News, news, news, and more news

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I have been traveling on business lately. The good news is that both RA and my bout of bronchitis have been quiet which is amazing. Usually the combination of airplanes, dragging baggage, bad diet, strange beds, and long hours is enough to throw me into a flare and/or aggravate any other health issues I have lurking around.

The bad news is that there has been a lot going on in the field of rheumatology and immune-related diseases and I haven’t had a chance to either keep up or post anything here.

Of major interest was the 2014 EULAR conference earlier this month. EULAR (www.eular.org) standing for European League Against Rheumatism. (I’d be shocked if there was a league FOR rheumatism, but still …). There were several major papers that were presented, bringing hope for new treatments, better diagnosis, and more insight for rheumatoid arthritis and similar conditions. Cliff Notes versions of these are available (among other sources) here: Medscape.com. Full abstracts of the presentations are available at the EULAR site.

Here’s a sample list of topics (with links to the Medscape article — you must have a free account):

The RA drug, Xeljanz, has also been making some very interesting news. First, it was used to reverse the baldness of a 25-year old man who lost his hair due to Alopecia. He was not only completely bald on his head, but had lost all body hair. After treatment, he now has a full head of hair along with eyebrows, eye lashes, and (I’m assuming) hair elsewhere on his torso. Alopecia is an auto-immune disease where the body attacks hair follicles. I don’t think there is yet much hope for standard male-pattern baldness, but this is a major step for the millions of people who have lost some or all of their hair to the disease.

Based on the results of a two-year study, Xeljanz has also been shown to be more effective for RA than methotrexate as a monotherapy (single drug therapy). On one hand, this is great news for the many people who cannot tolerate the side effects of methotrexate. On the other hand, methotrexate is very cost-effective and Xeljanz costs more than $2000/month. My insurance company would not cover the cost of Xeljanz until I had provided information that I’d completed the “step therapy”, i.e., taken other drugs first that didn’t work (including methotrexate and Enbrel).

The amount of information about RA and the research that is being done is wonderfully encouraging. Some of these advancements won’t come to fruition for at least a few years, but all of them describe a brighter future for RA patients than we’ve ever had before.

I hope that whatever news is in your life is all good. Thanks for checking in.

B is for Bronchitis and “Bye-Bye” Blogspot

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I reported in my last post that I had received the test report that showed carotid stenosis. I actually got the report because I had managed to contract the crud my husband had and wound up going to the doctor and asked for it during my office visit. I wasn’t too worried about the crud at first because I was on antibiotics after my dental surgery, but when I ran out of those, the crud got worse and migrated to my chest. They first thought it was pneumonia but we’ve settled on severe bronchitis after the X-ray came back okay. After two doctor’s visits, two antibiotic shots, a full round of oral antibiotics, two breathing treatments, and two different inhalers I’m finally starting to feel human again.

I mentioned to my doctor’s PA that because of my compromised immune system, that it might just take a bit longer for me to get well. She nodded then said something very interesting. She said that also because of my immune system, my body may not respond to illness like other people’s. For example, she said, I might not run a fever when I have an infection.

One — I had never considered those types of ramifications before and, two, it’s wonderful to have a doctor and staff who DO understand a lot about those of us with RA and are on drugs that impact our immune system. My previous doctor (may he rest in peace) sort of dealt with RA like it was a separate situation which was under my rheumatologist’s care. I didn’t think much about it at the time, but now that I have a doctor who takes my RA situation into account with the other aspects of my healthcare, it’s made a world of difference.

On another topic, I’ve drawn a line in the sand with BlogSpot. When I started my blog (nearly six years ago now), I had a friend who had used WordPress, otherwise I could have just as easily used BlogSpot or one of the other blog hosting sites, so I have no preconceived notions. As time went on and I discovered other RA-related bloggers out there, I found several I follow who do use BlogSpot. It has always irked me that to post a comment, BlogSpot required you to log in (usually with your WordPress or other open ID) as well as do those “type these letters and prove you’re not a robot” things. Many times the verification wouldn’t work and I’d just give up. One of my favorite BlogSpot bloggers, Cateepoo, recently posted a wonderful post and I wanted to post a comment indicating how it resonated with me and how much I enjoyed it. Her BlogSpot site now requires you to log in with a Google+ account and opens a window for you to create one if you don’t have one (which I don’t). I’m not going to create a separate internet identity just so I can leave comments. I already have more internet doppelgangers than I’d like. IMHO, blogs are for openness in information, building community, and including people. Creating barriers to entry such as these is contrary to those objectives. And while I will continue to monitor and enjoy “The Life and Adventures of Cateepoo”, I won’t be commenting on it or other BlogSpot-hosted sites.

