Helen story

“Grandma, you have arthritis, don’t you?” my 5-year-old grandaughter questioned me with a statement. Children have little tact and diplomacy. It was much easier to talk with her than with adults about my arthritis.

“Yes, I do have arthritis.” Like most children, I expected to have only a few moments of her attention on the subject.

“How come you have have it?”

“Something that we don’t know, I guess. Even though my hands don’t look good, I don’t hurt anymore.” That was it. Her thoughts were on to something else.

My six-year-old niece would simply stare at my hands, then at me. She had silent thoughts, and I could only guess what they were.

When my mother, a former grade school teacher, introduced me to her friends, she usually explained that I had arthritis and then called their attention to my hands as if to emphasize the correctness of her statement. My role in the introduction was defined. I could say noth-ing. I smiled to the pitying looks of my mother’s friends. It hurt my mother to see that I had arthritis.

I have been with the ladies of my Homemaker’s Club for 30 years. These friends have been absolutely wonderful. They look past my hands and my hurts. Their support through my most difficult times has meant more to me than any of them realize. All though my pain, surgeries, and restricted social activities, these ladies always had the time to send me get well cards, encourage my recovery from operations, visit me in the hospital, and do many other things that bond friends together.

Diagnosis

In 1971, a physician of the University of North Dakota Rehabilitation Hospital
diagnosed my condition as rheumatoid arthritis. By the age of 37, pain and swelling had become almost constant in my hands and knees.

Prior to the diagnosis, both my husband and I feared what it might be, but neither of us would discuss the matter. I held onto the hope of denial with the thought “if it hasn’t been diagnosed, I don’t have it.” Once the diagnosis was made, reality displaced the artificially safe haven of denial. The diagnosis was to be confirmed by four dif¬ferent rheumatologists over the next few years.

I really did not want to have rheumatoid arthritis. The disease was no stranger to my family; I knew it only too well.

Family history of rheumatoid arthritis

For almost as long as I can remember, my father, a farmer in north¬ern Minnesota, had suffered with the disease. He walked only as far as necessary and, in his later years, used two crutches.

When a race car at the state fair careened off the track and into the audience, my father had both legs broken near the knees. The next year upon his father’s premature death from diabetes, my father took on the obligations of supporting his mother’s family raising his eight younger brothers and sisters. He was only 17.

My father never complained—not about losing his father, not about helping raise his younger brothers and sisters, not about delaying his own marriage for 12 years until the last of his brothers and sis¬ters had reached maturity, and not about the farm home burning down in 1966. He had a wonderful, positive attitude and is one of my most admired persons.

My father could hide the pain in his selection of words, but not in his eyes. I saw him flinch when my 1-year-old son would run and jump on his lap. I saw him get the tell-tale moon face from using too much cortisone. I saw him agonize and grit his teeth when he got up from his easy chair, put on his crutches and walk to the table for dinner. I saw his swollen hands with tightened skin and no indenta¬tions between the knuckles. Yet I never remember him mentioning pain.

My father’s sister from southern Minnesota also had rheumatoid arthritis and had difficulty walking and using her hands. Her fingers were swollen, crooked and had the ulnar drift in which the four longer fingers lean away from the thumb. She walked, turned and had arm movements as if her spine and shoulder bones were fused. Since they rarely saw one another, I suspect this had little impact on my father’s thinking.

My father never knew that I was to suffer from the same disease. One year before my diagnosis, he died from cancer of the pancreas. He had no arthritis-related surgeries. I was to have seven. His hands and fingers were straight. Mine are not. I am happy that he didn’t know. It would have added to the burden that he carried with such dignity. He also did not know that some fifteen years later his nephew would be walking with two canes because of rheumatoid arthritis.

The impact of the diagnosis on my life

To mentally accept the fact that I had rheumatoid arthritis was a big adjustment. Different personal feelings about the diagnosis took turns buffeting my thoughts about. I wondered “Why me?” I was locked into a body with pain from which there was no escape. I felt hopeless. I was stuck with it. I was so young. I thought only old peo¬ple got arthritis. I feared that it would eventually take over my body like it had that of my father. There was no hope of it ever leaving me. I spent many nights crying.

