More updates

I went back for a third and final visit for the kidney infection on Wednesday. The results from the labs:

• Urine culture:  Confirmed bacterial infection that is sensitive to Cipro. That means that the kidney infection is no longer suspected but confirmed. That also means that a 10 day course of Cipro should have resolved it. They are repeating the urinalysis one last time to make sure the entire infection has been treated. If not, I suppose I'll need another course of antibiotics. 

• Blood work:  Kidney and liver function tests were normal! That rules out something huge and life threatening and is a major relief! The labs also measured my TSH (Thyroid Stimulating Hormone) and found that I have an overactive thyroid.  I've had this test done several times and it has never come back anything but normal. The doctor ordered more blood work to investigate the thyroid thing in more detail. So, stay tuned.
  

So, those are the test results. Now, onto how I'm feeling. I'm still incredibly worn out and still taking steroids and still feel kidney/flank pain and am still retaining lots of fluid. The blood work ruled out a lot of possibilities but has left me without an answer about why I'm retaining so much fluid and have occasional flank pain. I'm going to have to investigate it further on my own and maybe in 6 weeks or 2 months a doctor will be able to look back, long after I've figured out roughly what was going on, and finally provide me with a diagnosis. That's the way it usually works. I mean, the kidney infection was pretty straight forward and handled very well by the doctors at urgent care. But, I'm still the one that figured it out and diagnosed myself long before they got my file. But, most diagnoses take forever and are incredibly frustrating. My guess is this fluid retention/kidney situation will follow suit. 

On a positive note, I came down on my dose of steroids a bit without problems! I have needed 4 tabs a day for about a week or so now and that's a very high dose. A few days ago, I tried 3 tabs and woke up extremely inflammed the next day. So, disappointed, I went back up to 4 for another few days. But, for the last 2 days, I've gotten by on only 3 tabs without that crazy inflammation rushing back! Any reduction in the dose is a good thing. Now that it's been a couple of days of stability on 3 tabs a day, I'm going to see how it goes on 2 and report back. 

On a not-so-positive note, my heart rate and blood pressure are out of control now. As of November 10th, my average blood pressure reading is 130/80. The highest I've seen it go is 135/85. I've always gotten low readings. For years, the readings were low enough to cause lightheadedness but not low enough to be dangerous. But, about 6 weeks ago, I started getting the lowest readings ever, like 90/56. I've been on beta-blockers for years, which lower your blood pressure, but my dose has never changed and my readings have always been about 110/70 with beta-blockers. Then all of the sudden, they started getting lower and lower until I finally got that 90/56 reading. My cardiologist said if the systolic pressure (the top number) gets any lower that I would need to call him. So, fast forward to present day and my readings are now high by anyone's standards. What's going on? Worse than that, my heart rate has been out of control, even on beta-blockers. Lately, I've started every day with a heart rate of 125-135. That's way too high. Anything over 100 is tachycardia. Even 110 would be acceptable, but not 135. It's been like this everyday. So, I take my beta-blocker earlier in the day and it comes down either to normal or to near-tachycardia for a few hours. It's not good. I need to call my doctor, check in, and see what's going on.

At first, I thought the increased heart rate and blood pressure were a response to the overwhelming inflammation, my body's fight or flight response. But even after a week or so of the inflammation being controlled fairly well, they're still too high. My best guess now is that the steroids are causing it. The fluid retention alone can increase your blood pressure and the steroids could be responsible for at least some of the fluid retention now. I'm assuming that the lower the dose of steroids, 2 tabs a day vs. 4, the better my readings will be. We'll see. I'll see what my doctor has to say about it. In the meantime, the only things I can do to try to control my heart rate are drink more water, avoid caffeine (of course!) and do breathing and relaxation exercises. Since I don't yet know if my beta-blocker should be adjusted temporarily, there's not much more I can do to keep my heart rate low. Oh, it's all so confusing. One problem causes another. Medication treats one problem only to cause another. It's all so messy. 

I've been taking 4 methylprednisolone tabs a day for 4 or 5 days now. This seems to be the dose at which the skin pain stays nearly gone. So after several days of very little inflammation, which has helped my heart rate calm down a bit, I thought I should try taking only 3 tabs yesterday. The result...I woke up to skin pain this morning. It's all over my back, neck and chest. It's not quite severe; I would say it's only moderate. But, that estimation is coming from a person on 60mg of morphine a day.

