Monday, May 28, 2012

Happy Anniversary APL!

One year ago today, we kissed in the rain under an oak tree, ate bbq and cherry cheesecake, and danced in a barn with all of our friends and family. In just two days we'll welcome our baby boy into the world. What a crazy first year it has been! Happy First Anniversary, APL!!

Wednesday, May 23, 2012

Bed Rest

If you're having a busy day at work or a rough day at school, I'm sure bed rest must sound pretty awesome. You probably imagine luxuriating in bed all day, eating bon-bons, watching movies, having people bring you food or give you a foot massage. But let me assure you of this: bed rest is really not very much fun. Especially with arthritis.

I have been laying in bed, getting up only to use the bathroom, since I got checked into the hospital on Friday afternoon. So it has only been a few days but all the immobility has already been totally killer on my joints. They pretty much all hurt - which obviously doesn't make laying around all the time very easy or very fun. And, since my OBs want me to primarily lay on my side to increase bloodflow and reduce my blood pressure, my hips are objecting loudly and constantly. Yesterday afternoon I had to resort to some vicodin just to keep laying in the bed. 

Luckily, APL is taking extremely good care of me. He set up my computer next to the guest bed with a trillion movies and TV shows. He also got permission to work half days from home, so he brings me lunch and makes me dinner every day, and having him home limits my need to go up and down the stairs. River is also being extremely good company. She seems to know something is wrong and spends a lot of time laying on the bed with me. She cheers me up immensely. Our friends are also helping out - one brought us a pot roast for dinner on Monday, another took River on a hike yesterday, a third is texting me daily from California to make sure I'm hanging in there. We're very lucky to have such a good support system. 

It still isn't easy. My body hurts a great deal and today I feel like I'm having trouble being entertained by anything, even though I have a million options. I'm really hoping to make it another week on bed rest to give our little guy a bit more time to cook. While of course I want what is best for my baby that is also an overwhelming thought because the joint pain and stiffness seems to increase daily. It's hard to lay around and rest when it hurts to lay there.

But I'm trying to take it a day at a time - an hour at a time if necessary. And, luckily for me, APL will be home soon. And that always makes me feel better.

Monday, May 21, 2012

Mild Preeclampsia

TMI Warning: This post contains details about pregnancy that you may consider to be too much information. Don't say I didn't warn you!

After a week on prednisone, I had an appointment on Friday morning to see my rheumatologist. I like my rheumatologist, but honestly? This appointment wasn't the greatest. I told him I thought the prednisone was helping somewhat, but I was surprised by how much pain I was still experiencing. He examined my joints and seemed a lot more concerned with the pain in my hands, saying that the pain in my knees and hips was likely to decrease when the baby was born (and I weigh less; hence less pressure on those joints). And that's good, but I told him that I was quite concerned about how my hips would fare during labor. In response to that he basically said that he thought labor pains would overshadow any joint pain - which, of course, was not particularly reassuring. 

He did say that if I got an epidural he didn't think there would be much chance of damaging my joints during labor, so that is good. We also talked about options for meds after the birth while breastfeeding, but it turns out there aren't significantly more options than I have right now. So it was a little disappointing to think about dealing with this joint pain and a newborn. But he did say that he thought there was a good possibility that I would get a couple of weeks of relief from pain after the birth, maybe as much as 2 or 4 months, so that would be good.  

But the worst part of the appointment was the routine blood pressure they took at the beginning. It was high. My rheumatologist didn't seem too concerned about it - he said we would keep an eye on it - but I decided to call my OB and see if they thought I should be concerned. My OB decided to have me come in and get checked out that afternoon. And when I got checked out, I ended up getting checked in to labor and delivery. 

They put monitors on my belly for the baby and took my blood pressure every 10 minutes for several hours. They initiated yet another 24 hour jug-o-pee test. They drew some blood. They were trying to determine if the spike in my blood pressure came from the prednisone and/or if it was being caused by my pregnancy. In the end, they kept me overnight and through the entire next day to continue monitoring me.

Apparently, just having an autoimmune condition puts you at a higher risk of developing preeclampsia. Though the prednisone might also be contributing to the spike in my blood pressure, the 24 hour urine test confirmed that the level of protein in my urine is increasing. That means that my liver and kidneys are not working as well as they should. So I've been diagnosed with mild preeclampsia, which means that it might not be safe for me or the baby if I stay pregnant much longer.

Since I am not quite at 37 weeks yet (which is full term) I was sent home on strict bed rest to try to give our little guy a bit longer to cook before he is delivered. I have to lay on my side at all times - which increases blood flow and significantly improves my blood pressure. I am only allowed to get up to pee. 

