How I live successfully with Rheumatoid Arthritis

The results of my poll here on hubpages: Will lmmartin get health insurance? 100% of you said no. And 100% of you were correct.

And although 25% voted the reason would be no social security number, it is the 75% who said my pre-existing condition of rheumatoid arthritis who were correct. Of course, it might have come down to the lack of documentation if they couldn’t preclude me for health reasons.

According to my agent, the medical insurance companies are moving quickly to deny everyone they can before the laws change. It hasn’t even been a full two weeks since I applied, and they told me I’d have an answer in six weeks. The nay sayers have stepped up the pace of the machinery – get ‘em all denied while they still can.

At any rate, being as healthy as I am, and feeling as good as I do, I wondered why this might be an automatic preclusion, so I checked into the medical sites here in the U.S. to see what they had to say about rheumatoid arthritis (for the rest of this article known as RA.) And it depressed me. Apparently, I'm a lot sicker than I feel.

Rheumatoid Arthritis according the American Medical community

• RA is an auto-immune condition, caused by the body’s own immune system mistakenly treating bone and cartilage as a foreign agent and attacking its own tissues, causing chronic inflammation of the joints.
• RA is a progressive and systematic problem eventually leading to crippling deformity of the joints.
• There is no cure for RA.
• RA strikes women three times more often than men.
• RA crosses the boundaries of all races and ethnic groups.
• One source states 1.2 million, another states 3 million and still another states over 2 million people in the United States suffer from RA, including 200,000–500,000 children who suffer from juvenile rheumatoid arthritis.
• The condition is characterized by periods of flares, during which joints become inflamed, the patient experiences fatigue, loss of energy, lack of appetite, low-grade fever, muscle and joint aches, and stiffness, followed by periods of no symptoms known as remissions. Remissions may last days, weeks, or months.

The American College of Rheumatology classifies individuals suffering from RA as:

• Class I: completely able to perform usual activities of daily living
• Class II: able to perform usual self-care and work activities but limited in activities outside of work (such as playing sports, household chores)
• Class III: able to perform usual self-care activities but limited in work and other activities
• Class IV: limited in ability to perform usual self-care, work, and other activities

Treatment suggested for RA by the American College of Physicians.

"Class one patients may be treated with pain and anti-inflammatory medications alone. In general, however, patients improve function and minimize disability and joint destruction when treated earlier with second-line drugs (disease-modifying anti-rheumatic drugs), even within months of the diagnosis. Most patients require more aggressive second-line drugs, such as methotrexate, in addition to anti-inflammatory agents. Sometimes these second-line drugs are used in combination. In some patients with severe joint deformity, surgery may be necessary.”

"First-line" medications

“Acetylsalicylate (aspirin), naproxen (Naprosyn), ibuprofen (Advil, Medipren, Motrin), and etodolac (Lodine) are examples of nonsteroidal anti-inflammatory drugs (NSAIDs). Additional medications are frequently recommended to protect the stomach from the ulcer effects of NSAIDs. These medications include antacids, sucralfatee (Carafate), proton-pump inhibitors (Prevacid and others), and misoprostoll (Cytotec). Newer NSAIDs include selective Cox-2 inhibitors, such as celecoxicib (Celebrex), which offer anti-inflammatory effects with less risk of stomach irritation and bleeding risk. Corticosteroid medications can be given orally or injected directly into tissues and joints. They are more potent than NSAIDs in reducing inflammation and in restoring joint mobility and function.”

[My note] Long term use of aspirin may lead to thinning of the blood and bleeding disorders. Ibuprofen, Cox-2 and colecoxicib may cause gastro-enteritis, bleeding ulcers and bowel disorders

"Second-line" or "slow-acting" drugs
(Disease-modifying anti-rheumatic drugs or DMARDs)

“Hydroxychloroquine(Plaquenil) is related to quinine and is also used in the treatment of malaria. It is used over long periods for the treatment of rheumatoid arthritis. Sulfasalazine(Azulfidine) is an oral medication traditionally used in the treatment of mild to moderately severe inflammatory bowel diseases, such as ulcerative colitis.. A number of immunosuppressive drugs are used to treat rheumatoid arthritis. They include methotrexate (Rheumatrex, Trexall) as described above, azathioprine(Imuran), cyclophosphamide(Cytoxan), chlorambucil (Leukeran), and cyclosporine (Sandimmune).”

