Their Very Special Marriage by Kate Hardy

we’ll try it by tablet first. You just need to take one once a week. Though there are some side-effects you need to know about. You might find you don’t grow as quickly as the other girls in your class—though you will catch up with them—and your periods might become a bit irregular.’
    Paula flushed. ‘Oh.’
    Oliver smiled. ‘Sorry, but I’m afraid I need to embarrass you a bit more now. If you’ve been taking the odd sip of your mum’s wine, you’ll need to stop—if you drink alcohol when you’re on methotrexate, you can feel quite rough and you might damage your liver. You’ll also need to be a lot more careful than the average teenager when you’re old enough to have sex—if you get pregnant while you’re taking methotrexate, it can affect the baby.’
    â€˜I’m not having sex with anyone. I’m only thirteen,’ Paula muttered.
    â€˜I know,’ Oliver said kindly. Damn, he’d handled this clumsily. Rachel would have done a much better job. ‘But I also know how teenage boys can put the pressure on. You’ve got a great excuse to say no.’
    â€˜What happens if she doesn’t take them properly?’ Mrs Russell asked.
    â€˜You’ll get a flare-up,’ Oliver said. ‘So you need to take your medication regularly, Paula. And make sure you eat properly and get enough sleep, too—the healthier you are, the less your arthritis is going to affect you.’
    â€˜Right.’ Paula sighed. ‘Mum’s always going on about what I eat.’
    â€˜Everything in moderation,’ Oliver said. ‘If you fancy the odd choc bar or ice cream, that’s fine. Just don’t stuff your face with junk food all the time—and, just as importantly, don’t go on any extreme diets.’
    Paula looked worried. ‘Will I put on weight?’
    â€˜You shouldn’t do, no,’ Oliver said reassuringly. ‘Oh, andone more thing—chickenpox is doing the rounds. Have you had it?’
    Paula nodded. ‘When I was eight.’
    It was rare to get chickenpox more than once. ‘That’s good.’
    â€˜Why?’
    â€˜On methotrexate, if you get chickenpox you might get it a bit more severely than normal. The medication affects certain viruses, so I can’t give you a TB or polio vaccination, but you’re fine to have the meningitis vaccination.’
    â€˜Does this methotrexate work?’ Mrs Russell asked.
    â€˜Tests show it’s safe for teenagers to use and it’s effective, though it doesn’t work for everyone.’
    â€˜What if it doesn’t work for me?’ Paula asked.
    â€˜Sometimes the tablet form doesn’t work and you need to take it by injecting it under the skin instead. We’ll keep a close eye on you to see how you’re doing. If you need to change from tablets to injections, I can teach you how to do the injections yourself—a bit like if you were a diabetic,’ Oliver said.
    Paula pulled a face. ‘I don’t like needles very much. Is there anything else I can have instead?’
    â€˜There are other drugs, yes—but they’re still being trialled at the moment. There’s something called etanercept, a TNF-alpha receptor fusion protein, which looks pretty promising.’ He smiled. ‘And now I’m talking jargon at you. We might also need to give you something called corticosteroids—these aren’t the same as bodybuilders take, so don’t worry about that. What they do is reduce the inflammation and help you control the pain. Though they can have other side-effects. You might bruise more easily and your bones can become brittle, so if we give you corticosteroids you’ll need to make sure you get plenty of calcium—dairy foods and sardines.’
    â€˜What about these bumps on her elbows?’ Mrs Russell asked. ‘Show them to Dr Bedingfield, Paula.’
    Paula