Putting My (Inflamed) Foot Down

via Unsplash
via Unsplash

It’s been a busy last few weeks while I’ve been trying to get things rolling again. On top of editing, writing, and marketing, I’ve also been having trouble with my arthritis.

My joint pain is migratory, which means that it can affect any and every joint, often at different times. Sometimes it decides it’s comfy and moves into a particular joint for the long haul. For the last couple of years, I’ve had a lot of trouble with my right hip. Nothing was ever really done about it, despite the many specialists I saw for it—including my rheumatologist. I basically went ’round and ’round the medical merry-go-round—which is nothing new.

Throughout the last decade, this has been my experience over and over again.

So when I started having trouble with my big toe on my right foot, of course I totally, naively thought things would be different this time. After all, my rheumatologist diagnosed me with reactive arthritis last year and started me on treatment. I’ve been taking 1,500mg of Sulfasalazine every day for several months, but it really hasn’t made much of a difference. Lately, my joint pain has changed from a deep ache to an almost bruised feeling on top of the ache.

When I went to my rheumatologist for a followup, I let her know about all of this. Since she’s leaving the practice this summer and her spot is being filled by another rheumatologist, I figured we’d probably come up with a transition plan. I asked her about trying something else, and she said she wanted to continue the SSZ. Since there were periods of time when I’d stopped taking it for one reason or another—insurance lapse, hospitalization, total brain fog—I was willing to give it another shot.

She didn’t seem too concerned about my toe, though, and sent me on my way. No transition plan. No mention of trying another DMARD.

Doctors are overbooked. I know this. It’s usually prudent to stick to just one issue during office visits, otherwise things get lost in the midst. So I called the office and spoke with her medical assistant, reminding her about my toe.

I can barely bend it, and definitely can’t put weight on it. It feels just like my hip did for all that time. The thing is, my hip didn’t just magically stop hurting. It’s still there. The pain in my toe makes my hip look like a walk in the park—which I’d never imagined could feel any worse.

This is how it goes. I get used to one particular pain level, only to have my body say “Challenge accepted,” and throw something else at me.

My rheumatologist’s solution was Aspercreme with lidocaine.

Instead of facepalming and arguing, I replied that I’d give it a shot. Her assistant told me to call back if it didn’t work.

Here’s the thing: I have an entire box full of things I’ve tried that didn’t work, or worked a little but then stopped. I’ve got lidocaine patches somewhere in my house that I tried on my hip. I have half empty tubes of Voltaren. Tiger Balm does help quite a bit, but if I reapply too often, it loses its effect.

My rheumatologist is very by the book, with a light touch as far as treatment goes. I really appreciate the fact that she doesn’t send me off loaded up with prescriptions. I once had a primary who did just that, and it almost killed me because their office didn’t pay attention to interactions and I blindly trusted them. But it’s starting to get really frustrating that, with every new achy joint, I have to start from square one with her.

It never goes this way:

“Ah, yes, another trouble joint. Well, we’ve tried X, Y, and Z in the past, so let’s not even bother with that. Let’s move up to Plan B and not waste any time.”

I understand why she does it. But I almost wish she was a bad-ass like the attending in the ER who smashed the inflammation in my body with a super dose of Prednisone and a shot of dilaudid to tide me over while the steroids got going.

Instead, I had to play the game. Every chronic pain patient is familiar with this game. I already knew Aspercreme, Icy Hot, etc don’t do much of anything for me. But I still had to do things her way. I called back and let the office know that it didn’t work, and my rheumatologist personally spoke with me and told me that she wanted to try a week of Mobic (an NSAID). If the Mobic didn’t do it, she told me, she’d have me come in for a cortisone shot.

Thankfully, this was a prescription so my insurance covered it. Still, I’d already tried Mobic in the past, several times. It doesn’t work. But again, I did things her way because she’d told me she’d give me the cortisone shot; I knew ahead lay some kind of relief, even if I had to spend another week alternating between icing my toe and wanting to just rip the damn thing off my foot.

I did the Mobic for the week and, as expected, it didn’t help.

When I called the office, I was told that they would speak with my rheumatologist and find out when she wanted me to come in. Because I was still in editing land and doing a whole bunch of other marketing/administrative things (and I don’t get a signal for my phone inside my house, sigh), I missed the callback. I didn’t get to listen to the voicemail until Saturday morning. It was not good news.

In the voicemail, my rheumatologist’s assistant told me that she wants me to see a podiatrist and that I have to set up the referral myself. There was no mention of my cortisone shot.

I cried for a good solid thirty minutes, and then on and off throughout the rest of the day.

I know that steroids are controversial in the chronic illness community (for both patients and doctors), so I really don’t want to hear “That’s what you get.” My issue is, I was told I would get one. I was promised relief. Instead, I was passed off to yet another specialist. This has been the pattern for the last nine years.

I’m tired of this. I’m tired of feeling like my doctors either don’t believe me or don’t know what to do with me. I get that my rheumatologist is leaving the practice and probably just doesn’t have the time to squeeze me into her schedule before she goes. I get that. I really do. I’m crazy busy, too. But what I don’t get is why I had to go through all of this—the office visit, the phone calls, the Aspercreme, the Mobic—when I was only going to be handed off anyway.

