My PMR Adventure

My symptoms began about the first of March 2021. The first thing I noticed was that I was getting leg pain from sitting. It wasn't the first time I'd had discomfort from sitting, but the chair I was using was one I'd used for years, but it still could be the chair or just sitting, so on March 10th, I ordered a stand up desk (I am at my desk long hours, 7 days a week). I also added another cushion to my chair. On March 17th I went to my PCP and saw a PA about the leg pain. At 73, I'm concerned about hip arthritis. On examination, the PA thought I had piriformis syndrome (he didn't call it that, but he directed me to do PT using a foam roller). I couldn't get the x-ray that day, so I went again the the PCP on March 25th, and got the x-ray and a cortisone shot in my right buttock, and a prescription for prednisone (20mg per day for 5 days). By that time, I was also starting to have pain in my right shoulder, which was worse at night. This was not new to me because I had previously been diagnosed with impingement syndrome for which I received cortisone shots, which made it go away. The x-ray was negative. The day after the cortisone shot, my pain was gone everywhere. This lasted one day. As time went on, the pain got worse, and I am extremely stiff in the morning and I get a throbbing pain in my right shoulder that wakes me up at night. I had some Percoset on hand, so I started taking that when the pain was the worst, either middle of the night, or first thing in the morning. Never more than one 5 mg tablet per day. I am very leery of taking too many opioids. I had gotten a referral to see an orthopedic specialist, which I did on April 20. He x-rayed my right should and it was negative for anything. He diagnosed bicep tendonitis and sent me to PT, which I started on April 29th. I went to PT once a week for a month and also did the exercises at home. One odd thing about my condition was that during the day the symptoms went almost completely away, so I had no trouble doing the PT as long as I did it in the afternoon. The PT did not help. On May 4th I went back to the PCP clinic to ask for more Percoset; they would not provide it. I asked for referrals to get an MRI and to see a pain specialist. Those appointments were a month out. The PA also offered to give me another cortisone shot which I put off at that time. On May 11th I was back at the PCP clinic. Here are the notes from the PA:

"Patient was counseled extensively on suspected tendinopathy. Upon patient's insistence a right shoulder injection was provided. Patient had no pain in clinic so relief could not be determined. Patient was given 1 week prescription for Percocet. Patient advised no further refills would be provided from this clinic as it is not appropriate management of this type of pain. Patient was advised again to follow-up with orthopedic specialist to discuss multiple treatment options. Patient advised to continue physical therapy. Patient follow up with pain specialist. Patient completed MRI. Patient to return to clinic if signs or symptoms of worsening condition developed."

"Other:After a full discussion, the patient voiced an understanding of the risks, benefits, and alternatives to this treatment plan and accepted them. The patient has been told to ice his shoulder for 20 minutes 3 times a day for the next several days. If he does not have frank improvement in his symptoms within a week, We will proceed with MRI to evaluate the rotator cuff. If there is some improvement, The patient will follow-up for repeat injection."

During this time, I also started taking NSAIDs, first Aleve, and then 2400mg per day of ibuprofen. This had no effect. I had also been given a prescription for Celebrex, and which I filled and started taking in place of the ibuprofen; no effect. The Percoset provided more but not complete relief, but it did allow me to function after getting up the morning (typically 3 am).

On May 25th, I had arranged through the orthopedic clinci to see a rheumatologist. In five minutes he said, "you have PMR". He put me on 20mg per day of prednisone, and it had an immediate effect. I can sleep my normal amount of sleep without being awakened by pain. The pain and stiffness is still there in the morning, especially my right shoulder, but it still goes away during the day, so I can function fairly well.

The symptoms do not appear to be lessening after being on prednisone for a few days, but the rheumatologist said we would increase the dosage as needed. Right now I feel like it's going to take more.

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