I hope that if you have a “B” in your life today, it stands for bountiful amounts of health and happiness. Thanks for checking in.

A is for Atherosclerosis

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The exact diagnosis from the doctor’s note is carotid stenosis. “Carotid” for the carotid arteries — the large ones in your neck that carry oxygenated blood to your brain, and “stenosis” meaning narrowing.

I reported in an earlier post that I’d had a Doppler test on my carotid arteries and the technician heartily assured me that he’d tell me if everything went okay, and then he didn’t tell me that.

I got the test results back the other day and they did show a narrowing or plaque build up, but no “concerning” blockages. And while it’s showing up in my carotid arteries, that’s just an easy place to do the test. This generally means I have plaque build up (or atherosclerosis, a.k.a., hardening of the arteries) throughout my body. Usually they find atherosclerosis happens in the cardiac/heart arteries before it shows up in the carotid. (So I have that to worry about and now have something to discuss with my cardiologist the next time I see him.) It can also show up in places such as your kidneys and liver and cause peripheral artery disease which can cause issues with your arms, legs, and pelvis.

Coronary heart disease (CHD), where the plaque builds up in the arteries of the heart, is the number 1 killer of men and women in the United States, as CHD can lead to heart attack.

Other fun things include stroke and kidney disease or failure. There is also a potential link between atherosclerosis and Alzheimer’s.

There are a lot of risk factors for atherosclerosis including the usual ones of diet and exercise as well as diabetes, hypertension, and family health history risks. Interestingly, one of the emerging factors is inflammation as indicated by elevated CRP levels. Sound familiar? Yes, those same CRP tests that those of us with RA routinely get to see if our inflammation is under control.

So starting immediately the doctor has added low-dose aspirin to my mix of prescriptions and supplements. Aspirin doesn’t do anything about the plaque, but it does thin the blood so it can more easily move through the narrowed arteries. Doing something about the plaque is up to me and making better choices about what I eat and the exercise I get. I am also hopeful that now that Xeljanz seems to be improving my RA symptoms, that it’s also helping improve my overall inflammation.

“A” also stands for “attitude” and I am hopeful that you are able to face whatever your life holds today with a healthy, happy one. Thanks for checking in.

Victories

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Most health issues are like short skirmishes. Skinned knees, a 48-hour bug, a cold that lasts for a week, the flu that lasts for two weeks, gall bladder issues that are solved through surgery and recovery. Some skirmishes you win on your own. Others take WMDs (weapons of medical destruction) and armies of healthcare providers.

Chronic illnesses are not like that. They are long-lasting sieges. They are the 100-years War where you barricade yourself against the assault of the disease throwing out your best defenses, beating back the enemy as much as possible. With RA, you hope for an armistice or a truce SiegeTower_6_30_06when remission occurs, hopefully indefinitely. But still, the damage to your battlements is there.

And because there is no final victory over RA (yet), it is important to celebrate the battles that you do win.

So this is me doing a celebratory dance.

I’ve mentioned a couple of times that Xeljanz seems to be working and, to me, that’s more than a victory, it’s a miracle. I’ve been on numerous drugs but, until now, the first thing I did in the morning when I woke up was try to decide what hurt most. Now I wake up and mentally try to organize everything I have to do in the day. Stiffness and pain are not first or foremost in my mind.

Xeljanz is not a cure and it’s early in the treatment plan. There are a lot of things that could go sidewise. But I’m not there yet. Now I get to wake up and do a happy dance and blow raspberries at RA.

I hope whatever your day brings, there’s a reason to celebrate a victory. Thanks for checking in.

Updates

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I’ll start with the most recent news first.

