s worth it.  Because we all need to know that we have a group of people in our corner, people who don’t just have good attitudes but who genuinely want us to be well and don’t feel like there is only one right way to get there. We need doctors, and health providers, who have open-minds and a willingness to try new things.  We need people who will answer our questions honestly, who will give us information and allow us to make our own decisions (when possible, of course).

I have been feeling pretty blue lately, pretty discouraged with how crappy my body feels all the time.  But I do know, at the bottom of all that worry and fear and sadness, that I have a team who will help me feel better eventually.  I just have to stick with them and be patient.  I just have to do my part on the team, hard as it may be.

Failure

Yesterday I had an interesting conversation with my best friend, L. L and I share many symptoms, though she has been dealing with her chronic illness much longer than I have.  She’s also been cursed with a long diagnostic process which isn’t quite ended yet, while my road has been a whole lot smoother.  Besides those differences, though, our illnesses are often pretty similar, as are our attitudes toward being sick.

Yesterday we were talking about a potential plan for me to return to work part-time soon.  I’m very happy about the idea of going back to work part time; frankly I am bored out of my mind, at home everyday.  Plus, I enjoy my work most days, and I miss my co-workers and the volunteers I interacted with on a regular basis.  So I’m looking forward to being able to work again.  That said, I am pretty worried about going back because I am not sure what I am capable of doing physically. How many days will I be able to work? How many hours per day?  Will the commute be too much?  Will the stress make me worse?  Is the walk to and from the bathroom going to be too challenging on bad days?  There are so many questions running through my mind that it makes me want to just say I can’t go back.

But L. very correctly pointed out that one of the rough things about being chronically ill is that we must set ourselves up for failure on a regular basis.  The truth of the matter is I may not be able to work as much as we are planning; I may not be able to handle the drive.  But I have to try.  And I have to realize that I may fail.

Anytime we, as the chronically ill, make a commitment, we are setting ourselves up for failure.  Oh sure, we will not always fail.  But we must be prepared everytime for the “what if” to happen.  I want to take the kids to a movie this weekend, but I may not be able to do it.  I have an appointment tomorrow morning, but I may not be able to drive.  Not knowing if I can follow through on my commitments is so hard for me, but it is impossible to go through life refusing to commit to anything.

So we must accept that sometimes we will fail.  Sometimes we will disappoint our friends and family.  Sometimes we will look foolish or inconsiderate.  Sometimes we will seem selfish and rude.  But we can’t live by what others think of us, by what others expect of us.  We can’t live by the rules others set.

Instead we must be true to our bodies and to ourselves.  It is good to make plans, but it is also good to break those plans if we need to.  It is so unhealthy for us to force ourselves to fulfill obligations that we physically shouldn’t.  It is unhealthy for us to ignore the warning signals our bodies send to us.

So, we must make ourselves aware that failure is an option.  It is ok to try and fail.

To make this easier, we must communicate with our friends and family, our co-workers, that when we make plans we will try our best to keep them, but that we may have to cancel.   If we are honest with people about our abilities, and honest with them that we will do our best, then it is much easier to fail.  Oh sure, it will never be easy.  But it is easier if we don’t feel like we are constantly surprising people with disappointing news.

Of course, this is all easier said than done.  I don’t want to fail.  I want to know when I make plans that I can keep them.  I want to be dependable, reliable, as I always have been.  Now, I have to be content with trying my best.  Now, I have to put myself first, another hard thing to do.  Now I know that I have to learn to fail.  And I have to set myself up for that failure, over and over again.  To do otherwise would mean never really living, and that’s just not an option.

Depression and Anxiety Common in Arthritis Patients- Of Course!

Even before I read this article on MedPage this morning, I had been thinking a lot about depression and anxiety in my own life.  It makes sense that they would be pretty common in people with chronic illness.  To sum up the article, people with arthritis are likely to have depression issues, but they are even more likely to be dealing with anxiety.

If you think about the life of the chronically ill- the ups and downs, the unknowns- it is not at all surprising that this would be true.  Our health is a constant question mark; our lives hinge almost completely on that question mark.  Of course, we’re anxious!  Of course, we’re depressed!

I have been dealing with depression for years and years.  For the last five years I have been treated (successfully) for depression.  I see my p-doc every six months for a med check.  At this point I have been on the same med, at the same dose, for about two years.  I see him on Thursday, and I have been thinking a lot about that visit.  He asks me standard screening questions every visit, and every visit my answers are the same.  But this time, I think the whole conversation will be changed because of my other recent diagnoses.

Do you find yourself taking enjoyment in things?  Um, not really.

Are you having feelings of sadness?  Yep.

Do you have motivation to do things?  Um, no.

Are you sleeping? Ha!

Have you had many episodes of crying?  Well….

Yeah, it’s going to be a totally different visit.  And I’m curious about how it will go.  Because what I know is that I have been dealing with situational depression.  IE my situation is making me depressed.  For people with depressive disorder, it is often not a situation that causes it, but it is that depression is like a cloud that constantly hovers.  We can’t control it.  Even when life is fine and good, we may have the cloud hanging around.  Meds take the cloud away for me.  But that doesn’t make me immune (obviously) from situational depression.  But I have been wondering about this.  Have I been more upset than I should be about everything because my meds are no longer at their peak?  Do my other meds lessen the effectiveness of my anti-depressant?  Would it be helpful to increase my dose to help me through this period and then bring it back down in a few months?

