Rheumatoid Arthritis RA Category

Monday, July 19th, 2010

Misdiagnosed with Rheumatoid Arthritis (RA): My Lyme Disease Story

As some of you may have heard, I just recently found that I was misdiagnosed with rheumatoid arthritis (RA). I have Lyme Disease.

Anyone who has followed this blog probably knows that I thought that I had Rheumatoid Arthritis (RA) for over 9 years. I have always had some doubt about what was going on with my body and the effectiveness of the treatments the doctors were prescribing. But I trusted my doctors more than I trusted my instincts. My story is a cautionary tale for anyone who has been diagnosed with an autoimmune disease.

Let me start by saying that we live in rural Rhode Island. We have a small 3/4 acre wooded lot. All sorts of wild life can be found in our yard at any given time and there is no shortage of deer that visit our property. We moved out here to raise our family in a quiet, serene place with good schools and friendly neighbors. Unfortunately, with the good comes the bad, and the deer carry ticks that carry Lyme Disease.

Each member of my family at one time or another has had Lyme Disease. It is not uncommon to be outside for only a few moments and pick up one of the poppy seed-sized ticks. For the most part we have all either tested positive with Lyme Disease or the tick if we were able to keep it tested positive with the disease.

9 years ago I had been bitten by a tick. At the time, I was tending to my newborn son, and had two older boys to watch over as well. In prior exposures to the disease, I had felt “flu like symptoms” and that was my cue to get tested. I don’t know if it was adjusting to three boys and 2 jobs or if I was just too busy to notice, but I really don’t remember any “flu like symptoms”.

It started with my ankle. It hurt and was swollen so I went to the urgent care center where they X-rayed it and told me they could find nothing wrong with me. The doctor prescribed an anti-inflammatory and gave me and air-cast. We were going with the assumption that I must have sprained my ankle even though I couldn’t remember doing anything out of the ordinary.

The swelling did eventually go down on my ankle but shortly after my knee on the opposite side started swelling. Ice, rest, and ibuprofen seemed to help with the swelling in my knee. Then, my wrist on my left hand began to swell. My husband and I were discussing the weird joint issues I had had over the previous few months when he suggested that I go get a Lyme test. I thought that it couldn’t hurt, so off I went back to urgent care for a Lyme test. The Lyme test came back positive and the doctor gave me zythromax.

Unfortunately I did not get better after taking the antibiotics, so I went back to the same doctor who gave me another course of the same antibiotic. When after finishing the second course of medication and I was not improving, the doctor said to me that this was beyond his level of expertise and I needed to see either an infectious disease specialist or a rheumatologist. He felt that I should start with a rheumatologist because if it was Lyme or something joint related a rheumatologist would be the best choice. He gave me the name of a rheumatologist and sent me on my way.

The rheumatologist seemed nice; he listened to my story and took a medical history. It may be my perception of what happened next, but it seemed to me that the minute he heard that my mother had rheumatoid arthritis (RA) his mind was made up. He told me that more than likely it was RA. He examined me and put me on prednisone immediately. When I asked about the Lyme he said that it was very unlikely that I had Lyme and that he was fairly certain it was RA. He told me the steroids should get the inflammation under control and ordered some blood work.

The blood work came back and showed that I was positive for RA. What I did not know then that I know now is that an active infection like Lyme Disease can affect the test results for RA.  He gave me a prescription for methotrexate, talked to me about Enbrel, and sent me home with a handful of pamphlets.

To be completely honest, I never felt comfortable with the diagnosis, but I somehow talked myself out of trusting my instincts by comparing his knowledge on the subject with mine. His practice was a teaching practice with Brown Medical School and I felt like he should know more than me on the subject. I really trusted that he knew what he was talking about. I have beat myself up for not going with my gut many times over the years on this topic.

Over the next several years I just seemed to get worse. Every time I brought up the fact that I was not really improving he would tell  me that the first several years with the disease are the worse, when the most damage occurs and that we needed to increase the medication. For a while he really had me scared. He would say things like “We don’t want to see you in a wheelchair, do we?”. After way too long I decided to find a new rheumatologist.

I took my time looking for a new doctor. One I went to yelled at me when I told him why I was looking for a new rheumy. Turns out he was friends with the one I left. I finally decided on a rheumatologist who I was told was well versed in Lyme disease.  She had plenty of posters on the walls of the office with picture of both damaged joints and Lyme disease bulls-eyes. I discussed my story with her and she felt I had rheumatoid arthritis as well. She decided to add Plaquenil to the cocktail and that did seem to improve how I felt. The disease seemed to ebb and flow with the increased mtx and plaquenil combination. There was never a time when I didn’t feel sick.