So I guess it's back to 4 tabs a day again. But 4 tabs is a very high dose. Why is it taking such a high dose to keep the inflammation down. This is so frustrating. To look at me, aside from the bags under my eyes that I conceal before anyone sees me and the fact that I mostly just sleep these days, you wouldn't know I was in so much pain. When I say inflammation, you would naturally assume redness and irritation. But there's no outward sign of it. No rash. Nothing. Just invisible, abject pain. 

After several days on 4 tabs, I had a steroid moment last night. After spending a lovely, relaxed afternoon with my friend and her 3 month old baby, suddenly my cheeks were flushed, I was starving, and my mood shifted drastically to sad and angry. I couldn't stop eating. I had an enormous appetite. I ate meals and snacks all evening that were twice the size of my normal. Nothing filled me up; nothing satisfied me. I was also in quite a bit of pain. I'm still experiencing flank pain every so often, sometimes with my regular SI and hip joint pain. The flank pain isn't made better with ice like the joint pain. In fact, ice stings and makes it worse. That's very unusual for me. Ice has been my pain lifeline for a long time now and it's weird to me that it would fail to help. But last night was just straight forward SI joint pain. I tried ice and rest but it soon became intolerable anyway. I ended up taking  a pain pill which gave quite a bit of much needed relief. God, it was a bad night though. All of that was happening at once. I managed what I could with medicine and food and ice and rest and relaxation and on and on. But it all went on for hours and consumed my evening. I know that the steroids were responsible for the flushing, appetite, and mood swing. Those are classic side effects. I've had no appetite lately. It's been days of avoiding meals and snacks, not craving anything, and bad stomach aches when I do eat. I don't know what's causing that quite yet though. So to suddenly have this enormous appetite was strange. 

So I suppose I will try 4 tabs a day for now. This skin pain is unacceptable. The fluid retention remains a mystery for now. It's still happening, still everywhere, still seems to happen regardless of other factors like inflammation or fatigue or salt intake. I'll see my doctor this week and get the results from the kidney and liver function tests. I just want to know, just want to rule things out, figure things out, and move on. 

It's 8:30am on a Saturday and I'm up for no reason. I don't know why I bother with the part about it being Saturday, I suppose to clarify the injustice of being awake early on a weekend. But, it's always the weekend for me these days. It must be the principle of the thing.

So here I am. I sat up and downed this morning's handful of pills then got right back in bed. Normally I would be racing for the kitchen, in as much as I can "race" anywhere, for food and coffee. But not this morning. This morning, and last night for that matter, I don't really have much of an appetite. Maybe I'm still sick. I'm on steroids, I should have an enormous appetite. I did have an enormous appetite last time I took such a high dose. Maybe it is yet to come. Maybe I'm adjusting to that particular side effect. Or, again, maybe I'm sick. Hard to say.

The funny and sad part about all of this came after the realization that I'm still in bed and not in the kitchen getting breakfast. My first thought, at 8:30am on a Saturday when most people are making plans to go out to eat or do yard work or go downtown or what have you, was, "Nice, I'll be awake for a long time today, and that means extra meals and snacks, and that means many opportunities to take all the different medications I need to take with food, nice and far apart from each other." Yeah, I know, it's depressing. I got excited for a minute at the thought that I'll have lots of time to take all my medicine. The worst part came next. I looked at the clock and thought, "Well, appetite or no appetite, I better get started. Don't waste this opportunity!" Yeah, I know, that's even more depressing. I'm lying here, not feeling very well, pressuring myself to "get started" and not waste time when there are precious meals to eat and pills to take. What a sad state of affairs!

Pain-Yesterday and Today

Last night I was in a whole lot of pain. My lower back, right side only, was very inflammed. There was mild flank pain but severe inflammation of everything else in the area, including muscles and joints. It was pretty bad. All I did was rest yesterday. I tried ice packs first but they didn't help much. The pain was too deep and widespread for the ice pack to cover it. So I took a pain pill, always my last resort, expecting relief. It didn't end up helping at all. The pain was just uncontrollable. I paid close attention to it, though, because the location made me feel suspicious that it might be connected to the kidney situation. It's hard to sort out, though, because it could've just been a joint pain flare. I decided to just watch it closely and see if it improves. It's always troubling when pain medicine doesn't off enough relief because there's no where else to go from there. I usually try NSAIDs, muscle relaxants, ice and rest before I take an instant-release morphine. If none of that helps or the pain isn't controlled well-enough to function through whatever it is I need to do, then I feel a pain pill is justified. I don't take them very often. When even a pain pill isn't enough, there's nothing else I can do medically. I can't take more than one and I can't overdo any of the other meds either. I can use relaxation and guided imagery to cope with the pain but that's about it. Last night, nothing helped. Even on all of that medicine,  all I could do was lie there in pain and hope it would go away soon.

