Doctors Lounge - Rheumatology Answers
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Forum Name: Rheumatology Topics
|kumidian - Thu Dec 03, 2009 7:12 pm|
I do have a rheumatologist, and have received my diagnosis accordingly, however I'm not entirely comfortable with my diagnosis, the treatments and the explanations.
I've been suffering from severe pain in my hands and wrists (mainly fingers/wrists, and yes, both) for about 2 months now. This is not uncommon for me, but the pain has just more than doubled which is why it began to seem significant. Over the past week, it became so severe that I've been needing to take a lot more vicodin than usual. I went in to see my rheumatologist yesterday, and she informed me that she believes I have tendinitis and has recommended hand therapy.
She neglected to tell me what I can do in the interim, though I asked at least 3 times, and by the end of the appointment was so hopeful about the hand therapy I completely forgot about the fact that I'd have to suffer until at least that appointment.
I also asked her why I developed tendinitis, as crippled as my hands are, I hardly put them through any sort of strenuous activities, so it just didn't add up. She just said it was "...over a long period of time..." , the ellipses (...) being bits of her sentence I couldn't make out. I did a little googling (which I know doctors hate when we patients do this, but I don't sit here believing everything, I just try to stay as informed as I can be without bothering my doctors too much), and found that injections of corticosteroids can be very helpful. I wonder why she didn't suggest this, especially since prednisone (oral) has always been a good friend of mine during really bad lupus flares.
I really do not want to take vicodin. I have suffered from severe nausea (literally 24/7) for almost 3 years now, no definitive diagnosis (I do not suffer from indigestion, zero heartburn), oh and of course vomiting associated with the nausea. I'm down to vomiting about 3 times a week now, occasionally it's a couple times during the day, and I've tried not taking medication to see if it helped, I altered my diet tremendously--I'm a vegetarian, do not eat fried foods, no soda, juice, coffee, alcohol and am lactose intolerant so of course no dairy. I even try starving myself, but it seems that makes the nausea worse. Because of this, you can see why I do not want to be on vicodin, especially at such a heavy dose (besides the other health factors, while I do care for my liver, as a human being we tend to care more about what's happening right now, than what will happen in the future).
So, finally, I guess my questions are, a) what caused my tendinitis? I am positive it is not from over-use, b) why wouldn't my doctor recommend steroids? (I called her office this morning and left a message for a call back in regards to this) especially knowing how much vicodin and zofran I'm having to take, c) given my history, and this post, does it seem like I have received the right diagnosis? I understand that you can't argue much with blood work, but something just doesn't seem right. I do not want to live a crippled life. I want to get out there and get back to my old lifestyle, I want to have a family someday (hopefully soon), I really want children...I just want to be functioning again and I want to know how to achieve this.
I should also include that I try to stay as active as possible by going for 30 minute walks with my dogs twice a day, I go swimming (I live near the beach) for about 30m-1hr 3 times a week, and before this tendinitis thing I was also doing yoga 3 times a week. So it's not a matter of needing to push myself further, I am doing what I can. I have followed all my different doctor's orders to a 'T'. I've recently been able to cut my medication list waaaay down after carefully reviewing them with my general doctor, but I'm hoping to cut it down even more.
I'd at the very least like to know a little more about this tendinitis hooplah. All the googling I did seemed to repeat the same things over and over again all products of over-use, and rarely you see people with finger tendinitis or have it replicated in their opposing areas...it's to the point now that I can't sleep properly. Last night I woke up 5 times in tears from the pain. This morning (after taking a few vicodin to get myself to sleep) when I woke up, there wasn't much pain, though my hands were very stiff, a few hours later they began to hurt again. I've begun shutting myself out from my friends and family again, and I'm moody and angry, and this just isn't me. I need some answers...
Thank you so much for your time reading all this, I know I tend to babble, but I figure the more information (no matter how insignificant) I give, the more someone can help me...
|Dr.M.Aroon kamath - Mon Dec 07, 2009 4:33 am|
Without actually examining a patient in these circumstances, it may not be possible for anyone to hazard a diagnosis.One should be able to examine & determine what is causing the pain in your hands such as...... tendernesss in the muscles, joints or the tendons, the range of movements of the joints, swelling of the joints and so on.
Arthralgia, myalgia, and frank arthritis(in SLE) may involve the small joints of the hands, wrists, and knees. SLE arthritis or arthralgia (in contrast to rheumatoid arthritis), may be asymmetrical, with pain that is disproportionate to swelling.
You mention 'fibromyalgia' as well.Thus diagnosing your condition is not straight-forward. It is possible that you may have co-existing conditions(for example, SLE+fibromyalgia).
It is now-a-days possible to diagnose tendinitis and tenosynovitis fairly confidently by MRI.
You may discuss with your rheumatologist from this point of view (if you are not satisfied with the provisional diagnosis that has been offered).
|kumidian - Mon Dec 07, 2009 1:05 pm|
Thank you for your response. A few days ago I had left a phone message with my rheumatologist about receiving corticosteroid injections, and she agreed it'd be a good idea right now, so I went in and instead of receiving the injections in my joints/tendons because there were so many spots (it would have been every joint in both hands and my wrists) I received one intramuscular injection and was informed it may take about a week until I see the effects.
I do have a definitive RA/SLE diagnosis, I'm not sure what Frank arthritis is, but I will go read up on it on google. The fibromyalgia diagnosis I received a year or two ago is kind of up in the air because there are no real diagnostics for that disease and the only symptom I've suffered from it was random flares of tender spots around my body (pain only upon touch).
I also did receive a definitive diagnosis of tendonitis, I guess I'm just concerned because it seems like every other month I'm diagnosed with something new, and this just isn't making sense to me. I understand that it is part of SLE, but I still feel uncomfortable. I plan on being more pro-active and upfront with my doctor and hopefully things will improve...
Again, thank you.
|Dr.M.Aroon kamath - Tue Dec 08, 2009 10:31 am|
Thank you for the update.I appreciate your attitude.You should get well soon.
By the way, 'frank arthritis' is a way of saying that it is not just an 'arthralgia'!
|vagha007 - Tue Feb 09, 2010 10:11 pm|
I am a 39 year old female with a 10 year history of joint, muscle pain and inflammation. Strong family history or autoimmune and arthritis (osteo and rheumatoid).
Sed Rate - 42
LDL CALCULATED 142
CHOLESTEROL/HIGH DENSITY LIPOPROTEIN 4.5
WBC'S, UA/HPF 0-2
RBC, URINE HPF 4-10
EPITHELIAL CELLS, URINARY SEDIMENT, LPF FEW
BACTERIA, URINE HPF FEW
MUCUS, URINE PRESENT
ANTI - ds-dna 1:10
Doctors keep just telling me its Fibromyalgia, one Rheumatologist said UCTD and inflammatory arthritis. I know it's not just Fibromyalgia, I have educated myself over the years with my sister Crohn's and Behcets.
Please help me to steer me in the right direction with my rheumatologist. I am so frustrated, I can not work anymore or be a good wife or mother. Docs just want me to keep taking Narcotics. I am having a full renal workup due to the continous trace of blood in my urine.
They ruled out Lupus since my C3 are high and I never experience rashes. I feel it's Rheumatoid, but my doctor looks at me like I am making a mountain out of a mole hill. He won't take me seriously, and I am miserable. Please help
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