The Right Way To Do a Methotrexate Injection

I did my injections last night, and, yes, I did hesitate again over the Methotrexate one, but not as much as last week (for more on that, see a couple of posts back).

I considered looking away and doing it, but thought that wasn't such a good idea, and then I just did it! No hesitation, just darted it in and, of course, it didn't hurt at all!

Nothing, not even any sensation at all!

And that, ladies and gentlemen, is the right way to do a Methotrexate injection!

Now I just have to keep doing the Methotrexate dart! Just do it, do it, do it!!!

A Visit with My Rheumatologist

Today I went to see my rheumatologist for the first time since February.

I told her that up until last week, I've been feeling progressively worse, and that the week before last had been the worst week since I'd been on heavy-duty meds and, in fact, I had been going to tell her that I thought the meds weren't working very well. But last week I had a really good week (figures! just before I go to the doctor!), so that's changed.

She checked me over and I have no inflammation.

My bloodwork's been fine.

Confirmation that I have Raynaud's disease – check.

She asked about infections – nope, none.

When I mentioned my drippy nose, she said, "Allergies."

I said, "No. I don't have allergies, and it only began when I started the Methotrexate and Enbrel and that was in the winter."

When I mentioned pain, she asked where, and I told her. I said I've been having more pain now overall than I had, other than right at the beginning. And I told her about getting back into exercising on a regular basis.

She said that the pain was from exercise and muscle soreness and getting back into it.

I said, "No. This pain is from RA. I know what exercise pain feels like and this is different. I'm on the elliptical, and first my left foot hurts, then my right foot, then my left knee starts, then my left elbow. It's pain because of the RA."

Not to mention I have the pain all the time and had it before I started exercising.

Surprising response from her, I think (although, in the interest of full disclosure, I hadn't said exactly when I started exercising and when – exactly – I started having the pain).

Don't get me wrong – I like my rheumatologist. She immediately launched an aggressive attack on my RA in term of meds, etc. She answers my questions. She responds to my e-mails. She renews my prescriptions without making me come in for an appointment.

I just think it's odd she thought my pain was the result of my renewed exercise.

Of course, the appointment was way too short, and I thought of all sorts of things I should have said after. Not things I wanted to cover off: I had all my questions, and we went over them all, and I got all those questions answered and got all the prescriptions I needed renewed. What I mean is things I thought of in response to the conversation. Things like, if the exercise is the cause of the pain and not the RA, what explains what happened the other night? It was the Thursday night of that bad week. I was just sitting at my dining table, not moving my feet at all, and I'd been there a while. All of a sudden, I felt a sharp pain in my left foot, so sharp I gasped out loud and then started crying.

That's not from exercise. That's from RA.

My New Toy: The Kobo E-Reader

I just got a Kobo e-reader today and am so excited! It's a Canadian e-reader (it'll be on sale in the U.S. in the summer) and so has access to all kinds of books here in Canada that American e-readers don't, plus it's one of the smallest, lightest e-readers out there, which should make my body very happy. My elbows, hands and wrists have been getting quite sore of late when I've been reading, so this should ease some of that discomfort.

I have to admit that I'm still not quite sold on the idea of not having actual books in hand, but for some books, the e-reader will be just fine. And Kobo books are device neutral, which means I can even read them on my iPhone if I should happen not to have my Kobe e-reader with me, and I can also download to the e-reader all kinds of books from other sites, not just bookseller Indigo/Chapters, which is where you can buy the Kobo in Canada.

And total bonus: it was free! My new boss had gotten it at a press event and wasn't sold on the whole idea, so it was over to me. Sweet!!! And it comes pre-loaded with 100 classic books. I am beside myself!

Now I'll just have to not go nuts buying books! I've always thought bookstores are dangerous places: I can rarely get out of them without spending money, and now I don't have to go anywhere to get books, cause I can just go online and download them.

Scary, very scary!

Methotrexate Dart

I have no idea what's going on, but tonight I just couldn't seem to bring myself to do my Methotrexate injection at first.

I'd had trouble loading the syringe – this is the second time a syringe has leaked on me.

