It's supposed to take my last steroid this morning. Actually thought about not taking it at all, so that Dr. Lorenzo would have a better view of my real state when we see him tomorrow.
I've felt pretty good the last few days, including yesterday. There was less than the usual pain when I got off the bed, and I was walking pretty normally in a short time. And this was, of course, before I took my morning pill. So almost 24 hours since I took the last one. The night before, after dinner with the bureau and Rebecca, I found myself walking relatively quickly and painlessly to the car with Rebecca. She had noticed my feet when she arrived on Monday morning and seen me walk my way in the office but probably didnt think of it that night: I gave her little reason to. (I came to dinner from Pilates, which may partly explain why I was feeling so well.)
At least once, Kat pointed out that I get off the bed and walk into the dressing room as one man and walk out as another.
The inner-ankle pain is usually more on the left, though there have been a couple of days when it was more on the right. The heel pain transfers more often, or is often about equal. But there have been times in the last few days when I step into my blue Birkenstocks and feel almost absolutely normal.
I guess the worst I felt in the past week or so was after standing a long time at a book launch last week. Mental note: no long standing. Even after that, though, I dont think my ankles swelled up as much as they have in the past. They're still swollen though, and I havent seen the bone there for months now.
Sometimes -- like just now -- Kat asks me why I'm shuffling and I realize I am without needing to. I've gotten used to shuffling. That's another mental note.
Once in a while in bed my foot still jiggles on its own. Kat says she sees it happen when I'm asleep too. Should ask the doctor about that. Also, there are still pains in my lower back especially in the morning. It takes me a while to stretch and warm up in bed.
Wednesday, March 24, 2010
Saturday, March 13, 2010
Downhill
Halved my steroid dose midweek, as prescribed. I think I could feel the reduction the first couple of days. Last night and especially when we woke up this morning, I felt very stiff in my lower back and sides.
We got up at 10, I had a bun of three-day old muesli bread and popped my steroid pill. Then we went swimming at Rockwell. I used my fins for the first time and was happy I could finally propel myself with my legs. Then we had lunch at Pancake House then visited Pa for an hour or two at Makati Med.
We got up after Dr. & Mrs. Benitez arrived, and she said it was good to see me without a cane. (She's seen me using one a couple of months ago.) We left the room and saw Tita Nit and Tita Chery approaching. Tita Nit asked about Pa, then asked about me. I whispered I was on drugs so I felt fine. But as soon as we started walking again, I realized I was walking quite well and told Kat. She agreed. I felt very good.
After a nap, we watched a concert at Salcedo Park. We went separately. So, when I walked down the several steps in our basement parking, I had no one to show that I was touching the wall for support very lightly. When we got back, I tried it again and then dragged her out of the apartment into the fire escape to show her.
What happened? Was it because we slept till 10? Was it because the flippers flexed my ankles? Was it because the methotrexate was really kicking in?
With the good comes the silly though. After I showed Kat not once but twice that I could walk down steps, we found out we had locked ourselves in the fire escape. We had to walk down until we saw someone at a window on the ninth floor and asked her to let us in.
I have a new pain, at the very back of my ankle. But I'm not worried about it. It seems like the pain from using a muscle that hasnt been used much in a while, which I think I got from walking down steps and walking faster today.
Here's hoping.
We got up at 10, I had a bun of three-day old muesli bread and popped my steroid pill. Then we went swimming at Rockwell. I used my fins for the first time and was happy I could finally propel myself with my legs. Then we had lunch at Pancake House then visited Pa for an hour or two at Makati Med.
We got up after Dr. & Mrs. Benitez arrived, and she said it was good to see me without a cane. (She's seen me using one a couple of months ago.) We left the room and saw Tita Nit and Tita Chery approaching. Tita Nit asked about Pa, then asked about me. I whispered I was on drugs so I felt fine. But as soon as we started walking again, I realized I was walking quite well and told Kat. She agreed. I felt very good.
After a nap, we watched a concert at Salcedo Park. We went separately. So, when I walked down the several steps in our basement parking, I had no one to show that I was touching the wall for support very lightly. When we got back, I tried it again and then dragged her out of the apartment into the fire escape to show her.
What happened? Was it because we slept till 10? Was it because the flippers flexed my ankles? Was it because the methotrexate was really kicking in?
With the good comes the silly though. After I showed Kat not once but twice that I could walk down steps, we found out we had locked ourselves in the fire escape. We had to walk down until we saw someone at a window on the ninth floor and asked her to let us in.
I have a new pain, at the very back of my ankle. But I'm not worried about it. It seems like the pain from using a muscle that hasnt been used much in a while, which I think I got from walking down steps and walking faster today.
Here's hoping.
