Prompted by uric acid / diclofenac comment in the gout forum.

Gout research produced several references to uric acid problems with diclofenac in vultures, but nothing to worry about in humans. Summarize for GoutPal.com as a Gout Cures blog item with UDRP-Pain classification, emphasizing need to focus on uric acid numbers and remove the need for pain relief asap.

3 relevant studies follow.:

Effect of short-term use of different non-steroidal anti-inflammatory drugs on renal function during fasting in ramadan

Tags:

• uric-acid-pain

Notes:

• Uric Acid & Pain Relief: Kidney Function Effects

  Tags:

  • uric-acid-pain

Effects of some anti-inflammatory drugs on 12 blood constituents: protocol for the study of in vivo effects of drugs

Tags:

• Anti-Inflammatory Agents
• Aspirin
• Blood Chemical Analysis
• Blood Urea Nitrogen
• Cholesterol
• Creatinine
• Diclofenac
• Humans
• Ibuprofen
• Indomethacin
• Iron
• Ketoprofen
• Prospective Studies
• Retrospective Studies
• Serum Albumin
• Time Factors
• Triglycerides
• Uric Acid
• uric-acid-pain

Notes:

• Uric Acid & Pain Relief: Blood Effects

  Tags:

  • uric-acid-pain

Interference by analgesic and antirheumatic drugs in 25 common laboratory assays

Tags:

• Anti-Inflammatory Agents, Non-Steroidal
• Bilirubin
• Blood Chemical Analysis
• Blood Glucose
• Blood Proteins
• Cholesterol
• Creatinine
• Humans
• Iron
• Triglycerides
• Uric Acid
• uric-acid-pain

“What’d you wanna do?”

“I don’t know. What’d you wanna do?”

Now I can see this conversation come alive. (For those with rusty memories – it is Walt Disney’s Jungle Book. The scene with the vultures – of course you remember).  Well, these Asian bald-headed scavengers have reason to ask these questions every day at mealtime. Animal carcasses have become unfit for vulture consumption in India. The culprit – a common pain killer, called diclofenac.

Diclofenac, a member of the aspirin family is the answer to long-standing, painful joint diseases in humans and livestock, alike. While this drug can have side effects on the kidney, both humans and cattle usually tolerate it well in moderated doses. But in 2006, India banned veterinary formulations – to save the vultures.

In rural India, dead livestock is left for vultures to feed on. If a cow or goat was prescribed diclofenac before its death, the carcass contains enough to damage the vultures’ kidneys for good. Failing kidneys have managed to decimate vulture populations, placing them with other animals in the list of endangered species in India.

The ban on diclofenac seems to have done nothing for these birds. The drug is still suspected to be available in rural areas, and in 2008 alone, 5000 vultures died of kidney failure. Last week, three adults died in Ahmedabad in Gujarat.

On the other hand, three vulture breeding centers have come up – in Bengal, Haryana and Assam. Recently, the West Bengal center was successful in breeding a chick in captivity. While, this is an achievement no doubt, it is also time to ask ourselves an important question: can breeding vultures in these centers actually save these birds from extinction?

Vultures live to be about 40 years old and breed for at least a good thirty of those years. Every year the female lays one egg. If her egg disappears, she can lay another one after a couple of weeks. Even if breeding centers do use this piece of information to their advantage, how many vulture chicks can we successfully breed? And will these actually replace the disappearing populations in the wild?

Visitors to these breeding centers are taken by surprise when they are not allowed to crowd around the cages. The centers want to keep the vultures away from humans, in an attempt to simulate their natural environment. In the centers, vultures live as they do in the wild – in groups of five or ten that feed together. They are taught to remember their natural instinct: be wary of humans.

While this simulation can be of use when these vulture populations are released in the wild, they might be less trained to face other challenges. In the breeding centers, vultures enjoy a relatively disease free environment. Also they do not have to learn to watch out for planes – another huge menace to vultures in the wild.

Well, we can only hope that the captive vultures will do well when set free in the jungles – that they will learn to fight illnesses and recognize the droning engines of planes.

In the meantime, will the government do something about a certain banned drug that is still in circulation among farmers? That might help our feathered friends more.

Pic Source: Guardian, All Movie Website

Story Source: Times of India, The Hindu, Indian Express, Institute of Zoology -UK

They may not have the beauty of a peacock or voice of a Cuckoo, but vultures play a vital ecological role in the food chain by feeding on dead animals which would otherwise spread disease and contaminate the surroundings. During the 1980’s India had the highest density of vultures. Today, population of vultures has declined drastically.Various estimates place the figures at 60000, down from 40 million birds. 

