Life Update on Shane

Since this the Hood Family Blog, I would be remiss if I did not share some 'exciting' things that have been going on with Shane. It all started in April when his left knee and lower extremity started swelling. He had surgery on his knee years ago (before I even knew him) so he was not overly surprised that he was having an issue. He went to an orthopedist (the same one who Camden went to when he dislocated his knee), who ordered a MRI of his knee which Shane had on April 17th. Between the MRI and his follow up appointment 5 days later, he started experiencing excruciating pain in most all of his joints, especially in his shoulders, knees and hips. The morning of the follow up appointment he could hardly get himself moving due to the pain and when he did, he was extremely slow. When he saw the doctor,  the MRI results were reviewed, which showed that he had a piece of cartilage torn off resting in the knee. Because this specific doctor does not do surgery, he was referred to another physician in the group to follow up. While there, Shane told him of all his symptoms and pain. The doctor ordered lab work and prescribed him a medrol dose pack. 

The results of the lab work showed that Shane was anemic and his sed rate (which is an indicator of inflammation) was elevated, however the rheumatoid factor screen, which would possibly point to rheumatoid arthritis, was negative. He received relief while he was on the 5 day steroid pack, however by the end of the 5th day (which was April 27th) the pain was already returning. The next day, he woke up in horrible pain again and, as he did everyday, headed to school. Within a few hours, while at work, I received a phone call from Shane. When I answered, he was slow to respond, however when he did, he told me that he was lying on the floor in his gym and the nurse at his school wanted to call EMS because his heart rate was fast and his blood pressure was low. I told him I was on my way, not to call EMS. Upon my arrival, he was sitting in the nurse's office and said he was feeling better. I asked her if she would recheck his vital signs, which she did and they were normal. Because of everything that had been going on, I decided I would take him to the ER in hopes of them figuring out what was going on with him so he could receive some relief.

On our way to the hospital, I asked him about the incident and if he passed out, which he denied. He said he was having a horrible stomach cramp and was standing up trying to walk it out and stretch it out when he started feeling weird so lowered himself to the ground. While on the way to the ER, he was complaining of his right shoulder hurting as well as the tip of his elbow, but really was not sure why it was hurting. We arrived to the hospital, and they immediately triaged him. While I was waiting for them to finish triaging him, I received a call from his school nurse who told me they watched the video and that it was clear that he passed out. Once he came back to the waiting room to wait, I relayed to him what his nurse said. He then realized that maybe why his shoulder/collarbone area and and elbow hurt. I then went to speak with the triage nurse and informed him of Shane passing out as well as the collarbone pain, at which time they ordered an x-ray.

They then took him back to an area that only patients were allowed to be while I sat in the waiting room. They performed more lab work, and EKG and x-rays. While he was waiting, the campus nurse sent him the video of him passing out, which he forwarded to me. It was sooooo surreal to watch. It was quite obvious as to why his right side was hurting, because he fell like hard on it. The x-ray of his shoulder showed an ac joint sprain, and fortunately no fracture. After 5 hours in the ER, their presumption was that he had a vasovagal response to the pain from the cramp which caused him to pass out. They did feel his anemia looked liked iron deficiency anemia and recommended he follow up with a hematologist. They also recommended he follow up with a cardiologist due to passing out. As for the pain he has been experiencing, which is what we were really wanting answers to, they didn't really address it. Ugh! Funny side note, their were student's in Shane's gym when this episode was going on and they all thought he had a heart attack. I had texts from several parents who were checking on him. After watching the video, I could see how they thought that, poor things!

So the past few months have been filled with many doctors appointments. While awaiting to see a PCP, Shane was doing a lot of research on-line trying to find some answers. 

Shane saw a hematologist on May 6th, who ordered more lab work and recommended he follow up with a colorectal doctor for a colonoscopy.

On May 7th, I received a text from Shane with a link to the Mayo Clinic regarding polymyalgia rheumatica. He had researched his symptoms online and felt like this matched his symptoms. (You will see why I mention this a bit later.)

On May 8th he followed up with a PCP. The doctor ordered more lab work to rule out lupus and other autoimmune disorders. He prescribed gabapentin, which only seemed to make Shane's symptoms worse. His PCP offered to give him some pain medication, however Shane didn't want that, he just wanted a diagnosis so he could work on getting better. On the 13th, he received a message from his doctor after his lab work came back and noted that his CRP was elevated, which could be a sign of inflammatory etiologies, infections or malignancy. The doctor felt prednisone would work for him, however being on it long term he did not feel would be ideal. The autoimmune work up was normal, and there was no evidence of lupus or rheumatoid arthritis. There was also no evidence of lyme disease. He referred Shane to a rheumatologist for further evaluation. While waiting for his rheumatology appointment, his PCP did finally prescribe him prednisone which gave him some relief. 

After the hematologist received Shane's lab work, he ordered an iron infusion, which he had on May 15th.

He followed up with the colorectal doctor on May 16th, who scheduled him to have a colonoscopy. He had the colonoscopy on May 27th, which everything looked good. 

He finally had his appointment with the rheumatologist on May 30th. I went with him to this appointment to ensure that Shane relayed everything to him. After we gave him all the history of what has gone on since April, he told Shane he felt he had polymyalgia rheumatica. I just looked at Shane and laughed. The doctor asked why we were laughing and I told him that Shane had googled all his symptoms and he felt that is what he had. (Remember the text from May 7th) He told him the treatment was prednisone and that he would be on it for months. At that time he would not clear him for his knee surgery, but said he would follow up with him in a week to see how he was doing and would let him know at that time.

On June 9th, Shane had an appointment with the orthopedic surgeon who recommended surgery. He said he had bone on bone and would need a knee replacement in the future. He recommended that Shane have microfracture knee surgery so Shane went ahead and scheduled it with the hopes that his rheumatologist would clear him at his next visit, on June 13th - which he did. 

 

So, after starting this whole journey in April with knee pain, Shane finally had his surgery on June 24th. 

Resting after surgery

Everything went well and after several weeks on crutches, he is now crutch free and doing well. He continues to be on Prednisone, which the doctor will decrease by a milligram per month, which means he will be on it for another 9 or so months. His rheumatologist feels (based on his history of studying and treating polymyalgia rheumatica), treating Shane the way he is with slowly decreasing his prednisone, Shane should not have a reoccurrence. Fingers crossed that is the case because it has been a rough few months for Shane!

Still finding a way to have fun!