Living with inflammatory arthritis

 

Dear Bloggers,

I probably have told you in earlier stories about my stiffness in joints and on a rainy and cold day it is harder to get out of bed and go on the move. No, I am not a complainer somehow there is a feeling that people around don’t know a lot about the condition and that there is a lot of pain involved. (One of the reasons that I only write once a month instead of every week.) I have used quite some pain relievers during the last fifteen years. As I stopped last year with the medication on advice of the rheumatologist. The inflammations took a flight. From sour joints until inflammatory bursitis in my hip and being treated with a nerve Intercostal Block on my rib.

Inflammatory arthritis is a condition many people endure for a lifetime. Thanks to advances in treatment, however, innovative medications can delay and even halt the progression of the disease, and non-drug approaches have can help relieve symptoms so you can live a full and productive life.

What is inflammatory arthritis?

Inflammatory arthritis describes a group of diseases caused by an overactive immune system. The most common symptoms are joint pain and stiffness. Affected joints may feel warm, swollen, and tender. But inflammatory arthritis can also affect other tissues in the body, including the lungs, heart, eyes, skin, and other organs. Left untreated, it can cause irreversible damage. Early treatment is the best way to relieve symptoms and limit the effects of inflammatory arthritis on the body.

While it’s not known what causes inflammatory arthritis in every patient, what is known is that the immune system does not know when to put on the brakes. Normally when we are exposed to bacteria, viruses, or fungi, the immune system produces white blood cells called lymphocytes as well as immune proteins to mount an attack against these invaders. Lymphocytes and immune proteins cause inflammation, which under typical circumstances is limited and resolves once the foreign substance is defeated.

But in someone with inflammatory arthritis, the immune response does not know when to stop. It turns on your body, attacking your own tissues instead of the foreign substance and causes continued inflammation. For this reason, inflammatory arthritis is known as an "autoimmune disease" − auto meaning "self" and “immune” because the immune system loses its ability to distinguish self from foreign.

How are inflammatory arthritis and osteoarthritis different?

Although they share some common symptoms, inflammatory arthritis and osteoarthritis are quite different diseases. Osteoarthritis is a common condition causing wear-and-tear of the cartilage of the joints due to age and/or prior injury. Here are some other differences:

Inflammatory Arthritis - A "systemic" disease which may affect the joints as well as other organs, such as the lungs, heart, eyes, tendons, and skin. Patients may show elevations in proteins such as rheumatoid factor, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) on blood tests. Autoimmune disease related to body-wide inflammation.

Osteoarthritis - Symptoms are limited to the joints. Blood tests for biomarkers are negative. Mechanical wear-and-tear on joints due to age or injury.

 

What are the different types of inflammatory arthritis?

If you are experiencing symptoms that suggest inflammatory arthritis, your doctor will perform a number of tests, including a physical exam, blood tests, and imaging exams (such as X-rays, joint ultrasound, and/or MRI or CT scans). Sometimes the physician takes a sample of fluid from an affected joint for analysis − a procedure called joint aspiration. 

Based on the results of these exams, your physician will determine if you have inflammatory arthritis and if so, which type:

Rheumatoid Arthritis (RA) is the most common form of inflammatory arthritis. It tends to involve more than one of the small joints of the hands and feet. In particular, the lining of the joint or tendons (the synovium) is inflamed, causing warmth, pain, and stiffness. In 30% to 60% of people with RA, blood tests confirm the presence of proteins called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies. It is very important to control inflammation in the synovium to stop joint destruction and to treat RA to minimize damage to the heart, lungs, and eyes.

Psoriatic Arthritis is a type of arthritis called a "spondyloarthropathy" that is a combination of psoriasis (red, scaly patches on the skin, especially the knees, elbows, and scalp) as well as pain and swelling in the large and small joints and sometimes the spine. It can cause complete swelling of a finger or toe − a condition called "dactylitis."

 

 

Juvenile Idiopathic Arthritis (JIA) affects young people under age 16, causing inflammation in the joints and sometimes in the spine and ligaments (tissues that connect bone to bone) that lasts for more than six weeks. Swelling or mobility problems, including a limp if the legs are affected, may be the only signs of JIA. Some types of JIA cause eye inflammation that can occur without symptoms, so prompt diagnosis, treatment, and monitoring of JIA are vital to prevent permanent damage. Children and teens with JIA are best treated by a pediatric rheumatologist.

