Product Review: Quell

I have been given a Quell Relief device as part of a product review through the Chronic Illness Bloggers network. Although the product was a gift, all opinions in this review remain my own and I was in no way influenced by Quell. As stated in my product review policy, my reviews will always be honest. 

I first heard about Quell in a Forbes article. According to Forbes, "the Quell is an FDA-approved wearable device that Velcros around the upper calf and uses electrical stimulation to purportedly offer pain relief without the innate dangers or risks of addiction that come with drugs." While I don't love the implication that drugs are necessarily dangerous and should be avoided, because I know I would not be able to function without the use of medication, of course I would love to reduce my reliance on so many medications if possible. So Quell sounded promising, and when I was given a chance to try the device myself I accepted immediately.

The science behind how Quell works is fairly complex, but the short version is that by stimulating specific nerves a natural pain-relief process can be activated. There is some scientific evidence to support this claim - one study showed that 81% of Quell users reported improvement in their chronic pain. However, it is important to note that this study was conducted by the company who makes the Quell device. It would be really nice to see some more third-party research on the science behind this device - especially to help justify the rather significant investment in the product.

When my Quell arrived, I used the quick start guide to figure out how to attach the electrode and then place the device on my calf. The electrodes attach to your skin with sticky gel and the device Velcros on in a little pouch. Then it was time to calibrate, and I have to admit to feeling a bit nervous during this process! Was it going to zap me, I wondered? But really it was just a slight tingling sensation. In the end it felt like TENS devices I've used before at physical therapy.

After using the quick start guide to get my Quell therapy session started, I decided to download the app to my phone and have a look at that. Quell uses Bluetooth to sync with an app you can download for free from the App Store or Google Play. The app allows you to monitor your therapy sessions and change the intensity if you want. However, one thing I wish I had known in advance is that to pair your Quell and your app you need to have the last two digits of your device's serial number - and if the device is already strapped to your leg providing therapy that number is inaccessible. So you may want to pair your Quell and app prior to starting therapy if you want to make use of the app.

There are a couple of things to keep in mind if you are considering trying Quell. For one thing, it is somewhat wardrobe limiting - especially for girls who tend to have tighter pants that the Quell won't fit beneath. So I either wore loose pants, shorts, or a skirt. I feel like this would be more of a challenge in the wintertime, but one solution to would be to just use Quell around the house or at nighttime. I also don't love that you are supposed to replace the electrodes every two weeks, because that's an additional $90 every three months in addition to the hefty initial investment. But I do like that the device was comfortable to wear - and it's great that the battery lasts a few days so you don't have to charge it every day. I have to admit that at first I found the tingling sensation very distracting as I tried to go about my day. But, after a couple of days of use, it was a lot less distracting. And when I did notice it was almost comforting to know that I was doing something proactive to help reduce my pain.

And now the $10,000 question: did it help? Honestly it is a little bit hard for me to know for sure. There are so many variables that go into how much pain I feel from day to day, and it certainly did not take away my pain all together. But, that being said, my trial of the Quell did coincide with a difficult period of transition for me. Although Rituxan has turned out to be a really great medication for me, unfortunately I was unable to last a full six months between doses. So while my rheumatologist and I worked to reduce the time between my infusions, I ended up taking a fair amount of prednisone - the drug we all love to hate! In fact, I've been on prednisone pretty consistently since the birth of my second son, which was almost two years ago at this point.

I started using Quell right after my most recent Rituxan infusion, and with my next infusion scheduled for just five months away I was in the process of trying to wean of prednisone permanently. Those of who who have been through this weaning process know that it is neither easy nor pleasant! It took several weeks, but I have been able to wean off prednisone almost completely. And I did really appreciate having access to another form of pain relief during that process. I'm not sure if I will use Quell regularly due to the cost of buying new electrodes, but I am happy to have it on hand as another option for times when I am struggling more than usual.

PT & Me

I know that physical therapy techniques have done a world of good for some people. I also know that I won’t be able to tell if they will help me unless I try them. Do you have any advice for improving the experience? 

