Tag Archives: rheumy

Methotrexate madness

Wow, so my last post was almost a year ago… How has time gone so quickly?!

I’ve been seen in my Rheumatology clinic twice since last September and a lot has changed! I feel like it is time for an update.

Back in February I saw the rheumatology registrar who confirmed that I have a type of inflammatory arthritis, but was unable to determine the exact type of arthritis. Back then my arthritis was causing me a lot of problems. My SI joints had really started kicking off at the end of 2015, and I actually spent New Year’s Day unable to walk because I had gone on a night out for New Year’s Eve and over did it. Since then, my back hasn’t improved. By the time I saw the Rheumy reg, in Feb, my SI joints, costochondritis, fingers, toes, ankle, knee and my ligaments and tendons were all flaring. I wasn’t in a great way, thats for sure. We decided to step up my treatment plan by adding in Methotrexate (MTX) – an immunosuppressant.

As I had a chest infection and was on antibiotics at the time of my appointment meaning I couldn’t start MTX until I had been off antibiotics for at least a week. I didn’t start MTX until the start of March. I started on a really low dose of 7.5mg which equated to 3 tablets once a week. After 2 weeks I increased my dose to 10mg once a week, or 4 tablets. With MTX you always have to take folic acid to counteract some of the side effect of MTX so I was started on these too… But even with the folic acid the side effects were horrendous. I had nausea 4-5 days a week, I could only eat one meal a day and on top of that, I still had loads of joint pain, stiffness and inflammation.

MTX requires quite close monitoring as it can affect a lot of different organs, especially the liver and lungs. I have been having bloods about every 2-3 weeks since February to ensure my liver was functioning okay but also to check my kidney function and full blood count to make sure my white blood count did not drop too low and so far so good! Everything is just about in range, but there is nothing too out of range to worry about. A rare side effect of MTX is pulmonary fibrosis, which tends to present with a dry cough and shortness of breath. As a precaution, the reg decided it would be best to send me for a chest x-ray and pulmonary function tests to establish my baseline lung function for if there were any issues – but again everything looked fine!!

MTX can take about 12 weeks to kick in, and by week 14 or 15 on 10mg it was clear that my joints weren’t responding enough. I phoned the rheumatology helpline and explained what was happening to the nurses. They spoke to my consultant who increased my MTX to 15mg (6 tablets) but kept my folic acid the same as before. The nausea was way worse on 15mg: I dreaded MTX day, I dreaded eating, I lost more weight. Things were just not fun.

After being on 15mg tablets for about 8 weeks I made the decision to switch to injections. With injections you can sometimes reduce your dose by 30-40% because that is equivalent to how much absorb with the tablets so I switched to 10mg injections via the Metoject pen and so far things are a lot better in terms of side effects. I’ve had 2 doses of the injections so far and although I still have hardly any appetite, I can eat without nausea. I also got an intramuscular steroid injection because my SI joints and hip were making walking without an aid difficult, my costochondritis meant that taking a deep breath was virtually impossible and my shoulder (a new joint that kicked up a fuss from March onwards) was pure agony. The steroids took the edge off everything but my back and chest are still sore, just less sore.

I think that brings us up to speed to this week! Yesterday I saw my consultant rheumatologist who was amazing. My nurses had briefed my consultant on what had been going on before my appointment.When I was called in, before I had even said anything my consultant said this:

“Your arthritis is not controlled. We need to treat this more aggressively, but not over-treat at the same time. It’s a balance, but I would prefer to be more aggressive now because it’s easier to reduce meds than never get full control”

I am so glad that we are taking a more proactive approach, it’s scary that there are medications out there that I wouldn’t be able to access unless my rheumatologist was taking a more aggressive approach.

Once I had updated my consultant on things from my point of view, she suggested 3 options:

  1. Increase MTX
  2. Keep MTX the same but add a third DMARD
  3. Do both

We decided to just increase MTX since I had just had a steroid injection and we had’t given the last increase enough time to become effective, but at the same time we couldn’t do nothing. Starting tomorrow I will be on 15mg MTX injections and I will also be learning to self-inject. I also have open access to my consultant for the next 6 months when my next follow-up appointment will be, so if things don’t settle I can go back and see her with an emergency appointment.

