Best Health Blogs of 2013

From This Point. Forward. has been nominated for the second time for Healthline's Best Health Blogs of 2013 contest! There are lots of amazing health blogs on the list over a range of topics and health issues - so please check out the contest and vote for your favorite!!

November Articles on Answers.com

You can find a complete list of all the articles I have published on Answers.com by clicking here. Below is a list of the new articles I published in the month of November.

• Rheumatoid Arthritis (RA) 
• Treatment Options for RA
• Rheumatoid Arthritis and Sleep
• Arthritis Medications
• Biologics
• Biologic Medication Profile: TNF-Blockers
• Biologic Medication Profile: Interleukin-I (IL-1) Receptor Antagonists
• Biologic Medication Profile: Interleukin 6 (IL-6) Inhibitors
• Biologic Medication Profile: T Cell Suppression 
• Biologic Medication Profile: Abnormal B Cell Removal
• JAK Inhibitors
• JAK Inhibitor Profile: Xeljanz (tofacitnib)
• Diet
• Recipes
• Red Lentil Soup Recipe

Jumping Through Insurance Hoops

The hoops we have to jump through to follow healthcare and insurance procedures can be very frustrating, especially when we are already feeling our worst. I wanted to offer a few tips that might help.

Read more at RheumatoidArthritis.net.

Means To An End

Last weekend the weather was quite nice, so my mom and I went out into the backyard to to start attacking the one hundred billion leaves that were blanketing my lawn. Unfortunately my knees have been in so much pain lately that I found myself wearing double knee braces. And I only was able to do a little bit of raking before I had to give up and sit down.

I tried to remember the last time my RA pain had been this bad. Luckily, this blog is like a health timeline for me, so I scrolled back through my posts until I found the last time I was wearing double knee braces: right before my wedding and then again on my honeymoon.

There was a reason I was in so much pain at that particular time. Although I didn't make it public at the time, when my wedding rolled around I had already been off methotrexate for more than six months. I needed to get it out of my system so that it would be safe to conceive OZL. And although I stayed on Enbrel until I found out I was pregnant, Enbrel alone just wasn't enough to keep my RA completely under control. During the six months leading up to my wedding and the four months it took to get pregnant, I dealt with massive knee pain, excruciating hip pain, and extreme fatigue.

Luckily, I did experience at least some remission during my second trimester. But, by the time I hit the third, I was dealing with a huge pregnant belly and hip pain, hand pain, and major morning stiffness (not to mention a couple pregnancy complications). In the end I was put on bed rest until I hit 37 weeks, and OZL was brought into the world a bit early, which ended up being better for both of us.

I nursed OZL for three months until I reluctantly stopped so that I could start taking Enbrel again. Getting back on the Enbrel made a major difference in my quality of life and ability to be the mom I wanted to be. But since that time I have dealt with flare after flare because I never went back on the methotrexate.

Why? Because we want OZL to have a sibling. I have two siblings and APL has one. Neither of us can imagine our lives without our siblings and we really, really want OZL to have the opportunity to grow up with at least one brother or sister.

I never went back on the methotrexate because it was too much of a time commitment. It would take several months before it even started helping, plus however long I stayed on it to get the benefit, plus six more months to get it out of my system again before it would be safe to try to conceive another baby. We decided we didn't want our children to be so far apart in age. And, while we probably would have preferred to wait until OZL was a little bit older to start trying for a second baby, in our world the longer we wait the longer I end up dealing with RA that isn't completely treated. Which means I am living with more pain and more fatigue. So, after weighing all of our options, we decided to start trying for baby #2 when OZL turned one in May.

It has been seven months and unfortunately we are not pregnant yet, though I will admit that for at least two months my ovulation lined up so closely with my RA flares that we weren't even able to try. We are trying to remain optimistic, but in the meantime my RA has gotten worse and worse - to the point where I am wearing double knee braces just to stand in my own backyard.

The Enbrel just isn't enough on its own, and over the counter NSAIDs aren't helping. So I finally went to see my rheumatologist yesterday. With my options for medications severely limited by my desire to get pregnant, I agreed to try some prednisone (i.e. Satan's tic tacs). Prednisone and I have a long love-hate relationship. It is wonderful because it usually works great to give me less pain and more energy, but with prolonged use I get almost all of the nasty side effects. A few years ago, after being on prednisone for more than a year, I decided that the side effects were way worse than the benefit and swore never to use it again. But, of course, there are only so many options - especially when trying to conceive.

I know that I need more than just Enbrel to keep my RA under control so that we will have a chance to have a second baby. I am really hoping this will be a temporary commitment to prednisone, perhaps a month or two until I am pregnant at which point hopefully I will get some remission and not need it anymore. I don't look forward to moon face or weight gain or insomnia or blood pressure issues. But I do really look forward to growing our family - and that will make it all worth it in the end.

