General Medical issues thread

[rogerkambah]

Sorry to hear about your friend (or friend of a friend). I am just getting old from the sounds of it - my GP seemed to think medication would work well. Need to do some reading, as it’s not an area I know much about

If you're getting old, what does that make me.

 

[lakeman]

After LtL and Cossie’s friends my problems seem very minor .

First my good news - latest cholesterol tests

total cholesterol 4.5, HDL 2, LDL 2.2 and trigs .73- amazing what not being totally dehydrated will do

General rheumatological tests came back negative. However CRP and ESR elevated (48 and 83) and bone scan showed inflammation in the joints. Diagnosis is Statin induced PMR and yes it is a thing - apparently there is a study using the WHO database which shows a correlation between statins and PMR. Quite rare and I guess I have a genetic disposition, or my age or something. Most people taking statins would not develop PMR. What is a bit annoying is I don’t need Statins, as I don’t have clogged arteries. Anyway we decided against corticosteroids- I feel I have improved a heap in the last month and I am prepared to put up with a bit of pain and stiffness. Extreme tiredness is annoying, but I am having lots of rest. Am trying to do a bit of Tai Chi again to get strength into the muscles and flexibility to the joints.

Then I have the results of the 1 day Holter monitor. Still have to do a 7 day one and an echo, but things probably won’t change. This all started in February when I had an MRI to see if there were any issues as I had had double vision for a few years and my optician thought it would be a good idea. The MRI didn’t show any tumours, but did show I had had a stroke. My GP followed guidelines and put me on Statins, which then caused all the other problems. What the monitor showed is that my heart isn’t beating properly, (ventricular and atrial ectopic), so basically the blood sloshes around, forms a clot which ends up causing a stroke. Probably going to end up on xarelto but will let the cardiologist make the decision in July. Currently on low dose daily aspirin.

-Sorry to hear of your troubles.
For the benefit of others :
Statins are a 1 per cent risk of benefit in strokes.
No certainty that they are causing your inflamatory issues.( small risk in ceasing them)
Prednisone (depending on your comorbidities) will make you feel better quicker.
Warfarin/NOACs have proven benefit for stroke prevention only in AF.
You can't rule out a seronegative arthritis

 

[drron]

There is a difference to what most people think what is a cause of a disease and what Medicine considers a cause.Myositis is caused by statins.The bichemistry is understood and there is no doubt.there are cases of people on statins having polymyalgia rheumatica but it is an association not a proven cause and effect.Both are relatively common and both are more common as people age so likely that the 2 will co exist.That doesn't mean proof.You will however find some doctors who confuse the issue and sometimes also genuine differences between doctors

Polymyalgia Rheumatica is related to autoimmune diseases the cause though is unknown.It occurs in people over 50 with an average age at onset 72.It is twice as common in women than men.There is often a family history of autoimmune disease.There is no specific diagnostic test but ESR and CRP should be elevated.Also there is usually a rapid and dramatic response to steroi_s.I have had one patient going from being bed bound to walking freely 3 hours after 60mg of prednisone.

A link re PMR.Hopefully my login holds.

Polymyalgia Rheumatica (PMR): Practice Essentials, Pathophysiology, Etiology

Polymyalgia rheumatica (PMR) is a relatively common chronic inflammatory condition of unknown etiology that affects elderly individuals. It is characterized by proximal myalgia of the hip and shoulder girdles with accompanying morning stiffness that lasts for more than 1 hour.

emedicine.medscape.com

 

[Flying mermaid]

If you're getting old, what does that make me.

I would have thought we were similar ages

 

[Flying mermaid]

There is a difference to what most people think what is a cause of a disease and what Medicine considers a cause.Myositis is caused by statins.The bichemistry is understood and there is no doubt.there are cases of people on statins having polymyalgia rheumatica but it is an association not a proven cause and effect.Both are relatively common and both are more common as people age so likely that the 2 will co exist.That doesn't mean proof.You will however find some doctors who confuse the issue and sometimes also genuine differences between doctors

Polymyalgia Rheumatica is related to autoimmune diseases the cause though is unknown.It occurs in people over 50 with an average age at onset 72.It is twice as common in women than men.There is often a family history of autoimmune disease.There is no specific diagnostic test but ESR and CRP should be elevated.Also there is usually a rapid and dramatic response to steroi_s.I have had one patient going from being bed bound to walking freely 3 hours after 60mg of prednisone.

