Tag: rheumatologist

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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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, January 21st, 2010

Rheumatoid Arthritis: What Six Months of Sickness Has Taught Me.

The past 6 months have been somewhat like a bad dream.  I never could never have imagined being sick for this long with so many different ailments.  I can’t help but wonder if all the years on methotrexate had such an effect on my immune system that everything kind of shut down for a while. With all this down time I have had the opportunity to learn somethings about myself.  I thought I would share some of what all this sickness has taught me.

  • Trust your instincts. When two of my doctors had conflicting opinions on whether or not I had a second or continuing Lyme infection I should have trusted my instincts.  I could have saved myself valuable time and pain and not have subjected myself to way too many diagnostic tests had I just trusted my gut.  I know my body better than anyone else and I knew that I still had Lyme Disease. I shouldn’t have allowed my rheumatologist to talk me into more tests to prove that her opinion was right when I knew deep down inside all I really needed was another treatment of antibiotics.  When I finally got the antibiotics was when the symptoms went away and I started to feel better.  Lesson learned. Again. I hope this time it sticks.

  • Lyme Disease is something to take very seriously. I have had Lyme Disease in the past.  I thought that I knew and understood what this disease could do.  I could not have been more wrong.  I have never in my entire life felt more physically ill than I did with Lyme Disease.  I can’t say whether or not the Rheumatoid Arthritis (RA) had an effect on the severity of the Lyme Disease but I know that the treatments for the RA had an effect on how well my body was able to handle Lyme Disease.

  • I need to nourish my body and my soul. I have always been the one who puts everyone’s needs before mine.  It wasn’t a conscience decision, but none the less other things took priority in my life. Now every day I am slowing down and taking time to do things that nourish my soul.  Things that bring me joy nourish my self. I find that I have more patience and energy for other things after making my self a priority. Before I put anything into my body I am asking myself will it nourish me or fill me.  They are two very different ideas. I have tried to eat responsibly in the past, but I haven’t always looked at what I am putting into my body as nourishment as opposed to something that will fill me up.
  • Don’t be afraid to ask for help. Being an independent person and a bit of a control freak I frequently would rather do something myself than ask for help.  Part of me just didn’t want RA to get the best of me.  I felt like it was a bit of a battle of wills.  I wasn’t going to let RA take over my life completely, I could do most things myself and I hated to ask anyone for help.  Being as sick as I have been, I have had no choice but to ask for help.  There were days when getting out of bed to go to the bathroom was an ordeal.  An extremely painful ordeal.  It was simply impossible not to ask for help with some of the most basic of needs.  I discovered that the world did not end and it was okay if things were not done “my way”.
  • A clean is nice but really not all that important. I used to care very much about how clean my house was.  I felt that how my house looked was a reflection on me and how I cared for my family.  I know that sounds a little nutty but that is how I felt.  I really felt like I could not physically do a great many things anymore but I could take care of my family and a clean house was part of that.  Of course now looking back I can see how crazy that whole idea sounds.  My house currently is picked up. No one is going to trip over anything in my house, but it is a far cry from clean and I really don’t care.  I could spend the next few hours cleaning, or I could spend the next few hours playing with Kevin or reading a good book.  Now I choose something that will fill me up instead of depleting my resources.

  • Connecting with other people that know and understand what it’s like to have RA is important. Knowing that I am not alone in the day to day challenges that this disease brings has helped me in so many ways.  There is comfort in knowing that there are people out there that completely understand what I am going through.  I am very grateful to all the new friends that I have found here and for their kindness and support.
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Wednesday, June 24th, 2009

Rheumatoid Arthritis: Redirecting My Focus.

I have watched the Star Wars movies over the years many times.  At one time or another each one of my boys has gone through a Star Wars faze when they want to watch all of the Star Wars movies over and over again.  I have seen them all many times. The past few times I have to admit I probably was doing something else while one of the boys was watching.  Kind of a been there done that attitude.  They are all good movies but my attitude was I know how it all ends so maybe I’ll direct my attention to other things while he (which ever boy that may be at the time ) enjoys the movie. This morning was no different  when the sky was gray and it was still raining outside my youngest, Kevin asked if he could watch Star Wars – Episode I – The Phantom Menace. Not a problem. In the movie went. My thought was the house will be quiet for a few hours with the two younger boys being separated while Kevin watches this movie.

