Me "I want referral back to Rheummy", Doc "Not a chance"

bigjl

sunnyone wrote: »

You may have sero negative arthritis and thats why your inflamation levels are normal, that may be one route of seeing a rhummy again or maybe an orthapod can look at your back then they can pass you over to rhummy, theres more than one way to skin a cat;)

You are getting mixed up there a bit, sero negative arthritis is when you don't have rheumatoid factor (RF) showing up in your bloods, if your Inflammatory markers, ESR and CRP aren't raised then you have no inflammation therefore no inflammatory arthritis, obviously this doesn't include when your inflammatory markers are being normalised after treatment with drugs such as DMARDs or anti tnf's.

There are several different types of Inflammatory Arthritis, one being Rheumatoid Athritis, though confusingly you can be diagnosed with sero negative Rheumatoid Arthritis.



If your CRP and ESR are normal then even if your GP referred you to a Rheumatologist there is no guarantee the consultant would actually see you.


Going private is definately an option, but expect to pay about £200/300 for consultation.


If you live in the London/ Hertfordshire ares the Dr Grayson is a very good Rheumatologist, he has been one for the best part of 40 years.


There are better websites than this to get this information, such as ArthritisCare and Arthritis Research UK. Not forgetting all the good site about Fibromyalgia.

bigjl

Thelastunicorn said "Codeine withdrawal and abuse causes diarrhoea and stomach pain; you're only meant to take codeine for a maximum of three days and for acute problems, not twenty of them a month, and your GP should know this."

Actually Codiene will more likely cause constipation, though diarhhoea can present when stopped. And there is more than one dosage, up to 30mg, it is more normally prescribed as Tylex, which is 30mg Codiene and 500mg Paracetamol. Though can be prescribed on it's own.

I see hundreds of patients a year that are on Tylex for years, I took it for 5 or 6 years, along with Tramadol and recently Diclofenac, I now take Co Dydramol which is 10 mg Dihydracodiene and 50 mg Paracetamol, Dihydracodiene being stronger than Codiene.

I was only referred to a rheummy when my ESR and CRP levels where checked by the Spinal and Musculo Skeletal Assessment Service, when physio didn't help my pain. My ESR and CRP where three times normal.

Have not seen any mention of maximum usage of 3 days, don't have my BNF to hand, was this information in there?

As far as 20 Codiene a month being abuse, which seems to me what you have inferred, is nonsense, the maximum daily dose is 60mg three or four times a day, or eight a day.

Remember that IBS is a little like FMS, when they can't find anything else wrong such as Crohns or a polyp then the diagnosis will be IBS, and these would be ruled out by Colonoscopy or Sigmoidoscopy.

IBS can also present with inflammation of the stomach, but occasional Constipation isn't IBS, neither is occasional Diarhhoea. It would have to go on for years for a diagnosis of IBS to be given, unless it is just a presumptive diagnosis.


As far as the OP goes, it is very difficult to get a diagnosis of FMS, as it is for other problems, such as PMR (Polymyalgia Rheumatica)


A diagnosis of Fibromyalgia is normally given after all other avenues have been looked at, and you have tenderness in more than a certain number of points in the body.

Have you actually had a colomoscopy or sigmoidoscopy? I wouldn't be worried about IBS, I would be worried about cancer if I have had a sudden change of bowel habit, or passed some blood in a stool, did you tell the DR that you had some abdo pain and where a bit constipated or have you had proper investigations done, did the GP say, it might be IBS? Or did you get a confirmed diagnosis.

Did your GP give you a diagnosis of EDS or have you researched the internet and came up with that yourself? These are all relevant, as the NHS is sadly getting blocked by the worried well, who get worried after spending too much time googling symptoms.

You are also coming across from your posts as a bit of a hypercondriac, this may just the way your posts come across. However there is no clinical need to refer somebody to a rheumatologist without any inflammation present, not what you might want to hear, but sadly the way it is.

From what I have read, you have had some aches and pains, they have ruled out AS and RA, which is good clinical practice.


One further point Amitriptyline is one of the treatments for FMS, in a low dose. There is not really much physically that can be attributed to FMS, you can't use an Xray or a specific test, though it isn't unusual for a GP to diagnose FMS, though a lot of GP's don't think it exists, even some Rheumatologists think this way.

So it may be an idea to take the Amitriptyline, as prescribed, as it will give more benefit than less than 20 codiene tablets a month, a dose that franky wouldn't do anything, you may want to try Paracetamol or Ibuprofen, remembering that Ibuprofen can cause some gastric discomfort in some individuals.

I personally don't think your GP has treated you poorly, lets face it he has done 5 or 6 years of medical school, a couple of years as a junior in A/E and on the wards then been an SHO for a while then trained to be a GP, he also has years of clinical experience in General Practice, only to have somebody finish their appt by not informing him of a self help group you are attending, then saying "suppose so" and then going "Yeah right, whatever".

You don't think that that is a slightly incorrect attitude to have towards your GP.


Don't forget that FMS is such a grey area that sometimes a medical opinion can change, which is absolutely correct. My Rheumatologist initially thought I had Ankolosing Spondylosis and Rheumatoid Arthritis, it then changed to Sero-Negative Inflammatory Arthritis, Thoracic Spondylosis and Fibromyalgia. Though he says that it may be Polymyalgia Rheumatica rather than SNIA, but as the blood tests results are the same he is reserving judgment.

I am a Paramedic, but have been off sick for the last three months or so, was even working with a CRP of almost 60, and I was hoping to get back out there, but after seeing OH that now seems unlikely.

