THE BIG FIGHT (conclusion)

THE BIG FIGHT ROUND 2 (cont) THE CYTOKINE KID v INFLAMMATORY JACK

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30th Sept 2013.
Friends and fellow RA sufferers. I regret I have to make the following announcement. The candle is erect. Inflammatory Jack has been counted out in round 2.
The Cytokine Kid has just cut seventy yards of hedge and mowed a complicated shaped area of lawns, followed by thirty minutes tickling the ivories just to keep Ludwig Van up to scratch.
There is no trace of pain, stiffness or swelling in any joint and ESR/CRP remain < 1.
It seems the supplement Tocilizumab, trade name RoActemra the Kid was taking with his methotrexate has been too successful and robbed you of the contest we were all expecting.
When this contest started the promoters were expecting a long drawn out and evenly matched affair. This is why we have to apologise to all you loyal fans expecting a 12 round, evenly matched fight.
Like you we expected Inflammatory Jack to make a much better fist of things. It's very disappointing. We will refund all ticket money to those of you who feel cheated.
One thing I would ask of you.
Please warn any of your fellow RA sufferers who like a good bet, to be wary of backing any contestant who is facing an opponent on Tocilizumab. This drug is capable of producing miraculous results and you could lose your shirt.
Of course there is still a chance that The Kid might be disabled by complications, side effects etc in the future but if that happens we'll just have to cross that bridge when it occurs.
Now I have to discuss the implications of all this with the referee. We wouldn't want too many one sided contests like this ....would we?

THE BIG FIGHT - CYTOKINE KID (TOC H) v INFLAMMATORY JACK (Round 2 Cont)

.... It's Thursday - Methotrexate day again. From the word go the Kid looks good. Annie, his number 1 says his chest and back pain's nearly gone, breathing easier, no stiffness or swelling but shoulders still feel itchy and the candle is still wilted. It's a

miserable, grey, drizzly day. No big outdoor exertions then to goad inflammatory Jack into extra effort, just some light shopping. IJ knows The Kid will be briefly KO'd today, usually just after lunch. Methotrexate will put him out for the count if only briefly.
At 4pm the Kid rouses himself from his MTX sleep. The corner signal he's okay for the rest of today.  
Friday and the weekend is coming up. The Kid looks and feels good. No pain, swelling,stiffness or infections reported.
InflammatoryJack has taken a hammering by a rejuvenated TOC H who's had a good nights kip. Wednesday Blood test results today. Rules of the game say referee must be kept informed.
Friday.27th. Sensational turn of events! Is this a KO punch halfway through round 2? The seconds are holding up cards with the Kid's blood test results. ESR 2 CRP < 1.
IJ is flat out on the canvas. The Kid  is positively dancing round the ring. No sign of pain, swellings or stiffness there. The referee Gayle Githens-Mazer is starting the count. Is this it? Will IJ recover or will he stagger on until they have to throw in the towel? 
Looks like they'll be ordering the next batch of the Kids wonder supplement TOCILIZUMAB  (RoActemra) if it carries on being this effective and even better they might taper down the MTX which is the trial they signed up for as a precondition to the big fight.
Watch this space for more updates on the big fight.

to be cont.....

THE BIG FIGHT (Round 2 cont)

.....13th Sept
It would seem that Inflammatory Jack has developed new tactics to slow down the Cytokine Kid at the beginning of round 2 - going low for feet, ankles, knees and legs more now in a bit to curtail his outdoor activities. There's no doubt the Kid looks like he needs the magic stool after an hour in Asda, but once in the car things settle down and the Kid actually seems to be enjoying the trip. This tactic doesn't seem as effective as it once did.
 The Kid's seconds report that sleep has been a bit of a problem, but mainly because his waterworks seem to go into overdrive at night while during the day he hardly needs to go at all. The corner says the skin round his ankles feels less tight with less swelling but still some minor pain/weakness in knee joints  and leg muscles.The Kid says he's at his most comfortable when it's time to get up. Sod's Law he reckons. Any morning stiffness seems to disappear within minutes. This is bad news for Inflammatory Jack who depends on the stiffness, swelling and pain in his opponent to disable him.
IJ's seconds report he's puzzled by news that the Kid has itchy shoulders, neck and scalp. He doesn't do itchy. Interestingly IJ suggests possible use of illegal substances by the Kid. Is he cheating or could it just be the new meds he's on?
Sat. Sept 21st After poor nights sleep, it's a slow start by The Cytokine Kid reading news, computer stuff, collecting apples from orchard and lunch. The Kid let's it be known he fancies a trip to Lyme Regis. Inflammatory Jack's ears perk up.
The Kid and Annie, his number 1 park up and wander down through the town to the Cobb. Inflammatory Jack is trying hard. The Cytokine Kid is obviously suffering in the leg department, and has to take a few breathers to relieve aching leg muscles and painful feet and ankles but still manages to enjoy an ice cream and takes a few pics. He looks relieved to get back in the car and rest while  Annie drives him back. IJ has had a good spell and knows it. He tells his seconds if he can ruin the Kids sleep again it'll have been worth the effort.
The Kid takes paracetamol and retires to bed but gets up in the middle of the night for a couple of codeine. Wakes at 7.30 to make tea. Where is Inflammatory Jack. There's no sign anywhere. No aches, pains, swelling, or stiffness.
23rd/24th The Cytokine Kid has obviously overdone things. IJ is making him pay. He complains of pains in upper chest and back, itchy sore neck and shoulders. There's a small, hot, tender swelling on the top of The Kid's breast bone and it's painful to breathe deep or cough.  The Kid is forced to take a couple of codeine tablets to help him sleep.
25th The Kid takes a time out for blood tests and flu vaccine, which is a non-live vaccine allowed by the rules of the game. He reports a better nights sleep. Still itchy shoulders but the chest and back pains are not as bad and the tender swelling on the breast bone is no worse. The examining doctor says the fight will not be stopped. A pain in the middle finger tip joint of right and left hands still annoys him when pressure is applied.
An interesting possibility emerges that the Kid's feet problems may not be down to Inflammatory Jack but merely a common ailment caused by years of wearing tight shoes. They advise him to buy bigger size shoes and maybe pad the sore spots up a bit.
  (to be continued.....)