Ankylosing Spondylitis (AS) affects primarily the spin and hip joints, breastbone, and large joints in the body. Over time, AS can result in noticeably reduced motion in the spine. Up to half of people with AS have a gene called HLA-B27, the presence of which can help confirm the diagnosis of this condition when it is found in combination with AS symptoms.

Gout & Pseudogout (calcium pyrophosphate dehydrate deposition disease or CPDD) are forms of arthritis caused by elevated levels of certain crystals in the body. Gout results from excess uric acid, causing it to crystallize in joints such as the big toe and also raising the risk of kidney stones. CPPD occurs when calcium salts form in the joints and are engulfed by white blood cells, provoking inflammation − most commonly in the wrists and knees.

Other autoimmune diseases can cause inflammatory arthritis as a symptom. Examples include Sjogren’s syndrome and lupus.

You and your rheumatologist: A lifetime partnership

If you have inflammatory arthritis, it is imperative that you see a rheumatologist on a regular basis to monitor your health and customize your treatment. Rheumatologists are medical doctors with special training in the care of people with joint diseases and autoimmune diseases. They are different from orthopedists, who are trained in surgery and who may also be involved in the care of people with inflammatory arthritis when medical treatments are not enough.

How do you know whether to start with a rheumatologist or orthopedist? If you have ongoing joint discomfort without chronic swelling or other symptoms, such as fatigue, you may be able to see an orthopedist first. But if your joint pain is accompanied by warmth, swelling, other signs of inflammation, fatigue or discomfort in other parts of your body, a visit to a rheumatologist may be in order. Your primary care physician can guide you.

Because inflammatory arthritis is an autoimmune disease that can affect multiple parts of your body, you may need to see other specialists, too, to keep your symptoms in check and maintain the best quality of life possible.

To prepare for your visit with a rheumatologist:

·     Bring in a full list of your medications, including vitamins and supplements.

·     If you are already taking medications for inflammatory arthritis, make any notes about reactions or side effects you may be experiencing.

·     Provide a list of all health conditions you have had, prior surgeries, and symptoms you may be experiencing.

·     Prepare a list of questions you may have for your doctor.

Your rheumatologist may choose from a variety of treatment options for inflammatory arthritis, depending on the type and severity of your disease, such as:

·     Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

·     Steroid medications (corticosteroids) such as prednisone, which are typically used for shorter periods of time because of their side effects.

·     Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, hydroxychloroquine, sulfasalazine, minocycline, and leflunomide.

·     Biologic DMARDs, which target the proteins driving inflammation, such as infliximab, etanercept, abatacept, adalimumab and rituximab. These medications have revolutionized the care of people with inflammatory arthritis, sparing many from surgery.

·     Surgery may be indicated for specific joints with damage that can no longer be controlled by medications.

 

A diagnosis of inflammatory arthritis can initially feel overwhelming. It can take weeks or even months to come to terms with and understand what having this disease can mean in your life. By developing a close working relationship with your rheumatologist and other caregivers, however, there is much you can do to control inflammatory arthritis and maintain an independent and active lifestyle.

The Old Sailor,

You have Osteoarthritis and now what?

 

Dear Bloggers,

A few years back in the summer I first felt it: some painful morning stiffness in my fingers. The first signs of osteoarthritis. I resemble my father in many ways. We both went gray when we were 25. He developed osteoarthritis in his fingers around the age of 50 and had deformed, painful fingers and hands 20 years later. Other joints also gave pain complaints over the years. I am a bus driver now and would like to keep doing this until my last day. So, no arthritis for me.

You have to learn to live with osteoarthritis, GPs say and 15 years ago I went to the hospital and the Rheumatologist said it must be Fibromyalgia as there is nothing to find in your blood and you are still young. To keep performing in my job at sea. I had to try things out. They gave me a device that gave electric shocks to ease the pain. After a while it didn’t work out. So, I was getting pain medication and through the years I was on the highest possible dose. This summer the pain was getting back to me, and I became ill of it.

