The Single Gal's Guide to Rheumatoid Arthritis

The best consolation prize ever

There is no getting around the fact that having Rheumatoid Arthritis, especially when you have so much of your life ahead of you, sucks big time.  That's pretty obvious.  But, if you have to have it, you may as well get some fun things out of it when you can.

For instance, when I told my family about my diagnosis, once they got past the initial shock and sadness, my mother and sister immediately went to work planning a trip for the two of them to come to New York City the weekend after I visited my rheumatologist for the first time.  And this would not be just any trip, my mother informed me.  This would be a fabulous, extravagant, it-sucks-you're-sick-but-let's-make-the- best-of-it kind of trip. (It's no mystery who I inherited my indulgent streak from.)

If you ever have someone close to you get diagnosed with a chronic disease, and you don't know what to do for them, and you have good credit, then may I suggest the following:

My mother and sister arrived safely, one from Virginia, one from San Francisco, just in time for a quick breakfast before our facial appointments at Bliss. Not only is it a kickass spa, but they have sinful brownies to snack on while you are waiting for your treatment. Or after. Or both. (I'll give you one guess what I chose.) After our facials, we checked into this swanky hotel and felt sufficiently smug, then had a cocktail before we met a few of my friends at my favorite lounge for a quick drink and then headed here for a cozy, scrumptious dinner. 

When we got back to the hotel that night, my sister and I filled out the room service breakfast menu for the next morning.  I think we might have been a touch tipsy, because at 9am, the following appeared at our door: coffee, orange juice, eggs benedict with potatoes and asparagus, pancakes topped with strawberries, Irish oatmeal with caramelized bananas, croissants, bacon and sausage.  Yeah. There wasn't even enough room on the table to put everything on it, so we all stood around in our white fluffy bathrobes, walking about from table to bed to night stand, eating a little of this, then sauntering over to have a little bit of that.  It was ridiculously excessive, but so much fun.  We made a pretty good dent in all the food, too.

In order to work off our morning feast, we went shopping, starting at one of my favorite boutiques.  We crossed the city from the East Village over to Chelsea, then to 5th avenue, then back to Chelsea, where I got one of these. (I'm a big baker.  It's something I learned from my grandmother and have always enjoyed doing, but once the RA struck, things like whisking and beating batter with a hand-held mixer were really painful and put a lot of stress on my wrist.  Not anymore!)

We then headed back to the swanky hotel and got ready for dinner here. It was a truly divine dining experience.  We had foie gras served three different ways, including a foie gras creme brulee. (Who knew?)

Post-dinner, we thought we'd check out the action upstairs at the hotel's bar and lounge (complete with swimming pool), but it was really too noisy and too much of a scene for us, so we retired for the day.

The next morning (sans ridiculous obscene breakfast), we reluctantly checked out and loaded everything into a cab to go uptown to my place, where I realized that my entire apartment was smaller than our room had been at the hotel. Sigh. In one last stroke of indulgence, we went to get pedicures nearby, and then off they went back to their respective homes, and me back to reality.

None of this cured my RA, clearly, but it did do a great job of making me feel cared for. I laughed a lot, and it took my mind off all the heavy real life issues I would be confronting from then on. 

And now, I'm going to head into my kitchen to make some cupcakes with my favorite consolation prize. Take that, RA.

A few more treats....

After my last post on rheumatoid arthritis treatments (mostly on ones that I myself have encountered), Liz from Creakyjoints.org wrote to let me know about this great, non-brand specific video they've made about infusion therapy.  I've not yet had the pleasure of doing this myself, so I can't tell you what it's like, but if you are curious about it or about to do it and want to see what it's like first, head over to Creaky Joints to find out more.

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After a week of pretty bad fatigue, I decided it was time to get myself some bodywork. I went for an hour-long reflexology appointment here, and my god, it was absolute bliss.  Whether you have RA, another autoimmune disease, or are perfectly healthy and just want to feel amazing for an hour, I would highly recommend reflexology. It's like your average foot rub tripped out on ecstasy. Who doesn't want that?

