Month: May 2017

Purging, Bloodletting and Algorithms

At the beginning of the twentieth century, the old remedies of purging and bloodletting were left behind. Lister’s concepts of cleanliness had finally become widely accepted. Human anatomy was documented. The culprits of bacteria were identified. Medical knowledge base was growing beyond imagination. Yet doctors were stuck. There was no cure for a bacterial infection. There was no cure for a strep infection. If you were stricken with a strep throat, there was a good chance that you would die. Doctors had no solutions and people of all ages died from pneumonia, wound infections, meningitis, and more. Infection was feared. Today all this is unimaginable. But then, Ehrlich’s ‘magic bullet’ was yet to be discovered. The world changed forever with the discoveries of sulfa in 1936. Penicillin was refined and put into production in the 1940s. There were many more ‘magic bullets’ to follow. Doctors finally had new tools for their toolbox. It became the age of knowledge plus tools. Life became much better. Lifespans became longer. Today, in the twenty-first century, our doctors have …

The Classic Symptoms Of RA

The Classic Symptoms Of RA Symptoms may vary during a day and from day to day and from person to person. The unpredictability of symptoms makes daily activities harder to plan. The following are symptoms common to Rheumatoid Arthritis. Pain is a hallmark of rheumatoid arthritis. Pain comes in many forms in the same person. It is sharp as the edge of broken glass. It is burning. Aching. It is incapacitating and it can be unrelenting. Consuming. Sometimes it is excruciating. The middle joints of the fingers, the knuckles, wrists, the joints in the toes and the feet are affected. The shoulders, elbows, knees and ankles, and the hips become affected. The cervical spine is frequently affected. The lumbar and thoracic spines can be affected but less commonly. Pain may make it hard to get out of bed in the morning. Pain may increase as the day wears on. Pain can wake you in the middle of the night. The trouble is that the pain is not isolated to one spot. It encompasses many joints …

My Military family

This picture is one of few I have of my military career. It was a beginning. I am proud of my family’s service to our country. My dad was Army in WWII. My uncle was a bomber navigator. His plane was shot down over Africa and he was the only survivor. He was nursed back to health by Catholic nuns. Another uncle was stationed in Japan in the 50s. My brother was Air Force in the late 60s. I was an Air Force nurse during the same time frame. My children’s father was career Air Force. My son Steven was also career Air Force with several tours in Afghanistan. We were all proud to serve.

Bring a picture to your rheumatologist

I have tried bringing a variety of pictures as visuals to explain my condition to my rheumatologist. I found this one on the Medscape website. The image seems to be thorough except that the hips are not circled. The hips are more often involved in older patients. I think it is wise to bring visuals. Doctors are good at guessing. Showing them helps you explain your situation and helps your doctor understand your situation.

EORA or YORA another RA category

Imagine my surprise when I learned about the initials YORA and EORA. YORA is an acronym for Younger Onset Rheumatoid Arthritis as is EORA for Elderly Onset Rheumatoid Arthritis. I came to a new understanding of where I am in the scheme of things. Rheumatoid Arthritis (RA) can strike at any age from babies to the elderly. The elderly’s association with RA can be of long standing disease or it can be a new development. People who develop RA after age 60 are considered EORA. That is me. There are some notable differences with elderly onset RA. Initial symptoms may include large joints. With younger RA  onset small joints of the hands and the feet are usually first signs of joint involvement.  The shoulder joint may be a presenting joint in older onset.  My shoulder was involved initially as was the joints in my hands, wrists, feet, elbows. Initially I was in severe pain. Older adults may have more generalized symptoms. My grip was weak. I lost weight. I couldn’t sleep because of the severity …

Coping with the Symptoms of RA

  Beginning with the first symptoms of my rheumatoid arthritis (RA), I have lived in daily pain. It has been over four years. It has been a long time. Rheumatoid arthritis is an autoimmune disease. My body is on a suicide mission to destroy the linings of  the movable joints in my body. It is a scary disease in that it is unpredictable and it is progressive. I spent the first two years with severe fatigue/malaise. And it was as bad as the pain. This malaise is caused by cytokines, products of inflammation. Cytokines circulate in my bloodstream spreading RA damage. Add that to a high level of pain and it can be overwhelming. I wake to stiff, painful joints. In the morning as I walk painfully down to the kitchen to make coffee, there are times when I have become angry and tired of it all. I start the day in pain and I end the day in pain. It is too much. My feet are becoming deformed and I find it difficult to …

Polymyalgia rheumatica (PMR)

I have long  appointments with my rheumatologist. She is thorough and listens to what I say. She does think out loud which may be disturbing to some. I understand where she is going and I understand she is throwing out possibilities not absolutes.  I had a number of revelations but a big one was the possibility of adding polymyalgia rheumatica to my RA diagnosis. Both are autoimmune, inflammatory arthritis disorders that affect the elderly.   Polymyalgia rheumatica is an autoimmune disease that commonly affects the elderly.  The highest prevalence is between 70 and 80. It classically  affects the joints of the pelvic girdle and the shoulders bilaterally. Pain and stiffness. Muscle aching. Inflammatory pain in the neck affects some. It is not a symmetrical disease as is RA. Inflammation in the knees and wrists is usually unilateral. It is not curable. It is manageable however. The drug of choice is corticosteroids which controls the symptoms.  Prednisone is usually started around 25 mg for a month and then tapered to a dose that controls symptoms.  I felt …

Methotrexate NSAID or DMARD ?

I can now count myself  as one of the few who has read the package insert for methotrexate. I am researching RA drugs for my book.  I give myself injections of 25mg methotrexate weekly. I was opening a new box and preparing to give myself an injection.  Impulsively, I decided to read the insert. Methotrexate has become the gold  standard for RA treatment. It has been one of the few drugs to help relieve my symptoms. Imagine my surprise when I read the following. Medication guide insert with boxed  methotrexate; “Although methotrexate clearly ameliorates symptoms of inflammation (pain, swelling, stiffness), there is no evidence that it induces remission of rheumatoid arthritis nor has a beneficial effect been demonstrated on bone erosions and other radiologic changes which result in impaired joint use, functional disability, and deformity.” So since it doesn’t stop RA progression how can it be classified as a DMARD, Disease Modifying Anti Rheumatic Drug?  Shouldn’t it be a NSAID,  Non-Steroidal Anti-Inflammatory Drug?