Monday, March 1, 2010
The Philippine AS Society
Saw Dr. Lorenzo today, who interpreted the results of the blood tests I took last week. I knew that my ESR result -- 52, compared with a reference range of 0 to 15 -- was high. What I didnt know was that the ``positive'' result of my CRP test was also a bad sign, as ``positive'' often is in medical matters.
They're both inflammatory markers, meaning, as I understand it, my body is fighting something and, at 52, it's not just something in my foot.
One of the main reasons I wanted to see him so soon was to confirm that it was OK to take steroids for as long as he prescribed: one month. I had read somewhere (that's the boon and bane of the internet!) that seven days was long, and that side-effects included weight gain and (horrors!) hair loss. He said the dose he prescribed was low.
I tried to steer the conversation toward second opinions, particularly abroad, by saying there must be very few cases locally. He said there are 100 or 200 rheumatologists and each one must have at least a couple of cases. (He earlier said he had handled about 10, which isnt much experience.) I said, but there are no AS societies as there are in the US, the UK, or Singapore. He said that's true, but if I wanted to start one, he'd help me. OK, that didnt lead where I thought it would.
What really pleased Kat about this visit? The doctor wrote out and handed to me, without our asking for it, his cell phone number.
They're both inflammatory markers, meaning, as I understand it, my body is fighting something and, at 52, it's not just something in my foot.
One of the main reasons I wanted to see him so soon was to confirm that it was OK to take steroids for as long as he prescribed: one month. I had read somewhere (that's the boon and bane of the internet!) that seven days was long, and that side-effects included weight gain and (horrors!) hair loss. He said the dose he prescribed was low.
I tried to steer the conversation toward second opinions, particularly abroad, by saying there must be very few cases locally. He said there are 100 or 200 rheumatologists and each one must have at least a couple of cases. (He earlier said he had handled about 10, which isnt much experience.) I said, but there are no AS societies as there are in the US, the UK, or Singapore. He said that's true, but if I wanted to start one, he'd help me. OK, that didnt lead where I thought it would.
What really pleased Kat about this visit? The doctor wrote out and handed to me, without our asking for it, his cell phone number.
Sunday, February 28, 2010
Thus Far
Looking back, the first sign of my problems probably came a couple of weeks before we climbed Mount Kinabalu in September. I would experience a jabbing pain in the middle left of my torso. I'd experience it I think when I laughed and/or sneezed and/or took a very deep breath. I was worried it would get the better of me during the climb but I didnt experience it then. What I did experience was tiredness, within an hour of our ascent. I was clearly out of shape and resolved to get fit.
When I did experience it again, we went to see Dr. Tyrone Reyes. He poked at me (I dont think we did an x-ray) and said it didnt seem to be skeletal, just muscular and prescribed Arcoxia (I think).
The drugs worked and on my last two days on them, when I felt very good, I went to the gym. I believe it was a Monday and Tuesday. I considered Kinabalu a wake-up call and was determined to get fit. I do remember pounding the treadmill at least at one point.
I believe it was the very next night, Wednesday, when I walked home from work with significant pain in my heels. (In retrospect, I may have felt this pain in snatches in previous weeks, but attributed it to old shoes I made a mental note to change.) It felt like a condition that Bunny Fabella had (or has) so I called her once I got home, crosschecked the symptoms and added a new word to my vocabulary: plantar fasciitis.
(On Sunday, Oct. 25, I went back and forth to Los Banos for work and my back was feeling quite bad by the time we were on our way home. This may have been the night that, when I lay on my front for my now regular heating-pad treatment, I felt like my body was collapsing and cried out in pain and fear for Kat to help me turn on my back. I called in sick the next day. I was also out from Nov. 7 to 10.)
Within a few days, I was also experiencing pain in my right hip and my lower right back. As Dr. TR was away, we went to Makati Med rehab and saw Dr. Melissa Mercado on Nov. 16. She seemed to agree it was plantar fasciitis and seemed to say that the hip and back problems were a result of my ``compensating'' for the foot pain by walking in a way that strained my hip and back. She prescribed some therapy, mostly for the back, which I went through from Nov. 18 to Dec. 3.
When there was little or no improvement -- or my condition worsened in terms of having great difficulty getting out of bed, e.g. -- we saw Dr. George Canlas. The moment we saw him, he said what I had was pinched nerves, ordered an MRI, EMG and therapy. Before we left, I believe he had his therapists work on me and I felt some immediate relief.
The MRI was clear, the EMG showed five pinched nerves. I went for therapy in Makati because Dr. Canlas' clinic was in Alabang. I had at least 4 sessions from Dec. 7 to 14. Toward the end, I felt that the therapist had strained my hip flexors and so we decided to see Dr. Canlas again. After a short consult, his therapists worked on me again and relieved the hip flexor problem. They also seemed to better know what they were doing and so we decided to go to Alabang twice a week for therapy.