ROUND 2 THE BIG FIGHT

Thurs Sept 12th 2013
The Cytokine Kid looks relaxed on the stool in the blue corner as the medics check him over for infections and take bloods. As they connect the intravenous drip he seems to be enjoying banter with the research nurse referee and Dr M. the Rheumatology consultant.
They seem to be talking about the role of mice and how fortunate they are to get to try out all the latest super drugs before anyone else.
Inflammatory Jack sits glowering in the red corner. He's heard the news of the ESR and CRP points tally of his opponent being less than 1. He looks like a man who's confidence has taken a knock. The seconds tend to his bruised ego and physical improvements - the reduced joint stiffness and swelling,showing the more defined nodules, the lower fatigue level. The Kid should be getting weaker not stronger. He heard he was even finding it easier to get in and out of the bath. It was bad enough when he did the 2 mile walk along Budleigh Salterton beach and back, but at least he made him pay for that, even if it was only feet and ankles and a few achy leg muscles. But when The Kid played that Chopin it really did his head in. Round 1 is not the time or place for Mohammed Ali type shenanigans. Thankfully there were still a few aches and pains as consolation. For a while he had a distressing feeling of comfort in the absence of pain. The Kid might regret ditching those NSAIDS yet.
The Cytokine Kid or Toc H as some call him looks thoughtful as they top up his methotrexate tablets for the next round. He's probably wondering whether he'll be in the taper group come round 6. He won't know. Nor will the medics. The rules of the game are strict. Placebo or not placebo. That is the question.
The bell sounds for Round 2. The Tocilizumab drip is disconnected and The Cytokine Kid charges straight to the centre of the ring on the offensive. How will Inflammatory Jack deal with this new found aggression. He is not one to back pedal.

To be continued.....

The Big Fight Round 1 (Cont)

Sept. 7^th. The Cytokine Kid looks fresh after a good night but obviously has trouble with his right wrist. It must have been that last blow. Only five more days to the end of round one. The Cytokine kid seems to be holding on to a slender advantage.
 

THE BIG FIGHT

And now ladies and gentlemen.

Sponsored by RoActemra.

The Big Fight 2013/14. 

Middleweight Division (75 - 80Kg) Over 12 rounds.

Featuring in the Red corner, Rheumatoid Arthritis (Inflammatory  Jack)  v in the Blue corner,  on the Tocilizumab Drip, Harry The Cytokine Kid  (Toc H for short.)

Your referee for this contest is Gayle Githens - Mazer

Round 1  15^th Aug. to 12^th Sept.

The Cytokine Kid weighs in at 77kg but looks in bad shape as the drip is disconnected and they get ready for the bell. His knuckles, wrists and fingers are already swollen and stiff, he’s having trouble making a fist or straightening his fingers so won’t even be able to give a decent slap either. His Das 28 score is way up and the ref is not too happy the fight should be allowed to proceed. No way is he going to get them gloves on without an anaesthetic. He complains to the referee his legs and knees feel weak and ache and his feet are playing up rotten. He looks for the towel as the bell for round one rings but someone has removed it before he can throw it in.

Inflammatory Jack comes off the stool with a big smirk on his face that says this will soon be over.  If Toc H survives the anaphylactic shock of the drip, Inflammatory Jack has boasted he’ll sock it to him with a real big flare up before he can settle into any sort of routine.

The first twelve days are slow going as they feel each other out with jabs and counter IL-6 blockers but The Cytokine Kid is starting to move easier and lands several IL-6 blockers as Inflammatory Jack misses with a big flare haymaker. Toc H seems to be making a better fist of things now and bunches his fingers up tighter. The pain, swelling and tenderness in his fingers, knuckles and wrists seem to have improved. Could he be getting stronger?  

28th Aug. The Cytokine Kid connects with a beautiful right hook below the belt after the seconds relay his blood test results ESR 2 CRP 1. Inflammatory Jack is temporarily rocked back on his heels at this unexpected low blow.
2nd/ 3rd Sept.  IJ hits back causing some  serious aches and pains in The Cytokine Kid’s feet, ankles, knees and leg muscles.  The seconds throw paracetamol tablets into the ring. Toc H grabs a few gratefully.

5^th Sept.  Lots of leg work by the Cytokine Kid. Too much. Inflammatory Jack takes full advantage. Toc H complaining of sore feet, aching leg muscles, weak knees and aches and pains in shoulders. Taking frequent  breathers after bouts of fatigue. Couple more paracetamol but no NSAIDS yet.

This looks evenly matched. Could be a prolonged war of attrition decided on points. It all depends on how well The Cytokine Kid can pace himself against  IJ’s relentless onslaught.

To be continued...