I was sitting in the room with him paying some bills and tending to some email’s that needed my attention when I heard the most profound words…..The character Qui Gon is speaking to Anikan Skywalker and he says “Just remember,  your focus determines your reality”.  I stopped what I was doing and just sat there.  I repeated the words “your focus determines your reality”  All I could think at the time was. Yes. That’s it. That is exactly what has happened for me.

There was a time in the early days of the disease when my focus was on my limitations . That was all I could see, what I could no longer do.  I spent a great deal of time feeling sorry for myself and worrying if I would end up in a wheelchair or bed-ridden.  It was a really dark period of time for me and the more that I focused my energies on fear and pain the worse it seemed to get.  I had very little confidence in my rheumatologist at the time and it certainly didn’t help my state of mind whenever I questioned him about my course of treatment he would say things like “We don’t want to see you in a wheelchair, do we?  He seemed to be echoing my worst fears.

I took me several years to work up the courage to take my life back.  I read really good books that helped to change my perception of myself.  I did something that at the time was very uncomfortable for me and accepted help from anyone and everyone who offered it.  I slowly changed my thinking from what I could no longer do to what I can still do.  Every day I had to make a conscience effort to focus on the good in my life so that goodness started to become my reality.

It was not an easy transition.  I had to take a hard look at what was really important to me and I had to address what it would mean if my worst fears were realized.  Would it change who I am as a human being if I did end up in a wheelchair?  It would certainly change my reality. Things would be very different for me and my family. But would I as a woman, as a mother, as a life partner be different?  The answer came back yes and no.  Physical changes would limit my ability to do things and because of that my life would change, but fundamentally who I am would not.  I would still love my family with abundance and still share with them all my joy and happiness.  And when I really, really thought about it I came to realize that this body, my body,  is just a vessel.  Sometimes it is a little rough around the edges but still just a vessel housing the who that I am.  And most importantly I am so much more than this body that I have been given.

I still wake up every morning stiff and sore.  But my immediate thoughts are not on how the stiffness will limit my day.  My first thoughts are what will today bring? What is on the agenda for the day?  Where is my husband so I can give him a kiss?  What a nice morning hug from my Kevin  that was. Most importantly  I am so grateful for having been given this day. It has made monumental effects on my life and how I live it.

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Friday, June 5th, 2009

Check Your Prescription Bottles Carefully!

Correct R/X Label

Correct R/X Labels

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Incorrect R/X Label

A few weeks ago I decided to try ordering a refill for my prescriptions online. I ordered the refill from the same pharmacy chain that I always use just the online branch instead of the brick and mortar store.   Because we live in a rural area and it is bit of a pain to make a special trip for refills I thought that I would save myself some travel time and some gas money and just order the refill online and have the medication mailed to me.  I have ordered refills online in the past, but I have always driven to the pharmacy to pick up the refill.

This was the first time I had tried to have the medication refilled and delivered to the house.  The process online was fairly easy and straight-forward.  I just had to input the prescription number and within 7-10 business days I could expect to receive my medication.  I made sure that I had plenty of medication with me and allotted the appropriate amount of time so that I would be sure that I would not run out before the refill came in.    I thought that if this worked out I could save myself some extra running around.

When the medication came in I checked to make sure that I received the correct medication.   I opened each bottle and inspected the pills making sure that they looked exactly like the previously filled prescription.  Everything looked the same so I put the pills away and didn’t think about it again.  

Well it just so happens that I had a rheumatologist appointment coming up so I always check my pill bottles before I go to see if I need any new prescriptions.  My doctor doesn’t like to do refills over the phone so I always make sure I check to see if I am due for a new one.  When I pulled the bottles out of the cupboard I realized somehow, and I really can not figure out how, the online pharmacy mixed up the dosing instructions with the medication.  So that the new bottles instructed me to take my Hydroxychoroquine (Plaquinil) 8 tablets once per week on Wednesday when the actual dosage should have been once daily.  And my Methotrexate  label said  to take one tablet daily when it should have been 8 tablets once weekly on Wednesday.