It did. It was much better when I woke up this morning! I haven't had to take any extra medicine for pain or use any other coping mechanisms today. Perhaps it would've been wise to take that pain pill earlier on yesterday, before the pain got so bad. That's the thing about pain management. It's typically easier to keep pain levels at a constant than it is to bring down a high level of pain. It's smarter to take the medicine before the pain becomes a crisis so that it isn't up against such a high level. My problem is that I wait for it to get bad because that's the only way I can justify taking it. I use it sparingly and I intend to keep it that way. But, again, sometimes it's better to use it as a preemptive measure to keep pain at a more constant level. I'm still not good at knowing when to do that. I'm trying though. Anyway, the pain was much better by this morning. It's been very mild all day. I'm still too tired to get out of bed. I haven't left the house in days except to get some blood drawn. I have plans to hang out with my best friend tomorrow. She's going to make sure I get out of the house for a while. She really looks out for me. When we hang out, she takes such good care of me. She makes hanging out, getting out of the house and enjoying good distractions a lot easier. What would I do without her?

Also, I've been taking 4 methylprednisolone tabs for 4 days in a row now and the skin pain is nearly gone. I've also been retaining less fluid and that's a good sign. I was 5 lbs lighter today! I hope it's not a fluke but rather the beginning of this stuff finally getting better. I'm going to use the steroids for now, even though they're not ideal, because they will keep the inflammation low and keep my body from having fight or flight responses. Once the inflammation is controlled for a few days, I'll back the dose off a little. 

Ok, that's it for now. I've already been up for too long and am getting pretty sleepy. The sedatives are kicking in and that means it's time for bed!

A Few Updates

Ok, I will admit up front that this is a rather sloppy way to discuss or conclude some of these topics. I just scanned through a few of my latest posts and noticed huge gaps in information. I see that I've moved on from a few treatments or efforts I've made without discussing their outcomes. Please forgive the bullet points for now. I am too sick and too exhausted to put much effort into writing right now.

• Skin pain/inflammation & the anti-inflammatory diet-I did, in fact, participate in the full 3 days of eating nothing but turkey, rice, and pears. I chose jasmine and brown rice because they are both whole grain and significantly more substantial than many other kinds of rice. All in all, I can't say it helped much. I didn't notice any significant relief. Perhaps it helped to prevent further inflammation but that is not really something I can know for sure. I am glad I tried it, however, because it gave me an active role in fighting the inflammation. That's important because sometimes feeling powerless against illness feels as bad as the illness itself. Also, it was a valid option and certainly worth a try.

• Skin pain, widespread inflammation, and fluid retention have continued to be a problem-By the end of the second round of steroids (Medrol dose pack) the inflammation had returned. I spoke to Dr. Reifsnyder and he ordered that I stay on a lower dose of steroids for a while. He prescribed a large quantity of Methylprednisolone, the same drug and dose found in the Medrol dose pack. Methylprednisolone is made from prednisone and is much more powerful. Since the end of the second pack, I have stayed on anywhere from 2 to 4 tabs a day, 6 being the largest number of tabs in one day of the pack. The idea is that I should stay on the minimum number of tabs a day it takes to control the inflammation. On bad days, I should take an extra tab. So far, it's been nearly 2 weeks of varying numbers of tabs a day and the inflammation is controlled but not consistently. Even after a couple of days on 4 tabs, I was so swollen and inflammed that I looked 5 months pregnant and my legs felt tight and full of fluid. However, it's hard to know what was responsible for what at that time because shortly after, I was diagnosed with a kidney infection. More on that later. For the last 2 days, I've taken 4 tabs a day and the skin pain has been controlled pretty well. 

