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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
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Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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Hello, I am in desperate need for some answers and pain relief.

Resolved Question:

Hello,
I am in desperate need for some answers and pain relief. I am a 42 year old female diagnosed with Psoriatic Arthritis and Fibromyalgia 3 years ago. In regards XXXXX XXXXX I have skin problems on my hands and foot that were horrible. Dermatologist said Psoriasis. She sent me to Rheumatologist because i have also had horrible joint pain since I was a child that has come and gone over the years. For the past 3 years the joint pain has been significant. Rheumatologist diagnosed me with PsA. (I have nail pitting as well). I have been treated with Methotrexate and Enbrel, Humeria and now they started me on Remicade. * I've only had 1 infusion of Remicade so far. The reason for switching was that while I did get some relief from the joint pain, it wasn't as much relief as we had hoped. In addition, I still had elevated Sed rates and C Reative Protein. However, my skin has cleared dramatically.

In addition to this, I have been diagnosed with Fibromyalgia. I have horrible muscle and nerve pain in my chest, back and neck. I have just muscle pain in my knees and elbow area. It might be important to note that 3 1/2 years ago I had a horrible case of shigles on my right side that was in the dermatone that went from my chest and back. Now, this "fibro" pain is in the same area and it feels exactly like the shingles pain. However, it does cross over to the left side sometimes.

It may be important to note as well, that I became a below the knee amputee 11 years ago. This was after a MVA when I was 18 in wich I crushed my talus bone. After many surgeries to try to fix it until the age of 30, I was forced to have a below the knee amputation. I sufffered lots of pain during those years, and now since the amputation, I have had horrible phantom pain.

The final component is Fatigue. It is awful. Sometimes I could sleep for 12 hours and still be tired.

SO, that is my history. Currently, I am frustrated because I have had 3 new Rheumatoligists at the practice that I go to in 3 years. Because of this, I went 2 weeks ago for a consultation with a Rheumatologist at a different practice. He breifly went over my history with me without having my records and did a breif physical exam. In this short period of time, he said that he is not convinced that I have PsA. Rather he thought it was more Fibromyalgia and Psoriasis. (I thought this was crazy because my skin cleared up dramatically and my joints were feeling better on the immunosuppresants) So, he ordered a bunch of blood work, and Xrays of my shoulders, back, hips and hands. I follow up with him next week, at wich time he will have my records from my current rheumatology practice.

In the meantime, I was proactive and I got the results of the tests he ordered. The Xrays showed I have DJD in my Back, Hips and Shoulders. One hip being worse that the other, one shoulder being worse than the other. It also said there is disc space narrowing in my spine, greatest at L4/L5. (Note: I also have had a herited disc at L4/L5 for many years and for the past year my SI Joint has been horrible with pain. I did months of PT for teh SI joint and finally had to get a steriod injection in it this summer. It has become very painful again) There were no negative finding in my hands. So, these X Ray results are confusing, because I looked up DJD and it says that is Osteoarthritis and from what I found on the internet, not symptomatic of PsA.

The Blood work showed my Sed Rate is still elevated at 35, my Complement Total (CH50) is high at >60, and My BUN/CREATININE is slightly elevated at 22.3. My DNA AB (DS) CRITH, TITER is elevated at 1:80. I looked up the last test and it said that is a definate indicator of Lupus. So, I am just more confused.

My Urinalysis showed Calcium Oxalate Crystals being Moderate at (6-15/HPF).

Finally, I had a catscan done 1 1/2 months ago of my abdomen, (because I was having severe abdominal pain, and they found a large strangulated hernia. I had surgery for it). The reason I mention this is that the catscan showed arthritic changes in my spine as compared to my previous catscan in April 2010.(this scan was done in an emergency situation to diagnose my ruptured appendix) **My Surgeon believes that surgery and healing process is what lead to the weakened abdominal muscles and thus the strangulated hernia 1 1/2 months ago. IMPT: Because of this surgery, I have been off the Methotrexate and Remicade and my skin and joints are so much worse. I am ready to start treatment back up, but I wanted to wait to go over these results with the Rheumatologist I had the Consult with.

The med's I am on for my pain, In addition to the immunosuppresants are Cymbalta 120mg. and Neurontin 1200mg. I also take medications to help with sleep 100 mg. Trazadone and Klonipin .5mg.

This is my history and my present situation. If someone could please give me your opinion of what I may have, I would appreciate it. Do you think I have PsA? Fibro and or something else?
Submitted: 1 year ago.
Category: Medical
Expert:  Camille-Mod replied 1 year ago.

Hi,

My name is XXXXX XXXXX I am the moderator for this topic. I've been working hard to find a Professional to assist you, but sometimes finding the right professional can take a little longer than expected, as the Professionals come online at varying times. I wonder whether you would like to continue waiting for an answer…hopefully it won’t take too much longer. Please let me know, and I will continue my search. If you’d prefer not to wait, please tell me, and I will cancel this question for you. Thank you!

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Expert:  Dr. Rick, MD replied 1 year ago.
I am online and happy to help you with your question today.
Expert:  Dr. Rick, MD replied 1 year ago.
I have reviewed the assistance that the other expert has given you and I am sorry to hear about all the difficulties you have been having.

I agree with what he told you but, in addition, I think there is something else you can do at this point.

Well, it sounds like you have spent quite some time trying to get to the bottom of what is going on. I am sure that your previous doctors have thought of, and ruled out, all of the common and easily treatable conditions that could be causing your issues. Would you say this is a correct statement?

At this point I think the best thing for you to do would be to gather up copies of all your medical records and travel to a large University Teaching hospital. At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.

The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.

If you could tell me what large city you live near and how far it would be possible for you to travel in seeking treatment I would be happy to give you some names. Of course, you could also ask friends and associates or check the internet yourself. Let me know what you would like to do.

Does this answer your question to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick
Customer: replied 1 year ago.

Hello,


Thank you so much for your reply. I really appreciate the thought you put into it.


 


I was thinking the same thing about a large teaching hospital. I live in Pittsburgh. Pa. and I am only 20 minutes away from the University of Pittsburgh Medical Center. That is what I am going to do.


 


I am in so much pain since I stopped my Methotrexate and Injections/Remicade. I woke up this morning with painful, swollen fingers as I often do(however the xrays showed nothing in my hands). I just dont understand. I am supposed to start back on these med's next week. Also, my fibro pain is so bad, worse than ever. (again, it feels just like my shingles pain and it's in the same area as my shingles). But it is in other areas as well, however the chest and back are the worst.


 


I forgot to mention that my recent catscan showed several small nodules in my lungs, and apparently they were there when I had my catscan in 2010 (yet no one ever told me about it). The radiologist report said that there was no significant change since the previous catscan. Again, there has to be something going on that is causing all of this.....


 


Well, thanks again. If you have any other insight, I would appreciate it!


Shanna

Expert:  Dr. Rick, MD replied 1 year ago.
Shanna,

I'm glad I could help to point you in the correct direction.

As to the lung nodules, it is a good thing that they have not changed in almost 3 years....hopefully they will stay that way :)

I wish you the very best. :-)


It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 8474
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
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Dr. Rick, MD
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20+ years as a doctor. Internal Medicine Internship in NYC