I shoveled snow off of my car this morning.

Jesse has an eldritch umbrella that possibly is using her blood to summon a demon, pass it on.

Jesse has an old rich fella that possibly is using her blood to summon a diamond, pass it on!

I wish!!

Is someone here taking methotrexate (maybe for arthritis)? I seem to recall it coming up.

How are you tolerating it? Are you on a strong dose? Have you had many side effects? Have you found any tricks to limiting side effects?

My son has to start taking it to help out his IV Remicade (his main Crohn's Disease drug). Because Remicade is a biologic, patients can develop antibodies to it over time, which can both render ineffective and cause reactions.

He hadn't developed antibodies the last we checked, but his last infusion (before today) was on July 31st. When you've gone off Remicade for a while (he had to, for his surgery) and then resume, there's more of a risk that you'll develop antibodies.

He'll be taking 10mg of methotrexate once a week, and 1mg of folic acid every day (because methotrexate makes you eliminate folic acid faster than usual).

He had his first loading Remicade infusion today. He's planning to take the methotrexate tomorrow. They suggested taking it at night, in case it caused nausea. We decided on Wednesdays, because next semester, he has no classes on Thursdays, so we figured it was a good to add a buffer day in there.

Is someone here taking methotrexate (maybe for arthritis)? I seem to recall it coming up.

Tim takes it for his RA (he also was taking Remicade until recently), and I just grilled him about everything he's experienced and what he does to manage the side effects.

How are you tolerating it? Are you on a strong dose? Have you had many side effects? Have you found any tricks to limiting side effects?

His dose is 20 mg once a week. His biggest side effects are nausea and fatigue. He takes it on Saturday afternoon (he works Saturday mornings), comes home and takes a nap after work, and then he sleeps late on Sunday. ("Lots of sleep," he just yelled down the hall at me. He's an old pro at methotrexate.) By Monday, the side effects are pretty much gone. Your son may have to tinker with the timing of the dose to find out the exact best time to take it.

Did his doctor prescribe leucovorin with the methotrexate? It also helps prevent side effects, including the white blood cell count getting wonky.

Because methotrexate is a cancer drug, there can be some initial hair loss, but it's a markedly lower dose than used for cancer, and Tim's rheumatologist said that hair loss is usually spread out over the head, not in clumps. Biotin supplements have really helped with that. And also, that side effect does go away (at least, it did for Tim -- his hair is lovely).

Finally, the nausea. There are anti-nausea meds, and if your son needs them, use them. However, ginger is an excellent anti-nausea remedy, and that's all Tim uses. He gets Reed's Extra Ginger ginger beer to sip, but his real silver bullet is ginger chews (texture like Laffy Taffy or a Tootsie Roll, extra super crazy ginger-y). If you have a Trader Joe's, they have these in the checkout line: [link] (I don't know why that link is to Walmart) (they cost less at Trader Joe's). Tim swears by them. If he gets nausea, it's only the day of and the day after he takes his methotrexate, and the ginger chews knock it right out. We have ginger chews stashed everywhere -- home, his work, both cars, his jacket, my purse. (I learned the ginger chew trick from a pregnant friend with horrible morning sickness.)

I think since your son's dose is half of what Tim's is, his side effects may be less, and probably pretty manageable. Tim also said if you have any other questions, fire away. He's happy to share his experience.

I'm on methotrexate as well. Newly at 22.5 mg once a week, pills. I've honestly noticed no side effects from being on the meds (I have other issues, but that's the RA& whether this treatment is as effective for it for me.) My dr put me on daily folic from the get go. My hair hasn't changed, so either it's working or a nonissue.

But I also seem to have unusual reactions to many drugs, so.

Asking up top, so anyone might see this. How do you make ginger tea? I have never used fresh ginger, so it's new territory for me. Tep mentioned ginger beer and candies for nausea, but to the extent we can, we're supposed to limit sweets and soda, because sugar is inflammatory.

