Rheumatoid Arthritis

There's no doubt now that I am suffering from rheumatoid arthritis but not osteoarthritis which is characterised by degeneration of the cartilage of certain joints. My wrists, hands, shoulders, feet and sometimes other parts of my body are being attacked by my immune system to varying degrees, causing stiffness and pain.

The condition was definitely triggered by my fall about three months ago because prior to that I only had sporadic pain in my right shoulder and nowhere else. I'm not too troubled at the moment. The soreness and swelling in my left foot has subsided. There was one night when my wrists were causing me considerable discomfort. Ironically, this had been caused by finger exercises that I had been doing to ameliorate the stiffness in my fingers.

I have been walking between 2km and 4km a day, sometimes more, but I notice my knees are weaker than they used to be and sometimes hurt when I'm walking up stairs. I definitely need to resume by leg band exercises and squats. I just have to accept that the arthritis is not going away anytime soon. The more I can find out about the condition and how to manage it the better. This post was prompted by this YouTube video and is where the screenshot came from.

The body's decline creeps like a vine.

Day to day, the changes can be imperceptible.

You adapt. 

Then something happens that finally makes it clear

That things are no longer the same.

My condition is certainly not severe at the moment. There is no redness and swelling of the joints of my hands and certainly no deformities. Maybe that will come later. Maybe it won't. One thing is incontrovertible. My body is in decline. The price one pays for longevity. Fortunately, my mind seems largely intact. Let's hope that continues.

Monitoring My Exercise And Diet

My resting pulse rate is 63 beats per minute and, with light clothing on, I weigh 70.9 kilograms. I've been walking regularly of a morning, at a fairly brisk pace, and covering about 2.2 kilometers. However, yesterday (Saturday 14th July) I had a not so good day. My right shoulder joint had been hurting in the night and I woke up feeling stiff in my fingers with my ankle causing discomfort as well. I also felt discomfort in my chest when getting out of bed.

Today, Sunday, I feel a lot better comparatively speaking. I wonder if it's diet-related. Yesterday I had my usual toast in the morning following by pasta at two different times of the day plus a couple of pastries in between. On the Thursday and Friday prior my bad Saturday I'd two eggs with mayonnaise on toast, even though I'd been advised to eat only the whites of the eggs and not the yolks. Could this have triggered my subsequent discomfort?

I did some very brief and mild isometric exercises for my arms on either Thursday or Friday. Could this have triggered the discomfort behind my sternum? It's hard to say and thus it's probably a good idea to monitor my intake of food and drink as well as the amount of exercise that I undertake. Should I start another Airtable database or should I record the information using some other software, perhaps a spreadsheet? Before deciding, I should carry my phone with me whenever I leave the house so that any distances that I walk can be recorded. My daily walk around the block is about 2.2 kilometres.

For the moment I've opened a fresh document in Google Docs and will begin recording there. I'll see how that goes. I'm rather averse to phone apps or other online methods of monitoring diet and exercise. A simple pedometer is sufficient for recording distance walked.

Recrudescence

A recrudescence is defined as the recurrence of an undesirable condition and that's certainly a word that applies to me at the moment. For a while there, I thought that my stiff fingers, weak wrists and dodgy left ankle were on the mend and that the discomfort caused by my thymoma was largely in abeyance. However, the last few days have seen a rise in finger stiffness and a noticeable uptick in thymoma-related discomfort. My ankle remains tender but then again I've been walking fairly regularly of a morning so that's to be unexpected. Overall, my mobility and ease of movement have declined and I tend to dodder about the house being particularly careful when negotiating any stairs.

While on a walk, I can generally stride about as I did in the old days but with the constant awareness that all is not right with my left ankle. Apart from the morning walks, I'm engaging in very little physical activity around the house. I found my old resistance band that was fashioned from pantyhose but have yet to make use of it. One can only speculate on the cause of this decline and what the dire consequences might be if I were I to suffer another fall. I've spent no time at all on introspection designed to discover what remedial action is necessary on my part to stem and perhaps reverse this decline.

I've adhered to my a significant reduction in my intake of fried foods, assisted by use of an air fryer. This is a healthy choice of course but I don't whether it's sufficient in itself to turn things around. I need to look deeper into the underlying causes, both physical and psychological. To this end, I decided to take another Etorvel (Etoricoxib) tablet. I still had four tablets left following my tooth extraction. It was 2:30am at the time of ingestion and this gave me about four hours before my morning walk to monitor the changes in my physical condition.

If there's a noticeable reduction in my finger stiffness, ankle soreness and general restricted mobility, then my problem is definitely of an inflammatory origin. The body is attacking itself. I've written about the effects of this drug in my recent post titled Tooth Extraction. As I said in that post, it's not a drug that you'd want to take in the long term given its side effects but this one off experiment should prove useful. So how is the experiment progressing?

