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At the same time that you’re working on many other changes, you may be entering a new phase of dealing with external appearances and differences. Recall the time it took for you to get used to the change in your image after you started using assistive devices, such as braces or a wheelchair. Remember how Joan refused the power wheelchair for a couple of years because it looked stodgy and bulky? As she reentered life more fully, she realized that the power chair gave her greater freedom and autonomy to do the things she wanted to do. She began to adapt or modify her image of herself in the power chair. This is what reframing your self-image is all about.

As you gain more self-direction, you’ll probably feel free to make the decisions that feel right to you, including decisions about how you present yourself to others. Have you learned the art of reframing your picture to highlight those aspects of yourself that you value most – a well-developed, muscular upper body, beautiful long hair, friendly eyes, nicely proportioned figure, big smile, or symmetrical features? Lee, for example, is conscious of the cut of his suit jackets, preferring a shorter cut, which looks better when he’s in his wheelchair. Lark wears slacks because she feels she looks more attractive in them. She always dresses up, believing that “people treat you with more respect” if you are well dressed and that a good appearance creates positive attitudes and enhances relationships with others.

Remember: there are many “right” decisions. Listen to your inner voice to find out what you want. Some people proudly include their sports wheelchair or crutches or power chair in their photographs. Others do not. How you choose to see yourself is up to you. This is a part of the fine-tuning of your adjustment to spinal cord injury.

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Cyclosporine

Cyclosporine is often used to suppress the immune system following organ transplants. It also provides benefits in rheumatoid arthritis, inducing rapid improvement when taken in high doses and slower improvement at low doses. There is some suggestion that cyclosporine may actually be a disease-modifying drug that can delay the appearance of new joint erosion, although this is far from proven. Unfortunately, cyclosporine can cause numerous toxic effects, including seizures, inflammation of the brain and kidney injury.

Leflunomide

The new kid on the immunosuppressant block is leflunomide, sold under the trade name Arava. Approved by the FDA in the fall of 1998, leflunomide is said to work by different mechanisms’ than most other immunosuppressing drugs. However, the exact mechanism is not certain. It appears to prevent more cells from being made in the synovial membrane by limiting cell division. Clinical trials of the drug demonstrated that it was able to relieve pain and swelling associated with rheumatoid arthritis, and it may slow damage to joints. Side effects seen most often in these trials included stomach upset, weight loss, rashes and other allergic reactions, and reversible hair loss.

Warning: There are concerns, due to information from animal studies, that the drug may cause birth defects; it should not be used by pregnant women, or even by women not using reliable methods of birth control. Like most of the rheumatoid arthritis drugs, it may also be toxic to the liver, and should not be used by anyone with liver disease. Your doctor should check your liver enzymes periodically while you are using it.

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