Rheumatoid arthritis treatments 101

One of the things you learn quickly after you have been diagnosed with rheumatoid arthritis, if you are choosing to go the western medicine route, is what all the drug lingo means.  When I first started reading all the books I'd gotten, I had no idea what an NSAID was, even though I was taking one. Now, keeping in mind that I am not a doctor, here's a basic run down on some common drugs and treatments from my perspective.

Class A: NSAID's. 
NSAID's are non-steroidal anti-inflammatory drugs, and chances are you have taken one.  This category includes aspirin, ibuprofen and naproxen sodium (aka Aleve), among others. Back in the old days of RA treatment, most people were put on one of these, often in large quantities, to help treat the inflammation and pain associated with rheumatoid arthritis.  It was thought that most of the damage to joints didn't happen until later stages of the disease.  Now, however, it's been shown that joint damage often happens in the first, earliest stages and onset of the disease, so that is why they tend to treat people much more aggressively right off the bat.  NSAID's really just treat the symptoms of the disease anyway, and not the actual disease, and since RA is progressive in most people, meaning it gets worse and worse as it goes on, that's important to understand .

Plus, for many people, taking tons of NSAID's will rip up your stomach in ways that are not pleasant at all, so then not only do you have RA, but you also have a bum stomach.  Who wants that? My first doctor started me out on naproxen when he was running tests on me, and I continued on it after my first rheumatologist visit. But by mid-December, about three months after I'd been taking it, there was, shall we say, evidence, that it was starting to make my stomach very unhappy.  (If you need a clearer idea of what I mean by evidence, go read the back of an Aleve bottle, and you'll get a better idea.)  Needless to say, I stopped taking that right then and there.

Class B: DMARD's
DMARD's are disease-modifying, anti-rheumatic drugs, which, as I understand it, means that these drugs actually interact with your immune system in a way that modifies (hence the name) it and helps to halt the progression and activity of RA. They include the dreaded (well, for me- it works miracles on many) methotrexate as well as injectable gold, oral gold, sulfasalazine, and plaquenil (and many others).  My rheumatologist put me on plaquenil right after my first visit, and I've been on it for about eight months.

One thing about DMARD's is that many of them can take as long as six months to kick in, which, when you are in excruciating pain that keeps you from sleeping, moving and everything else, and so fatigued that you would just prefer to stay in bed for, maybe, ever, six months is wayyy toooo loooong.  Many DMARD's have some pretty crazy and serious side effects, too, so they aren't something to play around with.

Luckily for me, the plaquenil hasn't had any side effects that I'm aware of, so that's great.  Some people get rashes or become incredibly sensitive to sunlight.  I am already incredibly sensitive to sunlight, and have been plastering my skin with SPF 8000 for many years, so this was no biggie for me. It can, apparently, in very rare instances, interfere with or detach your retina, so if you go on it, you'll have to get a majillion tests by an ophthalmologist to make sure this doesn't happen (though my ophthalmologist told me I'd have to take gallons of it every day in order for this to actually happen...).  It was originally used as an anti-malarial drug, which I thought was a pretty cool bonus since I like to travel. Imagine my disappointment when I found out that I'm not taking a high enough dosage to actually protect me from malaria, which is annoying since I'm going to Peru this summer and have to get other malaria pills (can't one pill just do for all, dammit?) for that trip.

For many though, DMARD's just aren't enough, which leads to:

Class C: BRM's
Biologic Response Modifiers.  These are the crazy, wacky, bizarr-o drugs that have come out in the last decade or thereabouts, and have revolutionized the way that RA, and other arthritic diseases, are treated.  These suckers basically stop your overactive immune system in its tracks by binding to all the extra inflammatory things (particles? proteins?) in your body and taking them out of commission so that they can't keep causing the inflammation around all of your joints.

I am on one, and I have to say, as quickly as my life changed when the RA began, it changed just as quickly again when I started on enbrel back in January.  Most BRM's have to be injected or given in infusions, and have to be kept cold, so you could also refer to them as HMD's (high-maintenance drugs). 

As thankful as I am and happy to be on enbrel, there are some pretty serious considerations to think about when it comes to BRM's.  They work by suppressing your body's immune response, so that means that it's easier for you to get sick, and once you get sick, it's harder for you to shake it off, and an innocent cold or small fever could turn into something more serious, so you have to be vigilant about washing hands and doing what you can to prevent catching anything.  I already got flu shots before this, but I'll definitely be getting them from now on.

