Thursday, 11 February 2016

The knee mystery is solved.

Hi guys!

So my recent week back home was jam packed busy. Although Cardiff is a great city, it is annoyingly a little too far from everything else I have going on. I have to plan every trip back carefully to ensure I'm not spending all my time, back and forth on the M4. 
This first visit back was spent childminding, heading to Chroma meetings and importantly at two hospital appointments for my knee. 

My knees have actually been pretty good recently. Although I haven't been able to kneel properly since July and they do ache after any form of exercise, they are no longer swelling up or particularly painful. My first knee appointment was with the Ortho surgeon, it was a follow up from my last one - the idea was to ensure that the Rheumatologist was happy to take me on before Ortho discharged me. The waiting time has however been so long that upon my Ortho appointment I had yet to see the Rheumatologist... Safe to say I think the Dr felt pretty awkward at the lack of progress since I had last seen them but agreed that there was nothing they could do for me as no surgery was going to be needed! He was happy to discharge me & allow the Rheumatologist to take over treatment from here on, in. 

Five days later I headed to finally see the Rheumatologist. I had expected a 10 minute outpatient appointment as normal but ended up being in there for 45 minutes! I did however, leave with a diagnosis & plan of action going forward. 

It turns out that I definitely do have arthritis, enteropathic arthritis to be exact. This is not your usual rheumatoid or osteoarthritis, it is not associated with the elderly and often has little effect on the actual bones themselves. 
It is a form of "chronic inflammatory arthritis associated with the occurrence of an inflammatory bowel disease". Basically, it's all down the to Crohn's. Like the Crohn's there is no cure and no rhyme or reason why it happens. My body is doing the exact same thing it does with my bowel, but to my joints. It usually flares up when the bowel is inflamed but it can sometimes work alone. It is another thing that will need treatment and will come and go for the rest of my life. Fab news all round. 

The treatment for the arthritis is largely the same as with the Crohn's, meaning that the list of medications that no longer work for me with the Crohn's won't work on the arthritis either. The Dr has upped one of the drugs I'm already on & will now be in touch with my Gastro Dr on what can changed or swapped going forward should the knees swell up again. 

The last flare up occurred three years ago, before I ended up in hospital for the first time. The Dr explained that because of this it could be years before my next arthritis flare. If that is the case then he reckons treatment could be removal of the fluid and a steroid injection to nip it in the bud.
If, however, the flares become more regular then new meds will have to be looked in to, although I'm trying not to think about that for now.
He did also casually mention that really, I should have had the fluid extracted & a steroid shot right at the very start and that may well have sorted the knee out straight away... way back in July, seven months ago. Again, something I'm trying not to think about. 

After 20 minutes of going through my medical history, diagnosis & treatment plan I thought the appointment would be coming to and end. Boy was I very wrong. Upon examining my joints & realising that the knee was still giving me a little trouble he decided fluid extraction & a steroid injection would be a good idea. Now, the last time fluid was taken from my knee I think I hit the ceiling with the pain, and three pots of fluid were extracted. Safe to say I wasn't looking forward to this. 
I'll save too many of the details for the squeamish but the procedure involved a 2inch needle going in to my knee (with no local aesthetic), not the most fun way of spending a Wednesday afternoon.
Unlike last time, he wasn't able to get any fluid out, which meant there wasn't much inflammation at the time. He then put a steroid injection in to the joint, hoping to relieve some of the stiffness and achey pain when I exercise or kneel down.
Due to the joint not being inflamed the pain wasn't as awful as I remembered, although still pretty uncomfortable. Luckily after about 45 seconds it was all done and I was able get out of there! My knees ached a hell of a lot for the next two days but have since felt amazing. I am once again able to kneel down and have had no pain or stiffness at all, it's a miracle! 

My research and previous knee issues meant I was pretty prepared for the diagnosis, once again I saw it coming and turned out to be right. Being told for certain that it is something I'll have to deal with on going was a bit of a blow, but I am pretty used to it by now. Going forward there isn't really anything I can do to stop it happening again; reducing stress, keeping up exercise & taking my medication is really all that is in my control. I can also once again eat gluten, something which makes me ever so happy!
Hopefully the Dr is right & it could be years before I next have any issue. If it does flare up again, however, I will already be in the system and will never have to wait over 6 months to see the right person again.

Finally the mystery of the knees has been solved! 
Onwards & upwards....