Hoping for a new blog post? Don't worry, I've got you COVID.

You'd have to have been living under a rock for the last month to not be aware of what is going on in the world at the moment. The bad news is, you're probably bored of being stuck* at home. The good news is, I've come out of blog retirement to provide you with at least 5 minutes of reading material and tell you about what this means for me.

*safe. You're safe at home.

I fall into a 'high risk' category
This is because I take certain medications (immunosuppresants) which weaken my immune system. If I become infected with the virus I am at higher risk of becoming more unwell from it than the average fit and healthy 32 (yes, I'm 32 now...) year old.

My job role has changed
I'm still an A&E doctor, but I can't see patients face-to-face at the moment, even the ones who come to hospital with a non-COVID19 related problem. There are constantly patients in the department who have confirmed or suspected COVID19, and even those that don't have symptoms right now could still be carrying it. Therefore I am currently reviewing patients with confirmed or suspected COVID19 remotely via a video consultation platform, as well as doing various administrative tasks to free up others who can still see patients. Whilst I know that this is the right thing to do, I can't help but feel a mixture of emotions about it -

I'm hugely frustrated that I'm not able to do my job - doctors, in fact all healthcare professionals for that matter, have an intrisic need to help people and not being able to do that because of something completely out of my control is incredibly difficult to accept.

I feel immense sadness that I am not able to see my colleagues - my friends - and comfort them when they are having a particularly tough day. The things we, as A&E department staff, often have to deal with means that we know how to keep spirits up (tip top bants, basically) and I really miss being part of the team.

I feel guilty for having an excuse to keep myself safe whilst my colleagues are putting themselves at risk day after day.

I'm super anxious that I'm going to get sick anyway and I will have stayed away for nothing.

People check on me a lot
Mostly my mother. But also lots of others, even some who I haven't spoken to in a long time. I guess that's the thing; when you talk openly about your medical condition everyone knows when you fall into one of the government's 'at risk' groups!

I have free time
Well, approximately 4 minutes of it between 'homeschooling' my children (iPads count as homeschooling, right?), tidying the house 17 times per day and going to work. Which luckily for you means that not only have I had time to make myself feel guilty for neglecting this blog for so long, I have also found time to write it.

When I turn my back on my kids for 5 seconds...

I will have to put up with pain for longer
I've been having problems with my shoulder for 3 and a half years now; for a long time it was assumed that it was 'just' a frozen shoulder, but no steroid injections, medication changes or physiotherapy made any difference. A couple of months ago I finally had an MRI and I'm sure you don't have to be a doctor to recognize that 'erosive arthropathy of the glenohumeral joint with complete loss of articular cartilage' does not sound like good news...

Normal shoulder x-ray

My shoulder x-ray

No one wants to have their shoulder replaced at 32.
Also, no one wants you to have your shoulder replaced at 32.
It's major surgery, a replacement joint only lasts 10-15 years and younger patients have a higher likelihood of early failure and the need for further, more complex revision surgery. Recovery can take up to 3 months and in the short term I won't be allowed to lift anything heavier than a pen. I'll be reliant on others to do absolutely everything for me (although I'm practicing wiping my bum with my right hand so don't worry, I won't be asking you for help with that) and I'll be hugely restricted in what I can wear for a while (my surgeon suggested ponchos...if that's not the biggest travesty of this whole saga then I don't know what is).

Obviously I do have a choice as to whether to go ahead or not...except I don't, really. My quality of life has gone downhill significantly - I don't sleep well due to pain, I struggle to lift anything heavier than a kettle (a concept which my children fail to understand), and even brushing my hair can be difficult. I have reduced sensation down one side of my arm and hand due to nerve impingement and my grip strength is reduced because some of my muscles are torn, meaning I drop things frequently.

So it was an easy decision, really. That didn't stop me crying like a baby though because a) I cry a lot (even once during an episode of  'Homes Under the Hammer') and b) it's not fair that I have to make decisions like this at 32 years old.