Some of the side effects reported for enbrel and other biologics, though rarely, include multiple sclerosis-like symptoms, lupus-like symptoms, and some people (not necessarily doctors) posit that since it weakens your body's immune response, it may increase your chances of developing certain cancers like lymphoma, because your body won't recognize that those cancerous cells don't belong to you, which would suck.

In a way, it's a bit of a catch 22- damned if you do, damned if you don't. Some people decide to chuck all of these medicines out the window and approach treating their condition with diet, exercise, and alternative medicines like Chinese herbs, acupuncture, massage and ayurveda.  I am intrigued by all of these. I have practiced and taught yoga for years and deeply believe in its ability to aid in the healing process, and the nervous system is incredibly connected to the immune system, so that certainly plays a big part in any autoimmune disorder.  Studies have shown that certain supplements, like fish oil, can also impact RA positively. (Note to self- get on them.)

Maybe one day I'll be able to control my RA without the help of serious drugs, which I would love, but I was in way too much pain, was crazy-delirious with fatigue and sleeplessness and had already watched this nasty disease take out one of my toe joints in about three months time. (It is permanently damaged, folks, and persists in popping in and out of place all the time because the ligaments have been stretched out for good.  I guess it's a good party trick, but it's really gross, and it still causes a lot of pain.)   

Frankly, I'm not willing to risk letting RA take out any more of my joints if I can stop it, so for now, I'm readily embracing all the pill-popping and shooting up I need to do.  I also practice yoga, particularly restorative yoga, plan to begin acupuncture once I'm done with physical therapy (I can only do so much at once) and have begun to make some changes in my diet (though clearly giving up alcohol is not one of them- what can I say?). I will definitely be reporting back on these other therapies as I try them.

Ok. Class is over.

My first visit with the rheumatologist; aka, my methotrex-fate

During the three weeks between my diagnosis and my first appointment with my rheumatologist, every time I walked by a book store, I would slink in and nonchalantly find my way to the DISEASES section to check out their rheumatoid arthritis stock. (Couldn't they name that shelf something else, like the things that might be ailing you shelf, or, the I don't have one, I'm just curious about them shelf?)  For the most part, every store seemed to only have one or maybe two books at the most. Clearly, I had gotten a loser disease. There weren't even any celebrity books about having RA. (Since then, Kathleen Turner has written one!)

Slowly, I got a little collection together, and every night after work, I would sit at my kitchen table and read about everything horrible that was going to happen to me, or might happen to me, or could happen to me, all of which was really depressing.  There was a lot of crying during these sessions.

Words like chronic, progressive, systemic, pain, fatigue, damage, deformed, disability, and surgery screamed out at me from the pages, and even though the authors were all trying to be very nice about it, there isn't really anything nice about any of those words, especially when they suddenly apply to you.

Scarier, though, were all the new words and acronyms that I didn't know yet, like BRM's, DMARD's and NSAID's, all of which refer to different classifications of drugs used to treat rheumatoid arthritis, and it seemed like a pretty good bet that I was going to end up on one of them post-rheumatologist visit.

The options didn't look so hot. For instance, one of the drug treatments for RA is injectable gold. INJECTABLE GOLD????  I mean, hey, I like gold as much as the next person, and I enjoy wearing gold, but never in my entire life have I ever had the desire, inclination or inspiration to inject it into my body. No need to worry, though, apparently you can also take gold orally. No thank you.

Another fun option was steroids. Again, no thank you, I'd rather not. As I read through all of the different drugs, I zeroed in on one in particular that I realllllly really didn't want to have to take. Unfortunately, it was also the one that, from what I could tell, was prescribed the most: methotrexate. I think part of my immediate aversion to it was that it is used, in much higher dosages, as a chemotherapy drug.  The idea of putting something into my body so toxic it can be used to kill cancer just felt wrong, wrong, wrong. And here was the other thing: you cannot, absolutely not, drink alcohol. Not. A. Drop. It's evidently so toxic that drinking alcohol while on it could cause your liver to up and quit.

Great, so now, not only was I sick, but I couldn't even have a drink?  I made up mind I would inject and swallow all the gold in the world if I had to, but I did not want to be on methotrexate.

