Day 60: it was all going so well

The last five weeks have all been a bit up and down;  some days I’ve felt great and other weeks have been a total disaster.  The last couple of weeks have been particularly bad, however, but until today I just couldn’t work out why.  I knew I hadn’t been ‘pushing’ myself (no base jumping or tiger wrestling) yet the brain fog well and truly descended upon me and I’ve had the energy levels of a snail.

The reason for this became clear, following my third blood test on Monday.  I had a call this morning to say my GP needed to speak to me about my results. I admit I freaked out, just a little.  In my experience, doctors rarely call you at home to tell you anything you’d actually want to hear.  The last such home call I received was from a different doctor, telling me I had to see a neurologist immediately as my life was in danger.  But that’s a whole other story.

A flurry of phone calls ensued between my GP, the rheumatology nurses, the rheumatologist and myself.  Apparently, my white cell count and my neutrophils were crazy low, and this put me at a much greater risk of infection.  I swear I could feel my chest tightening and a tickle in my throat as soon as she told me.

If you so much as cough or sneeze or feel slightly hot or unwell you must come into the surgery straight away, my GP warned me.  But I’ll never get an appointment, I pointed out. Consider this a fast past to get in whenever you need, she assured me, just say you have to be seen as a matter of urgency.

Hmmm, look forward to trying that one out on the bull dogs receptionists who man the surgery phones.  They seem to regard every enquiry for a same-day appointment as a completely unreasonable and unnecessary request.  I once had to throw myself, weeping and wailing across the counter top before they reluctantly ‘allowed’ me to see a doctor.

To cut a long story short, my azathioprine dosage has now been cut by 50mg to see if this will bring my bloods in line.  I’m also back to vetting all my visiting friends in case they or their offspring are infectious or sick.  My melodramatic self is now picturing having to live in a vacuum packed bubble for the rest of my life.  Yes I know, I’ve already told myself to get a grip on reality and calm down.

Rewind to Day 20.

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Why is Lupus so difficult to diagnose?

Lupus is a chronic and complex disease that can throw up many different and often bizarre symptoms – symptoms that can vary greatly from person to person and often randomly come and go over weeks and months.

It’s known as ‘the great imitator’ as many of these symptoms mirror those of other, far more common conditions.  This makes the little bugger that much more difficult to diagnose.  To make things trickier still, there is no single laboratory test that can determine if a person has Lupus, and a test result may be positive one time and negative another time.

It’s safe to say that this certainly isn’t the most helpful or cooperative disease to have!

Before you can be branded with that great, big, ugly, Lupus stick, the doctors will have to look at your current symptoms (there are plenty of these for your body to pick and choose from), your blood test results, your full medical history and the medical history of your close family members.

The blood tests are used to assess your general state of health, check if you have an infection, see how well certain organs, such as the liver and kidneys, are working and screen for certain genetic conditions.

The first test off the starting block is the erythrocyte sedimentation rate (ESR) test, to determine whether there is any inflammation in your body.  This is quite a useful little indicator as Lupus has a habit of making various joints and organs swollen and inflamed.

Next up is the anti-nuclear antibody test (referred to as the ANA test)  the test you will probably hear about the most.  This test is to check whether there is a certain type of antibody cell in your blood, known as the anti-nuclear antibody.  Approximately 95% of people with SLE have this antibody, but it’s also possible to have the anti-nuclear antibody without having SLE.  In other words, this test needs even more tests to back it up. Useful!

Following in hot pursuit is the anti-DNA test, which also checks for a certain type of antibody in your blood, known as the anti-DNA antibody.  Sadly having this antibody means chances are you do indeed have SLE.  Of course, the level of anti-DNA antibodies increases if you’re having a flare-up, so that can be pretty changeable too. Oh yes, and the antibody is only found in around 70% of people with the condition. Even more useful still.

Finally, there’s the complement level test.  Complement is a chemical in the blood that forms part of your immune system. The level of this chemical may be tested to check how active your SLE is. The levels decrease when your SLR  is more active.

All test results will probably be sent directly to your GP and your rheumatologist to mull over.  In all these years no one has ever bothered to tell me what the results have been, possibly because I’m only the patient on a need-to-know basis,  more likely  because I wouldn’t have a clue what any of them actually mean.

I’m just a humble little patient, not a doctor, so to read more in-depth info about the different laboratory tests required, you might want to have a nosey here.

