A life in dentistry – Meera Alagarajah on dealing with rheumatoid arthritis

rheumatoid arthritisAfter her rheumatoid arthritis diagnosis, Meera Alagarajah talks us through how it is impacting her career in dentistry.

As we are all aware, dentistry is such a practical profession. It can come with a lot of physical strain.

Most of us have developed some kind of back pain due to poor posture or strain due to repetitive movements. How often have you come home feeling not just mentally, but physically exhausted?

Now, imagine on top of that, you have a condition that affects your entire body. It affects your joints, from your hands and feet, to your shoulders and elbows.

It’s not ideal for a busy, demanding job that requires you to move all day long.

Rheumatoid arthritis diagnosis

Three years ago, I went from being completely fit and healthy to developing an autoimmune condition in the space of weeks.

You can imagine what a shock it was to me. I really didn’t see that coming.

Having developed rheumatoid arthritis quite early into my career, I now know how difficult it can make every day life, as well as dental practice.

As I’m sure you’re aware, rheumatoid arthritis is a systemic disease causing inflammation of the smaller joints resulting in pain, stiffness and immobility. There is no cure, it is a progressive condition. However, medication can control it and hopefully prevent further damage. The end goal is ideally some sort of remission.

Advice

Once diagnosed, I found myself spending a lot of time online searching through websites and blogs looking for advice. Not just general advice, but advice for clinicians, or more specifically dentists.

Given how practical and demanding our job is, it’s obviously important to figure out how to manage my condition and still do my job.

It would have been great to come across some practical advice or even just find a group of people going through the same thing. But as far as I could see, it didn’t exist!

Surprising, considering I’m sure I am not the only dentist who has a condition that might impact their clinical work.

All the advice that I came across linked to dentistry and rheumatoid arthritis was patient centred. It was all about making sure we check our patients’ medications before treatment. Or how patients should recover after dental procedures given what condition they have.

But what about healthcare professionals? What happens when your rheumatoid arthritis flares up, you have a busy day of extractions and your painkillers just aren’t kicking in fast enough?

Or when you’re completely exhausted from fatigue and sleep just isn’t cutting it anymore?

It would be great to know how I could cope better, rather than just muddling through each day.

rheumatoid arthritis in dentistry

My story

My symptoms started with one index finger.

I realised one day that I had mild pain developing in that finger, which then became bent and immobile.

I didn’t think too much of it and assumed myself I had hurt it somehow doing an extraction. Following this I took some over-the-counter pain relief. This helped a little, but my finger remained in the same position and I couldn’t straighten it anymore.

After a few days, I noticed a tingling pain in both hands, which always seemed to appear first thing in the morning.

Pain relief was now failing to resolve the pain and symptoms would return each morning. At this point, I started to become more concerned.

All those lectures about autoimmune diseases were coming back to me and I recognised the symptoms of rheumatoid arthritis.

If I didn’t have this knowledge already, I perhaps would have ignored this pain for some time. It was tolerable for the most part with pain relief, so I could just about manage.

Rheumatoid arthritis treatment

I went to see my GP who was fairly sure it couldn’t be arthritis due to my age and lack of family history of rheumatoid arthritis. She referred me to the rheumatology department anyway.

At this point, I was taking a lot of pain relief just to manage through each day. It was becoming difficult to carry out normal tasks such as opening bottles or carrying anything heavy. Not to mention doing all the practical things at work.

Luckily, I did not have to wait long and was seen by a consultant who confirmed my suspicion of rheumatoid arthritis.

I know in my case I was very lucky. Most people have to wait for months to see a rheumatologist. I’m not sure how much longer I could have lasted taking painkillers.

After my diagnosis, I was put on a strong regime of medication (steroids, methotrexate) to reduce my symptoms and suppress my immune system. The steroids kicked in really quickly, which was such a relief.

It was nice to move my fingers again as normal. I was almost getting used to waking up with pain in the morning.

These medications kept my symptoms under control for a few months. But unfortunately I started to suffer from flare-ups on and off for the next year and a half.

Now the symptoms were spreading elsewhere, to my hands, wrists, all fingers, feet, shoulders. Pain would come and go, with some weeks fine and others where I was in pain for days.

My medication dosages have gone up and down in this time in an effort to relieve my symptoms and keep my disease under control.