Over the years I have had some symptoms that no doctor has been able to  explain. I have had extreme sensitivity to light and sound. It’s like having a migraine without the headache. I have ear pressure so it feels like I am in an airplane all the time. I have also had other more traditional RA symptoms (i.e.  joint swelling, pain, fatigue)

Last summer everything came to head when Kevin had a bout of the swine flu and I had to go off the methotrexate. I had to take antiviral medication for 3 weeks, and immediately following that I got bronchitis and was on antibiotics for two weeks, followed by 3 more weeks of antiviral medication because Nathan got H1N1, and finally 6 weeks of antibiotics because I got bit by another tick. I tested positive for an active Lyme infection and stayed off the mtx for another 6 weeks. After 14 weeks off methotrexate I felt surprisingly good.

The doctor told me to start back on the methotrexate, and being the dutiful patient I did what I was told. After 2 doses of the methotrexate I felt like I was back in Lyme hell. I went to the doctor and I told her I was not going to take any more mtx. She order more tests, including a new Lyme test. A few days later my primary care doctor’s office called to tell me that I tested positive for Lyme and I needed to start antibiotics. I was surprised that I had not heard from the doctor that ordered the test, so I called my rheumatologist office to find out what was going on.

She told me I did not have Lyme disease. She said that it was a cross reactive protein and ordered more tests. I again brought up the long ago Lyme test that started this RA nightmare and the look on her face scared me.  She looked frightened. She claimed that there was nothing from the previous doctor that mentioned Lyme disease. ( I know now that this was untrue because when I requested copies of my medical records from her office the previous rheumatologist did sent his notes on the Lyme and that he felt it was a false positive.) Over the next several weeks as I felt worse she ordered more and more tests, she managed to rule out quite a few different ailments and still could not explain the Lyme results. Finally, I got tired of being poked and went to see my primary care physician and asked her to put me on antibiotics. She agreed that there was no harm in trying antibiotics and if I felt better than it must be Lyme.

After 2 weeks on the antibiotics I started to feel normal again. After 3 weeks I felt better than I had in years.  The inflammation was almost gone. I walked with a spring in my step. I felt really really good. One day I was going about my daily routine and I stopped myself in mid-stride because it was as if I had been in the situation before. It was the most beautiful deja vu that I have ever experienced. As it occurred to me what I was reliving I began to cry. I felt the way that I did BEFORE. Before the rheumatoid arthritis diagnosis. It was as if time had melted away and that I was the old me, the healthy me. That moment will stay with me forever.

In that moment everything changed for me. I decided that I was going to investigate Lyme disease. I wanted to find out if this had happened to anyone else. What I found was that everyday people are diagnosed with chronic autoimmune diseases that really have Lyme disease because of the ignorance of some of the medical community about what Lyme Disease is and what it can do.

I took my time and thoroughly investigated several doctors. I knew after doing my research that I needed to find a Lyme Literate MD (LLMD). I got references and asked questions about each one. I decided that I wanted the opinion of someone who was respected in dealing with Lyme not only by his colleagues, but also by his patients. After quite a lot of research I found the doctor I felt comfortable with. It took me 2 1/2 hours to get to his office but I didn’t  mind the drive if it meant that I would get some answers. I figured if he told me that I did not have Lyme disease, I would believe him, and I would move on from there. I needed to know once and for all if I had Lyme disease or something else.

I spent 90 minutes with this doctor discussing the past nine years of my life. Every tick bite, every treatment, everything. When all was said and done, he said to me that it was no surprise that I did not feel better after the original doctor put me on a Z pack for 5 days and then repeated the process; it would not have done anything to fight Lyme Disease.  He felt very strongly that after I described all of my symptoms and heard all my treatments that I have Lyme Disease and never had Rheumatoid Arthritis.

I left the LLMD’s office overwhelmed. I could not hold back the tears. 9 years. 9 years that could have been so different. 2 of my children don’t even know what I was like before all this happened. I am angry and sad. I want as many people as possible to know my story because it could be there’s as well. I am not the first person to be diagnosed with Rheumatoid Arthritis that has Lyme disease and I am certain not to be the last.

My new doctor offered no guarantees. He told me that this is going to be a long, hard battle. The very last thing you want to do to treat Lyme disease is to weaken the immune system. We have a lot of work to do. I was prepared for that.

Today I have something now that I did not have 10 days ago.

Hope.

My final thought to anyone that ever had any doubt about whether or not they had been “cured” from Lyme disease,  or had concerns about their current autoimmune disease diagnosis is to trust yourself, trust your instincts, and if it feels wrong it probably is.

