Uveitis + Cataract

We had a follow-up for Mia’s Uveitis this morning.  She has been on the steroid eye drop 3 times a day for the past week, and we are still tapering her off very slowly.  We are still dilating her eye 3 times a day , and she has been on her eye pressure lowering drops twice a day.   At the follow-up today, we learned that she has an early cataract developing in her left eye (the uveitis eye) and her pressure is still higher than it should be.  We now need to  increase one of her pressure lowering drops to 3x/day.  The cataract might be a side effect of the steroid eye drops, or due to the inflammation from the uveitis that we’ve been fighting for over a year now.  We are hoping that it doesn’t continue to worsen and affect her vision further.  We now need to increase eye patching of her good eye to 4 hours a day, instead of 2.   We will continue to taper down on her eye drops and hope that her cataract doesn’t worsen.  We are also continuing her oral Methotrexate and hope that will keep the uveitis at bay all by itself once we are off the eye drops.  If the cataract gets worse and affects her vision, it’s a possibility that cataract surgery will be needed in the future, but for now, we don’t need to worry about that.  I hope in the near future, the cataract treating eye drops are in clinical use and are an option for her if it comes to that.  They still need to complete live human trials, but they seem to work well for dogs and for human lenses in the lab.

This is not the news I was hoping to hear today, but we are fortunate that she didn’t have any sign of inflammation in her eye, and no cells present, and no flare.   I just wish she didn’t have the added problem of developing a cataract.   :(

Since Last Time….

Since I blogged last, we’ve had to go back up on Mia’s prednisolone eye drops.  Hourly at first, and  now we are at 6 times a day, but we will taper down to 3 times a day in a few weeks and stay there until we see the doc again in January.  We also saw her Rheumatologist who increased her methotrexate dosage since her eye was still flaring up on the lower dose.  She is at a max oral dose right now.  If this doesn’t keep her uveitis quiet, then the next step is injectable methotrexate (weekly).   Mia hates needles, so I’m hoping and praying that we don’t have to go that route, but it is very common that oral methotrexate just doesn’t cut it because you absorb less of the drug orally than you do if it is injected.   We don’t know when we will see the rheumatologist next… actually, we don’t know who the rheumatologist will be… the old one seems to have moved, but he said we could see him in Phoenix if we wanted to.  They are still trying to find another Pediatric Rheumy to take his place here… so if you know anyone, New Mexico is in dire need of a Pediatric Rheumatologist.  The nearest ones right now are in Denver and Phoenix.

From here out, any  of the “next step” meds will be either injectables or even by IV infusion.  So we are taking it one step at a time, and hoping we don’t have to try the next step.

For now, her eye is quiet and clear, but we still need to get her off the drops as soon as we can.  Her vision in her uveitis eye has gotten a little worse since getting her glasses back in April.  With the recommendation of her eye doc, we’ve started patching her good eye for 2 hours a day to force her brain to use the bad eye, since her good eye was becoming more dominant.  She is putting up with the patching pretty well.  We bought these pretty eye patches with glittery designs.

Since increasing her MTX dosage, it seems her immune system is taking a harder hit… She has been sick with a cold/cough for a month now, and developed an ear infection and a cough that causes chest pain.  She’s been on antibiotics for a few days now.  The problem with MTX, is that it suppresses the immune system so the body can stop attacking itself in autoimmune diseases, but with a lower immune system, infections and illnesses can be easier to catch and harder to get over.  Just a simple cold for one child can easily cause a serious cold, leading to pneumonia or bronchitis for someone who is immunosuppressed.  So if anyone around us is ill or thinks they might be getting sick this cold/flu season, please let us know so we can try to keep Mia healthy.

In other news… Sean has a swim meet today!  He is a little intimidated because now that he is 11, he is in a higher age group than last year, so the kids are faster.  I’m sure I’ll post pictures after the meet.

Kai is becoming quite a sweet talker… Nathan said he might need lessons from him.  Kai is always coming to me and saying, “My beauty!” or telling me how much he loves me and how pretty he thinks I am… he is just way too sweet.  He certainly knows how to melt his Mama’s heart.

