Appointment and Update

I had my very first rheumy appointment about two weeks ago. I haven't posted partly because I'm holding my breath, waiting to see what happens before my next appointment in June. However, after two weeks I feel the need to share.

First, my appointment. It went very well! The doc is a little quirky, and had two students in with him that he spent a large amount of time talking to and prompting to draw conclusions or come up with ideas. That is not to say he neglected me by any means. He seemed very thorough. He told his students that he does not diagnose Fibro or Lupus based on the 'required' number of symptoms, insisting that those were for research only. (AKA, he'll diagnose with fewer symptoms if everything else falls in line with that diagnosis.) He asked me many many questions (most of which I answered no to, and had expected to be asked), he tested the Fibro points, and checked my joint flexibility.

Some of the surprising results of this examination. ONE, I've had trouble with my eyes since I was a child, and he said this may well point to RA being a good possibility. TWO, apparently my joints hyper-extend. When asked to hold out my arms, palms up, all three of them exclaimed in surprise and started playing with how far and how much I could bend/twist my arms/wrists. I was taken aback and stared as they chattered about it. I wasn't aware I was so different, rofl. (Apparently this has to do with something auto-immune related, though exactly what I never quite understood.) THREE, doc discovered I have issues with my SI joints, which I did not know were joints in the first place. When he tested my hip flexibility, and I winced a little, I think he was tipped off. In the process of things, he asked me if it hurt here, which it certainly did. That was a spot low on my back to the left. Then he touched the corresponding spot on the right, and that really hurt. I had been aware that I had painful spots there, but wasn't aware that it was significant in any way.

So, he said I have some "lupusy" things, possible indications of Fibro, and likelihood of some sort of arthritis, potentially RA. I asked him to please tell me that I am NOT okay, that something is indeed wrong, and that he would work to find out what. He warmly told me that no, I was not crazy, yes, something was definitely wrong, and that he couldn't promise he'd find out what exactly, but that he'd do his best to track it down. He then turned to his students and told them that some docs would prefer to attribute my pain to my being a "hysterical female" (said in a lowered voice and with a roll of the eyes). He also told me that he didn't believe pain was quantifiable, that if I am in pain and tell him so, that's good enough for him. (No trying to rate it on a scale, which I am relieved about because the pain I've felt is not measurable on such a flat scale as 1 to 10. It's a 3 dimensional sort of thing, lol.)

In the end, he ordered x-rays of my hands and SI joints, a bunch of blood tests, and gave me a Rx for in increased dose of ibuprofen. One pill is equivalent to four Advil, and I am to take one pill three times a day, along with Prilosec, and see him in six weeks for test results and a check on how the meds are doing. He said not to worry if it didn't work, that he had many options for relieving the pain, and that we'd try them if this dose wasn't enough.

Now, two weeks later, I can safely say that the upped dose of ibuprofen is NOT nearly enough. I did want to try just an increase in the ibuprofen, so I am glad he did it this way, but the pills are twice the amount I was taking, but it has not at all had twice the effectiveness, which is very disappointing. Storms rolled through, and my hips still made things terribly difficult. Even on quiet weather days, I still hum or outright hurt.

But on top of that, I am experiencing something new, and I was hoping some of you might be able to tell me if you know what in the world I'm talking about. I call them "pain attacks". I have had two this week, and have never had them like this before.

The first struck just before I was supposed to take another of my ibuprofen. About a half hour before taking it, I started to hurt in my hands and feet enough that I got off the puter and curled up to read. (This usually helps it to calm down,or at least stops provoking it to be worse.) Fifteen minutes later I couldn't even concentrate on reading. It began to hurt all over, and hurt bad enough to make me cry. Thus far, I haven't cried due to the pain. I noticed it was coming in waves, and each wave was worse than the one before.

By the time I could take my next pill, I had to call hubby to go downstairs and get it for me, because there was no way I was moving that far. Being in so much pain, the ibuprofen took a long, long time to get a grip on it. An hour and a half after taking the pill, I finally moved. Half hour after that I felt eased enough to get up and move around.

