Medication 101: Plaquenil/Hydroxychloroquine

I started taking Plaquenil/Hydroxychloroquine in November 2014 after being diagnosed with an autoimmune disease that doesn’t quite fit the criteria for Lupus. So far I haven’t noticed much difference but it can take 3 months for plaquenil to take effect.

Plaquenil is actually an anti malarial medication but is used in autoimmune conditions as a Disease Modifying Anti-Rheumatic Drug [DMARD]. Plaquenil works to reduce the inflammation caused by certain autoimmune conditions [where a person’s immune system attacks their body]. Plaquenil can be used to treat Lupus [both Systemic and Discoid],Connective Tissue Diseases [including Mixed Connective Tissue disease, and Undifferentiated Connective Tissue Disease], Rheumatoid Arthritis and Juvenile Arthritis.

Doses:

The usual dose of Plaquenil is 200-400mg but it has been known to be prescribed in doses as high as 600mg for people with Rheumatoid Arthritis. Plaquenil comes in 200mg tablets and doses of 400mg and over are usually split, taken once in the morning and once in the evening/nighttime.

[Note: Plaquenil is prescribed in much higher doses when used in the treatment for malaria] 

Right now I take 200mg twice a day, with the hopes of reducing this dose in March 2015 if my disease activity is at an adequate level, however Plaquenil is considered relatively safe so I won’t be too concerned if I need to stay on 400mg a day for longer.

Precautions:

Plaquenil is not indicated for use for people who are allergic to hydroxychloroquine, or similar medications [e.g. quinines, and quinones], for people who are pregnant or breastfeeding, or are intending to get pregnant or for people who have retina problems.

Before taking Plaquenil you should have your eyes examined as a baseline assessment, and this examination should be repeated every year that you are on Plaquenil to compare your vision to your baseline assessment. This is because in some cases plaquenil can build up behind your retina causing retina toxicity.

Side Effects:

Side effects that require medical attention [speak to your doctor]:  Allergic reactions [rash, swallowing and/or breathing problems, swelling of eyelids, lips, tongue, face and/or throat], visual changes [blurry vision, changes in the way you see colour, and/or light sensitivity], muscle weakness, muscle cramps, muscle spasms, changes in sensation [e.g. tingling], severe skin reactions [especially where blistering/peeling of skin occurs around mouth, eyes, nose and genitals], high temperatures, bruising more easily, anaemia [possible symptoms include dizziness, pale skin, fatigue, feeling faint, shortness of breath], liver problems [causing jaundice], lower blood glucose levels [feeling shaky, nervous, sweaty], seizures, Psoriasis

Side effects that might not need medical attention if persist for less than a few days [speak to your pharmacist]: Skin rashes, itching, changes in colour of skin inside mouth and nose, hair loss, loss of hair colour/lightening, feeling sick, diarrhoea, loss of appetite, stomach pain, feeling nervous, ringing in ears [tinnitus], headaches

Pros:

+ Considered a mild DMARD as it’s side effects are relatively mild in comparison to other DMARDs

Cons:

- Takes a while to work. People usually notice a reduction in symptoms around the 3 month mark but it can take up to 6 months to take full effect. I have been taking this for about 5 weeks and I haven’t noticed a difference yet but it’s early days… I will keep you updated for when I do]

- There is currently a shortage of Plaquenil in the US [see here]

This is the first of many Plaquenil tablets that I will be taking.... LETS DO THIS!

 

Sources:

A busy, busy week, and some more answers!

