#working to confirm with both my rheums

[dashing-hyphen]

Me: *goes out steppin' with my cane and my doggo*

My hip: *also goes out*

[crippleprophet]

looking through your AS doc ive had a bit of an "oh" moment... it explains me and my symptoms so well. i dont really know what to do next, because i have a feeling going through the nhs is going to get me nowhere.

one question: do you know if theres a link between RA and AS? my grandmother had RA and i was wondering if there could be a familial/ genetic link or if its just chance

(thanks so much for your info on AS!!!!)

:)

thank you so much, i’m so so glad it’s been helpful for you!! i actually have the unique experience of going through both the us american healthcare system and the NHS due to studying abroad, so this was my experience:

US (note that i had a really good rheumatologist, my gf looked at reviews for every doctor in the state)

i & my doctor thought from my symptoms i had AS

diagnostic blood tests for ESR, CRP, HLA-B27, RF, ANA, complete blood count, complete metabolic panel

pre-medication blood tests for hepatitis A & C, HIV, tuberculosis

urine panel

chest x-ray

MRI of spine and SI joint

after getting these tests and while waiting on results, my rheum put me on 20mg prednisone daily for a week.

results: elevated ESR outside normal range, elevated CRP within normal range, low vitamin D. everything else was normal. negative x-ray; MRI showed herniated disk but not inflammation.

because my bloodwork showed inflammation and the prednisone helped my pain and fatigue, my rheum said my pain was definitely inflammatory, diagnosed me with AS, and prescribed me Humira. i started out with injections every other week and then increased to weekly after 3 months when i still had a lot of pain in other joints. occasionally received short-term 20mg prednisone daily during flares.

NHS

got set up with a GP in mid-September, had appointment in early October for referral to continue Humira. they referred me urgently and because i already had an AS diagnosis and had been on 20mg prednisone as-needed before, they gave me some prednisone for flares (although definitely not enough to last the wait time).

received a rheumatology appointment for February 4. they said they needed to confirm the diagnosis and put me on etoricoxib (NSAID not available in the US).

got switched to celecoxib (NSAID) after 9 days because the first med didn’t do anything and gave me bad side effects (GI upset, vertigo). new med was not very effective but helped slightly and didn’t give me side effects.

blood tests for CRP, HLA-B27, hepatitis A & C, HIV, tuberculosis. chest x-ray; MRI of spine and SI joint. same results as before.

i received a phone appointment in April and they said because there wasn’t inflammation in my MRI, i was in remission and any pain i was experiencing was “leftover” from previous inflammation, but i was no longer inflamed. this was obviously bullshit because i was in the worst pain of my life and wholly unable to function. they kept me on celecoxib and referred me to physical therapy, and didn’t do anything else. i survived until i got back to the US by taking prednisone that i acquired extralegally.

so you could either try to go through the NHS and be prepared to go private later if you didn’t meet their strict diagnostic criteria (they follow the NICE guidelines) or fundraise etc to go private without going through the NHS if the waitlist was too long. personally i think it’s worth considering going through the NHS until you’ve gotten imaging and bloodwork so you don’t have to pay for that, but it depends on your time-sensitivity. i also don’t know how common it is for private UK doctors to contradict the NHS in their diagnosis.

we don’t know enough about how AS and RA work to know how they might be connected, just that certain things (mainly rheumatoid factor versus HLA-B27) are associated differently, but seronegative RA is definitely possible as is HLA-B27— AS. as with the overlap between a lot of autoimmune diseases, some people have both AS and RA, although if the true rate of comorbidity is known i haven’t been able to find it. anecdotally my grandmother had RA, too!

thank you again and best of luck to you 💕💕 feel free to send me another ask or DM me if there’s anything else i can help with!

[everyhowlmarksthedead]

❛ CLUB DOESN'T GO FIRST ❜

with Ezekiel Reyes.

Request: Second part of this prompt.

BY @ly--canthrope

Warnings: none.

Word count: about 2.9k

Aurora says: this writing hasn't been edited, you may find some grammar mistakes, I'm sorry about that!

Gif credits: @angels-reyes

Masterlist.

Sitting up and resting your back against the window, you cover your mouth to drown a loud yawn on the palm of your hand. Your head hurts too much, but not more than your heart, feeling yet the oppression squeezing it. Turning to the nightstand, you find a coffee with a hand written note that says ‘drink me with the pill’. Angel has been taking care of you for the last four days, sleeping on the sofa you can't imagine how hurt has to be his back. Feeling so sorry for him. The history repeats itself years ago. Lowering the blind a little, you grab the painkiller to swallow it with a sip of the cold drink. You don't want to check your phone, knowing what you are going to find. But the masochism is stronger than your desire for not doing it. Grabbing it from under Angel's pillow, you unlock it.