• The reason and plan for steroids-Dr. Reifsnyder explained it this way. The skin pain is a result of my immune system over-reacting to the recurrence of the viral infection Epstein-Barr. My immune system is sounding all alarms and calling in for way more back up than it needs. As a result, it is fighting the infection inefficiently, with resources going toward unnecessary and unproductive processes like inflammation of the skin and fluid retention. Steroids suppress your immune system and are not ideal for someone fighting an infection. They also mask signs of infections by preventing your body from having a fever and increasing your white count making it hard for doctors to interpret labs. Anyway, in my case, suppressing my immune system a little right now is a good thing because it will bring my immune response down to a reasonable level. That combined with anti-viral therapy with Acyclovir will, over time, make it more of a "fair fight" for my immune system. Now, I have been putting all of this pressure on myself to be on as little medicine as possible to control my symptoms. And, while that is a legitimate goal, I've realized it shouldn't be the focus at the moment. I've been trying to get by on the lowest dose of steroids possible. As a result, the inflammation hasn't been controlled all that well and it's causing my body to go into "fight or flight" mode causing my resting heart rate to jump to 135-far too high-and my pupils to dilate at random. When my pupils dilate like that, I get a debilitating headache. After a few days of that, I realized that it's more important today or this week to control the inflammation than to focus on getting down to a low dose of steroids. For now, I just need to use the resources I have to control the situation and take unnecessary pressure off of myself for now. Even if I end of up taking the steroids for as much as a few months, that it still considered a short course.

• The kidney infection- Last weekend, the fluid retention throughout my body, especially in my abdomen, became a problem. Even though I had taken extra steroids, I was extremely swollen and inflammed and I didn't know why. Then something called "flank" pain started on Saturday night. The week before, this same pain woke me up in the middle of the night when it came on suddenly and severely. It was pain that I've never experienced before. It was in my lower back, above my SI joints but below my rib cage, right about at my waist and just on one side. It was unlike any musculoskeletal pain I've ever had. I had also had an odd sort of headache that had been going on for 3 days. It was unlike the usual headaches I get and I kept saying I felt like I was probably coming down with something. I also had been having trouble emptying my bladder completely yet had no other symptoms that typically accompany a UTI like burning or urgency. Then I connected the dots and realized that something might be up with my kidneys. I researched the pain I was experiencing and learned that it is called flank pain. The description fit perfectly with what I was experiencing. So, I called Dr. Reifsnyder-but not before having a panic attack-and left him a voicemail. He returned the call pretty quickly. I explained the situation and he advised that I go to urgent care as soon as possible and have them run a urinalysis. The next morning, my mother took me to urgent care. My white count was elevated and my symptoms were consistent with a kidney infection. However, steroids can elevate your white count and make it hard for a doctor to tell if there is actually an infection present. They drew blood for a CBC and a urinalysis. This facility has an on site lab and the results come back almost immediately. With the labs and clinical presentation, they had to treat me for a suspected kidney infection. Again, it was their best guess given that the labs could be misleading. One thing that was not misleading was the fact that I had a fever, an obvious sign of infection. But, you're not really supposed to be able to get a fever on steroids so I suppose that's confusing too. They gave me 2 grams of IV Rocephin in the office and also prescribed a 10 day course of steroids. Then they scheduled a follow-up for 3 days later to repeat the labs and make sure the treatment is working. That was such a rough day, I was so exhausted I couldn't stand it. I was swollen everywhere and just at capacity. I felt like I might burst. I did look several months pregnant too; it was embarrassing. But, within 24 hours, I could pee normally again and the swelling went way down. In one day my abdomen went back down to normal. It was crazy how fast it happened! Anyway, I seemed to be responding to the antibiotics and the infection was going away.

• More problems with my kidneys?-Yes, that is the question now. Is there something else wrong my kidneys? I went back for my 3 day follow-up, they repeated the labs, and the doctor noted that I was recovering from the infection as expected. However, I could still feel mild flank pain and was still retaining fluid. My weight has gone up over 20 pounds in a matter of weeks but I can still wear the same sized clothing. How is that possible? At this weight in high school, I wore a size 10. Now, having swelled up suddenly to that same weight, I'm still wearing a size 4 or 6. That's weird! It doesn't make sense. That's partly how I know it's fluid not fat. It's everywhere, my doctor could even feel it in my arms. And even though the headache, pain and fever have improved, I'm still completely exhausted and retaining fluid. My doctor at urgent care said that severe fluid retention is a sign that something might be wrong with my liver or kidneys. He ordered liver and kidney function tests and asked to see me back in a week. There are a lot of things it could be, ranging from something simple like infection to life-threatening. However, no one is treating it like an emergency. They are taking it seriously and watching me closely, but no one suspects a major or life-threatening problem. I feel like things are being handled appropriately. I will know more next week. For now, all I can do is sleep. I can't get out of bed for anything. I'm just swollen and exhausted. I am alarmed at the thought that something might be wrong with my kidneys, of course, but not in a state of panic or anything. I am just really curious to know what the hell is going on. Kidneys? Really? No fair!

