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Spondylolistheses

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Spondylolisthesis  frequently occurs in the lower spine. A vertebrae is gradually pushed out of position. I had a spinal fusion years ago. The vertebrae above it was gradually pushed out of position. The classic symptom is not being able to stand without pain for more than ten minutes at a time. It can block nerves coming from the spine and cause paralysis and severe pain. I have pain in my lower back radiating to my left hip. Sometimes when getting up from a chair or getting out of a car my feet are numb and take a moment to have feeling  return.

Additionally, I believe the murder suspect mentioned that he had trouble with sexual performance. Severe pain can be a problem. The slippage can also cause bowel or urinary problems.

Physical therapy, over the counter NSAIDs are recommended (not for the elderly), rest, oral  steroids  and steroids injected into the back might help. Surgery is last resort.

I take pain meds, steroids, and cannabis for my RA so these measures might help my back. So back pain and numb feet are my main issues. It could be a lot worse and it sounds like the murder suspect has progressive symptoms.

What your need to know about Methotrexate

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  1. Methotrexate has been used for RA since the late 80’s.  It is the cornerstone for RA treatment and considered to have an impressive safety record.
  2. Methotrexate is classed as  a DMARD, Disease Modifying Anti-Rheumatic Drug. It decreases pain and swelling. It can lessen joint damage and consequently long-term disability.
  3. Methotrexate is taken once a week usually in pill form. The injectable form is reserved for those who don’t tolerate the pill or to extend the effectiveness of the drug. Self-injection is not hard to learn for those who need it. It can be easy to do with a prefilled  auto-injector that comes in a variety of doses. The auto-injector is useful for children with JIA, too.
  4. Methotrexate is frequently paired with other DMARD’s. Plaquenil, an anti-malarial drug is often used. Sometimes sulfasalazine is added, too. Drugs used in combination with methotrexate are usually more effective.
  5. Methotrexate is also paired with the biologics including Orencia and Rituxan. The biologics become more effective when teamed with methotrexate.
  6. RA can continue on its destructive path when there are no obvious symptoms. It’s reassuring to know that there are drugs on board slowing the inevitable progression of the disease.
  7. Nausea and vomiting are the most common side effects and usually dissipate as the body adjusts to it. There are a few who cannot tolerate the drug.
  8. Fatigue the next day is also common. It is wise to take the Methotrexate on a a weekend or when at home for the next day.
  9. Blood tests are ordered periodically to assess the impact of methotrexate on the body.
  10. It takes 12 weeks for methotrexate to become effective. Some see changes at three weeks and some need up to 6 months to be effective.
  11. On a personal note: I no longer take methotrexate. I developed soft tissue necrosis on radiated breast tissue. It took ten months to heal. Soft tissue necrosis is black box warning number thirteen for methotrexate.
  12. I have just started a low dose injected Methotrexate. My RA is still not under control after eleven years.

Adapt or Perish

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“It isn’t the strongest of the species which survives, neither the most intelligent, but rather that which adapts best to change.”  Charles Darwin

He must have been talking about rheumatoid arthritis. The most difficult aspect of RA is its unpredictable nature. RA may be simmering.  Suddenly, without warning, a severe fatigue, an exhaustion so bad its immobilizing,  arrives to totally disrupt your day. New severe pain in your right foot makes walking impossible. The simmering pain becomes more than simmering and the constant hurting becomes discouraging. A drug that has worked so well stops working. A very short list of RA’s unpredictable nature.

What to do?

Adapt and survive. The number  one consideration is your attitude. You will need to come to the understanding that you have a chronic, progressive  illness. It is not going away.

And YOU are in charge.

You have the balancing act between controlling symptoms of RA and the side effects of medication. You know the importance of RA medication is to avoid crippling disability, which is guaranteed without proper medication. Consider your health care team: rheumatologist, pharmacist, physical therapist, exercise specialist, nutritionist,  psychologist, social worker, other supportive members.