A Grand Forks rheumatologist thought that my arthritis really began at the age of 18 when I was diagnosed with rheumatic fever. Immediately prior to being diagnosed with this disease, I had gotten a small pox vaccination on the upper right arm in preparation for entering college in the fall. The next day while using a hoe to remove weeds from sugar beets on my father’s farm, I noticed a swelling in the area of the vaccination. I switched hand positions on the hoe for temporary relief. I forced myself to work for several more days. Finally, I succumbed to the fever and tiredness and had to lie down.

Upon making the diagnosis of rheumatic fever, our well-respected country doctor, who had delivered me as a baby in our farm home, recommended bed rest to prevent heart damage. For one month, I was in the local hospital and for more than another month I stayed in bed at home. Fortunately, my only remnant of rheumatic fever was a slight heart murmur. However, my knees, that had become sore with the rheumatic fever, never were pain-free from that time on. Immediately thereafter, I could only scrub floors if I were to first place padding down. Later, as the knees became more painful, I could no longer kneel at all.

During pregnancies, I felt great. However, I had big flares of pain and swelling after the births of our four children. After our first child was born, the pain was so great that I was not able to lift her up from the crib. My husband would pick her up, give her to me and then I would nurse the child. The post-pregnancy arthritis flare that occurred after the birth of each child would last from four to six weeks. During this time, the pain, swelling and stiffness would travel from one end of my body to the other. Then it would disappear. I gave birth to three children in four years. After the birth of the fourth child 6 years later, the aches, pains and swelling came on with gusto, and there was no reprieve.

My husband begins research

Upon diagnosis, my husband, then a professor at the University of North Dakota, went to the university of North Dakota’s medical school library to read about rheumatoid arthritis. In the evenings, we would talk. He reviewed what he was reading in a factual way all the while trying to encourage me. It became evident that the cause of the disease was not known, and that there was no cure. On the positive side, there were a number of medications commercially available to treat inflammation associated with the disease. He spared me what he was learning about joint destruction caused by rheumatoid arthritis and possible corrective surgeries. He concluded that I had ‘caught a big one.’

My husband tried to encourage me by pledging to alter his research plans to include arthritis. He didn’t want to see me suffer as my father had. He urged me to see a rheumatologist, then later to get a second opinion, a third and a fourth. Because Mayo Clinic of Rochester, Minnesota, has an excellent reputation in medicine, and had developed cortisone for the treatment of arthritis, he had me go through their program for rheumatoid arthritis.

Medication for my arthritis

The diagnosing physician began treating my rheumatoid arthritis using the then standard pyramid sequence of medications. In this approach, the medications judged more safe were to be tried first, with a progression into more potentially hazardous drugs. The physi¬cian encouraged me by saying that there were many medications available which he could use to control the disease. He reassured me that help was on the way. In his opinion, it was fortunate that he had diagnosed the disease in its earliest stages and, by treating it properly, not much damage would occur.

As a trained accountant, I began keeping a record of the medica¬tions used and what joints were giving me problems. Until 1981, the only medication for arthritis that I used was aspirin. My instructions were to take aspirin tablets four times a day in such amounts as necessary to control the inflammation or until ringing occurred in my ears. If ringing occurred, I was to reduce this amount gradually until the ringing stopped. Between 1971 and 1981, I took 7,300 5-grain tablets (7.6 pounds) of aspirin. I think it helped. Certainly, I had more pain as the effects of aspirin wore off. As the rheumatologist became concerned about aspirin causing stomach ulcers, he changed the medication to Ascriptin. In 1981, I took 5,840 tablets containing 6.1 pounds of the aspirin within this medication. In 1982, he changed the medication to Ecotrin. In all, I used 17,520 tablets containing 18.2 pounds of aspirin. In relatively rapid order between 1982 and 1984, the search for more effective medication led to tak¬ing 720 grams (1.6 pounds) of naproxen, and 798 grams (1.8 pounds) of d-penicillamine taken at the same time. d-Penicillamine and Plaquenil were added sequentially in 1984. Gold injections were not tolerated by my body. Each time that I was given a weekly gold injection, I spent the following five days in bed followed by two days up and around. This cycle was repeated four times before the gold injections were stopped. During the latter stages of this period, I continued using Ecotrin and naproxen along with the latest anti-inflammatory medication being tried. At mealtime, my first course would be a panorama of various sized, colored, and shaped tablets.

In retrospect from 1969 to 1984, at no time was I pain-free. Nothing seemed to stop the pain in my body. The disease was going ram¬pant.