My consultant also confirmed that my arthritis is seronegative because my rheumatoid factor is negative, and that spinal involvement is common with seronegative arthritis. We are now treating my condition aggressively rather than watchful waiting to see if lower doses will help. I feel like this is the turning point, where we will hopefully manage to get full control over my arthritis, or at least it gives us the best shot of getting full control!

#RABlog Week Day 3 – How my condition affects me

The third prompt for #RABlog Week is “Explain your RA”. Technically I do not have RA, I have another joint condition caused by my immune system attacking my joints that hasn’t yet been identified. I can’t explain what exactly is going on because I don’t know that myself but I can explain to you how my condition affects me, and how it makes me feel.

When I was diagnosed back in November I wasn’t ready for a diagnosis. I had gone for 7 and a half years with everyone telling me that they believed my pain but no one could tell me what was going on. I remember asking my Rheumatologist in despiration if she has ANY idea what was going on… her answer was “It might be autoimmune, it might not be. I do not know what is going on with you”. That was what I was told when I was 14. I wanted to cry, I was so frustrated at my body, at being sore all the time. I found it hard to explain what was going on to people because I didn’t have a diagnosis so I felt as if I was a fraud. Other people would go to the physiotherapist because of a sports injury and they knew how to treat it, I would go and they would say that they would try a treatment… but when it didn’t work I would get passed to a different physiotherapist. I saw 6 different physiotherapists in the space of 5 years. That is a lot of physiotherapy, and it is a lot of specialists who couldn’t help me, even though they truly believed I was telling the truth. They would all look at me with really sad eyes and tell me that they were sorry they couldn’t help, and that I should see my rheumatologist again. And every time that happened, any hope that I had built up was gone again and I felt really alone.

I felt that people would stop believing me because I didn’t have an answer for what was going on, and apparently no one else did either. So when my Rheumatologist turned around to me and said “I think you have an autoimmune condition, I want to start on you Hydroxychloroquine” I didn’t know whether to cry with happiness because I finally had an answer or to cry because I had found out that what I was hoping wasn’t true, was true.

As I said before, we haven’t quite narrowed down what condition I have. There is speculation that I could have Lupus or Mixed Connective Tissue Disease… or I could have Psoriatic Arthritis or Seronegative RA. We haven’t worked it out yet. I personally believe that I could have something similar to Psoriatic Arthritis or Seronegative RA due to my negative test results and the inflammation in my ligaments and tendons… and more recently, the whole finger that swelled up for 5/6 days for no reason [AKA dactylitis, although I need to get that confirmed by my rheumatologist]. I am lucky that I am studying physiotherapy so my lecturers understand what sort of problems I may have at uni but the problem with not having a name for my condition means that I can’t tell them straight out what I have and then have to explain the whole “I’ve been diagnosed but they haven’t said what it is yet… because I am a mystery to my rheumatologist”.

Of course all that emotional stuff stems from how my condition affects me physically, and also partly on how other people treat me because of my condition. If you look at me you cannot tell that I have a joint condition. If you had a line up and you had to choose someone who you thought was chronically ill, I very much doubt you would choose me. I look healthy… and to some extent I class myself as healthy but if you read my medical file you would probably picture someone who is unhealthy. I want to quote some things that my rheumatologist has written about our meeting and I want you to try to think about what a person with these ailments would look like.

“Lumbar sacral spine movements were grossly restricted”

“… restriction of plantar flexion subtalar movements and mid foot movements” [AKA restricted movements in my feet and ankles]

Morning stiffness remains a significant problem and can last between 1 and 3 hours”

“…feels extremely tired”

“… grossly restricted movements in neck and back”

If I saw a description of this written down I would expect to see someone who probably wouldn’t be very active, and probably wouldn’t be able to move very well because of all the stiffness. However, that is not the case. I am active, I can run, I can jump… Some of the time that is. And this is the thing with chronic invisible illnesses of an autoimmune nature, sometimes you can feel really good and the next day, or even the next hour, you can feel absolutely horrendous.

