Tag: H1N1

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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Tuesday, September 8th, 2009

Autoimmune Diseases and Flu Season: H1N1 (Swine Flu) and Seasonal Flu

Every time I turn around lately someone is talking about the swine flu (H1N1). There have been outbreaks on college campuses around the United States and with kids back to school everyone is a little nervous about what germs they may bring home. The vaccine for the H1N1 Swine flu won’t be available until October and the seasonal flu vaccine has only been available to selected clinics and doctors so far.  It is entirely possible that even with the vaccine, many people will catch the flu.

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Let’s face it even if you do everything  right there is a chance that you can get swine flu or the seasonal flu.  Hand washing seems to be the best line of defense and my kids tell me that there are hand sanitizer dispensers in every classroom.  The local schools seem to be doing everything they can to prevent an outbreak, but unless you are living in a bubble there is still that chance that you or the people that surround you will become sick. It is entirely possible that many will come down with swine flu before the proper agencies are even able to get the vaccine to the people that would benefit from it most. So I thought I would talk about what to do if you actually come down with this strain or any other strain of flu.

Firstly, you are not going to know if you have H1N1 or the regular seasonal flu. The symptoms of this and any other strain of flu virus are sudden onset of cold like symptoms. Fever (over 100 degrees), chills, headache, dry cough, runny nose, lethargy, body aches are the most common symptoms but sore throat, nausea, vomiting and diarrhea have also been reported. If you or anyone that you are living with is experiencing these symptoms, get to the doctor right away.

The sooner you see a doctor the better.  Anti-viral medications such as Tamiflu must be taken within 12-48 hours of the onset of symptoms to be effective. Tamiflu can help to reduce the duration of the symptoms of the flu up to 30%. Tamiflu is also prescribed for the prevention of the flu if you have been exposed to someone who has been diagnosed with the flu. This is particularly important if you have a compromised immune system.

If you are unfortunate enough to catch the swine or seasonal flu, there are many over the counter flu remedies that may ease your symptoms. Make sure to check with your doctor or pharmacist before starting any over the counter remedy because it may interact with any prescription drugs you are taking.

The most important thing you can do for yourself when sick with the flu is get plenty of rest. Having experienced the flu first-hand I can tell you that your body isn’t really going to want to do anything but rest. Make sure to get plenty of fluids when dealing with the flu because dehydration will only make you feel worse and may slow down the healing process.

If your symptoms do not improve or start to get worse, see a doctor right away. Many people with autoimmune diseases have a more difficult time fighting the flu because of the treatments for their disease often weakens their immune system. If you are experiencing shortness of breath, having difficulty breathing, experiencing chest pains as a result of coughing or are coughing up yellow, green or bloody phlegm get to a doctor right away.  These may be symptoms of a much more serious condition.

Secondary infections as a result of the flu include sinus infections, bronchitis, ear infections and pneumonia. Some secondary infections may result in hospitalization.  It is vitally important to listen to your body and if there is any indication that you are not improving call the doctor.

It can take up to two weeks for a healthy adult to get over the flu.  If your immune system is compromised it probably will take longer. Most people with the flu recover completely within a reasonable amount of time, but there may be lingering symptoms such as a cough and general weakness.  It is important that if you are unsure about any symptoms that you are experiencing that you contact your doctor and do not hesitate.  It is much better to ask to see the doctor and have it be a relatively small issue than hold off and wait to see a physician and have it be much more serious and harder to treat.

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Monday, July 27th, 2009

Rheumatoid Arthritis:Had to Throw a Pity Party

As some of you may know, the past few months it has been one thing after the other around here.  We had one person after the next with the swine flu; all the while I have been dealing with the effects of lyme disease and rheumatoid arthritis with no RA meds.  The doctor took me off the medication so that the Tamiflu stood a chance of helping get rid of the H1N1 virus that had overtaken my house. All that was fine and as far as I can tell worked well, but the consequence of all this is that my hands are really swollen and painful once again.  On top of my hands being swollen, painful and holding on to anything is next to impossible, the effects of the lyme disease have left me with unbelievable fatigue and muscle soreness.

I have done my best to just accept that for the time being this is what my reality is and I know that it is a temporary situation.  I am usually pretty good at dealing with this sort of thing because I know that it is out of my hands.  There is only so much I can do right now.  I am drinking water like it is going out of style.  I am staying away from my known trigger foods and Lord knows I have been getting a lot of sleep.  I have been meditating and exercising the joints that aren’t painful. I am doing everything I know to do to improve the quality of my life and yet it is still very hard.

Yesterday I fell apart. I am really not sure exactly what set me off. Was it my husband asking “Why are your hands so swollen?” which to me seemed like the dumbest question ever. Was it when my son innocently asked me to play a game of badminton outside with him? I would have loved to play but my hands couldn’t grip the racket. Was it when I was attempting to make breakfast and I couldn’t even crack the eggs and needed to ask for help?  Maybe it was all of that and more.  I suppose it really doesn’t matter what set me off, but I just started crying.

What started as a trickle streaming down my cheek turned out to be an all out torrent of tears.  For the next hour I cried, I blubbered, I wept and I felt really sorry for myself.  This disease is so hard, sometimes harder than I can often put into words.  It takes me away from all that I want to do sometimes.  It is painful and when I am in pain I am not my real self.  It distracts me from what I truly want to be doing.  Sometimes, and yesterday in particular, it feels like it is something separate from me that is demanding my focus,  demanding my attention.  Like a spoiled child that will do whatever it takes to get what it wants.  And so with my mounting frustration and anger and pain, I cried. And I cried. And I cried. And then I cried some more.