Read more at RheumatoidArthritis.net

The Snarky Voice

The snarky voice wasn’t interested in keeping an open mind or giving anyone the benefit of the doubt...The snarky voice is a defense mechanism I’ve developed based on my past experiences.

Read more at RheumatoidArthritis.net.

How Do You Dress A Tornado?

I really can't believe it, but OZL will be 11 months old in only 8 more days!! One year ago today I was 8 months pregnant, dealing with RA flares, and being tested for preeclampsia, which I eventually was diagnosed with resulting in bed rest. As soon as I hit 37 weeks, OZL was born via C-section. And, via some insane time warp, he will be turning one next month!!!

These days, OZL is interested in everything. He crawls in all directions at about the speed of light and pulls himself up on anything he can reach, reguardless of whether or not it will actually support his weight (case in point: he pulled a folding chair over on himself in music class this morning.) Most of the time he is speedy and full of energy and a very happy baby. Though he has also spent a fair amount of time over the past week or so being a big old grumpyface since the poor little dude has 5 teeth coming in at the same time.

Getting him dressed in the morning is like trying to dress a tornado. He flips and squirms and wiggles tries to crawl away while my clumsy RA hands fight to snap those tiny snaps and button the little buttons and pull itty bitty socks onto itty bitty feet. If it would only stop snowing I'd just put a clean diaper on him and call it a day! (Welcome to spring in Colorado - we've had more snow in the past few weeks than we got all winter.)

Honestly I have been struggling to keep up with him lately, especially since PT doesn't really seem to be helping. Both my knee and foot and all the muscles around them have been hurting a lot, and my knee has been doing this weird cracking/popping thing. The kneecap hasn't dislocated again (thankfully) but it doesn't feel like it's getting any more stable either. I'm wondering if surgery is imminent - and if it is how on earth I will ever keep up with OZL then?

I do have a college student who comes twice a week to watch OZL so I can have a couple of hours to get my writing done, but lately I've had to use most of her time to go to PT rather than work. So I'm using all of OZL's nap times to do my writing for Answers.com. I'm getting the work done, but I have almost no time to myself to rest or relax these days.

Hopefully I'll find a way to get a break soon!

PT and/or Surgery

I saw the orthopedist on Friday about my foot and my knee. There's good news and there's bad news.

The good news is that she isn't worried about my foot. It's bruised as a peach but it will heal. I'm supposed to wear the very sexy shoe you see in the photo for the next few weeks to help it heal, and I should try to stay off it when it hurts too much, but other than that it will be fine.

Surprise, surprise: the bad news is my knee. According to the orthopedist, the ligament that is supposed to hold your kneecap in place was likely destroyed the very first time my knee went pop. And apparently there's nothing we can do to get it back. So instead we're going to try some PT to strengthen the other muscles in my leg. This is supposed to encourage the kneecap to stay in place, but there's no guarantee it will keep my kneecap from dislocating again. Unfortunately, any additional dislocations could damage my knee and might lead to osteoarthritis (the last thing I need). So, if PT doesn't help and/or my kneecap keeps dislocating itself I may need to consider knee surgery.

In the meantime I'm just hobbling around with OZL (thankfully with the help of my mom right now!) and trying to stay positive. 

Bursitis

The good news: after more than a few weeks of physical therapy, my back is finally feeling ok again - even though my belly seems to be growing by the day!  Whatever was going on with my muscles and SI joint seems to have calmed down significantly. I feel like the PT has also helped me strengthen the area, so I feel better supported. And, when the pain does hit (like sometimes after a long day on my feet) I have come up with several coping strategies for dealing with it: epsom salt baths, stretching, lidoderm patches, gentle massage from APL. So this is good news.

The bad news: now my hip hurts. A lot! It has been hurting seriously and consistently for at least 3 days now. Unfortunately, there is literally no position I can get in where it doesn't hurt. It just hurts. So. Very. Much. And constantly. It's really been taking a toll on my sleeping the past few nights. And it doesn't feel like muscle pain - it feels like grinding, stabbing pain right in the joint. All too familiar joint pain, in fact...

