The Plot Thickens

The dark places between East and West

Here's a scary word: spondyloarthropathy. That's the term that the rheumatologist (who I saw almost two years ago when I was experiencing very similar symptoms and whom I saw again yesterday) invoked. This guy is old school, he's been around the medical business a long time. He has bushy ear hair and he's portly. He'd make a perfect inn keeper in Middle Earth looming over stiff-jointed hobbits with an air of authority.

What a surreal visit it was. His bubbly nurse's aid took my vitals in a freezing examining room (perfect blood pressure 110/63), then had me slip into the paper thin johnny to wait for Dr. Hoary Ears. The doctor comes in, sits down, asks me what the problem is and remarks that I look good. I tell him about the knee. Let's see it, he says. I get on the examining table, straighten it out, he glances at it, touches it a little, then says "Okay, put your clothes on and meet me in my office, I'll review my notes from the last time you were here."

Pretty cursory exam, I think, but do as I'm told. In his office next door, he sits in a plush leather chair behind a big polished wooden desk and beckons me to sit in a comfy leather chair as well. I do. He peruses his laptop and asks "Did your father have psoriasis?"

Not exactly the first question I expected and I'm immediately annoyed (my father, even in death, manages to intrude into my affairs). But Dr. Hoary Ears is getting at something by looking backwards, analyzing my genetic history. Though I don't know it at that moment, he already suspects something.

"Do you have any skin rashes?" he continues. No, I tell him, though when we'd looked at the knee in the examining room, it did betray a trace of dry skin, something I hadn't noticed before. He then asks about gout, have I ever had it? I tell him maybe once but that I don't think this episode is gout. "Neither do I," he answers, but still asks me about my diet.

A little more review of the notes, another minor question or two and he says: "You have one of two things. It's either gout or a form of spondyloarthropathy."

Yowza, I think, this guy is bold. "And I don't believe it's gout," he adds. "I'm inclined to think you're experiencing psoriatic arthritis." When I later look that up, the symptoms do seem to fit the situation, albeit broadly. Though I lack the skin condition associated with psoriasis (hmmm, what about that 'dry skin' on the knee cap? I think), this description seems to fit:

"Some people with psoriasis can also develop psoriatic arthritis, when the immune system attacks the joints as well, causing inflammation. Like psoriasis, psoriatic arthritis symptoms flare and subside, vary from person to person, and even change locations in the same person over time."

And this:

"Psoriatic arthritis also can cause tender spots where tendons and ligaments join onto bones. This condition, called enthesitis, can result in pain at the back of the heel, the sole of the foot, around the elbows or in other areas. Enthesitis is one of the characteristic features of psoriatic arthritis."

The thing is, there's no definitive test for psoriatic arthritis. Diagnosis is based on ruling out other things (like Lyme Disease) and then matching symptoms. Some of the symptoms I have match but I'm not showing all the symptoms. So what's to be done? Immediately, pain management and inflammation reduction. To achieve those goals he prescribes two drugs: indomethacin (25 mgs, 4 times a day), and prednisone (a steroid, 20 mg, twice a day). He also sends me to Emerson Hospital for blood work and X-rays of the knee and schedules another appointment for a week from now. So, take the drugs and see what happens.

All of which is quite interesting because an hour prior to seeing him, I'd gotten a treatment from Master Yang and we'd made progress. Yang was able to bend the knee and engage in some chi pumping both with me on my back and on my stomach. We hadn't been able to do that Wednesday. "Much better" he told me and suggested that "maybe next week, pain gone." I wanted to believe him.

But what if Master Yang is wrong? What if this isn't a pinched nerve and what if he's treating me for something that isn't? I ponder this. Again, the terminology is suspect. Perhaps "pinched nerve" means different things to each of us. The one interesting thing, which I realize later while reading about psoriatic arthritis, is that it's a condition that often develops in, and emanates from, the lower back and the sacroiliac joint. This matches the area that Yang is concerned with and for which he's treating me. So maybe, terms aside, he IS directing his treatment to the appropriate condition.

So I am now tethered somewhere between East and West. I want to trust Yang ("No need for X-ray" and "Is not a problem with knee, is a problem here <lower back>" but I'm inclined, perhaps out of lifelong cultural conditioning, to accept the Western explanation. It seems twisted but I almost want to believe that I have a "condition" (probably genetically-gifted) rather than a "pinched nerve" - I want to believe that what I've been doing (riding like a man possessed, eating well, stretching) is GOOD for me and not a cause of my current incapacitated state. If it's a condition that periodically flares up regardless of my behavior, than I can adopt the fatalistic approach of what is, is, and get on with dealing with it.

But if what I'm doing and the way I live is causing this condition, then I'll have to modify what I don't want to modify. Of course I'm thinking of cycling. That's the Big Unknown here. A genetic condition means that cycling is not causing this. But a "pinched nerve" might be the result of riding too much (or maybe being incorrectly positioned on the bike, or perhaps riding a bike that doesn't quite fit .... though these two possibilities seem remote as I've been fitted for my bike and have been riding in comfort all season, until now).

I'll take Dr. Hoary Ears' drugs and go back next week and review the X-ray and the blood test results. I'll also keep my next appointment with Master Yang. I will wrap myself in the swirls of the yin yang and hope that somewhere in the meeting of the two my corporeal self will come back into sweet harmony.