My Health Journey, Medications

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In the last post I described my first two weeks of recovery post surgery. Unfortunately, I left out one very major detail, and one other item that I said I’d discuss in the previous post that I never did…

Let’s start with what I forgot to follow up on. Two posts ago I said that in the next post I would explain why the Rheumatoid Arthritis (RA) didn’t end up being a big deal. I didn’t do that and now will.

When I got home, I realized that I didn’t have a single symptom of RA. I hadn’t thought about it in the ICU (where I didn’t have it either), but in the apartment, doing the things that normally were very uncomfortable at best, didn’t bother me. Of course, this was a blessing (a most necessary one), but it was also an enigma.

I didn’t see the Rheumatologist until nearly six weeks after the surgery. The symptoms hadn’t returned as yet, but were beginning to a bit in my hands (mostly fingers) only. I asked him what drugs could have been given to me during or after surgery that would have suppressed the symptoms this well, and he said “None!“.

He explained that it was almost definitely my own body producing cortisol levels way above normal, fighting to heal post surgery, that were overwhelming the normal immune system issues that were causing RA symptoms. He assured me that without a doubt, the RA would return.

Of course, he was correct. Still, it was dramatically milder, being only in my hands (recall that it was all over my body during November and December 2024). He wasn’t sanguine about that either. He said that if I left it untreated, it would eventually return everywhere.

He wanted me to start taking Methotrexate (MTX), but needed to check with my surgeon whether I was far enough from the surgery to start the medication. The surgeon said yes…

Now my dilemma. I don’t typically like taking medication, especially ones that could be lifelong affairs. He urged me to take it, saying that any deterioration in my condition could lead to permanent joint damage (as in irreversible). I told him I’d think about it and started reading everything I could about it.

I was still leaning heavily toward not taking it. I consulted with my godson who is a Hematology/Oncologist. He urged me to take it as well. He explained that all of the predicted side-effects were unlikely to affect me due to the dosage I would be getting.

I listened to both of them and started taking the medicine when we returned to VA in March and have been taking it ever since. My godson was correct that I had none of the side-effects that they warn you about (though I did have other potential side-effects that will be mentioned in a future post).

I still have RA, but it’s still only in the hands, and even there, almost exclusively in the fingers. I have no idea whether that would be the case without the MTX, or whether I would have deteriorated further without it. Is it arresting the deterioration, or doing nothing?

I tried to get my Rheumatologist to agree to letting me stop for a while and see. He preferred to up my dosage, claiming that it was too risky to stop the medication. We compromised on keeping the dosage the same…

While I didn’t have any physical symptoms from the MTX, there were things I needed to be mindful of. MTX can affect your liver (so far it has not affected mine), so you should avoid alcohol as much as possible. I haven’t had any since Christmas Eve 2024! You also can’t have any grapefruit. So I haven’t eaten that either.

Since this post is labeled Medications, I’ll continue with that, and then circle back to the opening paragraph topic.

For 24 years, I have resisted taking a statin. I’ve mentioned a couple of times that I’m one of the 25% of people who are lucky enough to be able to control their cholesterol levels through diet and exercise. My Cardiologist would still prefer me to take a statin, but I always said no, and became serious about my diet after each admonition.

When I had my surgical follow-up two weeks after surgery, I asked if I really needed to pay attention to my cholesterol level given that I only had a single 30% blockage and all of my other arteries were clear around the heart.

He said yes, since cholesterol entering the brain could do serious damage independent of any blockages. Darn…

Still, I intended to eat better to control it. When I saw my latest blood tests I was pleased with the cholesterol level. My Cardiologist was not. He said that these levels would have been acceptable before the surgery, but post-surgery, they wanted to see them lower than normal, in particular the LDL, which he said I would not be able to get down to a good level through diet alone.

He urged me to take a statin, and again after consulting with my godson, I finally relented. I’ve been on one since April, again with no side-effects. Different than the MTX, the statin is working wonders (from a numbers point of view). Six weeks after starting it, my cholesterol levels were down to exactly where the Cardiologist wanted them.

OK, circling back to the first paragraph…

While I didn’t have any RA symptoms, I had one excruciating problem (independent of the previously mentioned bathroom ones). My lower back muscles hurt like heck every time I needed to use them (getting in and out of bed, adjusting my position in bed, sitting down and standing up).

When the surgical nurse practitioner came to the apartment, I asked her if they had to cut through the muscles in my back during surgery. She said that there were no incisions on the back. The issue was more obvious (after the fact).

After they saw your breast bone, they use a spreader to keep the two halves of the rib cage apart, so that they can access the heart and ascending aorta more easily.

Your back muscles are connected to the back of the ribs. As the front of the ribs get spread apart, the back muscles get squeezed together. That’s a position they can’t get into naturally, so they had never been in that position ever before.

My surgery lasted five hours, and then I was wheeled back in and opened up again, though I don’t know if a spreader was used the second time…

Suffice it to say, those muscles were revolting over their treatment. It took three full weeks for them to start to relax and another few weeks after that to fully recover (thankfully, they did, which is why I even forgot to mention it before).

I can’t imagine what it would have been like if the RA had returned in full (throughout my body) at the same time as the back muscles were refusing to work. I’m grateful that I only needed to deal with one of them at a time.

This is another (typically) long post, so I’ll end it here and continue with the recovery and return to VA in the next one.