Didn’t make it to 2 weeks…

It has been a little less than 2 weeks since her last eye drops and her left eye is pink again.  :(  We have an appt with her eye doc tomorrow afternoon.  I assume we’ll be going back on the drops again temporarily, and will possibly have to make an appt. with the Rheumatologist to see if they need to tweak her Methotrexate dosage or anything.  We’ll see what they say… Feeling a little frustrated, but still thankful that her health is generally pretty good and no symptoms of arthritis.  I just pray that we can preserve her eyesight over the long haul.  Her eye looked a tiny bit pink the other day, but she said it felt fine and that she could see just fine.  I asked her about it again today, but instead of taking her word for it about her seeing clearly, I asked her to read me something.  I knew when she struggled with something simple, she was having problems.  When I asked her why she didn’t tell me right away that her vision was a little cloudy, she said it was because she didn’t want to have to go to the eye doctor AGAIN.  Poor gal… if I’m feeling frustrated, I can’t imagine how she is feeling.

Putting the drops away

I’m putting the eye drops away.  We are stopping Mia’s eye drops  today after a slow taper since late June.  She has been tolerating the Methotrexate very well since July, her left eye has been “quiet” since July also, and her eye pressure has improved.  We are hoping and praying that the MTX is enough to keep her eye flare free.  If her eye stays quiet while on MTX alone, then we can begin to think about tapering off the MTX.

Please keep Mia in your thoughts and prayers that she will not have problems going forward and that she will go into full remission from the Uveitis.  We’ve tried twice before to go off the eye drops, and her eye flared up again within 4 days to a week.  This is the first time we are stopping the eye drops while using Methotrexate, so hopefully this is the medication that will work for her.  Her vision is holding steady.  She still has scar tissue that is giving her an irregularly shaped pupil.  She also still has some band keratopathy (calcium deposits on the cornea that form “bands”, caused by the chronic inflammation), but thankfully it isn’t in her visual field so it’s not really affecting her eyesight.

I’m so thankful that with all the inflammation in her eye that she’s had in the past year+, her eyesight is still really good and I pray it continues.

14 Years of Marriage, 3 More Weeks of Eye Drops, and a Partridge in a Pear Tree.

Nathan and I are celebrating 14 years of marriage today.  14 years of fun, laughter, love, being nerdy together, celebrating birthdays together, and just sheer awesomeness.  <3

M had another follow-up today.  Her eye is clear, no inflammation, eye pressures are pretty good.  We are decreasing her steroid drop even more (every other day), while keeping her pressure lowering drop to twice a day.  Then in 3 weeks, we are stopping the drops.  We have a follow-up with the doc in about a month and a half, and as long as the Methotrexate is working, she should still be flare free by then.  Please pray that it happens.  It’s exciting, and a little scary at the same time, but I know God is in control.  She also has a follow-up with the Rheumatologist tomorrow, so hopefully that goes well.  She will be due for some blood tests pretty soon… not fun, but necessary.

We all went out for National Coffee Day tonight.  Thanks Krispy Kreme for the donuts and coffee!!!  You helped make our little anniversary celebration special (and cheap).  :)

Eye Update – Things going well!

I mentioned in my last post that M would be starting on Methotrexate (oral).  She started at the end of July.  She takes pills orally once a week, then a Folic Acid vitamin 24 hours later.  We missed a dose the second week because she had some odd test results that made the doc’s office want to make sure she didn’t have a latent Tuberculosis infection… odd, I know, but a blood test came back + for Tb, so we retested with a few different methods, and it was negative.  I have no idea what would cause a false +, but it happens.  Anyways, after we confirmed M didn’t have latent Tb, we resumed her MTX.  She has been tolerating it very well… only a few upset stomachs here and there, but overall it has gone better than I expected.  M also learned that she can swallow pills with no problem, and without having to taken them with something like applesauce or pudding.  What 6 year old do you know of who would skip applesauce or chocolate pudding to take pills with just water???  Silly girl.  So At this point, we have weaned down on  her eye drops to 1 drop of steroid a day, plus2 drops of pressure lowering drops per day… Did you get that???  We are down to ONLY 3 DROPS… per day!!!!  2 in the morning, 1 at bedtime.   Whoo-hoo!  We have an eye appointment next week, so we will see how long we stay at this level, but the goal is to try to get her off the eye drops completely and hope (and pray) that the MTX is enough to suppress her immune system just enough to keep her eye calm and flare free.