There have been times that I have used a disabled toilet because of the fear that I wouldn’t be able to get up off of a normal toilet without handrails. There have been times where I have sat in the disabled seat on buses because my joints couldn’t cope with me standing any longer. There have been times where I have been physically sick from pain. There are days where I can’t write, or when I find it hard to type. What I want people to learn from this is that living with an illness is very unpredictable and you have little control over which days you feel great and which days you don’t. I deal with pain, swelling, stiffness and inflammation every single day and yet some days I can still be “normal” whatever normal is. The point is that you cannot see my suffering so just because I don’t tell you that I am sore doesn’t mean that I am pain-free. Please remember that your sister, brother, parent, friend, relative, colleague… who ever you know with RA/Autoimmine arthritis, will most likely be sore every day and have symptoms every day. Just because you can’t see them, doesn’t mean that they aren’t having problems. If they are doing things slightly differently to normal then this is probably them compensating for said symptoms in a functional way… they might even ask you for help. Don’t make a big deal of it, just help them. Don’t treat them any different to normal, they are the same person they have always been. They do not need to feel more isolated by their illness because you feel the need to make a big song and dance about what they can/can’t do or what they may/may not need help with.

Time for a new Rheumatologist

A while back someone posted on one of the support groups I am a member of asked for people to take pictures of themselves holding a sign with a message they would like to give doctors so that they know how we feel. My sign had a message which said that just because my problem may seem small to you [i.e. the doctors], doesn’t mean it is small for me. When I wrote that I was thinking about my experience with my rheumatologist. She sees people who are really really sick and she also sees me. I am not that sick at all. My condition is not life threatening nor has it caused huge problems for me in the past. But the problems it does cause me feel like a big deal to me and when doctors do not take these things seriously it feels like you are being ignored. It feels like the problems you’ve come to them for are invalidated.

As a future medical professional myself I never compare people’s conditions. Just because one patient is sicker than another doesn’t mean that they can be made to feel that their condition isn’t a big deal. I also try to put myself in the patient’s position and think to myself, “if I was this patient, with this problem, what might I be feeling?” and based on that I try my best to treat them accordingly.

Yesterday I had my 3rd review since starting Plaquenil/Hydroxychloroquine in November 2014. I expected my rheumatologist to be engaged, to ask questions and to do a physical exam but instead I found her to be disinterested, unwilling to ask questions and unable and/or unwilling to answer my questions. The only examination that she did was on my ankles as these have been causing the most problems. I explained that my wrists were sore. Her response was to say “okay”, she didn’t look at my wrists or ask any more about them. I asked her about my hair falling out and all she could tell me was that it might be my autoimmune condition but she didn’t look at my hair. I came out of that appointment feeling totally invalidated, she knows I have pain and she doesn’t doubt that but by not examining me and not letting me know what she is thinking she makes me feel as if she doesn’t care.

I felt as if I couldn’t tell her everything that was going on because she didn’t care. I felt as if I was bugging her more than being her patient so I didn’t ask about things I was intending to ask about which was daft because I had waited four months for this appointment but when you are facing someone who you feel doesn’t care what you are saying or seems completely uninterested, it is hard to go into the things that you want to discuss. It’s easier to just leave them.

This appointment has had a few outcomes:

  1. My ANA is now negative where it was positive before… but we don’t know what this means or what has caused it [although I believe it was the Hydroxychloroquine]
  2. The MRI of my ankle came back clear but it is going to get reviewed by a specialist to double check, and if it is clear I will get referred to physiotherapy [which is what I requested]
  3. My Rheumatologist didn’t say anything about the Hydroxychloroquine so I am going to continue it at 400mg as I was prescribed until someone tells me otherwise
  4. I can try OTC topical NSAID gel to see if that helps on top of the Naproxen and paracetamol – I have since bought Voltarol
  5. I need to get a new Rheumatologist – as suggested by many, many people throughout social media

It has been a day since my appointment and I still feel quite upset about all of this. I have been with this rheumatologist since I was 14 or 15 and she has always believed me, though is never able to give me many answers. She doesn’t seem to care that much about my case and makes me feel invalidated. But if I go to another Rheumatologist [who will be an adult Rheumatologist, not an adolescent Rheumatologist] they might not take me seriously either or even worse, might not believe me. I have so many emotions flying around, my head feels like a bit of a mess but I have decided that it would be best to ask for a referral to another Rheumatologist. Hopefully this new Rheumatologist will be closer to my University than this one was.