At the moment, things are much better. I’ve started on biologics, which seem to be working great. So fingers crossed that this keeps things under control.

Working as a dentist

Initially, simple things were difficult for me and I was slower.

When I had a flare, daily tasks started to become almost impossible at home and in the clinic.

In clinics, it was easier for me having a nurse who was efficient and highly competent who could reduce my workload. But doing a busy day’s dentistry is really difficult when you’re in pain or feel discomfort throughout the day. It’s obviously not ideal to have to take painkillers long term to reduce the pain.

Additionally the chronic fatigue associated with rheumatoid arthritis makes it even more tiring. Even with a good night’s sleep, sometimes you still feel completely exhausted.

It was becoming difficult to try and work at the same fast pace, whilst often in pain and tired.

I personally found extractions the hardest, despite enjoying this aspect of dentistry the most. It didn’t stop me from doing them, but I would always worry that it would put extra strain on my hands and I may suffer a flare later.

Ignoring the symptoms

I informed my team of my diagnosis. But I did not know how to manage my patient list or when I should take time off.

At the time I felt it is better to continue with work as normal. I hoped things would just improve on their own.

Also, I felt that if I had to take time off every time I had a flare, I would only work a few days a week.

For the most part I was ignoring symptoms and working through them, taking more medication as needed.

Working through pain and flares only seemed to make things worse, resulting in more frequent flares and more pain. It was a vicious cycle.

Dentistry is a job that requires commitment and responsibility. I struggled to prioritise my health over my job.

Advice – tell your team

Inform your team of your condition. It’s important that your team knows that sometimes you may struggle or that you may be in pain.

It’s better to have the support of your team. Especially when you’re having a worse day with it.

If your colleagues are aware of your condition and what this means for you, then they can provide support to help you to continue to work.

Hopefully, they are willing to help wherever possible. Whether this involves lengthening appointments or perhaps moving patients so that days are shorter for you. Or even just generally being more sympathetic if you’re having a flare and are working more slowly than usual.

Isolating your problem will only make it more difficult for you in the long term. You may struggle to work at the same pace as before.

Don’t be afraid to take a break

If you’re having a flare and struggling, your body is telling you to slow down and take a break. You need to listen.

Taking more painkillers is only papering over the issue and won’t deal with the underlying problem. Your rheumatoid arthritis is active and you need to find a way to manage it.

I realise it’s hard when you’re used to being busy. You feel responsible for your patients and your team. But sometimes you have to prioritise yourself and your health.

From experience, ignoring the symptoms and working through the pain only makes it worse and seems to accelerate things.

If you want to have a long career in dentistry, then you need to find a way to work with your condition and make it manageable.

Sleep, eat, exercise and rest!

Sometimes it’s the simple things that work. Ensuring you’re sleeping enough.

Now this can mean that you need more sleep than other people or just more than you normally do. Listen to your body. If you need more, then don’t ignore that. Especially when you’re having a flare, you’re going to feel more exhausted and this is before you’ve even started your day.

Gentle exercise is really great to help prevent the fatigue. Again, play it by ear. You don’t want to over do it, so work out what exercise is right for you.

I personally find going on walks and yoga is the best. It’s gentle enough to not give me much of a problem afterwards.

The biggest trigger for my flares is stress. If I’m stressed and run down, I can predict that a flare is coming.

So, if you don’t already, you need to figure out a way to manage the stress. Yoga, meditation, deep breathing, walks or whatever else works for you.

The future

Personally, I am not sure if returning to clinical dentistry full time is the best option for me or my health.

I feel that I need to balance my work life and free time better to help me manage my health.

My advice to anyone going through a similar situation is to try and take a step back and consider that maybe prioritising your own health is the best option in the long run.

Ignoring a health issue and working through it will just result in you burning out that much faster. This will force you to take an involuntary step back from your job.

During this COVID-19 period, I chose to leave my previous job and return home for a while. In a way, I was forced to finally take some much needed time off to rest.

This is perhaps the first time since my diagnosis that I have tried to look after my body, with sleeping properly, eating well and exercising where possible.

My rheumatoid arthritis has been so much better as a result. I don’t think I will ever go back to that unhealthy cycle of neglecting my health.

As dentists we are so used to caring for our patients, but we have to remember to care for ourselves first.


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