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MTX or Job Burnout or Both?

Hi, so glad to have joined the group here and on Facebook.

I have been in such a fragile state lately. I'm on 25 mg (1 ML) injections on Tuesday's. I been feeling great since i started it, first in pill form but switched to injections. I even was in remission. But lately I have started getting very depressed, fatigued, stressed beyond what any human I thought could handle. My husband and I are self-employed. I run the office and he does outside service work. We been in business since 2001 and we recently hired an employee, about 3 months ago. My work has doubled as well. I work in my home office and never get out. This last weekend I went to Las Vegas and we took Friday off as we are closed on weekends anyway.I came back to 46 messages...actually 12 but as I tried to get them more came in. By 1:00 I had made my last return call as the phones slowed down. I not only answer phones but run the office, ie pay bills, payroll, accounting, submitting invoices for payment and so much more. I have severe RA and I don't know if it's the RA, the job (I have people in our industry who tell me they have 2-3 gals doing what I do) which is not an option. What keeps me from getting so behind and getting things done are the phones. I don't take breaks and many times forget to eat lunch and finally at 4 PM I do. I wake up at 5:30 Monday through Friday, have coffee, help get things ready for the office but lately the thought of getting in there early makes me sick. I started to get major panic attacks in there during the summer as I felt trapped, no air would flip out making my husband open a window. I have found myself outside pulling a chair into the sun with the phone in my hand considering calling my psychiatrist because of the severe depression. I've felt only once like walking into my pool and not coming up. That was bad that day. I think a lot of it is job burn out and the RA doesn't help. I shut my phones down at 5:00 and find myself making invoices for the next day and sometimes am in there lately until 6:30-7:30 PM with the family asking, What's for dinner". I use to be able to at least get dishes in the dishwasher or laundry done but I feel so overwhelmed and I can't get anything done (the super important stuff) while phones are ringing. I dread work, plus I am on Xanax due to extreme anxiety. That started mid last year before I was officially diagnosed. My husband was always about answer every call. So I would eat lunch in the living room with phone in hand. Lunch was often 10 minutes then back to work. Now I get no break and eat at my desk. My mental and emotionally state is so bad right now I am skipping my MTX injection just one time today. I did during the summer when my doc told me to because I got a bad heat rash. MTX makes me sick, tired and nausea plus I was just diagnosed with gastritis on top of it all. Hmmm...wonder why? My only saving grace is I was diagnosed several months before the RA with ADHD (I'm 51) and the drug I take helps with my fatigue as well as brain fog. I get out every morning was well and clean my horses, feed etc. I live for that. Once I come back in the house and shower I feel great.

My question is how to cope with the job burnout. I really think that has a lot to do with it. I NEED to be able to shut my phones down at least an hour a day and two 15 minute breaks or I'll lose it. I go out mid day and give our horses lunch which helps but I want to come back in and do paperwork without being disturbed. Get invoices submitted so we get paid, make the calls I need to other companies regarding issues that need to be taken care of and do it without feeling guilty. When I do it after 5 I am a zombie and my house is a mess, nothing gets done. Last Tuesday I worked until 6:30 PM and then fell face first into my couch and daughter even had to check a couple of times if I were alive.

I need to learn to pace myself. I need to learn how to do these things so I can catch up with work. It got worse when we hired someone(yes, we all want to make more money) and my work doubled. But if something is not done I am going to loose it....bad. My horses are my life and we do camping and riding on weekends. I use to ride after 5 during the summer at least 3 times a week until I got RA and that summer was so humid and I was so tired. Then on weekends as well. I am killing myself mentally, physically and emotionally to the point hopelessness is setting in. I really think it's burnout and not so much the RA but I'm sure it plays a part in it. There is nothing worse than walking by your kitchen during work hours and not being able to clean it up because there is work to do.

Getting help in it is not an option either. Just teaching someone would be stressful because I can't teach 30 years of our industry to some teen or young adult.

Any help, suggestions...... thanks so much.


  1. HI Melly! To put it mildly, you have a very busy life! I look at it this way; you only have so many hours in a day and so much energy. We cannot keep adding more and more 'energy draining activities' and expecting the same results when we are working with the same amount of energy as before. So, then we are left with two options; wither increase our energy or decrease our energy-drains. Since most people with chronic conditions like RA can only do so much to increase energy, realistically, something has to be let go from the energy-drain side of this equation. You simply cannot continue at the pace you are right now. Your body will most likely eventually put a stop to this cycle, one way or another. If you haven't heard of the spoon theory before, I highly recommend reading this link and seeing if it applies to your situation --

    When I work from home, I keep a strict separation between work and home life. I do not answer calls or get on my computer during certain times of the day. Period. You may have to train yourself to work on creating a strict separation. I think of it like this -- would I want my boss walking in on me while I am taking a bath to discuss spreadsheets and schedules? How about having a client just barge in while I am trying to get dinner ready? Of course not! It's unrealistic. Maybe try viewing things like that. The great thing about an office job (not at home) is that there is a physical separation of job from home. Working from home has awesome advantages, but it sounds like you aren't even able to enjoy those advantages at this time.