Progression of the disease

At times, even the weight of the bed sheets was painful. They felt so heavy on my body. I got through those years by doing a minimum amount of work—taking care of the family and preparing meals. My husband had the habit of inviting university students into our home for meals. When I entertained, it would take two to three days to recover to the point where I was before the event. However, I loved entertaining.

As the disease progressed, I began reducing my social obligations such as teaching a Sunday School class at the church, participating in church women organizations and socializing in the faculty women and wives organization at the University of North Dakota. I was sim¬ply too exhausted at the end of the day even though I would take rest periods throughout the day to conserve energy.

Morning stiffness was a big problem. I would take a hot shower in the morning to try to get my body thawed out. The stiffness was ter¬rible. It would take anywhere from one to two hours to get limbered up. I felt that I needed two to three cups of coffee in the morning before wanting to talk with my husband. I think it was difficult for him to understand this. Physically, I looked alright.

Still the arthritis continued going out-of-control in my body. My hands were getting the brunt of it. I was very hard on my hands with sewing, cooking, baking, and cleaning. I was taking care of four chil¬dren. For six continuous years, I rinsed cloth diapers in the cold water of the commode. My hands were continually swollen, painful and sometimes reddish in color.

An ulnar drift developed in both hands, but my right hand was the worst. I lost strength in my hands. I began dropping things as I worked in the kitchen. My knees continued to have pain, but I had learned to adjust.

Physical therapy

My attending rheumatologist referred me to the University of North Dakota Rehabilitation Hospital for physical and occupational thera-py.I was given splints in which to rest my wrists, hands and fingers during the night and during the daytime if necessary. The therapists taught me how to do a variety of exercises presumably to strength¬en my wrists, hands and fingers. The physiatrist recommended hot wax treatments for my hands and wrists. My husband converted a deep fat fryer into a wax bath with the correct temperature. Each day, I would dip my hands into the warm, melted wax and hold them there for awhile. After they got warm bordering on being uncomfort¬able, I would wrap my hands in a towel. The wax would slowly hard¬en within the towels as I rested in my favorite chair. After the hot was treatment, my hands hurt more than before and seemed to be getting worse. It certainly wasn’t helping. So that form of treatment was discontinued.

Depression

With the constant pain and feeling of hopelessness, I became weighed down. Finally I decided that feeling sorry for myself was not going to make me better nor make it easier for my family. I would get through this pain and really worked on developing a positive out¬look on life. During certain times when I had extra pain, this was especially trying. When I felt down, I would become quiet. However, most of the time I was positive and would not let other people know that I was hurting. No one seemed to understand anyhow. If I talked about my pain, they would talk about theirs, change the subject or discontinue the conversation in a polite way. By outward appear¬ance, I didn’t look like I was hurting.

I may have deceived my husband but not deliberately. He knew I was hurting, but I don’t think he knew how much. Certainly this was true in the beginning when he would ask me why certain household chores were not done.

In 1979, my husband’s then 76-year-old father developed rheuma¬toid arthritis. I remember his father telling the story of how his wife almost ‘broke his leg’ getting him out of bed in the morning. I over¬heard him telling my husband “Gee, is this what Helen has to put up with? I knew she was hurting but I had no idea that she was going through this! That poor woman!” Then I think my husband finally understood what I was going through. He became more considerate and helpful. He could correctly interpret my quiet periods, and then he would take care of the household chores not done and occupy the children’s time in order that I might get rest. I have never been good at expressing my inner thoughts about arthritis to him. I prefer to be quiet and adjust to whatever life gives. I really did appreciate those comments of my father-in-law to my husband. I felt that it was more influential coming indirectly from a person outside my immedi¬ate family than directly from me.

How much can one tell a husband about health problems without a negative reaction? I couldn’t bear to have him near me in bed when I was hurting. Yet, I didn’t want to lose him and compound my prob¬lems. It was a concern that I had—merited or not

Faith in God and prayer

I have a strong faith in God and had been doing much praying about this disease. My thoughts would go from pleading for relief to asking for a solution through research—my husband’s—or that of anyone else.

I had been taught that God would never give us a burden that is too big for us to bear. It checked out with passages in the Bible. However this pain that I was having was pressing the limit of big¬ness in my estimation. The ways that I had in mind that the prayer for relief would be answered were slow in coming. In fact, I could not see any progress at all. Though the scriptures teach that prayers will be answered, when they will be is carefully and frustratingly omitted from the promise. A strong trust in Him is needed.