A review of today’s appointments

I have a lot to update you guys on! Today has been hectic!

It started off with a rheumatology appointment at 9.30. I was super nervous about this appointment because I didn’t feel that my joints were as controlled as I would have liked even though my morning stiffness had improved and I am able to exercise now [I am training for a 5K 3 times a week, and I swim twice a week] as my joints still hurt and swell, I still have bilateral achilles tendonitis, both my MCL and LCL in my knees are still playing up and I am absolutely knackered. I was worried that my Rheumy would suggest an immunosuppressant [AKA methotrexate or azathioprine] and I was worried about the implications of this on my course and placement as I will be on an infectious disease ward on placement… but thankfully things have turned out for the better and right now I do not need to go on any sort of immunosuppressive therapies [although I was warned that this could change]. I don’t even need to change medications! I had struggled with fluid in my left knee throughout February but thankfully taking Naproxen twice a day [rather than as needed] every day has sorted that and I am happy to report that my rheumatologist found no inflammation or fluid in any of my joints!!! *Cue the happy dance* I also found out that I don’t have any inflammatory markers or auto-antibodies in my blood! First time in 5 years I haven’t had antibodies in my blood guys! This is big!!!

However, we did find that I have lost a significant amount of movement in my right ankle and I have experiences catching/locking in that ankle so the plan for now is to stay on Naproxen and Plaquenil/Hydroxychloroquine at the same dose [400mg a day] for another 4 months, get an MRI on my ankle to see if it is a mechanical or inflammatory issue, continue with my achilles tendonitis exercises, get bloods done and follow up in 4 months.

The nurse I had today was absolutely brilliant, I only had 5 tubes of blood taken today and the nurse remembered me as the girl who usually gets 8 taken… I feel that I must have a bit of a reputation. We had some great banter together, and swapped some funny patient stories about what we experienced on placement, or in her case, in work. I feel that people like her really make your day. My rheumatology clinic can be really depressing, no one wants to be there and you can feel the dread hanging in the air as you sit there surrounded by [mainly] elderly people, or worried parents of younger children/teenagers, but as soon as this nurse walks into the room it really lifts the atmosphere and lets everyone have a little chuckle… Things like that are important.

Me and mum then had to rush up to my university accommodation [about 50 miles from the hospital] so that she could get back down to go to work… and the road was full of lorry’s so that delayed our progress because a lot of them thought they were powerful enough to overtake each other, when they really weren’t. But I got up here in plenty of time to make my asthma annual review.

This was my 3rd asthma annual review… that’s crazy right? I got diagnosed nearly 3 years ago, it really doesn’t seem that long. This is my first asthma review since I moved to university and it was my first asthma review with my new asthma nurse, in fact it was the first time I have met my new asthma nurse so I was quite nervous. But I shouldn’t have been, the appointment went very well. I explained that I felt that I am well controlled [with the exception of a little episode the other week, as a result of having a drink with ice in it] but my big problem is exercise. I find that exercise sets my asthma off quite a lot and I feel that it is preventing me from getting to my full potential during exercise. So we discussed my treatment options, I am already on a combination inhaler so I am to increase that on days that I exercise [although she didn’t tell me how much to increase it by… I’ll probably take an extra puff on the morning and night], I can also pre-medicate with more Ventolin than I do already… She also phoned the GP in my practice who specialises in asthma who advised that I should have a trial of Singulair [AKA Montelukast], so I have to pick up my prescription tomorrow and try it for a month. And then I have to see my asthma nurse in April to see how I am getting on. My asthma nurse prescribed the brand of Singulair rather than the generic, Montelukast, which turns out has to be ordered in [I checked at 3 pharmacies] because it is 14 times more expensive than the generic… If this works I hope she will start prescribing the generic because it is crazy expensive! We aren’t sure if Singulair will help me because I do not have allergic asthma but we decided that if we don’t try it then we will never know, and if it does help, then it was an easy fix.

