end of the methotrexate experiment

I have taken my last dose of methotrexate. I gave it 4 1/2 months in the end, and still have no idea of whether it was actually working. I do know, however, that the side effects just became too intolerable. I felt way more fatigued whilst on methotrexate than I ever did before taking it. That, coupled with some pretty unpleasant mood swings, meant that I felt that it just wasn’t worth it to keep on with it. I ended up not feeling quite myself more often than not, and just felt an inexplicable sadness all too often that didn’t seem to tally up with hormones, or what’s actually happening in my life.  Sure, I get down sometimes, and sometimes this can turn into depression, but this has been more erratic than that, feeling fine one day, and in the depths of despair the next. It left me feeling quite unstable some days, where I’d burst into tears at the smallest thing. While I can be super sensitive sometimes, this has happened way more than ‘normal’ for me. Given that, even while this was going on, I was still flaring off and on, it just hasn’t felt worth continuing with this powerful drug.

I have another appointment at the rheumatology clinic in mid January, so I guess I’ll start exploring next steps then. Until then, I hope that having stopped taking the methotrexate a week ago, I’ll start to feel back to my normal self very soon. Hopefully I’ll regain some of my energy and motivation and feel at least a little more stable in my mood and emotions.

While I’m here, I’d also like to thank everyone for keeping reading my blog posts, and sharing my PR journey. Thanks also to everyone who has commented or contacted me personally. I feel very grateful to be part of a community of people who can often feel neglected and not heard by medical professionals. It’s good to know that by sharing our stories online, we don’t have to feel so alone. I hope everyone reading this has enough ‘spoons’ to enjoy the festive season and is as pain free as it’s possible to be.

Happy holidays!

Advice I wish I’d received

I’ve been contacted by a few people over the years about how helpful my blog has been, and how good it is to connect with others with the same condition. I have been thinking about how frightening it was when I was first diagnosed, and how much I would like to have had some advice about how to get taken seriously, and how to handle appointments with health professionals – whether it’s the GP or rheumatologist. So I thought I’d put a page together with some hints and tips for people which will sit on the site permanently. Please feel free to add comments and your advice to the page.

three months in

According to the literature, methotrexate is supposed to kick in after about three months after your first dose. I’ve now been on the medication for 13 weeks, so I should be starting to see an improvement in frequency or/and severity of flare ups sometime soon – if it is going to work, that is.

People keep asking me if it’s working and seem to find it difficult when my reply is “it’s still too early to tell”. I guess, three months is a long time to people, and there is an expectation in our culture of wanting things to happen immediately. After all, when you take a pill for a headache, you would expect your headache to go pretty soon afterwards. Unfortunately, the drugs for arthritis don’t work that way. Three to six months is what I’ve been told, so I’ve still got a way to go before I know for sure what difference it’s going to make.

One thing I know for sure is it definitely hasn’t started working yet – or if it is, it’s not doing a good enough job. I’ve been in pain most days for the last two or three weeks. It’s mainly been in fingers, wrists, hands and shoulders – though thankfully not all at the same time. It’s been flitting from joint to joint in its mysterious way and it hasn’t been much fun.

I’ve also noticed some unwanted side effects from the medication. My mood has been quite erratic (more so than usual), with me feeling quite down and tearful some days, and fine the next. My fatigue has also definitely been a lot worse than it was before I was taking the drug, with more frequent very fatiguey and foggy days, and feeling pretty tired more days than not. I’ve also noticed it has affected my ability to exercise  – I am getting out of breath a LOT quicker than I would expect – and my legs feel heavy and tired when I cycle or do zumba, in a way that they didn’t used to do quite so quickly.

I’ve been tested for folate, iron and B12 deficiency, but that’s all fine, and so it’s likely just to be a side effect of the methotrexate. A pharmacist explained that the drug could be impacting on the body’s uptake of oxygen, so things are fine when I’m at rest, but when my body needs oxygen – when it’s cycling, walking upstairs or zumba-ing – it’s just not getting it quickly enough, hence getting out of breath. He didn’t say whether my body would get used to it. It’s quite demoralising.

It’s also quite demoralising having these side effects but no improvement yet. I’ve decided to give it to Christmas before making a firm decision – but I’ve been a little low about the choice that I might be faced with if it DOES work: Do I plump for a) no pain but fatigue,  tiredness and really depressed/low days, or b) having flare ups as before, but increased energy levels. It’s not really a great choice is it?