And when I had gone thought the better part of a box of tissue and I felt as though I had no more tears I cried a little more. After a good long time of wallowing in my self pity, I started to feel better.  I really think I just needed to get rid of some of the frustration and anger and sadness.  I felt it all and had cried it all out of me.  I can’t begin to express how much better I feel.

My hands are still swollen and I am typing this with three fingers, but I feel so much better.  I had forgotten that when the disease was new and the emotions that come with it were new, every once in a while I would have a good old fashioned pity party.  I wouldn’t want it to be a very long party, but every once in a while, when the disease got the better of me I would just let it all out and I always felt better.  I wanted to share this so if you are feeling like I did maybe a good cry will help you feel better like I do.

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Monday, July 6th, 2009

H1N1 (Swine) Flu and Autoimmune Disease: An Update

This is an update on the status of the H1N1 ( Swine ) Flu information since my post on Swine Flu and Autoimmune Disease (click here to view previous post).  One June 11, 2009  Dr. Margaret Chan, Director-General of the World Health Organization (WHO) announced that the World Health Organization(WHO)  raised the worldwide pandemic alert to a Phase 6 ( also known as the pandemic phase).  This phase is characterized by community level outbreak via  human-to-human spread of the virus in multiple parts of the world.

Currently more than 70 countries have reported cases of H1N1 (swine flu)  infection.  This number has been steadily increasing in recent weeks.  The World Health Organization’s (WHO) decision to raise the alert level to Phase 6 means that the spread of the disease is worldwide.  At this time it is unclear how serious or intense this pandemic will be.  It is difficult to predict how many people will become infected and how serious the complications from this disease will be..  Because this is a new strain of the influenza virus many people have little or no immunity against it.  As of this post there is no vaccine to protect against the H1N1 (Swine Flu) virus. However the U.S. Government is taking steps to process and manufacture a H1N1 (Swine Flu) vaccine.  The CDC (Centers for Disease & Prevention) has isolated the virus and has made a candidate vaccine which will be used to create the vaccine.  It generally takes several months to complete the process to make a vaccine.

Countries in the Southern Hemisphere are just beginning their influenza season.  Information obtained from the Southern Hemisphere countries experiences during their flu season may provide valuable information to Northern Hemisphere countries in preparation for it’s own flu season

All 50 states in the U.S.,  the District of Columbia and Puerto Rico have reported cases of the H1N1 (Swine Flu) virus.  Most people in the United States that have become ill with the H1N1 virus have recovered without medical treatment.  Currently 33,902 cases of the H1N1 (swine flu) virus have been reported in the United States with 170 deaths reported. The Centers for Disease Control & Prevention (CDC) does anticipate that there will be more new cases of this virus reported, more hospitalizations  and more deaths associate with this virus in the weeks to come.  The CDC anticipates signification illness associated with the H1N1 (Swine Flu) virus in the fall and winter months which is typically the U.S. influenza season.

The CDC ( Centers for Disease Control and Prevention)  has issued priority use for antiviral drugs during this outbreak to treat people that are at increased risk of severe illness and those hospitalized with the H1N1 virus.  People at high risk include young children, people with chronic health conditions such as diabetes, asthma, metabolic disease, lung, heart or kidney disease or those with weakened immune systems and those with neurologic or neuromuscular disease.

The CDC has provided information on what to do if you become sick (click here for link ) and how to care for someone who is sick with the virus at home.(click here for link)  The most important thing that you can do right now is to stay informed.

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Thursday, May 28th, 2009

Can Rheumatoid Arthritis Drug Fight The Flu?

 

In a study funded by the National Institutes of Health (NIH) and Bristol-Meyers Squibb, researchers at the University of Maryland School of Medicine have found that  Abatacept (Orencia)  a drug for the treatment of rheumatoid arthritis and manufactured by Bristol-Meyers Squibb, reduced the severity of  illness and death in mice exposed to the Influenza A virus.  This may provide a new treatment for the influenza virus that would cut down on the immune response to the virus and still maintain the protective effects.

 

This drug does not interrupt the immune system’s attack in the lungs which helps to kill the virus, but it prevents the T-cells from overreacting which can make you feel sick and can lead to pneumonia. This “overreacting” immune response is most often found in young healthy people and is thought to be the leading cause of death from pandemic strains of flu.  It is thought to be true in the early cases of the H1N1 (“swine flu”).  Currently this drug is not approved by the FDA for treatment of influenza.  It is however approved for the treatment of rheumatoid arthritis.

 

The researchers tested the effectiveness of this drug on mice.  After the mice were injected with a lethal dose of the influenza A virus, the survival rate for the treated mice was 30% higher than the untreated mice.  The treated mice recovered faster and suffer less lung damage than the untreated mice.  The scientist found that treating the mice with Abatacept (Orencia) minimized the amount of tissue damage caused by the immune response and still enable the body to fight off the virus.  Treatment with Abatacept (Orencia) made a significant improvement to the survival of the mice infected with the lethal dose of the virus.  The survival rate was 80% for the treated mice verses 50% for the untreated mice.

 

There are three types of seasonal influenza,  A, B and C. There are numerous subtypes of Influenza A including the new strain H1N1 also known as the “swine flu”. Currently vaccination is the most effective way to prevent infection with the virus.  The antiviral drug, Tamiflu can help to prevent the virus from spreading in the body if it is taken within the first 48 hours of the onset of symptoms.

 

 

 

 

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