Every asthma review I’ve had has resulted in a load of follow-up appointments and changes to treatment plans so I am hoping that this won’t end up getting too complicated. I just want to be able to exercise when I want without worrying about having to plan it out with increases in meds on certain days and not on others… Is that too much to ask? Apparently it is… although if it works then I will take it. I have a feeling that we may end up increasing my Flutiform to the 250/10 inhaler in the future if this doesn’t work because I am exercising about 5 days a week now so I will have an increased inhaler dosage for 5 out of 7 days every week… It might just be easier, and cheaper, to have an inhaler with a higher dosage, but we shall cross that bridge when, and if, we come to it.

Right now I am super aware of how many prescriptions I have, I am currently up to 5 [or 6 if you include paracetamol] because it isn’t only going to cost me a lot as soon as I turn 19 [even with a pre-payment certificate] but it is costing the NHS a huge amount too… It’s a shame there isn’t an easy fix out there right now. Of course, I can exercise inside when it is cold but that only helps so much, I still get symptoms… and it probably won’t be any easier in the summer since humidity sets me off too. It’s annoying that the point I get to a point where my joints will allow me to exercise, my asthma kicks up a fuss!

Secondary school and chronic illness

When I was at secondary school (ages 11-16) I was incredibly lucky when it came to my joints. I was very close to my PE teachers, and while I didn’t always tell them that I was having a rough time they usually knew and would ask if I needed to sit out. In fact I actually only asked to sit out once because of my joints, every other time they asked me. And more often than not I refused because I loved sports so much I would have rather suffered than sat out. I also used to feel that because I didn’t have a diagnosis that I couldn’t sit out even though it was never really like that at all.

I remember taking a lot of trips to the nurses office in the early days when my fingers hurt too much to write. We didn’t know what I had or why they were sore so she would tape them up to try and give them support while I was writing, and then I would spend the rest of the day trying to hide them from my classmates and teachers so I wouldn’t have to answer questions about it.

When I was in year 9 or 10 I took up the Saxophone which I loved. I couldn’t read music but I could play by ear when my teacher played the piece to me. However, as usual, bad joints decided to interfere and there were some days I couldn’t play because my fingers and wrists were too sore. We changed my lessons to the afternoon/late morning so it would be easier on my joints. I was also a member of the orchestra and some practices I couldn’t play, so I would sit at the back and listen. I usually just told the teacher I wasn’t feeling well but one day I decided to explain what was going on with my joints. It turned out my music teacher had Juvenile Arthritis and totally understood what was going on, and how my joints felt. 

As you can see my secondary school experience was one of support when it came to my joints. There are so many people out there who have to fight their school tooth and nail just to get some small accomodations. I’ve heard of children being made to stand up for hours because the lesson demanded that they should be standing. I’ve heard of parents having to come to school every 3 hours to give their kids eye drops because their disease is attackig their eyes and the school doesn’t want to do the eye drops. I’ve heard of kids being forced to take part in physical education because the school doesn’t understand that kids get arthritis… Probably the most severe issues I’ve heard about is parents sending their sick kids into schools, exposing immunosuppressed kids to the sicknesses that can make them incredibly ill. 

And then of course is the issue of being absent from school. My school was okay with me missing lessons for appointments, especially because I was hardly ever off sick. However for many kids that wasn’t the reality and the school couldn’t understand that sometimes kids with JA/autoimmune joint conditions couldn’t get I to school on time, or at all. And that these kids have a serious medical condition that requires the attention of medical professions, many of whom only have appointments during school time.

Rough day? Tell me about it!

I’ve had a bit of a rough day today. I woke up feeling slightly more stiff and achier than usual… I had slept in a funny position and because my elbows were so stiff it was really hard to get out of bed. Trust me, unless you have some joint/muscle issues going on it really isn’t easy to just roll out of bed in the morning. I usually take a catalogue of things that hurt when I first wake up, today totalled a good 27 joints! That’s crazy! And then when I stand up I re-caculate to see if weight baring is adding anything into the pile… Only the ligaments in my knees and achilles tendons were added. So this mornings total was 27 joints hurt/are stiff and 4 joints are noticeably swollen.

Thankfully as the day went on the joints that hurt/were stiff reduced down to 7… I guess that means that the combination of Naproxen and Paracetamol every 4 hours is good for me.