Of course, the tests don’t stop once you’ve been diagnosed.  Once you have SLE it is possible to develop other conditions, such as kidney problems, so regular monitoring will be necessary to check for any changes or complications.  Certain medications also require regular testing to make sure everything still working as it should do.

You may also need to have scans, such as an X-ray, ultrasound scan, magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan to check whether SLE is affecting your internal organs.

All-in-all it can often take years for a Lupus diagnosis to be made.  To hurry up the whole painful ordeal it certainly helps to find yourself a sympathetic, empathetic and medically clued-up doctor who will take your symptoms seriously, and then move heaven and earth to get you treated.

Happy hunting and good luck!

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‘It’s not lupus – it’s never lupus’

On the US TV show House M.D, trying to diagnose lupus became something of a long-running joke.  ‘It’s not lupus – it’s never lupus‘ became something of a catchphrase for Dr House.

It took until episode 408 before a case Lupus was finally diagnosed.  That just about sums up how long it takes in real life!

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Day 20: light at the end of the tunnel

Twenty days in and things are definitely looking up.  Not only am I feeling almost human again, I no longer look like an extra from Thriller.  

I’ve gone up to my final daily dose of 150 mg and I had my first blood test on Monday. Thank heavens my local nurse is better with the needles than the last one, as I’m going to be seeing an awful lot more of her going forward.

The best news so far is that (fingers crossed, wood touched) some of the excruciating pain from my hands and arms seems to have calmed down a little. This in itself is a monumental moment as I’m now able to push doors open, pick up a cup of tea and hold my husband’s hand without wincing and grimacing. Understandably that last one was starting to give him something of a complex!

My energy levels are still on par with a hibernating bear, but baby steps and all.  I’m reminding myself that first and foremost I was put onto the Azathioprine to help with the pain, so anything else that improves is a bonus.

Rewind to Day 10. Fast forward to Day 60.

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Day 10: feeling bleurgh

A week and a half into these meds and I’m feeling absolutely bloody awful.

Skin tone for today is at least fifty shades of grey, with a dash of sickly green thrown in for good measure.  If Farrow & Ball were to name the colour, I’d say it would probably be a toss-up between ‘Deathly Pallor, ‘Decaying Corpse’ or ‘Watery Vomit’.  To make matters worse, my skin is also purging a year’s worth of impurities.  This ain’t good and it sure ain’t pretty.

Things don’t improve much from the neck down.  All four limbs feel like they’ve been encased in concrete and my bones continually ache.  Random sharp pains are jabbing me in the back.  My hands are sore and all scrunched up like arthritic old claws.  Body temperature wise I’m fluctuating between early menopausal flushes and Arctic chill.

I think my brain has short-circuited;  it’s spluttering along on just the one cell. The most it can deal with today is TOWIE, and even that’s proving a struggle.  God help me, I am in trouble.

Yup, it definitely feels like I’m grinding to a halt here. What the hell is happening in there?  And how much worse does it get before it starts to get better?

Rewind to Day 7.  Fast Forward to Day 20.

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Day 7: troublesome hormones & tardy tooth fairies

It’s now a week since starting the Azathioprine and there’s still no sign of the green scaly skin, tail or special powers.  More importantly, there’s still no sign of nausea either.  The dosage does however double today, so there’s still the chance I’ll be inhaling ginger biscuits by bedtime.

I had yet more interrupted REM sleep last night, though this time is was down to a 2am tooth fairy panic.  Mid-dream I suddenly remembered that the bloodied offering from my son was still sat awaiting collection at the end of his bed.  Tempting as it was to blame this on a tardy Tinkerbell, I staggered downstairs to fetch a coin and write a fairy thank you note.  Admittedly I could have skipped the note (this bit involved bright lights and a hunt for a pen) but tiredness is never an excuse for bad manners.  By the time I swapped the canine for cash and returned to bed I was wide awake.

So here I am, still feeling dog tired and looking rough. Of course, there’s nothing unusual about that.  It’s a Lupus + chronic fatigue + monthly hormone thing. Obviously I didn’t (but probably should have) calculate exactly what time of the month it was before starting these new pills.  This being the week I normally sleepwalk through the day and neck painkillers like smarties for the pain in my hip.  Incidentally, I’m still waiting for a doctor to explain to me why my overactive monthly hormones cause me to flare up in this way.

Normal tiredness aside, my body has felt extra rung out this week;  more battered around than usual.  My head has also felt a little extra woozy and a lot foggier in the brain department.  But all-in-all, physically speaking, everything seems to be going OK so far.

