Friday, March 26, 2010

Exploring the connection between food and inflammation

Last week, when my wee toe decided to throb mercilessly for a couple of days, I had myself a little pity party. For me, pity parties often involve chocolate. Or ice cream. Or cookies. Or all of the above. While I do watch my weight very carefully, I don't think it's wrong to indulge on occasion. However, when "on occasion" turns into 2 or 3 times a day, several days in a row—then we have a problem.

After few days of reckless eating—and really only feeling worse about myself—I decided enough was enough. I recommitted to a more balanced diet this week, and whether it's coincidence or quick effect, I am actually starting to feel better. My toe has quieted down and I'm able to exercise for about 20 minutes at a time without getting too achy.

Curious about this, I did a little poking around and found several sources that indicate refined sugar can be an inflammatory food. Likewise, certain oils and fats found in a lot of packaged cookies and other goodies, as well as animal fats and dairy, can all cause inflammation in the body. And a lot of the foods I decided to replace my poor choices with, like more lean protein, nuts, beans, berries, etc., are considered anti-inflammatory.

There is some evidence out there that certain antioxidants act on some of the same enzymes as popular arthritis pain medications. Ever heard of a COX-inhibitor (say, Celebrex)? COX is a type of enzyme that plays a role in inflammation, which is what causes arthritis pain for a lot of us. It turns out that certain foods and drinks can have the same COX-inhibiting actions as well-known medications.

Take red wine or tea, as an example. Both contain polyphenols, such as catechins, which are antioxidants that specifically target COX-2 activity and help reduce inflammation. Of course, not everyone can drink red wine (esp. if you're on methotrexate or trying to get pregnant!), but tea is tolerated by most.

Another natural anti-inflammatory is omega-3 fatty acid. Numerous scientific studies have shown omega-3 fatty acids can help reduce inflammation associated with heart disease, arthritis and other illnesses. I mentioned previously that I take fish oil capsules, as recommended by my rheumatologist. But there are a lot of natural sources of omega-3 fats, too, like fatty fish (such as salmon, halibut and sardines), walnuts, flax seeds, broccoli and kale.

Soy, berries and spices like turmeric, cinnamon, garlic and hot chilies are all high in antioxidants and can have anti-inflammatory effects, too. I always knew healthy eating didn't have to be boring! I'm going to keep trying to eat more of these anti-inflammatory foods and see how things go. I have a birthday party tomorrow that I'm making a delicious (albeit sugary) dessert for, so I'll also be interested to see how that affects me.

Anyone else have certain foods that bother your arthritis? Or ones that make it better?

Wednesday, March 17, 2010

How can something so small hurt so much?

Warning: Rant ahead....

1 week off the prednisone and I am feeling it. I hate to complain because I know so many of you are in more pain that I am. I just got so used to feeling good that this really stinks! My hands are achy, my ankles are stiff and my little toe is KILLING me! Seriously - it's just a wee toe, but it is hurting something awful today. I have erosions in the last 2 toes (the little one and the one next to it) on both feet, but most days with my granny shoes and orthopaedic inserts, I get by. Today my right pinkie toe wants nothing to do with shoes and is barely tolerating socks.

I think the worst part of it is that I kind of have to keep the pain to myself (well, other than sharing anonymously with the world wide web). See, no one other than my hubby and my rheumatologist know about the plan to have a baby. Not my friends, not my mom - no one. So, they don't really understand why I can't try a new medicine, go back to the Arava, etc. I know it's because my rheumy wants to keep me on a regimen that I can keep once we start TTC... but I really don't want to tell anyone that yet.

Why? I guess part of me feels like if I tell, then I'm committed to it. What if I change my mind? I'm 90% there... but life happens. I've got months to go before the Arava is out of my system. Which means months before we can start trying. A lot could happen! I guess part of me also worries that if we try to have a baby but can't for some reason... well, I don't know that I want to have to share that with others. Right now everyone close to me thinks that I just don't want to have kids - and that just seems easier.

Well, easier except when it comes to explaining why I'm limping around in pain. Right now I just use the excuse that the Arava was wiping out my white cells (true) and that my rheumy wants to wait another month or so to give the Plaquenil time to kick in (also true). So, it's not a lie... it's just not the whole truth.

I think if the Plaquenil doesn't kick in, we'll consider a small dose of methotrexate. I initially started on methotrexate when I was first diagnosed in October 2008. It didn't do much on its own, so we added Enbrel in December 2008. I think by that time I was up to 9 methotrexate tablets per week. While that seemed to get the pain and swelling down, the methotrexate left me incredibly tired (other than going to work, I did nothing for 2 days after taking it) and my hair started falling out. So, in March 2009, I swapped out the methotrexate for Arava. All was well and good until the white cells got super low...