I went to my doctor about it. I thought I knew what he'll say: "There's little you can do about it, just learn to live with it." I have heard from many people around me that this is the message they came home with. Or I'm on the doorstep with drugs that won't address the cause. On sites such as the rheumatoid arthritis fund, osteoarthritis is referred to as “this chronic disease” and the treatment consists of drugs such as painkillers and anti-inflammatories, which the doctors have to prescribe for you according to their protocol. To my surprise, I was immediately referred to the Rheumatologist Dr Baudoin in Lelystad. This doctor is not in favor of numbing people with painkillers and other drugs. This is better than just getting a diagnosis in which you are immediately labeled as a "patient" and the "cure" turns out to be an expensive medical treatment that is not yet available. I don't enjoy these kinds of things. First thing I had to do he said was stopping the painkillers and go back to Panadol and solve the hardest moments. My body was totally in distress as it needed to go back to work again. I have been sick of it for three weeks getting fever and diarrhea and as my immune system was totally on the floor. Surprise surprise I ended up with a pneumonia. Isn’t life wonderful.

No one is responsible for my body. That's just me. I have the task of taking care of this as best as possible and that starts with informing myself well. Fortunately, we live in a time when you can keep yourself well informed. I started researching osteoarthritis and what I could do myself to ensure that I can still do my favorite job somewhat decently at 65. Then what I read made me happy and I want to share this with you.

Osteoarthritis is a disease of joints. These can be fingers, but also knees, elbows or hips. It is a form of inflammation that usually ends in wear and tear. It is therefore important to be there early before the wear occurs. This usually only happens after the age of 40, but it is very common. Women are ten times more likely to develop osteoarthritis than men. Wear and tear occurs in the cartilage of the joints, making the cartilage less elastic. The bone outgrowths, together with muscles and tendons, compensate for this reduced function of the cartilage. This is what causes stiffness at first and pain later. Overloading the joint (sports) can also lead to (extra) wear and tear.

Osteoarthritis says something about your overall health

Osteoarthritis seems to be a local condition, but it says something about the health of your entire body. This has to do with that inflammation that it starts with. Osteoarthritis is in fact a signal that the body is deficient in nutrients. The body uses the nutrients present for your essential organs such as your heart and liver. Just like in a panic situation your heart and muscles get blood to take action instead of your stomach which "only" has to take care of digestion. That is equally less important in a panic state. Your joints are “low” on your body's priority list, as are your skin and hair. You can survive just fine with some wear and tear on skin, hair and joints. So they get less nutrients. Osteoarthritis has everything to do with how you feed yourself. Like almost all chronic diseases, by the way. It is therefore important to ensure good nutrition and therefore sufficient nutrients. This is not to say that it is always preventable.

As we age, we become more prone to inflammation. It is therefore important to delay this process as much as possible. Osteoarthritis also has to do with the balance between free radicals and antioxidants in your body, or the oxidation process. This too cannot be prevented, but it can be kept in balance. Eating like our ancestors did before agriculture and livestock were invented is the best thing you can do to fight inflammation like osteoarthritis. In particular, a good balance between omega 6 (vegetable fats) and omega 3 fatty acids (oily fish) is important. Not too much omega 6 but plenty of omega 3 is the advice. Bit of trouble when you are allergic to seafood like me.

Dairy, bread and too many fast carbohydrates can also cause joint problems, so it is important to reduce them. This also applies to red meat.

Soon I am starting together with my wife on a program where they learn us hopefully more to live a happier and healthier lifestyle. I will suffer from pains as I will go to gym again and having a few muscles being not in the best shape. The best is yet to come and the holiday season is on it’s way.

I will try to blog a bit more again although it is painful to my wrists and fingers.

The Old Sailor,

Back to work

Dear Bloggers,

I developed fibromyalgia in januari 2007 when I was a 40-year-old receptionist working under extreme pressure and deadlines for a busy ferry company.

I averaged about 6-7 hours of sleep a night due to job stress, coupled with a life-long tendency toward insomnia.

I had also been under a great deal of personal stress for many years.

I would try to catch up my rest by sleeping 7-8 hours a night on the days that I was free, but the family life would not let me.

After a few years of this, I suddenly developed a pain in my lower back and especially shooting pains in my arms, hands and fingers.

My muscles felt tight and inflamed, and I was physically exhausted.

I wanted to work less in the near future and change to another job, but I had to keep on working to pay the bills.
I had no idea what was wrong with me.