Besides the intensity of the pain, something else was new too. First, it wasn't just my joints. EVERYTHING seemed to hurt, so that I held carefully still. Secondly, when hubby was trying to be soothing, I discovered that my skin was extremely sensitive. Thirdly, as the attack faded, I realized my joints were all very very tender. It was exhausting and terrifying. If the ibuprofen hadn't taken affect, or if I had had to wait longer before taking it, I would have considered the ER, that's how badly I hurt. It made my heart race and made my stomach churn with acid.

The second pain attack was less intense and painful, but it happened well after I'd taken one of my ibuprofen, so I'd like to think that's what kept it from being so horrible. It still hurt though, and I still was very sensitive to touch. (Poor son, he was trying to make me smile by just barely touching the seam of my shirt... and about five seconds after he placed his finger there, I had to pull away because it hurt. He was dismayed and aplogized all over himself.)

Anyone have any idea why these pain attacks are so different from my usual joint pain?

Sorry to be soooo long, but I obviously waited too long before talking to y'all, and ended up with a book. I have a lot to tell my doc at my appointment in a month, but thought I'd let y'all know what was going on and seek advice.

Sounds like you have a great rheumy! I have hyper-extended and "loose" joints too! My rheumy had his resident gawk at my joints too when they saw my hyper-extension. Interesting that they said it's auto-immune related. Maybe that's why I have freaky joints too!

As for the pain attacks, I've never experienced something like that. I would definitely keep track of them and try to see if there are any possible triggers and report it to your rheumy on your follow-up appointment.

My next appointment is mid-June. Usually my joint pain is mostly what I call "humming". It's like a low vibration. The louder the humming is, the more it hurts and the warmer my joints feel from the outside (hubby notices it when he touches my hands, for example). It also reminds me of a choir, all singing in harmony. So my hands will be on the same 'sound' frequency as my feet, humming together in concert. Sometimes something will 'hum' louder than the rest. Sometimes one or two joints will decide to take a solo part, which is always MUCH 'louder' than the overall humming. Sometimes just hands will hum, sometimes everywhere hums.

However, none of that ever causes my skin to hurt or be sensitive. And though I generally massage my hands when they hum loud enough, it never makes my joints actually tender from the outside. I can worsen the pain by using those joints more, or I can have them flare up and get louder when I'm not doing anything to them, but it does not go in waves either.

This is why son thought it would be okay to touch my shirt on the shoulder. He wasn't pressing hardly at all, and usually some amount of force must be inflicted for a joint to hurt under normal circumstances. He would have had to lean on me in some fashion for my shoulder joint to protest, had my shoulder joint been hurting.

However, this new type of pain was very different. It wasn't the joint hurting when he touched me, but the skin... sort of. A little similar to when someone lightly touches a very bad bruise.

Yes, Talencia, I have this type of pain. Sometimes it is weather related but most times it is not. I can not find a sameness for every occasion. Have you hurt so bad that your hair on your head hurts? My sister has to shave her legs very frequently because the hair on her legs hurts her so bad. For me and her that is the fibro. My other sister has the same issues. There is a difference I think between fibro pain and lupus pain but I have never been able to convince anyone of the difference. I knew years ago that there was differences going on within my body and the pain was more intense somehow but I gave up on that issue and was just glad when I finally got a couple of doctors that finally agreed on the lupus. I know how real this is to you but I have no answers. I am on pain patches and norco as needed. I have no problems with the pills as I limit them to the point that I sometimes do not take them often enough. The sudden pain surges are quite often started by what we call "zingers". Zingers can bring one to their knees. The only other thing I might suggest is to see if you can get into see the doctor earlier. Good luck!