Perhaps the hardest bit to deal with has been knowing I’m on this stuff. It’s the unnerving knowledge that my immune system will now be ‘suppressed’ and my body is much more vulnerable to attack.  I’m already eyeing up everyone who coughs and sneezes within a 100-metre radius; to me, they’re a potential threat.

Being this tired every day means you spend rather a lot of time horizontal, dreaming up one possible undesirable scenario after the other. I am currently picturing my already traitorous blood cells (who throw all of their energies into attacking their host body), now picking up their placards and going on a strike.  And without them, my body becomes an unmanned, unprotected hotspot for every passing bacteria, germ, and virus looking to invade.

How can this scenario possibly end well?! Now, where did I put that face mask?

Rewind to Day 3. Fast forward to Day 10.

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Day 3: looking like death

What a difference 50mg of something horrible can make.

Last night I woke up at too bloody early o’clock.  From 4am to at least  5.30am, I lay there, panicking because I couldn’t get back to sleep.  It didn’t help  that my husband had hijacked half my pillow and the dog was talking in his sleep.

Unsurprisingly I woke up this morning looking and feeling like absolute shit.  Death warmed up, I think would the appropriate terminology.  Actually, make that death warmed up, reheated, eaten and then regurgitated all over the floor.

Had someone come to my front door today they would have been greeted by a yawning, pale and clammy looking individual with puffy hamster cheeks (my husband’s words, not mine) and eyelids that drooped below my eyelashes. Definitely not a day for selfies, that’s for sure.

Having felt pretty good since starting the Azathioprine on Monday,  I’m hoping today was a result of sleep deprivation, not a sign of things to come.  On a positive note, there’s still no sign of the nausea I was dreading.  I’ve already put in 8 collective months of morning sickness over the years so I can well do without any more of that, thank you very much.

Rewind to Day 1. Fast forward to Day 7.

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Day 1: down the rabbit hole

Ok, enough with the faffing.  My level of indecision has reached such ridiculous heights it’s threatening to bring on my vertigo.  I’ve finally decided to grow a pair, take the damn pills and sit back and see.  Just how bad can it be?

SickandalwaystiredAzathioprineA couple of things helped me make up my mind.  First up was the feeling that I was being selfish.  If Azathioprine offered a shot at living a more ‘normal’ life,  then I certainly owed it to my children to give it a go.  This could be my chance to stay awake for what’s left of their childhood before every one of their memories involves a sleeping mound under the blanket.  It’s time to think and act in the present.  Any worrying health problems that may lurk in my future (or my overactive imagination) will just have to be dealt with further down the line.

Secondly,  I asked the advice of those ‘in the know’.  No, not doctors, those with more of a clue.  Medical professionals may be trained and have letters after their names, but in all seriousness, who’s in a better position to tell you how it is:  someone who dishes out the toxic tablets but doesn’t ingest them or the poor sods who already take them.

With this in mind, I sent out a plea for advice on a Facebook Lupus page.  Straightaway I was inundated with positive replies, encouragement, and reassuring advice.  There was just the one negative response, citing liver damage, so I quickly skimmed over that before my paranoia had a chance to take hold.

‘Take it, do it’  was one person’s advice. So this morning I did.

I felt a little bit like Neo inThe Matrix.  If I take the green pill, I get to stay in Wonderland and see just how deep this rabbit hole goes.  Here goes nothing.

Matrix Neo Chooses The Red Pill

 

 

 

 

 

 

I’m not quite sure what I was expecting to happen after I swallowed it.  A drum roll perhaps? Or maybe for my skin to turn green and scaly and a forked tail to suddenly grow?  After months of worry and stress, it all felt like something of an anticlimax.

Perhaps the biggest let down was finding out that despite disappearing down the rabbit hole, I’m still unable to move in slow motion, stop bullets mid-air or walk upside down on the ceiling.  I reckon Morpheus was dealing much stronger stuff than my rheumatologist can lay his hands on… Fast forward to Day 3.

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Lists v Lupus

I love writing lists, always have. Getting things achieved, ticking them off and giving myself a smug pat on the back at the end of the day.  Some weeks the lists are the only way to get anything done; they motivate me out from under the blanket and away from Come Dine With Me and Escape to the Country.

Today was a good day and I started off with more energy than usual.  It’s fair to say I was positively brimming with great intentions.  So I made a list, quite a long one in fact.