You are in charge of your team. You call the shots while getting expert advice from your team. The first thing you will need is to understand your illness. Know that it is a chronic disease and it’s not going away. Some drugs work better for some people. Some drugs will not work for you even though they seem to work for many people. I find low dose cannabis and Medrol help me. Since very little works for me, steroids are an acceptable reluctant choice by my rheumatologist

Happy Thanksgiving

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I made my favorite cake this week. It is a cranberry spice bundt cake. Fresh cranberries. Cardamon. Ginger. Sour cream. It is a moist, flavor filled cake. I found it in the New York Times last year. It had previously been in a book on cakes. A dependable bake.

Baking involves a series of specific procedures performed in a specific way. When is the cake done? Most of the time you can tell by looking at it. It looks done.  Now just to confirm my choice of doneness, I use a food thermometer. Cakes are usually done about 195⁰F to 200⁰F.

Today is our Thanksgiving holiday in America. It is a family day. People fly and drive long distances to be with family. It is a day of too much food for many. Favorite family recipes. Storebought sides.  An aunt’s pumpkin pie recipe. The food is generally the same but people do rebel against the standard fare. Turkey, stuffing and mashed potatoes continue to be the standard fare. I have an excellent recipe for an orange cranberry sauce. And so it goes one generation to the next.

 I have spent many Thanksgivings with family. I have also  spent a few alone. Alone is hard during this season. And yet alone is a good time to stir the pot of change. It is a good time to look outward. Sometimes when it feels like no one in the  world wants to connect with you, it may be  a good time not to worry about it.  .Spend  your day doing something you like to do.  A movie. A book. A show. Cook your favorite food just for you. Sleep in.  Remember many people prefer to be alone.

Wherever you are in this vast world,  find something in your day to appreciate. . We are going to have our turkey and pie then a current movie. Our day is leisurely. We love living in liberal New Mexico.  Sunshine. Mountain air.. We are not a rich state but we are an intelligent bunch. A good life.  Have a very good day.

RA and Heart Disease

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The number one cause of death for those with rheumatoid arthritis is cardiovascular in origin.The mortality rate for those with RA is 2.5 times what is normal for everyone else.

The increased rate of cardiovascular disease (CVD) in those with RA is caused in part by accelerated atherosclerosis (hardening of the arteries) due to the chronic inflammation of RA. Atherosclerosis is the most common cardiovascular manifestation in RA.

Inflammation is bad for the body. It causes damage. Early aggressive treatment for RA may reduce the inflammatory process and reduce the number of deaths due to atherosclerosis. Paradoxically in RA, a low BMI (less than 18.5) has been associated with a high CVD risk.

RA doubles the risks of most heart related disorders including

  • heart attack
  • atrial fibrillation
  • heart failure
  • high blood pressure
  • stroke.

Those with RA have twice the risk of heart failure. The risk is higher in those with seropositive RA than  it is with those who are seronegative RA. RA patients do not have the typical signs of heart failure so they might be treated less aggressively than they need to be.

Rheumatoid pericarditis as well as  rheumatoid pleuritis, is often diagnosed at autopsy. Pericardial disease is seen most often in seropositive patients and in patients with nodular disease.

Rheumatoid arthritis related inflammation can affect the heart muscle, the heart valves, or the blood vessels of the heart. Nodular disease can affect the heart’s conduction system.

Hypertension (HTN) is associated with the inflammation of RA. The following increase the risk of hypertension in RA:

  • inflammation
  • medications, such as ibuprofen and steroids
  • inactivity.

RA patients do not often have their hypertension well-managed even though hypertension can lead to cardiovascular disease.

Excerpt from my book Living with Rheumatoid Arthritis. Just a reminder to check your blood pressure. Discuss your heart health with you rheumatologist when you have your next appointment.

OOO

Holidays are frequently stressful for those with chronic disease. RA flares may descend upon us during the holidays. We always live with that uncertainty. Family don’t understand why you are struggling. Your best bet is to decide what you are able to do and plan around it.

Last year I roasted a fresh turkey breast. I made orange-spice cranberry Sause. and stuffing. We bought everything else readymade. It worked out perfectly. The turkey is in the refrigerator. I will buttermilk brine it. Cranberry sauce is ready. This year I will make my favorite cake, a cranberry cardamon spice cake. Holidays can be fun even with crippling disease. You just need to decide what part of a holiday is important to you.