• After about half an hour, the physical effects are quite noticeable. I feel quite flushed and I'm sure my blood pressure is elevated. My brain is not working all that well. I don't feel like concentrating on anything too taxing. I have an inclination to listen to some music which I'm doing. My fingers still feel stiff so not much change there.
  
  
• After about an hour, there is a noticeable reduction in finger stiffness and wrist weakness and overall a general feeling of well-being. I'm continuing to enjoy the music.
  
  
• After about an hour and a half, the flushed feeling has subsided and my mental faculties have returned. The general improvement in my fingers and wrists remain but has far from disappeared entirely. I'm definitely moving more freely and am feeling far less stiff as I walk about.
  
  
• About three and a half hours later, I went for my morning walk and felt particularly strong with my ankle giving me very little trouble. It would be good if I always felt like this but I have the drug to thank in part this time.

What conclusions are we draw then from this little experiment? It would seem that the drug is working as it's supposed to:

Etoricoxib works by selectively inhibiting an enzyme called cyclooxygenase-2 (COX-2). COX-2 plays a role in the production of prostaglandins, which contribute to pain, inflammation, and fever. By blocking COX-2, Etoricoxib helps reduce these symptoms.

The question is why is my body continuing to produce prostaglandins that cause pain and inflammation. As Google's Gemini explained:

Prostaglandins are major contributors to the inflammatory response. They trigger processes like: 

• Increased blood flow to the injured area
• Increased permeability of blood vessels, allowing white blood cells to migrate and fight infection
• Pain perception by sensitizing nerve endings

 This process is what led to my DOMS but the problem is that the process never stopped.

ADDENDUM:

A day later and I'm still feeling very good. I have very little stiffness, my ankle is not troubling me and even the discomfort from my thymoma is greatly reduced. It will be interesting to see how long this feeling of well-being will last. Doubtless, the production of prostaglandins is still being inhibited by the Etoricoxib. 

Tooth Extraction

The decaying canine on the upper right side of my mouth has gone and only a gaping hole remains. So it goes. I had to wait two hours before entering the dentist's surgery but after that it all went smoothely. I fear that there may be more problems ahead but for the time it's all good. Only a few hours after the extraction, I can eat and drink normally.

I have taken the once-a-day pain killer that was prescribed and the fingers of my right hand are feeling a lot more flexible. Whether this is the result of the medication or not remains to be seen. I'm not in any pain so I won't take the medication again and I'll see if the fingers still remain relatively flexible tomorrow. I hope that's the case (see addendum at the end of this post).

Getting rid of the chronic abscess that lurked above my decaying tooth can only have a positive effect on my overall well-being. I've currently been advised by my psychic healer not to eat fried foods, peanut butter, egg yolks, baked beans and a plethora of other foodstuffs. If my stiffness disappears completely, then I can perhaps indulge in some of these forbidden foods again if the prohibitions can be at least relaxed in the future.

My umbilicus remains sensitive and this inhibits me from doing any exercises that put a strain on that area and my thymoma inhibits me from any exercises that put a strain on the solar plexus area. The stiffness in my hands doesn't help and so overall my upper body is slowly atrophying due to sarcopenia. I need to develop an exercise regime that maintains muscle mass in my upper body without exacerbating my existing sensitivities.

Walking regularly helps to thwart sarcopenia in the leg muscles but additionally I need to return to my squats and other leg exercises. Since my fall, I've noticed that my leg muscles have become noticably weaker. I tend to sleep in two sessions nowadays: two or three hours before midnight and then four or five hours beginning from four, five or six in the morning. Currently I weigh around 71 kilograms.

Of course, having completed my course of antibiotics, I need to rebuild my gut biome. To this end, probiotic foods like Kimchi, a spicy fermented Korean cabbage rich in beneficial bacteria like Lactobacillus Kimchi, and Kombucha, a fermented tea drink that may contain probiotic bacteria depending on the brand and brewing process. Choose kombucha with unpasteurized and unfiltered varieties for the most potential probiotic benefit.

ADDENDUM 

My fingers remains flexible and no stiffness has returned. I asked Google's Gemini about the pain killing tablet that I took yesterday. Interestingly, the medication is an anti-inflammatory drug as well as having pain-killing properties. The dosage that I took, 120 mg, is quite strong and I may still be feeling its effects. If the stiffness returns then we'll know that I definitely have some sort of chronic inflammatory condition. If it doesn't then I'll be very much relieved. Clearly it's not a drug you would want to take in over a long period of time. Here was Gemini's response to my query:

Etorvel (Etoricoxib) is a prescription non-steroidal anti-inflammatory drug (NSAID) used to manage pain, inflammation, and stiffness caused by various conditions. Here's a breakdown of key information about Etorvel:

Uses:

Treats pain, inflammation, and stiffness associated with:

• Osteoarthritis (wear and tear of joint cartilage)
• Rheumatoid arthritis (chronic inflammatory joint disease)
• Ankylosing spondylitis (inflammation of the spine and large joints)
• Gout (sudden and severe joint pain caused by excess uric acid)
• May also be used for short-term relief of moderate pain after dental surgery.