The first time, I started off thinking I was being clever: I'd noticed that I'd often get a big bubble in the syringe, so I decided to do things differently. I'd just been sticking the syringe in the vial, then inverting it and drawing the medication, which is what my rheumatologist had shown me to do. But she'd also given me some written instructions, and on those it said to draw half a dose of air into the syringe first, inject that into the vial, then draw the medication into the syringe. So that's what I did.

Ha!

Methotrexate everywhere! It all started dribbling down the syringe onto my hands and then the floor.

OK, not a good idea. Why it didn't work, I have no idea. So I've never done it that way again.

Tonight, I just had a big air bubble I was trying to get rid of. I know the instructions say bubbles really aren't that big a problem, but I still wanted to get rid of it, so I flicked the syringe and injected the Methotrexate back into the vial a couple of times, then drew it back out, when, tada!!, leaking again!!!!

Then the difficulty with the Methotrexate dart (hence the post title). Lately, I've been hesitating when I've gone to dart the syringe into my stomach. Not by much, but still.

Tonight, my brain froze and so did my hand. Stomach was all pinched and ready to go, brain and hand did not want to cooperate.

I seriously counted to 10 about 5 times, each time saying, OK on 10 I'm going to do it!!

Finally, I did do it (because, really, the alternative is what? pain? stiffness? not moving at all?). But I did it slowly, and I had to puncture the skin consciously – which I'm sure you'll all agree is not the preferred mode of injection – but I did it.

What is up with that?????????????????????????????????????

Report on Exercise

Illustration courtesy of Everyday People by Cathy Thorne

OK, here you go! The results of my little exercise study!

How do I feel? Well, I've been feeling quite sore the last few days, except today.

Is that because I've been exercising or because the meds aren't working? I can't help but think it's the latter to be honest – especially since I'm not sore today. It's something I started suspecting even before this little experiment began. Not sure if I mentioned this already (although I think I did in my Pain post): on Mondays and Tuesdays, it's been feeling like the meds were wearing off. Now it feels like they're not kicking in again till Friday nightish (I do my injections on Wednesday nights), and then not kicking in as well as they used to.

Do I have scientific proof of that? Of course not, so take it as you will... Or maybe it was a real flare this past week. What do I know? Not a lot, obviously, as I'm so new to all this.

All I can tell you is that, despite the increased soreness, I feel better for the exercise. It feels good to be moving more again and feels good, in some small way, to be building up some muscle mass again.

A surprise, though: I still feel way crazy fatigued – something that I thought being off for two weeks and exercising would help with. Not a chance. I blame it on the meds (more on the fatigue in another post).

Below, for each day I exercised, I noted what I did, how I felt before, during and after, and provided links where possible to images of the exercises I've been doing, so you know exactly what I've been up to. And at the end is a list of stretches I do, depending on the exercises I've done (it might be incomplete, as I couldn't find links to everything). I apologize in advance as it does go on a bit, but it's there for those of you who want all the deets...!

P.S. It's interesting to note that my left side is the one that's causing the most problems for me in terms of the RA. All the time that I've been working with my personal trainer (which I've been doing for years now, pre-RA), we've recognized that my left side is definitely my weaker side. I don't think you notice that sort of thing in day-to-day life, you just compensate for it unconsciously – things like stepping up on a chair with your dominant leg when you want to reach something high or always picking up something heavy with your stronger arm. Once I started doing strength training on a regular basis with a trainer who forced me to use both sides equally, I quickly realized how freakin' weak my left side was in comparison – insane! So we worked each session to address the inequality. And now I can't help but think that the pain and soreness I'm feeling on the left side is a result of that greater weakness...

WORKOUT 1, Friday
How I Felt Before Started off feeling good, joints felt quite good overall, some soreness in left foot toes, but overall just some minor aching in various places.
Cardio 20 minutes elliptical level 1
Strength 3 sets 7.5 lbs biceps curls, 50 lbs lat pulldowns, 50 lbs triceps pushdown, ab crunches
How I Felt During Fine. Some soreness in feet, but nothing at all to be concerned about other than momentarily.
How I Felt After Good!

