A lot has happened in a year!

I stopped posting to this blog. For two reasons. The first is I GOT PREGNANT! And the second is that my dad died 8 weeks into my pregnancy and my quest to cure my arthritis just didn't seem important anymore.

My Dad dying was a huge shock and something I'll never completely recover from. He was a wonderful man whose unwavering self-confidence instilled the same in me. I miss him more than I can say. Sadly he died quite unexpectedly of a subarachnoid haemmorhage - a brain haemmorhage. Over a year later, I still can't believe he's gone. He had more energy than anyone I've ever known and it seems impossible that he doesn't exist any more. But there it is.

My pregnancy was also a huge surprise, given that I was figuring myself to be infertile. I was so pleased that Dad knew of my pregnancy, his first grandchild. And I was and still am gutted that he will never meet James, the most beautiful boy in the world. He would have been an incredible grandad.

My pregnancy was a tough one, but seemed all the more precious because of dad's untimely death. James's entrance into the world is burned into my memory as a moment of unutterable joy! I am a lucky lady indeed.

He has proven himself to be an incredibly easy-going baby, who sleeps through the night and only cries when something is wrong. I feel that I have got off very lightly. My extensive reading of baby books helped a lot, however, as some of the advice is excellent and not to be missed. I especially made use of advice from 'The Happiest Baby on the Block', 'The New Contented Baby Book' and 'The Baby Whisperer'. They were all wonderful and kept the first 3 months as stress free as it is possible to be.

Now James is 10 months old and crawling and a little charmer. I am starting to think about trying for another baby, but in truth the thought terrifies me. Mind you, the thought of having one child terrified me before James came along, and here I am, coping!

I am now taking Humira, which is working wonderfully, and am steadily losing the pregnancy weight doing a diet called the Shangri-la diet - which I will write about another time. I have resumed my quest to CURE my arthritis ;-) , and am enjoying a little success in this area. Right now, I'd be happy with just 'making it less bad'.

I dread coming off the Humira to try and get pregnant, but hope that all my knowledge of ovulation and fertility herbs will help once again. It is useful to have this diary to refer back to.

One final thought before I go up to bed for the night... I also joined a study in London which is looking at the link between pregnancy and rheumatoid arthritis remission (I did indeed enjoy an almost total remission during pregnancy). I just managed to give them a blood sample before getting pregnant, whilst being pregnant, and six months after giving birth. I was the first on the study to do so. I am hopeful they'll discover something useful for future treatments. In the meantime, I'm back on the job myself!

The big explanation - why, what, who and how...

By now it's February 2005 and I know I have long cycles, LUFS (unruptured follicles) and low progesterone, so I decide to do some more research to see if I can sort any of this out myself.

I also know that rheumatoid arthritis tends to occur in teenagers, new mothers and menopausal women, and I've started to come across something called estrogen dominance over and over again, and the two seem connected somehow, so I get excited about finding out what the connection is.

First of all I research why rheumatoid arthritis goes into remission during pregnancy and find out that it is most likely because of huge increases in the amount of the sex hormone progesterone produced during pregnancy (up to 40 times the normal amount). I find out that progesterone not only preserves the endometrial lining, thereby sustaining pregnancy, but it also regulates the immune system, preventing one's own body from rejecting the foetus. (Many researchers erroniously think that raised estrogen is what regulates the immune system in pregnancy. They fail to find a link again and again, and I wonder why they keep focusing on the wrong hormone? I have yet to discover why this is?)

Progesterone, I find out, has many beneficial effects within the body, such as:

• Maintains the secretory endometrium
• Protects against fibrocystic breasts
• Helps use fat for energy
• It is a natural diuretic
• Natural anti-depressant / mood enhancer
• Facilitates thyroid hormone action
• Normalises blood clotting
• Restores sex drive
• Normalises blood sugar levels
• Normalises zinc and copper levels
• Restores proper cell oxygen levels
• Prevents endometrial (uterine) cancer
• Helps prevent breast cancer
• Simulates osteoblast for bone building
• Restores normal vascular tone
• Necessary for the survival of the embryo
• Precursor of corticosteroids and other hormones
• Modulates other hormones helping to restore balance
• Promotes sleep
• May help improve libido
• Contributes to reducing anxiety and panic attacks
• Reduces estrogen dominance symptoms

To give some context, I should explain that women have two phases to their menstrual cycle, the follicular phase and the luteal phase. In the follicular phase, estrogen is dominant and builds the endometrial lining of the womb in preparation for ovulation. The second part of the phase is the luteal phase and the dominant hormone in this phase is progesterone.

