The Power of Chemo

Methotrexate is one of the most commonly used medications in the treatment of rheumatoid arthritis. It is a disease-modifying antirheumatic drug (DMARD), so in addition to helping with pain and swelling methotrexate is also supposed to slow the progression of RA over time. For most people, methotrexate is one of the first medications they try after being diagnosed with RA.

That was true for me. After my diagnosis and some anti-inflammatory medications to get my immediate pain and swelling under control, methotrexate was the first RA treatment I tried. Unfortunately, it was never enough to keep my RA symptoms under control by itself. But, with the addition of a biologic medication, the methotrexate helped me get my RA under control enough to graduate from law school.

However, because methotrexate can cause serious birth defects (and is even purposely prescribed to terminate ectopic pregnancies) I stopped taking it about six months before my husband and I got married. That was four years ago. And though my RA has definitely not been as well controlled without the methotrexate, my hiatus from this medication did allow us to bring two beautiful little boys into our family. But now, after almost three months of breastfeeding my second little boy, my RA has gotten so bad that I can barely hold my baby (let alone my 30lb two-year-old!) I knew it was time to wean and go back to properly treating my RA.

So I recently started back on the methotrexate. I know that this drug is not a quick fix, so I didn’t expect to see any extra relief from my RA symptoms for the first few months. But I have to admit that I also didn’t expect the intense nausea I’ve been experiencing over the past few days. I knew that methotrexate had the potential to cause nausea, but I didn’t think it would happen to me since I didn’t remember feeling very nauseous the last time I took this medication. But I guess that was four years – and two babies – ago! And my body is obviously very different now than it was then!

I already talked to my rheumatologist about the terrible nausea – he’s increasing my folic acid and decreasing my dose of methotrexate – so hopefully I won’t feel as bad when I take the methotrexate next week. But I still found myself at a party last weekend feeling unexpectedly queasy. When my friends asked me what was wrong, I told them that I was having bad side effects from a new medication. And, to help them understand why the medication was making me feel so nauseous, I told them that I was taking a chemo drug. And that is how I discovered another interesting “side effect” of methotrexate: the power of the word chemo.

Methotrexate was originally developed as a chemotherapy drug to treat various types of cancer, albeit at much higher doses. But even though I explained to my friends that I was taking a much lower dose than a cancer patient would take, an interesting thing happened when the word chemo was added to the conversation: it got more serious.

Although I’d like to think that I have been very open and honest with my friends about my RA and the challenges it brings to my life, I definitely noticed a change after telling them I was taking a chemo drug. Suddenly it felt like they were taking me more seriously. They were more attentive. They were more concerned. And it wasn’t just one person – after noticing this reaction with the first person I told, I used the word chemo with several more friends and the same thing happened every time. After hearing I had to take a chemo drug, my friends almost universally reacted as if my RA was much more serious.

I suppose my friends had this reaction because most people are familiar with cancer, how scary it is, and how terrible the drugs used to treat cancer make you feel. Almost everyone knows someone who has dealt with cancer – or has at least seen it in the movies. And I am certainly not trying to compete with cancer. As I said in a previous article, "At Least It’s Not Cancer", cancer is scary. Cancer is serious. And I am very glad that I do not have cancer.

But I do think that it is unfortunate that RA and other autoimmune diseases are treated as so much less serious. Because, though the impact may be more invisible and (hopefully) less life threatening, RA certainly has a serious impact on my health and my life. So if I can use the word chemo to help my friends understand the seriousness of what I am going through then I guess I will. Because, though the doses may vary, I am actually taking a chemo drug to treat my RA.

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