Anyway, I received this news 3 days before lockdown so, thanks to this stupid virus, I have to wait indefinitely to have the operation. When that day comes I will no doubt have a lot to blog about and a lot of time to do it in. And don't worry, even if I can't hold my phone, I can always do a vlog whilst wearing a poncho.

Is that why your face is so round?

Recently Isla and I celebrated mummy-daughter hip week, which essentially involves a two-yearly fake hip review for mummy and an ultrasound scan for daughter. I'm pretty sure it'll be the 'hip' new craze soon. Ugh, sorry.

As you may remember from two years ago, every two years I pay a visit to the surgeon who performed my hip replacement operation. It's now been six years since that life changing op, and due to my age and my active lifestyle even the cleverest of surgeons can't predict how long it will be before I need it replacing again. Pretty much everything about this appointment, whether it be my emotions on the day or the radiographer's 'Aren't you a bit young for that?' reaction to learning that I have had my hip replaced*, was exactly the same as two years ago so to save my arthritic hands the trouble of typing it all again, have a read of this instead. Most importantly though, like two years ago, I STILL HAVE TWO GOOD HIPS.

*I'm pretty sure she was the same radiographer that x-rayed my hip two years ago, asked me the same question two years ago, and looked confused two years ago.

When Isla was born she was found to have a slightly clicky right hip. Despite knowing that, although children can develop arthritis at a very young age, they are not born with it, my boyfriend and I couldn't help but exchange a slightly worried glance/awkward laugh at each other when we were told this. I wouldn't wish my disease on my worst enemy, let alone my own child, but I have to live with the knowledge that Isla (and any other children I may go on to have) is more likely to develop rheumatoid arthritis because of me. Despite being a rational doctor and semi-rational human being I know that every time she complains of the slightest pain in any of her joints at the back of my mind I will be panicking that this is the start of juvenile onset arthritis. This disease has taken away any chance I had of being a rational mother.

Clicky hips at birth are actually pretty common though, and more often than not nothing to worry about. Just to be sure though Isla had to have an ultrasound scan at 12 weeks old, which was absolutely fine. The consultant who performed the scan however was ABSOLUTELY NOT FINE. Our conversation went something like this:

Him: "Is there any history of hip problems at birth in your family?"
Me: "No, but I have rheumatoid arthritis and I had my hip replaced when I was 20."
Him: Are you on steroids?"
Me: "Unfortunately, yes."
Him: "Is that why your face is so round?"

I have several issues with this.
1. Why would you think it's OK to ask a girl why her face is 'so round'?
2. Why would you think it's OK to ask someone on steroids why their face is 'so round'?
3. Why would you think it's OK to ask ANYONE why their face is 'so round'?
4. IT WASN'T EVEN MY BLOODY APPOINTMENT.

But, seeing as he so kindly brought it up, now seems like as good a time as any to talk a little bit about steroids. I've mentioned them several times before, but never really gone into great detail about them. I have a bit of a love-hate relationship with steroids. I love them because they reduce inflammation, ease pain, and essentially help me to function in every day life. I hate them because...well, I believe this stunning diagram found in many a medical text book summarises it better than I ever could:

The steroid I take is called Prednisolone, which suppresses the immune system and in doing so reduces inflammation. If you take Prednisolone for long periods of time like I have you become particularly prone to infections because your immune system is weak. These infections may also be much more severe than they usually would be, so I have to be careful to avoid exposure to infections such as chicken pox and measles. I am also eligible for the seasonal flu jab along with the elderly.

As you can see from the incredibly attractive diagram above, the side effects don't end there. In fact, the NHS website lists 77 potential side effects of Prednisolone in total. Mood swings and changes are common, which means one minute I can be happy and the next sad, and I can be extremely short-tempered. My boyfriend would argue that I'm pretty short-tempered anyway, however I'm willing to blame this entirely on my medication and not on my flawed personality. He won't argue with this because I'm short-tempered due to my medication.