There are thousands of texts and lost calls from EZ's number. And, like every morning since four days ago, you read all the messages. This time, you have fifty two. The most recent is from twenty minutes ago. You're aware that he has been sleeping on his brother's door waiting for you to talk with him. But you don't want any explanation. You understood why he was leaving in the middle of the night, thinking that you were sleeping. And you don't want to think about the fact that he has been cheating you. But if it's not, what else?

To: angelito 👼🏻

“I'm still alive to my misfortune”

Leaving the phone away, you try to get up stretching your whole anatomy after putting your feet on the warmth floor because of the sun going through the window. Walking straight to the bathroom and after having another drink from the mug, you place it over the marble sink to take off your pajamas, which is basically an old Angel's shirt, you get into the shower. The hot water wets down your hair and your anatomy, rubbing your face to get rid of the rheums and gargling to clean your throat from the taste of beer and cigars courtesy of last night. When your mane is already washed, and your body too, you step out from the shower wrapped in a soft blue towel covering from your chest to your knees.

From: angelito 👼🏻

“Drink the coffee, take the painkiller and come to the clubhouse. Prez wanna talk with you”.

To: angelito 👼🏻

“Is your brother there?”

From: angelito 👼🏻

“In Yuma till tonight”.

Sighing heavily, you nod at the last message walking back to his room to get dressed. For a moment you thought that he was in the building hallway waiting again for you to talk with him. But you're starting to see ghosts in a house that it's not haunted. When you're ready, picking your basic stuff around the house, like the keys of your car and your wallet, to keep them inside your bag; you leave the Reyes house. Unlocking the black Camaro, you find a note stuck in the front windshield. ‘I love you. I'm so sorry’. Crumpling it into a ball, you throw it to the ground without giving it more importance than it already has.

Driving your way to the clubhouse, your phone rings on the codriver seat, flashing EZ's name on the screen. And you're about to throw it too by the window, when you have to stop your car dead some inches away to not run Creeper over, at the entrance of the scrapping.

“Shit, mami!”

“Sorry, Crep'!” You say, sticking your head out of the car for a moment.

Biting your bottom lip, dying of shame, you continue by the gravel road to the front yard. Parking close to the motorcycles, Angel receives you between his strong arms, as soon as you step out of the Camaro.

“Gotcha!” He screams with a singing voice, lifting you up some seconds, squeezing you under his grip and making you laugh.

“Stop! You're gonna break me!”

“Yeah, sure… 'cause you're soft and fluffy, aren't you?” He jokes pocking the tip of your nose, before placing an arm on your shoulders.

“What does Bishop want?”

“You will see, (Y/N)”. He smirks at you, bringing you to the inside of the clubhouse. “He's in the Templo”.

Greeting the other members and grabbing another cup of coffee, you take off the sunglasses that cover the black bags under your eyes coming into it. Closing the sliding door, El Presidente gets up from his chair to hug you with an arm on your back.

“Sit down, querida”.

You have been all day thinking about the thing you want EZ to explain to you, making a whole speech in your head that you know you're going to forget when you see him again. Yes, you still be raged and bereaved, but you can't erase all at once a year of relationship, and a life of friendship. Your hands tremble over the steer wheel, clinging your fingers around it when you drive through the scrapping again when the night has fallen down above Santo Padre. Soon, you find him sitting on the porch waiting for you, after his brothers told him that you wanted to talk. Licking your bottom lip and breathing by your nose, you leave the car parked close to the motorbikes, getting out of it with dubious steps and your hands keeped in the back pockets of your jeans. Ezekiel smiles with a saddened aura wrapping him, noticing that the shine you used to have in your eyes now is gone. Standing up on his feet, you follow him to the roulotte, where everything happens. And even if you would like to have this conversation in another place, you know it's going to help you because of all the memories you have built there. This place is going to keep you in the real world.

Opening the door, the younger Reyes lets you come in first, closing it behind his back in the meantime you sit at the table. Your hands are intertwined in a first over the wood, with your gaze fixed on them, until he has a seat in front of you. Emboldening, you look at him.

“Those… three or four times you left past midnight, you went to see her?”

He nods.

“Yes”.

Licking your incisors with the tip of your tongue, you tour your lower lip with it. You already knew it. But it's painful hearing him confirming it to you.

“Did you f—”.

“No”. He just says, interrupting you with his eyes constantly on yours. No doubts, no trembling tone of voice. “I would never touch her. I would never touch any woman that it's not you”.

“Well, you were ‘actually’ touching her”. You laugh with a bitter and sarcastic laughter, resting your back against the sofa watching him snort. “Why? Why did you lie to me?”

“I couldn't tell you anything until being sure”.

“Being sure about what, Ezekiel? Fuck off with your secrets!” You bark hitting the table with the palm of your hand.

“Until being sure of who killed my mother... and who hired him”.

