I thought it was under control

Obviously its not. Last spring after coping with multiple colds that would last for two weeks and getting them every 8 weeks, we cut my methotrexate dose down. Some of the colds turned into ear infections.  With the lower MTX dose my immune system would not be as suppressed and I was less likely to have as many colds.

I haven't had a cold since last February. Until today.

Last week I was feeling crappy so I hibernated for a day and didn't feel that bad, for a few days. I also skipped my weekly MTX injection.

This week I had my weekly injection on Wednesday night. Yesterday I was getting tired and I thought I had done too much. But I woke up at 3 am, sleeping on my right side, because my left ear hurt enough to wake me up. I then rolled on my back and decided that both ears hurt. Even with all the pain meds I am on, my ears hurt.

When I got up at 8, I called my doctor's office and got a 9 am appointment. There I learned that while it looked like I had two ear infections but there was also a virus going around with similar symptoms. But with my medical history, they need to be sure. (I hate that line.) Maybe I had the virus last week which got worse.

But I did think this was under control and I wasn't going to get as many colds any more. Since I haven't had a cold since the end of February, I guess it is better. But I hate having a cold. And being on antibiotics, again. Grrr.

A very real problem

Drug resistant bacteria are now a real problem world wide. Think of the world before antibiotics where a simple cut could kill someone if it became infected. I find this very scary. As someone with multiple health issues, I am deeply concerned about getting a germ that can't be cured because it is antibiotic resistant.

The causes of this are multiple (from my layperson understanding):

• Doctors over prescribing antiobiotics for ailments that do not require them.
• Patients not taking entire doses of antibiotics so that the germs are not destroyed but adapt and become resistant to the antibiotic.
• In the food industry, livestock is given antibiotics for some silly reason - this leads to low level exposure that help build resistance.
• Discarded antibiotics end up in the water supply - this also leads to low level exposure that help build resistance. 

Now the problem is much more rampant. The World Health Organization recently released a report on this topic.

"Antimicrobial drugs are one of the foundations of modern health care – something we all hope to rely on when we get sick with ailments including pneumonia, urinary tract or blood infections, diarrhea or sexually transmitted diseases, Fukuda says. These infections occur worldwide on a daily basis.
But because of overuse or misuse or improper use of existing treatments, the ability to fight these infections is getting harder and harder, he says.

In its first global report on antimicrobial resistance, released Wednesday, the WHO says " a post-antibiotic era – in which common infections and minor injuries can kill – is a very real possibility for the 21st century."..."

"Conservative estimates in the United States alone suggest 2 million people get antibiotic-resistant infections each year, and at least 23,000 die because current drugs no longer stop their infections."

This is the part that is most scary to me:

"Some people may wonder why they should worry. Fukuda says that anyone who gets a serious infection, develops cancer and needs chemotherapy or requires any kind of surgery could be in a bad situation with no drugs left to treat them. The same is true for premature babies or malnourished children.

After two cancers and eight surgeries, and penicillin allergies, am I going to end up this way?
 
"Bottom line," says Fukuda, "we should expect to see that there are going to be some people who have untreatable infections."

The WHO says there's a need for a global action plan, including:
– better use of vaccines; – basic hand hygiene to reduce infections, such as washing hands; – reduction of non-health uses of antimicrobial drugs;
– support of research that will lead to new and better diagnostic tests; – and better surveillance, to get a better overall global antimicrobial resistance."
 
A lot of this is up to the patient/consumer. We should not demand/expect antibiotics unless they are for an infection. If given them, we should use them properly and finish the entire dose. We need to demand meat that has been raised without antibiotics. We need to go back to the basics and wash our hands and take care of minor injuries before they become infected.

Its too scary a world for those of us with not the best health.

I'm learning

You may call me slow sometimes but I am learning. Some medications when you start taking them  have a relatively quick impact on you. You take a tylenol and your fever usually goes down and pain subsides within an hour. Antibiotics often make you feel better with in 24-48  hours.

Rheumatoid medications are different. They can take months, as in 3-6 months.

When I was diagnosed with RA last fall, I was immediately put on prednisone and plaquenile and we quickly learned I was allergic to both. I was then switched to oral Methotrexate (MTX). The dose was upped to the maximum in January. I started to feel a little  better, I thought. But not better enough so I was switched to injection MTX in April.

I have felt some improvement but could not be completely sure. My back pain was making it difficult to 'feel better' because I was always in pain from something.

After I had my back treatment at the end of June, I thought my back was better but immediately got a double ear infection and was too sick to care about body aches and pains as I lay on the couch and watched Lifetime movies and bad reality TV.

Since I was put on antibiotics for two weeks, I had to go off my MTX. Its been three weeks since my last treatment.

Over the past week I have been feeling more and more tired with more and more aches and pains. Yesterday I was ready for a nap at 9am and my wrists were killing me.

Last night I started doing a little research to find out from Dr Google how soon after finishing antibiotics is it safe to restart MTX. After reading a lot of answers online I realized two things:

1. I was feeling awful because my RA has been acting up because I haven't been taking my MTX.
2. Methotrexate was working to help my RA.

