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Thread: Rheumy- " against my better judgement".

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    Default Rheumy- " against my better judgement".

    I am so confused right now.
    As I told you a week ago, my liver doctor, recommended that I start taking MTX agian.
    A few minutes ago, the rheumy ( his nurse) called and said, " the doc will let you take the MTX again, but against his better judgement". What the heck is that supposed to mean? I did asked her that and she said that with my liver being in relatively bad shape he doesn't think that I should take MTX.
    So I have asked her what kind of treatment he would suggest, because I have been without meds for several months now, she said that he didn't know what else I could take. " BUT I AM IN PAIN AND I NEED SOMETHING, I NEED HELP".
    She said to have a blood test done today, take the MTX for two weeks and have another blood test then.
    I am now starting on tuesday with a MTX shot, but only 0.4 mg, is that going to be enough? I used to take 0.15 mg and it helped me alot.
    It is so frustrating, that two specialists can't agree on a treatment. What am I supposed to do? I am not the specialist.

    Debbie
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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    I feel you, but maybe since you have been off it for 2 months the lower dose will help. I don't trust the Rhumy's much I got diagnosed by my pcp and treated by her. What does your pcp say? I would talk to them before starting anything right now. Maybe they have some better advice. Let me know how it goes!

    Gretchyn

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    There is still some trepidation amongst doctors to use Methotrexate in patients who show signs of liver damage. This is because, over 40 yrs ago, it was found that MTX could cause liver fibrosis in patients with psoriasis (especially those who consumed alcohol). However, this was seen in patients who took large doses on a daily basis. A similar study was conducted with RA patients who took smaller doses and it was found that liver fibrosis was much less common.
    Now, MTX is given in much smaller doses and only once per week. Since this change, liver fibrosis has not been a common side effect, although it is still listed amongst the possible side effects of MTX. So, due to these studies, three main safety features were added to Methotrexate therapy: Weekly doses (in contrast to daily Methotrexate in the past), folate supplementation & avoiding alcohol. They also cleared the air about severe liver toxicity with Methotrexate.

    Here is a website that might give you more information regarding MTX and liver fibrosis/toxicity:
    http://www.nlm.nih.gov/medlineplus/d...s/a682019.html

    I hope that this answers your question a bit. I wish you the very best.

    Peace and Blessings
    Namaste
    Saysusie
    Look For The Good and Praise It!

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    Thank you very much.
    My problem is, the liver damage actually comes from the Lupus, it is autoimmune hepatitis, with other words, the Lupus is attacking the liver.
    Do you see the problem? The Lupus has to be controlled, for instance with MTX, but the MTX might damage the liver even more. It is a catch 22. I am in a real pickle here.
    On top of that, I am in alot of pain, but my rheumy is not comfortable giving me any pain meds, because of the liver. For a few months, all I have been taken, Mobic ( anti inflammatory) and Flexeril ( muscle relaxer), plus three weeks of prednisone.
    I really don't know, what to do.

    Debbie
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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    Quote Originally Posted by blackeight View Post
    I feel you, but maybe since you have been off it for 2 months the lower dose will help. I don't trust the Rhumy's much I got diagnosed by my pcp and treated by her. What does your pcp say? I would talk to them before starting anything right now. Maybe they have some better advice. Let me know how it goes!

    Gretchyn
    Thank you Gretchyn,

    I do trust my rheumy, I just think he is too careful. My family doctor admitted to me, that he doesn't know much about Lupus, RA and Sjogrens, that is what my diagnosis is.
    I guess, I will start the MTX shot on tuesday ( my day off is wednesday) and go from there.

    Debbie
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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    BTW, Saysusie, luckely I don't drink, never have. I usually have one glas of champagne on New Years Eve, it's a German tradition.

    Debbie
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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    Have you thought about going to a pain managemt doctor to help with the pain issues while the other doctors figure out what they want to do? Not a perfect solution but getting the pain down will get your stress down which will possibly help calm the Lupus.

    I am not one to say jump to pain meds but I finally gave in after 3 years and it made a big difference.
    Mari

    Success is not final, failure is not fatal: it is the courage to continue that counts.

    ~Winston Churchill~







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    Thanks Mari,

    That is something to think about.

    Debbie
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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    Just another thing to look-out for there Debbie, is the mobic, which can impact the liver also, as can aspirin and tylenol. I don't think there's a "safe" nsaid pain reliever that doesn't affect the liver in some fashion, since it's the body's "filter" for the blood stream. I had to quit all meds due to my "hypersensitive whatchamuhcawlitt" reaction, which involved the liver (surprise, surprise, surprise... tic). I'm back on my thyroid meds, but I've not done "pain reliever" in almost 5 weeks now, and have to do bi-weekly liver enzymes bloodwork, just in case I've added "autoimmune hepatisis" to my list of ailments (doesn't look like it so far)... Definitely be governed by doctors' advice, and do it like you've done, and consult with more than one doc. You definitely want to be "educated" about the sitch...
    "There but for the grace of God, go I."
    "... His mercy endureth for ever."

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    Quote Originally Posted by jmail View Post
    Just another thing to look-out for there Debbie, is the mobic, which can impact the liver also, as can aspirin and tylenol. I don't think there's a "safe" nsaid pain reliever that doesn't affect the liver in some fashion, since it's the body's "filter" for the blood stream. I had to quit all meds due to my "hypersensitive whatchamuhcawlitt" reaction, which involved the liver (surprise, surprise, surprise... tic). I'm back on my thyroid meds, but I've not done "pain reliever" in almost 5 weeks now, and have to do bi-weekly liver enzymes bloodwork, just in case I've added "autoimmune hepatisis" to my list of ailments (doesn't look like it so far)... Definitely be governed by doctors' advice, and do it like you've done, and consult with more than one doc. You definitely want to be "educated" about the sitch...
    Thank you jmail,

    I am kind of leaning toward the liver doctor, who said to take the MTX, to prevent the liver to get further attacked by the lupus. The liver doc thinks I should take it and rheumy doesn't, but the rheumy can't come up with a solution.
    Not only am I in pain, my joints are getting worse my fingers are starting to cripple, it needs to be treated, I mean the Lupus, RA and Sjogrens. I can't keep going without meds any longer, it's been months and I can feel, that things are getting worse.
    I had a nice long talk with my hubby last night, asking him what I should do and he said " i have been watching you get worse and worse, since you had to stop the MTX, something has to be done, because i don't want you to suffer like this any longer. Since the liver doctor said you should take it, to prevent further damage, you should at least try it."
    So tomorrow afternoon, I will get my blood test done and start my first MTX shot in the evening. I will have a blood test done every two weeks and we'll go from there.

    Debby
    I may have been dealt a bad hand, but at least I'm still playing with a full deck. ( most of the time anyway).

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