As I became increasingly more desperate, I tried to bargain with God. If He would straighten my fingers and heal my joints, I would become a more powerful witness for Him than in my then present condition. This approach was met with silence.

Many friends and relatives joined me in prayer for research on arthritis. It was comforting for me to know they cared. One specific group that I met with regularly for over 15 years consisted of University of North Dakota faculty wives and town women. With them, I could share the joys and frustrations of the arthritis research. They understood what I was talking about.

Antibiotics and arthritis

Starting at the age of 18 when I had rheumatic fever, the attending country doctor had me taking daily penicillin presumably to prevent reoccurrence of the disease. I continued taking the medication until I was 40 years old in 1974. Then the rheumatologist overseeing my rheumatoid arthritis recommended that I discontinue. I was diag¬nosed as having rheumatoid arthritis in 1971. It appeared as though when I discontinued the daily penicillin, my arthritis took a turn for the worse. In 1994, my attending physician prescribed another antibiotic, minocycline of the tetracycline family. The only thing that I have noticed is that the dual rheumatoid arthritis nodules on my right elbow decreased in size and redness when on minocycline and increase when not taking it. The size decreases from about the size of two sugar cubes to one.

Diet and arthritis

In 1975, I read a book written by a physician, G.W. Campbell, D.O., who claimed that diet control would reduce arthritis symptoms in seven days. In effect, the physician was recommending what aller¬gists know as one form of the elimination diet. I discussed the mat-ter with my husband. After reviewing Campbell’s plan and not see¬ing any harm that could come from it, he encouraged me to use the procedure. On discussing the subject with my attending physician, the attitude was about the same as that of my husband’s except that he believed that there was not relationship between arthritis and foods.

With the feeling that I had nothing to lose, I made the decision to follow the Campbell plan. If I would find something, fine. If not, that was all right, too. At the very minimum, I had a plan to try to get bet¬ter. Some plan is better than no plan. Not having a plan to test tempted me to feel sorry for myself and allow a feeling of hopeless¬ness to enter into my thinking.

After seven days on the restrictive diet recommended by Campbell, I did improve as the physician had predicted. Then I followed his recommendations by adding foods of my former diet back one-at-a-time until my arthritis suddenly became worse. In this manner, I found that wheat-based foods made my arthritis flare. To obtain a confirmation, I asked my attending physician for a wheat allergy test. He explained that my observation was probably not due to the wheat as such but rather a protein within the wheat, gluten. Consequently, he tested me for a gluten allergy, and the test result was positive. Then he taught me that most all of the cereal grains contained gluten. If I were to eliminate it, I should convert my diet from being wheat-based to rice-based.

I was surprised to learn how many foods contain gluten: wheat, oats, rye, and barley. Fortunately, there are whole cookbooks that have been created for people with gluten allergies. With the help of these, I succeeded in removing gluten from my diet. After doing so, I did get better. However, the pain and swelling was reduced but not eliminated. Removing gluten from my diet was a partial answer, not the complete answer. Nevertheless, I was encouraged.

Surgeries

In 1980, a surgeon at Mayo Clinic in Rochester, Minnesota, recom¬mended replacing the major knuckle (MCP) joints on both of my hands, one hand at a time. My right hand was worse than my left. When learning of the surgery success rate, I chose to do my left hand first because I am right handed. I was disappointed to see that within three weeks after surgery, the ulnar drift was back again. The surgeon installed replacement joint made of carbon fiber that could move in all directions like the natural joint.

My hand apparently needed a hinge, not a ball and socket type like the original because my hand went into the ulnar drift almost imme¬diately after surgery.

Several years later, another surgeon at the United Hospital in Grand Forks removed the carbon fiber replacement joint in my left hand and replaced them with hinge-type plastic ones (the Swanson implant). The surgery was successful in keeping my fingers in line with the bones of the hand. However, this hand is now quite stiff. It is a good helping hand but is not able to grip much of anything. The surgeon referred to the second surgery as a rescue one and instructed me that the results would be less than perfect. He was correct.

My right hand was scheduled to have the MCP joints replaced in 1983. But I chose not to have that surgery based on my experience with the left hand. Now my right hand is much more functional than the left one, and I am happy with my decision.

