IT'S NOT GETTING BETTER

An interesting experience. It's loud!

Let's catch you all up since we last talked. Not a ton has happened, my symptoms have remained and seem to be more persistent. I haven't have the periods of "green" that I had before. Most days are a "yellow" now with the occasional "red." I did go on a four mile walk Christmas morning and on the third day after that I had a flareup. Almost like clockwork. I can't even go on walks or use the elliptical or anything without triggering it. It's definitely worse than this summer when I was doing PT and is becoming more debilitating by the day.

Two weeks ago or so I had an MRI on my right knee. Nothing special about the right knee, they just have to do one knee so they picked the right once since it was slightly more tender to the touch. The orthopedic doc doesn't seem to think it will really show anything, but I had hit my deductible and with the end of the year approaching it was a good idea to just get it done and rule anything mechanical out for sure. So I actually don't have the results from that back, but I'm expecting that it won't show anything. He'll be back from vacation soon and let me know for sure.

I did see the orthopedic doctor again just a few days after my last post. I mentioned the psoriatic arthritis thing and he seemed to think that was a good guess. His next step was going to be to refer me to a rheumatologist, and confirmation that I had psoriasis made that decision even more clear. He was pretty confident that MRI would rule out anything mechanical and referred me along even without the results of that. Which is probably a good thing, because the waiting list at the rheumatologist is two months!

That is the next step though, on February 20th I see the rheumatologist. Ugh. So far away with increasing symptoms. I'm on the waiting list if anything pops up sooner. Anyways, it just sucks, because I know eventually permanent damage can be done to my joints. Based on what I'm reading, exercise can't really make things worse, but I don't know about that, because it often causes the large flares ups. I don't know. Anyways, my plans to be semi in shape for Miami are out the window. Hopefully I can get two or three more short runs in and then just call it good. That race is going to put me in a wheelchair. After that I'll just lay very low until the 20th of February.

So that's the update. I just really want to see the rheumatologist and get this fixed. Assuming it is psoriatic arthritis, I can go on drugs and it basically should go into remission. I should be able to walk around like a normal young person again and not feel like I am 80 years old and in constant joint pain. I just want that day to be here already.

I'M A DOCTOR - WebMD SLUETHING

Okay, so I think I have enough body of evidence now to come up with a better conclusion. Since I've been passed around the medical system with no answers, I decided to do a little digging myself. Based on the fact that physical therapy and orthopedic specialists haven't really solved anything other than ruling some stuff out and subtracting large sums from my bank account, I decided I should be a little proactive for my next "step."

What I know is that while running or any activity does irritate my knees, I still get flare ups doing nothing. So there is more to it than just resting. I rested a long time and nothing changed really. The knee braces aren't really doing anything, I got a huge flare up while using them just walking around (a non-activity flare up) and using them while running hasn't prevented anything either. So while they may come in handy later to lessen the chance of a re-occurrence in my knees once this is fixed, right now I don't think they are doing anything.

So it seems to be chronic. If it was something that could be treated away it would have been done so by now. I don't know what sparked the thought in my head, whether it was a TV commercial or just something at the back of my brain, but for some reason one day the words "psoriatic arthritis" popped into my head. I have very mild psoriasis on my skin, easily treated with topical steroids when it pops up. I don't know if that fact came up with my PCP, PT, or orthopedic doctor. It's really out of sight out of mind.

Those blood tests did test for arthritis, but rheumatoid arthritis. Psoriatic arthritis is completely different. I checked my blood tests and none of them tested for it (I don't think a blood test can actually determine it). Hmmm. Digging into it a little more, the symptoms completely line up with what is happening with me. I've been having jaw pain (#) at the joint for years now too that flares up and down. I bet that is related as well. None of the exercises or stretches my dentist gave me did jack shit for that. Another symtom is a sore upper back... well, I had just chalked that one up to being thirty with shitty posture, but I have that too.

Needless to say, the more I read, the more I am convinced that this is what is going on. I think I'll go back to the orthopedic doc, summarize my results with the braces with him, mention this research of mine, and ask to be referred to a rheumatologist. They should be able to diagnose me with psoriatic arthritis, assuming that's what it is, and prescribe me treatment.

The good news is, it can pretty much be treated into remission. You can't cure it, but you can get it to the point where it doesn't affect you on a day to day basis. Basically feeling back to normal. Left untreated, it can actually cause permanent damage to your joints, so treatment is important. There are varying levels of treatment, hopefully my case will be considered more mild, because some of the stronger treatments are a little scary, but regardless, I should be able to treat it and get back to near normal.

This is all assuming my WebMD sleuthing was accurate. I feel confident on this one though, especially now that I've been passed around the medical system and lived with this crap for a year now.

UPDATE - PUSHING A WEEK NOW...

Definitely the worst flare up in a while. Even though I haven't kept a log until just recently, I don't remember an episode this bad since I was still doing physical therapy. It seems fairly clear that activity is causing the bad flare ups, even though they can still happen during periods of relative inactivity.

It is just so strange that I can go for a three mile run on the 25th, feel awesome for two days, then be crippled for a week. It's mind bottling. Anyways, when I get another "green" day I'll go for another run and see what happens. If I feel good for two days and then have issues on the third day, I think that would be a pretty clear pattern.

I'd still like to complete the Miami Half Marathon with my friends, so I'm hoping I can juggle this all to get in decent cardio shape before that event. Unfortunately, based on my previous experience, the elliptical also flares my knees up, so that as a secondary option isn't the great. Maybe I'll try it again. Who knows. As long as can run a few miles without dying, I'll probably be able to bullshit my way through it.

BAD FLARE UP

Well folks, I finally had a pretty bad flare up. I wish I could say it wasn't from the running, but I am not 100% sure. I ran the Friday after Thanksgiving and two days later I started a flare up that is lasting multiple days. I can still feel it today, but I think by tomorrow I should be back to feeling normal. If so, I'll try another run this weekend and see what happens.

I finally started logging my knee issues and it will be interesting to see if there is a pattern. Unfortunately, it appears the last two times I have ran, two days later I started to have bouts with my knee issue. The first time it was fairly minor and really didn't phase me too much, I mean hell, I was getting flare ups when I wasn't doing anything! However, the most recent flareup was pretty bad and kind of discouraging. It was bad enough that I was limping and co-workers were noticing.

So... we'll see what happens. I really would like to do the Miami Marathon in late January with my friends. To train for that I'd like to be able to run 5-6 miles at 11:00/mile. I'm already able to run 3 miles at 11:00/mile (which was my most recent run) so I can get there. Assuming I'm able to continue without the bouts becoming too bad, I'll do so. However, finally tracking my knees daily and seeing how it corresponds to my activity will be interesting and should solve the question of how much of my knee pain is cyclical and how much is activity induced.