Track and React the Impact of Arthritis

I get Arthritis Today, the magazine published by the Arthritis Foundation, and I generally read it cover to cover. The July/August 2013 issue has several things I plan to share here. The first is an online tool called 'Track and React'. As the magazine says, "Track which daily activities impact your arthritis with the push of a button". When you register to begin using the tool, it asks if you have arthritis, then gives you a long list from which you choose the one type that affects you the most (tough decision for those of us with multiple issues).
In the 'Profile' section, besides basic identification, this is the place to enter all your meds, so you can keep track of taking them. There are fill-in-the-blank fitness goals, and a space for other goals.
 The 'Track' section is the the meat of the tool. There are six pages, for nutrition, fitness, sleep, meds, your day, and symptoms. On each page are several questions, with slider bars to give your responses from low to high. Each page also has a space for your own input. There are also links you can click on for more information about each topic.
The 'Results' page creates graphs, showing the relationships between what you do, and how you feel. You can choose a graph based on nutrition, fitness, meds, your day, or all of these combined. You can also choose a single day, or a span of any number of days to be calculated into a graph. The graph is fairly basic, with just a bar representing how well you are caring for yourself, and a line indicating your symptom level. Over time, you may notice trends in how the bar and line fall. The 'Track and React' tool can't tell you how a specific food or activity is affecting you, but it can indicate if things are going smoothly or if you might need to change your diet or exercise routine, or see your doctor.
I think this is a useful tool for keeping tabs on how you are doing. When I first read about it in the magazine, I thought the graphs would be really informative, and the reason I would use this tool. Now I think the real benefit of this tool is the 'Track' section. It is a quick and easy way to check in with yourself in multiple areas on a daily basis, the graphs are an added bonus.
Give 'Track and React' a try at www.arthritis.org/trackandreact.  It is also available as an app, so it can go with you anywhere. When you are done with that, explore the rest of the Arthritis Foundation website.They have so much useful information, and so many useful tools, it can keep you occupied for hours.

What if's

I had a recent health scare, which, thankfully, has resolved. I went to my rheumatologist last week, and he took some blood for routine lab-work.Only this time, it was not so routine. My kidney labs were off. I had to stop taking my NSAID's, the category of pain meds I take. (This is the category of meds that includes aspirin, Advil, Ibuprofen, Aleve, as well as a number of prescription strength meds).I had to get my blood retested.  I was only off the meds and waiting for the test results ix days, but it seemed longer, as such episodes tend to do. A big part of the issue here is that without the pain meds, I am in more pain. My whole body felt ornery and irritable, and both hips were downright cranky.
I sometimes found myself falling into the trap of "what-if's" What if my kidneys were permanently damaged? What if I could never take that kind of pain meds again? What if we never got my pain under control again? What if I'm in pain like this when we go on our trip to California? What if...? What if...? What if...?
"What if" thinking has no outlet, and no direction other than down. There is no definite answer (at least, not at the time of the question), so all it does is stir up worry. One possible option on how to handle "what if" thinking  is to take the next step, and ask "Then what?" What if my kidneys were permanently damaged? Then I would discuss with my doctor what the options are, do my own research online, as I always do, explore what meds I can safely take that won't compromise my kidneys further, etc. Once you think it through rationally, it usually isn't as scary, even if it is bad news.
I prefer to take it one step at a time. When I catch myself what-iffing, I politely ask these thoughts to leave, and I find something that will fully occupy my mind, so they can't slip back in.Puzzles or tasks that require following directions are good for this, or anything else that requires focus. I think everyone "What if"s from time to time. When you catch yourself doing it, try to either use it to motivate you to seek solutions, or get involved with anything that requires your full attention to get the "What if's" off your mind.

Medication Coordination

I have just been started on three new medications, two of which replace other medications I had been taking, and the third one is for a new issue.  I have also recently started on a new dosage of another medication. That makes nine prescribed medications, along with fish oil, and a variety of vitamins and minerals.  I have several recommendations to share regarding the coordination of medications for others like me who are helping to keep so many people employed in the pharmacy industry.
First of all, when a doctor suggests a new medication, ask these questions:  what is it for; what is the dosage and when should I take it, and with or without food; how long until the med starts working; possible side effects, and what to do if they occur. Also find out if the medication is for a specific period of time, such as an antibiotic, or something you may need to take long term, such as blood pressure medication.  Have your doctor check to make sure there are no contraindications for any malady you may have, and that there will be no adverse interactions with your other meds.
Don't start more than one new medication at a time.  If you do, it will be difficult to keep track of which med is having what effect, and if there are side effects, you won't know which one is causing them.  When I started these four medications, I did them about 1 week apart. For most meds, that is enough time to tell how it affects you.  Ask your doctor if you should wait longer between starting new medications.
These medications were given to me by three different doctors- my primary care physician (PCP), my gynecologist, and my urologist.  I had each one check that there were no adverse interactions with the other meds I take.  Once I am established on a new medication, I always reorder it through my PCP.  That way, there is one central place that I go to for all my meds, I don't have to try to remember who I need to call, which pharmacy, etc.
Speaking of pharmacies, I have some thoughts there, as well.  Our medical insurance requires that we get our meds from their mail order pharmacy, 90 days supply at a time.  Many pharmacies and chain stores have their own list of inexpensive meds, such as Walmart, which sells many generic meds for $4 for a 30 day supply, or $10 for a 90 day supply.  This is less expensive than our mail order pharmacy, so two of my meds I get at Walmart, and skip the insurance.
Always keep a list of your medications, including dosages and times per day in your purse or wallet.  That way, you will always have it handy when going to a doctor, or if you need to go to the emergency room.  Include on the list a section of any meds you are allergic to, and what reaction it causes.
When you start a new med, remember that some meds need to build up in your system before you will get any effect, so be patient.  Other kinds of meds will kick in right away, with sharper effects and side effects, which will calm down after a few days or a week.   One of my new meds caused terrible dry mouth and nose initially, which has calmed down over the week I have been taking it.  If you don't think a medication is working, or if it continues to have side effects you can't live with, talk to your doctor.  Don't try to adjust it or stop taking it on your own.  If you do, you may get yourself in trouble by ending up with an unintentional overdose, or ineffective underdose.  