Maybe you don’t even like Tirkey dinners. Maybe pizza delivery and a Costco pumpkin pie is perfect for you. This is the year to shake things up a bit. Enjoy.

My husband was a military man. We spent almost five years in Europe. One year we spent the Thanksgiving weekend in Paris and another year we spent it in England. We never did miss the turkey.

My best wishes to you. I grew up in a housing project that was set off from the rest of the community. My parents struggled sometimes desperately. They always made sure we were safe and that we had enough to eat. My brother and I raised our own families. We also made sure our children had enough to eat and that they had the things we considered essential to being middle class. Our children were fortunate in a way that they would never understand. Just as well.

Cannabis at Eleven

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For about half of us the biologic medication of the last twenty-five years has been helpful in reducing symptoms and lessening disability. Methotrexate has been a big help. It is especially helpful when given in combination with the biologics. The JAK inhibitors can cause cancer. Since I have had five cancers, they are not advisable.

It has been eleven years since my diagnosis. I have learned to live with my symptoms. I do know that it is important to keep moving. Sitting in your favorite chair reading a good romance novel or instead catching up with your broadcasts, or podcasts, is inviting. But it is still important to alternate physical motion with sitting in the easy chair. We all know how stiff we feel after sitting for a while. It is called gelling.

I still have a bad flare that lasts a week once a month. There is not much I can do when my pain level is between a five and a seven. The inflammation level is high and makes me feel sick. I take extra pain medication and Medrol. I low dose cannabis gummies. Before I started taking cannabis my flares were getting to be almost constant. It was a pain laden existence.

I would like to caution you about cannabis. Low dosing for me is  taking a quarter of one at a time. 2.5 mg. It takes the edge off and reduces the inflammation.  It’s best not to take more  than that at a time. It is tempting to take more. They taste good. There is a delay before the effect kicks in and if you take too much you might get very dizzy. If you take too much, remember it will eventually wear off. It is best to sit it out and be more careful the next time. Gummies are powerful odd as that sounds.

WANA and Wyld are two cannabis brands that are manufactured to a particular standard. They are dependable in a sealed container that lists the ingredients and the strength such as THC, CBD,  CBG and CDN. They may list Indica or Sativa. They are a little more expensive, but worth it.

The advantage of smoking the cannabis is the broad variety of strains you can buy. Gummies are limited in that respect. There are other brands of gummies that bring stronger results. They may appeal to you. If you are new at trying cannabis, you will be more successful id you wade slowing into this. It is a trial and error game just like the biologics. As cannabis becomes legal in more states, options for RA relief increase. My suggestion is to try it. It will help RA as long as you increase your dose very slowly.

Visit my website for Matilda and her Alien, https://matildaandheralien.com/

RA, a Progressive Disease

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I have seronegative rheumatoid arthritis. That means I have more issues with inflammation and less joint damage that a person with seropositive rheumatoid arthritis. My rheumatologist sometimes thinks they must be two different diseases.

Once diagnosed both are given the same treatment. I was on methotrexate for seven years. It helped about fifty percent. Biologics helped anywhere from twenty to fifty percent. The combination made life bearable. Methotrexate had been a difficult drug with the side effects of nausea and diarrhea. They passed. With the injectable version of methotrexate, the side effects disappeared.

I have a history of breast cancer that required surgery and radiation. It left my breast tissue with poor circulation. I developed methotrexate black box complication number thirteen, soft tissue necrosis. It took ten months to heal and included surgery. Absolutely no more methotrexate, or it would happen again. So I lost my fifty percent relief. I was lucky to get twenty percent relief with the biologics. I have been through most of them. The TNF inhibitors can cause cancer and the newer JAK inhibitors can cause cancer. Not a good choice as I have had five different cancers.

I am on Kevzara. Good for twenty percent. Low dose methylprednisolone. More of it for flares. Low dose cannabis gummies. No more than 2.5mg at a time. I use a combination of THC, CBD, CBG and CBN. A combination of CBD and THC work better than any slinge element. Cannabis helps me by relieving some of the inflammation I have.