Besides the two MCP joint surgeries, I have had total joint replace¬ments on both knees, the right hip, the right wrist, corrective surgery on both feet, and a hammer toe straightened on my left foot.

My husband’s research 12 years later

With my husband’s arthritis research program at the University of North Dakota, days went into weeks, weeks into months, and months into years. It was difficult for me to place much hope that my husband could or would add anything to the arthritis picture. I felt that his research was more for my mental attitude than for a solution to my physical problems. I always gave him credit for trying and sup¬ported him with prayer. I never discouraged him. All the while, my hope was that a new magic medicine would be discovered some¬where, and that when I took it my pains would disappear.

Some 12 years after my husband pledged to begin research on arthritis and after a speaking engagement in Pittsburgh, he came back excited. My husband told me that he thought he understood rheumatoid arthritis and how to control it. I smiled and said nothing. He was always getting excited about something happening in the research laboratory. I was of the belief that a wife can best support her husband by listening. Most of the time, I didn’t understand everything he was talking about so the listening was more physical than mental. After all, 12 years had passed and he hadn’t solved rheumatoid arthritis. It was difficult to get very excited one more time. He passed through many ups and downs in research during those 12 years.

I had my hopes up each time my attending physician would change my medication. When the medication failed to remove my pain, dis¬couragement would come. I was accustomed to this pattern and didn’t wish to get my hopes up high only to have them bashed once again. So I gave my husband an encouraging smile.

The decision

In 1984, I accompanied my husband on a trip to an international inflammation research conference at the Indian government research institute in Jammu-Tawi, India. He was to give the plenary lecture on his inflammation research. Prior to this time, I had been in a lot of pain. When my husband asked me to go with him on the trip, I was uncertain. I discussed the matter with my attending rheumatologist. He suggested that I go along. To make the trip more enjoyable, the rheumatologist put me on a two-week, tapered regi¬men of cortisone (prednisone) beginning at 15 mg/day then a main¬tenance dose of 5 mg of prednisone each day. I was to stay on my existing regimen of other medications. He made no promises.

We arrived in India one day after Prime Minister Indira Ghandi was assassinated. This was one of the worst possible times to visit India. When we arrived at the airport, buildings in Delhi were on fire, and the city was embroiled with street riots. The nearby hotel was filled and could not honor our reservation. People were milling around the airport seemingly without direction. My husband negotiated with a young man to take us to a downtown hotel in his taxicab for double the usual price. Rather than one taxicab driver, we had the driver and two of his same-age friends in the front seat of the taxi. On the way to the hotel, our driver came upon a group of about 100 young men on the road who were carrying whip-like sticks. They appeared to have just set fire to a bus. The bus was burning in the ditch on the right-hand side of the road, and most of the rioters were watch¬ing. They stopped our taxi. The three young men in the front seat of the taxi chattered loudly with the rioters in Hindi. I don’ know what was said, but they let us go through unharmed. My husband decid¬ed that this was not a time to take pictures, although he held his camera on his lap. He must have been excited because when the film was developed, one picture was of the lapel of his suit with the ceiling of the taxi in the background!

The next day under heavy security provided by the Indian army, we traveled to Jammu-Tawi by plane. Even though not all speakers were in attendance, the conference proceeded as scheduled. Since the Director of the Institute advised against travel in the local village because he could not guarantee my safety, I attended all sessions of the conference. The talks were essentially unintelligible to me. The atmosphere of the conference was tense. The townspeople came to the gate of the Institute complaining that they had heard that we were eating rich food inappropriate of the time of mourning for their late Prime Minister. The gate attendant assured the crowd that we were not, and the crowd dispersed. As a precaution, the Director had the government-owned motor vehicles spread around the Institute’s grounds fearing that a crowd might burn them.

Two weeks later my husband gave the same talk before the staff at the Central Drug Research Institute in Locknow, India. By this time, the atmosphere throughout India had become more relaxed. In his lecture, my husband outlined conclusions of his cortisone research in animals and was recommending that patients with inflammatory diseases be allowed to self-administer cortisone. The idea was essentially simple: patients were to take cortisone on the bad days and not on the good ones. The average amount of cortisone used would be less than that which the body ordinarily makes, and no side effects would be expected. He argued that by using cortisone in this manner, the patient would get all the wonderful benefits of cortisone without its well-known side effects.

