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!!