I’ve had a crazily busy week this past week with 3 different appointments. On Monday I had to see my GP. I had rang him up 3 weeks ago [it takes 3 weeks to get an appointment with my GP]… I rang him when I was in the middle of a flare, and I was hoping that he would be able to help me out with some pred. However, he was incredibly rude and said that he was unwilling to do anything for me as I have a consultant. He also said that I was going to become disabled because I have an autoimmue disease… I was completely shocked, not only has this doctor just met me 2 minutes ago, and clearly had no idea how to treat my condition, he automatically assumed that I will become disabled despite not being a specialist and then he was unprofessional enough to tell me that I will, not that I might, but that I will become disabled. When he saw the look on my face he added that I’ll only become disabled if my condition doesn’t magically disappear… Anyone with an autoimmune disease will know that they hardly ever disappear, although we know that remissions can happen. My GP, although being brusk and rude, did send an urgent appointment request through to my Rheumy about my joints in the hopes that I could see her earlier than March. And he gave me quite a lot of Naproxen and paracetamol to tide me over the time till I got to see my rheumatologist, and he made sure they were on my repeats. I also found out that my Rheumatologist has diagnosed me with “Autoimmune disease (doesn’t quite fit criteria for Lupus)” so it looks as if she is thinking along the lupus route for my diagnosis… I’m not too sure how I feel about that.

My second appointment was on Wednesday and was with a physiotherapist. We discovered that I don’t have bursitis but I have inflammation of my piriformis muscle. It’s unclear whether I’ve ever had bursitis and if all my symptoms were a result of my piriformis, or whether the intramuscular steroid injection I had back in November has helped. Actually this past week I have been feeling really good, I have had about an hour and a it of morning stiffness but I actually feel quite good so maybe that steroid injection has helped. The physio asked me what I wanted her to do so I have asked for a load of stretches that will hopefully help with all my stiffness, and I am happy with that outcome… She said she will leave her appointment schedule free for me for 8 weeks, meaning that any time in the next 8 weeks that I feel I need an appointment I can ring and she will see me, or if I don’t need to see her then I don’t need to ring which works fine for me.

On Wednesday my Rheumatologist’s office phoned me saying they had got the appointment letter from my GP [that I had seen on Monday] and they asked me to come in to see them on Friday [AKA today]… Talk about efficiency right?! And that leads on to today and today’s Rheumy appointment. My appointment was at 11.30, and I was actually feeling pretty good, which is good but then when you are seeing a Rheumy for a flare which has now passed, it’s not the best timing. I got to see a junior doctor first as my actually rheumatologist is on holiday till January. He did an extremely thorough examination including an examination of my chest. He said that my joints looked good, which I already knew, and I explained that when I had phoned my GP 3 weeks ago, I was flaring. He did find a little bit of fluid in my ankle which surprised me and he found that my heel pain was actually caused by achilles tendonitis. He said that he thought that I might benefit from a steroid injection in my ankle but he wanted the registrar to see be first. I had to sit back out in the waiting room for about 40 minutes, as the registrar was held up on a ward but when I finally did see her it was a really good and informative appointment. She greeted my mum and I and asked my how my SLE (Systemic Lupus Erythematosus, AKA Lupus) at which point my mum freaked out because we both are well aware of what lupus can do to a person, but when we explained that SLE can affect each person differently, Mum seemed to calm down a bit. I explained for a second time that I was mid-flare 3 weeks ago but I was doing very well now except from heel pain. She agreed that I have a little bit of fluid in my ankle but not that much, and I do achilles tendonitis but because I have flat feet she wasn’t sure whether my achilles tendonitis is a mechanical problem or an inflammatory problem… so she has decided to hold off on the steroid injection for now, and she has referred me to podiatry so they can give me more insoles… However, I have already been waring insoles for years so I am not entirely convinced that this tendonitis is mechanical, especially because it came on at the same time my flare started. I am hoping, with crossed fingers, that it is mechanical as we will be able to sort it out easier.

We also discussed my diagnosis, and we were trying to identify exactly what might be going on. She explained that arthritis is a spectrum with a lot of symptoms that overlap into more than one condition but that they try and categorise symptoms into one condition, when perhaps they shouldn’t. She said to me that I don’t quite fit the criteria for lupus, which I already knew from Monday, but that my achilles tendonitis, if it is inflammatory, actually points to Psoriatic Arthritis, and as I already have a family member with Psoriatic arthritis this makes Psoriatic Arthritis a more likely diagnosis… But then the joint distribution of the joints affected in my hands suggest Rheumatoid arthritis but my Rheuamtoid factor and anti-CCP are negative so it’s more likely that I have sero-negative rheumatoid arthritis… So in one appointment I was told that my autoimmune condition has characteristics of Lupus, Psoriatic Arthritis, and Rheumatoid Arthritis, and when you throw in Raynauds [another autoimmune condition I was diagnosed with in November] that can point to Lupus and Rheumatoid Arthritis, which means that I might have a combination of the two… AKA Mixed Connective Tissue disease… So that is a fourth Autoimmune disease that was discussed… Basically we don’t now whats going on, but we do know that I have something autoimmune going on, and we do know that the DMARD I am on, Hydroxycholorquine [Plaquenil], can treat Rheumatoid Arthritis, Lupus and Mixed connective tissue disease so it isn’t too important that we know what the condition is, as long as we can treat it.