WORKOUT 2, Sunday
How I Felt Before Somewhat achy, sore in feet, knees felt loose, hips aching vaguely last night, elbows sore
Cardio 20 minutes elliptical level 1
Strength 2 sets 7.5 lbs biceps curls, 50 lbs lat pulldowns, 50 lbs triceps pushdown, oblique crunches, 10 lbs dumbbell side bends
How I Felt During Elliptical was good to start (music made me want to go faster, but am keeping it slow because haven't done anything consistent over last 4 months), but about 10 minutes in, my feet starting aching more. For the last two minutes or so, they hurt quite a bit (not killing me, but uncomfortable) + my left elbow was unhappy, too. Strength stuff went quite well, although I only did 2 sets because once I started, I realized my muscles were tired, even though they hadn't felt sore or anything before.
How I Felt After An hour or so after workout, felt really good! Very little achiness, which is saying something! Felt great for about two hours – almost as if all my joints had been lubricated + I was almost back to "normal." After that, effect wore off + soreness/achiness/"looseness" started setting in again. My hips were somewhat sore that evening/through the night.

WORKOUT 3, Wednesday
How I Felt Before hands + left ankle kind of stiff, otherwise pretty good
Cardio 23 minutes elliptical level 2
Strength 3 sets 7.5 lbs biceps curls, 50 lbs lat pulldowns, 50 lbs triceps pushdown, ab crunches, 10 lbs dumbbell side bends
How I Felt During While doing elliptical, about 6 minutes in, right foot started hurting, then stopped after a bit. A few minutes later, left foot chimed in. At about 13-minute mark, right foot started up again, along with left knee – they hurt quite a bit + wasn't sure if they'd let me get to my target time (20 minutes), but I kept going + they soon stopped hurting. Then left elbow started aching a wee bit + left foot again. The whole thing was like a day with RA – random joints chiming in now + then, with some more problematic than others. Strength stuff felt fine.
 How I Felt After Fine – not as exhilarated as last workout, but not worse off than before. Some workouts are just like that!

WORKOUT 4, Thursday (strength session with my trainer)
How I Felt Before Legs felt "loose," left toes felt sore.
Strength 3 sets ball squats, single leg raises (while lying face down on exercise ball), straight leg raises (while on side with hip in extension), supine glute bridge with hip abduction (I did it without the band)
How I Felt During OK; left toes hurt, my glutes felt the pain during the bridge exercise – they haven't done that much work in a while, but it was good to feel that!
How I Felt After Legs felt pretty immediately loose again, toes weren't as bad as before.

WORKOUT 5, Saturday
How I Felt Before The day after trainer workout, glutes + quads seriously sore! Not surprising, seeing as I've done no lower-body strength workouts in months!! Balls of feet have been really sore last 2 days when walking for any distance; hands + left elbow sore.
Cardio 20 minutes elliptical level 2
Strength 2 sets ball squats, straight leg raises (ditto), supine glute bridge with hip abduction (no band) – oops! forgot the single leg raises!
3 sets 7.5 lbs biceps curls, 50 lbs lat pulldowns, 50 lbs triceps pushdown, ab crunches, 10 lbs dumbbell side bends
How I Felt During Right foot really started hurting about midway through. I try thinking about good-looking men in the hopes it will help (just read Globe and Mail article in morning about connection between reduced pain and thoughts of something pleasurable).
How I Felt After Alright. Not the exercise high I like, but still good for having done it.

WORKOUT 6, Tuesday
How I Felt Before Legs felt loose, which is never good sign – those days are usually bad ones.
Cardio 20 minutes elliptical level 2
How I Felt During Feet hurt, elbows were sore, knees felt loose, neck felt tight, I felt unenergetic + blah.
How I Felt After Not a great evening: feet were sore, particularly left toes, which hurt. Hands, left elbow, knees, neck were sore.

