The Most Exciting Time in the History of RA

The treatment of inflammatory arthritis has changed dramatically over the past 15 years and the talk I am blogging about is a great introduction to anyone with a new diagnosis.  

I was there at this presentation and have recommended it to many people since.  It's a good way to get a basic understanding of inflammatory disease and the treatments.  The mechanisms of action of the various treatments are well described. 

Dr Edward Keystone is a dynamic speaker and also Director of The Rebecca MacDonald Centre for Arthritis and Autoimmune Disease  - a center devoted to research into genomics, therapeutics, and outcomes in autoimmune inflammatory joint disease and osteoarthritis. It is part of  Mount Sinai Hospital in Toronto.

Dr. Keystone gave a talk in 2010 that is still relevant, even though many more drugs have been introduced in the years since then. The title of the talk was The Most Exciting Time Ever in the History of Rheumatoid Arthritis and used to be found on the site of The Arthritis Society. 

                                   And it's even better now

It's a long talk and he starts speaking 10 minutes in after the intros.  He describes what RA is and makes the scientific information about biologic drugs very understandable. It would really help someone faced with a treatment decision or a new diagnosis of inflammatory arthritis.

Here are some of the points that he made:

If the joints are swollen they will sustain damage

Aggressive early treatment is important

RA feels like a fire in the joints.   (In this post you can see I described the rheumatologist as a fireman)

RA is a medical emergency.

Tight control is the best strategy. Adjust therapy frequently to reach the target, which is now remission.

You start with methotrexate ...

                                Fun Wow Methotrexate injection time

This talk is one of my favourite resources.  Dr Keystone's enthusiasm is infectious.

I had hand surgery just before I wrote this blog post.  I needed the surgery because of early damage that happened before I was diasgnosed and had good treatment.

There were no fun pictures to see under hand surgery. (they were informative but not for everyone) This is not too bad though.

I was going to blog about wrist fusion but I am not sure how many people are interested in something that is done less often now.  At the moment I am taking the ostrich stance on it.  It's easier to stay calm that way.

I did not know ostriches really did this.


** Here is another excellent resource for a patient facing a treatment decision.  It's a blog post by Dr. 
Shashank Akerkar called Time, tide & inflammation waits for nobody...
He followed that up with another that is very informative History of Rheumatoid Arthritis that shows the pace of progress in treatment.

So, the doctors weigh in, and seem to agree on the best course of action. It worked for me - with good treatment I worked until I retired. Honestly, it was no picnic but it was a goal that meant a lot to me.

The Groundhog is a Symbol of RA Awareness

At last we have a day dedicated to raising awareness of Rheumatoid Disease! This accomplishment did not occur overnight. Congratulations to Kelly Young, @RAWarrior, on this huge achievement that obviously took a great deal of sustained effort.  Here's the press release from Year 1 -  2013!

We hope that this will help to raise awareness of RAD (Rheumatoid Arthritis Disease) in new areas. The more awareness we can spread the better it will be for all of us now, and for those to come in the future.

Unfortunately Rheumatoid Arthritis Disease can't be treated as though we were in the movie "Groundhog Day" where we can work on our skills and refine our treatments until we achieve success and then are rewarded with a healthy normal life once we get it right.  Bill Murray had time to perfect all of his skills by repetition.  Not like us.

When we pop out of our burrows with RAD (Rheumatoid Arthritis Disease), whether the doctor sees the shadow (RAD) and treats it, or doesn't see it and we wait longer, the reaction is vital to us.

Ideally fast treatment that is the "right" one for us affects our lives dramatically, much more than the length of our winter this year will.  These are our lives that we are talking about here.

Awareness is important at all levels, from parents, to friends, to doctors who may not readily recognize this tricky disease. Lack of knowledge may cause you to miss that narrow window where the right treatment could bring you into remission. 

For too many of us we just don't have time to get a chronic complex disease, or we believe doctors who insinuate that it is all in our minds, or just due to our circumstances.

                                                       thejanedough.com

After all, we know we can cope with life - we've been doing it all along.  It takes something like being unable to get out of bed in the morning due to painful feet, or being unable to unlock a bathroom stall, or falling asleep over dinner to convince us that there's a problem.  Some of us realize things aren't right when we notice we're sleeping longer than our cats

                                                           Toiche and his pillow
 or other pets (The dog wants in)

                                                Dolly on her monkey bed

So I would urge everyone to build on Kelly's success and to spread awareness of RAD through articles, blogs, passing on the press release, an even getting articles in church bulletins.  This infographic/poster called RA Symptom's: A Patients Perspective in particular lays out symptom details very effectively for anyone to understand.

In the meantime I am going to try to be like this little fellow and hope that arming myself with knowledge will help me cut though all of the obstacles and shadows that will face me in the future.

Heartbreak: Shoes and RA

The whole truth is that I have given up on cool sexy shoes and now concentrate on comfort and being able to walk in a way that looks normal.  It has taken a long time for me to become so philosophic about this issue.  It often felt like the main limiting factor in my professional life was my footwear.  I used to cringe at my overall "look" in a full length mirror, even though I don't think most people look at your feet when you are talking business in a room full of colleagues.  But we all know the people with "good" shoes check yours out. It's a ranking system for them.

                                          Greg Blackstock Shoes

How many of the shoes above can you still wear? Are you trapped with ugly shoes?

I almost walked right out of the store years ago when a salesperson suggested I get shoes like this (really I almost cried):

They were unthinkable as a shoe choice!! I got some cool lace up blue leather boots instead.