I also got my ESR and CRP retested… my bloods last month showed my ESR to be 7 which is well within normal range, however it has increased from 2 which is where it was in May therefore suggesting that I do have a little bit more active inflammation but not an awful lot as some people end up with massively high, but this is subjective to each individual so it’s hard to compare peoples results. I also got baseline x-rays on my hands, feet and ankles which totalled 9 x-rays although I ended up having to have 10 because one didn’t turn out well, but that should do me for a year or so… Overall I have had a really busy week, and I’m really happy with how my rheumatology appointment went, even if it did take 2 hours [from going in till finishing with the x-rays].

Some progress, sort of… and a plan of action

I’ve been officially diagnosed for 3 weeks now and I think I have finally got over the initial shock. I went into that appointment expecting to be told to come back in 6 months because they didn’t know what was going on like usual, but instead I came out with 2 diagnoses of autoimmune conditions, a script for a DMARD [Disease-Modifying Anti-Rheumatic Drug] and an intramuscular steroid injection… That’s a lot to get your head around when you don’t think anything is going to happen.

I just wanted to up date you all on what has been going on with me since then. So first of all, I have noticed my Raynaud’s symptoms are popping up more than they used to… I.e. my hands and feet are constantly cold, and they change colour to this awful shade of white, they feel numb, and then when blood starts to return to them they go bright red and burn… pretty typical Raynaud’s symptoms there. I’m not sure whether I am just noticing these symptoms more because I have a diagnosis now and I am paying closer attention, or if the cold weather is causing more issues? I presume it’s a bit of both, however I have noticed that if I pick up a cold drink, or something out the fridge or freezer, my Raynaud’s symptoms flare, and that never used to happen… I virtually always wear gloves when I am outside now but it’s the activities in normal life that are causing the issue now, not the weather… I am definitely going to bring this up with my Rheumy in March, although I fear there isn’t an awful lot she can do other than offer advice. I have now started pouring my drinks into mugs with handles so my hands aren’t in contact with the cold for that long, and my Rheumy suggested wearing rubber gloves to get things out of the freezer so I will probably start doing that as soon as I get to the shop [life has been pretty hectic these last few weeks].

As for my joints… well they aren’t doing that great. I think I can officially say that the intramuscular steroid injection hasn’t helped, which is a shame but at least I know that it doesn’t help me now so I can [hopefully] avoid being jabbed in the arse again! I’m still experiencing about 2 hours of morning stiffness every day, my knees are swelling, my ankles are swelling, my hip is aching so bad, my PIPs [Proximal Interphalangeal joints… the middle knuckles] are sore, and puffy and turn pink so I think it’s reasonable to say that the steroid hasn’t helped me that much… In fact I am feeling so rough that I rang my GP and I have made an appointment for the 15th to hopefully sort out some symptom relief for over the christmas holidays until I can see my Rheumy, but I am not sure if I am going to manage through this week so I am going to ring my Rheumatologist’s advice line tomorrow and leave a message to see if they have any ideas on what to do. I am at the point where I would take a burst of pred, and I actually think I need one but I had a steroid injected into my butt just 3 weeks ago so I don’t know if you can take oral steroids so close to having an IM injection? I presume so because my old GP was happy to offer me 2 bursts of pred within a month of each other, but that will be something to bring up with my GP and Rheumy. I have also noticed a few new symptoms that have been gradually increasing in severity. The first is that my heels hurt, especially first thing in the morning… I can’t decide if it is actually my achilles tendon that is sore or if it is the attachment of my achilles tendon [AKA enthesitis] or if it’s both, but I am going to try and investigate a bit further into that. And the other is that my SI joints have been hurting, this has happened in the past when I have flared so it does kind of make sense that they are hurting now since I believe that I am flaring but it is really painful this time, more so than last time and it is really stressing me out because I can’t find a comfortable position… but such is life.