[My note] Immunosuppressive medications can depress bone-marrow function and cause anemia, a low white cell count, and low platelet counts. A low white count can increase the risk of infections, while a low platelet count can increase the risk of bleeding. Cyclosporine can cause kidney damage and high blood pressure. Other side effects of any of these drugs may be vision changes, ulcerative colitis, cirrhosis of the liver, bone marrow deficiency, bone thinning, osteoporosis, hardening of the arteries ,and inflammation of the vascular system among others-- including death.

Conclusion

No wonder the insurance company declined me. According to all the information on the medical sites, there’s no hope. I will continue to degenerate until I can no longer look after myself. I will have to rely on these horrific sounding medications, with all the related side-effects, including weakening of my bones, osteoporosis (which one would think to be the last thing I want,) bleeding ulcers and gastroenteritis and that’s just in the first stage of treatment. Later, I can look forward to cirrhosis, kidney failure, vascular problems and premature death.

Not true

Such an attitude assumes that all persons with RA are equal. Some do progress at an aggressive rate, need all the treatment they can get, and die prematurely. Others, like me, live a long and active life and the ailment is nothing more than an unpleasant inconvenience – most of the time. In a flare period, it is a major inconvenience.

I was diagnosed with RA in my early thirties. My mother had it, as does one of my nieces. The tendency to RA is an inherited condition, particularly common in women.

As RA is an auto-immune condition, there are no hard and fast rules as to the progress of the disease. Everyone will present differently, and no one knows why. In my case, the degradation of my joints has never progressed beyond the small bones in my feet and hands, and most of that progress happened in the first ten years. I’ve been in remission for over a decade, without one “flare” in that time. This is a condition known to doctors as “burnt out” RA, and is common to over 30% of those originally diagnosed. Again, no one knows why.

It is my personal belief that “burn out” is directly attributable to choices I made to avoid the pharmaceuticals and to adopt life style changes under the mentorship of a naturalist – a ‘wellness” practitioner. But I will get to that later.

The last flare I remember happened when I was in New Orleans looking after my mother-in-law following her heart attack. Stress is a known trigger to flares, and believe me the situation was very stressful. On top of that, I had digressed from my usual diet and life style.

Flares are far more than aching joints. The entire body is involved, and while the joints are under attack, so is much of the rest of the body – it’s misery. After three days, and with a sick woman to look after, I needed help.

I went to see a doctor in a nearby clinic, who immediately insisted on my seeing a specialist. Possessed of good “out of country” supplemental health insurance, same as I have here and now, I agreed. For the first time since diagnosis, I was treated with modern drugs. He prescribed Celebrex, which he promised was much kinder to the digestive tract than older NSAIDs.

Two days on the drug found me curled up in the fetal position with my gastric system in agony. I was dehydrated due to terrible diarrhea, and the cramps and pain were unbearable. I called the specialist and told him I couldn’t take the drug. He said I should persevere and phoned in a prescription for a strong ant-acid to the nearby Walgreens.

By the fourth day, my husband flew down from Calgary to look after his mother. I was in the Mercy Hospital in New Orleans with severe gastro-enteritis, bleeding bowels and an inflamed esophagus.

This was the first, the only and the last time I ever took NSAID’s. The pain in my bones is preferable to that agony in my guts. And I will never take immunosuppressants. (Are you crazy – do you know what they do to you?)

My Treatment Plan and it will work for you

Contrary to what I found on the American College of Physicians website,("There is no known diet for RA -- and no correlation found between diet and the condition") diet plays a strong role in the progress and control of RA, as it does in any autoimmune condition, such as lupus or fibromyalgia. I fact, the regime I adopted almost thirty years ago works as well with those conditions.

