Saturday, December 15, 2007

Same Old, Same Old

No real news from the visit to the internist yesterday.

She thinks my chest pain is caused by inflammation in the joint between the sternum and the chest wall. This, she says, is consistent with both the parvovirus theory and the connective-tissue autoimmune theory.

(She explains it by saying that the parvovirus made me sick initially but for some reason caused an autoimmune response, which is why I'm still ill. It's uncommon, but has been documented in the past. Apparently, something similar can happen with strep throat, which can morph into an autoimmune disease that causes severe joint pain. Who knew?)

She did an EKG, which was similar to my past ones except she could tell from the print out that I was shaking during it. I suspect that was mostly from my lack of sleep the night before, but I do shake more when I'm in a lot of pain for some reason. The neurologist I saw said it was most likely an essential tremor.

She also ordered a chest x-ray. Unfortunately, the radiologist was otherwise occupied, so she said it was inconclusive whether I have fluid in that joint area in my chest, which would explain why the pain is so severe.

She put me back on the higher dosage of Prednisone (60 mg/day) because in theory that will reduce the inflammation and make my chest hurt less. We'll see. She did not agree with my theory that the Prednisone was the cause of the chest pain, but she did acknowledge that my body just doesn't react well to steroids in general.

She told me that another patient of hers who has a similar chest pain gets shots of cortisone into her chest, but I said I really wasn't interested in going that route because I've had so many cortisone injections previously in other areas of my body and I've never gotten any good results from them. She had no problem with my decision there.

So, essentially, she just gave me more and stronger narcotics to hopefully get me through this. When I was home from the hospital, I was on one Percoset every 4-6 hours as needed. Unfortunately, after a couple months of that, I started having an allergic reaction and itching uncontrollably so we changed meds. Eventually, I ended up on Dilaudid, 4 mg every 4 hours as needed. The Dilaudid was helpful with most of my joint pain, but it really doesn't even begin to touch the chest pain.

So now, when the chest pain is really bad, I'm supposed to take two to three Percosets every four to six hours. The hope is that the chest pain will lessen, and I'll be able to cut back to either just a single Percoset or the Dilaudid.

And I guess now I just wait for my Jan. 8 appointment with the new rheumatologist. And hope that my blood sugar stays under reasonable control without needing medication.

I also had a bunch of blood drawn for yet more tests. I had read that the parvo titre should be taken at least twice to be able to tell if it is an active infection or not and whether or not it's getting better. She also decided to do the strep titre on me because, hey, it's one thing we haven't tested yet and it also could explain my symptoms possibly. And then the usual stuff, like SED rate, blood counts, etc., just to make sure nothing is changing in a bad way there. We expect my SED rate to be lower because it does respond to the Prednisone (although I don't understand why I don't experience less pain when the SED rate goes down ... but maybe it's less than it would be without it. I certainly don't know.

And after a week on the Prednisone, the lovely drug-induced chipmunk cheeks are definitely back. Oh, joy.


SharonMV said...

That was my first thought(see my previous comment) - that's what costo-chondritis is (not sure about the spelling). I've had this too - it can be quite painful.

I remembered that a friend of my husband had Fifths disease as an adult. She was sick for several months & it took a while for the docs to figure it out. I don't know if she had the joint problems.

The shaking could also be from changes in blood sugar. Or thyroid getting too high (syhtroid dose may need adjusting).
The virus could also cause an onset of fibromyalgia in addition to the AI response. Anti-inflamatories will not help with fibro pain.

One good thing if it is from the parovirus, all your symptoms could resolve over time.

PS: I'm with you about the shot in the sternum. Other joints, I'm glad to get that shot & the pain relief, but in the chest - wouldn't like that.

Aviva said...

Ah, thanks! I did see that previous comment, but had no clue what the costochondritis was! I feel a little like I should go to medical school just so I can understand what the heck is happening to my body.

I'm just not sure I buy the Fifth Disease thing. But I do agree that it would totally be great if it turned out that this was something that went away. I guess one of the things that really bugs me is they can't tell me the maximum amount of time the parvo-induced autoimmune stuff can last.

My doc said it could be several years of this, and while I realize a few years is WAY better than a lifetime, it's a little hard to see it as such a blessing since I'm missing out on my kid's preschool years with no end in sight.

Sigh. Sorry. I guess I'm in a bit of a self-pity mode right now. I don't cope well when my pain feels out of control, and that's where I am right now. I'm getting some Yoga for Arthritis DVDs from the library next week, and I'm hoping that maybe they'll help me relax some.

Thanks again for your comments! I always appreciate them!