In the past I probably would have just dealt with my symptoms, and I am in two minds whether I am making this a bigger deal than it actually is but I am currently on my first physiotherapy placement at my local hospital which involves being on my feet for about 8 hours solidly a day [I usually get between 15 and 30 mins sit down time in that 8 hours] and I am actually really struggling, and some of my seniors have noticed it too and made the odd comment… I was taking part in a Pulmonary Rehab class to learn about what patient’s do in it, and it was obvious to everyone that my joints were far stiffer than everyone else’s despite all the patients being at least 5 decades older than me… slightly embarrassing as you can imagine.

This past week I have been really pushing myself on the exercise front. I have found a fab little gym that is outside and is on the riverside near where I live, and it has a lovely view of all the bridges, it’s really beautiful actually and is one of my favourite places in the world right now… I’ve managed to go to the gym about 3 times last week, and I have been again tonight. I find it really good to give my joints a good work out and it is helping with my joint stiffness, especially because I tend to go after I have been sitting down in a chair for a couple of hours doing work but it hasn’t really helped much with the pain yet… I also invested in a foam roller which hurts like hell but I can really feel it helping with any muscle tightness that I have. I am going to try and keep up this intensity of exercise for as long as I can, and I am going to try and get to the swimming pool at some point this week too [the swimming pool has really odd opening times which makes it difficult for me to go] which will hopefully help with the stiffness. I also see my new Physio on the 17th so I am hoping that she can help me out on reducing the stiffness.

All in all I think I am coping quite well with everything, the side effects from Plaquenil [mainly heartburn which meant I could only have one meal a day for 2 weeks] have subsided significantly, and I am still optimistic that it will start working… It can take up to 3 months and I have only been on it for 3 weeks so I’m not surprised I haven’t noticed any improvement yet… and if worst comes to the worst and Plaquenil isn’t the medication for me, well there are plenty others that I can try, of course I would rather this one work but I’m not going to get too discouraged if it doesn’t. This is the start of my journey into finding the treatment regime that works for me, and I am well aware from my experience with asthma, and from hearing about other people’s journeys that I might have a long way to go till we find the right med/combo of meds for me, but actually being started on meds is a move in the right direction!

It’s official, I have a diagnosis!

I never thought that I would ever be writing this post. Ever. I mean I had thought about it, I had longed for it but I never thought that this would be real. I have a diagnosis guys… I have an actual official diagnosis from my Rheumatologist. I have Raynaud’s and an, as of yet, unidentified autoimmune inflammatory condition. It’s been years and years but I have finally got here.

It’s weird because I was so stressed about getting fobbed off again by my rheumatologist but she came through for me just when I was getting ready to give up on her and try someone else. All of my physio’s have said how good she is at her job, but until today I had never actually seen why people were saying that.

It all started like a normal clinic appointment, i.e. sitting in a waiting room,  surrounded by people who are decades older than me, and as usual I was the youngest patient there. There was quite a lot of medical students hanging around in their pale blue scrubs too, and I have come to the conclusion that this must have been their first experience in Rheumatology based on how clueless they were. I got called in to see my Rheumatologist early [this was unheard of until today… I guess today was a day of firsts] and she asked if 2 of the medical students could sit in on my appointment, which of course was fine. She asked me how I was doing and I told her that I wasn’t the best. I told her about my issues  and how my joints are being problematic on nights out which is preventing me having an enjoyable time. The worst my joints have been was this past Thursday where my knees and ankles swelled up so much, and were causing so much pain that I had to be carried around. Literally, one of the guys on my course had to pick me up and carry me around with him.