Should You Play With Your Meds?

Before I get into the topic of playing with meds (stopping, starting or changing the dosage of medication without the guidance of a doctor), I have to post a disclaimer.  I am not a doctor or pharmacist, and can not and will not presume to tell you how to take your medication.  I am not advocating the practice of playing with your meds, I am writing this post because I acknowledge that people do play with their meds, and often they do it without understanding what they are doing, which can be dangerous.

The two most common reasons for admission to the psychiatric crisis unit where I work are stopping medications and taking too much.  People stop taking their meds for several reasons.  They don't like the side effects, the med costs too much or they think they don't need it anymore.  Some medications cure the problem, and these medications are prescribed for a short term.  Other medications don't cure the problem, but they control the symptoms.  These medications are prescribed long term, and if you feel like the problem is gone, it is because the medication is working.  If you stop taking this kind of medication, the symptoms will likely return.

So what should you do if you think you no longer need a medication you are taking, if you don't like how it affects you, or you think you need to adjust the dosage up or down?  Call your doctor, tell them what you are thinking.  (S)he will guide you with any changes in your medication, or explain to you why changing would not be a good idea.  Your doctor doesn't know that there is a problem unless you tell them, you should work together as a team to optimize your medications.  We sometimes have patients admitted to our hospital units so their doctor can closely monitor a medication change.  Most meds don't need this level of monitoring, but do need some guidance from your doctor.

Sometimes, despite knowing that it is not the best route, people change their meds on their own.  As I said before, I can not tell you how to take your meds, but I can give some suggestions that can help you manage your meds safely.  The most important thing is to know about each of your meds: the name, what you take it for, the strength, dosage, when it should be taken, with/without food, etc.  Among the things to find out are any interactions to avoid.  Some medications affect other medications, and should be taken at different times.  Sometimes there are foods that interact, such as grapefruit juice, which interacts with several types of meds.

There are some meds which can give you rebound or withdrawal symptoms if you stop them cold turkey.  These medications need to be tapered off of slowly, some over a shorter, others over a longer period of time.  If you think a medication is helpful, but does not do as much as you want, you might be tempted to increase the dosage.  Either taking it more often than prescribed, or taking more each time you take it may increase the effect you want, but it might not, and it might be dangerous.  Your liver and kidneys are responsible for filtering out foreign substances from your body.  Increasing a medication might be toxic to your liver or kidneys.  This is one of the many reasons why having a doctor's guidance for med changes is important.    

Medications are usually delivered with a sheet of information.  Sometimes these are very helpful, but often they are too generic, and don't give all the info you should have about your meds. Pharmacists are very knowledgeable (its their job), and can answer any questions you might have.  There are websites and books that have information about meds.  I f you just take one or two meds, you can go to the website for that med, or for the manufacturer to get full info- more than you ever cared to have.  If you take several meds, it might be worth investing in a book about
medications.  Here are some popular ones.
Some good med info can be found at these websites (among others): Web MD, Rx List, Drugs.com.  Useful info includes dosage, side effects, maximum to take at a time and maximum in a 24 hr period, interactions to avoid, contraindications, whether the med needs tapering, the mechanism by which the med works and how it is metabolized and removed from your system.  Some meds are fast acting, and are effective each time you take them.  Others need to build up in your system, and adjusting the dosage up one day and down the next can throw off the balance.

When a patient comes in to our hospital after taking too much medication, we ask them why.  Sometimes it was deliberate, either a suicide attempt or a call for help.  Often, though, they say something like "I just wanted the pain to go away for awhile", or  "I just wanted to sleep". I can understand this urge.  There have been times that I felt this way.  Taking an overdose of medication can be too costly for the brief 'relief' it might bring.   Keep open communication with your doctor.  If you show understanding and responsibility, your doctor may give you some flexibility in how you take your meds. Whether (s)he does or not, you are the one taking care of your body.  Take your medications responsibly.