How it Works:

Etoricoxib works by selectively inhibiting an enzyme called cyclooxygenase-2 (COX-2). COX-2 plays a role in the production of prostaglandins, which contribute to pain, inflammation, and fever. By blocking COX-2, Etoricoxib helps reduce these symptoms.

Dosage and Administration:

Dosage depends on the specific condition being treated, its severity, and the patient's individual needs. Always follow your doctor's instructions for dosage and duration of treatment.

Etorvel is typically available as tablets and is usually taken once daily, with or without food.

Side Effects:

• Common side effects of Etorvel include:
• Stomach pain, heartburn, diarrhea, indigestion
• Headache, dizziness
• Upper respiratory tract infection
• Fluid retention

Important Considerations:

Risks: Etoricoxib can increase the risk of heart attack, stroke, and stomach ulcers, especially with high doses or long-term use. It's crucial to discuss these risks with your doctor before starting the medication.

Contraindications: Etoricoxib is not suitable for everyone. Inform your doctor about any allergies (especially to aspirin or other NSAIDs), a history of stomach ulcers, heart problems, high blood pressure, kidney disease, or liver disease.

Pregnancy and Breastfeeding: Consult your doctor before taking Etoricoxib if you are pregnant, breastfeeding, or planning to become pregnant.

Interactions: Etoricoxib can interact with other medications. Be sure to tell your doctor about all medications you are taking, including prescriptions, over-the-counter drugs, vitamins, and herbal supplements.

Tooth Trouble

In addition to my current woes, the decaying tooth on the right upper side of my mouth has started to play up again. I've decided to take the plunge and swallow the prescribed antibiotics for five days prior to the extraction of the tooth. It's not a great idea to have a decaying tooth just sitting in my gum. It is subject to chronic low level infection that from time to time flares up and becomes acutely infected. I have an appointment scheduled for Thursday the 27th June.

I need to take two 200mg tablets of Cefixime Trihydrate daily for five days. Here is what Google's Gemini spat out when asked about the medication.

Cefixime Trihydrate is a prescription antibiotic medication belonging to the third-generation cephalosporin class. Here's a breakdown of its key characteristics:

Uses:

Treats a variety of bacterial infections, including:

Ear infections (otitis media)

Strep throat

Bronchitis

Pneumonia

Urinary tract infections (UTIs)

Gonorrhea (often as a single-dose treatment)

Lyme disease (in some cases)

How it Works:

Cefixime works by interfering with the bacteria's cell wall formation. This weakens the cell wall and prevents bacteria from multiplying and spreading.

Dosage and Administration:

Dosage depends on the specific infection being treated, the patient's age and weight, and kidney function.

Available as tablets, chewable tablets, and suspension (liquid) for oral administration.

Typically taken once a day, with or without food.

Side Effects:

Common side effects include diarrhea, nausea, vomiting, abdominal pain, and headache.

Less common side effects include rash, yeast infections, and allergic reactions.

Important Considerations:

Antibiotic Resistance: Like all antibiotics, overuse or misuse of Cefixime can contribute to antibiotic resistance. It's crucial to take it exactly as prescribed and complete the entire course of treatment, even if symptoms improve.

Allergy: Inform your doctor if you have allergies to penicillin or other cephalosporin antibiotics.

Kidney Function: Cefixime is eliminated from the body by the kidneys. If you have impaired kidney function, your doctor might adjust the dosage.

Pregnancy and Breastfeeding: Consult your doctor about the safety of Cefixime during pregnancy or breastfeeding.

Here's hoping. The dosage is quite high and to quote from this website:

Cefixime Trihydrate Film coated caplet and Film coated tablet : For adults and children weighing > 30 kg, the usual recommended daily dose is 50 – 100 mg (potency) of Cefixime given orally twice daily. Dosage should be adjusted according to the age, body weight and condition of the patient. For more severe or intractable infection, the dosage may be increased up to 200 mg (potency) given twice daily.

So it's bad news for bacteria, good and bad, but after the extraction I'll hopefully be able to repair my devastated gut biome. 

In Recovery

Following my psychic surgery in Medan to address my thymoma problem, I'm feeling quite good with only some lingering stiffness in my right hand and a sensitive left foot that I need to be careful to not subject to sudden stress. These are the residual effects of my DOMS and it's quite unusual that should have persisted for this long. 