This was the main cause of me having to be carried around... My ankle was so swollen you couldn't see my ankle bone any more.
This was the main cause of me having to be carried around… My ankle was so swollen you couldn’t see my ankle bone any more.
This was how swollen my left knee was a few days after Thursday's night out, it had reduced by quite a lot thankfully but was still swollen.
This was how swollen my left knee was a few days after Thursday’s night out, it had reduced by quite a lot thankfully but was still swollen.
Another picture of the swollen knee
It’s slightly easier to see the swelling in my left knee on this picture [right hand side of the picture]

My Rheumy totally understood how embarrassing it was to have to be carried around on a night out, especially by someone who was on the same course as me, which was nice of her. She also asked about my morning stiffness which is now lasting about 2-3 hours every morning and then about 1-2 hours after sitting immobile for any longer than about an hour. She agreed that, that wasn’t fair on me and was too long, which again was nice as she doesn’t usually say anything. She examined my knees and found crepitus [cracking/grinding noises and sensations] in both knees but more so in my left knee which makes sense as my left knee is significantly worse in terms of pain, stiffness and inflammation than my right knee. I also let the two medical students have a feel of my knees although neither of them could find crepitus in my right knee, which we think is because of all the movements they were getting me to do was loosening up my knees so they were less stiff than they were when my Rheumy has examined them. My Rheumy also didn’t find any fluid on my knees which is excellent news, even though I wasn’t expecting there to be any fluid.

My Rheumy then looked at my ankles and again found no fluid but found quite a lot of restriction in the range of movement, although this is nothing new and has been the case for the past few years. However she did notice that my feet were extremely cold, and my toes were “like ice blocks” which I always assumed was normal for me. She asked if my feet ever change colour, which they do into a disgusting looking white/grey/blue colour. She then looked at my hands and found the same, that my fingers are freezing cold and change colour when they get really cold. Based on this I was diagnosed with Raynaud’s, a condition that causes discolouration of fingers and toes because of excessively reduced blood flow to the extremities… Mine occurs usually because of the cold, but we believe that it is autoimmune in my case [not everyone’s Raynaud’s is caused by the immune system attacking it’s self].

My Rheumatologist felt that my joint pain, swelling and morning stiffness had been going on long enough now that we should probably start treatment so I was prescribed Plaquenil [Hyrdroxychloroquine] 200mg twice a day. Plaquenil is a Disease Modifying Anti-Rheumatic drug [DMARD] which should basically reduce the activity of the condition [even though it still hasn’t been identified] and hopefully will help with the inflammation I experience. However, Plaquenil can take up to 12 weeks to work so I was given a steroid shot intramuscually into my bum [yes it was painful!] which should hopefully help out with my symptoms until the Plaquenil kicks in. Apparently the steroid should work within 36 hours which I am really looking forward to, because as I sit here I am really struggling with knee and ankle pain despite Naproxen and paracetamol.

This is the first of many Plaquenil tablets that I will be taking.... LETS DO THIS!
This is the first of many Plaquenil tablets that I will be taking…. LETS DO THIS!

I am struggling to comprehend that I now have a diagnosis, it has been so long that my emotions are literally a mess… Relief, anxiousness, worry, happiness, there are too many to list. I am glad that I have a diagnosis, and I am glad that I am getting the proper treatment, but I am slightly upset that I actually do have an autoimmune condition but that’s expected right? I mean, I always knew that I had something going on, but no one wants to be sick! As you can see, I am still not 100% sure of my emotions, which is perfectly fine, today was a lot to deal with, but the main thing is that we are on the right road now!

I see my Rheumy again in March to see if the Plaquenil is working, fingers crossed it does!

Halloween pranksters – egging

Throughout the lead up to Halloween there was a lot of things popping up on my Facebook feed about The Teal Pumpkin Project, which is essentially an initiative that enables kids [and adults] with food allergies to go trick or treating for non-food treats. All you had to do is paint your pumpkin teal to show that you were offering non-food alternatives to the usual sweets and chocolates and people who were avoiding foods could come to you and know that they could enjoy themselves while being safe. Personally, I think that was a really clever project and it has allowed so many more kids to be included in activities without having to worry about whether they were going to react to the treats they were being given. You guys might find it strange that I am writing about this today when Halloween was on Friday, and in fairness it is strange, but I am not writing this blog to talk about The Teal Pumpkin project. I’m writing this blog to talk about something else, related to Halloween, that is happening more and more commonly nowadays… Egging.