The three weeks slowwlly creaked by, as did I. November 7, 2007 (7 is my lucky number, so I hoped this would be a good omen) finally arrived, and with it, my first appointment with my new doctor, Dr. R. I walked into the huge Beth Israel complex at Union Square and felt incredibly intimidated.  I wondered if any of the doctors there would look like Patrick Dempsey (alas, so far, no McDreamies have been located).

I made my way up to the rheumatology division, gave them my name, paid my copay ($50, at that point) and sat down. Surprisingly, there was another young woman about my age in the waiting room.  I wondered if she had what I had.  There were also several older women, one of whom had a cane, another had a walker, both had huge, orthopedic shoes on and I hoped, perhaps selfishly and maybe meanly, that they had something different from what I had. I sat down and waited, again, to be called by the nurse to go back and see Dr. R. (I have gotten very good at this- one could classify me as an expert waiting-for-the-doctor-er.)

Now, one word about what it feels like to be told you have a chronic illness at the age of 29 (or any age, really) and be at your first appointment with your new specialist doctor, ie: doctor who is in charge of your medical fate from this point forward.  It feels big. It feels huge, earth-shatteringly important, scary and urgent. To you, that is.  What you realize when you enter into the big medical engine that is our health care system (and I hope you never do if you haven't already), is that while it is the most huge, earth-shatteringly important, scary urgent thing to happen to you, everyone a specialist deals with every day is also experiencing a huge, earth-shatteringly important, scary urgent illness or they wouldn't be there, so in fact, it is just business-as-usual for everyone who works in that office, and you are the only one freaking out about what is happening to you.

So it was that day.  When I was called back for a nurse to take all my vital signs, they were very nice, but totally relaxed, discussing what they were going to order for lunch that day like it was just another day at work (oh, right, for them it was just another day at work). I was shown into the exam room, where I waited some more.  As my grandmother used to say, I was as nervous as a witch. (Don't ask where that expression comes from, we none of us have any idea.)  Every time I heard someone walking up to the door, my stomach twitched and quaked and made gurgling noises. Finally, she came in, and I liked her instantly because she had a really approachable, warm smile.  This was a good thing, since I'd read in all my books how important it was to like your rheumatologist and have a good relationship with her. I wanted things to start off on a good foot.

She looked over my information and started asking me questions (including 'do you drink', to which I replied with a resounding 'yes'), and took down my patient history (ie: the story of the toe).  She then looked over the copy of the test results I'd brought with me from my regular, non-specialist doctor, and then said, 'Yep. You've got a pretty straightforward case of RA, but otherwise, you're perfectly healthy.'  (gulp.) 'I want to do a physical examination, and then we'll talk about treatment.' (dun dun DUNNNNN-my methotrex-fate was about to be handed down.)

I changed into the lovely, very fashionable haute couture hospital gown, and she came back in and looked at all my affected joints, asked me to lift this, move that, etc. I said 'ow' a couple times. Then she listened to my heart.  And kept listening to it. 'Did you know you have a heart murmur?'  I didn't. She told me she wanted me to go to a cardiologist to have it checked out, but assured me I'd probably had it since birth and that it was most likely benign. Great, something else to possibly be wrong with me?

Then I changed out of the haute couture trash bag gown into my normal clothes, Dr. R came back in, sat down, and I knew the moment had come-it was time to hear the verdict.

'I want to put you on plaquenil.  It's an older drug, but it doesn't tend to have a lot of side effects.' WHEEE! HALLELUJAH! (even though I'm not religious.) I had escaped!!!!  Of course, in all my time reading about the drug I didn't want to be on, I hadn't spent as much time reading about the others, so I didn't know all that much about this plaquenil thing, though she mentioned it was originally used for malaria.  One possible side effect, though, was that it could detach my retina (wait, that sounded bad...), so she informed me I'd have to go to the ophthalmologist to get tests done, and then go a few times a year to have it monitored.  Hmmm. OK. She wanted to see me again in six weeks to see how the plaquenil was working, and she warned me that it could take anywhere from a few weeks to six months for it to kick in fully. She also wanted me to continue taking the naproxen my other doctor had started me on.  She gave me the name and number for the ophthalmologist, the name and number of the cardiologist, and also one for a neurologist since I told her I've had migraines but had never seen a doctor about them.  Good lord. Within the span of 20 minutes, I'd gone from having one doctor (not including my midwife/GYN) to five.  How had that happened?