The Solution to the Skin Pain!

I called my new doctor, Dr. Reifsnyder, after nearly 2 weeks had gone by and skin pain hadn't improved. He recommended I stop my antibiotic, Cedax, for 3 days and see if that helps. If it doesn't, I would have to go in for an office visit. After 3 days off Cedax, the pain had not improved at all. So, I had to go to Lakeland for a visit one week before my scheduled follow-up appointment. I was just hoping that this visit would replace the scheduled follow-up and I would not find myself driving out to Lakeland twice. Luckily, my sister had her initial visit with him that week so I caught a ride with her on day 5 off of Cedax.

When I told the doctor about the pain and inflammation, he said he had seen this exact thing many times before. In his opinion, when the Cedax suppressed the bacterial Lyme infection, it gave the viral Epstein-Barr infection an opportunity to take over. He said the skin pain was a clear result of my immune system trying to fight  viral infection. This answer is in keeping with the answer I got long ago about my joint pain. I was told that it was a result of immune complexes settling in my joints as my immune system fought the bacterial Lyme infection. 

We didn't talk much about the fluid retention but I think I understand that better now too. If you think about how inflammation causes swelling in tissue you realize that it takes fluid in order for the tissue to swell in the first place. I had inflammation and swelling everywhere, especially in my abdomen and legs. My legs and ankles were so swollen that there was a little roll around each ankle. It looked ridiculous! I was so swollen and puffed up that none of my clothes fit. I didn't realize that at first because I had to wear dresses for the pain anyway. It wasn't until I tried on every single pair of jeans I owned, even the ones that were a size bigger, that I found out that none of them buttoned. It was so frustrating. I only had 2 dresses I could wear and then I was out of clothing options. But I didn't go out much while this was going on anyway.

Back to the appointment. Dr. Reifsnyder prescribed a Medrol dose pack, a powerful and short course of steroids, to knock out the inflammation. The idea was that the steroids would take care of the inflammation and swelling while my body adjusted to fighting the viral infection. It was not a solution to the problem. It was only meant to help me deal with those symptoms until the infection was under control, much like cold medicine when you have a cold. He also said to stop the Cedax and continue the anti viral medication, Acyclovir. He said to call his office in 10 days and let them know how I'm doing. Other than that, he just wanted to see me back in 3 weeks.

When we got back to Orlando, I was very tired and frustrated. I had been sitting in the car for 3 hours and in the waiting room for over 2 while my sister had her appointment and I was in so much pain. Plus, we took my mother's car and her suspension is such that I could feel every single bump and pothole on the road. That meant that every few minutes I was jostled around unless I held on tight to the handle above the door. The problem with that is that after a few minutes, I felt too weak and tired to hold onto that handle. So I was at the mercy of my mother's frantic driving and every bump in the road. The pain of sitting in a seat at all, the pain of my skin and muscles pressing into it, was bad enough without being jostled around. It was such a long day that I was very, very over it by the time we got in the car to go home. By the time we got home, I wasn't just exhausted and in pain, I was mad. I was very unpleasant to be around, I'm sure.

The next day I started the steroids. You have to start them in the morning so I had to wait until the next day. I was warned that they might make me feel wired and could make it hard to sleep. After the first 2 or 3 pills, I could already feel a difference. The inflammation and swelling was already going down. The pain began to improve. By the 2nd day, the pain was almost completely gone and I could see my ankles again! It was amazing. They really worked so well and so fast. I was so relieved to be able to get in bed or take a shower or wear a tank top without pain. The inflammation and swelling continued to get better and better over the next few days. That was, until the last day...

