It didn’t start with my toe, although my toe is certainly an important player in this tale.
The start of an infection
It really started years ago with my hip replacement which occurred just a few weeks after my RA diagnosis. I was cautioned that an artificial joint was an infection concern (apparently bacteria likes to congregate on these surfaces) and that I needed to take antibiotics for things like having my teeth cleaned. Then followed my shoulder replacement, knee replacement, and two separate spinal fusion surgeries – all with similar warnings to be careful about infections and being diligent about taking antibiotics. This was interspersed with various RA treatments, all of which have warnings about impaired immune systems and being susceptible to infections.
In the back of my mind, I was thinking, “Yeah, yeah, yeah, whatever” but I try to be a good patient and so I take my antibiotics before seeing my dentist twice a year and if I have any other invasive procedure done.
Fast forward to now.
I’ve been on a walking kick since the first of the year, gradually increasing both the distance and number of days that I walk. But a bit of inattention on my part led to a perfect storm of ill-fitting shoes mixed with a belated pedicure and multiple miles of walking. I will spare you the details but I’ve seen pictures of ballerina’s feet that looked better than mine. The most concerning issue was one toe that was clearly infected and that wasn’t getting any better despite days of antiseptic soaks and topical antibiotics.
Still trying to be a good patient and remembering the cautions about infections, I got in to see the new physician’s assistant at my doctor’s office. She promptly prescribed a strong dose of Augmentin, an antibiotic that’s an amoxicillin combination drug.
Precautions while taking medications
The surprise came when I picked up my prescription. There was a warning from the pharmacist that my antibiotic could interact with my methotrexate in ways that not only would not be good – they could be serious. I was able to contact my rheumatologist prior to my next methotrexate injection and she instructed me to stay off methotrexate altogether until I finished the antibiotic. I thought perhaps I could just take a reduced dose.
I don’t know that being on a biologic and methotrexate contributed in any way to being susceptible to the infection in the first place. I suspect any “normal” person who so seriously mistreated their feet like I did would wind up with a similar situation.
Surprising impacts of RA
What was startling to me was that after so many years of dealing with the disease, something new came out of the blue and smacked me. I shouldn’t be surprised (especially with the number of drugs that I take) that there are interactions. But unlike the (seemingly) daily warnings about infections, except for when I’ve started a new drug, I don’t remember being warned to be cautious about interactions. If my pharmacist hadn’t been alert to the issue, it could have been a very serious situation. (This is a major reason I keep all my prescriptions at one pharmacy and resist my insurance company’s pressure to use their mail-order prescription service.)
For me, having RA has become my new normal. It’s become a routine – or as routine as having the disease can be. I check off all the things I need to do – take my drugs, do my labs, see the doctor, etc. But like the zookeeper that feeds the tigers, you can’t let your guard down. It’s not only RA, it’s all the things that come along with it and any day can bring a new challenge or a new (not-so-pleasant) surprise.