I’m not ill but I live with a chronic illness. Most of the time I don’t think about it. I’ve made certain modifications to deal with it . I’ve accepted the ugliness of it. And I’m oh so grateful as it could be a lot worse.

I have psoriatic arthritis. As a child and a teenager I suffered from psoriasis. It would come and go. As a young child I remember being smothered in cream and wrapped in plastic before pulling on my pyjamas. At its worse it covered most of my body including my face. I was a student nurse at the time and forever being asked by patients whether it was catching. And it then disappeared only for it to re-emerge in my 30s in its arthritic form. Fortunately it was only in my fingers although more recently it has moved to my thumbs. I’m on medication that has significantly slowed down its progress. There is no cure. It can only be controlled.

Over the years my joints have become inflamed and then deformed. My hands have got uglier, but they still do what I wanted them to albeit a little clumsier. So I have resisted the offer of joint replacement. I have to keep my hands warm. If they get cold they are extremely painful. I love weightlifting so have to use straps when performing certain lifts. A 100kg deadlift would be excruciatingly painful without my straps.

But my chronic illness wasn’t content with just my hands. It went for my heart. Well that was the conclusion of the cardiologist although my rheumatologist was less convinced. Whilst there is a lot of evidence of heart disease associated with rheumatoid arthritis there has been less research on psoriatic arthritis.

But something calcified my aortic valve needing me to have open heart surgery in 2015. I’ve now got a mechanical aortic valve and a lifetime of warfarin to stop it getting clogged up.

Being on warfarin is a pain. It is a high risk medication. It works by reducing the time it takes for your blood to clot. Reducing the time by too much can cause bleeding, too little and clots could develop. Unfortunately so much can alter the effect of warfarin. Other medication, supplements, alcohol, exercise. Life has to be consistent. I’m supposed to eat the same amount of green vegetables, drink the same amount of alcohol and do the same amount of exercise every day. Of course I don’t. But I manage to stay within therapeutic range most of the time. The one time when it became dangerously high was when my GP started me on statins but failed to inform me that it would interact with warfarin. My track record with GPs isn’t great.

The biggest risk of being on warfarin is sustaining a brain injury that could result in a huge bleed. It would be game over. A year after my open heart surgery I competed in a Tough Mudder. It was great but I was probably taking too much of a risk. I’m now a bit more sensible.

So I now have psoriatic arthritis and a mechanical heart valve. I take medication for both. I have regular blood tests for both. But I only get seen by my rheumatologist. At least once per year. I haven’t seen a cardiologist for over four years. I’m not sure whether this is by design or negligence.

Like many people with a chronic illness when the pandemic hit I considered whether I was in a vulnerable group. I concluded that I wasn’t. And as no health professional told me differently I waited in line with the other over 60s for my COVID vaccine. It was only when I was invited to have a 3rd vaccine (not a booster) that I was told that I was in a high risk group. Not due to my heart or being on warfarin but due to the medication I’m on for my arthritis. It makes me immune suppressed. Although you’d never guess. It’s years since I had a cold.

Being told that I was being offered an additional vaccine due to being in a vulnerable group did make me think. I’ve never considered myself vulnerable. I’m fitter and stronger than many people of my age. I invest in my health. I enjoy a life that is only possible with good health.

But what if it disappears tomorrow? What would happen if my arthritis migrates to my knees? Or my mechanical valve starts to leak? Could I live a life with reduced mobility? Could I go through more heart surgery? People have gone through a lot worse so I’d just need to suck it up.

But it scares me.