Ok, wait, before I get into that, I should say something about feeling wired. I didn't. Far, Far from it. For the first 3 days, I did nothing but sleep all day. Exhaustion wasn't the word for it, I was too wiped out to move. When I wasn't sleeping, I was just lying there with my eyes closed. I thought about how sad it is that that was me on steroids. What the hell would it have been like without them? Would I have slept for 24 hours again like that day months and months ago? I reasoned that it was probably an Epstein-Barr flare because steroids suppress your immune system and probably made it possible for the mono to flourish at first. It did, in fact, feel like when I had mono. I was just too tired to move or eat or anything. But then, all of the sudden, day 4 came and I was wired. I went on a cleaning frenzy. I did laundry and cleaned my bathroom and sorted through clutter that had been in my room for months. I even cleaned my car which I never do because it's really hard for me. I finally felt more like a person on steroids. Even still, I probably only ended up being capable of about a quarter of what normal can do. 

On the last day, the skin pain returned. It came on slowly and subtly. It wasn't as severe or expansive as it was before the steroids, but it was definitely there. It affected my neck and back and shoulders first then spread to my abdomen. Again, it wasn't as bad but it was troublesome. I took my final dose last night and went to sleep in a whole lot of pain. By last night, the pain was pretty bad and I went to sleep so worried that it would all come back when I stopped the steroids. When I woke up this morning, the pain was almost gone. I pressed all the spots that hurt before bed and it took a whole lot more pressure to cause pain. It doesn't hurt to lie in bed and my clothes aren't bothering me. So, ok, it looks like things are ok for now. I will just watch it and see what happens. Maybe there will be an adjustment period after I stop the steroids as my body gets used to being without them. I will try not to panic about the pain until the full 10 days have passed and I call Dr. Reifsnyder. The course of steroids lasted only 1 week and he told me to call after 10 days. There's probably some reason he picked 10 days so I will wait until then to draw any conclusions. But for now, things are ok and the steroids worked really well. Thank god. 

I woke up feeling rested this morning. My energy really improved a few days ago and has stayed that way. It's really nice to have enough energy in the mornings to make making coffee and breakfast possible, almost easy. Instead of this daunting task that has resulted in me making a little coffee station that I can reach from my bed. That way, I can just reach over and grab some coffee and a protein bar in the haze and pain and misery of the morning. Lately, though, mornings have not been miserable. I have been consistently waking up more rested and have noticeably more energy throughout the day.

The pain, however, is still here. I haven't taken Cedax in 2 days and today will be the 3rd day in a row without it. By tomorrow, or maybe Monday, I should feel a difference. If the pain and inflammation all over improves, then we'll know it's caused by Cedax. If it doesn't improve, then I will have to go in and see Dr. Reifsnyder for an evaluation. The pain is still all over, the same patches, same intensity. It does vary in intensity from day to day, but today it is no better than it's been on any day over the last 2 weeks. I've been managing it mostly by just avoiding the things that hurt like tight clothing, hugs, carrying my purse on my shoulder, putting my hands on my hips, etc. I've also been taking Aleve for the last several days and it definitely helps. 

Yesterday I had my monthly appointment with my pain specialist. I told her about this new pain and she said she's heard of other patients who start antibiotics and have a very similar reaction. She said it makes their skin hurt all over and usually only lasts a few weeks. I think she's right. I think Dr. Reifsnyder is right too, it's probably a reaction to that new antibiotic Cedax. The pain started about 4 or 5 days after I started Cedax. During my last appointment with her, we decided to decrease my extended-release Morphine because I hadn't been in all that much pain and didn't think I needed so much of it. That decision was also based on the assumption that it would probably be a while before I started treatment again. Then I got in to see Dr. Reifsnyder pretty quickly and started treatment right away. After that, the lower dose of Morphine wasn't enough. Then I ran out of instant-release Morphine for breakthrough pain. For the record, it's taken me 8 months to go through a bottle of 30 instant-release pain pills.

So, my pain specialist said she had no problem bringing my dose of extended-release Morphine up for now and wrote a new script for instant-release too. She said she wants to make me as comfortable as possible right now. She's said that before and has always followed through. She really has improved my quality of life and seems genuinely happy when she's able to make me comfortable. It also doesn't hurt that every time I see her she goes on about how pretty I am. I never get tired of that! Anyway, I'm glad I got a new script for instant-release pain pills because I was completely out and had to just hope I didn't need them in the meantime until my appointment yesterday. She also said that it would be ok to take them a little more often for a while until we get this pain and inflammation all over under control. All in all, it was a good appointment.