Slender Billed Vulture Image Source: Wildlife Trust of India

One of the main reasons for the decline in the number of vultures is the use of the drug Diclofenac for veterinary purposes, said the Chief Conservator of Forest Akhouri Subir Kumar Sinha.

Diclofenac is the drug used to treat sick livestock that die and are  left for scavengers.Vultures feed on the livestock treated with diclofenac and die. Diclofenac has been found to cause kidney failure in vultures.  In 2006, Government of India banned the production and sale of diclofenac.

The decline in population of vultures can also be attributed to decline in forest areas or trees which these birds call home, and rapid urban development which eliminates open spaces where dead animals were abandoned. These grounds used to be ‘prey ground’ for vultures.

Reversing the decline is a slow process. Vultures do not breed until they are five years old and produce only one egg each year.

Government of India launched a ‘Vulture conservation program’ this month. Captive breeding centres for vultures have been set up at zoos in Bhopal, Bhubaneswar, Junagarh, and Hyderabad.

“Birds can only be saved from extinction through banning the retail sale of Diclofenac, promotion of the safe alternative, Meloxicam, and the capture of more birds for the breeding programme,” Neeta Shah, working with the Bombay Natural History Society for the bird’s protection said.

Read more here.

The three most commonly prescribed topical creams for actinic keratoses (AK’s) are:

1. 5-Fluorouracil (5-FU), “chemotherapy in a cream,” selectively kills the more rapidly dividing skin cells which are generally the precancer and cancer cells.  Efudex or Carac cream is applied once or twice daily to the entire affected area of involvement for 2-4 weeks.  It can cause quite a bit of redness, swelling, and crusting in the treated areas along with some stinging and burning.  The cure rate is high and usually yields an excellent end result.

2. Imiquimod stimulates the patient’s own immune system to produce the natural cancer fighting chemical interferon which destroys the abnormal cells.  Aldara cream is applied 2-3 times per week to the affected area for up to 16 weeks.  It is recommended to treat more limited areas of skin per course of treatment than with Efudex.  Aldara may also cause a significant amount of redness, erosions,and pain, but it is generally well-tolerated and gives good results after healing.

3.  Diclofenac (Solaraze gel), a non-steroidal anti-inflammatory drug, is combined with hyaluronic acid, a natural substance in the connective tissue of skin.  Its mecanism o f action in treating AK’s is not known, however, it produces much less inflammation in the skin than 5-FU or imiquimod.  It also takes much longer to achieve results because it is applied twice daily for 2-3 months.  My impression is that the results are inferior to the first two listed here.

What is new?

The latest innovation for treating multiple AK’s is Photodynamic Therapy (PDT), which patients call the “blue light special.”  This treatment combines the application of a light sensitizing chemical called Levulan to the affected skin with a special blue light source.  Neither treatment used alone would have any effect.  After the chemical incubates on the skin for about an hour, it is selectively taken up by the abnormal skin cells.  The skin is then exposed to the blue light for about 16 minutes, and the precancer and cancer cells are targeted for destruction.  Patients may experience stinging and burning and eventually redness and swelling in the treated areas for a few days.  Sun exposure must be strictly avoided for the first 48 hours after the procedure.  Healing is usually complete in one week.  Results are comparable to 5-FU with the added bonus of some noticeable rejuvenation of the skin.

Diclofenac veroorzaakt blijkbaar abortussen?

>> Het nieuws artikel <<

De medicatie die hij toediende (methotrexate en diclofenac) staan bekend om hun zwangerschapafbrekende werking.

Diclofenac is vrij te verkrijgen onder o.a. de naam Voltaren

arthritis subsiding… but slow… yet, wonder why entire lower half of body is aching so much?… especially the ankles… ligaments still super tight… but anyway, so glad i can hobble better today… thankful for small improvements… the diclofenac is working better than piroxicam…

the jaw is still painfully tight… ulcers still painful… but managed to have a decent lunch and nice dinner… dinner with a good friend who came over to help me return my library books… another friend came over yesterday and cleaned my apartment floor… i am very blessed… all i need do is ask and i hv friends coming over to help me…

and perhaps resolution inside is also slowly beginning to breath again… slow… but still alive… hope’s embers still burn beneath the rubble…

Nama generik: Kalium diklofenak. Nama brand: Cataflam. Kalau Voltaren, Voltaren-XR adalah Natrium diklofenak. Brand ini adalah milik Novartis, merupakan molekul baru yang ditemukan pada April 2004.

