The Medication Game
It’s been a rough few months, and my medication list reflects this. Whereas only a year and a half ago I was on just one drug for rheumatoid arthritis, I’m now on four. While I’m grateful to live in an age of so many RA treatment options, I wish I didn’t require so many of them. My current medication regimen not only reflects the severity of my recent disease activity, it also comes with baggage of its own. Like all luggage, my medications feel necessary to have along with me on this journey of my life, but they get heavy to carry around.
I’ve been on a variety of biologics for the better part of the last 15 years. While the benefits of the drugs on my RA have varied, the negative effects have been very similar. As rheumatoid arthritis is an autoimmune disease, the most sophisticated medications used to treat it suppress the immune system. That means that the internal army that is shooting “friendly fire” at my joints is subdued. This ends up being a great thing for all potential targets, my own body and foreign invaders alike. While my joints see less pain and inflammation, my body is also prone to more infections.
On top of the colds that I seem to contract more frequently than my peers and that tend to hang on for much longer durations, I almost always develop sinus infections whenever I get sick. If there’s a chance of secondary infection, the odds are in favor of my getting it. Even when I’m feeling pretty well, I experience recurring yeast infections that crop up every four to eight weeks in spite of the top-of-the-line probiotics I take daily in addition to eating yogurt every morning for breakfast. Furthermore, the yeast infections I get are too stubborn to respond to Diflucan pills or the one-day or three-day medication options available, so every time I get a yeast infection I am inconvenienced with seven nights of treatment. I’ve gotten to the point where any time I see a sale on over-the-counter yeast infection medication, I stock up on multiple boxes.
While I’ve had cold sores since I was a teenager, I used to go months or even a year between outbreaks. Now I’m getting them every two to six weeks. Fortunately my doctor provides plenty of refills, so I always have medication on hand for them, and I’ve become so familiar with the tingling sensation of a fever blister that I begin treating it at the first twinge I feel. This prevents them from becoming too unsightly, but it still means I’m usually taking cold sore medication on a monthly basis. The pattern here is that because of my RA medications, I develop infections that require treatment and therefore… even more medication.
In addition to extra prescriptions, the RA medications I take lead to an increase in doctors visits. One of the drugs I’m on is Plaquenil, which necessitates monitoring by an ophthalmologist. The recurring cold sore outbreaks and yeast infections have led to additional visits to my dermatologist and OBGYN. At my last appointment with my OBGYN, she noted that there was bilirubin in my urine, and asked when I was going to see my rheumatologist. In an effort to miss less work, I try to lump my various doctor appointments together, so I told her I was actually headed straight to his office for a checkup. She said that in that case she wouldn’t request additional labwork, since I have labs done at every rheumatologist checkup in order to monitor liver function. This is because I take Arava, which can pose a threat of liver damage. Fortunately, there was not bilirubin in my blood, which could indicate a problem with my liver. My doctors told me that as long as there is bilirubin in my urine but not in my blood, I shouldn’t be overly concerned. Yet, it’s hard to feel at ease when any lab results are abnormal, although I was relieved that my OBGYN said I didn’t need to return to her office for additional urinalysis labs.
As I write this, I’m contending with a cough that started as a result of allergy-induced post-nasal drip. The cough has lodged itself deeper in my chest, and is becoming more severe. I’m pondering whether to go ahead and go to the doctor, as less than two years ago I was struck by a case of walking pneumonia. When my internist diagnosed me, she referenced the immunosuppressant drug that I was on as the likely cause. As I’m on even more immunosuppressants now than I was then, I don’t have the luxury of assuming a cough is just allergies when I run the risk of once again developing walking pneumonia.
I’m actively working on reducing the stress in my life, which I know from experience will decrease the severity of my symptoms. I’m also striving to do at least a few minutes of yoga daily, to eat well, and to get lots of sleep every night. If I can lower the activity level of RA in my body, I will also decrease the need for all these medications. However, until I’m successful in that endeavor, I’m left with the choice of debilitating pain and fatigue or a treatment regimen that comes with a whole lot of baggage.