As I left, prescription and eight million referrals in hand, my head was spinning, but one thing was clear: I was going to go home that night and pour myself a big glass of wine.

The day after D(iagnosis)-Day

What exactly is one supposed to do the day after being diagnosed with a chronic illness?

If you are me, you lay in bed for a long time, stare at the ceiling and feel really weird.  Was I supposed to tell people? What do I tell them? What am supposed to do next?

One thing I did know was that I had to call my doctor back, so I hoisted myself into a vertical position, which was no easy task, and called his office. Naturally, I couldn't actually talk to him, but I left him a message.

It's funny the difference knowing you are sick can make. Every wince and pain I'd been holding at bay or pushing through the last few weeks when I was waiting to hear that something was officially wrong with me suddenly gave way. EVERYTHING hurt. I stumbled through getting ready as best as I could, then made up my mind. I would go to the nearest book store and clean them out of their entire rheumatoid arthritis collection in the hopes that I could read a book that would tell me what I was supposed to do. 

I walked into the Barnes & Noble and marched (OK, hobbled) my way over to the health section, feeling a little strange and a bit like a social pariah as I located the shelf labeled with the word DISEASES. I started looking at the selection of books, hoping no one was looking at me.  I figured there would be plenty of books on RA this day and age where everybody has written about everything, twice. Ha ha ha. Boy, was I was wrong.  While there were a bazillion books on breast cancer, diabetes, fibromyalgia (surprisingly) and even restless leg syndrome (I'm not kidding. I didn't count them, but there were multiple books on this topic), I could only locate one lone rheumatoid arthritis book on the shelf.  Geez, seems like if I had to get something, couldn't I have at least gotten one of the popular diseases? Apparently not.

I went up to the register to buy it. As I put it up on the counter for the woman to scan, I felt suddenly very self conscious, realizing the cashier would obviously know that I had rheumatoid arthritis because why else would you buy a book called Living with Rheumatoid Arthritis unless you were? And that's when I got my very first deer-in-headlights/pity look. I threw down the cash, grabbed the book, and headed out.

Well, that felt weird and crappy.

I skulked down the sidewalk, not sure what I wanted to do next, and then decided to go get a pedicure. When all else fails, why not? After the flight from hell, version 2, my ankles had joined the swollen joint party that was my body, and my toe was becoming a full-fledged disaster zone, so I figured having them soaked, massaged and coddled was one thing I could do for myself that day that would feel good. Plus,  I could start to read up on this thing that I had, even though that would mean pulling out my book and outing myself in public.

Mid-pedi, my phone rang.  It was my doctor calling back to give me the name of a rheumatologist at Beth Israel who would be taking over from this point forward. I couldn't think of any questions to ask him while I was on the phone with him, and I didn't feel like announcing to the entire salon that I had a chronic illness and had just found out, so I scribbled the name and number down, hung up, and waited for my toes to dry.

Once I got home, I decided I needed to formulate a plan of action. I also decided to keep this news quiet until I knew more about what was going to happen next and had time to absorb the news myself.

I called the rheumatologist's number, but the secretary informed me that he didn't take my insurance. Luckily, another doctor (a woman!) did.  The earliest I could get an appointment with her was in three weeks, which to me seemed very far away since my joints were, according to what I'd read at the nail salon, being eroded and damaged with each passing day. I didn't really know what else to do, so I booked it.

Then I took a big, deep breath. Those three weeks were going to be an eternity.

Having rheumatoid arthritis does not make you virtuous or more responsible

In my first therapy session post-diagnosis (yes, I am in therapy, people. I live in New York-you get one when you sign a lease here), I remember talking to my therapist about how, now that I was 'sick,' I was going to meditate and practice some kind of yoga every day, start drinking alcohol more moderately (I wasn't kidding myself into thinking I'd become a saint and give it up completely unless I really had to), eat only good-for-me foods and suddenly have some kind of grand epiphany and become the lovely, ideal version of me I'd always wanted to be.