Things are doubly complicated in that depression often is part of fibromaylgia.  So does that mean, my treatment should be different, should be the “standard” fibro/depression treatment (assuming there is one)?  Or does it mean we have one more thing to take into account in our semi-annual meetings?

As with most things, we shall see!  I’ll let you all know how it goes on Thursday.

 

 

Really Easy is Really Hard

Let me just say this first: there was a time, years back, when I was in good shape.  I exercised regularly.  I was never skinny because I’m not built that way, but I was in pretty good shape physically.  But the key point here is I could do med-hard exercise without much issue.  The past few years I have gained a lot of weight, for one reason or another.  I am no longer in good shape.  I know it.  But up until the last year, I could still walk a mile (for example) without a problem. I could still move my out of shape body.

But now, here we are.  It’s all difficult.  Walking.  Exercising.  All of it.  Part of that is being over-weight, but a big chunk (more than I knew actually) is the fibro/RA taking their toll on me.

All of that said, I know I have to exercise.  I need to lose some weight, but more than that I have to keep moving so I can try to keep the fibro and the RA under control.  Mostly I have just been walking the dog with Bill, but I have also started adding in some arthritis exercise dvd’s, some light yoga, lots of stretching.  I also decided to start taking a “gentle” water exercise class once a week.  It is not an arthritis foundation approved class, but it’s in the same vein, I think.

Anyway, yesterday was my first class.  I got there early, and checked in at the front desk.  I wasn’t sure if I needed to sign in or anything, and I had missed the first class, so I asked if there was anything I needed to do.  When I told her what class I was taking, she laughed and said “Oh, that class is easy.  Really easy.  You can just go in.”

Really easy.

After braving the locker room (how I hate them), I went to the pool, where everyone was at least 30 years older than me.  Including the instructor.  Most of the ladies were also overweight like me.  They were all incredibly nice to me, including the instructor who gave me lots of direction.

But here’s the thing: it wasn’t really easy.  Oh, it should have been.  With my past exercise knowledge, I know it really is an “easy” class.  Besides being in the water, which helps, all of the moves are pretty simple, and there is nothing overly demanding involved.

And yet, I wanted to stop after about eight minutes (yes, I looked at the clock).  It was hard.  Very hard.  Not only that, but it was exhausting.  I came home and wanted to go straight to bed.

So, I have to ask: is this my life?  That taking the easy class with the 70 year old instructor is going to kick my ass?  That my 35 year old body is actually less able to do things than someone’s twice my age?   Is this what I have to look forward to?

Does it get better?

I guess we’ll see (there’s that we’ll see again).  Maybe with all the meds, and with physical therapy, and with acupuncture, and with regular walking, and with my once a week water class, and with all the other things I am doing, maybe with all of those things my body will be less broken.  Will be more functional.

Maybe.

 

Product Reviews and Tips (A Not Quite Blog Post)

I’m not going to blog today.  Except obviously I am!  Actually, I just want to point people to the page I added today because I worked hard on it this morning!   You can find it at the top by clicking on “Product Reviews and Tips” or you can click the link.  I plan on adding to it as I go, so if you have things you’d like to see reviewed, let me know!  Or if you want to add your own, feel free to send me info and I will include your reviews.   Or tips.  Or both.

Q. Why am I doing this?

A.  Because I always read reviews before buying anything.  Because there is too little info out there to help people with chronic illnesses make good purchases and decisions.  Because I want to and it gives me something to do.

Q.  Is someone providing me with free products?

A.  I wish.

Q. What if you disagree with my review?

A. Tell me!  I’m happy to add people’s comments/opinions/reviews.

Doctor/Patient Relationships

I have to see a dermatologist tomorrow.  My first visit with this particular doctor, and I’m nervous.  I hate first appointments.  I am particularly worried about this appointment because I have this weird….thing that my rheumy couldn’t name.  The internet yielded nothing.  So I am going into this appointment with no clue what I may hear.  I don’t like it.

Last week, I read a great blog about first dr appointments: Ambivalence.  That blog led me to a terrific blog by a doctor who wrote about dealing with patients who have chronic illness: A Letter to Patients with Chronic Disease which gave me a whole new appreciation for doctors who deal with people like me.

These blogs raise good questions.

What is the best way to start a dr/patient relationship?  How much information should you reveal at first visit?  Should you go into an appointment with ideas about what’s wrong or is it better to go in totally ignorant?  Is it a good idea to come in with a long list of questions or a short list?  How much patience should we have with our doctors and when is it time to shop around?

As patients with chronic illnesses we are too often at the mercy of our doctors.  Many of us require pain medications, but there are docs out there reluctant to prescribe them.  Many of us have strange illnesses that require patience and lots of detective work, but there are docs out there who see the first negative test as an absolute negative.  Many of us don’t react well to commonly prescribed meds, but there are docs out there who don’t want to try six more to see which works better.  So, as patients, we must either subject ourselves to the whims of our doctors, or we must keep looking, which is a pain in itself.

I have been very fortunate with my rheumy, who has been great with questions and with giving information.  Who has done the detective work and not cast me aside because of negative results.  But my urologist is another story.  He and his nurse were disorganized and not particularly helpful.  I saw him three weeks ago and have not heard back from him; instead I got my results from CDI, who ran the ct scan.   I know I should follow-up with him to see what we do next, but frankly, I don’t want to.

So, it will be interesting to see how things go tomorrow with the dermatologist.  For once, I go in with absolutely no idea what I may hear.   But hopefully, she’s a good detective.  I mean, doctor.

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