There’s tender, and then there’s “tender” …

I have reason today to meditate upon the word “tender.” Usually, I reserve its use to describe grilling chicken breasts to the perfect point of done-ness, when the meat is neither undercooked and still slightly pink, or overcooked so that it’s tough and stringy. “Tender.” Cooked through but still moist and piping hot, firm to the bite but eminently chewable … you catch my drift.

I also frequently see the word used to describe gentle affection, as in “the

I prefer this perception of "tender," personally ...

I prefer this perception of “tender,” personally …

mother gave her little girl a tender kiss.” Lovely. We all get that one.

And then, there’s tender. As in sore. As in … ow. That’s the best way to describe how my hands have been feeling the last few days. They’re … tender. They ache, but it’s a low-level ache, hardly worth noticing most of the time. But then there’s that tenderness… like when I pick up my coffee cup and the joints in my knuckles and fingers feel like they’re being pulled apart, with the accompanying sharp, poking pain. Ow.

Or as when I’m typing, like now. Mostly, it’s not bothering me much (or I wouldn’t be doing it). It’s just that when I stretch my fingers to reach certain keys, I get that mean, pulling sensation again. It takes my breath, forces a frown and then it’s gone.

Tender. As in painful under slight pressure.

I do get weary of the sensation. And, of course, I worry about it. This is happening while I’m taking a big handful of DMARDs (disease modifying anti-rheumatic drugs) every morning and every night. It’s happening even though I’m taking Tramadol every six hours, rarely missing a dose. It’s happening in spite of the odd Vicodin here and there, when tender turns into “holy s**t that hurts!”

And despite all the medications, anti-rheumatic, pain-killing, etc., my knuckles are still swollen. Day and night, every day.

In a few days I’m going to the lab for my quarterly blood tests. I’m really curious to see how the sedimentation rate, which measures the level of inflammation in the body, looks. It was somewhat higher (for the first time in a couple of years) last quarter. I’ll be floored if it’s not higher still, this time.

But I’ve been disappointed surprised before. Perversely, sometimes lab tests simply don’t reflect perceived pain levels or actual disease activity. I guess that’s why “healing” when applied to medicine, is an “art.”

Hmm. Two more words to meditate upon …

12 responses to “There’s tender, and then there’s “tender” …

  1. I don’t know Wren. I may be…well probably am… overstepping a boundary here but I think it is time to look at a med change. I have read your blog for quite some time and it seems that this level of pain seems to be becoming the norm. If not the norm than it presents itself more often than not and interferes with your quality of life. Sometimes the blood work doesn’t show the whole story. My doctor rarely refers to the blood work when making a decision on a med change. Even if the blood work looks ok, if I have pain and swelling and have given a med regime a good long try, she will make a change. Yes the biological present some risk but, for me, I felt like time was ticking and each day was a day I could never get back. I just decided I would rather live as pain free as possible even with the possibility of side effects. Fortunately I have had none and have seen a great improvement. Perfect…no but oh so much better. I know you are a strong tough woman when it comes to this dragon but admitting that it is time for a change doesn’t mean giving into the pain or that you are weak. It means taking control and fighting back. Forgive me if I presume too much. I simply hate to think there is something that could help that isn’t being offered. Hmmm could someone help me off this high horse I seem to be on.

    I hope the dragon takes a break and that the only tender things in the coming days are the sweet moments spent with family and friends.

    • Mary, thank you for your kind words. You’re absolutely not “overstepping;” I really do appreciate your straight-forward honesty. And you’re right, of course. I’ll be seeing my rheumatologist in a few weeks, and I do plan to talk to him seriously about taking the next step. I think I’m already at the maximum dosage in my triple-drug cocktail. Biologics are the next obvious step.

      I’m a little apprehensive about injecting myself, but like everyone else, I expect I’ll get used to it. I’m not needle-phobic, thank goodness!

      Thanks again for your concern, Mary. I hope this finds you feeling well and enjoying the weekend. :)

  2. Wren, I clicked through with roughly the same thoughts as Mary, above. Your pain levels worry me, and I’m concerned that your doctor is wedded to your sed rate as a measurement of your disease activity. There’s quite a bit of scientific evidence to suggest that as many as 40-60% of people with active RA have normal ESR (sed rate) and CRP levels, and that even when the values are normal, these patients are still experiencing joint damage. (http://jrheum.org/content/36/8/1568.full) Adequately treated RA doesn’t cause this kind of pain and swelling! Yes, biologics have risks, but so does uncontrolled RA. I hope it isn’t the monetary cost of biologics that’s preventing your doctor from presenting them as a viable option. :/

  3. I have been dealing with tender hands and swollen knuckles every day, despite being on medication; it’s always worse in the morning, getting better as the day goes on. I think I have adapted to it as my new normal, and perhaps, I shouldn’t. Maybe it’s time for a chat with my Rheumy. I am sorry you are having the same difficulty. I hope the tenderness subsides soon and you will feel better in days to come.

    • Thanks, JG. I’m sorry to hear that you’re also having to cope with sore, aggravating hands. Here’s hoping that they feel better soon, that your meds will work better than they are at present, and that your doc has so good ideas up his sleeve when you see him next. :)

  4. Yes, the healing arts. I, too, need to remind myself that it’s trial and error. Something that works today may not work tomorrow. I hope you find relief soon! Sending you good thoughts.

    • Thank your for the good thoughts, Irma. This “trial and error” thing sometimes seems like just a trial, doesn’t it? I hope this finds you feeling well, m’dear. :)

  5. I know what you mean. This time of year is the worst! It’s been as low as -20 F, and my joints are revolting! “Tender” is such an excellent word to describe the pain. (((pain free hugs)))

    • OMG, April! -20F!?! That’s incredible. I’ve been watching the news on TV about the extreme cold this last week or so and wondering how folks with RA were getting along. I understand, though, that this weekend is bringing warmer weather.

      I wish I could send a lot of this freakishly warm California weather out your way! We’re facing a serious draught here. And honestly, I’m pretty bored with days that look the same, day in and day out.

      Thanks for your kind words, April. I’m sending warm, gentle hugs your way. :)

  6. Hey Wren: You know sometimes there just aren’t the words to describe … I tend to agree with Mary. If you presented as a new patient with the problems/symptoms you’re displaying now (in spite of being on medication), they would be prescribing something for you. Biologics are scary, but I’ve been on them for more than five years now with generally good results and no noticeable side effects. As Mary pointed out, every day you suffer is a day you can’t get back and living every day on pain killers is not a good situation. Sending hugs.

    • Hi, Carla! Thanks for the hugs and the kind words. You’re so right about a change in meds. I’ll be seeing my doc in a few weeks; I do plan to bring it up with him.

      How are you doing, RA-wise and otherwise, with this wierd weather the whole country is facing? I hope you’re well. Sending warm thoughts and a “tender” hug your way. ;)