Therapy in Alabang (More than 6 sessions from Dec. 15 to Jan. 16) appeared to be effective on my back and legs, which appeared to have atrophied/weakened but which they were beginning to restrengthen. I was concerned, however, because the plantar fasciitis, which I thought had caused the other problems, remained, and could possibly cause the same or other problems in the future. From what I had read, many cases of plantar fasciitis run their course in about three months. My great fear then was that I was not one of the many.
And then, as January rolled along, the plantar fasciitis appeared to moderate significantly. I felt optimistic that it was fading.
If my memory is correct, I had my last therapy session on Sat., Jan. 16. I remember that because I had made a morning appointment which I had to move because we got an interview with Gilbert Teodoro. I moved the appointment to the afternoon. I remember the therapist was a bit aggressive with my feet, which is why for a while after that weekend, I attributed to her what I thought was a sprain.
In fact, I remember only feeling great pain the next night, during or after dinner with my family at a Japanese restaurant. That exacerbated things because we were sitting on the floor and it was an ordeal getting up. I thought maybe I wasnt ready to sit on floors yet. By the next day, there was very obvious swelling. When Kat said Maget F. was at our place, I rushed home for a free consult. She said it looked like a sprain, taught me how to bandage it and told me to elevate it and apply hot compresses.
After a day or so, it appeared to get better. On Jan. 21, I covered Noynoy Aquino's Makati Business Club speech at the Pen, spending most of the time on my feet. By that evening, it was worse than the previous day. I still thought it was a sprain that I hadnt given enough time to fully heal and so continued to bandage it and apply hot compresses.
During the last visit with Dr. Canlas, he asked me to get several blood tests to find out if my slow progress was the result of a certain condition, although he himself said he doubted it. I took the test -- for HLA-B27 -- which turned up positive, a strong sign I may have -- another new word -- ankylosing spondylitis. I saw Dr. Canlas again on Feb. 3 and he referred me to a rheumatologist Dr. Paolo Lorenzo, whom I saw on Feb. 5.
Dr. Lorenzo said based on my symptoms and my profile (young male), it seemed like AS. He prescribed a low, weekly dose of Methotrexate (7.5 mg a week) and two more weeks of Celebrex.
Feb. 19, Friday, was my last day on Celebrex. Feb. 22, Monday, we saw Dr. Tito Torralba. He ordered an x-ray and an MRI of the sacroiliac joints (an addendum if it was in my first MRI, a new MRI if not). He hardly looked at us as he asked questions and even less when we asked questions. He made me stand and poked my back in several places demanding ``does that hurt?, does that hurt?'' ``Not especially,'' I said at one point. ``What do you mean, not especially? Does it hurt or not?'' he said. ``It hurts because you're poking hard,'' I said.
On Tuesday my foot felt numb so I set the earliest appointment I could with Dr. Lorenzo (for Friday) and consulted Dr. Gerry Pedragosa after work. He didnt seem overly concerned and, thanks to Dr. Benjie Benitez, we got to see Dr. Lorenzo the next day, Wednesday, when he had no clinic. He prescribed Prednisone (2 tabs per day for 15 days, 1 tab per day for another 15 days). Scarily for me, he literally took a breath and started talking about Remicade (2-hour I.V. 8 times a year) and Enbrel (2 self injections per week). They're costly, and I'm scared to death of injections.
The steroids worked great on Thursday, my first full day on them; less so in the days since. Today and yesterday, my main pains are on my left heel (I'm not sure if it feels like plantar or something else) and my left ankle. The ankle is painful and sensitive.
When I did experience it again, we went to see Dr. Tyrone Reyes. He poked at me (I dont think we did an x-ray) and said it didnt seem to be skeletal, just muscular and prescribed Arcoxia (I think).
The drugs worked and on my last two days on them, when I felt very good, I went to the gym. I believe it was a Monday and Tuesday. I considered Kinabalu a wake-up call and was determined to get fit. I do remember pounding the treadmill at least at one point.
I believe it was the very next night, Wednesday, when I walked home from work with significant pain in my heels. (In retrospect, I may have felt this pain in snatches in previous weeks, but attributed it to old shoes I made a mental note to change.) It felt like a condition that Bunny Fabella had (or has) so I called her once I got home, crosschecked the symptoms and added a new word to my vocabulary: plantar fasciitis.
(On Sunday, Oct. 25, I went back and forth to Los Banos for work and my back was feeling quite bad by the time we were on our way home. This may have been the night that, when I lay on my front for my now regular heating-pad treatment, I felt like my body was collapsing and cried out in pain and fear for Kat to help me turn on my back. I called in sick the next day. I was also out from Nov. 7 to 10.)