I’m sorry, but I won’t be seeing a podiatrist.

I have autoimmune arthritis. Next month it’ll be my elbow or my hip again. I shouldn’t have to see a different specialist for each body part, going through the entire thing all over again: the consult, the battery of tests, the waiting, and then maybe some treatment. Emotionally, I can’t continue coping with the strain of this pattern. It’s exhausting. Physically, I can’t wait an entire summer before I get this taken care of.

Summer is supposed to be for getting outdoors, doing what little physical activity I can. It’s not supposed to be like winter, where I sit on my couch with my pain meds and heating pad, missing out on family functions.

I’ve been doing this for almost ten years; I’ve been doing everything their way. Only when I push back—insist on treatment—do I ever get anywhere.

So, this afternoon, I called my rheumatologist’s office again. I got the front desk’s answering machine (it’s Monday, so they must be crazy busy after the weekend), and left a message asking for clarification and repeating that I’d been told that I would be able to come in to the office for a cortisone shot.

And I’ll call again tomorrow.

And the next day.

Every day, if I have to.

I’m putting my foot down (but with all of my weight on my ankle, off my toe, of course).

I think I’ve patiently played the game long enough.

The Lump On My Chest

via Unsplash
via Unsplash

I knew that stress aggravates my arthritis. In the last nine years, some of my worst flareups occurred during stressful times in my life. Because I also suffer from PTSD, it’s extremely beneficial for me to incorporate relaxation into my daily life. If I don’t, I easily become a messy blob of pain, anxiety, and depression—all of which, of course, feed into each other. So when the news dropped that my publisher is closing its doors, I knew right away that it was time to ramp up my R&R.

After months of skipping my nightly meditation routine and daily yoga, I forced myself to get back into it. I use aromatherapy almost daily—okay, yes, this is actually how I justify my Yankee Candle addiction, shut up—and nightly (with lavender essential oil on my wrists and pulse points on my neck), but ramped that up too. Still, I almost immediately felt the effects of stress on my body.

I have chronic pain. I’ve had Reactive Arthritis (AKA Reiter’s Syndrome) since 2007 (and my rheumatologist tells me it could still be Rheumatoid Arthritis). Mine is enthesitis-related, meaning the inflammation is where my tendons insert into my joints. It’s brutally painful, and I’ve been in a flareup for over a year now (with a brief respite in September/October because of Sulfazine). With the weather all over the place and allergy season under way, my pain was already high. (Hay fever causes inflammation in the body. Just one more reason for me to religiously take my allergy medicine.) But last week something completely new happened to me.

I’d heard of costochondritis from other spoonies, but hadn’t experienced it myself. I do get swelling in my ribs. It’s really only uncomfortable if I wear a “real” bra, which is why I’ve basically been living in Gilligan O’Malley camis for the last couple years. (Praise my lord and savior Target.) I’ve had a rough time with my ReA, so was very thankful that I hadn’t had to deal with anything like costochondritis, because from what I’d heard, it’s pretty nasty. And now I can confirm this from firsthand experience.

Since the news dropped, I’ve had heartburn and nausea on and off. (Thanks anxiety.) Usually drinking 2-3 glasses of ginger ale eases it. At this point I should buy stock in Canada Dry. But last week, as I toweled off after a shower, I noticed that there was a big lump on the right side of my sternum, right under my right collarbone. And it hurt, even if I didn’t touch it.

So of course I ignored it. Or tried to, anyway. As the night wore on, it became more and more painful. It felt like someone was sitting on my chest. Taking Tramadol and massaging it eased it a bit, but even after my heartburn abated, it was still there. I tweeted about it like a good #spoonie, but it was midnight and I didn’t really expect anyone to be on. Because I enjoy torturing myself, I started Googling my symptoms.

After examining a diagram of joints in the sternum, I determined that the swelling was dead on the manubrium—the joint where the first rib and sternum connect. It was definitely costochondtritis.

Unfortunately, there isn’t much you can do for costochondtritis. You basically have to ride it out. You can take anti-inflammatory medication, like an NSAID, but since they don’t usually much help my arthritis, I figured it probably wasn’t worth aggravating my heartburn any further. I did consider going to the ER and begging for a super shot of Prednisone. One of the last times I had a really nasty flareup, the attending in the ER did that for me and it brought the pain down immensely. I was exhausted, though, and didn’t really want to sit in the ER for potentially hours. I decided that if I didn’t feel any better in the morning, I’d go.

Thankfully, the swelling went down and the next day, it was as if nothing had happened. That spot is still tender to the touch, but nowhere near as painful as my hands, wrists, big toe, and hip have been lately. It’s now hardly even a blip on my radar.

In the days since, I’ve taken care to make sure I’m getting enough rest. My sleep schedule is way out of whack lately, as I’ve been staying up late working and combating pain. I’m easing my bedtime back an hour every night. I’ve now graduated to going to bed at 1am rather than 5:30am. I’m also continuing my nighttime yoga routine (mountain pose, standing forward bend, triangle pose, and wide angle standing forward bend). Stress is fun times.