You want a definative diagnosis and you want it now, well sadly medicine isn't like that some of the time, it is sometimes as much an art as a science, drawing on experience as well as test results.

It is also impossible to diagnose IBS after stomach pains, assuming you mean your stomach rather than you bowel, for 10 days. Though sometimes a GP will say it might be IBS so as to put your mind at rest, as it may well be IBS, though it is just as likely not to be.

Anyway i have rattled on enough now, ain't Insomnia a !!!!!!.

LittleTinker

cally6008 wrote: »

In 2004, all my pains and problems started. I was literally walking one foot in front of another, very slowly and could not stand without leaning against something. (think old woman stooped over n shuffling along without moving her feet very far). I was like this for 3 years. Then I left my full time job, took some time out and my health slowly improved although not to the point of pre-2004 which was pain free and fully active.

Several doctors later ...

In August 2010, my doc told me I was having an irritable bowel syndrome flare up. This was after me having excruiating stomach pains within minutes of eating anything. I did not know what was wrong and only seen him after symptoms carried on for 10 days. I did not self diagnose myself.

In Sept 2009, my doc said I had fibro. He prescribed codeine. I am now on my 3rd lot of 100 since Sept 2009.

In Sept 2010, my doc now says he only thinks I may have fibro.

Anyways I dont have to explain myself to you

I have just noticed that you wear your 'self-diagnosis badge' with pride!

Why do you 'want' to have these illnesses and list them as signatures........especially when you have not even been disagnosed!!??

Hypercondria at its best!!

cally6008

cally6008 wrote: »

In August 2010, my doc told me I was having an irritable bowel syndrome flare up. This was after me having excruiating stomach pains within minutes of eating anything. I did not know what was wrong and only seen him after symptoms carried on for 10 days. I did not self diagnose myself.

In Sept 2009, my doc said I had fibro. He prescribed codeine. I am now on my 3rd lot of 100 since Sept 2009.

I love the way you care about me so much.

qwertyuiop12345

bigjl wrote: »

I personally don't think your GP has treated you poorly, lets face it he has done 5 or 6 years of medical school, a couple of years as a junior in A/E and on the wards then been an SHO for a while then trained to be a GP, he also has years of clinical experience in General Practice, only to have somebody finish their appt by not informing him of a self help group you are attending, then saying "suppose so" and then going "Yeah right, whatever".

You don't think that that is a slightly incorrect attitude to have towards your GP.

It is a sad fact that there are many doctors who for whatever reason don't know what they are doing and allow their prejudices to prevent them from making accurate diagnoses.

If the OP feels sure there is something serious wrong with them, they should continue to push for referrals. I am glad that I did so after several doctors diagnosed me with IBS and chronic fatigue syndrome. Eventually I managed to get the correct referrals and was diagnosed with Leukaemia. I dread to think what would have happened if I had been persuaded not to seek further medical help by the earlier doctors' patronising attitudes.

qwertyuiop12345

LittleTinker wrote: »

I have just noticed that you wear your 'self-diagnosis badge' with pride!

Why do you 'want' to have these illnesses and list them as signatures........especially when you have not even been disagnosed!!??

Hypercondria at its best!!

Why are you so interested?, unless you just enjoy trying to upset and provoke people who are unfortunate enough to have problems with their health.

There are many, many people who have complicated and serious health problems and have a difficult time trying to get to the correct diagnosis and treatment. These people have enough difficulty and stress in their lives without needing people like you trying to make things worse!

Penny-Pincher!!

OP....I think your original post has now been answered and you have been offered lots of good advice.

PP

LittleTinker

qwertyuiop12345 wrote: »

Why are you so interested?, unless you just enjoy trying to upset and provoke people who are unfortunate enough to have problems with their health.

There are many, many people who have complicated and serious health problems and have a difficult time trying to get to the correct diagnosis and treatment. These people have enough difficulty and stress in their lives without needing people like you trying to make things worse!

She has said she has self diagnosed and I wondered why anyone wants to have these conditions so much that they would actually list them as signatures as though they definitely have them.

I know full well that people have difficulties in getting a diagnosis....I did mention that fact in my earlier post.

I dont see you having a pop at other posters who have said similar. Why pick on mine?
I really cant see how your post is any 'better' than what you see mine to have been.......yours is certainly much nastier!!

hannahO_2

Some of us have battle scars....I think it's a real battle over many years and I don't know if you really understand the worries, frustration and not to mention physical & metal difficulty we have to go through. Try put yourself being told it's all in the head over 20 years where doctors have nothing really better to offer other than paracetamol.

As for signature, "debt free wanna be" list how much deep !!!! they are in. It's nothing to be proud of but something that consume, dominate our lives. Some it's health, some it's finance, for some it's both!!!

LittleTinker

hannahO wrote: »

Some of us have battle scars....I think it's a real battle over many years and I don't know if you really understand the worries, frustration and not to mention physical & metal difficulty we have to go through. Try put yourself being told it's all in the head over 20 years where doctors have nothing really better to offer other than paracetamol.

As for signature, "debt free wanna be" list how much deep !!!! they are in. It's nothing to be proud of but something that consume, dominate our lives. Some it's health, some it's finance, for some it's both!!!

I understand all of that.

What I dont understand and was asking about was why someone would list ailments that they do not have.....what is the purpose of doing that?

People reading see that that poster has x condition, y condition and suffers from z.........but in reality the poster has none of those an d might jjust have a mild form of w.

On reading that kind of signature people are likely to think "Oh poor thing" or "She has such a lot to deal with"........is that a fair way to be with people, manipulate how they think?

I wonder what the motivation is.