I guess I’ve also been a little low because there was always this slim hope at the back of my mind that methotrexate would somehow be the ‘fix-it’ cure that I was looking for. So if this doesn’t work, then I have to accept (once again!) that I’m probably stuck with this disease, with the pain, fatigue and all the other things that go alongside it. Of course, there might be other drugs to try, but as PR doesn’t cause joint damage, I’m unsure whether I will be prescribed them.

On the plus side (because there is always a bright side), I’ve had a fantastic yoga holiday in Iceland where, despite flare ups nearly daily, I managed to get through some amazing yoga classes with my body doing things I honestly thought it would never be able to do. The experience of doing daily intensive yoga classes has left me feeling much more IN my body than it was before, and also feeling quite positive about my body, despite its limitations. I know that yoga and meditation is good for my mood and my physical body and it’s made me want to try and prioritise these practices even more.

handstand

Yes, that’s me! Despite frequent wrist flares (and with a lot of help getting up there) I managed to do a handstand. It did not cause any pain or flaring and it felt amazing knowing I have the strength to hold myself upside-down

Methotrexate update

Just a quick post update on the methotrexate. Obviously it’s way too early to know if it’s doing anything at all for the underlying illness. I’m only three weeks in after all. But so far, it does not seem to be disagreeing with me – in that the most common symptom that people have reported (nausea and sickness) isn’t something that I’ve had too badly at all. I’m surprised by this as I’d almost expected it to be terrible, as lots of people I know have said it was for them, but in fact, it has been quite mild, and definitely bearable. The rheumatology nurse said that if I hadn’t experienced it by now (that I’m on the full dose), then I would be unlikely to. So hoorah!

I also learned from the rheumatology nurse that echinacea is not recommended for people with auto-immune disorders, and she advised against taking it. It’s a herbal remedy used to strengthen the immune system and I usually take it at the first sign of a cold or virus, particularly during the winter. I guess that the reason is that if it works, it may provoke a flare up or something. I hadn’t particularly noticed whether it did or not, as actually when I am ill, I often am flare free (body’s too busy fighting virus to fight itself?). It’s worth knowing though, so I will see how I go this winter without taking it.

If that’s the advice, then it must mean that someone somewhere believes that echinacea DOES work to strengthen the immune system, so perhaps that’s good to know for everyone without an auto-immune condition!

 

Trying something new

After 12 years of living with palindromic rheumatism and experimenting with various lifestyle and dietary changes I’ve made the decision to start taking new medication in addition to the hydroxychloraquine that I already take.

Doing yoga and avoiding gluten and eating healthily has served me pretty well. But it has not cured me. I am still flaring. I am still fatigued. And I am still none the wiser as to what triggers a flare, or what will make it go away once it’s there.

I’ve resisted taking methotrexate for a long time. The side effects looked too scary, and I kept reasoning that as I was generally coping with my arthritis, there was little point in putting these scary drugs into my body.

But sometime over the last twelve months, my perspective has shifted a little. I experienced a three month wrist flare in the winter which led to a lot of stress and worry that permanent damage was likely. I’ve had scans and x-rays and luckily, that’s not the case. But even so, living with that constant flare for three months really did interfere with my quality of life and ability to do some of the simplest tasks. My yoga practise suffered too.

On top of that, the unpredictability of flares, and an extremely severe shoulder flare a couple of months ago made me think “You know what – you don’t have to live like this” and decide that it was time to try something new. I felt like a failure at first and had to work through a few feelings around that, and the fear that comes with starting something new and potentially as damaging to my health as the arthritis itself. But I reasoned – if there’s a problem, I come off it. If the side effects are horrible, I come off it. If there’s no change. I come off it. I’ll be no worse off than I am now.

As well as the fear, there’s positive emotions as well. The fact that methotrexate DOES work for a lot of people gives me some hope. I know people taking it with no side effects at all. And the idea of being pain and flare free, even if it only works for twelve months, is extremely appealing.

I started my first dose on Sunday, and will be taking folic acid four days later. I will be closely monitored at first (blood tests every two weeks) and will be careful to stay away from people with horrible infectious diseases as I will be more likely to catch infections and illnesses as a result of the drug.

I’ve been told that it will take around three months to know if it’s working, so for now, it’s a waiting game. I wait to see if there’ll be side effects and I wait to see if it’s going to work. In the meantime, I continue with the lifestyle changes that I know help me, even if they don’t cure me.