Yesterday I went to the oral surgeon for the first step in getting the replacement implant for the tooth I’d broken and subsequently had removed last January. The jaw has to have time to rebuild the bone where the root of the tooth was before they can start the implant procedure. The first step is putting a post into the jaw to hold the crown that will eventually be in place. alftoothacheThis is what I had done yesterday and it takes several months for the bone to heal firmly around the post before the next steps of putting an abutment (the part that extends beyond the gum line that the crown holds onto) and the crown. Since the location of my missing tooth is directly below a sinus, the oral surgeon inserted a bit of additional bone below the sinus and above the implant for extra protection. I opted for general anesthesia rather than local for several reasons and, other than the anticipated multiple pokes (5), to get the IV started, all went well. When I woke up, they had wrapped a band around my head that held an ice pack to help with any swelling. I was reminded of Alfalfa from the old “Our Gang” show. I am doing really well. I’ve had no pain and spent most of yesterday sleeping off the anesthesia. Just as a matter of practice, after any kind of surgery, I always take the pain medication “on schedule” the first day, although I didn’t really feel like I needed it. Today, I’ll definitely switch to the “as needed” approach. I go back in a week for another X-Ray and follow-up visit, then in three to four months we’ll take the second step of inserting the abutment into the post. A couple of weeks after that, I’ll get the final crown and it will be as though the tooth was never gone.

Before that, I visited my orthopedic surgeon for a follow up on my knee replacement. While on vacation, my knee started making a definite “clunking” noise. As this was new and it has been 10 months since the surgery (close enough to my one-year evaluation to count), I decided to get it checked out. Everything looks, as my doctor says, “perfect”. As the knee continues to heal, which can take 18 months to two years, the muscles continue to relax and swelling recedes. This makes the area around the new knee a bit looser and, as such, the components move more freely and can make noise, particularly when the knee is in a twisting or turning motion. He also checked my hip replacement which also looks great so I’m good to go for another two years on both of those. The only fly in the ointment (not actually as big as a fly, more like a gnat or a noseeum) is that my other hip is showing some degeneration and narrowing of the cartilage and more arthritis. Not headed for a replacement there quite yet, but it is changing.

The really good news is that I had my rheumatologist follow up and the Xeljanz seems to be working. My labs look good and most days I actually feel pretty good. I’m currently still on 7.5 mg of Mobic and 20 mg of Arava (leflunomide). I’m dropping off the Mobic starting next week. I was on 15 mg per day, but as Xeljanz can have pretty severe gastric consequences, I cut it in half and, with my rheumy’s blessing, am going to drop it off altogether. I was on it mainly to help with the transition to the new drug. In addition, I’m going to move from 20 mg of Arava to 10 mg with the goal of dropping off it altogether by next spring. My one fear is that I’ll build up a resistance to Xeljanz like I did the TNF inhibitors. But so far, so good. One step at a time.

Finally, there is the unknown. The same day I saw my rheumatologist, my PCP ordered a Doppler scan of my carotid arteries. I have cholesterol and blood pressure problems and as I generally eat the same diet as my husband who has triple-bypass and have the additional risk factor of inflammation from RA. It’s probably a good idea to check for plaque build up. The Doppler scan is very similar to a sonogram where they put a gel on your skin and move a wand/device over it. I really wasn’t expecting anything, but I have to say that now I’m a bit concerned. The technician said that I would probably hear from my doctor in a few days, but that he would tell me if everything was okay (which he shouldn’t have said). At the end of the test, he DIDN’T tell me everything was okay, just that my doctor would get back to me. I haven’t heard anything yet. I’ve been trying to be patient because of the recent Memorial Day holiday and then being out for oral surgery, but I am going to start calling next week if I don’t get some information soon.

So that’s my life lately. Lots of stuff going on but RA has generally been quiet due to (fingers crossed) the new drug routine. I hope whatever is going on in your life brings you a smile. Thanks for checking in.

 

“RALLY” ’round; thank you Healthline

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I must have checked a box somewhere, sometime otherwise I wouldn’t have gotten the letter. You know those letters that start out “You previously contacted us and requested information …” This one is from Bristol-Myers Squibb (BMS) and even though I usually toss this kind of letter directly into File 13 (aka, the wastebasket), this one has piqued my curiosity.

BMS is introducing a data collection research projected called RALLY. It’s a long-term study evaluating the impact of RA on the quality of life and treatment experiences of people with RA and rheumatic conditions. There’s not much effort. About twice a year fill out a questionnaire that takes 30 to 60 minutes. Their recruitment goal is 20,000 participants.

On one hand, this is the kind of thing that I support because I believe that knowledge is power and the more we understand about RA, the closer we come to finding better treatments and, eventually, a cure. On the other hand, there is a certain qualm about providing so much information that goes into a database. (This comment from me — the woman who has given her fingerprints and retinal scans to the NSA to get through airport security and immigration more quickly …. ) I haven’t looked at the questionnaire yet but, among other things, the letter says they might contact my doctor to verify my diagnosis. I get it, they want valid information.