WORKOUT 7, Thursday (trainer) 
How I Felt Before So-so. Yesterday was injection day + was feeling pretty sore + achy + today left foot toes were sore + left knee felt like it might kick up a fuss.
Cardio 25 minutes elliptical level 2
Strength 3 sets arm punches 10 lbs (lying with head + shoulders on exercise ball arms at side elbows bent "punch" arm straight up into air), elastic band triceps kickbacks, 20 lbs two-arm rows (I used a dumbbell), 5 lbs draw-the-sword, exterior rotator cuff (one caveat: only move as far as you can. In the image, the girl has her arm out almost 90°; I can barely move mine 10°, but that's as far as it goes, so that's as far as I push it!)
How I Felt During We concentrated during the strength part on upper body (did the cardio on my own), and focused on keeping my form, since left elbow felt rather rebellious, like it wanted to crap out on me, but it hung in, so that was good!
How I Felt After Good for getting through with no joints causing major problems. Still feeling rather sore, but think that's due to the drugs not taking full effect yet, rather than anything else...Evening was another story. I hurt. No other words to describe it. Think drugs aren't working the way they should be. Or exercise is adversely affecting me. Not sure which. Bloody hell!!!!!!!!!!

WORKOUT 8, Sunday
How I Felt Before Sore. Have been very sore the last few days. And stressed, which is why I decided I so needed this workout. (Family – can you say stress???)
Cardio 25 minutes elliptical level 2
How I Felt During Surprisingly good, considering how crap I've felt during last few days. Not sore at all really!!
How I Felt After Still stressed but not quite as bad. Neck feels sore, so I'm sure to stretch it out.

WORKOUT 9, Monday (trainer)
How I Felt Before Good!
Cardio 15 minutes elliptical level 2, 10 minutes level 3
Strength 3 sets ab crunches, hip extensions, torso twist with medicine ball (important to keep knees aligned!), dying bug, 1 set supermans (done on 2 mats for extra cushioning)
How I Felt During Good. Right knee whining a bit, and left foot as usual, but fine otherwise.
How I Felt After Happy!

STRETCHES
Glute stretch; quadriceps stretch, shoulder stretch, triceps stretch, hamstring stretch, calf stretch, neck stretch

And there you have it, ladies & gentlemen!

Getting Better & Fun with Westies

Went to visit Gail, former editor of Style at Home, while I've been on vacay. A big highlight of seeing her is getting to play with her two Westies, Tilly and Clara.

The last time I was at Gail's place was for our annual Christmas visit over the holidays. I always pop in to see her then, but this year I wasn't feeling very good at all. RA was in its first month of working its black magic, I hadn't been diagnosed yet and was only on anti-inflammatories, and I was super-stiff.

Needless to say, there wasn't much playing going on with the two white cutie pies! I just sat in a chair and touched their heads as they passed by...

This time, the visit was so much more fun. I could sit on the floor – woohoo! Crossed legs weren't happening – still too uncomfortable to sit for any length of time like that now – but I could sit with my legs out in front of me, and the little munchkins were very excited!! And when I lay flat out on my side (that would have been so impossible the previous visit), they were absolutely beside themselves! They ran around head butting me, jumping about, grabbing their little toys to show me, and were totally overcome with doggie joy. I was pretty overcome myself with happiness.

Have I said before how much I love animals???

Such an improvement over the last time!

Below is a shot of one of them with one of their toys (hard to tell the dogs apart unless I can see the colour of their collars!). So cute, no? Clara, the oldest, always has to show me her stuffed hedgehog the minute I arrive. Haha! Just love those puppies!

Passing It On: The Sugar Doll Blogger Award

I was so surprised to find that Lana over at Living It, Loving It just suggested I receive the Fabulous Sugar Doll Blogger Award.

To continue the fabulousness, I'm supposed to let you know 10 things you don't know about me (hmmm...!) and suggest 5 other bloggers (that's the easy part!). So here goes!

10 Things You May Not Know About Me

1 I have many nicknames, some dating way, way back: Larry, Luigi, Algae, Lor, Lurleen, Leo, Dixie and I'm sure others I'm not even aware of (!).