Nama IUPAC : 2-[(2,6-dichlorophenyl)amino]benzeneacetic acid.

Apa itu diklofenak? Diklofenak adalah sebuah non-steroidal anti-inflammatory drug (NSAID) yang menunjukkan aksi anti-inflamasi, analgesik, dan antipiretik pada hewan model. Mekanisme aksi Cataflam, seperti NSAID yang lain berkaitan dengan menghambat sintesis prostaglandin. Prostaglandin merupakan sejenis hormon yang menyebabkan inflamasi dan nyeri di tubuh.

Diklofenak digunakan pada perawatan sakit atau peradangan yang disebabkan oleh arthritis atau ankylosing spondylitis.

Informasi apa yang paling penting yang harus saya ketahui tentang diklofenak?

Obat ini dapat meningkatkan risiko ancaman/life-threatening jantung atau masalah sistem sirkulasi, termasuk serangan jantung atau stroke. Hal ini akan meningkatkan risiko Anda menggunakan diklofenak lagi. Jangan gunakan obat ini sebelum atau setelah operasi bypass jantung (disebut juga coronary artery bypass cantum atau CABG).

Carilah bantuan darurat/emergency medis jika Anda memiliki gejala-gejala jantung atau masalah system sirkulasi, seperti sakit dada, lemah, sesak nafas, berbicara slurred, atau masalah dengan penglihatan atau keseimbangan.

Obat ini juga dapat meningkatkan risiko efek serius pada perut atau usus, termasuk perdarahan atau perforasi (pembentukan lubang). Keadaan ini dapat menjadi fatal dan efek gastrointestinal dapat terjadi tanpa peringatan kapan saja saat Anda mengkonsumsi diklofenak. Kaum dewasa mungkin memiliki risiko lebih besar dari efek samping serius gastrointestinal.

Panggil dokter saja sekalian jika anda memiliki gejala pendarahan di perut atau usus. Ini termasuk keadaan hitam, berdarah, atau tinggal beberapa stools, atau batuk darah atau muntah seperti ampas kopi.

Hindari terkena sinar matahari atau sinar UV buatan (atau sunlamps tanning bed). Diklofenak dapat membuat kulit Anda lebih peka terhadap sinar matahari dan sinar matahari dapat menyebabkan rasa terbakar.

Apa yang harus saya bicarakan dengan tenaga kesehatan sebelum mengambil diklofenak?

Jangan gunakan obat ini jika anda alergi diklofenak, atau jika Anda memiliki sejarah reaksi alergi aspirin atau NSAID lainnya.

Sebelum mengambil diklofenak, katakan pada dokter jika anda alergi pada obat tertentu, atau jika Anda memiliki:

1. sejarah dari serangan jantung, stroke, atau bekuan darah;
2. penyakit jantung, congestive kegagalan jantung, tekanan darah tinggi;
3. sejarah perut ulcers atau perdarahan;
4. Penyakit ginjal atau hati,
5. asma;
6. polips di hidung;
7. pendarahan atau clotting disorder atau darah; atau
8. jika Anda merokok.

Jika Anda memiliki kondisi ini, Anda mungkin memerlukan penyesuaian dosis atau test khusus jika akan mengambil diklofenak.
Indeks keamanan menurut FDA adalah kategori C. Obat ini mungkin akan berbahaya pada bayi yang belum lahir. Katakan pada dokter jika anda hamil atau berencana untuk hamil selama pengobatan. Konsumsi diklofenak selama 3 bulan terakhir dari kehamilan yang dapat membahayakan bayi yang belum lahir. Jangan ambil diklofenak selama kehamilan kecuali dokter Anda telah diberitahu. Diklofenak dapat lolos ke dalam air susu ibu yang dapat membahayakan selama menyusui. Jangan menggunakan obat ini tanpa memberitahu dokter jika hal menyusukan bayi. Jangan memberikan obat ini untuk anak tanpa nasihat dari dokter.

Bagaimana cara konsumsi diklofenak?

Ambil obat ini persis seperti yang diresepkan untuk Anda. Jangan mengambil obat dalam jumlah besar, atau untuk mengambil lebih dari yang direkomendasikan oleh dokter. Ikuti petunjuk pada resep label.