If my life were a movie, this would be the part where a great song from the 80's began to play over a fabulous montage sequence showing me, in a fit of self-improvement ala Bridget Jones, smugly throwing away bottles of booze, cigarettes and ice-cream from my apartment. This would be followed by alternating scenes of me buying a slew of 'Why I Love the New, Virtuous Me' self-help books and working out at the gym, becoming slimmer and slimmer (and therefore happier) and magically transitioning into a new, ultra-healthy version of myself who always makes decisions that support my health and whom everyone adores.

Yeah right.  My life is soooo not a movie. I gained 15 pounds after my diagnosis (which is the topic of a forthcoming post), and though I've had plenty of hard core reality-checking moments followed by some smarter-decision-making moments since the onset of my RA, I have not managed to transform myself into a virtuous version of yours truly who does everything right and to the benefit of my health at all times.

Case in point: Last night, I meant to only go out for a drink with two of my friends before seeing a show, then go home and get a good night's sleep. I was even going to tidy up my apartment a bit before going to bed.  Instead, I went out for drinks pre-show (champagne, of course), followed by more drinks afterward, along with some fries dipped in aioli (alright, mayo), and then that turned into a late night drink at our favorite lounge, followed by more drinks and a second wind here. I took a cab home, which I can't really afford to do, spent way too much money and crawled into bed at 3am.

Sometimes I feel guilty and like a total RA-loser for this (even though it really was tons of fun). Obviously, this was a very excessive evening (Mom, I promise most nights are not). It is also only afforded to me now because my meds are working and allowing me to feel like my pre-RA self, because back in December, I would have been dead on my feet by 7pm and burst into tears of true misery if you told me I'd be up until dawn.

When I woke up this morning (without a headache, I'll have you know), I felt remorseful and started to lecture myself about how I should be more responsible and respectful of my health (and of my liver, specifically). Truth is, though, rheumatoid arthritis or not, I'm human, and 29, and want to be able to go out and be a little excessive and go where the night takes me without feeling bad about it.  After all, isn't that why I live in New York City?

Besides, tomorrow, I'm going to drink nothing but purified water, eat bran and organic, locally-grown, green leafy vegetables while practicing yoga and meditation for many hours and have a grand epiphany about the meaning of my diagnosis and everything else in my life.

Or maybe I'll just shoot for something in between.

Chronic Culture, indeed.

After doing some exhaustive hunting around on the internet for others like me, I found this cheeky site today.  If you have any kind of chronic illness, go there and check it out.  It's basically a social networking site for the chronically challenged, whether it's RA, MS, IBS or some other letter combo that might be ailing you.  I'm looking forward to checking more of it out over the next few days!

A tale of two shoes

When it rains, it pours, at least that has been the case in New York City (as in much of the world) for the past two days.  Unluckily, on my way back from physical therapy (with my totally awesome physical therapist, Marco, who just gave me a pedometer, and who totally rocks), I got caught in it.

Now, these are the shoes I should have been wearing:

But, practicality with shoes has never been my strong part, something my ex-boyfriend never let me forget (one more reason to be glad he's gone).  Being diagnosed with rheumatoid arthritis changes you forever, but evidently, it doesn't change everything about you forever.  Now that my meds have kicked in and I'm feeling more human again, my vanity and attachment to cute shoes has resurfaced.

I thought I'd never be able to wear heels again (one could argue that I shouldn't, but let's not go there right now), which might seem like a shallow and stupid thing to lament when your health has just gone kaput, but what can I say, just like my grandmother, I've always had a thing for shoes, so on a day like today, when I wake up and my now infamous toe isn't screaming at me and feels (gasp!) almost normal, and even when the NPR weatherman tells me it's going to rain cats and dogs, these are the shoes I put on instead:

As with so many things in life, though, I did kind of pay for it in the end, because when the sky falls, you do not want to be sloshing around in ankle-deep run off from New York City streets (gross, gross, gross), nonetheless, that is what I did. 

My own damn fault? Undoubtedly.  Worth it to look cute and feel normal again? So far, yes.

*Repost: Getting diagnosed with rheumatoid arthritis over voice mail is way worse than being dumped over voice mail.