My symptoms bear some similarities to mild gout but I doubt if I'm suffering from that condition. I just don't fit the profile (somebody who eats a lot of organ meats, seafood and alcohol). Here is what Google's Gemini had to say about gout:

Gout is a complex form of arthritis that causes sudden and severe attacks of pain, inflammation, redness, and tenderness in your joints. Here's a breakdown of the symptoms and risk factors:

Symptoms of Gout:

Sudden and severe pain: Often described as excruciating and debilitating, gout attacks typically strike at night and can wake you up. The pain usually affects one or more joints, most commonly the big toe, but it can also hit ankles, knees, hands, wrists, elbows, or even feet.

Inflammation and swelling: The affected joint will become swollen, red, and hot to the touch. Even slight pressure, like the weight of a bedsheet, can be very uncomfortable.

Tenderness: The joint will be extremely sensitive to touch, making even minor movements painful.

Limited range of motion: As the attack progresses, the inflammation can limit your ability to move the affected joint.

Risk Factors for Gout:

Several factors can increase your chances of developing gout:

High uric acid levels: Uric acid is a waste product created during the breakdown of purines, which are found naturally in the body and certain foods. When uric acid levels become too high in the blood, it can form sharp crystals that deposit in your joints, triggering gout attacks.

Diet: Consuming excessive amounts of certain foods and beverages high in purines, such as red meat, organ meats, seafood, sugary drinks, and alcohol (particularly beer), can contribute to high uric acid levels.

Obesity and metabolic syndrome: These conditions are associated with increased purine production and difficulty eliminating uric acid from the body.

Certain medications: Diuretics, low-dose aspirin, and some immunosuppressant drugs can elevate uric acid levels.

Medical conditions: Some health problems like high blood pressure, kidney disease, and psoriasis can increase the risk of gout.

Genetics: Having a family history of gout significantly increases your susceptibility.

Age and sex: Men are more likely to develop gout than women before menopause, but the risk for women increases after menopause.

It's important to note that not everyone with high uric acid levels will develop gout. Conversely, some people with normal uric acid levels can still experience gout attacks.

It's interesting that the Gemini article describes gout as "a complex form of arthritis". I simply don't know what I've got but I've been placed on a diet that restricts the amount of fried food that I consume and that forbids the consumption of many other foods that I was formerly fond of. The details are still being worked out.

I smile when I think how the so-called medical professionals in Australia would react if I said I'd had psychic surgery to address my physical problem. Hopefully I'll never be at their mercy and, if I was, I'd be very careful about what I disclosed to them. It still staggers me how brainwashed the majority of medical professionals are in Western countries and what little real help they are able to offer. 

Meanwhile I have done some walking and intend to do more as my strength returns. I probably will never return to the physical level that I was at before my fall but I can try to arrest any further decline. My weight is slightly under 71 kilograms at the moment which is good. I'd like to stay around that weight.

State of Play

I've made an appointment to have my decaying tooth on the right upper side either filled or extracted. It's only going to disintegrate eventually just as the one of my left upper side did some time ago. I felt that perhaps some bacteria was leaking into my bloodstream and exacerbating the autoimmune problems. 

I asked Google's Gemini: 

Is it possible that a decaying tooth could trigger an autoimmune response in the body? 

No, a decaying tooth itself wouldn't directly trigger a full-blown autoimmune response. Here's why:

Autoimmunity: Autoimmune diseases occur when the body's immune system mistakenly attacks healthy tissues.

Decaying Tooth: Tooth decay is caused by bacteria feeding on sugar and starches in your mouth, producing acid that eats away at the tooth enamel.

However, a decaying tooth can indirectly contribute to inflammation and potentially worsen existing autoimmune conditions:

Infection:  The bacteria that cause decay can spread through the tooth and into the gums, leading to an infection. This infection can trigger inflammation, a localized immune response.

Weakened Body:  Chronic inflammation from a dental infection can put stress on the body's immune system, potentially worsening symptoms of existing autoimmune conditions like Sjogren's syndrome (which affects saliva production) or rheumatoid arthritis.

Overall:

Decaying tooth -> bacterial infection -> inflammation (not full autoimmune response)

Inflammation can worsen existing autoimmune conditions.

So the tooth is probably not to blame for my current troubles but it's best to deal with as such decaying tooth can certainly spread bacteria around the body with unpredicable consequences. Meanwhile my autoimmune situation has become chronic and is proving quite debilitating. 

With difficulty, I'm walking around the block everyday just to keep up my mobility but the stiffness and soreness in my hands, feet and right shoulder are a constant. I'm not getting worse but then again I'm not getting better. This afternoon I felt especially bad and took one Ibuprofen and one Paracetamol. This gave me considerable relief and now, hours later, I still feel quite comfortable.

However, once the medication fully wears off, I'll probably be back to where I was. I still can't sleep in my bed and have resorted to spending the night on the sofa in the lounge room. I want to try some visualisation and self healing this evening in an effort to effect a cure.