Because these particular medications I have been taking for years I know that I should not follow the dosing instructions that are listed on the new prescription bottles. So I showed the bottles to my rheumatologist this morning at my scheduled appointment.  Because it was an online issue, I had tried to go to the site to report the problem when I realized it last night.  Unfortunately the link that the online pharmacy shows to click to report a problem does not work.  So I asked my rheumatologist what the next step should be.

She called the number listed on the prescription bottle and reported the problem.  By the time I arrived home from my appointment, there was a message from the online pharmacy asking my to please call.  

I called the number left on my machine.  The woman I spoke to apologized and told me that they had started investigating how this could have happened.  The ball got dropped on this particular issue, not once but twice. Apparently, the prescription is filled by a pharmacy technician and then it is checked by a pharmacist. The woman from the online pharmacy apologized profusely. She told me that they would be sending me a $25.00 gift card for my troubles and that I should expect a call from a supervisor.

I appreciate the apology.  I really do.  What concerns me is what could have happened if I had not been so familiar with these prescriptions and not known that the dosing instructions listed on the refills were very wrong. When I asked what the possible ramifications could have been if I had actually taken 8 plaquenil at once, I was told that it could have caused retinal damage that is irreversible.

From now on I plan on checking not only the pills inside the prescription bottle to make sure that they are correct and that the count is correct, but I will be checking the labels carefully to make sure that the dosing instructions are exactly as my doctor has prescribed.

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Monday, May 18th, 2009

Rheumatoid Arthritis: One Disease, Two Generations

When I was 9 or 10 years old my mother started complaining that her thumb on her right hand was bothering her.  She couldn’t remember hitting or injuring it in any way.  I clearly remember her telling a neighbor that it felt like she had bruised her thumb.  It wasn’t even something that she considered going to the doctor about.  It just seemed odd.  About 2 months later she woke up in the morning and could not get out of bed.  I remember how scared I felt as my mother cried out in pain while my father lifted her from the bed to carry her to the car and take her to the hospital.  I had never seen my father carry my mother before.  At that point my sisters and I knew that there was something seriously wrong.

My parents spent the better part of the day and night at the hospital and when they came home my father helped my mother to bed and told us that the doctors thought that my mother had rheumatoid arthritis.  I had no idea what that mean or how it would change our lives.  I just wanted my mom to stop hurting and just be Mom again.  

I watched this disease change my mother.  In the 1970′s there was not a lot of treatment options for rheumatoid arthritis.  The doctors mostly gave my mother enormous amounts of aspirin to help with the symptoms.  She had these bizzare scaffolding like contraptions that she wore on her fingers that used rubber bands to keep the fingers in place at night.  The objective was  to keep the joints from contracting and to try to hold off the deforming effect of the disease.  It did not work. Continue reading Rheumatoid Arthritis: One Disease, Two Generations

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Thursday, April 2nd, 2009

Poll Results: Are You Happy With Your Current Rheumatologist?

According to LivingRheum’s first non scientific poll 53% of those polled are happy with their current rheumatologist.  32% of readers that participated in the poll said that they were not happy with their current rheumatologist.  And 16% said that they had not made their minds up yet. 

 For me it is very disappointing to hear that almost 1/3 of all that participated in our poll are not happy with their current rheumatologist.  I am interested in learning why. Is it because their is a lack of qualified rheumatologist?  Is it because insurance companies limiting our choice of doctors?

 I spent several years with 2 different rheumatologist that I was not at all happy with before I found my current really fantastic rheumatologist. I am fortunate that I live in a part of the country that I affords me the opportunity to choose from a great deal of rheumatologist so that I could find one that I feel comfortable with.  In the state of Rhode Island their are 24 rheumatologist listed in 1545 square miles (that is 1045 land miles and 500 water miles) that is one doctor for every 16 square  land miles.  Those are pretty good stats for those of us in the littlest state.

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