All this immobility and limited positions to lay in has not been easy on my joints so far. But I'm just trying to take it one day at a time (or sometimes one hour at a time) because I know that the longer I am able to stay pregnant the better it will be for our son.

Thursday, May 10, 2012

Pregnancy & Prednisone

I've been putting off writing this post for days. I have to admit that I am feeling a little bit reluctant about being my usual honest self here, because I really don't want to scare or discourage anyone out there with RA who might be considering getting pregnant. 

But, ultimately, I decided that one of the things that scared me the most when I was considering getting pregnant was that there was just so little real information out there about pregnancy and RA. Sure you can find lots of articles with vague medical information - "many women with RA experience remission when pregnant" - but what does that even mean?!? How many? How much remission? What if I am not one of the "many"? Then what?!?! When I was planning to get pregnant I desperately wanted to find just a few personal stories about what being pregnant with RA is really like, so that I could have some idea - any idea - about what I realistically might be facing.

So, with the disclaimer that everyone's RA is different and there seem to be no hard and fast rules about RA and pregnancy (plus the always obvious talk to your own health care providers to figure out what is best for you), let me share with you what I am currently up against:

It's week 34 of my pregnancy - six weeks to go - and I have really been struggling.

The vast majority of the past few weeks I have been in a great deal of pain, extremely achy, highly fatigued, and seriously uncomfortable. Most days I find myself on the couch by mid-afternoon, with an ice pack on each hip, hoping for just a little numbness and relief. My hands are so stiff and sore when I wake up in the morning I feel like it's a wonder if I can make myself a cup of tea. I'm exhausted and having trouble sleeping. I take my tylenol and pretend that it's vicodin, hoping to trick my brain into feeling better.

Despite the mounting evidence over the past few weeks, I've been in a little bit of denial about the return of my RA symptoms. Some part of me kept stubbornly insisting that these issues could just as easily be caused by third trimester pregnancy as by RA. There's a huge belly and a lot of extra weight on those hips - no wonder they hurt! I have another pregnant friend who is dealing with swelling in her hands - maybe that's all it is! And all pregnant women are exhausted and have trouble sleeping! Just hang in there!

But then last week my prenatal massage therapist commented on the heat radiating out of my hips. Then my pilates instructor commented on how hot my hands were and pointed out that my shoulder was behaving just like it does during a flare. Then, despite keeping my exercise routine extremely low impact, I suddenly started experiencing some unexpected - yet highly familiar - pain in my knee that sent me searching for my knee brace. Within a day or two I started noticing increased pain in both of my knees whenever I stood or walked for longer than a few minutes.

With the number of affected joints adding up, it seemed more and more difficult to say that this pain was pregnancy-related (rather than-arthritis related.) So I brought it up with my OB on Monday - and she agreed.  While pregnant women often experience hip pain, she told me, the hand pain and the knee pain clearly suggested arthritis. And despite everything I have been doing to try to manage the pain (physical therapy, pilates, water aerobics, prenatal massage, heat, cold, rest, relaxation, de-stressing...) the pain was only getting worse. My OB's concern only increased when I told her about the difficulty I had practicing birth positions. She thought it was time to start taking some prednisone. 

As anyone who has read this blog in the past knows, I sincerely dislike prednisone. Ok, let's not lie: I pretty much hate the stuff. I hate that it works so well but comes with such nasty side effects (at least that's how it seems to work for me). I hate the way it makes me look and feel. I hate how hard it is to wean off of once you have been on it for an extended period of time. (And I hate how I feel like just a tiny bit of a failure for having to resort to prednisone when I really don't want to...even though I know that is absurd.)

Unfortunately, even putting aside my personal feelings about prednisone, the decision to start taking it while pregnant is just not quite as simple as I wish it was. It does come with a price. First, prednisone (or any steroid) can mess with your adrenal gland, and if your adrenal gland isn't working properly it can inhibit labor. So being on prednisone now will require me to have an IV dose of some other drug (can't remember the name...placenta brain!) during labor to make sure my adrenal gland is functioning well enough to get me through labor. This is obviously not the end of the world. It's not like I'm a stranger to IVs, and it sounds like I'll only need one dose - so I won't necessarily be tethered to an IV the whole time.

The other issue is the side effects. We know that in the past prednisone has seemed to mess with my blood pressure. And, since my favorite jug-o-pee test did come back a little bit high, I am still at risk for developing preeclampsia. This would obviously not be safe for me or the baby. So we'll have to keep an extra close eye on my blood pressure while I am taking the prednisone to make sure everything progresses safely. 