Is It Time To Retire Walking For Arthritis?

This is a very interesting point of view: is it time to retire walking for arthritis? 

Even though I agreed to be the honoree for the Jingle Bell Run/Walk this year, I sort of tend to agree with the point he is making.

Stuck In The Middle

The more I think about it, the more I realize that I belong to a demographic of arthritis sufferers who receive less support, recognition, and resources than they ought to.

Read more at RheumatoidArthritis.net.

October Articles on Answers.com

You can find a complete list of all the articles I have published on Answers.com by clicking here. Below is a list of the new articles I published in the month of October.

• Other Types of Arthritis & Related Conditions
• Ankylosing Spondylitis (AS)
• Treatment Options for Ankylosing Spondylitis
• Fibromyalgia
• Treatment Options for Fibromyalgia
• Gout
• Treatment Options for Gout
• Lupus
• Treatment Options for Lupus
• Psoriatic Arthritis (PsA)
• Treatment Options for Psoriatic Arthritis
• Sjogren's Syndrome
• Treatment Options for Sjogren's Syndrome
• Diet
• Ingredients 
• Salmon: A Great Source of Omega-3s
• Recipes
• Ginger Salmon Recipe
• Drinks 
• Steamed Turmeric Milk Recipe

Sigh.

Last week, when I called Aetna Specialty Pharmacy for my Enbrel refill, I was instead informed that I would be unable to get my refill until I obtained a new prior authorization form. Though I was frustrated not to be given warning that I would need this paperwork, I got the appropriate form from my doctor as soon as possible. This morning I called back to order my refill. After confirming my Aetna ID number, name, and birthday, I had the following conversation:

Me: Hi. I would like to order a refill of my Enbrel.

ASP Person #1: Let me put you on hold.

(lengthy pause)

ASP Person #1: You will need prior authorization.

Me: Yes I know. I had my rheumatologist send the paperwork last week by fax. 

ASP Person #1: Yes but it hasn't been approved yet. 

Me: Oh. How long does that take?

ASP Person #1: 7 to 14 days.

Me: Really? I'll miss two doses if it takes that long. Isn't there anything we can do to speed up the process?

ASP Person #1: That's not my department. Here's a number you can call.

At that point I'm pretty sure I muttered something about this being a stupid system, then promptly apologized since I know it was not Person #1's personal fault. So I call the second number and get an automated machine, which makes me enter my Aetna ID number and my birthday and then confirms my name before turning me over to a human. But I'm not sure what the point of that was anyhow, because the first thing Person #2 did was ask me for the exact same information. Then this happened:

Me: Hi. I'm trying to find out how long it will take before I can get a refill of my Enbrel.

ASP Person #2: Ok. Let me transfer you over to the pharmacy.

Me: No! I just talked to them. They told me that I need to call you. 

ASP Person #2: If you want a refill you need to talk to the pharmacy.

Me: They told me I need a prior authorization, which my doctor sent. I am trying to find out how long it will take to have that approved.

ASP Person #2: Can you hold please?

(lengthy pause)

ASP Person #2: It has been approved.

Me: Really? The pharmacy said it would take 7 to 14 days.

(thinking: good thing I bothered to call this second number instead of just waiting to hear back from the pharmacy)

ASP Person #2: No, it's approved now. Let me give you the approval number.

Me: Great. So I just call the pharmacy back with this number and I will be able to order my refill?

ASP Person #2: Yes. I can transfer you there right now.

Me: Thanks!

But (of course) it was too good to be true. She transfers me back to the pharmacy, and, after a lengthy hold (of course) I get a human. She (of course) wants my Aetna ID number, birthday, and name for the fifth time. Then this happens: 

Me: I'd like to order a refill of my Enbrel. 

ASP Person #3: Let me put you on hold

(lengthy pause)

ASP Person #3: Oh. This was just approved today. Unfortunately you can't order a refill at this time.

Me: Why not? They just transfered me over here and said I could.

ASP Person #3: Well the system isn't letting me. It takes some time for the different systems to connect. 

(thinking: does it? Pretty sure the interwebs are instantaneous...)

Me: So...what does that mean?

ASP Person #3: You can try calling back in a few hours. Or maybe tomorrow.

Sigh. Forty-five minutes later, it turns out I might maybe be able to order my Enbrel in a few hours. Or tomorrow. Or in 7 to 14 days. It's unclear.

The only thing that is certain is that I will be missing today's dose of Enbrel. Sigh.

Jingle Bell Run Kickoff Party

As I let slip in an earlier post, I have agreed to be the honoree for the 2013 Denver Jingle Bell Run. Yesterday I took OZL to the zoo for a few hours and after work we met up with APL to attend the Jingle Bell Run Kickoff party. Some friends of ours - who have been members of Team Z since day one - also joined us there (and even won some Jingle Bell Run swag in a raffle!) It was really nice to get to meet the Arthritis Foundation staff and members of the Jingle Bell Run Committee who work so hard to put together such an important fundraiser. 