2 I wanted to be a vet or marine biologist (shades of Jacques Costeau!) when I was growing up.

3 I love animals – sometimes I think more than people...

4 If I had to pick, I'd go for British over American television.

5 I was a bookworm growing up.

6 I never paint my fingernails colours, only my toes.

7 I love to travel but hate to fly – not because I'm scared, but just because I find it so bloody uncomfortable (and that was before the RA diagnosis!!).

8 I was meant to be rich (something obviously went seriously awry!).

9 I speak some German, Italian and French – enough to get by day-to-day, but not at all fluently.

10 I don't hold grudges, but I do obsess about things.

Passing It On

Here are my picks for 5 other bloggers without whom my RA journey would be a much lonelier one. They keep me company, give me support and make me laugh. Thanks so much, ladies!!

1 Wren at Rheumablog – could there be anyone more supportive?

2 Helen at Pens and Needles – just the cheer I often need, and she's Canadian!

3 WarmSocks at Itis – another great support in a cold RA world.

4 Mariah at From This Point. Forward. – a law student who makes me laugh and props me up.

5 Bionic Pony at, yes, Bionic Pony! – a funny Canadian RA'er.

Check them out! You're sure to enjoy their blogs! And thanks, Lana!!

It All Comes Down To Feet

When I got RA, my feet were super painful, so I started wearing a pair of slip-on runners (above right) around the house, because they provided the most support/cushioning for my feet. After quite some time wearing those runners, though, it occurred to me that that they might not, ultimately, be the best thing for my feet.

Why, you ask?

Well, I'd just been reading an article about how barefoot running is actually better for your feet than running in shoes that have all kinds of artificial support. I can't remember what exactly the article was, but here's a link to one from Science Daily that explains it even better I think. Daniel E. Lieberman, professor of human evolutionary biology at Harvard University, is the scientist behind the study that came to the conclusion, and he says, "Our feet were made in part for running." They were also made in part for walking, and walking without shoes, so by artificially supporting them with my runners – heavy ones at that – it occurred to me that fateful night (cue melodramatic music!) – that I might not actually be doing them, or my joints, any favours.

So once again, experiment time!

I got out my regular slippers (above left) and started wearing them. They might look like it, but they're not actually those great big huge sheepskin slippers; they're quite thin, but warm and soft. They weren't as comfortable as the runners at first, and I had to walk slower because of that, but we're just talking around my apartment after all.

Lo and behold, over the next few days, my feet slowly started feeling somewhat better!

Since then, it's sans runners pretty much. Don't get me wrong: my feet still hurt at times, and let's face it, I don't doubt that much of the improvement I'm feeling in my feet and elsewhere is due to the drugs I'm on. But there was a marked enough improvement over a short enough period of time when I stopped constantly wearing the runners at home that I can't help but feel the improvement was down to that.

Some days more than others my feet still feel like they need some extra lovin' – an extra little cushioning at the bottom, they're so sore, so I try to wear shoes/slippers that accommodate that. For instance, yesterday I went out to do a few errands, and the soles of my feet really hurt for some reason, despite the fact that I had been wearing my über-comfortable Rockport boots, so when I got home, I put on some flip-flops I have. They're quite cushy, but flat, so no support, so they're perfect for those damn-my-feet-are-achin' days.

Life with RA: in the end, ya gotta do what ya gotta do!

Macarons, Macarons & More Macarons!

Last night I went to see my friend Leotard and her pet parakeet Tip (above). If you've been reading this blog from the beginning, you know all about Leotard, how she got that nickname, the fact that she's French and owns our horse, Lex.

I love Tip, who's very affectionate when you get to know her. I babysat her at my place once for a few days, and even though she had eggs at that point and spent most of her time in her cage, she did fly out onto my shoulder and wanted me to scratch her neck and watched me cooking (I use the term loosely, of course, crap cook that I am!).

The latest scoop on Leotard is that she's obsessed with making macarons, specifically pretty pink raspberry ones with white chocolate mousse filling. And I am one of the happy recipients of her macaron-making endeavours, along with Leotard's boyfriend Mark! I think we're all doomed to get fat in the process! Probably not the best thing for me at this point (and one of the reasons why I'm detemined to get to the damn gym!), but, hey, you only live once and eat so many macarons!!!