A link re PMR.Hopefully my login holds.

Polymyalgia Rheumatica (PMR): Practice Essentials, Pathophysiology, Etiology

Polymyalgia rheumatica (PMR) is a relatively common chronic inflammatory condition of unknown etiology that affects elderly individuals. It is characterized by proximal myalgia of the hip and shoulder girdles with accompanying morning stiffness that lasts for more than 1 hour.

emedicine.medscape.com

Definitely not a proven cause, but in my case I think it is not unreasonable for my GP to assume it. PMR could be caused by a virus, infection, environmental factors such as chemicals - hopefully one day they might pin it down better, or maybe it will always be multiple things that can trigger it. Autoimmune diseases are a difficult area.

If I was not getting better - have improved massively in 2 months - I would look at corticosteroids, but given the side effects, my GP and I were happy to steer clear of them. In March I was unable to walk properly and couldn’t raise my hands enough to wash my hair properly. Now I can walk off any stiffness in my legs in a minute, I can raise my arms quite well and have even been able to resume Tai Chi (although working up to how much I do it). Surely given that improvement, it is worth keeping off corticosteroids and letting the healing happen naturally?

 

[Flying mermaid]

-Sorry to hear of your troubles.
For the benefit of others :
Statins are a 1 per cent risk of benefit in strokes.
No certainty that they are causing your inflamatory issues.( small risk in ceasing them)
Prednisone (depending on your comorbidities) will make you feel better quicker.
Warfarin/NOACs have proven benefit for stroke prevention only in AF.
You can't rule out a seronegative arthritis

I am more than happy to feel better more slowly and keep off corticosteroids.

I will be seeing a Rheumatologist as well - just waiting for an appointment. I also had a bone scan to help confirm the PMR diagnosis.

No doubt after my 7 day Holter monitor and echo my cardiologist will find the appropriate treatment.

 

[drron]

The problem with PMR is that it is often associated with temporal arteritis.The major complication of that is sudden blindness.steroi_s prevent that.
Also as far as symptoms go steroi_s are very effective very quickly so you can go from severe pain to virtually none with a short course of steroi_s.If you take them for less than 3 weeks there are very few side effects.

 

[Flying mermaid]

The problem with PMR is that it is often associated with temporal arteritis.The major complication of that is sudden blindness.steroi_s prevent that.
Also as far as symptoms go steroi_s are very effective very quickly so you can go from severe pain to virtually none with a short course of steroi_s.If you take them for less than 3 weeks there are very few side effects.

Yes I know about GCA - bit scary. 3 weeks would be OK, but in most cases of PMR you seem to need them much longer. My GP seemed to think you were talking multiple months and she was happy not to use them. Anyway as long as my current rate of improvement continues I should be fine. Our generation doesn’t mind a little pain

 

[lakeman]

Also as far as symptoms go steroi_s are very effective very quickly so you can go from severe pain to virtually none with a short course of steroi_s.If you take them for less than 3 weeks there are very few side effects.

Listen to the experienced older doc.
I love your stoicism FM (sorry ,originally said LTL who I think is a friend ?) but I wouldnt like my friends or family to suffer for so long.( of course allowing for your comorbidities )

 

[Flying mermaid]

Statins are a 1 per cent risk of benefit in strokes.
No certainty that they are causing your inflamatory issues.( small risk in ceasing them)

i only took the Statins for 9 days. I was such a mess by then I just couldn’t keep on them. Massive muscle and joint pain which started improving after I stopped, although after 2 months there is still a way to go. Fortunately I have now had a carotid ultrasound and my arteries are normal, so going off them is not an issue. I think I am setting some sort of record in the number of tests and specialists I have managed to see in 2 months

 

[Flying mermaid]

Listen to the experienced older doc.
I love your stoicism LTL but I wouldnt like my friends or family to suffer for so long.( of course allowing for your comorbidities )

Not suffering I promise you . Just a little pain and many would have far worse. I mean really when you look at ltl and Cossies friends - this is just a minor illness.

