My husband has just had his second appointment with a rheumatologist, Dr. O. I went with him to his first appointment. Seeing that my husband has long standing psoriasis and has had an increase in morning back pain and stiffness, as well as cycles of fatigue, it was time for him to be seen. He has also had some unexplained (so far) numbness. He was started on an antiinflammatory and told to come back in three months. In the meantime, he had a nerve conduction study for the numbness, with no known cause.
I saw my rheumy, Dr. L, and mentioned that Jason had seen Dr. O. She wondered why he hadn’t come to see her. Now I know why she asked this. Not all rheumys are created equal. My husband came home yesterday and told me about his visit. Dr. O still is insistent that my husband has mild carpal tunnel syndrome even though that was ruled out. He suggested Humira, but didn’t explain his thinking at all. He then suggested MTX, but again, with no explanation. My husband left with a prescription for prednisone for 15mg for 5 days, then 10, then 5. Why? My husband has no hot or swollen joints, and feels that the antiinflammatory is doing the job.
I have already made my husband an appointment to see my rheumy. I’m not saying that she’s perfect, but Dr. O was just utterly ridiculous.
Eeeek. What’s so troubling here @Stoney is that if you didn’t know any different he would think that his experience with this doc who presented a waffling and weird treatment plan were the norm. Why on earth, if the rheumy REALLY believed he had carpal tunnel, would Humira or even MTX have been offered as options? Glad you got him in to see your doc.
That sounds like an unfun Rheumy experience (and very confusing). My first two Rheums were like this, and I wasn’t very good at advocating for myself (I’m still not very great at it, but I’m better at expressing when something is at least not working for me). Hopefully your Rheum will provide a much clearer explanation of whats what.
Just a couple of comments @Stoney I certainly don’t have enough info to have an opinion on Dr. O… If anyone told you that the nerve condictions studies ruled OUT carpal tunnel, THAT is the first person I would be concerned about.
At best a nerve conduction study is 87% accurate and that is with a very good physiatrist on the the other end. But at the same time mild carpal tunnel never shows up on a Nerve conductions study. The idea with carpal tunnel is to treat it before it is a problem. Most Carpal if properly treated never becomes surgical (which about all the nerve conductions studies are good for - justifyimg surgery) The nerve they are testing runs from you neck to the tip of your finger. When compression is relieved either surgically or with medication it repairs itself at a mm/day. The WHOLE nerve has to regenerate not just the part below the compression. 3 mos on NSAID therapy is reasonable. Without a lot of improvements a 20 day taper of Predi would be next.
Active psoriasis is enough reason for MTX and Humira. especially anywhere close to age 50.
My husband knew that this was wacky. What I found most disturbing though was this doctor’s insistence that my husband has carpal tunnel as one of his issues even after having a nerve conduction study. I like my doctor WAY better! I really lucked out in starting out with her.
My big concern @tntlamb was that the doctor just threw out different ideas, with no discussion of why. It felt like there was no game plan that he had at all. And yes, we are fast approaching 50 (45 years old now).
Hi, I have psoriatic arthritis with spinal involvement, and also have numbness and tingling, and sometimes complete anesthesia in my hands. The Rheumy sent me to the Neurologist who did a complete work up for Carpal tunnel, which it was not. Nerve conduction studies were mostly normal. The symptoms are unexplained…however…since doing some research on my new spinal symptoms, I found reference in many places to numbness and tingling in the hands, and/or legs, depending on where the arthritis is. If hypertrophy/bone growth narrows the opening where the spinal cord/nerves are, the pressure on the nerves can cause those symptoms. Does you hubby have any Cspine issues?