I then had to go to Uni… I only had 2 lecturers and both of them were only 1 hour each. Normally if my lecture is over an hour long I get really stiff but if they are only an hour long I can usually get away with not being horrendously stiff at the end, although today was rough. I had made the mistake of sitting nearer the back of the room which involves more steps than sitting at the front of the room and I ended up practically waddling down the steps to get out of the room… and then some genius had decided that it would be a good idea to put my lecture room at the bottom of a flight of stairs, so more waddling ensued.

After uni I had to get 3 buses [totalling 1.5 hours] to get the the hospital for my first podiatrist appointment [she specialises in rheumatology]. The journey was really rough, joints seized up again and the bus practically broke down every time we had to go up a hill… It’s not a good sign when you are only doing 20mph on a motorway and really heavy lorrys towing massive JCB diggers can overtake you with ease. Anyway I finally made it to the hospital and got taken 30 minutes early [BONUS!!!] although the waiting room consisted on 3 hard, uncomfortable, plastic chairs so I was really glad to be taken early. The podiatrist told me that she could still feel swelling in both my achilles tendons with my left being the worst, which is odd since my right ankle is actually the most painful. She also gave me some exercises and showed me how to massage the fluid away, and checked my insoles which are doing the job fine. I go back to see her on the 8th of April to see how I am getting on. I asked her if she thought this was autoimmune related or if she figured it was from overuse/flatfoottedness but she said that she was almost 100% it is autoimmune as it is in both feet, and it came on during a flare, and I have had insoles for years which appear to be doing their job correctly. I’m hoping the swelling will be down by April because I am not sure what they will suggest next. Thankfully I see my rheumatologist in March so I will be able to report back that the podiatrist believes this is autoimmune rather than mechanical.

So that appointment only took about 10-15 mins and then I was back on the road on a bus headed towards the bus station where I had to swap buses. I had a 45 minute wait at the bus station which wasn’t too bad but wasn’t the best. I don’t know why but I always seem to attract drama! I was sitting on the bench waiting for my bus and all of a sudden there was this overwhelming smell of weed [anyone who has smelt it will know what I mean], I looked around and there was a guy half hanging onto a railing smoking a joint, completely stoned. Past experience has told me not to bother a person when they are stoned unless you know they won’t kick off at you so I left the guy be until he had finished and asked him if was okay, he looked at me said he needed help and then collapsed… Seriously! [I told you I attracted drama]. So basically all my old first aid training kicked in, there was no danger so I shouted for help… there was loads of people around but I still had to shout twice before someone decided to come over and help and it was actually a girl who was my age, all of the adults just stared [thats the by-stander effect for you, look it up]. I asked her to phone an ambulance and sent another guy to find security. Thankfully the guy fell in the recovery position so I didn’t actually have to do all that much to help him other than keep him comfortable and get as much information out of him as I could. I am almost 100% certain that this guy collapsed because of the weed, but he did manage to tell me that he had a blood clot somewhere in his body which could possibly have explained the collapse. In this time, I managed to miss my bus so I had to wait another hour! And then I had the bus ride from hell, with 2 children who just wouldn’t pipe down… I understand it is a long way for small kids to travel on public transport and I was patient with them but when a kid wipes their spit on my face I am not happy about it… I felt sorry for their poor granny who was trying to keep them under control.

So now I am back home and I have finally had something to eat, and I am relaxing, watching some netflix but man to day has been rough on my joints… they are so achy and swollen… and apparently my achilles tendons want to join in properly rather just being the nagging pain I’ve had for the last month… fun times guys.

Knee bother and University

I have fluid on my left knee… That is not a good sign at all. Thankfully it isn’t too swollen or too painful and one of the benefits of doing Physiotherapy as a degree is that I have access to professional physiotherapists, some of whom have worked in the field of Rheumatology, and who can give me advice. BUT… and it is a big but, I need to feel comfortable about sharing my condition with the people I work with. I have a massive internal battle going on about how professional it is to share my health with my teachers, and although sometimes it is unavoidable, I really do try to keep my condition as separate from my working life as I can.

Only 2 of my lecturers know about my condition, and both times it took real guts to tell them. I am so used to hiding my condition from people, and avoiding talking about it. I am really good at shutting down questions if I don’t want to talk about it, and although I am always happy to answer questions about my condition to raise awareness, I always try to give a general answer rather than using what has happened to me as an example [although this predominately happens when I am talking to someone face to face, I am good at sharing things when I don’t have to see a person’s reaction, and I am also good at talking about issues with people who are going through the same things I am]… For instance I might tell of how people I know have faced some difficulties rather than saying exactly what I have been dealing with. However, since I have gauged the reactions of people as generally supportive I think that I might start coming out of my shell a bit when people ask me questions face to face.