Placing both forearms on the table, frowning confused and your mouth slightly opened, you try to say something. Stuttering nonsense words. Now, in part, you feel like shit. You don't care anymore why he didn't tell you but the fact he has been through this alone. Rubbing your face with both hands and pulling back your hair from the roots to flood them onto your nape, you snort.

“Angel knows it?”

“No”.

“And… why Emily? What does she have to do with all this?”

“Jose Galindo hired a hitman to kill my parents”. EZ briefly explains, keeping his gaze on yours at all times. “Pops worked for him, but when he met my mom and got pregnant of Angel, he left the Cartel and ran away. I don't know if he… did it because he thought that pops could speak with the DEA or… I don't know… I don't know yet”.

“Do you… know the name of the… man who shot your mother?” Ez told you that he saw his face, but it wasn't enough to find him. He just nods, freezing your blood.

And you know it's the exact and perfect moment to drop your condition on the table.

“I want you to leave the club”.

The youngest Reyes twists his neck confused, because he wasn't expecting these words and you're talking pretty serious.

“If you want me to come back, I want you to leave the club. I want you away from Emily, from the Cartel, from all this shit. I'm not gonna live as your mother did. I love you, but this life is not for me, Ezekiel”.

“You can't ask m—”.

“Yes, I can. And I'm doing it. I've been with you for the last eight years. Unconditionally. Always by your side. But I can't. I can't anymore”. You sentence about to cry, gesticulating with one hand to cut the air between both. “I'm leaving Santo Padre tomorrow. You have until noon”.

You're hating Bishop right now more than you thought you could ever hate someone in your life. But that man is wise like a damn rat. And sometimes, he knows you better than yourself. Even so, you're fucking up EZ so bad that he's about to break into pieces when he watches you getting up from the sofa. A lot of bullshit dances in your head. His mother's murderer, Emily trying to get him closer, Angel living happily in his ignorance. You're sure that your brain is going to explode from one moment to another, when a strong and firm hand grabs your left wrist. Bowing down your orbs to the fingers clinged around your skin, you raise up your gaze to the man with his eyes filled with tears.

“I cho—choose you over everything”. He says with a broken thread of voice, shaking like a scared kid, slowly pulling you closer.

Surprised and stunned, you let him sit you on his lap. Sinking his face in your neck, he finally lets go of all those things that were oppressing his heart, turning them into tears. His tensed arms surrounding your waist, making you know that he doesn't want you to go.

“Isn't it enough to asking him to do it?”

“Querida, words will always be words. And words are gone with the wind”.

“I'm gonna destroy him”.

“Didn't he do it first? I want his kutte on my table”.

Doubting, you bring your hands to the back of his head. As soon as he feels your touch again, his cry gets louder staining your shirt holding you stronger. EZ is trying to ask you to stay, to tell you that he's going to do whatever you ask him for, but his voice is so low that you can't hear him well. Your fingers caress his scalp slowly, from his nape to the top of his head, resting your cheek on it.

Ezekiel takes one last look at the leather kutte exposed over the table of the roulotte. Since he came out of jail, the only two reasons he have had to continue his life have been you and this piece of clothes. They're his family. They love him. He enjoys the shit he does in some kind of way, but he can't imagine a life without you. For him it's going to be easy to find a job, start from zero in another city, another country. He knows it well. But he's going to miss riding his bike as much as he has done until now.

Taking the kutte and cleaning his tears, EZ has a deep breath before stepping out of the trailer, guiding his steps through the alley towards the clubhouse. Every member of his charter is sitting at the table inside the templo, without understanding what's happening when they watch him coming in with the vest in a hand. No one, except Bishop and Angel. He's devastated, having his heart divided in two. One of them falling into pieces. But that feeling is taken to the background because of the confusion that tours through his body, when he finds you there too behind Bishop's chair, resting your back on the dark wall.

“I just… want to thank you for… welcoming me here, as one more of you. For letting me be part of this family, but…” Ezekiel leaves the kutte over the table with trembling fingers, running his hands through the fabric to wipe out some small wrinkles. “I leave the club”.

“What?” “Brother, the fuck?” “Bishop, what is that?”

All the members talk in unison, while Angel looks at his brother in silence. Actually, he's feeling proud of what he is doing. Yes, he's leaving the club. But Ezekiel is showing that he cares about his family, more than anything.

“I don't know if I have to do… something before… leaving”. He says then, clearing his throat and tangling his hands behind his back.

“Wear that fucking kutte and place the boxes of beers that came this morning”. Bishop just says, while you take some steps to put your hands on his shoulders. “See? I told you, kid”.

“Listen, querida, I would leave the club too if you asked me to do it. You're the kind of person that could put out the flames of hell”.

“But… I don't want him to do it”.