If your skeletal structure is under attack and suffering from inflammation, it becomes an imperative to maintain control of your weight. The diet I was taught to follow automatically keeps you at optimum weight.

Rule 1 – avoid all dairy foods, particularly milk. Anyone over the age of two was never meant to drink milk, and none of us, of any age, were built to digest cow’s milk. There is only one exception to this rule, and that is natural yogurt.

Rule 2 – reduce protein intake and avoid red meats. Excess protein causes the build-up of uric acids in the body, and is an affront to your immune system. Try to limit animal protein to no more than four to six ounces daily and make this fish as often as possible– preferably fresh. I eat vegetarian at least three days out of the week, and when I do eat animal protein, I try to make it fish. Dr. Andrew Weil recommends that sufferers of RA eat sardines packed in oil every day (but I’ve never cared for sardines and don't. And I'm not saying I don't go out and scoff down a nice rare T-bone once in a while -- I do -- I'm Albertan for heaven's sake. But I feel it in my general health for days and pay for it.)

Rule 3 – avoid sugar. Sugar is an acid. Sugar is a poison to the body. And an interesting side effect of avoiding sugar is that it automatically eliminates processed and prepared foods. Try as hard as you like, you’ll never find any without sugars.

Rule 4 – watch your fats and oils. Avoid polyunsaturated oils and shortenings – like margarine. Instead use virgin olive oils, canola oil, grape seed oils – these have the omegas that will actually help heal your inflamed joints.

Rule 5 – eat lots of vegetables – there’s not a single one of them that will hurt you, and some, like avocados will help.

Rule 6 – when it comes to fruits, avoid the citrus fruits (sorry Florida) because they increase acidity.

Rule 7 – coffee, tea, wine, beer, alcohol in general – limit these. I tried to give them up, but found that in limited quantities, my body didn’t object too much. Hey, we have to live – right?

Rule 8 – get tested to find out what food allergies you may have, and then avoid those foods like the plague. Many of us have slight allergies we’re not even aware of, but when you suffer from an autoimmune disorder an allergic reaction can trigger a flare.

Rule 9 – exercise – RA is characterized by atrophied muscles as the joints degenerate. First thing in the morning – light stretches, lots of stretches then, limbering exercises, such as squats and twists. Weight training is very important, but never to excess. All exercises should be light, and often and never to the point of building up lactic acid in the muscles. Avoid impact exercises -- your sore bones, remember? Swimming is excellent.

Rule 10 – maintain manual dexterity. The hands and feet are normally the first areas of degeneration and it is important to keep up the dexterity. In my case keyboarding works, but you have no idea how hard it is for me and how much effort is involved to put words up here that make sense and aren’t full of typos. Trust me, when you read my writing, it’s been written at least twenty times, and edited forty. (And still they get by me.) I also crochet – not that I make anything; I just keep my fingers busy. Once that dexterity is lost, it’s gone for good.

Other hints – There are many supplements that are reputed to be of assistance, but I can’t attest to them as I have an aversion to taking pills or capsules of any kind. I rely on good diet alone.

There are excellent sites for natural wellness on the net, and I recommend everyone who is dealing with any chronic condition to check them out.

Prognosis

Here I am approaching my sixth decade and I’ve fought RA for almost thirty years. I can’t run, can’t jump, can’t ride horses anymore, but I can walk for miles and still hike in the Rocky Mountains. I walk every day for at least two or three miles. I’m limber, can still touch my toes, dance, do yoga. I’m strong. I can carry that fifty pound bag of dog food out of Sam’s Club.

My feet hurt a lot, but I’m use to the pain. I don’t believe that pain should be automatically masked – I can live with sore feet easier than with a shot digestive system. I can’t wear pretty shoes, and buy men’s sandals when I can find a pair small enough. But it’s only a minor problem.

There is no doubt that aging with RA brings about challenges, but in all humility I find I’m in better shape, stronger and healthier than many of the twenty-somethings I see walking around. I’m doing just fine thank you.

And I bet I outlive Ms. Fields who just wrote to tell me that I’m automatically declined health insurance, because I have RA.