Although I wouldn't go as far as saying I have an 'obesity' problem as the diagram suggests, I currently weigh more than I did when I was pregnant. I WAS CARRYING AN EXTRA PERSON FOR CRYING OUT LOUD and yet still not as heavy as I am now. This is in part due to water retention and partly because steroids also increase your appetite, so I am always hungry. Prednisolone also tends to cause your face to begin to resemble the moon or, to give it the medical term, 'moon facies'. So in answer to your question Dr Insensitive, yes that is why my face is 'so round' and I'd like to take this opportunity to thank you for making me feel even more self-conscious about it than I already do.

As we learnt a couple years ago long term steroid use has also left me with osteoporosis, which means my bones are thinner than they should be and are more prone to fractures. I'm also currently covered in bruises, and I have two tiny cuts on my leg that have taken over a month to heal.

That all said, Prednisolone is doing a great job at keeping me going at the moment until the time comes to start the new wonder drug. I have already had the mandatory chest x-ray and blood tests, so now it's just a case of waiting for the call. In the meantime I'm off to find some doughnuts.

Dr Catherine Bull MBChB

A man went to his doctor complaining of aches and pains all over his body. 
"Doctor, my whole body hurts," he moaned. 
The doctor asked him to show him exactly where the pain was.
The man touched his shoulder - "Ouch."
The man touched his knee - "Ouch."
The man touched his nose - "Ouch."

"You've got a broken finger."

My boyfriend told me this joke a few days ago. It's relevant for two reasons:
1. My index finger currently resembles a sausage.
2. I'm now an actual doctor.

This blog post is a few weeks overdue actually, because my graduation ceremony was back in July. For once though it's not because I'm completely rubbish at finding time to blog. I've opened this page several times over the last few weeks, but it's been really difficult to put my feelings from that day into words. I have passed some of the time by searching for pictures of sausage fingers online. I didn't find any, but I did find this:

I have a sausage finger AND I graduated.

It appears that I have sunk to new lows in the name of procrastination. 

The truth is I don't think I'll ever be able to put into words how I felt that day, because there are no words in existence that would do it justice. My only solution is to describe to you my journey over the last eight years and let you imagine for yourself. I realise that this involves a bit of effort on your part, but I did just provide you with a picture of a sausage wearing a mortar board so I think it's only fair.

It's fair to say that most, if not all, people doubted whether I'd ever be able to make it as a doctor. It's not that people thought I wasn't capable but, let's face it, how many doctors do you know that have RA? Medicine is hard enough without all the pain, immobility, fatigue, and hospital stays that the disease brings. Careers advisors at college strongly advised me to consider another degree. Medical students on my course gossipped behind my back asking each other, "How is she going to be a doctor if she's got RA?" Even my parents, though they didn't admit it to me until recently and have always supported me, were horrified when I first told them I wanted to be a doctor. But, as regular readers of this blog will know, I'm not one to shy away from a challenge. And a challenge it definitely was...

May 2005 I become ill just at the time I am about to sit my AS level exams. 

August 2005 I don't get the grades I need to apply for medicine. 

October 2005 I apply anyway. I don't get in.

October 2006 I reapply for medicine and take a gap year to resit my exams. 

March 2007 I get accepted to the University of Leeds. 

April 2007 I get told by my rheumatologist that I need my hip replaced. The operation is scheduled for the first day of university. I cancel it. 

September 2007 I hobble around for a term, sleep for around 15 hours a day, don't make it to many lectures, with the end result being I fail my first exam. 

December 2007 I finally get a new hip. 

March 2008 I am allowed back to university at last, having missed most of the second term and two more exams. 

July 2008 Whilst everyone else is enjoying their summer holidays, I spend mine sitting every single first year exam in the space of one week. I pass. 

January 2009 My first of many gastritis-related hospital stays and my first of many endoscopies. 

January 2010 Another gastritis-related hospital stay. Another endoscopy. 

May 2010 The tonsillitis I have developed gets out of hand as my immune system cannot cope. I end up in hospital for a week following a collapse in A&E. 