I consulted many doctors--neurologists, orthomolecure therapists, fysiotherapists, chiropractors, rheumatologists, doctors of internal medicine, etc. Each one had a different theory: fibrositis, arthroses, sarcodiosis, pinched nerves, lyme disease, and even a hypothyroid condition.

The final diagnosis was fibromyalgia.

I had tenderness at 13 of the 18 trigger points characteristic of fibromyalgia, and stiffness and pain in my muscles.

At times I also had muscle tremors and herendously tired.

I felt totally burned out.

The doctors prescribed drugs, anti-inflammatories, muscle relaxants and painkillers but nothing really helped.

It was very frustrating!

I tried taking vitamins by changing my diet and exercising.

The vitamins helped me feel stronger, but the debilitating pain and stiffness of fibromyalgia still persisted.

Exercise actually made the condition worse sometimes but I was told to keep in motion--it felt like my muscles were tearing.

Even mild stretching, such as reaching too far into a cupboard, would cause me days of misery.

I was puzzled that I even had pain when my body was completely at rest!
Since it was unlike any other pain I had ever experienced, I found it hard to describe to others. Sometimes it was a sharp stabbing sensation, at other times a dull, miserable ache that wore me down.

It felt like the nerves and muscles were irritated and inflamed.

Because I looked healthy and kept up with my responsibilities, a lot of people didn't believe that I was suffering like I was.

Some even said it was "all in my head" or that I was lazy and trying to avoid work!

Needless to say, this increased my emotional stress levels!

Unfortunately, not much was known about fibromyalgia in my surroundings but internet could answer a lot of questions but some parts that you read will make you more sick.
I started losing the feeling of "connection" between my brain and my hands.

I would think I was going to drop something, when actually I would be gripping it very tightly. Also, if any weight was put on my arms, such as carrying grocery bags, lifting a heavy pot from the stove, having a child pull on my arm, etc., I would get terrible pains in my arms that would last for the whole day.

I felt practically disabled!

So many activities I never gave a second thought to now became obstacles throughout the day!

As a "Type-A, take-charge, high-achieving" kind of person, these drastic changes in my life were hard to accept.

It was a nightmarish time financially as well.

I tried physical therapy, cortisone shots, massage therapy and chiropractic to relieve my fibromyalgia.

Of all the remedies I tried, massage helped the most, but it was very expensive and the relief I obtained ended almost as soon as the massage did! My muscles were drawn up and tight, especially in my upper back and neck.

Massage therapists told me that my muscles felt "hard." My whole body was painful and stiff. If I sat for more than 10 or 15 minutes, I could barely get up again because of the pain and stiffness in my knees and legs. I felt like a very old person. I learned to sleep on my back because of chronic pain in both shoulders.

After a couple of months at home on sick leave and many visits to the hospital, It is time to go back to work now.

But question is can I handle it and can they get used to the new me.

The same person dealing in a different way with his energy levels.

The fibromyalgia will flare up or ease off depending on how much sleep I was getting or how much stress I will be under.

I feel pain and tired much of the time and also suffer from insomnia, but I am not the person that sits down and feels depressed.

I actually became more and more aware of what my body is still capable to do.

I had a lot of trouble with insomnia.

Usually one bad night's sleep led to 4 or 5 more nights of even worse sleep!

I tried a lot of remedies, and a chinese method learned me how to relax eventhough I did hardly sleep, the body came to a full rest.

And I had enough energy the next day.
The physical pain of fibromyalgia is bad enough, but the fatigue wore me down mentally as well. For months I was so physically weak that even a normal car trip would completely exhaust me and I would fall asleep on the couch!

Also, the pain sensations were very severe at these times, but I was not willing to give up and let this sickness influence my mind.

Al my back up sources were depleted from years of sleeping problems.

And that was where my body simply started to hit the brakes.
In order to cope, I learned to reduce all forms of stress in my life and to curtail any activities that would make the fibromyalgia worse.

I came to accept the fact that I could no longer participate in many of the activities that I would normally do but that I had to regulate my sources.

I had previously enjoyed, and I eventually adapted to a limited lifestyle.

The carefree days of good health seemed over for good, and I had given up any hope of a "cure" for my fibromyalgia.

I don’t believe there is a cure for it, but if you believe in yourself you can learn how to deal positive with the pain.