It is SO NICE to not have to think about eye drops all day, let me tell ya!!!  She also had photos taken of her retina and optic nerve to make sure there was no damage or inflammation.  Everything looks normal.  The scar tissue that she already has in her left eye that makes her pupil an odd shape will stay there.  We are no longer dilating her eye twice a day… since it has not gone away by now, it is very unlikely that it ever will.  It’s not too big a deal because she hasn’t had any problems from it.  Her vision in her “bad” eye is 20/30, so we are thankful (and blessed) that the inflammation didn’t cause more damage than that.

So that’s where we are… she has a follow-up Rheumatologist appt next week as well.  I don’t anticipate any new news… it’s just a follow-up to see how she is tolerating the MTX, get prescription refills, and figure out when she is due for her next blood test.  We aren’t looking forward to that, but we know it must be done.  Thanks for all the thoughts and prayers, as always, and please keep them going.

Rheumy Follow-up, Adding New Medication

We finally got an appointment for a follow-up with the Pediatric Rheumatologist.  We had to miss an appointment in April because of being out of town, and they called yesterday to see if we could come in early this morning.  We have been on a waiting list since April, so there was no way we would miss this appointment. Thankfully my mom was able to meet me at the clinic to watch the boys while I went in with Mia.  (Thanks Mom!!!)

Since her uveitis is flaring up every time we go off the eye drops, we need try other meds to get her immune system to stop attacking her eye.  The first one that is usually tried is methotrexate, since it has been in use for a long time, and the side effects and safety in children are known.  We will be starting on MTX (Methotrexate) this week.  Please pray it goes well.  As long as she tolerates it orally, we can administer it with weekly tablets, but we may have to go to a weekly shot later on down the road (I’d have to do it myself – dreading having to do that) if it causes too much nausea.   The MTX will compromise her immune system, so she will be more prone to illnesses.  If anyone who will be around us is sick or might be sick, please let us know, so we can take a little extra precaution.  The drug also affects folic acid in her body so she needs to take a supplement as well.  The nurse said most kids tolerate the MTX just fine with little or no nausea… I’m praying she will be in that group.

She had to have more blood tests today, and more in 3 weeks.  She is such a brave little girl.  She cried a few tears when the needle went in, then proceeded to laugh at her mommy being silly while the phlebotomist was drawing the various tubes of blood he needed.  I was threatening to lick her post-needle lollipop and stick it in my hair.  :) We will be monitoring her liver function while she is on MTX since it can affect the liver.  If she does start to have liver problems, they will hopefully resolve after discontinuing the meds.   I hate that this has become a part of her life.  I wish I could take it all away.  She asked me today why there are so many things wrong with her.  Ugh! Makes me want to cry.  I don’t want her to see herself in terms of “what’s wrong with me” because she has health issues.  I want her to see what I see… how wonderful, strong, brave, capable, and courageous she is despite her health issues.  She might have this eye/autoimmune issue, but otherwise, she is healthy, so I’m very thankful for that.

The Pediatric Rheumatologist (the only one in NM) we first started seeing is now only seeing patients one week each month.  The clinic has another Pediatric Rheumatologist that is flying in from California (we saw her today) for a week each month to also see patients.  They currently have 2 positions open for permanent Pediatric Rheumatologists, so hopefully they are able to fill those positions soon.  It is very hard to find someone in this specialty since there are only about 300 Pediatric Rheumatologists nationwide.  I’m so glad that we are still able to see a doc here in NM, and not have to travel to another state to see a specialist.  This is why it has been so hard for us to get an appointment.

The Rheumy also said that Mia’s joints were hypermobile (too flexible) and recommended that we take some precautions to help prevent pain and injury.  She is very flat footed, and this might be the cause of her frequent foot, leg, hip and back pain.  The doc recommended getting her arch support inserts for her shoes and taking extra precautions to try to prevent injury when she is doing sports activities.  She said she should try to stick with lower impact sports like biking and swimming, and that gymnastics (which is what she really wants to do),dancing (which she loves to do), and running (which she also enjoys) might not be the best fit.  I’m a little torn on what to do there… I don’t want to limit what she participates in based on what might happen or injuries that might occur.  People get injured every day, right?  But at the same time, I would feel guilty if she got injured doing something the doc said was a bad idea.  I just don’t want to limit her activities based on “what if’s”.

