Sunday, May 30, 2010

"When It Rains, It Pours"

For me the title applies to my current medical condition.
I have been battling with achy muscle, sometimes very significant, interfering with sleep and certainly with quality of life. I had thought it was due to my cholesterol medication because the strength of that medication had been changed recently. I had spent some time stopping and starting that medication to see if it made any difference with my symptoms and it did seem to me to help. My blood tests that might show the muscle damage that can occur with cholesterol medication were normal. Since I have recently been treated and cured from giant cell arteritis, a blood vessel inflammatory condition tht requires high dose prednisone to supress, I have a risk of a complication of that disease called polymyalgia rheumatica. This is a small vessel inflammation that involves the muscles of the proximal extremities that cause achiness and fatigue. But we had thought of this and the blood test that would help confirm this had remained normal. All through our trip to Eastern Europe I was very achy, and had difficulty sometimes getting around the castles and ruins that we explored on this trip. It made this trip very difficult for me and fraught with suffering. We arrived back in town on May 27 and I went through with my preop testing and exam as planned. My internist suggested I contact my rheumatologist about these aches. Id did and even over the phone he agreed that I did have polymyalgia rheumatica -- the complication I referred to above. He told me it occurs 60% of the time when patients are coming off prednisone for treatment of giant cell arteritis. He suggested I go back on prednisone but in low dose. In two days of 10 mgm per day my symptoms are about 70 % better, though not gone. So again my blood sugars are out of control due to even the low dose prednisone. I am told none of this should have any negative affect on my melanoma surgery planned for June 2 so that will proceed next week on June 2.

Even though I myself was (am) a physician, I never liked going to see a physician as a patient myself. I always went when I had to, but strangely enough I got nervous, my blood pressure would go up (so called white coat hypertension), and I experienced some dread about the visit ahead of time. As I have gotten older, I have had to go to the doctor more frequently to check my diabetes, my cholesterol, my blood pressure and then of course the giant cell arteritis, so I have become some desensitized to these visits and my blood pressure no longer goes up. But lately I am getting an idea that life is being unfair to me. There should be a rule that says any individual patient only needs to be struck with one life threatening illness at a time. Alas, there is no such rule. So I just plod along and do what I have to do to treat each individual condition but it ain't easy. As a physician, sometimes I have felt great compassion toward patients who are going through cancer treatment just because of all the tests, and treatments, repeat status checks etc -- constant visits and procedures. I wondered how these people keep going through all these machinations of their bodies. When an obituary says: "After a battle with cancer, so and so died of the disease..." I truly realized that indeed that person was in a battle, maybe more of a war with repeated battles won and lost against the cancer. I can see under some circumstances where the patient would just get tired of this battle and decide not to proceed with the next recommended treatment or testing procedure. Of course, I am not at that point; I will do what needs to be done. But the classical question: "Why Me?" and this feeling of unfairness, and "Enough is enough." are upper most in my mind right now. Again stay tuned.

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