Sunday, December 1, 2013

Dealing With A Flare-Up

I had a fairly productive summer. But when October rolled around, suddenly my fingers and knees got stiff and began to throb. No matter what I took: ibuprofen, aspirin, Tylenol, Norco, and combinations of them, I got no relief. I kept smearing topical ointments on, but the relief was brief. I know I built up a tolerance to all the medications I have and as the weather gets colder, and my body started to hurt more, I started to lose my ability to cope. In one of the many email newsletters I get, there was the ugly word: Hyperalgesia – when you build up a tolerance to Opioids and the probability that they end up making pain worse vs better. I tried to get in to see my PCP sooner, but she’s a popular doctor & is booked for weeks in advance.

I pulled out my knee braces. I pulled out my cane. I wondered how I was going to handle getting supplies I needed or doing my laundry. Meanwhile I went through all my books and printouts and magazine articles searching for a solution. And I was back to what I thought I had overcome: with my entire day being about finding ways to get relief. The only time I got a break from hurting was when I listened to a meditation tape or climbed into a very warm bath. While I was in the water, I was able to completely relax and disconnect from pain.

My doctor appointment was coming up (with my PCP)… and I found the “Partners Against Pain” website. They suggested planning ahead for doctor visits, gathering background materials, and establishing goals for your office visit. Since I did a lot of this anyway, it was reassuring to know this was a good thing for me to do. I worked on this ‘project’ for almost a month—organizing all my thoughts—and typing up a detailed report to hand to my doctor.

At the appointment, I told my doctor that my general weekly activities had included volunteering at the Chamber of Commerce a few half days a week, going for a 20-25 minute walk almost every day, doing some simple exercises on a therapy ball I have at home (plus a few planks and squats against a door), doing some traction at home, and spending time on the internet using facebook and reading email newsletters, reading books, and writing. I added that my huge accomplishment was getting another book finished. SO, I began to feel empowered vs. helpless/hopeless and was doing better, and have been a bit more active than in previous years (haven’t used a wheelchair or motorized cart that are in the stores in a LONG time). I wasn’t prepared for the change of season triggering a major flare-up and dragging me back down again—especially with the onset of hip, leg, thigh and knee pain. If I don’t have my legs, I can’t go for the walks. And there is no heated pool nearby to exercise in. I may also be experiencing some PTSD.

I added that I’ve been able to see Dr. Cully (chiropractor) twice a month for the last year (covered by Medicare with a small co-pay). Yay! I’ve made progress with the regular therapies he offers as far as arthritis in my spine, but there isn’t a whole lot he can do to alleviate the fibromyalgia symptoms. Dr. Cully helped me a LOT with my lower back and neck, but, as with the rib, I am still struggling with the C5-C6/T1-T4 area. He got me an over-the-door traction device to use at home for my neck awhile back (which I regret to not using regularly), but I do get some relief while I’m in it. I have two visits left this year (for chiropractic) that Medicare will pay for. I don’t know how many I will have in 2014. He recently got a heated water-jet massage bed which I get to use for 10 minutes prior to him working on me. When I get an extra $20, I will be able to use it for 30 minutes in the evenings. He also got a decompression table. He hoped this device would be beneficial to my Degenerative Disk Disease situation and Spondylolisthesis. Last month he did decompression on me for the first time and I got “rebound spasms”. I couldn’t even stand up when I was released and I found out what 10 is on the pain scale. As much as my body hurts, I am grateful I am not like THIS every day!

Back at home, I had found in a Self magazine, an article on Pain-Depression: so I researched the Mirtazapine I am on to see if it targets both serotonin and norepinephrine. The answer was yes and it seemed I wasn’t on a high enough dose. I also found an article on Benzodiazepines and FMS so I began to use more of the Ativan I had when spasms were triggered. I went through my old medical records and found a 2006 rheumatologist report to show my doctor so she agreed on getting new x-rays on my knees.

I reported on the medications I was taking regularly and asked for input on my ideas about increasing the dose of Mirtazapine and Gabapentin. She agreed. Gabapentin, by the way, has been suppressing the Herpes virus I’ve been plagued with for 37 years, and perhaps it suppresses the other viruses in my system, too.

The following Monday, I got a call from the nurse that the x-rays showed that I had ‘mild’ arthritis in my knees and I was prescribed Meloxicam (generic for Mobic) along with increased doses of Mirtazapine and Gabapentin. That night I took the first Meloxicam and the next morning I woke up without pain in my fingers and knees AND SPINE. I haven’t taken any Norco since then… and I started slowly getting back to activities I was enjoying and was able to start my exercise routine again. Oh, yes, I can play my guitar again.

I love my PCP!