If you would like to learn more and/or participate there are two websites. For frequently asked questions, go to http://www.arthritis-research.org/participate/frequently-asked-questions. If you want to participate, you can either call 1-800-323-5871 or visit the RALLY website at www.ndbrally.org and click on “NDB & RAlly Participant’s Entry.”285x285_Best_RA_Blogs_2014_1_0

In other news, I’m proud (and somewhat humbled — again) to have been notified that Carla’s Corner has been named one of Healthline’s best Rheumatoid Arthritis blogs. Many of my favorite bloggers have also made the list. Check them out at http://www.healthline.com/health-slideshow/best-rheumatoid-arthritis-blogs. If you aren’t already familiar with the terrific people who write these blogs and share their stories, I think you’ll find it well worth your time and effort. There are some extraordinarily inspiring and educational posts out there.

This week is filled with doctor’s visits. I should have lots to report by the end of the week (hopefully all good!). Thanks for checking in.

 

 

Have pharmacy, will travel

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It seems forever since I posted. My husband and I just back from an almost-three-week adventure and the couple of weeks prior to that were very busy with work and getting ready for the trip (more about that below).

Happy Pills store in Barcelona

Happy Pills store in Barcelona (sells candy “pills”)

One of the “joys” of having a chronic illness is making plans around your medication schedule. As we were going to be gone for such an extended time, I had to make sure that both my husband and I had enough of our prescriptions to last us (per the Hobbits) there and back again. Part of the issue was that both of us had just started new medications so it was going to be too early for a refill but we’d run out during the trip. I’d managed far enough ahead on our other medications that I got refills right before we left, so we had a full supply to see us through on those.

With prescription medications (especially specialty medications such as Xeljanz) there are limited options for addressing this. With my husband’s new medication, I could have gone to our local pharmacy and had some extra pills “loaned” to us against his next refill. I’m not sure if all pharmacies do this, but our local pharmacy will make some accommodations in special circumstances like these or if, for example, a physician refill authorization is late in coming. Since the Xeljanz comes from my specialty pharmacy, this was not an option.

As noted in earlier posts, I got both a two-week sample from the manufacturer and my doctor’s office provided a sample bottle as well, which was enough to solve my problem. For my husband, I took a cue from my Xeljanz experience and called doctor’s office. They had originally provided a small sample bottle of the new medication, so I asked if they could provide us a couple more to see us through the vacation, which they did.

I have to say that switching to Xeljanz when I did was very opportune. Otherwise I would have to figure out how to manage my pre-filled Orencia injections through multiple security screenings and keeping them cold over the course of trip. I had already decided to take one injection early before we left on the trip then just be late for the next one scheduled for two weeks later. Fortunately I didn’t have to deal with that situation.

We take 18 prescription medications on a daily basis.

We take 18 prescription medications on a daily basis.

Together, my husband and I take 18 prescription medications on a daily basis (plus a plethora of vitamins and supplements). On top of those (which got placed into the daily pill minder boxes), there was another bag full of the “occasional” medications that I needed to take along, just in case. Those included such things as prednisone, prescription pain relievers and muscle relaxers. In addition to those prescriptions, there was yet another bag full of “travel” medications that our new doctor had prescribed including Cipro, Tamiflu, and something to address stomach viruses. We had most of a bag of just prescriptions.

But about the trip … It was terrific.

From Dallas we flew to Miami Beach where we spent the night. The next day we boarded the Norwegian Epic for an 11-day trans-Atlantic cruise from Miami to Barcelona, Spain with a stop on day eight at Madeira, a Portuguese island where the wine by the same name is made.

The cruise was wonderful with great food and lots of fun things to do (especially in the evening), but I remarked to my husband that it reminded me what living in a luxury retirement home must be like. As we were on the ship day after day after day, things got pretty routine and revolved around meal times. One of the highlights was a guest lecturer who does documentaries for PBS who spoke on the history of the railroads, Grand Central Terminal (which I love), and the Packard automobiles.

Alcove in the Catedral de Barcelona

Alcove in the Catedral de Barcelona

After the cruise we stayed a couple of days in Barcelona. We had visited once before a couple of years ago when we were on our last cruise, but this time we figured out the subway system which made getting around to all the sites a whole lot easier. Barcelona is an amazing city and one of the cleanest cities I’ve ever visited. Renown for its Gaudi architecture and Picasso museum, we spent a large part of a day visiting the beautiful Catedral de Barcelona.