The audience’s interest in my husband’s lecture was much greater than it was in Jammu-Tawi. The discussion after his lecture was spirited and lasted about one hour. Dr. Nand was the catalyst of the discussion, and her concern was that the patients would get worse during the days off cortisone than they had before the program. This had become known as the steroid rebound effect. Her husband, the Director of the Central Drug Research Institute—Dr. Nittya Nand, sat in the front row, attentive and quiet.

After the lecture, Dr. Nittya Nand talked privately with my husband. That evening when we were alone sitting on the balcony of our hotel overlooking the Institute, my husband told me what Dr. Nittya Nand had described. Dr. Nand’s father had developed asthma at the age of 40. He refused medication. But by the age of 60, his father no longer had a choice. When prescribed cortisone for the asthma, his father cut the tablets and used them in a manner Dr. Nand didn’t understand.

Dr. Nand didn’t bother to ask my husband if the research results my husband described in his lecture applied to asthma as well as rheumatoid arthritis. Dr. Nand realized that my husband’s research applied to inflammation control, and prolonged inflammation was common to both asthma and rheumatoid arthritis. In the first, the inflammation was in the air passages and in the second in the joint. That needed no clarification.
“Now I understand what my father was doing,” Dr. Nand exclaimed. His father had been cutting the cortisone tablets into smaller, less-potent sizes. Then he used the minimum necessary to stop each attack of asthma which he devised by trial and error. He didn’t use cortisone when there was no breathing problems. His father had died at the age of 84.

As my husband and I talked that evening, I first realized that I had overlooked something that was most important to me. The rheuma¬toid arthritis pain was about gone, and the swelling in my hands was down. In all the excitement of the trip, I hadn’t been watching. I was most impressed with the performance of prednisone. It was the only drug which had ever worked effectively for me.

After I heard the Nittya Nand story, I made the decision to use pred¬nisone as my husband was recommending in his talks. My husband never pressured me to use the plan. I stopped using prednisone daily and didn’t take it again until the pains returned. Then I took small amounts of prednisone over several days until the pain was gone. After awhile I got pretty good at it. When we got back to our home in Grand Forks, North Dakota, I enthusiastically reported the results to my attending physician. He was upset.

My physician warned me about the dangers of abruptly stopping prednisone. He was skeptical; however, since I had not suffered serious problems thus far by abruptly discontinuing prednisone, he allowed me to continue to self-administer prednisone. He requested that I telephone him whenever I thought a flare was starting and before I began taking prednisone. If the flare happened on a week¬end, I was to start taking prednisone and telephone him first thing on Monday morning. I willingly agreed because I wanted to earn his trust and perhaps he could learn and use this procedure on some of his other patients. Then my husband’s work would begin moving into clinical application.

However, my physician never became comfortable with this method of handling prednisone. As my husband began working with the Division Chief of Rheumatology at the University of North Dakota School of Medicine, I transferred my records and medical supervi¬sion to his care. The Division Chief was most supportive and encouraging.

That was over 10 years ago, and I have been virtually pain-free ever since. I didn’t think it was possible to ever be pain-free again. I have been able to keep active, and I just can’t express enough happiness and joy over the change this has brought to my life and to my family. I am so thankful that my husband didn’t give up on his research, though there were many times when he was discouraged.

Clinic development

In keeping with traditional medical experimentation, the animal experiments and the double-blind, crossover clinical trial results of my husband’s research were published in the medical journals. I assumed that all physicians would want to add this program to their practices. The Division Chief of Rheumatology presented the results at the 1990 International Rheumatology Conference in London and the 1992 American College of Rheumatology meeting in Boston. My husband presented the results at the 1991 and 1993 International World Interscience Conferences on Inflammation in Geneva, Switzerland. There was some interest but not at the level that caused rheumatologists to adopt the procedure.