10 things you may not know about living with arthritis

It’s National Arthritis Week from 12th – 18th October and I’ve been asked by Arthritis Research UK  to ‘donate’ a blog post to raise awareness about the week. One of the suggestions was to do a Q&A – 10 things you might not know. The thing about arthritis is it isn’t really a universal condition, and affects us all differently, even though there will be things that we share (pain mainly!), so I thought the Q&A was a really good way to highlight this and how it impacts on my own life.

The condition I live with is called: Palindromic Rheumatism. Most people have never heard of it. Some medical professionals haven’t even heard of it. Palindromic means a word that is the same when you read it backwards and forwards. In the case of this type of arthritis, it means that the joint flares come and go. They can be in one joint at a time or many. They can be there for hours, days or even weeks. They can flit from joint to joint with no warning, and sometimes I can wake up with a pain in one joint, and go to bed with a pain in a completely different joint. There is no rhyme or reason to my particular PR. I can’t predict when I’ll flare or when the flare will go.

I was diagnosed aged: 34

How my arthritis most affects my day to day life: Because PR causes pain and fatigue, I have to be careful that when I don’t have any pain or fatigue that I don’t overdo it. Its unpredictability means that I sometimes have to cancel things at the last minute. It’s hard to plan when I don’t know how I’m going to feel. I can have loads of energy and do lots of physical things and brain taxing things. I can also have days when I can’t get out of bed and even formulating a sentence is too taxing on my brain. The one predictable thing about my PR is that it is not predictable. Even when I am not flaring or fatigued, I don’t forget that I have PR because I have to plan and manage my energy carefully. I also have quite a strict regime to help me live better with PR. I eat healthily (no meat, minimum dairy, no gluten at all, not much refined sugar), exercise often (most days of the week I will do SOMETHING), and meditate most days. I probably spend a lot of energy and time looking after my mental and physical health. I was already prone to depression before developing PR. Since developing PR, I am even more likely to sink into depression so the exercise and meditation is as important in keeping me mentally healthy, as physically healthy.

A new hobby / interest I’ve taken up since my diagnosis: The most significant thing I’ve learned or taken up since my diagnosis is learning about mindfulness and meditation. It has helped my mental and physical health enormously, and I use it in my work (teaching it to others), as well as in my daily life. I may not have decided to attend a course about meditation if I had not been trying to learn ways of managing my pain.

What living with arthritis has taught me: Living with arthritis has taught me many things. One of the lessons I’ve learned is to be grateful for the things that I have, and the parts of me that work, and not to spend too much energy on the things I don’t have and the parts of me that don’t work. I’ve also learned to live more in the present, than to spend too much time worrying about the future.

My advice for other people living with arthritis: Arthritis is one word to describe lots of different illnesses and everyone’s experience of it will be different. So my advice would be to spend time finding YOUR best way of living with it, rather than to think there is a ‘one size fits all’ way of staying healthy. Don’t give up trying new things – even if you’ve had it for years – and instead of fighting your arthritis (you probably aren’t going to beat it!), learn to accept and live with it. This isn’t the same as giving up. It’s simply recognising what your limitations are at the time, and making the best of it.

My biggest challenge/triumph has been: I was always so frightened of pain when I was younger. So my biggest challenge has been to learn to live with pain. There are lots of triumphs over the years, but my most recent biggest challenge has been to do a ‘crow’ pose in yoga. I can’t do it every time, and mostly I can only stay there for a few seconds, but this is a huge triumph for me, given that my wrists have been very weak due to the PR and flare a lot. Interestingly, they have flared less often since my yoga practice has intensified.

What gets me through a tough day: Some days are just tough! Recognising that some days are tougher than others and sometimes you just have to be EVEN KINDER to yourself and do whatever it takes to make that day bearable – even if that’s going to bed and crying!

How my friends and family help me: My friends and family help me  ENORMOUSLY by trying to understand, by offering to help when I need it, but not smothering me with help when I don’t.

This National Arthritis Week I’d like to say thank you to: everyone who’s been with me on this journey! That’s too long a list to type up now, but it includes all my friends, my family, my consultant, and my employer! Also, my yoga, zumba and pilates teachers for keeping my mind and body as healthy as they can be.

Arthritis is not just a physical condition

I haven’t blogged since December 2014! How did that happen?!

Mostly, it’s because I’ve been too busy, rather than too ill. I’ve been loving my work at Manchester Mind, though it does keep me pretty occupied and sometimes a bit stressed too. However, the fatigue and flares have been manageable, and I’ve not had to take any time off because of my arthritis so far. I’ve continued to stick to the gluten free diet, though I’m finding staying off the sugar slightly harder to stick to these days. Overall, however, I think I’m doing okay.