As a side note, as of this writing I have been on antibiotic therapy for ten days. The results are that at least half the inflammation if gone from my joints. I don’t need any more proof than that.

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Friday, June 18th, 2010

Innovative New Treatments for Rheumatoid Arthritis (RA)

Gary S. Firestein, MD,  of UC San Diego Medical Center speaks about innovative treatments for rheumatoid arthritis including promising new findings with inhibitors of signal transduction. It is good to know that there are new treatment options on the horizon for those whose current therapy is unsuccessful.  There is not a one size fits all remedy for this disease. I think that it is important to have choices and options.

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Wednesday, June 2nd, 2010

Rheumatoid Arthritis: First Visit With The Rheumatologist

I have to admit I was a little nervous about my first visit with the rheumatologist. I wasn’t really sure what to expect and there was a certain amount of fear of the unknown.  At the same time I was really hopeful that this doctor would help me get back to my old self again.

When I got to the office I realized that this was a practice of 4 rheumatologists and my mother had been to one of the doctors in the practice years before when she still lived in Rhode Island.  At the time I really couldn’t remember if she liked the doctor or not.

The office was clean and the office staff seemed to be efficient and polite.  I filled out all the necessary paperwork and insurance information and waited to see the doctor.  Lucky for me the wait was only about 15 minutes.  The nurse called my name and led me to the doctor’s office.

He was about my age and he seemed very professional.  I learned that the practice was associated with Brown University Medical School and was a teaching practice. He seemed very nice. He asked me a few questions about what was going on with my body. I explained that it all started with my ankle and then my knee and then my wrist.  I told him about the Lyme Disease, that we live in a area where there are a lot of deer ticks.  He asked about family history and I told him that my mother has rheumatoid arthritis.

It may just be my impression, but it seemed that the minute I mentioned that my mom has RA, that was it. There were no more questions, no other ideas as to what was going on with my body.

He then led me to the exam room, where he listened to my heart and lungs and moved all my joints every which way.  He squeezed my finger joints and wrists and then announced that he believed that I had rheumatoid arthritis.

My initial reaction was “What happened to Lyme Disease?”

He said no it was RA.  He said that he wanted to do some more testing but he was fairly certain that it was RA.

I said something to the effect that I thought that Lyme Disease kinda jumped from one part of the body to the next and what about the fact that I had tested positive for Lyme.

He said that with my family history, he really felt that it was RA.  He said that he wanted to put me on some medication that should make me feel better, while he did some testing. He told me to trust him, that he would help me feel better.  That the medication would get me back to my old self again and that he would see me again in a few weeks with the test results.

At the time I was in so much pain and this man was offering some relief.  I decided to have the additional test done and take the medication. It was only for two weeks and maybe this guy could help me feel better.  After all the other doctor wasn’t really helping.  I needed to be able to take care of my baby and I was sure that the tests would show that he was wrong about the rheumatoid arthritis.

He gave me a prescription for prednisone and told me to set up an appointment to come back in two weeks.

My instincts were telling me that this wasn’t right, but I told myself that this doctor was teaching at one of the most prestigious medical schools in the country, who was I to question his expertise.  So I took my prescription and I made my appointment and I hoped that he was really going to make me feel better.

The next part of my story has had the biggest impact on my life.  It has taught me a great many things and I can’t wait to share it with you.

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Thursday, May 20th, 2010

Rheumatoid Arthritis: How My Journey Began

When I started this blog the idea was to talk about what works for someone with rheumatoid arthritis.  I wrote a fair amount of posts about what foods and herbs help to fight inflammation and a few about the products that made my life with RA a little easier.  All in all I have been pleased with what I have shared and learned along the way about RA.  I hadn’t planned on all the amazing women and men that I have met through this blog that have given me strength and support. That was an unexpected blessing.  To all of you I am truly grateful.

It occurred to me that I really have not shared my story.  How I got to where in am now and the questions that I have been wrestling with lately.  I haven’t written much because I was hoping to have some answers to report instead of more questions.

So I want to take a step backward and start at the beginning, because  how I got here is important.   I didn’t know until recently how important.

About 6 months after Kevin, my youngest, was born my right ankle started to swell.  I hadn’t twisted it. I hadn’t fallen.  There seemed to be no explaination as to why it was swelling and why it hurt. So I went to an urgent care center where they took and X Ray and really could find nothing wrong with my ankle.  The doctor told me I must have sprained the ankle and gave me an air cast to wear for several weeks with some anti inflammatory drugs to take and sent me on my way.  I followed his instructions; I stayed off the ankle as much as possible, I iced it and I took the medication.  Eventually the ankle improved.