In the first half of the menstrual cycle, levels of estrogen rise and make the lining of the uterus grow and thicken. In response to follicle-stimulating hormone (FSH), an egg (ovum) in one of the ovaries starts to mature. At about day 14 of a typical 28-day cycle, in response to a surge of luteinizing hormone (LH), the egg leaves the ovary. This is called ovulation.

In the second half of the menstrual cycle, the egg begins to travel through the fallopian tube to the uterus. Progesterone levels rise and help prepare the uterine lining for pregnancy. If the egg becomes fertilized by a sperm cell and attaches itself to the uterine wall, the woman becomes pregnant. If the egg is not fertilized, it either dissolves or is absorbed into the body. If pregnancy does not occur, estrogen and progesterone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

The trouble is, menstrual cycles aren't always 28 days long. In fact, mine are somewhere around 60 or more days long. When cycles are longer than 28 days, it is the follicular, or estrogen part of the cycle that is extended in length. The luteal, or progesterone part of the cycle, is always about 10-16 days long, not longer or shorter. What this means for me is that when I have a 60 day cycle, my follicular phase is 46 days long and my luteal phase is 14 days long. This means that I am exposed to estrogen for 46 days instead of 14. This leads to a condition called estrogen dominance. It is not that I am producing too much estrogen per se, but that I am producing it for too many days in a row, without having it balanced out by progesterone.

To see the effects of the two hormones side by side, see the table below:

Physiological effects of Estrogen versus Progesterone

Estrogen effects Creates proliferative endometrium Causes breast stimulation Increases body fat Salt and fluid retention Depression and headaches Interferes with thyroid hormone Increases blood clotting Decreases sex drive Impairs blood sugar control Loss of zinc and retention of copper Reduces oxygen levels in all cells Increases risk of endometrial cancer Increases risk of breast cancer Slightly restrains osteoclast function Reduces vascular tone Increases risk of gall bladder Increases risk of autoimmune disorders

Progesterone Maintains secretory endometriun Protects against fibrocystic breast Helps use fat for energy Natural diuretic Natural antidepressant Facilitates thyroid hormone action Normalizes blood clotting Restores sex drive Normalizes blood sugar levels Normalizes zinc and copper levels Restores proper cell oxygen levels Prevents endometrial cancer Helps prevent breast cancer Stimulates osteoblast bone building Restores normal vascular tone Necessary for survival of embryo Precursor of corticosteroids

As you can see, being exposed to estrogen uninterrupted for months at a time can be very detrimental to a woman's health. Indeed, when I was a teenager, and before going on the birth control pill, I wouldn't have a period for four to six months at a time. I didn't think anything of it back then, assuming it was stress of exams or that my periods would settle down eventually, but I now think that this could have been instrumental in either the development or exacerbation of my rheumatoid arthritis.

I start acupuncture and change ...well, everything!

So now it's November time and I've read Toni Weschler's Taking Charge of Your Fertility and I've been temping (taking my temperature every morning to try and pinpoint when I ovulate) for several months. I've finally ovulated at about day 50 in my cycle and I have the most annoying cramps from then on until I get my period. And my period makes me feel like crap too. And I have terrible back-ache, and to top it off I have sciatica for about 7 days before my period as well.

Not knowing much, I assume I am pregnant and tell everyone as much! Oh dear, I am not pregnant and my period comes as usual 14 days after I ovulate and it's painful and miserable and scant, and I am very confused. So I turn back to my beloved internet and go onto www.fertilityfriend.com and start searching posts to see if anyone else has any of my symptoms.
I come across the most wonderful group of people on a discussion forum called 'Acupuncture Anyone?' and I read and I read, and I am convinced from what they're all saying about the benefits of acupuncture (or acu as we call it) to find an acunpuncturist and try it. By now I am in a lot of discomfort all cycle long and I have an uneasy feeling that things aren't right down below. I've seen a doctor at my local GP's surgery who was no help at all and knew less than nothing, so I figure what have I got to lose?

I am pleased to find that there's an acupuncturist in my own town and give her a ring. She tells me that she is no fertility specialist, but that she can probably help with my arthritis. The truth is, I'm so sure at this point in my life that my arthritis is too big and bad for anything other than serious medications I dismiss her comments about the arthritis entirely and just go along to see if she can help with my cycles.