Things to do ranged from the quick and easy ‘clear up breakfast’ and ‘reply to email’ to the slightly more ambitious ‘make soup’, ‘do washing’, ‘sort legs’ (tired shouldn’t really be an excuse for hairy) and ‘put stuff on Ebay’.

This last item on the list was probably the most unrealistic delusional challenging of all, due to the ever-growing stack of unwanted clothes in the corner of the room.  A stack that now looms so large it threatens to permanently flatten the pile of the carpet underneath.

Unfortunately, by the time I’d finished my first tea of the day my ‘great intentions’ threw in the towel and decided to lay down for a rest.  So eight hours later there was only one item crossed off my list.  Not bad you might think until you learn the only completed task on my list was to ‘Make a List’.  At least I did that well.

The important thing to remember (as my husband keeps telling me) is not to get too frustrated; to accept my limitations and pace myself.  Live like a sloth, basically.  I think it’ll take me a while longer to recognise what my body can and can no longer do.  I am however happy to accept that everything on today’s list can always be done tomorrow.  Or the next day.  Or even the day after that.  Or failing that, by somebody else altogether!

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Pointless questions and shiny new drugs

Had my twice-yearly Lupus MOT yesterday, and as ever I went in armed with plenty of questions and came out with even less of a clue.  Realistically low expectations successfully achieved again.

The annoying thing was I actually look forward to these appointments, bizarre as that may sound.  After months of pain there’s always a sense of hope to be had when speaking to someone in the know; in this case, it’s my rheumatologist.  Also known as my go-to dealer with a prescription pad offering a choice of pick-me-up injections and ever stronger pills and drugs.

So armed with a pot of warm wee and my kindle I trotted off to the hospital with a slight bounce to my hobble.  Breaking with NHS tradition there was no queuing for me that day.  I was whisked onto those weighing scales (I wish they’d let me take my boots off, they’re really rather heavy) and into pole waiting position within minutes. So far, so good.  My positive attitude went up another notch.

“So, how are you feeling?” he asked.  What an unoriginal question, can’t these doctors at least make the effort to jazz it up a bit.

“Not great, tired as usual.”  My standard Lupie reply.  Then I realised I best seize the moment, so I got into my stride. “Actually, I’m continually exhausted, I struggle to stay awake and I’ve had to give up my job.  I’ve got horrible pains in my arms that leap from joint to joint, my bones feel bruised and my skin is too sore to touch.  I recently spent two days being prodded and poked by four different hospital departments and I seem to bleed at the drop of a hat. Oh yes, and my hips still hurt when I walk.”  I was quietly pleased with this synopsis, especially given the diminishing state of my memory.

“Well, your bloods aren’t looking too bad, have you been overdoing things perhaps?” I gritted my teeth.  Have I been over doing it? Hmmmm, let’s think.

(In the words of Craig David) I went swimming with sharks on Monday, scaled the side of a mountain on Tuesday, entered an Iron Man triathlon on Wednesday, base jumped the Shard on Thursday and wrestled a tiger on Friday.  The weekend was mainly a quiet affair.  Just a few body pump classes and a bit of caber tossing up North.  No, I don’t think I’ve been overdoing things at all.

“I’ve barely left the house,” I said, “I did, however, clear out a kitchen cupboard last Thursday (after the Shard jump) and it took me 5 days to recover.  Does that count as overdoing it?” No, I didn’t think it did either.

You see, here’s the frustrating thing about this shitty little disease: bloods tests can often lie. On paper I shouldn’t be feeling any worse than I did before, but in reality, I feel like crap, I hurt all over and staying vertical is a perpetual struggle.

The doctor’s solution on this particular visit?  Firstly a possible new diagnosis to add to the list (fibromyalgia) and the suggestion of some different drugs to try.  Part of me was rather pleased to make a bit of progress.  Part of me was thinking ‘Jesus, how can I possibly consider this progress and why on earth am I pleased?’  But that’s the nature of the beast I guess; sometimes it’s just nice to have a new name to put the pain.

So next up to the table is Azathioprine, an immunosuppressant drug used to prevent organ transplants from being rejected.  From my so far limited research, it works by suppressing or reducing the strength of the body’s immune system.  In the case of Lupus this is meant to help calm down the pain and fatigue.  Of course, the downside of suppressing or reducing the strength of your body’s immune system is that it also makes an already defenceless body even more susceptible to every blinking germ, bug, and virus that’s floating around.

As far as I can see it’s a toss-up between ‘exhaustion and pain’ v ‘hot and cold running infections’.  What a cheery choice to make.

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