For those of you who don’t know what egging is, you’re lucky! It is basically when someone chucks a raw egg at your house… or even worse, actually at you. Although I have known what egging is for a long, long time I hadn’t actually experienced it myself until Friday. To be honest it sounds rather funny [or hilarious], and I am not even angry that a guy ran up to me and smash an egg on my head [even though it hurt so bad at the time, I thought I had been glassed]. In fact I am grateful it happened to me, because if it had been my friend who was standing right next to me she would have ended up in hospital. Why? Because she is severely allergic to egg.

There is so much awareness about safety when it comes to trick and treating but when the tricks can cause people serious harm then where is the fun in that? Unfortunately people don’t think enough about allergies, and when they aren’t directly affected many people forget that other people DO have allergies. I have come to the conclusion that when drink is involved people become selfish and are willing to ruin people’s nights out by egging them and they don’t think about the consequences at all, all they think about is how to look “cool” in front of their friends, and how to have a good time… Although I can’t see how egging someone is entertaining.

I understand that people do get pranked on Halloween but in the future I really hope that people will try to have fun in a way that doesn’t put other people in danger. You can’t tell if someone has an allergy, it’s an invisible illness! Please don’t assume that other people don’t have an allergy, just because you don’t have one yourself.

 

Do you know what inhaler you are on?

I have just been reading a blog post on Asth.ma [a blog by an Asthma Researcher at Harvard] about how a lot of people don’t know the names or doses of their inhalers whereas they often know the names of the other medications that they take e.g. Enbrel, or Methotrexate. And it has really got me thinking about 3 conversations I have had in the past couple of weeks.

A few days after I had moved up to uni I found out that one of my flatmates has asthma, and being naturally inquisitive I asked her if she was on any sort of preventer inhalers, to which she replied that she was on the purple one… I knew she meant Seretide/Advair and I didn’t really think that much of it because so many people know their inhalers by colour rather than by their actual name that I wasn’t that concerned. I wasn’t even that concerned when I found out that she didn’t even know the dose of her inhaler, but I could see just by looking at it that she was on the 125/25 Seretide inhaler. The next week I had 2 similar conversations with two other people from uni, both of which had asthma severe enough to be on an inhaler corticosteroid combined with a LABA [Long acting beta antagonist]. One girl identified her inhaler as being red and white – meaning that she took Symbicort, but she didn’t know if she was on the 100/6, 200/6 or 400/12 dose, and the other said that her preventer inhaler began with an “R”… We later identified her inhaler as the new Relvar Ellipta inhaler using google.

At the time I didn’t think that much of it, but if either one of these 3 people has any sort of emergency or ends up in a situation where they need to identify their inhalers they are going to have a really tough time. 2 of them didn’t even understand why they were moved off of Clenil [AKA the brown inhaler] and onto an inhaler containing both an corticosteroid and LABA… They both said that their doctors/asthma nurses had said they need to take something stronger but hadn’t gone into any detail about what the “something stronger” was. Am I the only one who finds this remotely worrying? Absolutely not, and the point was well highlighted by Dr. Wu.

Personally, in addition to my Ventolin, I almost always carry my asthma medication card in my wallet/purse [anyone can order a card from the Asthma UK website, here] which, gives details on all of my asthma medications. This including the name of my medications, the dosage, how much I take, when I take it and there is also a column for extra information… For example, since I have been prescribed both the 125/5 and 50/5 doses of Flutiform, I have written that I would take the 125/5 if I am yellow zoning, and I have written these zones in too. This means that although I know what medication I take, by name, if I was ever in a situation that meant that I could not talk then health care professionals do not need to mess about trying to find what medications I am on. This also helps when I see my GP or asthma nurse because we are able to discuss medications in full rather than getting confused with all the different colours…

[Note: I do admit to using the colours to identify inhalers in some situations but this is purely to help people understand which inhalers I am talking about, and I would not do this unless I thought necessary to aid understanding]

Freshers’ flu

So I am heading into my third week at uni and so far it has been a blast. I have made new friends, and [thankfully] I have settled in really well. I am quite lucky in the fact that I have always been very independent and I was ready to move out, so this transition, though scary as it was to begin with, has actually been really good for me.