Rar. What on earth is it with this body of mine? If it's not one thing, it always seems to be another!!!

So I emailed my rheumatologist this morning. He thinks the hip pain is more likely to be related to bursitis, rather than hip arthritis. I didn't know what bursitis was, so I had to look it up. 

Turns out bursitis is inflammation of fluid-filled cavities near joints where tendons or muscles pass over bony projections. It commonly occurs in the shoulder, knee, elbow, and - of course - the hip. It can be caused by chronic overuse, trauma, infection, or it can be caused by rheumatoid arthritis. So it isn't RA, but RA can cause it? Awesome. 

RA, you never cease to amaze me.

So, though I just finished up with PT for my back, it looks like I'll be heading back to physical therapy for my hip. (Assuming, of course, I can get an appointment in the not too distant future.) And what if PT doesn't help? Looks like steroid injection is back on the table again. 

In the meantime, I would kill to be able to take a NSAID right now. Or maybe some vicodin.

Physical Therapy

It's snowing just a little bit in Boulder today. The picture is of the snow that has accumulated on the fence in my back patio since last night - I would say it is almost a foot. And it doesn't look like it is planning to slow down any time soon.

So, after looking out the window, I guess I wasn't too surprised to find a voicemail on my phone letting me know that my physical therapy appointment for today had been cancelled. What did actually surprise me was how that message made me feel: slightly disappointed, actually. Which is a really good thing - because it means I actually like this physical therapist and I actually think it's helping.

After my last less than stellar physical therapy experience, I have to admit I was pretty reluctant to waste my time and effort (and money) trying it again. But the pain in my back wasn't getting a lot better, and my belly certainly isn't getting any smaller, and I can't exactly just take a handful of Advil and hope the pain goes away. So last time I saw my OB I bit the bullet and asked her for a recommendation for PT. 

And I am ever so glad I did. She recommended a rehabilitation center associated with a branch of the same hospital where I will give birth - and they actually have PTs who specialize in prenatal therapy. (And postnatal therapy, which may also turn out to be super useful). SCORE. So I've been seeing this new PT for two weeks now. This morning, when I was actually disappointed that my appointment was canceled, I realized that this PT is actually helping. 

This PT has been focusing more on loosening and strengthening the muscles in my back (as opposed to focusing on the actual SI joint itself). Now that I think about it, the physical manipulation she has been doing and the exercises I have been doing really do seem to be helping the pain in my back - especially since I am now showing a whole lot more than when I was seeing the previous PT. Plus she is super nice and willing to answer all of my questions and she is full of good suggestions. For example, on Wednesday she pointed out that the pregnancy is causing me to stand with my pelvis tipped forward, which is putting extra strain on my back. And, when I thought about how I have been "naturally" standing recently I realized she was right (which is probably how I was standing during the three hour visit to Babies 'R Us last weekend, which explains the extra pain I was in this weekend). So of course she showed me how to correct that.

In any event, though I am disappointed not to have her help today (and a little nervous that I will have to until next Wednesday to see her again) I am really glad I had the realization that it this PT is actually helping. That makes me feel good. Because it did take a lot of effort on my part to start over and try again with a new PT. But, as it turns out, with a trustworthy recommendation and someone who actually specializes in my issues, it was totally worth the effort.

SI = Sad Inside

Several months later, my right SI joint is still not a happy camper. I have to be honest: it is really starting to get to me. 

Since pain is certainly not foreign to my everyday life, I don't run to the doctor as soon as something starts hurting (or I'd be there constantly). I usually settle for stretching, taking it slow, taking some anti-inflammatory meds, and hoping it will go away. It's only after something bothers me for a good long while that I will give in and finally call the doctor. 

So, when my lower back started bothering me on the right side back in October, I didn't think too much of it. I did some gentle stretching, took some Tylenol (which is safe for my pregnancy), and tried to ignore it. Then I got distracted by the lump I found in my armpit (when it rains it pours?). In fact, the pain in my back didn't really start to worry me until my pilates instructor told me in November that she thought it was being caused by some inflammation in my SI joint. The thought of the pain being associated with a joint started to make me nervous.