Almost as soon as my ankle improved, my left knee started to swell and hurt.  I thought maybe that I had been over compensating for the ankle and had somehow thrown my knee out of whack.  I iced the knee and took anti inflammatory medication and rested it as much as possible and it seemed to improve after about a month or so.

Shortly after my knee stopped bothering me my left wrist began to give me problems.  It really hurt and was swelling a lot.  I thought maybe that I had carpal tunnel because I spend a good amount of time everyday typing.  I went back to urgent care and they seemed to agree that this could be carpal tunnel and they gave me some wrist guards to wear.

I wore the wrist guards as instructed, took more anti inflammatory medication  and hoped for the best.

While my body was giving me all this trouble I was trying to raise a 10 year old, a 6 year old and a new baby boy.  I was exhausted all the time, but at 35 I figured that I was not as young as I used to be and now I had 3 boys needing my attention, a full time job and a business to run with my husband.  I certainly had a full plate and there were plenty of reasons for me to be tired all the time.

My husband works outside all the time and Lyme disease is something that I thought we were pretty familiar with.  It was Eric who thought that maybe it was Lyme disease that was causing this joint swelling.  It is typical for Lyme disease to kind of skip from one spot on the body to the next wreaking havoc. So a few days later I was back at the urgent care center asking for a Lyme test.  The doctor asked me if I remembered a tick bite and I really didn’t.  We live in a wooded area and there were many times that I have been bitten by ticks. We are really careful with deer tick and I am fairly sure that if I had seen a deer tick in me I would have been tested immediately.  The thing is some of these ticks are the size of a poppy seed.  It is within reason that I could have been bitten by a tick the size of a poppy seed in a location that I could not readily see and not know it.  It doesn’t hurt when they bite.  So it is completely possible that I could have been bit and not known it. That was really not what the doctor wanted to hear but I was able to convince him to give me a Lyme test.

Anyway to make a long story longer… after about a week the test came back positive for Lyme disease.  The doctor put me on zythromax for 5 days.

After two weeks I was still not feeling better.  My wrist was really bothering me and the swelling was so bad that I actually lost the ability to give a thumbs up.  There was so much swelling in my wrist that the ligament that moves the thumb was lifted from its initial location (because of the swelling) so that I could no longer give a thumbs up.

I went back to the doctor and he put me on another course of zythromax with some new anti inflammatory medication and sent me on my way.  He told me to give it another two weeks and I should be feeling better by then.

By the time two weeks had passed not only was my wrist swollen and painful but now my feet were swelling and my knee was back to giving me trouble again.

When the doctor took one look at me and knew that the current course of treatment was not working.  He said to me that this was beyond his level of expertise.  He said that he could send me to a infectious disease specialist or he could send me to a rheumatologist.  He felt that the rheumatologist was probably the best way to go because a rheumatologist could handle Lyme disease as well as any arthritis issues that I might have. He said that there was a new rheumatologist in Providence that he had heard good things about and he set up an initial appointment for me and wished me luck.

This is how my journey began.

Stay tuned to hear how we progressed to where I am today.

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Friday, May 7th, 2010

Lyme Disease Again.

Just when I thought that I was on my way back from this bad turn my body had taken, I got hit with another setback.

Lyme disease.

Again.

I think the universe is trying to tell me something. I’m just not sure what the heck it is.

It just so happens that May is Lyme Disease awareness month.  Let me do my part to make everyone aware that Lyme Disease is not something to mess around with.  It will make you sicker that you ever thought possible. Even now after way too many times with this dreadful disease, it still amazes me that some little critter the size of a poppy seed could do so much damage to my body. If you are ever unsure if you have lyme disease or not trust your instincts and get treatment.  The sooner the better.

The latest bite my outside exposure was literally less than 1 minute.  I was not in a wooded area.  I was not treking through a meadow.  I walked out my front door, said “Man it’s cold out here.” and I walked back in the house. Hours later, I scratched my leg and found the tick and naturally it was a deer tick.

Outside of living in a bubble I am really not sure how to protect myself and my family from this awful disease.  We have done everything the literature suggests to keep ourselves free from these nasty ticks. And yet here I am again with Lyme disease.

I’ll keep you all posted as I am able.

I hope everyone has an amazing Mother’s Day weekend.

:)

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Thursday, April 22nd, 2010

How I See My Rheumatoid Arthritis

Yesterday I decided to stop by the market on my way home after dropping Nate at a friend’s house.  Kevin and I ran (and I use the term loosely) into the store and picked up a few odds and ends that we needed to get us through the week.