But, despite all of this, I am also reasonable enough to recognize that prednisone is pretty much my only option right now. It will help control my RA symptoms while also being safe for the baby. It will make the remainder of this pregnancy more bearable. It will reduce the joint pain which will help me get through labor. And feeling better right now and having a less painful and productive labor is better for me and the baby. 

So, my love-hate relationship with prednisone continues. And, honestly? After just one dose yesterday I swear I am already feeling better today. 

Tuesday, May 1, 2012

PRODUCT REVIEW: Trudeau's Stress Less Kitchen Tools

DISCLAIMER: I received these product samples unsolicited and for free - and promised to review them completely honestly without receiving compensation. For details, please see my Product Review Policy.

Trudeau's Stress Less Salt & Pepper Mills

The salt and pepper mills are both large and easy to grip. The fact that they are quite large might be considered a con - they do take up a lot of space - but they are not unattractive and I think they would look fine on the table. To operate, you simply hold the slightly padded black knob and turn the handle - clockwise gets you a fine grind and counter-clockwise gets you a coarser grind. Both the gear in the center and the handle itself rotate. For me, the handle on the salt mill was a little tight (i.e. slightly more difficult to turn than the pepper mill) but that may be something that would loosen up with use. One other negative might be that as I moved them around from counter to table and back, they did sometimes leave a little salt and/or pepper residue on the surface where they were sitting. But overall I would say these are useful and probably easier to use than salt or pepper grinders that require a smaller, tighter grip. 

This pizza cutter is bigger than most others I have seen, so it will certainly take up more storage space, but I have to agree that it is pretty easy to use. What makes it so easy is that it's not just a handle on a circular cutting wheel - there is actually extra space for your thumb and forefinger to grip. I think this makes it easier to use more downward pressure while at the same time spreading the impact out over more of your fingers. It's also pretty easy to clean, because you can hold the cutter upside down to pop the cutting wheel off and wash separately. Popping the cutting wheel back in after cleaning is a little bit more tricky, however, so be careful.

As a disclaimer, I have to say that I don't own a regular garlic press - so I haven't really got anything to compare this to. When dealing with garlic, I've found it to be much easier to simply buy a jar of pre-chopped garlic to keep in my fridge - still fresh but no chopping/pressing effort involved. But I did test out this garlic press and I will say that it is pretty easy to use. You put the garlic clove in the press chamber, put the press on a flat surface (which is a tiny bit tricky because the press will balance on two small, padded points), and then press the top handle downwards using your body weight to minimize the effort. The key here is that you have to follow the directions to actually make it easier - if you don't it still can take quite a bit of hand effort to press the garlic. I thought the best thing about this garlic press was that the press chamber swings open, which made it easy to clean.

I had a little bit of trouble with this one. The spring-loaded door (where the un-grated cheese goes) was not that easy for me to open or hold open while I tried to put the cheese inside. Also, the compartment inside is not very big - which means the cheese will need to be cut into relatively small pieces to fit in there. However, once you get the cheese inside, the grater is easy to hold and operate - which you do by turning a crank handle similar to the ones on the salt and pepper mills. You can even reverse the product for right or left-handed use. But while the label says "grated cheese falls vertically with no wrist torsion" I did not really find that to be true. For me, the grated cheese stuck up inside the grating chamber and I had to knock the grater on the counter or stick my finger up there to get the cheese to fall. Perhaps this would not be a problem with a harder cheese, but on the softer cheddar that I used it was problematic to get the cheese to come out. Additionally, this product was very difficult for me to clean. I had to try to hold the spring-loaded door open while washing it and, in the end, I wasn't very successful in getting that compartment or the grating chamber clean. Unless the product comes apart (which I can't obviously see how to do) or can be put in the dishwasher (which it doesn't say on the label) I think cleaning this product will be problematic.

UPDATE: I put this in the dishwasher to see if it would get cleaner than I could do by hand. It didn't. I'm still not sure how to clean it.

I have to admit that I totally failed in the use of this product. This may be user error on my part - perhaps I was doing it wrong - but I tried multiple times to follow the short directions on the label and I was simply unable to succeed in opening a can. The problem was that I could not get the can opener to properly latch on and puncture the can. The directions say "Open handles and align can opener on top of lid positioning the cutting mechanism along the side of the can. Close handles." There's even a little picture. But though I tried to replicate this several times, in the end I was totally unable to do so. I did apparently manage to cause a small invisible leak in the can (liquid came out when I held the can upside down) but I couldn't seem to puncture the can so that I could move on to step 2 of the directions and cut it open. So, though this may be user error on my part, I did not find this product at all easy to use.

