Elbow

[wellinghall]

I went to see the doctor today, because my elbow is still swollen. He agreed it was bursitis, like this:
http://en.wikipedia.org/wiki/Bursitis
and this:
http://en.wikipedia.org/wiki/Olecranon_bursitis

I'm going back next week, so he can drain it, with a local anaesthetic first and a steroid injection afterwards.

Comments

[applegail.livejournal.com]

ooowh ouch.

will be thinking of ya matey...

[the-marquis.livejournal.com]

Oh dear, you poor thing two things you won't like ...

[rustica.livejournal.com]

Yikes! Sorry to hear that :(

[emperor]

That sounds uncomfortable, but readily treatable. I hope the therapy proves efficaceous!

[cavedweller-isl.livejournal.com]

:( that's bad.. I hope the treatment will be successful. Get well!

[minoukatze.livejournal.com]

Ow....hope it all goes smoothly for you:)

[tovaglia.livejournal.com]

Make sure he sends it for MC+S, white cell count, and also polarised light microscopy to check for uric acid crystals. Also next time you have a blood test get your urate level checked.

[romancinger.livejournal.com]

Good luck - I would donate you some of my needle-stoicism if I could ;) I hope they are as quick and efficient as they normally are where I live!

[wellinghall.livejournal.com]

"MC+S" ?

Uric acide crystals? Like, gout, you mean?

Blood test? Me?? Hah! (Seriously, though, I will be having some taken when they put the canula in for my IV next month - that way I'll only have to have one needle for the two - and hopefully I'll be so dopey on whatever I persuade them to give me first that I won't notice too much.

But most seriously - can I just ask for that to be done, with a reasonable expectation of getting it?

(Oh, and I should say, thanks for the advice!)

[wellinghall.livejournal.com]

Thanks :-)

How are you doing?

[wellinghall.livejournal.com]

I think it actually works out to be three needles! I can see a Very Large Whisky coming on afterwards.

[wellinghall.livejournal.com]

Thanks :-)

How are things with you? We don't seem to have heard from you for a little while ...

[tovaglia.livejournal.com]

Yes, gout, exactly. Has there been any redness or peely skin? Gout is horrendously underdiagnosed in the community, particularly in males who happen to drink alcohol sometimes, and it's relatively more common in people who have increased cell turnover for any reason (I don't know if PJS hamartomas cause increased intestinal cell turnover, but it sounds plausible to me). And even if there's a really small chance you have it, it's important to diagnose early because it's very easy to treat by dietary modification. Much easier to prevent buildup of crystal in hitherto unaffected joints than to try and get rid of crystals that have accumulated unnoticed.

MC+S means send to microbiology for microscopy, culture and sensitivity. This is routine in hospitals although a bit more of a hassle for GPs (but not if you offer to drive home via the local hospital path lab and drop the sample off yourself). Might not be absolutely necessary if fluid appears beautifully pristine, but one wouldn't want to miss an infection if one is going to inject steroids.

How easy it is to get polarised light microscopy depends very much on your local lab. In our hospital, they quite enjoy doing it, but they never seem to see anything. Which is why a normal urate would also be reassuring in effectively ruling out gout.

Fortunately for you, it's less useful to measure blood urate during the attack (nobody knows why this is, but it's true - elevated levels can dip during a flare of gout) - it's best to measure it later, once the inflammation has settled down.

I don't see why you can't ask for all that, especially if you say that you wondered if there could be any association between PJS and gout, because you've heard that gout quite commonly appears as an olecranon bursitis. Most GPs, if faced with a talkative patient requesting a fairly cheap test on a sample they're going to take anyway, take the path of least resistance and simply agree. It takes 5 mins or so for the local anaesthetic to start working, so there will be time to chat!

Like the jolly GP who sent my blood for TFTs and ferritin recently (not knowing that I am medically trained) on the basis that I'd been "feeling a bit tired and cold and my mum said I ought to get it done". You just have to ask in a "I was really worrying about this and just wondered if you could set my mind at rest" kind of way, not a "look, as a taxpayer I pay your wages" kind of way.

If you went private, they would definitely do it if you asked, partly because it's all billable to the insurance company.

[wellinghall.livejournal.com]

Thank you!

[wellinghall.livejournal.com]

Thank you!

[tovaglia.livejournal.com]

should only be 2, you can inject the steroid through the same needle that was used for aspiration.

[wellinghall.livejournal.com]

Many, many thanbks for all that!

I've also done what I should have done yesterday while I was there - rung the surgery, and asked for Lorazepam. The receptionist was helpful, said she would ask the doctor, and I could ring back Monday morning. If I can get it (and I don't see why not), I'll stop by sometime before Wednesday, get the prescription, then take a tablet that morning.

[wellinghall.livejournal.com]

Thank you :-)

[wellinghall.livejournal.com]

Thank you!

[wellinghall.livejournal.com]

As you say.

[wellinghall.livejournal.com]

Oh good.

[didiusjulianus.livejournal.com]

But...if you can manage this, you should be able to then manage blood tests also ;)

[wellinghall.livejournal.com]

As you say - although I think "if" is the operative word!