Her latest attempts, based on a recipe from the famed French pastry and chocolate shop Ladurée, are pictured below. You can see why I'm a happy victim!

P.S. You'll note Leotard's clever coordination of her jacket with the colour of the macarons?? Those French, eh!! What a sense of style! Haha!

Spa Days

I just started two weeks of vacation – or staycation since I'm not going anywhere – and I kicked it off with a pedicure yesterday. I hadn't been planning to get one but was out for a walk in my neighbourhood and passed my local mani/pedi place and popped in on the spur of the moment.

I haven't had a pedicure since RA hit. To be honest, I've been a little scared to get one since my feet have been so tender. But they've been feeling somewhat better lately, and the weather has been awesome here, so I decided to go for it. I just told the pedicurist to please be careful, that my feet were sore, especially the left one, and she was great about it. I love getting pedicures – they're my favourite spa treat. I love having my feet done, I love seeing my toes painted afterward, and those pretty, pretty toes basically last for two weeks, so they're worth every penny!

Tomorrow, I continue my spa treats with a visit to a spa that has different water pools – a salt pool, hot tub and cold plunge pool. There, I'll be getting a head-to-toe glow treatment, including a facial and hair conditioning, plus a 90-minute massage. Woohoo! I am so looking forward to lounging around in the pools (except maybe the cold one), then getting the treatments.

I can already feel myself destressing, and that's pretty much the point of this vacation!

To Exercise Or Not To Exercise

I've been trying to figure out desperately whether or not I should be exercising and how much and what exactly I should/should not be doing. I have RA in multiple joints and am on Enbrel/Methotrexate but have pain/aches many days. However, from what I can tell, other than maybe my little left toes, I don't seem to have inflammation anymore.

Back when I was first diagnosed in January, my rheumatologist said exercise was OK as long as it didn't hurt. Using that definition, exercise is pretty much out right now for the most part (and I have to admit, other than that brief question/answer, I haven't discussed it with her since then).

But there's a lot of controversy on the subject.

Many sites on the internet that I can find recommend gentle stretching exercises or yoga. This WebMD link mentions that when regular exercise are painful for joints, you can try isometric exercises. But for someone like me, who has many joints that are painful most of the time, that means cardio exercise that actually gets your heart rate up is pretty hard to achieve. And that's exactly the sort of workout I need right now. I've been having trouble sleeping, and from past experience I know that cardio workouts will help with that and also help me feel better mentally.

Swimming is also recommended for those with RA, but that means getting to a pool and, for me, time is of the essence. When you're as tired as I am already, the thought of getting up at some ungodly hour to drive to a pool is not appealing, to say the least. Not when the gym I belong to is right across the street and offers readily accessible exercise options...

On a recent Rheumatoid Arthritis Warrior post on exercise, DadwithRA commented that he thought that the arthritis community in North America takes a more conservative viewpoint toward exercise than they do in the Netherlands.

I've been doing research trying to track down some scientific data to try to explain the difference in tack taken re exercise between the two communities. Here's a link that outlines a study undertaken by a doctor at Leiden University in the Netherlands that I found very interesting.

And here's another more detailed study.

I've been trying to find more links, but, most of the Dutch ones are, well obviously, in Dutch! If I find more in English, I'll add them to this post.

It seems to me odd that there should be two such differing viewpoints. Then again, maybe not. Half the time (and that's just a turn of phrase, not a scientific measure!) doctors can't even decide if someone has RA. So why should it surprise me that they can't agree on whether or not exercise is good or not for someone who has RA? And "active" RA is another thing, and how you define that "active" RA is yet another...So you see the problems that arise.

All I know is, I feel like crap from the RA anyway. Now I'm really feeling like crap mentally, too, and the lack of sleep from that is wearing on me. So, as much as I'm really a lazybones and am not that into exercise and never have been, I love the way it makes me feel, I love feeling fit and strong, and I'm going to do my damnedest to get to the gym and workout as much as I can (without straining my sad, unworked, sorry-ass muscles!) over the next two weeks while I'm off work.

I'll report back and let you know how it goes and how I feel! Consider it my own personal little RA study!