But I still put off calling the doctor until my OB told me that I ought to check in with my rheumatologist. So I did. And then my rheumatology team prescribed some physical therapy in an attempt to deal with the problem without having to take any extra meds. Thus, for the pasts couple of weeks I have been seeing a physical therapist twice a week to learn stretches, posture, and exercises to lubricate the joint, as well as getting focused massage in that area to try to get the muscles around the angry joint to relax. 

Unfortunately, it really hasn't been helping that much. I'm not getting quite as much sharp pain as I was before, which is good, but I'm still dealing with a fairly large amount of dull, constant pain in my lower back on the right side. It hurts to stand. It hurts to sit. It hurts to lay. It hurts to carry. It hurts to lift. So most of the time I'm not exactly sure what to do with myself. My belly is finally starting to show, so I'm also starting to get a lot more nervous about the future. If I can't take the pain now, how will I deal with it when I've got extra weight to support? But I've been diligent with my stretches, posture, and exercises and I was still optimistic that my physical therapist/massage team would have something up their sleeves to get me through.

Until yesterday.

Yesterday, my physical therapist essentially gave up on me. We talked about how I was diligently doing everything they had taught me but that it still wasn't really helping. And, it seemed to me, she just got overwhelmed. I got the distinct impression that my combination of problems - SI joint pain, RA, and pregnancy - was just too much for her to figure out. It felt like she just wasn't up to the challenge. Instead of offering me PT solutions, she told me that she thought it was time for me to speak to my rheumatologist about anti-inflammatory meds or getting an injection in the joint. She even offered to cancel my upcoming appointments until I had a chance to speak with my doctor.

Maybe she's right. Maybe it is time fore me to move on and consider other options. But I left physical therapy feeling pretty discouraged about how she had basically washed her hands of my problem. I mean, I realize I have a complicated set of issues. I know that sometimes stuff is going to hurt no matter what I do because of the RA. I understand that being pregnant makes me difficult to treat because I can't do everything you want me to. But I just felt so discouraged that she didn't have any more ideas.

I did call my rheumatologist and the nurse got back to me this morning. He's going to have me try taking 650mg of Tylenol every six hours for the next week to see if that helps. Unfortunately, this doesn't seem to be significantly more Tylenol than I have already been taking on my own to deal with the pain - so I am not super optimistic that it is going to solve the problem. The next step is to consider an injection to the joint, but my rheumatologist says he would prefer not to do so, so that makes me nervous too. 

I don't want to feel worried. I don't want to be stressed. It doesn't make me happy and I know it isn't good for the baby. But I can't help feeling a little overwhelmed by my inability to do anything at all about the pain in my back. And I'm starting to feel pretty scared that I have been working so hard for weeks to fix this problem but I haven't managed to make any headway. What on earth will I do as my belly grows?

Secret Post #20: SI Joint

NOTE: This post is part of a series that I wrote in secret during the months before I announced my pregnancy. The series chronicles my pregnancy journey: from weaning off my RA meds, to trying to conceive, to searching for helpful advice and information, to discovering I was pregnant, to the ups and downs of my first trimester. You can read all the posts in this series here.

 This Post Written November 16, 2011

Today I went to see my rheumatologist's assistant about the pain I have been having in my SI joint. Considering that I will be supporting considerably more weight in that section of my body over the next few months, having back pain during the first trimester is making me pretty nervous. Having it be associated with a joint is making me even more nervous.

But it turns out that RA doesn't usually affect the SI joint (usually). And though there are some other inflammatory diseases out there that do affect the SI joint (like AS: ankylosing spondylitis) apparently it's pretty rare for those to go hand in hand with RA. She said another option is OA in that joint (awesome), but that is also unlikely given my age. So this is a good thing - she said whatever is wrong with my SI joint it isn't likely to be caused by an inflammatory disease or OA.