In honor of World Arthritis Day, a look back at the onset of my RA and my diagnosis....almost exactly four years ago to the day.

(Originally posted June 15, 2008)

A good month or so after my symptoms had started, I finally faced reality and went to the doctor.  I went to my general practitioner, who was around the corner from where I work. There were a million thoughts running through my head, and I kept trying to get a read on my gut feeling- was there something really wrong with me? Was this all in my head? Would it be something big?

I really couldn't tell how I felt. I sat in the waiting room, hating the fact that I was there but trying to remain casual and pretend like I was there because I had a cold or pink eye. Finally, I was called back.  We went over all my symptoms, he asked me a bunch of questions, and then he took a lot of blood. I always hate that part (does anyone not, though?).

Scary words were tossed out like lupus, lyme disease, rheumatoid arthritis and several others.  He said he should hear by the end of the week, and that I should make an appointment to get my results. Yippee. In the meantime, he had me start taking naproxyn in the morning and evening to help alleviate some of the inflammation and pain.

I trudged back glumly to my office and did what most of us do this day and age.  I immediately googled every disease and ailment he had tested me for, and promptly scared myself into a doomsday version of all the horrible scenarios about to befall me. What if I had all of them? Or what if I had none of them, and it was really all in my head?

Suddenly, I realized that I was hoping he would find something, because it was becoming more and more clear to me that what was happening was not a figment of my imagination.  At this point, my regular yoga practice was nearly impossible because my toe hurt so badly, my wrists and fingers were swollen, and I couldn't lift my arms much above my waist. I tried to breathe deeply and practiced a lot of restorative yoga poses that week, at one point breaking down and crying because I knew that whatever was going on was beyond my control, and I would just have to wait until I found out. There is no fun or witty way to describe this week. I was scared shitless, and it sucked.

(You are probably wondering what the picture above has to do with this post, but relax, I'm getting to that.)

The interminable week finally went by.  I went back to my doctor, who told me some good news: it wasn't lupus or lyme disease (YAY!!!!!!!!!!!!!!!). I immediately ruled out scary scenarios one and two.  My rheumatoid factor levels; however, were slightly elevated above average, so he wanted to do more tests since the results weren't conclusive.  More blood. The results would again be ready by the end of the week or early next. 

Thing was, that Friday, I was heading to Greece- part vacation (boy did I need one-from my life) and part work for a festival that was happening in Athens.  He told me to go ahead and go (honestly, I'd not considered not going- I figured if I was sick, I might as well be sick in Greece), and that if the results came in after I had left, he'd call me and leave a message. That sounded like it would be a horrid way to get bad news, but I wasn't going to call off the trip just to get it in person, either.

So I got on a plane with one of my friends who was coming along, and we flew to Santorini.  The flying hurt, and took forever (thank you British Airways for your terrible delays).  But, the next morning, which was also my 29th birthday, I woke up to that beautiful view above outside the door to our hotel room, and that made things feel a little better, if only visually.

I was in Greece all in all for about 10 days. In hindsight, I have no idea how I managed to get by.  Our hotel was perched on a cliff, accessible only by little bumpy, windy paths, but I walked all around to the different villages as much as I could, and got by alright. I'd be damned if I was going to let this stop me from seeing everything I wanted to see and enjoy being in such a beautiful place.

On about the third day, a voice mail icon appeared on my phone.  I just knew it would be my doctor, and I decided I didn't want to find out while I was on vacation, so I decided to put it off until I was home.  Plus, checking voice mail on my cell phone from Greece would have cost me a lot of money, and I sure as hell wasn't going to pay to be told I had some kind of disease.

I spent the next few days drowning my fears in lots of Greek wine and delicious food, and by the time we got to Athens, I was swept up in the busy schedule of the festival.

Finally though, it was time to go home. This process took a ridiculously long time thanks again to British Airways in what has to be the most miserable experiences I could have had at that point.  We ended up being cordoned off in line for about six hours while they decided whether or not they were canceling or just delaying our flight. (I ask you, does it really take six hours to answer this question?) We ended up getting rebooked, and the only good thing about it was that Anthony Bourdain and his cute production crew from No Reservations had apparently been in Athens filming and were booked on our flight all the way back to New York, so we enjoyed stalking them at the airport, immigration and customs (even in my painful state, I was able to rouse myself for a good celebrity sighting. Hey- I deserved some cheap thrills).