Well, the first thing I noticed, after just one session, is how much more energy I've got. And how relaxed I am. And how happy I feel. Bloody hell!

I hadn't realised it at the time, but my arthritis had been steadily worsening, I was obsessed with trying to conceive and the continuous pain of my menstrual cycle had been getting me down. On top of that, not knowing what was going on in my own body was getting to me too. To my utter surprise, suddenly that all fell away. It wasn't as though anything in my life had changed, but that my attitude to it had changed. It was as though I was a tightly coiled spring that had unfurled in half an hour flat. After my acupuncturist had put the pins in, I almost burst into tears after about 10 minutes. The tears burned in my eyes but I fought it back. (Fortunately, being uptight and British saved me from this worst of all fates - crying in public ;-) ) This was no needle phobia, this was some kind of much needed release.

From this moment on, I am a convert. Not only has the Atkins diet worked for me, now acupuncture of all things is working too!! I am shocked to find that I do not know everything after all, and kind of relieved too. It's good to find out that I can have some control over my own health that doesn't involve jogging or otherwise making my arthritis worse with exercise.

I join the 'Acupuncture Anyone?' group and am welcomed in by the most wonderful group of women who have all been trying to conceive for longer than me and through it all have retained a sense of humour. This support group alone has made half the difference. Being able to voice my highs and lows to people who not only understand my feelings, but who also understand the jargon of trying to get pregnant is probably more important than any other change I've made.

About a month into the acupuncture I ovulate again and my own (excellent) GP suggests I have a progesterone test at 7 days past ovulation. My results come back very low (about 7.5) and do not clearly indicate ovulation. At best it is a very poor ovulation. I go back to the internet and try to work out why this might be. Meanwhile, I've read Randine Lewis's The Infertility Cure and after a bit of self-diagnosis, decide to try and find a Vitex and Red Rasberry formula to try and improve my cycles.

I ordered a wonderful 'dirt tea' from Canada called Green Goddess Tea (containing a mixture of Red raspberry leaf, Nettle herb, Chamomille flower, Lemon balm herb, Black haw bark, Vitex (agnus castus), Motherwort herb, Black cohosh root, Ginger root and Yarrow flowers) and drink 3 cups of it a day. Suddenly my luteal (post ovulation) phase is pain free and I have a totally pain free period and more red blood than I've had in years. Whether this should be attributed to the acupuncture or the herb tea or both, I'm not sure, but I did notice a definite improvement as soon as I started the tea.

At the same time as this I've ordered some Red Rasberry Leaf and Vitex supplements (along with evening primrose oil and flax seed oil) from another wonderful web site called www.tryingtoconceive.com. I had assumed (wrongly) that I wouldn't like the taste of the tea and that taking capsules would be easier, which I suppose it is. This is all starting to cost rather a lot by the way, especially as all this is imported and I keep having to pay import tax (bloody Customs & Excise). When I receive the parcel I am so excited I decide to follow Momma Kath's regimen of pills and just drink an occasional cup of Green Goddess tea when I feel like it. (I've never been overly worried about overdosing, which is probably stupid, but that's me.)

So now I have a very calm uterus, which I'm very pleased about, and a very calm mind, which I'm even more pleased about. Now, when I get my period I am happy as I now know that it will take 3 months to produce a good egg and, because I'm so relaxed, I'm more than happy to wait. I'm enjoying just watching my health improve.

I start researching on the internet about low progesterone and come across some information about LUFS (Luteneised Unruptured Follicle Syndrome) and how it is caused by taking anti-inflammatories, which of course, I am taking. Basically, what happens is the anti-inflammatories supress prostaglandins and whilst this suppressing action helps reduce PMS cramps, these prostaglandins are also needed to help the follicle burst and release an egg at time of ovulation. It would appear that my follicles are not rupturing and may be turning into cysts instead - hence all the cycle long cramping.

I also do some research and find out that I have endometrial sciatica as I get sciatica down the back of my thigh only in the days before my period (thank goodness for charting - the only reason I notice this pattern). So now I have LUFS, cysts and endometriosis - a damning diagnosis, but which somehow doesn't really bother me.