Personally, I feel a little bit awkward having the spotlight turned on me - especially in person. I talk all about my innermost feelings and struggles on this blog, but I do that behind a shield of words. Generally, I am not faced with anyone's reactions to what I write, and when people do send me their reactions I have my own time and space to process what they say and figure out how to respond. But talking about my story and my experiences in person is a different matter and one that, as of yet, I am still a little bit uncomfortable with. So I am planning to try use this experience as a chance to grow and improve my speaking and interpersonal skills! (Translation: be less awkward, Mariah!!!)

Aside from potentially improving my awkwardness in talking about my arthritis in person, I don't  think that I personally need the honor of being the honoree. However, I am glad that the Arthritis Foundation chose me because I am proud to serve as the face of a demographic of arthritis sufferers who I feel receive less support, recognition, and resources than they ought to.

The Arthritis Foundation is a truly a fantastic organization, doing amazing things for everyone who lives with arthritis and helping to fund the research that will hopefully lead to a cure. But, like any organization, they also have limited means. Unfortunately, within those limited means, I feel that my demographic sometimes gets lost in the middle when it comes to promoting awareness and providing support.

On one end of the spectrum, the Arthritis Foundation spends a lot of time and energy focusing on older adults with osteoarthritis (OA). This makes a lot of sense because it is the largest population of people living with arthritis. Providing support and resources for people with OA is especially important because it can bring the largest number of people to the cause, which can only help promote awareness and improve fundraising efforts. Not to mention that the focus given to lifestyle changes, therapies, and assistive devices for older people with OA certainly overlaps to provide some useful support for older people with RA and other forms of arthritis. 

On the other end of the spectrum, the Arthritis Foundation spends a lot of time and energy focusing on children growing up with juvenile arthritis (JA). I can only imagine that having arthritis makes for a very difficult childhood, so I honestly do think these children and their families deserve all the love and support they can get. And, realistically, the sad story of a child growing up with arthritis also speaks to the heart and can certainly help a great deal with fundraising.

But what about those of us who were diagnosed in our 20s or 30s? Those of us who haven't yet started a career or started a family or who are in the middle of doing so? Or even the kids who grew up with JA who are no longer young enough to benefit from the JA materials? I personally do not think there is enough support for this demographic - my demographic of young adults. The support for kids seems to end at adolescence. And the language used to speak to older adults about adjusting to their arthritis - the need to slow down and make compromises - is not really something that someone just starting out with their life wants to hear. (In fact, I was quite upset about the use of this type of language when I was first diagnosed.)

Being a young adult is a difficult enough transition when you are perfectly health. I really think that young adults with arthritis deserve more resources and support, though do I realize this is difficult to accomplish without taking away from the other demographics. But we need hope too. We need more stories of people finishing college and grad school and starting successful and satisfying careers, despite their arthritis. We need more advice about how to talk to our employers about our physical needs, and more information about our workplace rights. We need more hopeful and uplifting information about how to survive off our meds so that we can start a family or breastfeed our babies. We need more resources so we can connect to and support each other as we travel through the prime of our lives while battling arthritis.

This is one of the main reasons I write this blog and it is certainly the main reason I agreed to be the Jingle Bell honoree. And, seeing as the Arthritis Foundation chose me as the honoree, hopefully we are all taking a step in the right direction.

Feeling Special (Yet Again)

After researching, investigating, and endlessly discussing, APL and I finally determined that we had the best health insurance that was available to us for the time being. Despite the open enrollment period, we decided to stick with the health insurance plan that we already had. So we didn't change anything at all. The enrollment period just ended and the new plan year started on October 1st. 

Unfortunately, I have just been informed by Aetna Specialty Pharmacy (after 10 minutes on hold obviously) that simply being in a new plan year counts as having "new" health insurance, even though we did not change anything at all. This, of course, means that I need to get a new prior authorization from my doctor to get my Enbrel refill. Why is it that every time I talk to the "Specialty" Pharmacy there seems to be some sort of problem?

I am particularly frustrated about this one because I have been sick, so I put off taking my last dose of Enbrel an extra day to make sure it didn't make my cold worse. But now I am concerned that I won't be able to jump through the hoops in time to get my Enbrel refill in time for next week. This is partially my fault - I didn't realize there was only one dose left in the fridge - but I am frustrated that it never seems to be easy. And that I usually end up dealing with issues like this when I am not feeling that well.

Too bad my insurance forces me to get my Enbrel through this particular pharmacy, otherwise I'd have ditched this place after strike two. By my count we are on about strike six, but I have no choice but to stick with them.

In any event, here is an unrelated and adorable picture of OZL to make everyone feel better! Time to go get him from school!