As soon as we got in the cab at JFK to head home, I decided it was time to find out. After all, if I had something, then I already had it, and this would just be a verbal confirmation, in a way. I called my voice mail, and there was my doctor's voice, telling me that the tests for rheumatoid arthritis had come back 'strongly positive,' so it suggested that that was what we were looking at. It was the one test in my life I hadn't wanted to get a high score on.

I think the moment of diagnosis is impossible to describe fully, but emotions I remember feeling included relief (oddly), total shock that something was really wrong with me even though I knew there was, and fear, of course.  And I have to say, hearing that over voice mail had to be the worst possible way to get that kind of news, but there it was.

One week into my 29th year, I officially had rheumatoid arthritis.

I'm just a pill-popping gal who likes to shoot up.

Sundays for me have always served as relaxing, lazy days when I could sleep in, fix a big breakfast with a hot mug of coffee and hang about, maybe watching a movie or reading a good book.

That's exactly what I did this morning, and plan to do for the rest of the day, but with a few delightful additions.  Accompanying that big breakfast are my three daily morning pills: hydroxychloroquine (200mgs), calcium (600mg) and magnesium (250mg- to help with my increasingly frequent migraines). I will also take the hydroxychloroquine again at night, along with another calcium, when I eat dinner. 

I've been on the hydroxychloroquine, aka plaquenil, (originally used to protect against malaria, but it works on RA- who knew?) since November.  I think it helps now, but it was pretty slow acting at first, and wasn't enough of a match for the mighty RA, so in addition to tossing back the pills this morning, I'm getting ready to shoot up again for the second time this week.  I use a drug called eternacept, or enbrel, and I inject 25mg twice a week.  When I first began the shots, I used the more typical 50 mg shot once a week, but I got insane, children-would-run-screaming-from-me-if-they-saw-this reactions at the injection site.  They looked like massive alien welts that had attached themselves to my thigh in order to multiply and take over the world. Definitely a man-deterrent, too (though I am currently on a self-imposed dating strike until conditions improve), and the idea of putting on a bikini in public became even more dreadful than usual.

When I visited my awesome sister and soon-to-be- brother-in-law in February at their home in San Francisco, they got to see one first hand, and it was literally the size of my hand. And repulsive. So about a month ago, my rheumatologist switched me to the 25mg shots, which are sooooo much better, and they hurt less, too.

Taking the pills isn't so bad, though sometimes it's a little awkward when I'm out to dinner with people from work and have to toss it back-though I've gotten pretty slick at doing this without anyone being the wiser.  When I first had to start injecting myself, I was terrified. My brother assured me that it wasn't bad (he's had EMT training and is basically superman, so a little tiny needle is no big thing to him).  I wasn't so sure about that, and masked my fear by making jokes that I was going to bring back the heroin chic look and bleach my hair blond, wear ripped up stockings all the time and smeared red lipstick. (I didn't, FYI).

When I finally got my shots- it took a solid month to coax my insurance company into giving me their approval (meanwhile, I WAS IN CONSTANT PAIN, assholes), I made my appointment with the nurse at Beth Israel (where all the members of my medical supersquad work) to learn how to give them to myself.  The nurse, Lorraine Whitson, was truly remarkable and so kind and patient with me, and I will forever be grateful for that, because having to stick a needle into your flesh for the first time is completely intimidating and scary. There's no getting it wrong.  She let me practice on a rubber ball with a practice needle over and over again until I felt confident to do it to my leg.

And it was kind of like when I got my tattoo in college; it hurt like HELL (not the needle so much, unlike the tattoo, but actually injecting the medicine, which surprised me), but then my body released a flood of happy little adrenaline streams, and I felt all pumped up like a rock star. I felt that way all day and celebrated by going out for drinks that night in white go go boots and breaking into an impromptu concert U2-style. Well, I'm exaggerating a bit, but you get the point.

Now, as my brother predicted, it's really no big thing, and I secretly like it.  It's my little Nurse Nancy moment twice a week, and what I like most of all is the feeling that I am doing something to make myself better.