July 2010 I fail an exam, mainly due to being ill (again) but also in part due to my poor knowledge of the female anatomy ("Considering you're a woman, Cat, you have surprisingly poor knowledge of the anatomy of the female genitalia." - Dr Pat McConnell, Anatomy Lecturer, University of Leeds). I am told I have to resit third year.

March 2011 The treatment I am on suddenly stops working, I visit my GP so many times in one week that I'm surprised they don't take out a restraining order against me. I miss several weeks of placement through illness. 

January 2012 Another hospital stay and another endoscopy means I miss my psychiatry placement and have to rearrange it for the summer holidays. 

September 2012 I am admitted to hospital after the ear infection I have developed gets out of hand because apparently my immune system doesn't do ear infections. 

November 2012 Hospital stay, endoscopy, yada yada. 

May 2013 I PASS MY EXAMS. 

July 2013 I am finally able to put two fingers up to every single person who ever told me I wouldn't be able to become a doctor and, most importantly, to RA. 

What do you get if you cross an RA sufferer with an ear infection?

A hospital admission and a suspected brain infection. 

Apologies if anyone was expecting a hilarious punch line there, but a) I'm not a funny person and b) this was no joke - this actually happened to me last week. 

Having had at least one admission to hospital every year since I started university five years ago I was adamant that this would be my year. Yep, I was going to have one whole admission-free year before becoming a doctor...I made it to day 1 before ending up in a hospital bed. Note the use of the word 'to' - I didn't even make it to my first lecture. I'd laugh if it didn't hurt my ear so much.

The problem* with having RA is that the medication used to treat it suppresses my immune system. For the average person getting an ear infection might be a bit uncomfortable and a bit inconvenient. For someone who is immunosuppressed getting an ear infection, or any kind of infection for that matter, can be very dangerous. Because my immune system is weak it finds fighting off even the simplest infections a challenge, and this is what led to the series of unfortunate events that I will now go on to tell you about. 

*NB There are many more problems than just this with having RA

Saturday. I visit an out-of-hours GP with ear pain severe enough to keep me awake at night. She diagnoses a middle ear infection and gives me antibiotics. 

Sunday. I am now in so much pain that I am overdosing on pain relief in an attempt to get some sleep (Disclaimer: as a doctor to be I obviously do not condone this behaviour). 

Monday. I visit my GP because the antibiotics don't seem to be working and the pain is getting worse, not better despite dosing up on Tramadol (see previous blog entry about Tramadol). He touches my ear, I cry. A lot. He attempts to look in my ear, I cry. A lot. He sends me to hospital where I am seen by an ENT specialist. Repeat previous sentences re: ear touching and crying. I am admitted and dosed up on IV antibiotics and morphine. I still don't sleep. 

Wednesday. The pain is no better, I still haven't slept, my temperature is through the roof, and I can no longer eat because the pain has spread to my jaw. The ENT consultant sends me for a CT scan.

Thursday am. ENT consultant tells me on the ward round that the CT scan looks clear. He needs to get a radiologist to report it, but he's sure it's fine. 

Thursday pm. CT scan is not fine. My parotid gland and brain look abnormal. It is suspected that the infection has spread to my brain. I am sent for an MRI scan. An MRI scan is not a nice experience at the best of times. But when you are in agony and have to lie completely still for 40 minutes, without even crying because this would cause your head to move, it becomes an horrific experience. Fortunately the MRI confirms there is no brain infection. It has however spread to my parotid gland which is pressing on my facial nerve. Incidentally one half of my brain is apparently bigger than the other...make of that what you will. 

Friday am. I am told I can go home. 

Friday am. I am told I cannot go home.

Saturday am. Doctors discover an abscess in my ear canal. They drain it. The 'horrific' MRI scan is nothing compared to this experience. I have a panic attack. 

Saturday pm. I can finally go home with antibiotics and pain relief. 