Jika Anda beralih merek diklofenak, Anda dapat mengubah dosis kebutuhan. Ikuti petunjuk dari dokter tentang berapa banyak untuk mengambil obat.

Obat jangan dikunyah atau dibelah untuk tablet lepas perlhan/ extended-release tablet. Telan tablet yang utuh. Hal ini secara khusus dibuat untuk melepaskan obat secara perlahan di dalam tubuh. Memecah tablet akan menyebabkan terlalu banyak obat yang akan dilepaskan pada satu waktu.

Jika Anda mengambil diklofenak untuk jangka waktu yang lama, dokter Anda mungkin ingin memeriksa Anda secara berkala untuk memastikan bahwa obat ini tidak menyebabkan efek yang merugikan. Jangan lewatkan setiap jadwal kunjungan ke dokter Anda.
Simpan obat di suhu ruang, hindari panas dan kelembaban.

Apa yang terjadi jika saya terlewat satu dosis?

Ambil dosis yang terlewat segera setelah Anda ingat. Jika itu hamper ke waktu untuk dosis berikutnya, lewatkan saja dosis tersebut  dan minum dosis obat ini pada waktu berikutnya sesuai yang dijadwalkan secara teratur. Jangan mengambil ekstra untuk membuat obat yang terlupa tadi.
Apa yang terjadi jika saya overdose?
Cari bantuan darurat medis jika Anda telah menggunakan terlalu banyak obat ini. Overdose gejala mungkin termasuk mual, muntah, sakit perut, kantuk, black or bloody stools, batuk darah, bernapas dangkal, dan pingsan.

Apa yang harus saya hindari saat mengambil diklofenak?
Jangan menggunakan OTC  lainnya, alergi, atau pain-killer tanpa terlebih dahulu meminta saran dokter atau apoteker. Banyak obat-obatan yang tersedia berisi aspirin atau obat-obatan lainnya yang mirip dengan diklofenak (seperti ibuprofen, ketoprofen, atau naproxen). Bacalah label dari setiap obat-obatan lainnya yang anda gunakan untuk melihat apakah berisi aspirin, ibuprofen, ketoprofen, atau naproxen. Jangan minum alkohol saat mengambil diklofenak. Alkohol dapat meningkatkan risiko pendarahan perut disebabkan oleh diklofenak. Hindari terkena sinar matahari lama-lama . Diklofenak dapat meningkatkan sensitivitas dari kulit ke sinar matahari. Gunakan sunscreen dan memakai pakaian pelindung bila terkena sinar matahari yang tidak dapat dihindari.

Efek samping diklofenak

Dapatkan bantuan medis darurat jika Anda memiliki salah satu dari tanda-tanda reaksi alergi: hives; kesulitan bernapas, pembengkakan di wajah, bibir, lidah, atau tenggorokan. Berhenti mengunakan diklofenak dan cari perhatian medis atau dokter panggilan sekaligus jika Anda memiliki salah satu efek samping yang serius:

1. dada sakit, lemah, sesak nafas, bicara slurred, atau masalah dengan penglihatan atau keseimbangan;
2. hitam, berdarah, atau tinggal beberapa stools;
3. batuk darah atau muntah seperti ampas kopi;
4. bengkak atau cepat mendapatkan berat;
5. kencing kurang biasa atau tidak sama sekali;
6. mual, sakit perut, demam rendah, kehilangan nafsu makan, dark urine, clay-colored stools, jaundice (yellowing dari kulit atau mata);
7. demam, sakit tenggorokan, dan sakit kepala parah dengan blistering, kupasan, dan ruam kulit merah;
8. bruising, geli parah, rasa, rasa sakit, kelemahan otot, atau
9. demam, sakit kepala, leher kaku, chills, untuk meningkatkan sensitivitas cahaya, ungu bintik-bintik pada kulit, dan / atau serangan (kejang).

Efek samping kurang serius termasuk:

1. enak, ringan mulas atau sakit perut, diare, sembelit;
   bloating, gas;
2. pusing, sakit kepala, nervousness;
3. kulit gatal atau ruam;
4. penglihatan kabur atau
5. nada di telinga Anda.

Ini bukan merupakan daftar lengkap dari efek samping dan lain-lain dapat terjadi. Katakan pada dokter tentang apapun yang tidak biasa atau efek samping yang menyusahkan.