She said it was more likely that the joint just got out of alignment and the muscles got mad. She prescribed some physical therapy, so I'm going to try that first. If that doesn't work then we are going to consider a short course of anti-inflammatories, as apparently there are a few that are considered safe at this stage of pregnancy (though of course we'll get my OB's approval if we go this route.)

Hopefully one or both of these plans will be enough to make the pain go away. If not, I'll have to suffer through it until the baby is born and it's safe to get some x-rays of the area. But, since the stretches I do every week with my pilates instructor actually do seem to help alleviate the pain (at least a little bit), I am optimistic that the physical therapy will be enough.

Even though my rheumatologist himself didn't have time for a full appointment with me today, he did pop his head in while I was with his assistant to say hi, see how I was doing, and offer his congratulations on my pregnancy. Also, my Arthritis Ambassador assignment this month was to ask my rheumatologist to join the Arthritis Providers and Researchers Advocacy Alliance and he told me today that he would join, which is very cool of him. His awesome nurse (who has helped me so much with insurance nightmares in the past) said congratulations too. The whole office is really excited for us, and that made me very happy. After all, these folks have been a big part of my life for the past three years. It's really, really nice to have their support.

In other news, I got a message today that the bloodwork from my first prenatal appointment came back. Everything looks good, except that my thyroid dosage needs to be increased a little bit. I'm actually really glad to hear that, because the increased dosage ought to help somewhat with the intense fatigue I have been experiencing.

In more different other news, I wonder if the nausea is finally starting to die down and if the cravings are starting to set in? Because I'm pretty sure I'd do anything for an In-N-Out burger right now. ~;o)

Rheumatologist Appointment

On Tuesday morning I broke down and called the rheumatologist to ask if there was any way to fit me in before next week because I just felt so gross. They got me in on Wednesday afternoon, which was awesome. I have to give my rheumatologist (and his awesome nurse) credit for always responding to me quickly when I finally work up the nerve to let them know I'm struggling.

APL also left work early to go with me, which was also awesome. Sometimes I get really overwhelmed at the doctor's office and forget to tell or ask the doctor things I meant to. Generally, APL and I sit down the night before an appointment and make a list of things to ask about, but sometimes I forget things even when I have a list, so having APL there is really helpful. Plus, sometimes he remembers stuff that I forget or that wouldn't occur to me to say. And just having him there makes me feel better. So I'm really grateful when he comes with me.

We told my rheumatologist about how I have been feeling and he did an exam of my joints. None of them were really swollen and of course my knees weren't actually hot while I was there (why would my body cooperate like that?) so he had to trust us on that one. We talked about  the possibility of switching from Enbrel to Orencia, Rituxan, or Actemra, but he was reluctant to do so because he thinks the RA itself was actually under fair control and that there could be other causes for my current pain and malaise. 

We  took x-rays of my knees (and, while we were at it, of my feet and hands to check for  RA damage) because he thinks that patellofemoral pain may be a contributing factor of my knee pain. This has something to do with how the patella tracks along the groove of the femur. Considering that I have definately already had trouble with my patella, this seems pretty reasonable to me. As I understand it, a possible cause of this pain can be weakening of the muscles that work your knees, which also seems reasonable considering I've been much less active over the past two years. Apparently he will be able to tell whether this is likely from the x-rays, and if it is then I will need physical therapy to help with that pain. If it isn't, well we'll cross that bridge when we come to it.

He also ordered blood tests to check for other causes of the fatigue. But, if those turn up negative, he seems to think my "malaise" is caused by depression. I honestly don't like this idea because I do feel like I'm doing a lot better and feeling a lot happier, and I certainly have less stress since the semester ended. But I'm sure my rheumatologist is more experienced with watching patients adjust to an RA diagnosis. 

As much as I would really like to take fewer drugs instead of more drugs, I mostly just want to feel better. My rheumatologist says that there are some anti-depressants that have been shown to help with pain as well, so I guess that sounds pretty good. So we're trying Cymbalta, which is prescribed for depression and general anxiety disorder but also for diabetic nerve pain and fibromyalgia (which, as far as I understand it, is major pain with  a pretty much unknown cause). 