The Old Sailor,

They call me fibromyalgia

Dear Bloggers,

Let me introduce you to my new companion in life.
I found this on the Dutch fibromyalgia site and translate it, as it comes quite close to my feelings.

Now they gave it a name and now the fight against it finally begins.

Hello,

I am an invisible disease.

I am now with you for the rest of your life.

Others around you to see me, but your body feels me.

I can attack you when and how I want.

Also I can take care of you by giving severe pain attacks.

And if I'm in a good mood I can even ensure that you have pain.

Remember that you did a lot with your energy and had a lot of fun?

Well, I took that energy away from you and gave you fatigue instead.

You now also trying to have fun, but I get you out of your sleep and give you a headache in return!

You know what I can do more?

I can ensure that you vibrate inside and you are cold or hot when everyone feels normal.

I can also make you anxious and depressed.

You did not ask for me but I have chosen you.

Why?

Perhaps by a trauma (car- crash/whiplash, surgery....?) That you had.

Or by a virus that you caught somewhere.

Anyway, I am here now and I will stay!

I hear you went to a doctor, to get rid of me.

Hahaha, I rolling over the floor and laugh!

Keep on trying!

You will be going to many doctors if you finally can get rid of me.

Also you will probably be packed with pills: sleeping pills, vitamins, painkillers, energy pills?

You will get massages and sometimes they will tell you that you are anxious and depressed. They will tell you that if you take pills on time, and do your exercises well, I will go away.

But the worst is that sometimes you will not be taken serious, when you are yelling at the doctor that you do'nt have a normal life anymore.

Your family, friends and colleagues will all listen to you until they are sick and tired of knowing how I let you suffer and that I am a disease from hell.

Some will say: "You just have a bad day" or "Yes, you can not do anything more that you could ten years ago."

They are not you then say: "Ten years ago? Ten days ago!"

Also, some will talk behind your back while you slowly get the feeling that you are losing your self-respect.
Still you try, while you know, to explain them so they would understand.

This can be especially difficult if you have one “normal” person where you are talking to, because sometimes you'll suddenly forget what you wanted to say.... The only people who really understand you and support you are, the people in whose body I am also present.

And unfortunately, you will also discover that your true friends you can count on 1 hand.

But the ones who are there are those, which are there for you REALLY!

The Old Sailor,

painful fingers

Dear Bloggers,

If you find yourself moved to write me about something, you may reasonably expect to get an answer.
That isn’t likely to happen, though, and I’d like to tell you why. I simply cannot be your pen pal.



Three or four months ago I woke up one morning, showered, dressed, grabbed a cup of coffee and jumped in my car to go somewhere.
That was when I discovered that overnight, without warning, my right hand had so enfeebled itself that I couldn’t turn the key in the ignition.
The rest of my body seemed to be aswell affected, so I reached over with my left hand to start the car, meaning to ask my doctor what the hell was going on this time at the next chance I got.



I will start from the beginning I went to my own doctor and told her about my stiff fingers and being totally stiff in the morning hours.
As we came to the conclusion that I had mentioned this last winter as she looked through my files.
We blamed it on the cold and moisty weather and that it would disappear when springweather would come.
A few months later I took up the talk again as there was no progress in my situation.
There are good days and there are bad days.
It is getting so bad that getting up in the morning has become a challenge.
The morning stiffness is the biggest issue, after a hot shower I am getting slowly in motion.

I ended up talking to a doctor of internal diseases and an eye doctor, being subjected to various high-tech tests.
What’s going on appears to be a rheumatological problem.
Fortunately for me, they take their time about it, but they’re pretty thorough.
The fingers of my right hand are the worst affected so far.
What makes that annoying is that I use that hand for writing.
At least the first draft of a lot of my blogs was written by hand.



That option is no longer open to me, because my handwriting, always atrocious, is now often quite illegible even to me.
Also my job is getting to heavy and it is bitter if you have to give up on something you like.
One of the biggest problems is the fatigue attacks and the sleeping disorder.
Being tired all day is very heavy, but I am starting to turn things around.
The pain I am living quite good through, although it is hard sometimes.
I try to see the positive sides of my situation.
If I go out for a walk to get my body in motion, I breath in the fresh air and enjoy what nature is showing.