Tonight I will go back on MTX and hope I start feeling better soon. I hope it doesn't take months to feel the effects again.

My rheumatologist told me if you have been on MTX for ye ars and go off it fo a few weeks for antibiotics, its not that big a deal because your blood levels are high enough. But since I have only been on it since April,  I would probably feel the lack of it. She was right.

I am learning, slowly. I will suck it up, wear my wrist splint, and take my pain meds.

Okay I learned a few things

I have had this stupid evil cold since Friday afternoon, June 28. It came to me courtesy of my husband. This is a normal event, one family member gets exposed to germs and brings them home to share with other family members.

My theory on colds has always been to take good care of myself and basically ignore them unless I become fairly sick. Rarely does a cold send me to bed for more than a couple of extra naps. I have never had a problem with this theory. Ignorance keeps the colds away.

This worked for decades.

Not any more.

In  the past 24 hours I have learned:
- when you start to feel sick, stop RA drugs
- when you start to feel sick, call your PCP, not after a week or 10 days as I normally would
- colds more easily turn into pneumonia when you have RA both due to the disease and due to the medication.

Today I am home in bed sick again/still whatever. If you are keeping count this is day 14. Normal colds evolve and slowly get better. Evil RA colds, stick around and get worse. My sore throat is gone but my cough is not and my ears are clogged.

I am on antibiotics that I started yesterday morning and if I don't feel better by Saturday I am supposed to go to the walk in clinic. Next Tuesday I see my new rheumatologist and will probably learn more about the common cold with rheumatoid.

The only good side to all this is that the scale seems to be going in the right direction even though I have been eating ice cream every day.

Antibiotic resistance

When was the last time you were prescribed antibiotics? And took them? The entire course of them? And what ailment did you have? I think the last time I was prescribed antibiotics was a few years ago after some surgery. I very rarely take them.

I hear more and more complaints from friends and family that they were sick for a couple of weeks, went to their doctor finally, and were told they would have to wait it out with over the counter medications, fluids and rest. They were not given antibiotics as they had expected and were frustrated.

This is a good thing. One of the biggest medical problems we have these days is resistance to antibiotics and the emergence of 'super germs' which cannot be treated with antibiotics. Too often prescriptions for antibiotics have been given without signs of infection and often prescriptions are not being taken for their entire course - the patient feels better but is not completely recovered and still has the germs in their body which now have the potential to become antibiotic resistant.

On Monday, I was a moron (to use the term loosely) and managed to cut the palm of my hand with pruners. Yes it bled a lot. Yes it was deep. Yes I panicked. No it wasn't very big. But as it was on my lymphedema arm, I called my doctor's office which sent me to the minor ER (who knew there is a minor ER but there is) in case it needed stitches. It needed a pressure bandage, no stitches, no steri strips. I felt somewhat like an idiot that I even went to get medical attention in the first place but was concerned about my lymphedema arm which is not supposed to have any punctures or pressures, never mind incisions from pruners, to prevent lymphedema which can become a permanent problem.

They also gave me a prescription for antibiotics and told me that at the least sign of infection to fill the prescription and take the entire course of them. I toyed with the idea of taking them to prevent infection but rejected that thought on the grounds that I really don't want to take any more medications at this point. I hadn't expected to get antibiotics at all.

I do think that patients go to the doctor and expect to get antibiotics for almost anything these days. Doctors are heeding the call of reducing prescriptions to prevent the emergence of more super drugs but patients do not always understand.

As patients we need to understand the bigger picture. Antibiotics are good but should not be taken unless they will help. And if you take them you need to take the entire dose.

It sounded like a good idea at the time

Just because something sounded like a good idea at the time, doesn't meant in the long run it will be. I am sure we can all think of many of these in our lives - we have all done them and then after said to ourselves 'Doh! What was I thinking?'

Here is a prime example, and explains something to me that I never understood (I'm claiming chemo brain here as I think everyone else probably already knew this): Where did MRSA come from? As we should know MRSA is a nasty anbiobiotic resistant form of staph infection that can easily be fatal. It started in humans and was treatable but now can kill us off:

"The strain, Staphylococcus aureus CC398 started in humans and was still treatable with antibiotics, said Lance Price, director of the Center for Food Microbiology and Environmental Health Translational Genomics Research Institute in Arizona.

It  spread to livestock, which are usually pumped with antibiotics, to keep them healthy. “The lineage appears to have undergone a rapid radiation in conjunction with the jump from humans to livestock, where it subsequently acquired tetracycline and methicillin resistance,” according to the study.

Methicillin and tetracycline are among the most common antibiotics used to treat staph infections.

The problem is in the way animals are raised and pumped with antibiotics, said Price, the lead author of the study.  He said that farmers and ranchers give millions of pounds of antibiotics to farm animals to make them grow faster and to prevent - rather than treat - diseases."

Well, doh! If the meat we eat is full of antibiotics its no wonder that the infections have become resistant to it as they are already over exposed. Okay, now I want organic meat. I also don't want antibiotics unless I really need them. Icky poo. Just because it helps farmers grow healthier, fatter beef faster, it doesn't mean there won't be problems done the road for other people. Just another idea which sounded like a good idea at the time.