Cue 'Also Sprach Zarathustra'

I went on methotrexate last fall, and it seemed pretty good.  However, when my dosage was upped to therapeutic levels, I got some nasty side effects -- I was nauseous 3-4 days per week (even with prescription anti-nausea meds) and it wasn't related to digesting the pills (as it started 24 -36 hours after taking them) and had incredible, earth-stopping fatigue 7 days a week.  It worked, however, and I thought I might just have to live with it for a while (and maybe it would settle down).

My Rheumie's face fell when we discussed this in my last appointment.  I quickly told him I didn't what him to think it wasn't working (scared, y'see, that he would take me off it and then I'd go back to the fun world of sitting in a chair and cursing my hands and feet).  I pushed very hard for the addition of a biologic... which he didn't want to do yet.

His solution was to try the injectible methotrexate at the same dose as the oral form.  He told me the injectible was about 20% more effective than the orals.  I said "GREAT!  But, hey, will it fix these side effects?"

His face fell again.  He looked at his lap.

I said: "I've got to fix the fatigue at least.  I can't see continuing to teach for 17 more weeks like this.  I mean, I think I have to go on disability every single day and I hate it."

He nodded sadly and said "It might help with these sides, but its not probable.  We might have to take you off of the methotrexate."

"Nooo!" I said.  "It works."

He looked me dead in the eye.  "Yes, it sounds like it is working, but the price you are paying...  That doesn't seem equitable."

Of course, the black tide of panic welled up in my mind.  No methotrexate?  But Plaquinal didn't do a dang thing for me except kill my appetitie.   What do I have to do, just suffer through the pain?  I'd rather go on disability...

"Let's try the injectible for a month.  If it doesn't get any better, we'll try a new direction -- maybe a TNF drug, and we might try that later anyway.  We might also try to partner the methotrexate with something else so we can lower the dose, but then the dose might be too low to be therapeutic.  We'll just have to see.

"But for now, let's focus on one change at a time and see if we can make it better.  Let's freeze all your other scripts and dosages.  By the way, do you think you can stick yourself with a needle?"

What a question, right?  I said I probably could (I have some background in medicine, and have given shots to animals, and assisted in injections for humans).

His office keeps a full time RN on staff to train patients in self-injection.  She was waaay cool and took away a lot of my nervousness.  Turns out methotrexate can be injected any old way you want (e.g SC, IM, IV, even straight into the bone marrow!) and it's effective.  He gave me the subcutaneous form.