“He will do it, if he loves you. If he truly considers you his family. We're always with this shit about ‘club goes first’, but that's not true. Blood. Blood goes first. No matter how bad your true family treated you, it's in our DNA. I will not let him go, it's just a test. And if he chooses the club over you, I'll fuck him up”.

“If you cross a single world, again, with Galindo's wife, listen to me, Ezekiel”. El Presidente gets up from his chair, placing one hand over the table to use the other to point at him. “I will cut your body into pieces, keeping you alive all the time possible, to spread it all over the desert. Don't play dumb, prospect, I am not kidding”.

The crew are still confused, but they know that as soon as you leave the Templo, Angel will explain to them what was the conversation between Bishop and you.

“And about you, querida”. The man turns a little, twisting his neck. “Look where you drive by. Creeper was shot some months ago, don't run him over too”.

“Yeah! Exactly! I'm fucking fragile, mami”.

“Like a Fabergé's egg”. You say rolling your eyes.

“If you say that because of what I'm thinking… I'm not bald, I like to shave my head”. He replies making fun of you, watching how you walk closer to EZ.

“Oh, c'mon! Isn't that bad to be bald, Creeper. You save money on shampoo”.

The laughs flood the Templo, in the meantime that you grab the kutte to help a confused EZ to put it on.

“Let's go, prospect, you have work to do”. Palming his shoulders, you accompany him to the bar, after closing the glass door.

“I… I… Wha—What hap…” Your boyfriend isn't able to form a sentence, rubbing his face with both hands. “Did you… Did he…?”

“We did” You reply, crossing the bar to grab some beers. Opening both, you offer him one. “I didn't want to reach the extreme of watching you hand over the kutte, but Bishop wanted to push you to your limits”.

“But, then… What happens with us? Are you leaving? Are you leaving Santo Padre? I did what you ask me to, you ca—”.

“Sometimes, I really think that you're not this… smart as you used to, Ezekiel”. Drinking from your bottle, you shake your head with a fleeting smile. “It was just a test, EZ. I'm not going anywhere. Bishop had the… brilliant idea of makes you proof me your love over the club”.

“So… You're staying?”

“I'm ready to punch you in the face, if you ask me again”.

Leaving his beer away over a table, he takes three big steps towards you, clinging his arms around your body. For a second you're sure that you're running out of air, before he starts to kiss your face all over it. He was truly fucked, and now is when you're seeing it. Surrounding his back with your arms, you push him closer to you, shortening all the possible distance between both.

“I promise I'll not keep any other secret from you. Never. I swear to my mom, baby. There's no one in this life over you, over what I feel for you”. Ezekiel assures you, sinking his face in the space between his forearm and your neck. “I love you. You're gonna see it every fucking day, mi amor”.

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[atonalginger]

Today’s adventures in medical appointments is one for the books...

So I got conflicting confirmations this week, one automated AI that was a barely coherent run-on sentence and another with a receptionist from the main rheumatology clinic. Neither made mention my Doctor was now in a WHOLE NEW BUILDING on the hospital campus during the confirmation. Just rattled off an address that matched the hospital campus and called it the diagnostic clinic...which is what its always been called so guess where I went today...the hospital clinic I always went to! Luckily I was 15 minutes early so we had time to get down the road.

I should note there is a ton of work going on at this hospital right now and all the convenient entrance/exits are closed and you can only get in from the ER and children’s ER entrances. So...a hike to get in and out of the building. We get to my appointment, Nick hangs in the car while I go up and everything goes smoothly...until I must go to get labs. My whole appointment with my Rheum took maybe 15 minutes. I get downstairs for labs and “it’s not in the system. Go wait and I’ll keep checking and if in a bit its still not there I’ll send you upstairs.”

I wait 10 minutes. 2 people come and go in that time. Checked in, taken back, and gone in that time. I go back to the desk and talk to person two who checks me in and says “yup go and wait.” Person one says, “she’s not in the system. I’ve been checking.” Person two doesn’t say anything. I go and wait another 10 minutes. two more people are checked in, get called back, and leave in that time. So I go back up as Nick is waiting in the car and has been for almost an hour at this point and person one immediately sends me upstairs because, and I quote, “the order isn’t in the system.”

Person 2 heard this. Did not say anything. Did not say anything while I waited for the elevator. I get up there and the receptionist is on it and super sorry because I should not still be here after 20 minutes. My doc’s nurse prints out the order and everything. I go back down and person 2 yells at me.

She yelled at me for listening to person 1. 

“I checked you in and told you that you were checked in and she messed up and you shouldn’t have gone up there. The lab tech is waiting for you now and has been waiting.”

I was speechless and thankfully my mask hid my slack jaw because...why are you yelling at the person just trying to get bled so she can leave. I didn’t fuck up, your desk mate did. Yell at her, not me.

When I went back to the tech I apologized and told hee I was getting conflicting information and was told I both was and wasn’t in the system and she was very understanding. 

I just......today has been exhausting.