At this point I should probably mention my long suffering boyfriend who endured the majority of this traumatic week with me. No one likes to see someone they love sobbing because they are in so much pain (especially as I am an ugly crier, he tells me). And holding your girlfriend's hand and talking crap to her for 40 minutes whilst she attempts not to cry mid-MRI scan is probably not anyone's ideal way of spending an evening, but he did it. And he even managed to sneak me in a Maccy D's at one point as well. So big kudos to the boyfriend. 

Right ok, now I've got that un-funny tale out of the way I'll try to end with a joke. 

A man walks into a pub with a piece of tarmac under his arm and says, "One for me and one for the road."

No? Told you I'm not funny.

Day 95: Never taking solid foods for granted again

This is the current situation going on in my mouth:

These are just the ones you can see...

It seems a family of ulcers have set up home here, and I definitely do not remember inviting them to do so. Having one ulcer is inconvenient. Having 10-20 at once hurts. A lot. And they're spreading like wildfire. I am rapidly running out of space in my mouth to accommodate food. My diet currently consists of yoghurt, mashed banana, and Bonjela. Bonjela has become my new best friend. I am having to apply the stuff every 10 minutes or so to cope with the pain, although by the time I've covered them all it's usually time to start again anyway. I might as well just pour the whole tube in my mouth, it'd probably save me some time.

Why has this happened? Good frigging question. Noone seems to be able to figure that one out. I am now in week 3 of cold (I wasn't kidding when I said I get stuck with them forever). One theory is that I'm immunosuppressed; my immune system is struggling so much at the moment which provides ulcers with the perfect opportunity to invade my mouth. But I have been pretty much living at my GP surgery for the last week and having blood tests every day to check my white cell count, which come back normal every time. As I rung up for my results for about the 5th day in a row today I actually found myself disappointed to hear the words, 'your full blood count is completely within the normal range.' At least if it had been abnormal I would have had an answer. 

So as you can see, despite my joints being the best they've been in weeks, the RA is still managing to take a great big shit on my life. I am never taking solid foods for granted again. 

Love,

Cat x

Day 84: No big deal...?

I was hoping to have something perky to talk about as I have realised that my last few blogs have been a bit depressing to say the least. But then I also realised, this is kind of the point of me doing this; to educate people what it is like to be me, a sufferer of RA, right now. So if something good happens then I will talk about that. But if there’s something to rant or moan about then I’ll bloody well do that too. And today is no exception. Wait for it...

I HAVE A COLD.

“...And?” I hear you say. Because having a cold is no big deal, is it?

Well usually I’d agree. But when you have RA it’s a bit of a different story. The problems with having a virus when you have RA are twofold; 1) because some of the medication I take dampens down my immune system, my immune system is not equipped to deal with said virus, so I come off worse than your average Joe and am stuck with it for what seems like forever, and 2) my feeble immune system does at least attempt to fight off said virus but in the process decides to attack my joints as well.

So when you have RA having a cold is pretty bad news. And I can’t afford to be ill at the moment – I have just started an obstetrics and gynaecology placement as part of my doctor training and being sick just isn’t part of the timetable. So in my attempts to deal with this somewhat shitty situation I have been going to bed at about 9PM for the past three nights. But then because of the extra pain in my neck and back (and standard crippled hand pain, obviously) I keep waking up at ridiculous o’clock in the morning. So on top of being ill and in pain I’m also exhausted. All because of a stupid cold. 

It’s a shame because I am loving my placement at the moment. There aren’t many people who can say they spent their day feeling babies kick, listening to their heartbeats and watching them on an ultrasound scan, and I feel very lucky that my treatment has got me to a point where I am well enough to train and do all these things. I did get some funny looks when I checked some mums’ blood pressures today, though; it’s probably not the most reassuring thing when the person checking your blood pressure is wincing with every squeeze as she inflates the blood pressure cuff... (my hand wasn’t impressed with being made to do that and despite all the practice it’s had my face didn’t manage to hide the pain on this occasion).

Anyway it’s nearly 9PM which means it’s nearly time for bed. Ugh, I can’t believe I am saying that at the age of 23.