Apa obat-obatan akan berinteraksi dengan diklofenak?

Beritahu dokter jika Anda mengambil antidepressant seperti citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (paxil), sertraline (Zoloft), atau venlafaxine (Effexor). Mengkonsumsi salah satu obat ini dengan dikofenak membuat Anda menyebabkan luka memar atau mudah terjadi perdarahan.

Sebelum mengambil diclofenac, katakan dokter jika anda mengambil salah satu obat berikut:

1. pembuat tipis darah seperti warfarin (Coumadin);
2. cyclosporine (Neoral, Sandimmune);
3. lithium (Eskalith, Lithobid);
4. methotrexate (Rheumatrex, Trexall);
5. diuretics (pil air) seperti furosemide (Lasix).
6. steroids (Prednisone dan lain-lain);
7. aspirin atau NSAIDs lainnya seperti etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve , Naprosyn), piroxicam (Feldene), dan lain-lain, atau
8. ACE inhibitor seperti benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (prinivil, Zestril), ramipril (Altace), dan lain-lain.

Daftar ini tidak lengkap dan mungkin ada obat-obatan lainnya yang dapat berinteraksi dengan diklofenak. Beritahu dokter tentang semua resep dan obat OTC yang Anda gunakan. Ini termasuk vitamin, mineral, produk herbal, dan obat-obatan diresepkan oleh dokter lainnya. Jangan baru mulai menggunakan obat tanpa memberitahu dokter.

Did I say the inflammation and pain had calmed down again?! HAH!! Well, it did I suppose … for a few days, then it was back, then it was gone again, then it was back … but I definitely don’t think the Arcoxia is as effective as the diclofenac was. Trouble is I REALLY don’t want to go back on the diclofenac as my stomach is actually normal now for the first time in about a year!

‘I can’t go back to Rheumatologist 2.’ Bula is angry. Having emptied his little bag of tricks he told me I was free to look for another doctor.

‘Chaliat….constantly bragging,’ her older sister pipes in. ‘Not available this weekend, I am away at a conference and will then take a couple of days off at Hawaii!!’ While his patient is confined to bed in pain.’

Rheumatologist 3 is identified. A wheelchair and an Innova with a good suspension are identified.

‘Take charge.’ I offer my four-annas worth of advise. ‘Tell him you are willing to live the rest of your life with the SOMI brace and do your bit on the physiotherapy front but you need to be on minimum medication.’

‘The rest of my life?’ Bula falters.

‘Well isn’t that better than spending it in a Halo brace  (which is what my learned friend was secretly planning…and because he is a good friend he hopes to monitor Bula’s case and lets me onto the secret – despite his considerable experience this is the first time he is proposing such a style of management)? If you are going to sit and simper…the rheumatologist will be tempted to throw a bag of antidepressants at you. You have to take charge of your treatment. The ‘talk nicely to me for I am very ill’ stage is long over.’

Rheumatologist 3 has cut out the Tegretal, the Neo Gaba and all the Diclofenac (Voveran tablets and Jonac suppositories). He is a man of few words. ‘We have to keep your kidneys safe,’ is all he says. ‘You are allowed up to 6 tablets of Paracetamol in a day.’

In addition he prescibes 15mg of Folitrax methotrexate to be given subcutaneously once a week. ‘ The first injection is given in a hospital setting the rest will be given at home.

Bula still complains of pain and sneaks in a Jonac and a Neo Gaba now and then. But it is nothing compared to what she experienced prior to discharge. She has climbed down from the fifth floor all the way to the ground floor and to the park in front to sit in the sunshine for an hour.

Bula is like the olympic gold medalist on dope. We are waiting for her to clean up.

“Ohne die Unterstützung aus der Apotheke ist eine Dauerbelastung wie bei der Weltmeisterschaft kaum möglich” wird Novartis vom Hamburger Abendblatt zitiert. Es geht um die deutsche Handballmanschaft – und deren Analgetika-Bedarf. Besonders das NSAR Diclofenac (Novartis Voltaren(R)) werde gerne genommen. Das birgt gleich zwei große Probleme: Doping und Gesundheitsschäden.

Bei Schmerzmitteleinnahme kann der Sportler Leistungen bringen, die sonst schmerzbedingt nicht möglich wären. Hier wird von legalem Doping gesprochen.

