|New artwork adorning my doc's office|
At today's appointment, I had two primary objectives. Firstly, although I did not have any new symptoms or problems to discuss, I wanted to request a prednisone burst for my upcoming trip to San Diego for the American College of Rheumatology Annual Meeting (and, of course, share some details with my doctor about what the Rheumatoid Patient Foundation would be doing there this year -- even though nobody from my doctor's office will be able to make it to the meeting this year). I've found that just a 10-day prednisone burst does wonders to ward off flares during periods of high activity, as ACR will undoubtedly be. I typically will take 10mg for 5 days, then 5mg for 5 days. I'll start that right before I leave for my trip and take it through my return. Prevention is the best medicine, or so they say (or, is that laughter??).
Secondly, in light of my recent cold, I wanted to ask my doctor for advice about when to hold off taking my Humira, if sick. He recommended halting Humira if I have a fever (I didn't) or if I have colored drainage (I did, somewhat). He said he'd typically err on the side of caution and skip the dose. I probably would have done so sooner, except for not wanting to have a break in treatment right before my big trip. I did skip last week's dose, though, since my cough was not going away.
My doctor did a physical exam of several joints (including my feet, asking if they hurt -- they don't right now). He spent a lot of time looking at my wrists, knowing that is my problem area. He noticed some inflammation and said that they felt warm to the touch, and, despite how well I feel overall, he was not satisfied with there still being inflammation there. I did remind him that I skipped my Humira dose, so that may be contributing to it. They hurt a little, but not bad at all. But, now I have to go in for some lab work. I've mentioned before that blood tests scare me sometimes because they can add a little too much transparency. If I have inflammation, it shows up. My Sed Rate, which is the marker of inflammation he normally tests, has declined and been within the normal range the past few times. I am a little afraid that with skipping a Humira dose, it may spike up a bit. I also noticed on my lab order that my rheumatologist is actually going to test my C-Reactive Protein (CRP), as well. I am not entirely sure why he threw that in there, but I have looked through all of my previous lab work and haven't been able to find a measure of my CRP at all in the past, so I am very curious how that will come back. I want everything to be normal, because I feel well and don't want to switch medications at this time. I'll take my Humira dose probably today to try to get back to my "normal" so it's a more accurate read, and then get the lab work done on Thursday -- when I have to go in to have the results of my TB test read anyways.
Yes, I had my yearly TB test done today, and was also talked into getting a pneumonia vaccine. Apparently they are recommending this for everyone on biologics now -- once every five years. I gave in. I don't want pneumonia.
As far as my inflammation levels and what to do if they're elevated... I don't think there's much we'd do right now. My doctor said he'd recommend Actemra as a next step for me, but understands that it's more inconvenient, that there would be a risk that it wouldn't work as well as Humira, and that I'd like to have kids before I get into non-TNF drugs. That being said, we'll probably hold steady for now.
So, now I'm going to go study for my blood tests on Thursday. I hope I pass.