Given the history of fatigue and hair loss, I'm not super excited about going back to the methotrexate, but my rheumatologist thinks we could do a lower dose and hopefully avoid the side effects. He explained that methotrexate tends to work well in combination with other medications - like Enbrel and Plaquenil - so you don't necessarily have to take as much.

But as far as pregnancy and methotrexate - they don't mix. You have to quit the methotrexate before you start trying to conceive, but there isn't a long washout period like there is with Arava - only 1-2 months (vs. up to 18 for Arava!!). Methotrexate can cause birth defects and miscarriage. (An injected form of it may actually be used to end tubal/ectopic pregnancies - so it's serious stuff!) So, it would really be a short-term solution to get me through to TTC time.

Right now, I'm just taking my Aleve, keeping my foot up and hoping for the best. Dear Plaquenil - please kick in soon!! And dear Arava, please get out of my system soon!!

Monday, March 8, 2010

See ya later Hilda! (a post about prednisone)

Today is my last day of a 20-day prednisone taper. I'm very happy to say goodbye to Hungry Hilda (my alter ego who comes out when I'm on the juice and demands food every 2 hours), though I worry how I will feel in a few days. I suppose we'll cross that bridge when we come to it!

Being on prednisone for the 3rd time in a little over a year and experiencing more side effects this time got me thinking more about this "wonder drug." Yes, it makes me feel better pretty quickly. But this time, there was also the insomnia, Hungry Hilda, and the messed up menstrual cycle (just a day late this time, phew!).

A couple of readers noted they've had problems with their cycles, too. It got me wondering if the effects extended to ovulation - since prednisone might be something I'll have to use if I start flaring again when we start trying for a baby. Turns out - there is some evidence that prednisone *can* affect ovulation.

Prednisone is a hormone, so it can mess with other hormones in your body - including follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both of which are necessary for normal ovulation. For women with normal levels of hormones, it appears that higher doses of prednisone may delay or suppress ovulation. For women with high levels of androgens (for example, women who have poly cystic ovarian syndrome - PCOS), prednisone may actually suppress the androgens enough to allow the body to ovulate. So - I guess we can say that yes, prednisone affects ovulation - but it could be a good thing or a bad thing, depending on where you're starting from. Interesting info - and definitely something to keep in mind.

Also a little tidbit for any guys with RA out there -  I also read prednisone can lower sperm count at high levels.

OK - enough about the prednisone for now. I'm off to feed the Hilda! :)

Sunday, March 7, 2010

Balance

The sun was glorious today and it warmed up to about 50 - downright balmly for March in New England! My husband and I decided to get out and enjoy the weather with a walk. I suggested we do our "long" route, which is about 3 miles. My husband said "OK, but as soon as your feet start hurting, we're turning around," as my feet have hurt on nearly every walk, long or short, lately.

It turned out that my feet didn't start bothering me until after the 1/2 way point, so we kept on our way. By the end of the walk, I wasn't as achy as I had expected, considering that was the longest walk I'd taken in at least a month. Still, I needed to rest for a bit before going out to lunch, just to get my feet back to normal.

Since I started feeling the effects of being off the Arava, I've had to get back to this idea of balancing rest and activity. When I was in remission, I was in this sweet place where I could pretty much do whatever I wanted. Stand up baking cookies for 4 hours on end? Sounds great! Do 30 minutes on the bike in the morning, 20 minutes on the elliptical at lunch and walk around town at night? Sure, I'm young - let's do it!

These days are different. I'm still lucky enough to be able to get some exercise most every day, but it always needs to be followed by a rest. Like most RA-ers, I get frustrated by this sometimes. But I know that it's really the best thing for me, since if I push it, I'll pay for it.

So this got me thinking about the energy of kids. Take my 4-year old nephew who pratically bounces all the time. He may be an extreme example - but he is just a ball of energy. I usually try to get him to play Legos or Lincoln Logs to give me a bit of a break, but that only lasts so long. I try to play as long as I can because I feel bad about saying "I can't." 

Here's what I'm wondering: if it frustrates me, a logical 29-year old woman, to have to take so many rests - how does a 2, 3, 4-year old deal with it? Does your child just get used to it because he/she grows up only knowing that? Or does he/she struggle? If so - do you feel guilty about your child's struggles? (Not saying you should feel guilty! I'm just wondering if you do... if I would... ??)

Tuesday, March 2, 2010

Practicing for baby

I swear the prednisone is helping me understand the sleeplessness that will ensue if/when baby arrives. If I take it after 5pm, I have the worst time sleeping. Last night, I didn't get it down until after 6, so I tossed and turned for about an hour before falling asleep. Then I was awake at 12.. and 2... and 4... and finally got up at 6. Fortunately, I took another "hit" of the juice this morning - so I'm up and running again! Ha!

I am definitely feeling better than I was 2 weeks ago. I still have some aches and pains, but they're totally manageable - and my rheumy thinks things might get better the longer I'm on the Plaquenil. 6 days left of the prednisone - a good night's rest is in sight!