Rock (noun): Deal with the side effects of IVIg using conventional, over-the-counter anti-inflammatories and pain medication, and just wait until they subside.
Hard Place (noun): Deal with the side effects of Prednisone, which rendered me angry, aggressive, hormonal, and bursting out of my skin.
After taking the Prednisone for two weeks, and been off it now for a few days, I've gained a deeper understanding about the nature of different types of headaches. Now that its effects have worn off, I can see Prednisone is reasonably effective in reducing the inflammation reaction to IVIg. Yes, the headaches and neck soreness have returned, so it's back to Nurofen etc to deal with that. Drugs like Excedrin don't work - there is pain, and there is pain. Because mine arises from inflammation, your typical pain killers (even strong ones) don't really do the job.
Being trapped like this between two sets of side effects has me in a bit of a down mood. Maybe I should take something for that?
Saturday, April 11, 2009
Tuesday, April 7, 2009
'roid rage?
I really hate Prednisone. I'm finally tapering for a bit longer after being on it for just over a week at 25mg, and this time, it's really messing with me. Hard to put words on it ... I'm "edgy", not tired at night, sort-of anxious, peckish. Have put on 4-5kg in just a few days, which has made me feel bloated. Is this 'roid rage?
Whatever it is, I can't stand it. It's making me something I don't like, and I can't wait for these side effects to fade away.
It's strange that I don't recall these side effects last time I took Prednisone. This time, we did it as a premedication before the IVIg, so the circumstances and the combination of things going on in my body are a bit different. They have helped to alleviate some of the IVIg side effects, but it has been a very unpleasant journey. In addition, the Prednisone does seem to have a negative effect on my hand strength, so the benefits of the IVIg are held back somewhat. This is something that also happened in my last treatment cycle.
The good news is that my consulting neurologist from Johns Hopkins suggested something different next time. The thought of having to fiddle with doses of Prednisone each time was really depressing me. Instead, he's suggested an IV cocktail of dexamethasone plus a couple of other "mixers" as a one-shot premedication. It's a much stronger form of steroid, and because it's a short, sharp dose, the side effects should be reduced. Anyway, something else to look forward to in a couple of months ...
Whatever it is, I can't stand it. It's making me something I don't like, and I can't wait for these side effects to fade away.
It's strange that I don't recall these side effects last time I took Prednisone. This time, we did it as a premedication before the IVIg, so the circumstances and the combination of things going on in my body are a bit different. They have helped to alleviate some of the IVIg side effects, but it has been a very unpleasant journey. In addition, the Prednisone does seem to have a negative effect on my hand strength, so the benefits of the IVIg are held back somewhat. This is something that also happened in my last treatment cycle.
The good news is that my consulting neurologist from Johns Hopkins suggested something different next time. The thought of having to fiddle with doses of Prednisone each time was really depressing me. Instead, he's suggested an IV cocktail of dexamethasone plus a couple of other "mixers" as a one-shot premedication. It's a much stronger form of steroid, and because it's a short, sharp dose, the side effects should be reduced. Anyway, something else to look forward to in a couple of months ...
Wednesday, April 1, 2009
juicing again
Walked in this morning for the third and final day of this course of IVIg, and Michelle (Jamie has left the position, so Michelle is running the "juice bar" while they find a replacement) greets me with a friendly "How are you?"
"It's fantastic! I woke up this morning with full strength in my hand, and the side effects had all just vanished .... APRIL FOOLS!" Maybe it was funny at the time. Maybe you just had to be there.
I should hardly be surprised. The side effects started showing up an hour or so after the first day of juicing, and have steadily increased. Hard to tell if they are slightly less severe than last time as a result of the premedication with Prednisone - I think it has helped a bit. Will be watching it closely over the next few days as I continue with the Prednisone (plus regular pain medication), and then taper off for a few days. On the bright side, there is a slight improvement in hand strength, and it isn't collapsing under any pressure the way it was a few days ago.
So having established that the juice does help (just that it doesn't quite get on with me), this now turns into a trial-and-error exercise in working out how to manage the side effects: headaches, neck soreness, sensitivity to light and loud noises (like kids crying and shouting). It looks like a mild case of aseptic meningitis (which is what they suspected the first time around), which is usually treated with: steroids! So for each juicing, we will attempt to tune the Prednisone dose to one that works, and hope that other things remain stable for a period of time.
Of course things would be boring if the Prednisone didn't have its own side effects: a touch of nausea, sleeplessness (although I felt quite tired this afternoon), edginess (but who wouldn't be in my condition?) I'm thinking the best thing to do is head off to a spa for a few days of R&R after each juicing. Do you think I can get a prescription for that?
"It's fantastic! I woke up this morning with full strength in my hand, and the side effects had all just vanished .... APRIL FOOLS!" Maybe it was funny at the time. Maybe you just had to be there.
I should hardly be surprised. The side effects started showing up an hour or so after the first day of juicing, and have steadily increased. Hard to tell if they are slightly less severe than last time as a result of the premedication with Prednisone - I think it has helped a bit. Will be watching it closely over the next few days as I continue with the Prednisone (plus regular pain medication), and then taper off for a few days. On the bright side, there is a slight improvement in hand strength, and it isn't collapsing under any pressure the way it was a few days ago.
