At my worst, just before I was diagnosed and began treatment with MTX (and later, Humira alone), I would work, come home and be done. ON weekends, I was just done. My husband says I basically spent a couple of years doing nothing but working and not moving from the couch.
Your experience with MTX sounds like mine. I injected on Friday evenings and spent Saturday napping. Sometimes, I spent Sunday napping also. By Tuesday, sometimes Wednesday, I noticed a distinct downturn in how I felt. Are you taking oral MTX or injecting? If you're doing oral MTX, talk to your doc about injecting. It may help--a bit--with the nausea.
I did notice the crushing fatigue left pretty quickly after I began treatment. I well remember the day I testified for a former client and spent the entire day in a very uncomfortable seat outside a courtroom in Louisville, Kentucky, then went to lunch with colleagues. Instead of being down that night and the next two days, I went to work the next morning.
Now that I'm three years in, with other physical ailments also being treated (200 mg Progesterone twice a day; 5 mg Methimazole 6 days a week), I'm doing a lot more. I noticed REAL improvement when I began Progesterone in October of 2014.
Now, we're swimming one to two days a week. I'm walking more and going to restaurants. I'm going to the grocery regularly. We've been to the mall several times, we've been to three concerts this year and were in Gatlinburg for three days back in October. For the first time in two years, we're having dinner with some old colleagues this Saturday evening. At some point between now and Christmas Eve, I'll be going to the library, also for the first time in two years.
I'm tired after I spend the day visiting clients (at least a one hour drive, one way) in various Kentucky jails and prisons, but I'm not down for a couple of days afterward. I try to schedule those on Fridays so I can spend Saturday doing nothing, if I need to. Sometimes I do, sometimes I don't.
I've also had to testify a couple of times this year, luckily those have been on Fridays so I can have Saturday to rest. I did a presentation at my agency's annual seminar this year--I was away from home for three days to attend that. Once again, I was tired but not down. I did make sure to schedule Friday of that week off. I spent the day alone, reading but because I was talked out and tired of people, not horribly exhausted.
Last week, I worked on my trial case and lived in a hotel room about 100 miles away from home. We did five days of very intense work, worked on and filed 10 motions, discussed a number of other motions and had other case discussions. I also visited the area one afternoon and saw my client another afternoon. Having PsA means I don't sleep well in hotel rooms any more--if it's not the left arm/shoulder and c-spine issues, it's the right hip.
The point of all of this is I took two naps on Saturday and another on Sunday--nearly fell asleep at work yesterday afternoon and today, I'm still recovering. It's not the awful, crushing fatigue like before I was diagnosed, but it's more than normal exhaustion from five hard days, including not sleeping well. Definitely a point to talk about when I see my rheumatologist on Thursday.