Langjährige Schmerzmitteleinnahme, insbesondere von NSAR wie Diclofenac, schädigt den Körper, insbesondere die Nieren. Der Ex-Werder-Fußballer Klasnic durfte es am eigenen Leibe erfahren: seine Niere versagte.

Novartis läßt offenbar kritische Distanz zum Schutz von Sport und Sportlern vermissen.

Fuss ist abgeschwollen. Daher sieht man jetzt auch ganz genau dass der mittlere Zeh die Ursache ist. Der ist nämlich immer noch dick. Er wird wohl gebrochen (gewesen??) sein. 

Da man da sowieso nichts machen kann (steht auch hier und hier) und ich auch schon zweimal zuvor “Probleme” hatte, die sich hinterher – als alles verheilt war – als gewesene (und inzwischen verheilte) Brüche herausgestellt haben werde ich mir jetzt weitere Arztbesuche schenken. Das geht ja schon seit vor Weihnachten so, und in 1 – 2 Wochen dürfte dann alles vorbei sein.  Die Idee, den Zeh zu tapen, schreckt mich jedenfalls ab. Ich halte ihn auch so schön still (sonst tut’s nämlich tierisch weh).

Diese Erkenntnis und eine Telefonkonferenz bis fast 20 Uhr haben mich dann vom Sportstudio abgehalten. Aber morgen (mit schön fest geschnürtem Schuh) bin ich wieder dabei. Will ja keine Ehrenurkunde als Fördermitglied bekommen

Pünktlich um 7 Uhr zur kleinen Runde am Mainufer.  Die Wege waren schneebedeckt, aber o.k.

Bewundernswert: Ganze Armeen von Radfahrern waren unterwegs. Scheinbar Schulkinder.

Minus 5 Grad waren es. Aber nach der Kälte der vergangenen Wochen fühlte sich das schon fast wieder warm an. Angenehme Lauftemperaturen auf jeden Fall.  Warscheinlich wird es im vorhergesagten Schmuddelwetter kurz oberhalb der Frostgrenze wesentlich unangenehmer sein.

Mein Fuss war beim Laufen schmerzfrei, juhu !!  Trotzdem mache ich mit meiner nur-eine-Tablette-am-Tag-Kur erstmal weiter. Nach einigen Diskussionen im Bekanntenkreis habe ich mich überzeugen lassen dass die Tabletten nicht nur den Schmerz betäuben, sondern auch die Ursache bekämpfen. Und ich will ja nicht ewig damit  herum machen.

 Schon seit Mitte Dezember hatte ich Probleme an der Außenseite des Mittelfusses, die sich nach 10 Minuten laufen dann aber gelegt hatten. Inzwischen hatte ich mich irgendwie dran gewöhnt, habe aber der guten Ordnung halber seit 2 Wochen mit homöopathischer Teufelskralle versucht, das Thema aus der Welt zu kriegen.

Da es nicht nur nicht besser, sondern schlimmer wurde, bin ich dann (doch)zum Arzt…  Ergebnis: Mehrere Vermutungen (und zwar genau die Auswahl, über die ich auch schon nachgedacht hatte), einstweilen könne ich ja  Diclofenac  nehmen.  Die im Beipack beschriebenen Nebenwirkungen, und das sind einige,  haben mich die Packung dann erst mal zur Seite legen lassen.

Ich habe mich vielleicht geärgert…  Aber heute morgen bin ich eingeknickt und habe doch eine Tablette genommen. Und siehe da, keine Schmerzen.  Na ja mal sehen was draus wird.

Image via Wikipedia

I have a diagnosis. Well, actually I have diagnoses. I accept these diagnoses, but I am refusing to let them change who I am.

I have a form of spondyloarthopathy; most likely ankylosing spondylitis. Simply put, I have severe inflammation in my spine. It cannot be cured, but progression can be slowed and there are treatments available.

“Ankylosing spondylitis causes stiffness and low back pain. Over time, the pain usually moves from the lower back into the upper back. In severe cases, the affected joints in the spine fuse together, causing severe back stiffness. Other areas (such as the hips, chest wall, and heels) may also be affected.” WebMD

I have a secondary diagnosis of fibromyalgia as well. In 18 months, the one thing I’ve specifically prayed not to hear was fibromyalgia. I was scared it would be fibro because there’s not much you can do about it – you live with the chronic pain and fatigue the rest of your life. Fibromyalgia brings with it pain, fatigue and “fibrofog.” While it can’t be cured, it can be treated and there are steps I’m already implementing. The thing that scares me most about fibromyalgia is the comorbidity with depression. For years, depression was an everyday part of my life and I refuse to allow it to seep back into my life.