UPDATE: Ok. I had APL try this can opener when he got home today and he totally did it on the first try. For one thing, this can opener cuts the can along the seal of the can, not through the lid - so it doesn't open exactly the same way as a regular hand-held can opener. This is actually a very nice feature, because it doesn't leave any sharp edges afterwards. Once I saw it was possible, I tried again - but I still had some trouble getting the can opener latched on properly (i.e. I still failed at step 1). But APL insists that it was really easy to do once you got it on there properly. Next time I need a can open, I think I'll try again - because APL also said it took a lot less strength and effort than a regular can opener. So, yeah, like I said: user error!!

ONE LAST UPDATE: I successfully managed to open a can of olives! And it was actually pretty easy. ~;o)

My Product Review Policy

Sometimes I get requests to review products. While I certainly don't think there is a one-size-fits-all solution to dealing with the challenges presented by chronic illnesses, I do think my readers may still find product reviews helpful. If you read my reviews, please keep in mind that everyone faces different challenges - and what works or doesn't work for me might turn out differently for you!

My reviews are always 100% honest and based on my own personal experiences and opinions. This policy will always be made clear to the company before I accept any samples or agree to write a review.

Birth Positions

TMI Warning: This post contains details about pregnancy and childbirth that you may consider to be too much information. Don't say I didn't warn you!

First things first: the results from my very favorite jug-o-pee test came back and, thankfully, everything looks good. The level of protein in my urine is a little bit higher than normal - but it's not significantly higher than my baseline test from January, so the doctors aren't concerned. So that's a relief.

In the meantime, APL and I have been attending a birth class for the past two Sundays - and we've got one more to go this upcoming Sunday. Since the weeks that our little bun will remain in the oven are quickly ticking by, we're both really glad that the class is forcing us to think about the inevitable end of this long pregnancy journey - birth!! And though the some of the information the class provides is really obvious, and a lot of it is quite repetitive, we're both learning things that neither of us previously knew about the birth process. So that's a really good thing.

Since the joint pain in my hands and hips seems to be increasing rather than decreasing, and since I've been dealing with increased levels of stiffness and fatigue lately, APL and I are also very happy to be adding ideas to our "things we might be able to use to get through labor" list. We've learned about breathing techniques for staying calm and distracting me from pain. APL has learned massage and acupressure techniques to help me manage. We've talked about music and other relaxation techniques. And we were seriously excited to discover that every room in the hospital we have chosen comes with a hydrotherapy tub (which I am guessing we will use a lot during labor).

However, on Sunday we also discovered that, because of my arthritis, our "things we might be able to use to get through labor" list may end up being considerably shorter than most other couples. The primary topic of this Sunday's class was birth positions. The instructor emphasized how important it is not to just lay on your back like you see in the movies. Instead, you're supposed to change positions often and focus as much as you can on positions where gravity is on your side. Obviously this makes a lot of sense.

Unfortunately, in order to get gravity on your side, you also end up supporting a lot of your own weight. And as we attempted to practice these positions (on a day where my belly is six weeks smaller than it will be at birth and without the additional pain of labor, mind you) it quickly became apparent that a lot of the positions just weren't going to be options for me. Almost all of the kneeling and squatting positions put too much strain on my hips and my knees. Despite pillows, props, pads, and APL attempting to hold up as much of my body weight as he could, I had considerable difficulty staying in most of those positions for a few minutes - let alone the recommended half hour or so before changing to a new position. I felt like a lot of these positions would increase the overall pain in my body - and tire me out more quickly - rather than allowing me to deal with the pain of contractions. 

Honestly? At first it was pretty discouraging. The instructor kept talking about using what nature provides to make the birth process easier (she was talking about gravity), but I couldn't stop thinking about how unfair it was that what nature provided to me was a bunch of stupid inflamed joints and the ability to get fatigued more easily - which simply wasn't going to help make the birth process easier!! I kept looking at the posters of birth positions around the room - not to mention the five other couples successfully enacting these positions - and feeling overwhelmed.

But then I took a few deep breaths (see? That breathing stuff is coming in handy already!) and APL and I tuned out the rest of the room, ignored the posters of suggested positions, and got creative to come up with positions that I could actually handle. We discovered that there were lots of options for standing/walking (mostly with me leaning on APL) that would be a good way to keep gravity on our side without overtaxing my knees and hips. And, with the use of a birthing ball, we actually managed to find a couple of kneeling and squatting positions that I could handle. We even came up with a position on our own (me squat/sitting with my back against the birthing ball, APL with his back against the other side of the ball, and our heads resting on each others shoulders, cheek to cheek) that the instructor liked so much she pointed it out to the whole class.

So while Sunday's class made it painfully obvious (quite literally for me) that my arthritis will most likely make the birth process more challenging for us, we also discovered that if we stay calm, work together, and get creative we'll be able to get through it. And that's a really good thing to know!!