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Wit and Wisdomby Beth Broderick“There’s a new injection that is proving very effective. We are seeing great results. It does have one black-box side effect, though. (A black-box side effect is one that is potentially, but not often, fatal.) Do you have a history of depression?” she asked.I was in my Rheumatology office with Ashley, the Physician Assistant to the Big Cheese doctors in the practice. She is whip-smart and stays on top of my case, insisting on doing blood work every three months and giving me a thorough once-over. I prefer to work directly with her as she is more familiar with my health than the docs are and she’s just as knowledgeable.“Well, I struggled with it in my 20’s and 30’s but have not had a bout of it in a long, long time,”I answered.“Okay, because with this drug, there is some history of suicide involved with its use. Depression and suicide.”Suicide. Huh. I wrinkled my nose. That’s a pretty bleak black box. Depression is one thing (60% of the country risks falling into a funk every time we turn on the news), but suicide sounds a bit off-putting.“We got anything else?” I asked.“Yes, there is another one, a pill. How is your cholesterol?”“Okay, I think. My GP says my ‘good cholesterol’ is off the charts, so I’m assuming I’m fine.”“We don’t believe in ‘good cholesterol’ anymore,” she said, scrolling through my labs. “Oh boy. Yours is high. We don’t like that.”“It’s high?”“Very high.” She pointed to the number on the screen, but my poor eyesight could not grasp the image from so great a distance.“Okay, okay, but it’s just because of the ‘good’. It’s the good that’s high, right?” I protested.“The ‘good’ is bad.”“The good is bad now? Well, shoot!”Shoot and Gol Dang it! I was so happy about my “good.” I was planning on living forever and such, and now they tell me that it is actually bad. That doesn’t seem fair. It’s like when they told us to quit coffee and we Californians (who are wont to comply with those sorts of suggestions), clutched our respective pounding heads, only to be told two years later that it’s actually good for us. Now there are studies that confirm that coffee is the ONLY thing that actually aids with memory loss. Forget about that stuff made from jellyfish and all the other crap they are trying to sell you. Just enjoy a cuppa and get on with it.“The pill is raising those levels for some people. Its use is associated with a higher risk of heart attack and stroke.”I have first-degree AV Heart Block, Mitral-Valve Prolapse and a hole in my heart (ASD), none of which are terribly worrisome, except the latter makes folks more vulnerable to stroke.“Heart attack and stroke. Huh.” I pulled on my ear.This is why I had hoped to stay on the current medication, which is not very effective, but has exhibited no side effects over the last year. I was hoping to stick with the devil I know, but it has proven impossible.It stopped working. The N17 blocker I have been on for a year just up and quit. They all stop working … even the best biologic medicines, after two to three years. Just one year felt like too short a time to be changing meds, so we had decided to muddle through a while longer. It was worth a try, but this disease made a mockery of our optimism. It broke through with a vengeance.Pain. It’s mostly pain, which hits my joints, hands, feet, knees, back and jaw. It is sharp and brutal but short-lived. To turn a doorknob can be agony, but not for long. Thankfully it comes and goes. Then there is the burning sensation in my feet, which flows down in wave after wave. That is just plain weird, but it doesn’t hurt and is mildly entertaining, so it’s my favorite symptom. The skin issue is mostly confined to my heels and soles where the psoriasis creates lesions and hard scabs … I call them carbuncles. This makes it hard to walk without copious bandaging. I order boxloads of Band-Aids, the healing, rubbery, disc-shaped kind. My feet look like they have been through a war, which in some respects they have. But as my pal Kat once said when I was worrying about how unsightly they are: “They are just feet!” Overall I felt flu-Ish and achy and fatigued. We would have to deal with it, because things promised to get worse, and when things get worse with psoriatic arthritis it’s no fun; no fun at all.I am not complaining. Compared to a lot of folks, I’ve got it good, and I know it. Everyone I know in my age group is dealing with some kind of malady. This is mine. It’s a b***h, and it would have been a catastrophic diagnosis 25 years ago, but now there’s good medication and, when that fails, a shot.When I lived in Austin, no one told me there was a shot. I went through many a flare with my doctors nodding empathically and prescribing pain pills which I will not take. I fill the order in case one of my pals has a dental emergency or some such, but I don’t take any because if I took medication for the pain, I could end up taking it every day and we all know that’s no bueno.BURNED BEFORE. I had only been seeing my L.A. docs for a short time when I had a serious flare.“I was in a car accident and ever since, everything is on fire and I feel like I have the flu, but I don’t,” I explained. “I guess the blunt trauma triggered it. I know there is nothing we can do; just thought you should know.”I was at my three-month check-in at my new doctor’s office in Los Angeles. His practice is renowned in the Rheumatology field. My physician at the time (he has since retired) was a pre-eminent specialist. He was also a likable fellow.“I have a shot for that,” my new doctor said confidently.“You do?” I asked, mouth agape.“Yes. I’ll have the nurse prepare it. You’ll feel better in a few hours.”He was right. It worked quickly and I felt myself again. I was grateful, but also had half a mind to call up my docs in Texas and tell them such a thing exists. Why had they not known? That sort of thing baffles me. American medicine is oft times a crapshoot.When I was back in Ashley’s office last week, she stepped out to get the syringe and vial we would need, and I contemplated my options. The black-box side effects of the two new meds did not sound appealing, but I would need to pick my poison. When Ashley returned, I stood up and pulled my pants down slightly so she could give me the blessed shot.“I think I’m going to go with suicide. It has got a nice ring to it,” I said.She might have smiled, but I don’t know because she was wearing a mask.“Okay, we’ll start you with one dose per month, but it’s approved for two if we think you need more. Let’s do some more labs and I’ll get you some samples.”“God, please let the one shot work. Two shots a month is a lot of suicide-y shots,” I thought as I wandered down to Room Five to squeeze the ball while the nurse tied on the tourniquet. She couldn’t find a good vein, so she had to go through my hand, which left a nasty bruise, but we got the blood drawn and according to Ashley everything except my formerly good, but now bad cholesterol is stable.The shot worked wonders, and I will start the new medication in July, so things are looking up. Now I suppose I will have to get after the whole high cholesterol thing. Or maybe I will just pour a big ole cup of java, slather some mayo on my B.LT. and wait a couple of years. Might not be long before “bad” is “good” again. Or is it “good” is “good” again? Tossup really; hard to say.Let’s go with the latter. More my style. I am pulling for good, no matter the evidence of bad all-around.I’m pulling for good every damned day.On we go …We extend our heartfelt gratitude to our valued subscribers whose support makes the publication of Wit and Wisdom possible. Thank you! This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit bethbroderick.substack.com/subscribe