I was lucky and got a good parking space close to the entrance.  I normally don’t mind a spot that is a bit away from the door because it gives me a chance to walk off the stiffness before I actually make it into the store.

While I have made improvements with my walking, lately it is a deliberate act, not something that comes with ease.  Things got complicated when Max, my 110 pound golden retriever ran head first into my knee when he got spooked.  So everyday I have been moving that knee a lit bit more and it is coming along, but it has been slow.

Kevin and I made our way through the market, picked up what we needed and a few things that we didn’t and checked out.  We got to the car and my little helper opened the hatch to the back of the vehicle and helped me load the packages.  When we were finished, he took the carriage to the return spot and hopped in the car.

While he was returning the cart, I was slowly trying to get my sore knee in the vehicle.  It took me a couple of minutes to maneuver myself so that I was not in pain trying to accomplish this simple task. When I had finally got myself situated and started to put my seat belt on, I was startled by the honk of the horn coming from the car beside me.  There in the neighboring car was a little old lady gesturing with her handicap placard, mouthing the words “You need one of these.”

I couldn’t believe what I was seeing.  I was stunned.  It never occurred to me that I might need a handicap placard.  All I could think is “How bad do I look?”

What I did was cry.  I couldn’t help myself.  I just burst into tears.

From the backseat I heard, “That lady is a jerk!”, “You are not handicap.”

I couldn’t even respond to my sweet boy.  I just cried more.  He didn’t realize I was crying and when he did, he unbuckled and climbed in the front with me hugged me and cried with me.  He just  kept repeating “You are not handicap. You are not handicap.”

At this point I had to pull myself together so that I could talk to my son.  We sat for a few minutes and talked about the fact that I can’t do some of the things that other people can do and what handicap means to each of us.  We also discussed that the lady next to us probably had the best of intentions, even though she made me cry.

All of this has made me question, what handicap really means to me.

Am I handicap?

Well yes and no.

Is it more than a physical state of being?

I think so.

Am I not being honest with myself about how my body is doing?

I really don’t know right now.

I am still working on the answers for me.

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Thursday, April 1st, 2010

Rheumatoid Arthritis: Survival Mode

These past several months have been an exercise in survival.  I am feeling better than I have in months, but I still have a way to go before I am at a place where rheumatoid arthritis is not in every other thought.  I have come to a place of survival.

All this down time has made me wonder how many of us are living with this disease and how many of us are in survival mode?

What is survival mode? For me it is getting through another day.  Surviving the day with rheumatoid arthritis.  Not exactly my idea of fun, but I am getting by. I wonder what survival means to everyone else with this disease.  While survival is better than giving up it is not where I want to be.

I am an optimist so I believe that this is just a temporary setback on my journey to living well with RA.  The idea that this survival mode is a permanent situation is not something that I am willing to entertain ever.  I have too much fight left in me to settle for half way.

I am grateful to be out of bed. Two months ago I was flat on my back all day long.  I am grateful that I am able to tackle small tasks on a daily basis so that I feel that I have accomplished something.  But this is not where I want to be.  I know that I have a ways to go and that this will probably take longer that I originally anticipated, but I am in this for the long haul and I am determined to find a new way to live with this disease without adding toxic chemicals to my body.

Here is what I have been doing so far and it seems to be having an impact on my overall wellness.

  • I am monitoring my diet and have eliminated dairy from my diet. I have found out the hard way that if I do ingest something that has dairy in it I will swell. I have been adding and subtracting different foods from my diet to see what is having an impact on inflammation. So far dairy has had the biggest impact.
  • I have been taking Flaxseed Oil (I can’t do fish oil supplements) and Vitamin D daily.
  • I have found that mediation helps me sleep better and makes mornings a little more manageable.
  • I am starting to be able to exercise ( I am using this term loosely because the rate of speed that I walk would hardly be called exercise, but it is movement and more than my body has seen in months.)
  • I am careful about what I eat and have lost over 25 pounds since January 1, 2010.
  • I spend time every day visualizing what it looks like to be free of stiffness and pain.

So far I am improving and I hope to be back to my old self soon.

In all honesty I have felt this bad on methotrexate.  I have had the same levels of pain, inflammation, and stiffness while on mtx so I have been pleasantly surprised at my progress and so far happy with my decision to look for an alternative solution to mtx.  It has made me wonder on more than one occasion how well the mtx was really working for me.

So for me, tomorrow is a new day with new hope for less pain and inflammation and life mode not just survival mode.

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  • Jo-Ann Colburn: Kelly, I will email you the name and address of my...
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