My poor Louise, I'm confused about which foot got cortisone and how long ago and how that foot is feeling now. Forgive my stupidity. But I'll err on the side of caution and ask: DID YOUR RHEUMATOLOGIST HAVE THE WITS TO TELL YOU that while you're likely to experience immediate relief from a cortisone injection, that it's extremely common to have a CORTISONE FLARE shortly afterward that is often more painful than the pain you had before? Sorry to yell, but I want to be sure you know that. I think you probably know this, but in case you don't, it's normal, actually means the cortisone is working and the pain will go away very soon. Cortisone flares usually occur 24-48 hours after an injection. (I don't know why this is in italics, or how to make the print normal, and I certainly don't know why you should pay attention to anything that a person who can't even handle a computer says. Sorry, Louise!) A cortisone flare doesn't last more than a day or two.
If you Google "cortisone flare" you'll find many sites that will give you better information than I can. I find ice helps a cortisone flare a lot.
Often after a cortisone injection, there's local pain from the injection itself - it hurts to have a needle stuck into you and your body protests. But over the first couple of days after a cortisone injection, some of the cortisone crystallizes in the joint, so you've got some sharp little jabbers that are making your joint generally unhappy. They will dissolve in a couple of days and your joint is likely to feel very much better than it did before the cortisone injection. It's actually good news, because it means that your rheumatologist actually injected the cortisone into the joint, and didn't miss it. (Sometimes they do miss it - not to shake anyone's faith in doctors.) Did your rheumatologist also tell you that a little of the cortisone leaks out of the joint and finds its ways into other joints and tissues and has a generally beneficial effect on them, too? So people might expect some general relief after a cortisone injection in a joint.
Your comparison with the pain of a migraine says a lot. I'm finding that it's very hard to get people to understand how intense the pain can get.
And my goodness, yes, your podiatrist should absolutely start injecting a numbing agent as soon as the needle penetrates your skin. I'm not a podiatrist, but my orthopedist uses the same needle for both the anesthetic and the cortisone, so it doesn't take two injections. She just injects the anesthetic, leaves the syringe in, and after the anesthetic starts working - which for me is quickly - she just changes the barrel - the pump - the tube that has the medication in it. She has it right there and ready. She's a tough old bird from the days when women had to fight to get into medical school, and she knows what she's doing.
Again, I am not qualified to give medical advice, but of the "caine" medications - like novocaine - that numb tissue, the one that lasts longest - up to sixteen hours or so - is marcaine. When I have surgery, or more than ordinary dental work, I ask for that, because a lot of pain from a surgery or complex dental work has settled down after sixteen hours. I don't know if it's the best choice in a rheumatoid disorder.
Also, Louise, I'm afraid that because I'm not sure which foot you're having more cortisone in on Wednesday, I hope that at least one of your doctors has talked with you about how many injections of cortisone it's okay to have in one joint during a specific period of time without any injury to the joint? This is more complicated in rheumatoid disorders, and I don't know the answers, but I would sure ask the question.
Please forgive me, Louise, if my comments have been intrusive, incorrect or in any way out-of-line. Like you, I think images of how our bodies look inside are cool, and I have a couple of copies of my chest x-rays that I think are nifty. Is my rib cage really that small? I can't believe I actually fit into it. My vertebrae look about the size of the ones you find in a can of salmon.
My right foot is my most painful area, and the first symptom to lead anyone to think about PsA.
Thank you for the thoughts on MRI, DaveAus. Very helpful! I had an MRI last October, but the doctors were looking for signs of a bone infection and maybe missed what they weren't looking for. I have my first rheumatologist appointment Feb 10, so you've prompted me to do whatever amount of paperwork it takes to make the CD of the MRI available to her. She's the person who should know what to look for. I wouldn't have thought of that on my own, so many thanks.
As an old granny, I certainly take no offense to your description of walking, Margmotherof4. I'm sure you want so much to be able to wear your shoes all the time and to run around in them doing what you want to do. At 58, I still don't feel that old, and just this morning I was crying because I can't run around and play with my grandchildren as I could a year ago, and as I thought I would continue to do. Our five-year-old grandson is visiting in 42 days (I'm so eager to see him that I tick off the days) and it hurts that I can't take him to the playground or on walks as I used to. Thank goodness my husband, at 65, has "the body of a teenager" as his doctor says, and was able to teach our grandson to ride the little bike we got him, and take him out to ride every day on our last two-week visit. So that's fortunate. I hate being afraid to carry our one-year-in-one week granddaughter around because I feel, and am, so unstable on my feet. But she's just learning to walk, so pretty soon she won't need to be carried. In the meantime, I can hold her on my lap.
I haven't been able to wear shoes since last October, so I'm looking forward to an appointment with an orthotist who can build me shoes with a toe box that allows for the swelling that just doesn't go away. I'm very tired of going around town in slippers and oversized garden clogs.