So having established that the juice does help (just that it doesn't quite get on with me), this now turns into a trial-and-error exercise in working out how to manage the side effects: headaches, neck soreness, sensitivity to light and loud noises (like kids crying and shouting). It looks like a mild case of aseptic meningitis (which is what they suspected the first time around), which is usually treated with: steroids! So for each juicing, we will attempt to tune the Prednisone dose to one that works, and hope that other things remain stable for a period of time.
Of course things would be boring if the Prednisone didn't have its own side effects: a touch of nausea, sleeplessness (although I felt quite tired this afternoon), edginess (but who wouldn't be in my condition?) I'm thinking the best thing to do is head off to a spa for a few days of R&R after each juicing. Do you think I can get a prescription for that?
Sunday, March 29, 2009
miscalculation
It seems that with all the extra tests I was having, I took my eye off the main game, and overshot the timing for my second treatment. With my 20:20 hindsight glasses, I probably should've done it several weeks ago. In the meantime, my hand strength has deteriorated quite rapidly in the last two weeks, and is now quite severe. Part of the delay was me not wanting to accept the notion of needing regular treatment; I have to deal with that.
The neurologists say that pain is not something that is associated with MMN. Of course, by this they mean that a nerve conduction block will not cause pain. They may be right about this. However, many people with the condition do experience pain, and I think the reason is quite simple. If your hand does not have strength to support movement in certain directions, and you actually do move it or pur pressure in those areas, then the hand collapses. The radial nerve doesn't seem to be that important when it comes to hand movement - I would think gripping (which is the median nerve) was a far more common action that needed support of motor nerves. But surprise, surprise, there are many movements where my hand and wrist collapse in pain - pulling off a t-shirt, turning a steering wheel, shaking hands, ...
Every time I see my neurologist, or discuss it with my pilates instructor (who is also a physiotherapist), I learn so much about the nervous system and biomechanics. While I'm a person who thirsts for knowledge, and people are impressed when I can explain this stuff to them in simple terms, in the back of my mind, I'm thinking "do I really need to know this?"
Anyway, I've started the premedication before the next treatment tomorrow. Hopefully, I will not experience the side effects of last time. This course is just three days, so that might also reduce the chance of side effects. I really need it to work - having my hand like this just isn't doing it for me.
The neurologists say that pain is not something that is associated with MMN. Of course, by this they mean that a nerve conduction block will not cause pain. They may be right about this. However, many people with the condition do experience pain, and I think the reason is quite simple. If your hand does not have strength to support movement in certain directions, and you actually do move it or pur pressure in those areas, then the hand collapses. The radial nerve doesn't seem to be that important when it comes to hand movement - I would think gripping (which is the median nerve) was a far more common action that needed support of motor nerves. But surprise, surprise, there are many movements where my hand and wrist collapse in pain - pulling off a t-shirt, turning a steering wheel, shaking hands, ...
Every time I see my neurologist, or discuss it with my pilates instructor (who is also a physiotherapist), I learn so much about the nervous system and biomechanics. While I'm a person who thirsts for knowledge, and people are impressed when I can explain this stuff to them in simple terms, in the back of my mind, I'm thinking "do I really need to know this?"
Anyway, I've started the premedication before the next treatment tomorrow. Hopefully, I will not experience the side effects of last time. This course is just three days, so that might also reduce the chance of side effects. I really need it to work - having my hand like this just isn't doing it for me.
Friday, March 20, 2009
next juice ...
My hand strength has degraded a fair bit in the last week, and with the protracted diagnosis phase all but complete (just a review discussion with my neurologist next week), I decided that it was finally time for my second IVIg treatment. I ought to be pleased because it has been three months since the first one, which indicates a very slow progression, but instead I'm feeling flat and depressed about it.
Approaching a second treatment course is very different from the first. While I am unable to get excited or enthusiastic about any medical procedure involving a close relationship with a needle, at least with the first treatment, I anticipated a successful outcome, and was not particularly concerned about side effects.
This time around, my anticipation is very different. I think the treatment will result in improvement to my hand strength, but the side effects are a concern, mostly because there hasn't been a satisfactory explanation as to why the headaches went on so long. This time, I am going to premedicate with Prednisone, which should help, but as always, the operative word is "should".
But the other thing that weighs down on me is the long-term future. By embarking on this a second time, I'm accepting it as a part of my life - that regular IVIg "juicings" will now be established as a regular part of my diary. While I was already advised that there is no cure, and that this is just about the only treatment, this is the moment when its permanence is truly felt.
Approaching a second treatment course is very different from the first. While I am unable to get excited or enthusiastic about any medical procedure involving a close relationship with a needle, at least with the first treatment, I anticipated a successful outcome, and was not particularly concerned about side effects.
This time around, my anticipation is very different. I think the treatment will result in improvement to my hand strength, but the side effects are a concern, mostly because there hasn't been a satisfactory explanation as to why the headaches went on so long. This time, I am going to premedicate with Prednisone, which should help, but as always, the operative word is "should".
But the other thing that weighs down on me is the long-term future. By embarking on this a second time, I'm accepting it as a part of my life - that regular IVIg "juicings" will now be established as a regular part of my diary. While I was already advised that there is no cure, and that this is just about the only treatment, this is the moment when its permanence is truly felt.
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