In 1991 while on vacation in Minnesota, our son telephoned with the news that a Connecticut physician had called and was interested in talking with my husband about his arthritis research. The inquirer was John B. Irwin, M.D., a retired obstetrician/gynecologist who was doing overload work, locum tenens, at a local clinic in Grand Forks. He learned of my husband’s research and was interested. Dr. Irwin had arthritis himself and had devised a solution using another steroid, spironolactone, that had controlled arthritis quite nicely and safely for him. Spironolactone was already established as a pre¬scription drug and was commonly being used as a diuretic. He was interested in joining in the research effort to get his discovery evalu¬ated by clinical trial. Dr. Irwin and his wife joined my husband and I for dinner, and plans were made to establish a one-year demonstra¬tion clinic at the University of North Dakota. In this clinic, Dr. Irwin could get his discovery evaluated while generating more data and physician interest in my husband’s research. My husband was to aid in designing and implementing the clinical trial on spironolactone and Dr. Irwin do the doctoring for my husband’s discovery. The results of the Fiechtner clinical trial were nicely duplicated. Routine anti-inflammatory medication for arthritis were removing about one fifth of the pain and my husband’s procedure two thirds. In addition, spironolactone was proving to be valuable particularly for difficult cases of arthritis.

However, the ill reputation of cortisone for causing side effects when used long-term caused physicians to be skeptical that cortisone could be used safely without causing these side effects. That corti¬sone was effective for controlling arthritis was well accepted and needed no further proof. After the one-year demonstration clinic was completed, we made a most difficult decision to establish treatment centers in selected geographical areas where there was physician interest. My husband took early retirement from the University of North Dakota in order to devote full time to the effort.

Since I wanted to work with him, I soon began to give invited lec¬tures to different organizations and to help train staff and physicians from the patient’s point of view. I was thrilled to know that others who were hurting were finally getting this help. I thank God that I am able to work 8 to 10 hour days and still go home feeling great. For so many years, I was unable to do this. My family had to put up with many things undone because of my pain and immobility. Having put up with it for so many years, I couldn’t imagine a body without pain.

Now between miniflares, I am pain-free. I catch each reoccurring inflammation flare early and quench it with prednisone so it never gets a chance to build. Earlier, I would wait two to three weeks before the pain would force me to go to the physician. By then I had intense pain and reduced mobility. These are the flares to which physicians have become accustomed. Because of this, I refer to my flares as miniflares—just enough new pain to know that an arthritis attack is starting—not the big flare that the physician observes in patients.

In the last 10 years, neither I nor my physician have observed any of the well-known side effects of prednisone. Every two years, I have a bone density measurement done to check if the bones are abnormally weakening. Each time, the results come back that my bone density is normal for my age group.

I feel more comfortable with cortisone since I learned that it is pro¬duced by my body. My husband explained that prednisone is a syn¬thetic form of the body’s natural cortisone. In terms of prednisone, my body naturally produces about 5 mg each day. Since I have averaged 2.3 mg prednisone/day for the past 10 years, the use is less than half the amount produced daily by my body.

Developing the patient diary

One of the things which frustrated my husband about arthritis clini¬cal trial research was the lack of good daily measurement of dis¬ease activity. He felt that this was essential to learn the efficacy of medication for arthritis control. He didn’t doubt that the rheumatolo¬gist could measure the disease symptoms relatively accurately, but the rheumatologist was unavailable for daily measurement. Consequently, he began devising various measurement procedures for patients to use in their own homes that would be acceptable to the medical profession. He settled on the pain-by-number daily diary in which the patients are to rate the pain in each of their joints on a defined number scale, and then enter these numbers on a prepared form.

The daily diary form that my husband designed had entries for the different joints commonly affected by rheumatoid arthritis. His form was an expanded version of one developed earlier by another research group.

At the time I began treating my arthritis pain, the daily diary was not available. I really like the diary. It forces a person to review the pain over the whole body—not just in the one area or joint that has the most problems. The diary also helps identify a flare in its earlier stages.

Now through the use of computers the diary information is processed into progress- and medication-use graphs. People with arthritis use the graphs to study how they have been using corti¬sone to treat flares and how they might use the cortisone more effectively. Physicians learn how the patient has progressed between visits.

I have been under the care of many physicians, four different rheumatologists—including one at Mayo Clinic—since the time of my first diagnosis of rheumatoid arthritis. Many of these physicians told me that I must just tolerate the pain. Now my message is peo¬ple with inflammatory pain don’t have to put up with it. Pain is the body’s signal that it has a problem. When solved, the pain leaves. I encourage those of you who suffer from arthritis pain due to inflam¬mation to get training on how to use cortisone and to seek the care of a physician who understands and is comfortable with the pro¬gram. Be in charge of your disease, don’t let it control you.

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