I also find out that my anti-inflammatories can cause fetal abnormalities and go and tell my doctor all this. He is surprisingly receptive and agrees that I need to get off them. I tell him that I am due to see my rheumatologist in late March and will ask him to put me on Humira instead, so that I can get off the anti-inflammatories, so we leave it at that. He also agrees it is likely that I have endometriosis but says that he can't give me any treatment whilst I'm trying to conceive, so we make no real progress there either. Despite this, I feel 'heard' and am in good spirits. Plus, I feel that the acupuncture and herbs are doing a good job of keeping my endometriosis in check, so I've got no real complaints. (I just can't seem to feel down since acupuncture - hurrah!!)

My first blog post... My quest to become pregnant and cure my arthritis all in one fell swoop ;-)

Ok, so the title is a little ambitious...

Maybe I should have stopped at 'My first blog post'.

But I am feeling optimistic and ambitious today!

Just as a quick summary before I begin the long explanation process, the important findings so far, are as follows:

1. Having regular periods is really important to both fertility and rheumatoid arthritis
2. Being low in progesterone is bad for many reasons
3. Zinc is especially important as a supplement when you have rheumatoid arthritis
4. Acupuncture works, in a way that makes sense in Western medicine's own terms
5. Vitex Agnus Castus and Red Raspberry Leaf supplements do help with regulating hormones and calming endometriosis and PMS
6. Supplementing your diet with omega oils (and folic acid when trying to conceive) is important
7. Being happy (having lots of beta-endorphins) helps suppress disease, whether it be RA, cancer or anything else

OK, I guess I have to start at the beginning. I'm 31 years old, and recently married. I've had rheumatoid arthritis since I was 15 years old and I've had it pretty badly too. I've taken fair cocktail of drugs in my time and still do, even now, whilst trying to get pregnant.

The reason I'm writing this in a blog is because I've found out so much stuff lately, by researching on the web, that I don't want to forget it, lose track of it, or otherwise muddle it all up in my head.

OK, so you should look away now if you're squeamish because I am going to be talking about menstrual cycles and periods - well, a lot really!

Up until my 31st birthday, I'd pretty much left the treatment of my RA in my doctor's hands. I never believed I could influence the disease much and I'm a great believer in Western medicine and science generally.

Strangely, I also didn't believe that diet played much of a part in treatment of one's illnesses. I considered my disease to be so deep and severe that no amount of avoiding tomatoes, or other such crapola could help me at all. Well, I still don't believe the problem lies with tomatoes, but I am *much* more careful about what I eat now.

It was six months to the day before our wedding that Rich and I decided we really needed to lose some weight and that we probably only just had enough time left before the wedding in which to do it. So, after seeing the success my brother and sister-in-law had had with the Atkins diet we embarked upon it with zeal. And you know what, it worked! Not only did we lose weight (30 pounds each), we also felt much healthier, woke up earlier, had less afternoon fatigue, less hayfever, my migraine's disappeared completely and haven't returned since and my blood pressure went down and so on.

Have I stayed on the diet? Well, no. Not really for any other reason that I am too lazy to stick to such a rigid regime. I have kept some of the changes as permanent parts of our diet though. I now cook all food from scratch. I also eat as much organic food as we can. (Apart from the supposed health benefits, it does actually taste better too.) I avoid white bread, white rice, white pasta and concentrated fruit juices and I also try and avoid sugar whenever I can. I do not stick 100% rigidly to any of these rules, apart from cooking from scratch.

With these small changes, I can see and feel that our health is much improved.

OK, so I lost a load of weight just in time for the wedding and felt much better, but my arthritis still wasn't good. I decided in August 2004 to start trying for a baby and although I didn't think it would be easy, I didn't think it would be this hard either.

I stopped the Remicade (my wonder drug) and the methotrexate (a cytotoxic drug, that is toxic to foetsus) well in advance of trying to become pregnant and switched to 7.5mgs of prednisolone (an oral steroid) and 20mgs daily of valdecoxib (an anti-inflammatory or NSAID).

My arthritis worsened, which, with my history was what I expected, and after two perfect 28 day cycles after stopping my birth control pill, my cycles went wacky and went from 37 days, up to 60 days or more. I knew this wouldn't be helping my chances of getting pregnant, so within a month or so of trying to conceive, I decided to take action and see what I could do to increase the odds in my favour.

As a web designer, I spend all day in front of the internet, so I went to my beloved Google and started to research.

The first place I came to was a wondeful web site called www.fertilityfriend.com. I signed up and did a lot of reading about the Fertility Awareness Method and bought a wonderful book by Toni Weschler called Taking Charge of Your Fertility.