Dr. I put me on 100mg of diclofenac daily to reduce the serious inflammation in my body. Because of the strength of this anti-inflammatory, Dr. I also put me on Prilosec to ward off the ulcers that are commonplace from the medication. Dr. I also told me that it was imperative that I begin doing light exercise every.single.day. On Sunday I did 30 minutes of yoga and then today I did 30 minutes on the elliptical machine in the gym at work. I have set goals with the exercise (and plan on rewarding myself) and have the mindset that this is for my health.

The three words Dr. I added to my self-description are scary words. I spent Saturday in a dark hole contemplating my diagnoses. I snapped out of it when a loving friend asked me “has your pain changed since you got a medical word to describe it?” It hasn’t. I am in the same pain with or without a diagnosis. I am more than a diagnosis. Words may be incredibly powerful, but you don’t have to let them take all the power.

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The last week has seen my biggest leap in improvement – about time considering it’s about ten weeks since my op (I am losing count now, which is also a good thing).  This week I have managed to get through every day without having a daytime nap and still manage to stay up until 10pm (unheard of for years!).  I have managed to take care of my children, on my own, for a lot of the time (I am yet to do more than two full days in a row but I shall next week).  I have managed to cook meals, clean the house from top to bottom (bar the heavy work such as vacuuming), I have managed to socialise (with LOTS of giggling) with a friend on a week night until 10pm, and yesterday I managed to sit in the hairdressers for three hours and finally find me again! (my hair was in desperate need of attention)

Going to the hairdressers highlighted very clearly the improvement I have made in seven days.  Last Friday I walked around the town for 30 minutes, then sat in a cafe for 30 minutes and then had to go straight home to bed, I was absolutely exhausted.  I was also still on Diclofenac three times a day (having only come off dyhydrocodeine two days previous).  This Friday I was only on Ibuprofen as and when needed (normally morning and night) and I had the energy to walk around town for an hour and sit in the hairdressers for three hours.

Whilst in the hairdressers I had a few moments of revelation.  The first being the most exciting! I realised that for the first time in YEARS I was sat in the hairdressers with no anxiety as to whether I was going to have to dash off mid cut for the toilet, this was amazing.  For the last year or so I had had a home hairdresser for this reason (but it was not as nice as the whole salon experience).  I realised that I was just sat there very relaxed – bliss.  I did have a few moments of new experience…

After walking around town for a while I realised that I would in fact need to empty my bag before I went to have my hair done.  This wasn’t an issue as we have a centre with toilets which are never used so I just headed there (they are also really, really nice toilets just a little off the beaten track).  I then had a bit of anxiety about having to empty my bag in the hairdressers, but whether by fate or subconscious purpose I happened to choose a hairdressers with a toilet in a next door building (shared by a few little shops) which is barely used.  I have air freshener but it doesn’t matter what people say the smell from emptying the bag is rather more potent that the average poo! Still, I got on with it and my God it was a million times better than worrying about or actually having to dash off to spend 20 plus minutes on the loo with UC!

My next challenge is to dance with my bag.  I am a little nervous about this but I am going to go to a venue in my town, with my husband and take it very easy.  If it doesn’t work out I shall know why, be able to come home and reassess the situation.  I hope to do this next week but N wants me to wait for another two weeks just to ensure I really am much better, so we shall see.  I managed to walk the mile to school and back this week so my fitness is much better.

Walking is still a little uncomfortable as I am still getting quite a lot of cramping in my back passage.  I am beginning to think this is due to some muscle damage as it seems to ease off if I walk and feel better throughout the day if I have a good walk in the morning.  The good thing is that it is definitely improving so I can see that it will, one day, disappear.  Another minor issue is that my posture has definitely been effected. This is not so bad as I aware of it and am working hard to improve it (dancing will help a lot too) but it is annoying to have lost my core strength.

All in all, I can see the light and as I embark on a more normal life I am starting to appreciate the enormous benefits of not having UC anymore.  My husband was delighted this morning when I got up with him and the children at 8am and proceeded to make us all breakfast – it is a good few years since I have managed that on a weekend as normally getting up and having to spend an hour on the loo was such a chore – now I practically bounce out of bed

It would seem that hope is working out *clap clap*