Even if I actually need the drug for depression, I have to admit that it somehow makes me feel better that it is also used to treat pain. I guess that's because I don't want depression. I want to be able to say "it must have helped with the pain" if the drug makes me feel better. I don't want to think of myself as depressed. I want to be happy. I want to be healthy. I want to be doing a good job handling everything that is happening to me and my body. But I guess I am actually doing a good job handling everything that is happening to me and my body. Asking for and accepting help is part of doing a good job.

However, I also have to admit that I really had mixed feelings about putting this depression treatment in this blog. It somehow feels more personal than the bloody belly-button (though I'm sure some of you will disagree!) But these struggles are certainly part of my RA journey, even if I don't completely understand them myself. And the purpose of this blog is to help me figure myself out and to be an honest record of my RA journey. I'm trying to accept the fact that it's ok for me to struggle. I want to be ok with needing help and asking for it. I'm not there yet, but I'm trying. And if putting my own struggle on this blog helps someone else with theirs, even a little bit, it's worth it.

My Secret Full Time Job

February is a short month. And we're only 22 days in. But I have already had SEVEN medical appointments this month alone.

(1) Physical therapy for my paterllar sublexation.
(2) More physical therapy.
(3) General doctor for blood pressure.
(4) Rhuematologist.
(5) Physical therapy again.
(6) My first appointment with the nutritionist. (Did you know that there is sodium in everything?? So turns out I've been doing a crummy job at being low-sodium. So, hopefully with the nutritionist's help I'll be doing better at that soon.)
(7) Even more physical therapy.

And I'll rack up at least three more by the end of February:

(8) General doctor for blood pressure tomorrow.
(9) Orthopedist follow up for paterllar sublexation on Wednesday.
(10) Physical therapy again on Thursday.

March doesn't look to be much calmer.

(1) (2) (3) (4) (5) For the time being, I'm still going to physical therapy every week. Between my knee and other RA issues, will I have to keep going? Probably.
(6) For the past nine months I've been seeing my general doctor every couple of weeks for the blood pressure, so she'll probably have me book at least one follow-up for March
(7) (8) I'm supposed to book a follow-up with the nutritionist. Maybe I'll be seeing her more than once in March?
(9) Perhaps TMI, but it's time for my annual at the women's center. (Bleh.)
(10) After the advice of two doctors and the unsolicited advice of multiple friends, I'm going to try going to see a therapist again. Starting next week.

On the one hand, I'm really proud of myself for staying on top of all my medical stuff and trying to get the help I need. And it's kind of nice to have a whole team of doctors and specialists who are working to help me feel better.

But...at the same time....multiple doctors appointments every week is completely exhausting. Even without the fatigue from RA and law school I think it would be totally exhausting. As is, sometimes I just feel totally overwhelmed at the thought of just one more doctor's appointment. Going to the doctor has become a damn full time job. And this job doesn't seem to come with any vacation. And that sucks.

NOT ok!

After a long day of class and trying to get around through the snow and slush without slipping and injuring myself still more, I returned to the creepy Oz this afternoon at my physical therapy appointment: more electricity sent through to stimulate the muscles in my knee. The therapist also used two other machines this time: the ultrasound and the infrared. I'm not sure I understand the difference in what all these machines are supposed to do. All I know is they are supposed to help my knee feel better. Though I have to admit that my knee actually felt worse after PT this afternoon. And I'm starting to get a lot more pain in my right hip, which I assume must be related to whatever is going on in my knee.

When I expressed to the therapist that I was experiencing more pain in my knee than I really feel comfortable dealing with (on top of the rest of the pain I deal with on a regular basis) she told me that it would be ok for me to use a cane while walking. I know she only meant temporarily and I know she was just trying to help me. But here's the thing:

I JUST TURNED 27 YEARS OLD!!!
IT IS NOT OK FOR ME TO NEED A CANE!!
NOT OK.
AT ALL.
IN ANY WAY.