It sounds a lot like Fibromyalgia dear. Along with Lupus pain, it can be very harsh and debilitating. I do get numb hands, forearms, feet and lower legs. I also get tingling and intense pain. They swell terribly. This is neuropathy or Rayneuds I guess. I also get sharp pains in my thighs and if I walk too long, my hip feels like it’s grinding on bone. Ok, back to Fibromyalgia. It causes nerve pain. Your skin becomes very sensitive, someone touching you hurts badly. I have been told that anything electric can intensity the issues. Even power lines. I haven’t researched that part yet. The medicine that really helps me with it is Gabapatin. I have heard good things about Lyrica but it didn’t
help me. It’s great he gave you Prilosec to go along with the Ibuprofen. Sadly Ibuprofen can cause your joints to deteriorate and becme week. It could be possible that the medicine is making you feel worse. Since you take more than 800mg at a time, it could be making everything worse. Since your doctor is willing to help you, explain to him what is going on and maybe he will prescribe you something different. Good luck and stay blessed. Keep us posted.

I have what I call break through pain. It’s where I will suddenly feel extremely sick and in pain and I get a sudden fever. It comes out of the blue without warning and makes me cry sometimes. It perplexes my family because I’m pretty strong, so when I begin crying out of the blue because of an intense wave of pain and not feeling well they know it’s bad. I think it’s a combination of both lupus and fibro causing these “sudden attacks”. I take ibuprofen when it happens. I’m thankful it passes quickly after the ibuprofen kicks in, then it’s back to “normal” lupus aches and pains throughout the day. I also have arthritis of the SI joints which caused me lots of difficulty and pain for the first 4 years after diagnosis. My SI arthritis and lupus were revealed at the same time. I had lots of pain, would sometimes almost fall when my SI joints would give out, had difficulty standing or walking at times, showering and dressing myself. I couldn’t bend even slightly. I really came to appreciate chairs with wheels. I can’t believe how bad I used to feel because of my SI joints. It’s worse when the seasons change, then calms down.
I’ve never heard anyone else mention these “attacks” of intense pain. I’m not sensitive to touch though. I’m thankful because it sounds terrible to have this type of pain in addition to the sudden attacks of all over intense pain, malaise and fever.

Talencia, I'm glad you got such great responses from the members here about their personal experiences. I don't have personal experience, but I read an interesting article about "central sensitivity syndromes" such as fibro, which explains what might be going on when you have this type of pain attack. You feel it in your body, but it may originate in the central nervous system. Read the article, and see if it makes sense (ignore the migraine part):

http://www.achenet.org/resources/allodynia_when_touch_hurts_but_shouldnt/

About the extreme hypermobility, you may wish to research Ehlers Danlos Syndrome, a connective tissue disorder that causes hypermobility and joint pain. There are some other members here with EDS, I believe.

I'm glad you like your doctor!

Talencia,

Your Rheumy sounds great! Thanks for sharing this with us, and all the great comments you got. I have the fibro pain, but never my skin hurt to be touched like you experience.

I enjoyed your humor here, thank you for sharing. Reading your post was a mirror image of my experiences. I have tried to explain and quantify my various pains without success. I am going to use your "It's a 3 dimensional sort of thing" in the future to try to explain the levels/types of several different pains I have all occurring at once. To answer your question, IMHO I believe the joint pain is like a stabbing pain in the joints with inflammation and/or swelling added, which differs from the pains in the hands and feet--a different receptors kind of thing. One is like a deep stabbing tooth ache in the joint. The hands and feet pain is like an electrical shock that comes in waves, short circuiting. Ever seen a diabetic or seizure episode? They leave the person extremely exhausted afterwards because of the extreme stress to the body systems. My Lupus causes different pains then my fibromyalgia; my other issues also add to the mix and bring their own unique pains. It is confusing when they are all occurring at once, it often brought me to tears before I started several medications which keep them down to mostly a bearable level.

Thank you everyone for sharing your experiences, thoughts, and suggestions. It helps me come to grips with what I'm experiencing and solidify it in my mind so that I can relay it to my doc. Hearing your stories also helps me to grasp the wide variety of pain and the methods it challenges us with. To me, that becomes a reminder that since everyone else's pain story is valid, mine is too. Sometimes it's hard allowing myself to admit that I hurt, that I hurt often, and that I hurt a lot. Lately it's become easier to talk about it in a calm, rational, and honest way with those I know and love. That is due to all you wonderful people! Thank you!