So for now, her eye is stable.  We will start MTX and hope that will allow us to decrease the eye drops down to zero.  Then if she stays flare free on MTX for a while (1-2 years, usually), we can start to wean her off if it and hope and pray for complete remission.  Her vision is stable in the bad eye, the last flare didn’t seem to cause further damage since we were able to be seen right away.  She still has plenty of scarring in that eye though where the pupil is stuck down and oddly shaped.  Please keep us in your prayers and thoughts.  Keep praying for healing and for us and her team of docs as we make decisions for her.  Pray that she tolerates the MTX with minimal side effects.

 

Here we go!

After checking the calendar to be sure, I figured out that Mia’s last day of eye drops is today, not next week, as I originally thought.  After today, we are supposed to stop all 3 drops and hope for the best.  She has only been having the steroid eye drop every other day for the past 3 weeks.  We’ve also been continuing the dilating drops and the drops for her ocular pressure daily.  We are about to leave for a week-long trip, so hopefully no problems come up while we are away from home.  Please keep our girl in prayer that the uveitis doesn’t return.

 

UPDATE:  We went on our trip and her eye flared up again.  We had to see an eye doc in Galveston, pay out of pocket since our insurance wasn’t accepted there, and drive through a tropical storm to get to her eye appointment.  We promptly got her back on the drops, and her eye quieted back down within a week.  Now we need to figure out what other medication to try since the drops themselves aren’t working to get rid of the inflammation completely.

Progress Report

I can walk in sneakers without limping!  Today I walked a mile and my calf felt pretty good, except on the uphills, it felt a little tight and I had to slow down.  Four days ago, I walked a half mile and was pretty sore afterwards.  The other day I discovered that I can ride my bike pain free.  I’m still sore in the mornings, but after some stretching and massage, I can get around as normal around the house.  I’m back to cooking and doing chores as usual.  I will try out the elliptical trainer tomorrow to see how that feels.  I’m so thankful that after 3 weeks, I’ve reached this point already.  Yay for answered prayers for healing!  Yesterday, I walked down 5 flights of stairs in a parking garage with no problem (I took the elevator back up), I just had to take it slower than normal.  I will still have to stay away from high impact activity for a little while longer, but I prefer walking/biking/elliptical training anyways.

 

In Mia’s eye news, we are down to 3 times a day on the Prednisolone (corticosteroid) eye drops, still dilating 3 times a day, and using drops for her ocular pressure twice a day.  We have a follow-up appointment on April 14th.  Things are looking good.  After Friday, we will take the Prednisolone down to 2 times per day.

We are making progress, but now all 3 kids have colds, some with fevers.  Hopefully these colds will not linger for too long.

2 weeks post calf tear – Limping along!

I can limp without crutches!  Whoo-hoo!  I still need to use a crutch/crutches if I’ll be on my feet for very long, but it’s nice to be able to “walk” on my own again.  I’m still pretty sore and the muscle is still very tight, but I’m making some progress every day.  Keeping a compression bandage on has really helped.  I realized that I had been wrapping it too loosely, under the direction of the Nurse Practitioner that I first saw (“don’t wrap it too tightly” and she wrapped it pretty loosely).  Then over the weekend, we visited some relatives and Uncle Dan, the PA, wrapped it more firmly, but still not too tight, and that really helped with the pain and since then I’ve been making good progress.  I still can’t flatten my foot , but I’ll get there in the next week(s) or so if I keep working it.

The bruising is still purple around my ankle and bottom of my leg, but that is starting to fade finally too.  My ankle is a little sore, I assume from the bruising.  I’m still icing it, especially after being up for a while, and elevating it when I’m sitting.  I cooked dinner last night for the first time in a while.  That felt great, but I was pretty tired and a little sore afterwards.

I’ve also been able to start doing some light strength work with a resistance band and pointing and flexing my foot.  That also is helping with my flexibility.  No standing calf raises yet, but I’ll work my way up there.  Muscle tears are no joke!  I’ve lost a lot of strength and flexibility in that muscle and I know it will take a while to get back to where I was, but that is the goal.  After that, the goal will be preventing this from happening again by building more strength and increasing my flexibility.  I can hardly wait to be able to take walks around the neighborhood again!  It’s only 1.3 miles, but I know I’ll have to build back up to it.