Medication Updates

Y’know back in the day … the most intense medication I had in my cabinet was OTC NSAIDs or some cold medicine. There were a lot of vitamins and minerals around the house … and I took them regularly. These days … it’s a whole different story!

One Rx NSAID and two DMARDs later (and Rx vitamin too) I have one more decision to make. My rheumatologist believes in treating this (luscious) RA aggressively and I agree with him. So we are going to add a biologic on top of everything else. But which biologic is now the big question?

I have to consider my health insurance company’s tiered formulary, because a biologic moves out of the Tier 1 drugs I now take. The rheumy suggested one drug that’s in Tier 2 and another that’s in Tier 3. And two more that aren’t in the formulary at all. Picking my battles, I feel like I should start with the Tier 2 drug … considering it’s more likely to be approved.

Tier 2 drug: Humira
Tier 3 drug: Enbrel
Non-formulary: Orencia or Remicade

I’m also looking at some of the practicalities of my life. I’m not needle-phobic although I’ve never had to inject anyone else much less myself. So maybe an injectable would be okay. If I can’t do the injections, then my husband will be another option. Although he swears he could never do it … and I tend to believe him! I also like that Humira is bi-weekly or weekly.

At 45 I still have good veins in hands/arms. So it wouldn’t be hard to do infusions, but why start there yet? I also know that I don’t sit still very well unless I’m completely exhausted. So the idea of sitting for an infusion doesn’t seem like a lot of fun. I’m also a small-business owner and making money depends on my presence. So that’s another nail in the infusion coffin.

I’m really leaning towards Humira, despite all the dire warnings and possibilities of major side effects. There isn’t a single biologic that doesn’t have similar warnings. Additionally, I have read some very positive reviews of how much it has helped RA patients. And the alternative of joint damage just isn’t an option I’m willing to take lightly.

If you were in my shoes (what you know of them), what would you do? Thanks!

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My Methotrexate Journey – Weeks 4 and 5

They say that nothing is ever simple. And that’s been the story of the last couple of Sundays (my MTX day) for me. Sunday of Week 4 was pretty good … if you don’t count the two feet of snow that fell the day before. Sunday of Week 5 was pretty nasty … but not really because of the MTX.

I’m still finding that the ginger nearly eliminates the nausea. And that MTX makes me a bit more tired than usual.

But the biggest lesson over the last two weeks has been what my limits are. The snowstorms of February 2010 taught me that I may be able to do something I used to do (like shovel snow for an hour), but that the price I will pay is a steep one. And because I work in a business where happy clients are essential to my livelihood, it’s been a challenge to figure out how to reschedule people and not hurt myself even further.

I have had alternating days of great accomplishment and productivity. Followed almost immediately by days of incredible fatigue and frustration. But somehow this still feels like an improvement.

Last summer when the RA hit my life with full force, I had a very simple rule. Do only what is necessary and take it very slow. My main symptom was overwhelming fatigue. I did have some joint pain, but it was 20% of the issue while fatigue was 80%.

Then when I began to take medicines for the RA, the rules changed. The fatigue levels are improving markedly, and actually that is making it harder. I find that I can do more, but that this is making the pain levels go up quite a bit. So, the new rule seems to be do whatever I can one day but don’t forget I will pay for it the next day with exhaustion and discomfort. And if I go really nuts, I WILL be in pain.

My big challenge seems to be finding a balance of accomplishment and recovery. MTX day / Sunday seems to fit well as a recovery day. However, I clearly need more than one recovery day in the week. This is a very new concept for me … and one that will be another part of this luscious journey.

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Paraffin Dip Tips

Who started this paraffin dip thing? The practice started back in the Roman Empire. Romans poured hot waxes on the body before massage therapy. The French also used paraffin to accelerate wound healing by melting the wax and spreading it on wounds. And the British used paraffin wax therapy to treat orthopedic disorders in World War 1 military hospitals.

And here is a more recent definition (more about remelting paraffin in a moment):

Paraffin dip: A treatment for the symptoms of joint and muscle conditions, such as arthritis, that consists of melted mineral wax derived from petroleum applied to a body area. Paraffin dips can be especially helpful in relieving the pain and stiffness of arthritis involving the small joints of the hands when used as a small bath. The hands are repeatedly dipped into the melted, warm wax and the wax allowed to cool and harden around the sore joints. The paraffin is then removed by peeling off and can be remelted in the bath for repeated use.

So what are the practical tips you should know?

First, be sure to consult with your physician if you have questions about the appropriateness of heat therapy treatments.