From Barcelona we traveled to London. We used to spend Thanksgivings in London, but haven’t been to London since 2012, so we couldn’t miss the opportunity of being on that side of the Atlantic and visiting it again. Last time it seemed like the whole city was under construction for the Summer Olympics and the Queen’s Diamond Jubilee celebration, so it was nice to visit again to see the improvements since last time. I’m pleased that many of the subway stations are becoming “step free” making the city more accessible to those of with mobility issues. We visited some favorite haunts and restaurants, took in a showing of the latest Jeeves and Wooster play which is classic British humor, and stumbled into the premier showing of Godzilla in Leicester Square just as the stars made their appearance on the red carpet. In all, a good time.

The trip was capped off (thanks to airline points) with a first-class return on British Airways which is the closest I’ll ever get to being treated like royalty. As an American it was almost embarrassing to be treated to that much service. But it was my birthday so I enjoyed every minute of the 10-hour flight back to Dallas.

I am pleased to say that I did extremely well over the trip, even with all the tramping around cobblestone streets in Barcelona and London. I was sore and my joints were starting to be a bit swollen after Barcelona so I took a low-dose of prednisone while in London (three days of 10 mg, followed by three days of 5 mg) which seemed to calm things down. I can only conclude that the Xeljanz is working because the issues I had been having on Orencia are no longer there and I barely thought about RA the entire time I was on the trip. I have a follow-up visit to my rheumatologist next week, so we’ll see what she has to say. (My one concern is that I put on 13 pounds after starting the drug, the majority of which was before the trip, so I can’t blame cruise-line food.)

So, back home again. I apologize to those bloggers that I follow who posted some wonderful posts in my absence. There were connectivity issues on the ship and while traveling so while I got to enjoy the posts via emails for the ones I subscribe to, I wasn’t able to post a comment. Now to get caught up on work and laundry and all those other parts of my life that didn’t go “on hold” just because I was gone.

It’s great to be back. I hope whatever adventures you’ve had in your life have been good. Thanks for checking in.

 

More Xeljanz Adventures


So on my way over to the rheumatologist’s office to pick up my Xeljanz samples, my specialty pharmacy called me and said that my real prescription was ready to be picked up. I was expected a two-week supply from my doctor and was pleasantly surprised to find a full 30-day bottle. (This was on Friday.) So, after picking up the prescription, I have 60 days in stock plus the two-week sample from the company that arrived yesterday (Tuesday).

Then Friday afternoon I got a letter from my insurance company saying that my authorization had been denied because I hadn’t been through the step therapy program of Humira and Enbrel before going to Xeljanz — which I had but on a different insurance. I’m reasonably intelligent and I”ve dealt with insurance and doctors so  my head was telling me that pharmacies just don’t pass out expensive drugs unless they’ve cleared the insurance hurdles. But emotionally it felt like quite a blow because it seemed like I had already spent so much time trying to sort everything out.

So Monday rolls around and I’m trying to figure out who to call first — the pharmacy, the insurance company, or my doctor. Fortunately, Monday afternoon brought a second insurance letter stating that my doctor had already provided the information and that the drug, in fact had been approved.

But wait there’s more.

Tuesday, the people from Xelsource call me. Xelsource is Xeljanz’s patient support arm. They confirmed that everything had been approved, touched base on the co-pay card, and informed me that Pharmacy X would be mailing me my prescription. I thanked them, but I told them that I had already picked up my prescription from my regular specialty pharmacy, and they said, “Fine.”

Today the people at Pharmacy X called me. They needed to clarify something and were more than a bit surprised to learn that I had already picked up the Xeljanz from another pharmacy and, as such, my insurance surely wouldn’t approve a second prescription. I told them I didn’t know how duplicate prescriptions got sent/approved, but that I have an appointment with my rheumatologist in May and that I would ask about it.

So first I couldn’t get a supply of Xeljanz for love or money and now I have people falling all over themselves making sure I have more than enough.

I’ve only been on the drug for a few days so it’s too early to know if there are any positive effects. I had some stomach issues over the weekend which was a bit troubling since that’s one of the known side effects of Xeljanz. However, I’m also taking an NSAID and prednisone and about six other medications, most of which can cause stomach upset. So even with the Protonix I take, it’s not surprising that my tummy rebels a bit.