Remains the computer.
That still works for me, but not easily.
I can still touch-type with my left hand (in the old days at almost about fifty words a minute not superfast but good enough) but the right hand can only hunt-and-peck with the forefinger.
Not that I was that good in typing with all fingers something I never learned eventhough I had a course in it.
Isn’t life hilarious?

This is bad news.
It’s horribly slow and prone to a million mistakes, which I have to correct as I go along, and, worst of all, after a page or two my right index finger begins to get pretty painful.
So my writing time, whether for blogs, letters or any other task, is limited. Therefore, at least until I finish a couple of things I really want to write, correspondence time is squeezed even harder than my cervical nerves.
A blog like this normally took me one or two hours, now it takes up to four days.



And listen, this isn’t a plea for sympathy.
Hey, I’m 41 years old.
That means that I am far luckier than most of the people I know in being still able to write at all.
It’s just to say that if you ever happen to think you should properly have had a longer letter or mail from me, or indeed any letter or mail at all, it isn’t that I don’t treasure you, it’s just that my fingers hurt.

The Old Sailor,

Spring has come at last

Dear Bloggers,

Spring has come at last to the low country.
Heralded in by the song of the frogs in the duck pond, the roaring sound of agricultural machinery is all around.
The air is alive with the constant song of native birds, the melody and harmony of all these birds is telling the story of the spring.

I used to say I can tell the season by my hands.
Yes, it’s spring.
A blister from shoveling, a blood blister from pliers, a torn cuticle from a hammer, a cut finger from barbed wire, and more.
My hands are swollen in the mornings when I wake up.
I do not like that feeling.
I know they have worked.
My hands are my tools.
Their idle time is over.
My wedding ring no longer fits.
I managed to squeeze it off, rather painfully, and now I am waiting to see if we can have it stretched to accommodate the swelling.
I miss the feel of the simple metal band, no longer there on my hand where I expect to feel it.



Also my hands and wrists are swelling up now and I have days that I cannot wear my watch as it is too painful.
And working in the garden is long time ago.
When I was diagnosed with costocohondritis and figured out that my body was my enemy in this case.
Ok I still was mowing the lawn on good days, but shoveling or redoing the tiles and oiling the deck has not been my job anymore.
Although my wife has taken over these jobs and my kids are helping to pick the weed, I really feel manytimes that I became useless.
Sometimes I sit down and cry as I can hardly bear it that my body has so given up on me.
Everyday is different and I experienced pain in the strangest places.
Although it hurts like hell every now and then, I keep on going as everybody tells me to keep in motion.


A good reason to keep on moving

A biking tour from 30km as in my “old days” I can dream about that, but if I can keep up on doing my daily tour of 3 km.
When I come home I am fully done and crash into a deep sleep on the couch.
What the **** has happened to the old me.
It is not that I want you to feel sorry for me but it can be mighty frustrating,
I try to enjoy life as much as possible.
There are enough negative people in this world.
I am doing my best to make my wife and kids as happy as I possibly can.

Living off in the countryside has given me the opportunity to experience my fair share of country stories.
Most of which, I really can not tell you… but here’s one that is rather appropriate.
It involves herbal love… and gardening!
The days that I was young I had a teacher who was much into herbs.
They lived very close to nature and they were nearly never sick.



Now I am having pain and the medical people can still not really figure out what is attacking my body from inside.
The only thing they give you are painkillers (bad motherfuckers) as you are being high of them all the time and your body is ending up with a lot of toxic waste.
When I asked the therapist if there was a friendlier way of taking the pain.
She laughed and said I cannot cure you but maybe I can make your live less painful. But do not expect miracles, well it is a bit short term but I am using a little less painkillers.
It is a herbal mix and I have too follow the schedule, let’s hope it will give more results on the long term.


The flower that might give some relief

My question is why are these people still placed in the corner of witches and charlatans?
Why don’t we look at nature as a pharmacy and we still have not discovered all curing plants.
And why are all these doctors so afraid of these natural healers is this only because of money?
I should think that they should join eachother and believe in eachothers knowledge. So we need to spend less money on finding the right medication by listening to the patient.
I am quite a sceptic if it comes to medication at all, but I am not afraid to try new things.

I am waiting for less rainy days in my life.

The Old Sailor,