    To be frank, you need to make self-care a priority. If you don't start taking care of yourself now, things will only get worse and you may end up in a position where you literally cannot work at all. Then what will happen to your business? I think you are on the right track with shutting off the phones. I think you need to make that a HARD and FAST rule in your mind and stick to it. And try to avoid that, "I'm just gonna check a couple of things really quickly" mindset when you do have some downtime at home.

    The good/bad thing about work is that it will always be waiting for us the next day. Start small, maybe. Just shut that phone off every single work day for 30 minutes. EVERY DAY. And make sure your husband and everyone else knows that you are BUSY during that time. You are not available for any work-related activities for that 30 minutes. And go check those horses. Sit down and have some lunch. But no multi-tasking with work things!

    If you worked in a different setting, you would be legally entitled to regular breaks and a lunch. You should take them! Just because you own your own business doesn't mean you don't deserve breaks! One of the main reasons many people choose to own their own business is so they can be their own boss and make their own schedule. It doesn't sound like that is the case for you. I know that you do need to maintain certain hours to keep the business successful, but think what would happen if your body suddenly collapses on you and you cannot work at all. Then what will happen to the business?

    I think it is possible to scale back and still keep the business running smoothly. You can do this!

    And, even though you cannot even think about it right now, having a back-up person may not be a bad idea. Just something to keep on the backburner!

    Thank you so much for sharing with the community. I sincerely hope you get some rest and relief very, very soon! You deserve it.

    Best, Erin, Team Member

    1. Thanks Erin for your I sit here in front of my computer eating breakfast.

      I have been so stressed, down and depressed that last few weeks I decided I was in no frame of mind to take my MTX injection Tuesday. It might have thrown me right into that tailspin with me in the hospital.

      Wednesday I felt great all day. Husband thinks it's the RA which makes work hard but even as great as I felt yesterday, I was still overwhelmed but handled it much better and even Tuesday I did. In fact, Tuesday was even simpler. I still do too much for only one person even if I was healthy as an ox. In my office you never catch up.

      Well, I slept horrible last night. Every time I moved something hurt, my feet, neck, whole body. Last time I stopped the MTX for a week while letting a heat rash heal I was fine the whole week. This only tells me what my doctor confirmed, I have severe RA. I been on MTX now for 13 months. I felt horrible this morning so I took my injection and plan to take it next Wednesday and then bring back to Tuesdays. It really is true when they say it's better to have 2 days of feeling bad than having pain 7 days a week. I just feel like a zombie.

      About the depression.....I don't know whether to talk to my RA doc or my psychiatrist? I know depression plays a huge roll in RA....I never been hit with depression in all my 51 years. I think a lot of it is lack of family support and unless you have it you don't get it.

      Oh yeah, I know about the spoon theory. I need to buy a poster of it and hang it on my office wall.

      I want my energy back and from what I've read, learned and researched is maybe try a combo of MTX and a Biologic. I will talk to my doctor. I hate how tired I get.

      Thanks again!

      1. Thanks for the update, Melly! And please keep us posted on what your doctor says, if you feel comfortable sharing here. As far as the depression, if you have an established relationship with a psychiatrist, you could discuss it with him/her. I bet many rheumatologists have experience dealing with patients that also have depression, so your rheumatologist could be helpful as well. Also, if you don't think that Methotrexate is helping after this long, please let your doctor know! It may be time to consider other meds and combinations of meds.

        I am glad you are already familiar with the spoon theory -- don't be afraid to get that poster and hang it up as a reminder to take care of yourself first! In medical and self-care communities, we have an analogy we really like to use to drive home the importance of self-care. If you have ever flown, you know how the flight attendants tell you that in case of the loss of cabin pressure, oxygen masks will drop from the ceiling? And they always stress that if you are traveling with small children or people that need assistance that you should put your own mask on first? I am a mother and I always found that advice so counter-intuitive to motherhood. What mother wouldn't take care of her child first?

        But then, a flight attendant shared why they say that with me, when I was traveling with my two-month-old. He said, "If you pass out before you get your mask on, you can't be of help to anyone else. Who will calm your child or help adjust your child's mask? Who will help get your child off this plane? You can't count on others doing it for you. If you want to help your child, you HAVE to help yourself first."

        It's advice that really stuck with me. And, although I thought I was being so original sharing this story with others, it turns out that many people already knew this.

        Melly, in order to help your husband, your company, your horses, your family; you have to help yourself. You can't help ANYONE if your body and soul are crushed by the weight of RA and depression. Don't be afraid to reach out and get help!

        Thank you again for sharing! I hope you shut those phones off and get some good "Melly time" this week!

        Best, Erin, Team Member.

        1. I hope you are taking some time for yourself this week, Melly65! Have a good (restful!) holiday season! Best, Erin, Team Member.

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