Within a few days, I was also experiencing pain in my right hip and my lower right back. As Dr. TR was away, we went to Makati Med rehab and saw Dr. Melissa Mercado on Nov. 16. She seemed to agree it was plantar fasciitis and seemed to say that the hip and back problems were a result of my ``compensating'' for the foot pain by walking in a way that strained my hip and back. She prescribed some therapy, mostly for the back, which I went through from Nov. 18 to Dec. 3.
When there was little or no improvement -- or my condition worsened in terms of having great difficulty getting out of bed, e.g. -- we saw Dr. George Canlas. The moment we saw him, he said what I had was pinched nerves, ordered an MRI, EMG and therapy. Before we left, I believe he had his therapists work on me and I felt some immediate relief.
The MRI was clear, the EMG showed five pinched nerves. I went for therapy in Makati because Dr. Canlas' clinic was in Alabang. I had at least 4 sessions from Dec. 7 to 14. Toward the end, I felt that the therapist had strained my hip flexors and so we decided to see Dr. Canlas again. After a short consult, his therapists worked on me again and relieved the hip flexor problem. They also seemed to better know what they were doing and so we decided to go to Alabang twice a week for therapy.
Therapy in Alabang (More than 6 sessions from Dec. 15 to Jan. 16) appeared to be effective on my back and legs, which appeared to have atrophied/weakened but which they were beginning to restrengthen. I was concerned, however, because the plantar fasciitis, which I thought had caused the other problems, remained, and could possibly cause the same or other problems in the future. From what I had read, many cases of plantar fasciitis run their course in about three months. My great fear then was that I was not one of the many.
And then, as January rolled along, the plantar fasciitis appeared to moderate significantly. I felt optimistic that it was fading.
If my memory is correct, I had my last therapy session on Sat., Jan. 16. I remember that because I had made a morning appointment which I had to move because we got an interview with Gilbert Teodoro. I moved the appointment to the afternoon. I remember the therapist was a bit aggressive with my feet, which is why for a while after that weekend, I attributed to her what I thought was a sprain.
In fact, I remember only feeling great pain the next night, during or after dinner with my family at a Japanese restaurant. That exacerbated things because we were sitting on the floor and it was an ordeal getting up. I thought maybe I wasnt ready to sit on floors yet. By the next day, there was very obvious swelling. When Kat said Maget F. was at our place, I rushed home for a free consult. She said it looked like a sprain, taught me how to bandage it and told me to elevate it and apply hot compresses.
After a day or so, it appeared to get better. On Jan. 21, I covered Noynoy Aquino's Makati Business Club speech at the Pen, spending most of the time on my feet. By that evening, it was worse than the previous day. I still thought it was a sprain that I hadnt given enough time to fully heal and so continued to bandage it and apply hot compresses.
During the last visit with Dr. Canlas, he asked me to get several blood tests to find out if my slow progress was the result of a certain condition, although he himself said he doubted it. I took the test -- for HLA-B27 -- which turned up positive, a strong sign I may have -- another new word -- ankylosing spondylitis. I saw Dr. Canlas again on Feb. 3 and he referred me to a rheumatologist Dr. Paolo Lorenzo, whom I saw on Feb. 5.
Dr. Lorenzo said based on my symptoms and my profile (young male), it seemed like AS. He prescribed a low, weekly dose of Methotrexate (7.5 mg a week) and two more weeks of Celebrex.
Feb. 19, Friday, was my last day on Celebrex. Feb. 22, Monday, we saw Dr. Tito Torralba. He ordered an x-ray and an MRI of the sacroiliac joints (an addendum if it was in my first MRI, a new MRI if not). He hardly looked at us as he asked questions and even less when we asked questions. He made me stand and poked my back in several places demanding ``does that hurt?, does that hurt?'' ``Not especially,'' I said at one point. ``What do you mean, not especially? Does it hurt or not?'' he said. ``It hurts because you're poking hard,'' I said.
On Tuesday my foot felt numb so I set the earliest appointment I could with Dr. Lorenzo (for Friday) and consulted Dr. Gerry Pedragosa after work. He didnt seem overly concerned and, thanks to Dr. Benjie Benitez, we got to see Dr. Lorenzo the next day, Wednesday, when he had no clinic. He prescribed Prednisone (2 tabs per day for 15 days, 1 tab per day for another 15 days). Scarily for me, he literally took a breath and started talking about Remicade (2-hour I.V. 8 times a year) and Enbrel (2 self injections per week). They're costly, and I'm scared to death of injections.
The steroids worked great on Thursday, my first full day on them; less so in the days since. Today and yesterday, my main pains are on my left heel (I'm not sure if it feels like plantar or something else) and my left ankle. The ankle is painful and sensitive.
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