 

[suze2000]

I have taken several short courses of prednisolone and actually find it makes me feel quite good. The lack of pain in my joints and body reminds me very much of when I was young, and I feel far more alert and energetic. Have never suffered any significant side effects on them, but also the doses I've needed have not been particularly high and as long as you are not on them for long you don't end up with a puffy face or anything.
That said, I can tell you are determined not to budge FM, and given your experience with the statins, I might be a little pill-shy as well.

 

[love_the_life]

Listen to the experienced older doc.
I love your stoicism LTL but I wouldnt like my friends or family to suffer for so long.( of course allowing for your comorbidities )

Not suffering I promise you . Just a little pain and many would have far worse. I mean really when you look at ltl and Cossies friends - this is just a minor illness.

I think you might have meant FM. The friend of a friend who was diagnosed with station induced myositis from what I understand had been on statins for many years and the symptoms got worse over that time. It wasn't that that ended her up in hospital; she had a fall (is well in her 80s) and it was as part of that treatment they discovered the myositis.

PMR does seem to run in our family as both parents suffered from it at times some years ago. Both took steroi_s as that was the given treatment and both made good recoveries. Father has since passed away but mother is keeping as well as can be expected at 96. This week she is just starting to have meals on wheels for 2 days a week. I seem to have escaped PMR so far, though shouldn't count my chickens.

 

[love_the_life]

My friend's 'partner' passed away last night. Sad though it is, we are all thankful that it was a peaceful death, without leaving him to suffer. His children and her were with him which was good, I am glad I saw him yesterday even for a brief time. I think the speed of the disease has shocked everyone.

 

[love_the_life]

If you're getting old, what does that make me.

Not too much older than me!

 

[Flying mermaid]

I have taken several short courses of prednisolone and actually find it makes me feel quite good. The lack of pain in my joints and body reminds me very much of when I was young, and I feel far more alert and energetic. Have never suffered any significant side effects on them, but also the doses I've needed have not been particularly high and as long as you are not on them for long you don't end up with a puffy face or anything.
That said, I can tell you are determined not to budge FM, and given your experience with the statins, I might be a little pill-shy as well.

yes I was just discussing this with Mr FM and I said most of my obstinacy is a result of the Statin fiasco. He is totally supportive of my decision.

 

[rogerkambah]

Saw my GP yesterday just routine to get some scripts.
He said I was looking pretty well and I replied that I feel well too.
He runs through a checklist and when he got to pain I said I didn't have any. Nothing in the joints or back.
Beside a bp drug and lipitor he has prescribed 600mg of allopurinol a day to keep my uric acid levels low. I have been at this level for about 6 months. I used to have a little back pain when I first woke but it is no longer. Don't know whether its the allopurinol or gym exercise that has helped.
Anyway not complaining.

 

[rogerkambah]

Not too much older than me!

More than 10% I would think.

 

[love_the_life]

Saw my GP yesterday just routine to get some scripts.
He said I was looking pretty well and I replied that I feel well too.
He runs through a checklist and when he got to pain I said I didn't have any. Nothing in the joints or back.
Beside a bp drug and lipitor he has prescribed 600mg of allopurinol a day to keep my uric acid levels low. I have been at this level for about 6 months. I used to have a little back pain when I first woke but it is no longer. Don't know whether its the allopurinol or gym exercise that has helped.
Anyway not complaining.

You seemed very well in the photo you posted in the cars thread. I commented to Cossie when I saw him how good you looked. Long may it stay thus.

 

[JohnK]

If you're getting old, what does that make me.

We're all getting old. We're all one day older each new day.