Wrist Pain: Cortisol injection

I went to see my rheumatologist and found out my chest x-ray was negative for TB. After all the negative TB tests, I thought he would finally admit that I didn't have TB. So. I asked him. He replied:

"There hasn't been any evidence of TB."

So, that grudging response is the nearest thing I would get to an admission.

He said the next step was a cortisol injection. He offered me the choice of having it injected into a muscle or into the wrist. It would be more painful to have it injected into the wrist so I opted for what a thought was the easy and comfortable choice of a muscle injection. I thought the injection would be into my arm. He sent me off to the nurse with a note. She told me to drop my pants as she was going to inject it up my bottom. I feared for my comfort returning on the bus that day.

It was a painful prick but I managed to sit down 10 minutes later. The injection has helped a bit although I do sometimes get shooting pains in my wrist, which I never had before. I wonder how long it will last. Next time, I might need the cortisol injected into my wrist.

I will be back to see the rheumatologist on 8/1/08.

Wrist Pain: Mantoux result - Spot the TB

I went to the hospital for the second time this week. (first time on Monday to get the Mantoux injection) I had a nice red spot at the injection point on my arm and the nurse looked at it. She got out her black felt-tip pen and drew 2 parallel lines with the distance apart equal to the diameter or the spot.

This highly scientific test takes its results from the spot size. More than 1.5 mm diameter and you've got a TB infection. Less than 1.5 mm diameter and you've not got the infection but have got the BCG antibodies ie a weak form of the infection.

My spot size was exactly 1.5 mm. The nurse wasn't sure how to interpret it. She consulted her colleague. Apparently even a large spot size might be a false positive!!

She thought about sending me for a chest x-ray which is another way of detecting TB. Why wasn't this suggested first. Probably because it's more expensive and has a longer waiting list. She wanted me to come back for it. I persuaded her to send me for one today, as I would have to take yet more time off work another day.

I went to the x-ray department and had to take a numbered ticket before I could speak to anyone. After 20 minutes the counter had ticked up to my number. I spoke to the receptionist. She said I was in the wrong place!! I had to go to the Accident & Emergency X-Ray department. Why couldn't I have been told that by the TB department? It wasn't obvious to me that I needed an x-ray due to having an accident or an emergency. I had wasted a lot of time.

I went to the A&E department but didn't have a long wait for an x-ray. Unfortunately, I couldn't understand the x-ray technician as English wasn't her first language and she wasn't anywhere near fluent in it. Let's hope she didn't over-expose the x-ray photograph and sterilise me in the process.

I'm going back to the rheumatologist on 11 December. Hopefully, he won't want to continue his hunt the TB game and I actually get some treatment for the arthritis. It needs to be tackled quickly as research shows that tackled late, it gets worse more than tackled early.

Wrist Pain: Third Time Unlucky?

I finally saw my usual rheumatologist - free for the first time. He seemed to take a different view from the other rheumatologist and wasn't interested in talking about drugs to minimise the arthritis symptoms. After negative blood test and biopsy results, he still wanted to do a further test to eliminate TB. He seems to be hoping I've got TB rather than arthritis and keeps looking for evidence for it.

So, I've got to go back to the hospital next Monday to get the Mantoux test administered by injection and then on Wednesday to see if there is a reaction to the injection.

In any case, I'm going back to work tomorrow. The plan is to work 25% part-time in week 1, 50% part-time in weeks 2, 75% part-time in weeks 3 and back to 100% in week 4.

Wrist Pain: Diagnosis

I turned up on time. I had to wait 1.5 hours. Even though the rheumatologist I had seen privately twice and his name was on the letter, I didn't get him but got someone else, as I predicted (He was just the "consultant presiding" but doesn't turn up). She went over the biopsy results.

The good news was that I didn't have TB.

The bad news was that I didn't have TB.

I have arthritis in the risk. It isn't rheumatoid arthritis so it seems to be a generic inflammatory arthritis that can't be positively identified as the rheumatoid variation.

It's incurable and progressive.

She said that there were different drugs to try and deal with the symptoms but didn't know what her male colleague was going to suggest. I said I should have seen him or she should have spoken to him before I arrived. She agreed. She was keen to offer me leaflets for different options, instead. She seemed to be fobbing me off and procrastinating making a decision on which drug.

There were leaflets for 2 options. From the Net, they take up to 3 months to work but only work in less than 50% of the patients and have significant side-effects.

Sulphasalazine
Possible side-effects:

• nausea
• diarrhoea
• abdominal pain
• dizziness
• headaches
• rashes
• drop in fertility
  
• turns urine, sweat & tears orange

Methotrexate
Possible side-effects:

• nausea
• hair loss
• ulcers
  
• rashes
• fatigue and feeling like having the flu
• increased risk of infection
  
• liver damage (exacerbated by alcohol)
  
• lung damage causing breathlessness
  

She looked at my wrist. At the time of the biopsy, I was told that the stitches were dissolvable. Now, we could see the black stitches were still there and she thought they were nylon so would not dissolve. So, I hadn't been given an appointment to take out the stitches!!

Furthemore, I had to wait 1/2 hr to get them removed and I will have to go back to the hospital on 13 November to see the first rheumatologist, to find out what drugs he thinks I should take and stop boozing.

Wrist Pain: MRI & Blood Test results

I went to see the rheumatologist again today to discuss my MRI scan and blood test results.

The blood tests were fine.

He said there is lots of inflammation and fluid in the wrist. Well, I could have worked that out without an MRI scan.

Here are a couple of views of my wrist taken by the MRI. The scan took lots of slices at different depths of the wrist and from different angles, eg top, side.














[view from top]











[view from side]

Unfortunately, some of the little bones in my hand have been "disrupted", which means that the ligaments which are supposed to be holding them in place are all over the shop and the bones are out of position.

Possible causes are TB (Tuberculosis) or arthritis. Apparently the BCG injection I had in school doesn't protect against getting TB in a joint and there's a lot of it about.

He suggested having an arthroscopy and a biopsy. That means he thinks I should go to a hand surgeon to cut open my wrist and poke around to see what's wrong which apparently the MRI can't show. Then, on the way out, he'll cut off a bit of my wrist for analysis.

I can just imagine the CSI CGI - whirring circular saw cuts through flesh like butter, blood spurts out, we fly with a camera plunging into the wrist and zoom into the bones and ligaments. The camera is rapidly withdrawn to be replaced by a shiny sharp scalpel that, with a flick of the wrist, cuts a chunk of flesh which is grabbed.