Sorry for the shouting. It's just that adjusting to all of the changes in my body since my diagnosis has been really difficult for me - both physically and mentally. And to keep myself sane, I've had to figure out how to laugh at situations that just aren't funny. At all.

But recently I sort of feel like my ability to stay positive is backfiring on me. I've been feeling like my doctors aren't really taking me seriously about the amount of pain I'm in. Or how upset I am about being 27 years old and having RA and being too exhausted to do anything fun and dislocating my knee on top of all of that. Just because I come into the doctor's office trying to smile and stay positive doesn't mean I'm ok. It doesn't mean I'm exaggerating when I say I'm in pain.

Aren't doctors supposed to know that?

The Creepy Oz, Not the Munchkin One

Yesterday I had my first physical therapy appointment to work on my confused kneecap, which thought it might be fun to do its own thing and totally dislocate itself from the rest of my leg last week. Bad kneecap! My dad's theory on my knee's misbehavior is that my muscles are now weak because I've been less active in the past year and a half than ever before in my life. He is probably right, though that is not exactly a happy thought.

After examining my knee and showing me some exercises I should do to work on strengthening the muscles that will keep my bad kneecap in line, it was time for the creepy part. The physical therapist hooked me up to a machine that sent an electrical current through my knee to stimulate the muscle. While I understand the theory behind this (stimulate and strengthen the muscle without me having to distress my already distressed knee joint) let me just say this:

Do. Not. Like!

(1) It is highly creepy to watch your muscles move against your will.
(2) That machine looked like the one from Return to Oz - the creepy Oz, not the munchkin one.

And, after the treatment was over, I still had to wait in the pharmacy for 45 minutes for them to refill and process the payment assistance on my Enbrel, even though I had called the refill in that morning. Needless to say I didn't get home as early as I wanted to and was up later doing homework than I should of been. On top of the physical and emotional exhaustion from traveling to the funeral this weekend, I am now adding the exhaustion of too much work and not enough sleep this week. Plus I got all mad and riled up over that ABC Article instead of doing homework this afternoon, so I have to admit that I am less than a happy camper this evening.

Having a chronic condition is a full time job. Do you think the economy is crappy enough that I could hire someone to do it for me???

Yeah... didn't think so.

My Kneecap Went on Vacation Without Me

After an hour in the sports medicine waiting room this afternoon, APL and I finally met a very nice orthopedist who gave us some good news: there doesn't appear to be any permanent damage in my knee and crutches won't be necessary!

She says what happened was patellar subluxation, which basically means that my kneecap thought it would be a good idea to pop out of the socket and then changed its mine and popped back in again. (So turns out Pop Goes the Knee(sel) was a very appropriate post title.) This was highly painful and my knee is still traumatized from the event, but there is nothing physically wrong with my knee right now except bruising and soreness.

While she said that this could happen randomly and to anyone, she also said that people with RA are slightly more likely to have this happen because recurrent swelling of the knee can make the muscles that hold the kneecap in place weaker. However, I haven't really had trouble with my knees since I was very first diagnosed with RA, so maybe this was a random event for me.

In any event, the treatment is to wear the knee brace, walk gently on it, and start physical therapy to strengthen certain muscles to reduce the likelihood of this ever happening again. So I'll see the physical therapist on Monday.

Thank goodness I don't have to keep using those crutches. RA + crutches = sucks real bad! In addition to the pain already in my knee, the crutches made my fingers hurt from gripping and my wrists and shoulders hurt from supporting my weight. I only used the crutches for half a day, but I am 100% exhausted this evening.

The news could have been so much worse. To be honest I was pretty nervous and freaked out about this whole experience and what it might mean for my future if my joints were already starting to fall apart, despite treatment. So I'm sure some of the exhaustion I am currently feeling comes from worry too. So, though my knee is still killing me despite the vicodin I took a little while ago, I am extremely grateful that there is no permanent damage in my knee.

And I'm super thankful for APL through this whole thing - coming running to me when I cried out, bringing me lunch and coffee at the law school, chauffeuring me around, and helping me through all the waiting rooms and doctors appointments. Looks like I picked a good one!!