So that’s where we are. I have enough Xeljanz to see me through the trip and hopefully everything is established so there won’t be issues going forward getting the prescription filled.

I hope whatever adventures you have going on are wonderful. Thanks for checking in.

Xeljanz Update

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Some progress. (Fingers crossed.)

I spoke with my rheumatologist’s office last week and they had submitted all the paperwork to Xeljsource which is the patient support arm and (I believe) the direct pharmacy for Xeljanz distribution. So I called Xeljanz.  After I had gotten through the maze of the “push this button” maze, and spoke to a human, they were quite pleasant and helpful. Yes, they have the paperwork (finally). Yes, it’s in process. No, there’s no way to estimate how long the insurance approval will take. Yes, I’ve been approved for a (free) two-week sample of the drug which they will try to expedite.

There is a timing issue here. I will be out of town at the end of the month and if I don’t get the prescription filled soon, then it will expire while I’m traveling. Hopefully the two-week sample is in addition to the full month, which should be more than enough to see me through my travels.

Today my rheumatologist’s office called me. They have received some samples of the drug. I can go by their office and pick them up, so by tomorrow I should have my first dose of Xeljanz. About 10 minutes after the call from the rheumatologist, Xeljsource called me back to confirm that my two-week sample will be delivered on Tuesday. So between them and my doctor, I should have about a full month’s supply to get me started. (For free!)

Even though it’s a pill form, it’s every bit as expensive as the other biologics that weigh in (depending on your pharmacy and prescription) between $2000 and $3000 per month, so getting a free month is, indeed, a blessing.

In the meantime, I’m “gimping” along with my 20 mg of leflunomide, the 7.5 mg of meloxicam (NSAID), and temporarily, some prednisone. Hopefully the Xeljanz will kick in quickly with few side effects.

So that’s the update on the drug situation. Hope you’re doing well. Thanks for checking in.

 

What do you do when you can’t?

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From One Big Happy comic strip, March 25, 2014.

From One Big Happy comic strip, March 25, 2014.

We’ve all been there. The day you have something important — or even not-so-important — to do is the day you flare. Or the day you’re especially suffering from fatigue. Or the day the side effects of the meds really start kicking in. Or just the day you feel so overwhelmed with dealing with the disease that it’s hard to deal with anything else.

Sometimes we just get up and go anyway, with varying results depending on how well we can actually function. Other times we (once again) beg off with some excuse or other, then wind up feeling guilty on top of feeling bad.

But that’s mainly the physical effects of RA. What about the mental outlook?

I’ve been paid a major compliment. I’ve been asked to submit a guest blog. No details here to spoil the surprise, but I was very pleased. I mainly do this blog for myself but as a wonderful consequence I’ve made some great friends and occasionally something about which I’ve written has resonated with other people dealing with similar situations. The fact that someone else wants me to contribute toward their efforts on education about this disease is, indeed, flattering.

The topics they are suggesting are all positive. I get it. With all the negative, scary information out there, it is truly helpful to know that real people have overcome challenges and have victories (however large or small) over the disease. I was especially taken by Pollyanna Penguin’s “Life in the Day” post where she contrasted her life today with when she was first diagnosed. Her life is certainly not perfect, but through treatment and her own determination (and wicked sense of humor), she’s doing better.

My problem is that mentally, right now, I’m not in a good place to do something positive. As posted earlier, the Cimzia hasn’t been working. The Arava and Mobic are “supplemental” so they’re not supposed to carry the main load of combatting the disease, so for some time now I’ve been without mainline treatment and it’s catching up to me. It’s scary because I can sit here and tell myself that this is what my future is like — constant pain, chronic fatigue.

My doctor has switched me to Xeljanz but, due to a mix-up getting my recent cholesterol labs to my doctor, I haven’t yet started on the drug. Now that I’ve (hopefully) gotten the lab situation straightened out, we still have to go through the insurance approval process and then it will take a minimum of weeks and possibly months before the Xeljanz provides any improvement. In the meantime, I’m like the boy in the cartoon — it’s really hard to get excited about getting out of bed in the morning.

I intend to do the guest blog. In my case, it’s a mind-over-matter situation. (If you don’t mind, it doesn’t matter.) And I do have plenty of positive things to provide the fodder for the piece, I just need to remind myself of them.

Until then, I hope whatever gets you out of bed in the morning is a good thing.

Thanks for checking in.

 

 

 

 

 

 

 

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