Flares are still debilitating. Cannabis usually takes the edge off inflammation. Lately, I have had more problems. More pain in the multiple involved joints. More inflammation. I take extra cannabis and I find tramadol helps. It is easy to get discouraged.

I believe writing a romantic adventure helped take my mind off how relentless my symptoms are on a daily basis. Baseball season is done. Maybe it is time to write another book.

Matilda and her Alien

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Her parents were visitors from another planet. They settled here in Albuquerque. Matilda was born. Both her parents were murdered by the evil Cyrus Pettibone. Matilda Finnegan was saved by Bertrand and raised by Martha Love. As she grew, she learned to manage the special skills she possessed. She could travel anywhere using portals. Easier than a bike or a car. She could levitate objects. Great way to fetch a cookie when they were out of reach on a counter, Handy when she was a baby. She could read minds and talk with others through thoughts. Languages were easy for her. She had a photographic memory. Her favorite memory was of Bertrand saving her when she was a toddler. She longed for his return. She became a librarian and a archeologist. Worked for the CIA and settled in to owning a bookstore. Bertrand comes to see her and the story begins. More about the characters on the Matilda and Her Alien website.

New Book and cannabis report

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I finally finished my book. I published it as a Kindle book. An adventure. A romance. Science fiction.

 Matilda Finnegan meets up with an old acquaintance . A handsome six foot white hair, sexy  blue-green eyes charming man. Romance blooms. Adventure beckons. The story is about outcasts from a nearby planet finding refuge on Earth. Their obstacles and their romances.

 Book website, Matilda and her Alien and place to buy,  Amazon Book site

I have known about my rheumatoid arthritis for about eleven and a half years. A little more. Despite Kevzara, steroids and cannabis, I still have a week long severe flare at least once a month. The flares are bad. Most of the moveable joints in my body are affected. All but my knees. Strange ads that seems. However, flares  are still better than what they were. The inflammation  is reduced. My RA seems to simmer the rest of the time. Not good but better than it was. I am on the last biologic left to me. I either have tried them or I can’t take them because they cause cancer. The Kevzara helps about twenty percent. Still better than nothing.

I only microdose cannabis gummies. If I take too much, I get dizzy. So I don’t take too much. We are all looking at cannabis gummies as our last hope of RA relief. It is easy to take too much. Cannabis helps reduce inflammation. It can do so in small doses. Like a quarter of a gummy. I use gummies that have a combination of THC and CBD. Plus THG and at night CBN. Combinations work best.   Cannabis gummies are strong.  You might have more success with them if you keep your dose down.

We have voted. Thank goodness we live in New Mexico. Absentee voting and cannabis. Our days are sunny.  Our air is refreshing and cool. Still going up to eighty.

Almost Halloween. Children in our neighborhood have grown so we no longer have little children coming by to Trick or Treat. We still buy our candy supply. Just in case.

Diagnosing rheumatoid arthritis

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Once a person has at least one joint that is painful and inflamed, a rheumatologist can use a ten point check to help diagnose rheumatoid arthritis (RA). The assessment covers four areas: joint involvement, serology, acute phase reactants plus duration of symptoms. There is a total of ten points. A score of six confirms a diagnosis of rheumatoid arthritis. Here is how it breaks down. Choose one from each group and total..

A. Joint involvement
One large joint 0 points
2-10 large joints 1 point
1-3 small joints 2 points
4-10 small joints 3 points
Greater than 10 joints including at least one small joint 5 points

B. Serology (blood tests)
Negative RF and negative ACPA 0
Low positive RF or low positive ACPA 2
High positive RF or high positive ACPA 3

C. Acute phase reactants(inflammation blood tests)
Normal CRP and normal ESR 0
Abnormal CRP or abnormal ERS 1

D. Duration of symptoms
< 6 weeks 0
 6 weeks 1

My choices are a total of 7. Note I am seronegative, and it took a lot of joint involvement to get a positive diagnosis. Your doctor should have ordered these lab tests. Ask for a printout of each. He should be fine with it. You should have all test result copies for your records.