Now, why would you get a paraffin dip? Whether you do this at home or with a trained spa professional, a paraffin dip is most often used for hands or feet. It will soothe and moisturize your skin, open pores, increase circulation, and offer a chance to slow down during your busy life.

But more importantly for RA and osteoarthritis, paraffin therapy can reduce pain and stiffness around joints by helping remove excess fluid from surrounding tissue. Paraffin is heavy in molecular weight, so it can increase the blood supply to the area being treated which can also be beneficial to joints and soft tissue.

Paraffin treatments are not recommended for people with the following conditions:

  • Hypertension
  • Diabetes
  • Varicose Veins

Especially when you are immuno-suppressed, it is best to throw paraffin away after each use. Do not use paraffin baths at a salon or spa unless you verify that they are not re-using paraffin. A common bath would be a breeding ground for fungus and bacteria. With each dip, small amounts of dead skin slough off into the tub, making the wax dirty and unsafe. More salons and spas are offering single-use paraffin products, which give you an extra opportunity for safety. (See these sites for more info & another take on hygiene)

What if you decide to invest in a home-use paraffin dip? What else do you need to know?

  • Be sure to remove all jewelry prior to treatment.
  • Thoroughly wash and dry the area that is to be treated.
  • Use hand lotion without mineral oil, which can create additional dryness after initially feeling moist.
  • Try the medium temperature first, in case the hot is uncomfortable.
  • Be sure not to touch metal sides or bottom of the paraffin bath. Use a plastic shield for the bottom if it comes with your equipment.
  • When conducting a paraffin dip, relax the body part to be treated and immerse it gradually in to the warm paraffin wax.
  • While dipping the area into the paraffin therapy bath, layers of paraffin wax will build up.  You will want up to five layers of paraffin for maximum warmth to penetrate.
  • Allow it to cool & harden without standing on your feet or using your hands. You can put the hand or foot in a plastic bag and then a specially designed mitt to prolong the warmth and keep from getting paraffin everywhere.
  • If you are doing this without help, you may have to treat one hand at a time.
  • Once the treatment is complete, the wax is peeled off  (can be done right inside the bag with a little practice). Toss the bag with used paraffin in the trash.

Some paraffin has lavender or other scents. Or you can find unscented paraffin at Massage Warehouse. This is the brand I use, and it has always worked well for my clients.

It is also possible to paraffin dip your elbows, but you will need to enlist someone to wrap them lightly with plastic wrap.

Here’s a video with some info aimed at spa professionals and massage therapists that is still applicable when you do your own.

More instructions:

http://www.ehow.com/how_2218771_use-paraffin-bath.html

http://www.ultimatewatermassage.com/home-spa-paraffin-Q&A.htm

Great site from @Farfbaz (thanks Steph!) http://www.therabathpro.com//treatments/general_tips.php

And just so you know, the only thing that qualifies me to discuss this would be my seven years of experience as a nationally certified massage therapist who also offers paraffin dips to her clients. Always use your best judgement, and follow qualified medical advice first.

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My Methotrexate Journey – Week Three

Week Three (Sunday) was pretty much a non-event, which is maybe why I haven’t blogged it until now (Wednesday). I moved up to 7.5 mg, which is three pills. Only one pill away from the final dose of 10mg/week.

As with Week Two, I did start with some crystallized ginger & ginger tea on Saturday and continued on Sunday.

I took one pill at lunch on Sunday, and ventured out of the house to spend some time with friends. The afternoon brought a pretty good energy level and no real nausea. Sunday at dinner I took the remaining 2 pills, and again experienced nothing significant in terms of side effects.

Now I am wondering if the nausea from Week One was due to the glass of wine I had on Saturday night. I haven’t had any alcohol since, and the nausea is certainly less significant. We are planning dinner with friends this coming Saturday night, but I think I’ll skip the wine … much as it pains me …

And I have to say that the last two Sunday nights have been poor sleeping nights … but not because of MTX. Instead, I have had a sick and coughing husband who keeps waking me with his restlessness. So I’m now wondering if the overtired feelings on Monday are really all the MTX or not.

I have had some mouth tenderness, but nothing that I’d really count as a sore. Just little spots that seem slightly irritated for a brief time. And no hair loss yet either. Hoping it stays that way. I do take 1 mg of folic acid every day to help combat this.

Maybe this weekend will be more “normal” and give me a better idea. But overall, I continue to be hopeful that the side effects will remain small and the MTX benefits will be well worth the effort.

Thanks for listening …

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