I’ve even managed to start trying vigorous and athletic styles of yoga and been shocked and amazed by what my body is actually able to do. I’m building up my upper body strength and even managed a headstand unaided at last week’s class.

So overall, life with PR is pretty positive at the moment.

But what I did want to write a bit about is a new development in my work which I’m pretty excited about.

Living with palindromic rheumatism – or any type of chronic condition – isn’t just as simple as living with the physical symptoms. The flares, the pain, the restrictions and the fatigue also have a psychological and emotional impact and this isn’t often taken as seriously by medical professionals. When the consultant asks how I am, he is interested in how bad my flares are, and whether there’s any joint damage. He’s not generally asking how I am coping with my PR. Coping with the unpredictability, with the chronic pain, the lack of sleep, and the fatigue isn’t always that easy. I think that sometimes the psychological and emotional impact of the condition can be even harder to deal with than just the physical symptoms. A friend with rheumatoid arthritis told me that she wished she was told when she was diagnosed that it wasn’t just a physical illness she had, but a mental illness too, its psychological impact has been so profound at times.

More than once, I’ve phoned the rheumatology nurse, or Arthritis Care Helpline  in tears. It might have been after a disastrous appointment with a consultant who hasn’t taken my symptoms seriously or just during a long flare when I’m at the end of my tether from lack of sleep and constant pain. The early days were particularly stressful and upsetting – when I didn’t know what I had, what to do about it, or what was going to happen to me. I didn’t have any coping skills, and it felt as though no one really ‘got’ what I was going through. It took 8 years before I was even referred to a pain management clinic – by which point I’d already learned the most useful tool I was ever going to learn – meditation and mindfulness.

Life can be stressful enough without a chronic condition, but throw in an unpredictable and little understood invisible illness which causes chronic pain, disability and fatigue, and stress increases massively. I can point to plenty of different stressors. There’s the frustration of not having any effective pain relief when I’m flaring. The stress of the pain and lack of sleep. The disappointment and frustration of having to cancel on friends, or having to take to bed from fatigue. Even people trying to help by offering ‘helpful’ suggestions or commenting “but you don’t look ill” can be a frustration and a stress. There’s also the stress of the financial cost of living with a long-term illness, and in the current economic climate with a whole raft of disability benefits being cut, this is a huge stress for a lot of people.

In the early days, I was often very low, worrying about the future or giving up on certain dreams. Sometimes I still spend a lot of time just wishing I didn’t have this stupid darn condition. Of course, wishing things were different uses up and wastes a lot of energy, and it’s something that happens much less since I discovered mindfulness. But it’s still something that I have to revisit time and time again and work on – the transition from resistance to acceptance. After all, why wouldn’t you wish you didn’t have a lifelong condition that probably wasn’t going to be cured?

One thing that’s been really rewarding for me over the past year is my job for Manchester Mind, which is running a ‘resilience’ course for people with diabetes or heart disease. The course teaches people cognitive behavioural and positive psychology techniques and introduces meditation and relaxation and stress management techniques too. It has really helped some people and I’m really excited because now we’re going to be offering the course to people with arthritis too.

I think this is hugely important. We don’t get taught these skills at school, and unless we are referred to a therapist or counsellor by our GPs, or gone of our own accord (not always affordable for many people), we don’t learn them as adults either. We don’t get taught the importance of relaxing and of deep breathing, and we don’t learn that we don’t have to believe the negative self-talk that can often drag us down into a pit of depression. We don’t learn that accepting pain and illness can be more beneficial to our mental health than trying to resist it. (This doesn’t mean giving up – a longer post is needed to explain this more fully!)

Teaching people these techniques and seeing them learn from each other, and integrate relaxation and meditation into their lives hasn’t just helped them cope with their conditions – it’s helped me with mine. And it’s not a case of such courses or techniques only appealing to a certain, narrow age range. The youngest person I’ve had on the course so far, is 20, the oldest 89. They’ve pretty much all said that they’ve learned something and it’s helped them in one way or another.logo

Thanks to some additional support from Arthritis Research UK, from July Birmingham Mind, and Manchester Mind will be extending the Building a Healthy Future course to anyone with arthritis. It’s completely free. It won’t make your pain or your fatigue disappear, but it will help you cope with all the extra mind stuff that comes along with a diagnosis of arthritis.I’m so happy to be involved and know that my work can help people with diabetes, heart disease and now arthritis too.