i have not taken my 10mg of methotrexate since i was restarted on it by my rheumy on April Fool’s, for more than what i can count on 1 hand. (it’s a weekly dose)
i don’t have to find excuses to reason out why i did not take them, because they are not excuses. i am not proud of it, but i have my own reasons. i am falling off my compliance bandwagon. the pill burden is getting to me. i have a fear that the vicious cycle of MTX->transaminitis->MTX discontinued->transaminitis resolved->MTX restarted, will never ever end. i can’t even count how many times that has happened. i am tired of it. my GIT (gastrointestinal tract) is a huge mess. i get easily nauseated with my meds these days, though i almost never get nausea from my meds anymore in recent years. i discovered my gastric motility is quite delayed- an inevitable side effect of the severity of my eating disorder i guess. i could involuntarily puke food that i have eaten 9 hours prior and discover that they have been barely digested. (sorry, too much info.) the only anti-emetics i get are OTC, and are pretty much useless. so i procrastinate on taking them each week, and i end up not taking them. because my liver is in a precarious position, i have bloods to do between my appointments for my liver. and it so happens that i left my job. my finances are looking bad. i don’t only pay for my RA treatment. my psychiatric treatment goes into the thousands. so i told myself, “bah, maybe i could just skip these bloods since i’ve not been taking my MTX and save myself the money”, because i still owe my hospital, my ex-employer, money for my CT scan.
these are psychosocial issues in rheumatology that never gets address, you see. i, for one am on the receiving side of it. doctors could get at us for being uncooperative, non-compliant and all. but do they ask sincerely, “what’s wrong? what’s going on?”. they don’t. and this is something i want to change in rheumatology in Singapore. patients are never at fault. we have our excuses, our reasons, no matter how unlikeable or unacceptable they can be. but if doctors are in our shoes, perhaps they could understand our struggles. we want to control our disease, but there lies many obstacles in our ways that prevent us from doing so, which we think are more important than controlling our disease. there is so much we can do to remove these obstacles, to empower, to gather support, just to help one patient.
that said, i’m losing the fight again. it feels like my body is giving in to my RA all over once more. the constitutional symptoms are back. the fatigue that sleep can never remedy. the pain that analgesia and physical therapy cannot get rid of. and of course, without a doubt, the flares that hit much harder. the dysthymia worsens. it all winds up to me feeling like giving up. nothing new. i have bouts of these sometimes.
maybe i should have just taken my MTX like a “good girl”, just like what they all want me to be.