The first lecturer I told happens to be the Head of the Physio department at my uni and was incredibly supportive. She told me that as long as I felt that I could cope with what was going on, she was totally fine with it. And as soon as I feel that I am not coping so well, that I should come and speak to her and we will get occupational health involved. She also told me to keep her informed about what is going on and she was genuinely caring towards me.  The second lecturer found out kind of by accident. As you all know I have had issues with the ligaments in my knees for well over a year now , approaching the year and a half mark, and I still haven’t had many answers about it. I still didn’t know if it was related to my autoimmune condition [although we have suspected it was]. We were doing a practical session on the knee and so I figured I would ask whether he knew what it was, and any exercises/stretches I could do to help them. Again, he was totally understanding and listened to me explain how I have no idea what happened but the ligaments [LCL and MCL] in my knees have been sore for well over a year and did he know anything that could help. The first thing that he asked me what if I have autoimmune arthritis, or a family history of RA… That hit me like a brick, I wasn’t expecting anything like that. He pretty much hit the nail on the head within 30 seconds of me asking the question… something that every other health care professional I have seen over the last 8 YEARS have only just been able to figure out. I explained to him about my diagnosis, and told him about the morning stiffness, which on that particular day was 3 hours, and asked that because it was most likely autoimmune related was there nothing we could do to treat it… My lecturer was then nice enough to give me a good 30 minutes of his time and explain all the different exercises that I could do to help different muscle groups in my upper legs so that we can reduce any patella mal-tracking and basically increase the strength of the muscles in my legs to try and reduce any problems I might get in the future. The only problem is that I haven’t been able to do the most beneficial exercises on my left leg because of my knee…

Which brings us back to the fluid on my knee. As part of the assessment that we were taught to do on knees we had to learn how to test for fluid on the knee… usually done by 2 special tests, one called the patella tap [where you brush the fluid down from the upper leg into the knee and tap on the patella, if the patella bounces back up then there is fluid in the knee, if not it means that the patella is resting against the femur where it should be] and the bulge sign, where you brush the fluid away from the inside of the knee then brush down the outside of the knee and if you see a bulge appear on the inside of the knee then there is fluid on the knee. [Note: there are other special tests but these are the ones we mainly focused on]. When we were practicing these in class mine were negative… no fluid in the knees! However the other day when we were practicing them for out exam, my right knee was negative [wooo!!!] but the poor left knee was positive… I had a positive patella tap in my knee [Note: we didn’t try the bulge test]. We repeated this a few times to check but it was definitely positive. On the bright side, at least I know what a positive patella tap looks like.

On Monday I will have been taking Plaquenil [AKA Hydroxychloroquine] for 13 weeks, I was told it should be working by the 12th week but that hasn’t really happened. My morning stiffness is bouncing around all over the place, from as little as 1 hour, all the way up to 6 hours… And I am getting stiff when I am sitting down too long. Most of my lecturers are 2 hours long and I can’t stay sitting for that long, it’s too painful. I have taken to leaving the lecture once an hour to “go to the toilet”, in other words to stretch my legs… but that means that I have to try and sit at the end of rows and nearer the front so not to disturb everyone… It’s difficult sometimes. A lot of my friend’s on instagram have been telling me not to give up on Plaquenil, as I was feeling quite disheartened that it wasn’t working as well as I had hoped. Some of them found that it took longer than 12 weeks for plaquenil to kick in, and other people found that when they came off it they found that it had been helping but it was a gradual improvement, so gradual that they hadn’t really realised until they came off of it. So I am hopeful that I am one of those people!

On Wednesday I am headed back down to my rheumatologist’s office to see a podiatrist who specialises in Rheumatology. The thought was that he could maybe help with new insoles to help with the achilles tendonitis which has been on-going for a good 3 or 4 months now, although thankfully it is quite mild right now. And then in March I see my Rheumy again and we decide where to go with the treatment.