Thank you Steph and sarameg. You're the people I remember talking about it, but my memory has been Swiss cheesy lately, because I've been so hyper-focused on everything going on here. I may suggest he take it on Friday nights instead, just based on Tim's nausea experience. Thank Tim and his great hair, for me.

Did his doctor prescribe leucovorin with the methotrexate? It also helps prevent side effects, including the white blood cell count getting wonky.

He didn't, but they draw blood ahead of the Remicade infusions to track his Remicade levels, his inflammation levels, etc., so they can tweak meds and supplements as needed. White blood cells are a key part of what they monitor, so I'll keep that in mind.

Right now, our hope is that he'll only have to take the methotrexate for six months. That is, that's the initial plan, but Crohn's has reminded us plans are just fungible commodities.

Regarding the biotin, I'll ask if it is okay to add it. In addition to the usual pre-Remicade infusion blood tests, yesterday, they also drew blood to check things like his vitamin D and B12 levels. The part of his intestines he had removed is where B12 is absorbed, but some supplements can be inflammatory in the gut, so we're only adding as needed/permitted.

My son has great hair, but he's also already got the high forehead that's a forerunner to a receding hairline, and he's only 19, so I know that will be important to him. Thank you for mentioning it. I knew it could be a side-effect, but it slipped my Swiss cheese, because I was mostly thinking about nausea and mouth sores.

Dr. C (the fellow) was for adding the methotrexate, but didn't seem fully on board and left it up to us whether we'd add it right away, or only add it if he developed Remicade antibodies, but when Dr. V (the attending) came in, he looked right in my eyes, dropped his voice and said, "I STRONGLY RECOMMEND he take the methotrexate." That didn't escape my son's notice and was enough for both of us, even though usually, we're the ones saying, "Do we really need that med too?"

Remicade is the best med for the way his Crohn's manifests, and has worked well for him, except on the parts of his gut which were already too ravaged by the disease, but those were removed during surgery, so we'd like to keep him on it as long as it works. All of this is preventative maintenance right now. He's in surgically-induced remission, so we'd like him to stay there.

Teppy, you mentioned anti-nausea meds. Are these prescription or OTC? (Do any names come to mind?) BTW, we run every med addition by his doctor (including things like Benadryl, Claritin, and the Flintstones Chewable vitamin the inpatient nutritionist recommended post-surgery), so don't worry that we'll go take something just based on a recommendation.

One of the goals aside from keeping the Crohn's at bay is to stay off Mercaptopurine (6-MP) if possible. Remicade increases the risk of lymphoma, particularly in young men my son's age. Methotrexate can increase it a little more, but 6-MP seems more of a risk to his age group, so we'd like the methotrexate to do its job, and then we'd like to be able to eliminate it, too.

Sorry for all the gut talk early in the morning, Buffistas.

Happy Impeachment Hearing Day!

I can ask a nurse today, who I believe is on methotrexate or tried methotrexate. And is also a nurse! She too has RA, so no real thought's specifically for Crohn's, although she is a nurse.

Thanks, Sophia. Good morning.

RA's not the same as Crohn's but all of these auto-immune diseases are cousins. And the meds don't care what you're taking them for when they give you side-effects.

Crohn's has a heredity factor, but no one in our family (out to my son's great-grandparents, aunts, uncles, cousins, or DH and My aunts, uncles, cousins -- and that's a lot of people -- DH is one of 9 kids, his mom was one of 10, his dad was one of 6, my mom was one of 6, my dad was one of 4) has had it. DH has gout (as did his father, and a few others in the family). I think there's some RA on his side. On my side, it's just osteoarthritis.

Congrats, Maria! Relax and enjoy your time off.

As far as ginger tea goes, I use minced ginger in a jar from the Indian grocery store because I am lazy and it is tasty. Just maybe a teaspoon with some lemon and honey. Easy peasy.