Two weeks ago I saw a new Rheumatologist, new to me but not new 'in post'. WH had seen this chap once and we were both impressed with his approach, study ALL the notes, ask endless, seemingly unrelated, questions, quick-fire fashion all whilst his brain was processing the information at lightening speed. As it happened, he didn't think WH's problem fit his diagnostic criteria and recent events have confirmed that. I was thus prepared to be dazzled with the speed of a clever doctor's mind working overtime for me and overwhelmed by having to answer and hundred questions at once. I was also apprehensive that he would, like his colleagues dismiss me as another, over worrying 50-something.
Disarmingly he greeted me with a smile and with the words that he had studied my entire medical history and had noticed a large number of random ailments which he thought just might be connected. He said I had previously seen all the Rheumatologists in the district and now maybe I should get some answers. He proceeded to outline my collection of symptoms, starting at age 12 and a problem with my wrist, through sacro-iliac problems following being hit with a hockey ball the following year until he reached recent matters with my hands and feet, via skin rashes, allergies and the myriad investigations of the typical heart-sink patient. He then examined me and again surprised me by seemingly ignoring my hands other than a cursory glance and paying far more attention to my arm (long standing rash) and my feet which he poked and prodded and caused more pain then I have ever had in them and that's saying something. He asked me about cortisone I had had in my hands, shoulders and feet and got me generally confused and reduced to a gibbering wreck as I tried to answer him succinctly and quickly. After all, who can remember the precise date they had an injection in the sole of the foot, the pain, yes, but the month, possibly, the year probably. And so it went on. He told me to get dressed and then shouted from the other room to ask if I had ever had anything wrong with my scalp. I had, I have right now. He rushed back in and stroked all over my head, with a gentle version of an Indian head massage. 'Very extensive' was his only comment.
Returning to the office fully dressed, he appeared to be surfing the internet. I sat and waited. Finally he asked me about my family if anyone had arthritis - all except my mother, or psoriasis - my sister, my cousin. He then delivered his verdict. I have probably had psoriasis most of my life and now have full blown Psoriatic Arthritis. He described in detail symptoms I had which no doctor has ever made much of, the rash I can feel but is invisible, the joints which feel like they will burst, the itch I have had for upwards of 10 years but which will not go away, the sores I had on my head and which lead to long term bullying at school. My miraculous recovery last year was due to 2 things, the eradication of the Lyme bug from my system and the fact that the Lyme treatment is an old fashioned treatment for arthritis. A classic case of killing two birds with one stone, or in this case two illnesses with the same treatment. Which is why the arthritis and psoriasis have returned to fight another day but the Lyme symptoms have not. My previous diagnosis of Rheumatoid Arthritis was similar but he felt only part of the picture.
He wrote me 3 prescriptions there and then and I had 4 x-rays, some blood taken and have to have a full bone scan and a MRI of my hands. 'About the only two tests you don't appear to have had already,' he joked. After the scans I can take some of the heavy duty stuff he has prescribed but for now I have pain killers which work (makes a change) and some weird cream made from chili peppers which magic the pain away in minutes. I have to be careful where I put that stuff though!
He smiled, was gentle and caring. I liked him, I trusted him, even more so when he said he has relatives with the same complaint. His aim is for me to be pain free in the long term and significantly better in a couple of months. After all he said you've seen enough people who had missed it, it's about time I had some treatment.
So once again I have been failed by the NHS and their cost cutting, time saving piece meal approach to patient care. When someone took the trouble to view me holistically and look at all the information instead of a tiny part the answer was staring him in the face and probably had been for 40 years.
Disarmingly he greeted me with a smile and with the words that he had studied my entire medical history and had noticed a large number of random ailments which he thought just might be connected. He said I had previously seen all the Rheumatologists in the district and now maybe I should get some answers. He proceeded to outline my collection of symptoms, starting at age 12 and a problem with my wrist, through sacro-iliac problems following being hit with a hockey ball the following year until he reached recent matters with my hands and feet, via skin rashes, allergies and the myriad investigations of the typical heart-sink patient. He then examined me and again surprised me by seemingly ignoring my hands other than a cursory glance and paying far more attention to my arm (long standing rash) and my feet which he poked and prodded and caused more pain then I have ever had in them and that's saying something. He asked me about cortisone I had had in my hands, shoulders and feet and got me generally confused and reduced to a gibbering wreck as I tried to answer him succinctly and quickly. After all, who can remember the precise date they had an injection in the sole of the foot, the pain, yes, but the month, possibly, the year probably. And so it went on. He told me to get dressed and then shouted from the other room to ask if I had ever had anything wrong with my scalp. I had, I have right now. He rushed back in and stroked all over my head, with a gentle version of an Indian head massage. 'Very extensive' was his only comment.
Returning to the office fully dressed, he appeared to be surfing the internet. I sat and waited. Finally he asked me about my family if anyone had arthritis - all except my mother, or psoriasis - my sister, my cousin. He then delivered his verdict. I have probably had psoriasis most of my life and now have full blown Psoriatic Arthritis. He described in detail symptoms I had which no doctor has ever made much of, the rash I can feel but is invisible, the joints which feel like they will burst, the itch I have had for upwards of 10 years but which will not go away, the sores I had on my head and which lead to long term bullying at school. My miraculous recovery last year was due to 2 things, the eradication of the Lyme bug from my system and the fact that the Lyme treatment is an old fashioned treatment for arthritis. A classic case of killing two birds with one stone, or in this case two illnesses with the same treatment. Which is why the arthritis and psoriasis have returned to fight another day but the Lyme symptoms have not. My previous diagnosis of Rheumatoid Arthritis was similar but he felt only part of the picture.
He wrote me 3 prescriptions there and then and I had 4 x-rays, some blood taken and have to have a full bone scan and a MRI of my hands. 'About the only two tests you don't appear to have had already,' he joked. After the scans I can take some of the heavy duty stuff he has prescribed but for now I have pain killers which work (makes a change) and some weird cream made from chili peppers which magic the pain away in minutes. I have to be careful where I put that stuff though!
He smiled, was gentle and caring. I liked him, I trusted him, even more so when he said he has relatives with the same complaint. His aim is for me to be pain free in the long term and significantly better in a couple of months. After all he said you've seen enough people who had missed it, it's about time I had some treatment.
So once again I have been failed by the NHS and their cost cutting, time saving piece meal approach to patient care. When someone took the trouble to view me holistically and look at all the information instead of a tiny part the answer was staring him in the face and probably had been for 40 years.
1 comment:
Wow, what a cool Rheumy! I like the sound of him. I've had skin problems literally all my life and my GP thinks it's psoriasis but my LLMD thinks it isn't. I've had so many ailments over the years (originally minor ailments but they're certainly not minor anymore) which the NHS hasn't taken that seriously or just treat odd symptoms in isolation without thinking to fit the various pieces together in case there's a connection.
I'm sure I have Lyme Disease cos' I actually remember the tick bite and now I have an EM rash as well as a bunch of other symptoms but I'll also definitely want to look up psoriatic arthiritis as well.
Neelu
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