Imagine these on your feet: 

Of course these shoes would take too much money out of our drug and pain rub budget as well as torturing feet, but can you imagine?!  That's all I can do - imagine.  I could wear them in a wheelchair - maybe.

I'm glad to see there are more sensible choices now that do not look so bad these days. 

ComfortShoes

I couldn't wear the shoes above but I bet many people with RA could.

I just stick with my trusty New Balance 926s. 

They have a rollbar that does part of the walking for me and a lot of cushioning built in. 

Wishing for the feet of a baby.

My Feet Were the First Victims of RA

After almost two years of being sick and having no diagnosis, the problem of dealing with feet I could hardly on walk on was serious. I had to take steps to find out what was the matter with me.  Dr A had no answers so I switched to Dr B - a sports doctor. Neither helped and it seemed that they never would, so I decided to go to a foot clinic.  There I met some enthusiastic residents with many ideas, but when the orthopedic surgeon stepped in he said "Send the lady for a blood test"

So after all that time of feeling that I was walking on knives when I got up in the morning, I had an answer.  The blood test showed unmistakably that I had Rheumatoid Arthritis.  

The Little Mermaid in fairy tales kept going through my mind during that time. That feeling she had of walking on knives when she gave up her tail was the biggest downside of being human.

                                                                     openlibrary.org

Luckily as my treatment plan unfolded with a team of health professionals the OT (occupational therapist) sent me to the hospital foot clinic for orthotics. I think of them as splints for the feet.  They helped: I was able to walk much better with them and had a lot less pain. Over the years the materials used to make them changed.  At the hospital the orthotic workshop used rubber that had some "give" to it.  This was good because I needed something softer to walk on, and they were able to accommodate my toes that were turning under, as well as align my feet properly.

When some of your toes start to stick up above your other toes they rub on the top of the shoe and get swollen sore red bumps. Sheep's wool padding helped with the top of the foot. Because the orthotics were custom made, they allowed little depressions for the toes that needed room below the level of the sole of my foot. The orthotist used leather as a top layer to make a smooth surface.

                                   side view of orthotic, inside view of foot back2feet.com

This is a side view of an orthotic showing the layers used to make it. It is a little short for that foot.

Once I had a pair of lovely to look at orthotics. They were made of acrylic plastic and clear like jelly.

                                     fracturedamy.blogspot.com

They were so disappointing. Lovely to look at and just like walking on concrete. I've been told that RA feet are more sensitive because we lose the fat pads on the soles of our feet.  I can attest to that sensitivity and add to it the other common feeling of walking on marbles.

These days I wear socks with padded feet made for people with diabetes. They give me a little more cushioning. The best socks are actually techno ski socks of pure wool but no one in Florida or the south would want to wear them. It takes a cold climate to appreciate their smart padding.

                                                   smartwool socks
I may never have really happy feet, but with my orthotics I don't limp anymore, and I am sure that my knees and hips are better because of them.

                                 flickr CCCvrcak   Happy Feet

Blogging For Health

What do you think the best health strategy would be?  A bowl of fruit daily, a blog post at regular intervals or a multivitamin?

Some may say that's like comparing apples and computers.

    

Fruit courtesy of DH

From what I have been reading you are well advised to turn on the computer and start blogging if you are looking for a novel yet accepted method of dealing with chronic disease.

Creative outlets are distracting in a good way. When you are creating something it is a huge distraction from pain or unpleasant circumstances.  That's why we see people with hand problems adapting in many ways to keep from losing their creative outlets. 

                                                          garlic clove

                                  cactus & mutant bunny all knitted by Cat Beattie

The act of writing a blog is a creative work also. I read at The Seated View last week that Lene researched writing before she started her book and found two things essential to success as a writer. It was the second essential where she cited Dorothy Parker and Stephen King  that made me remember her post and look back as I was struggling with this one. To see the essentials have a look at her post here. 

One thing I have always appreciated in Stephen King is his ability to use details of music, books and surroundings to set his work in a specific time or place.  This is a quality you find in many blogs of all types, not just health blogs.  Here's my idea of a shelf of interesting books. You can see why advice from King might resonate with me.

I was advised to keep a journal as a method of improving my health in a self management course and was very skeptical of the value.  Now I am coming to realize that a blog is a lot like journaling and I can see benefits to continuing to do this. 

This is a quote from the Health Mentor program that I mentioned in this post. "Personal reflection has long been recognized as an important learning tool, where new ideas and concepts can become integrated into future critical thinking and practice." It is a learning tool for others as well as for the blogger, so blogging makes you feel good about sharing hard learned information.

                                         Rosetta Stone

If you are a person who likes to help others or is accustomed to being in what I think of as a "helper profession" it can be very satisfying to share your knowledge. Julia's past career as a nurse helps her to do a great job now at  Reasonably Well in sharing information about Sjogren's Syndrome and other "fun" issues like bursitis.  She's the only person I know who ever made cookies for her infusion nurses - Mousie cookies.

                                    Julia's mousie cookies

And here are some conclusions of a paper by Pamela Ressler, Y. Bradshaw, K. Kwan and Lisa Gualtieri. The data was gathered by online questionnaire and they say it warrants further study but it makes sense to me.

Communicating the Experience of Chronic Pain and Illness Through Blogging

"Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations.
Respondents reported that initiating and maintaining an illness blog resulted in increased connection with others, decreased isolation, and provided an opportunity to tell their illness story. Blogging promoted accountability (to self and others) and created opportunities for making meaning and gaining insights from the experience of illness, which nurtured a sense of purpose and furthered their understanding of their illness."