I have been going out a lot with my flatmates and other people on my course, and it has been excellent fun, although it has been very tiring, especially for someone with [self diagnosed] insomnia because I can’t sleep during the day unless I am ill, and I wake up early on a morning so my average hourly sleep was about 4 hours during the first week of uni… Thankfully now it has increased to about 5 or 6 so I am not constantly knackered. However, the lack of sleep in addition to mixing with new people, living with new people, and partying a lot made me more vulnerable to illness and I have ended up coming down with what only can be described as, the dreaded, Freshers’ flu…

It all started last Saturday when I was feeling a little bit off, and I didn’t really want to talk to anyone or to eat anything. I kept getting spells of being boiling hot then freezing cold… but I decided that I would be fine and I went out that night anyway. BIG MISTAKE… Those of you who know me, will know the details of the events that night but for those who don’t, lets just say that you should try to think rationally, and be responsible even when you are drunk. I did a stupid thing that night that very nearly put me in hospital and it ended up with my asthma control being chucked out the window. Every since then I have been fighting to get my asthma under control: bumping up my Flutiform to 3 puffs twice a day, then up to 4 puffs twice a day [so I was essentially taking the equivalent of 20 puffs on the brown Clenil inhaler]… and I was still needing quite a lot of Ventolin throughout the day. Being the person that I am, I figured that I could cope with it and that I would be fine after a couple of days, which I was also wrong about. I had a constant temperature from Saturday through to Tuesday, my asthma just didn’t get better [but it didn’t get worse either, thankfully] and my usual asthma cough became a lot deeper and very productive… essentially I developed a chest infection.

I am registered with a new doctor up here, but I didn’t think I was bad enough to go and see what they said because I have had things like this before and I have always gotten over them after a few days. I spoke to my Mum and she agreed that I should wait and see what happens. Well it got worse, thats what happened. I woke up at about 3am on Tuesday feeling sick to my stomach and wheezing up a storm. I was incredibly short of breath and coughing up massive amounts of disgusting stuff [sorry if that was TMI] and my chest was really tight. I was feeling so ill that I couldn’t even stand up and I had to crawl to the bathroom, which thankfully is only a metre or two away from my bed. When you feel that ill and you have a temperature it is very difficult to think clearly and it is also very difficult to stay calm… my initial thought was that I needed an ambulance, but then I thought that I was so out of breath I probably wouldn’t be able to speak down the phone, so my next thought was that I needed my inhaler… Thinking back, I don’t think I was ill enough to need an ambulance, especially as I hadn’t actually tried my inhaler and in pure panic had crawled straight to the bathroom… My inhaler did work after quite a few hits, I stopped counting after 10 but it was definitely under 20 puffs total and my lungs were responding. Then I thought that I should tell my Mum to come and pick me up and we could go to urgent care to get some antibiotics, but then I figured that since I was breathing a lot easier I could wait until the morning as I didn’t think that Mum would appreciate the wake-up call… but thinking back, that was probably a bad idea as no one knew that I was feeling so ill. Somewhere in that situation I briefly thought of crawling down the corridor to wake up my flatmates so they could get help… but I decided against that too. However, if this ever happens again [and this is advice to all of my readers too] I definitely suggest that you let someone know, because things might not turn out so well… And generally when you are thinking you need an ambulance, you do need one.In the UK there is a service that allows you to text the emergency services if you are in a situation where you find you cannot speak for one reason or another, however you do have to register your phone first before you do this. [PLEASE SEE HERE FOR DETAILS]. I am actually kicking myself looking back because I should have told someone but my brain doesn’t work that well when I have a temperature and so I didn’t think clearly about what could happen.

It’s over a week since I first got sick and I am improving dramatically… The secretions in my chest are a lot thinner and easier to move when I cough although, I am still coughing more that I would like to, my wheezing has been at a minimal for the last couple of days, I am sleeping a lot better, my temperature has been normal for quite a while now except from a little episode yesterday. On the whole I am feeling significantly better, but I would not like to repeat any of that again.