Scan

Despite the PMR flare which had me sitting on the stairs with my head in my hands yesterday I decide to walk. It’s a fine day in between winter blasts, low sun streaming down the street in a great headlamp dazzle. I go past the Roath Laundry on the corner of Marlborough and Blenheim, its red brick outer walls still in place but its innards almost entirely demolished. There’s a man in a long ragged coat and knitted hat picking his way across the top of one of the rubble piles like this was a pit village in the 40s. A mechanical digger lifts a rusted RSJ and bends it as if it were rope.

I’m wearing loose clothing as advised. Track suit bottoms, t-shirt, sweat top, trainers. I shouldn’t feel out of place. I’m dressed as much of Kentucky Fried Chicken Britain usually is. But you lose authority weraing clothes like this, don’t you. Could you sell insurance door to door wearing Nike? Or if you read the news on TV dressed as a bag lady would anyone believe what you said? Probably not.

Beyond the parks, full of cyclists now we are suddenly allowed to ride on their paths, the tennis courts and the Lake end roundabout, lies Wedal Road. Before the coming of hard-topped roadways the Wedal was a stream. A tributary of the Roath Brook. It’s piped now, a lost Cardiff river, running below the road’s tarmacked surface. The Wedal Road dump, officially a council Household Waste Recycling Centre, has eighteen notices across its gates. These warn against climbing, arriving by truck, walking, being commercial and driving too fast. The latest, a splendid bilingual banner with a drawing of a pick-up truck at its centre, reminds dumpers that if they intend arriving in too big a vehicle then they will have to book.

Around the corner, beyond what was once the Allansbank but is now the Grape and Olive, is the hospital. UHW. The Heath. I’m heading for my first of four tests this week. Each will be performed on a different day, the relevant departments being unable to speak to each other and patient consideration being pretty far down the list. Today it is bone density. Prednisolone has a detrimental effect on bone thickness. The steroid thins. Osteoporosis sets in. A counter measure is to also take Alendronic Acid and up your intake of calcium. I’m on two Calichew daily and Alendronic (stand up, drink loads of water, then swallow) each week. The bone density test will put a measure on all this. Set a reference point to which in the future I can return. Are my bones now more susceptible to breaking? I’ve asked the GP that. Her answer was yes.

Outside the hospital entrance is the usual clash of signs banning smoking with the smokers themselves. White haired ancients in dressing gowns with bandages on their limbs resolutely puffing. Thin faced young men in wheel chairs with drips on wheels beside them pulling hard on roll ups. Well-dressed doctors and file carrying administrators going by without saying a word.

Bone Density measurement takes place in the Department of Medical Physics and Clinical Engineering, a place I’ve never heard of let alone been to before. It’s situated way up the main drag beyond X ray, Pharmacy and the Surgical Day Unit. The procedure itself is done in no time flat. I’m given hospital trousers as my loose fitting track suit bottoms, worn as instructed, turn out to have metal zips on the pockets. I lie on a machine that vaguely resembles the laser table in Goldfinger but lacks the straps with which to tie me down. This is a Bone Density Scanner but we call it a Dexa the nurse tells me. Put your feet here, stay still, breath, don’t breath, breath, there we are, done. Let’s just check. Okay. Get up slowly so you don’t fall over. Fine. You can go now. Put the pants in the dumper. Results will go to Rheumatology. Take two weeks.

I’m done, gone back down the long corridor to the exit, filled now with slow moving patients in robes and on sticks, theatre staff in blue scrubs, blokes in anoraks from Matalan, a man his head totally bandaged with only a small gap for his eyes, a woman carrying a ladder, a porter pushing a chair, a business man in an expensive suit.

Tomorrow I’ll be back. Bloods again. I can feel the polymyalgia there in my legs, a dull throb. Outside the sun’s still shining. But it’s lost its edge.

Taking the Tablets

When I get the bag of drugs home and lay them all out on the table I am overwhelmed. There are so many of the things. The brown tubs of Calcichew, the smart bright white boxes of Dr Reddy’s Omeprazole, and the small pink and orange op art boxes of Alendronic Acid, marked for ‘oral use’ in case you thought you might have to rub them in. But by far the largest in number are the toppling piles of Prednisolone, box after box. These are white splashed with green and blue, Damian Hurst could have designed them, maybe he did.

Inside are the detailed instructions. Package Leaflet: Information for the User. The small print. And just like that on an insurance policy, it covers every eventuality in the fullest of detail employing the smallest of print. No one is going to sue these drug companies for not giving out comprehensive and magnificently detailed information on just about every aspect of their product bar none. The leaflets even show where the drugs are made. The Prednisolone come from Eastbourne, where the Nazis would have landed had they come.

I have to take Prednisolone at the rate of 40 mgs daily, in the morning, and after eating. This means eight tablets. I push them out of the bubble wrap and swallow the first set immediately, just as I’d been instructed. It’s 10.50 am. Am I going to feel elated, nauseous, faint, spin headed, or pain free? It’s that latter thing I need so badly. Something, anything, to get these pulsing PMR spasms from out of my arms and out of my legs.

But there’s nothing. Not immediately anyway. But by the end of the evening, touch wood, throw salt over my shoulder, whisper it, the pains do seem be lessening. But they can’t be. Not that swiftly. Yet they are. I get my first night’s sleep in ages that doesn’t depend on big bomber pain killers and have in attendance inside my head the swirling fog.

By day three I guess the PMR has reduced from 100% active to something less than 10%. There are still trickles of pain, now and again. But nothing constant. And sleep comes so easy, it’s wonderful. Can this be the cure? Am I imagining it? I keep sending my mind down my legs and round my arms to check. Anything happening? Has it gone? Will it come back?

But it doesn’t return. In fact the trickles of PMR discomfort themselves start to retreat. As the days pass a certainty grows that PMR is fading. Everything is weak still, I find it hard to lift things and to crouch and squat. But the pain has gone or just about. Prednisolone, right now I love you. What else can I say? But steroids and especially this one are two-edged swords. As I’ll find.

Maybe I should check the detailed package leaflets next.

How It Begins

In the pharmacy they ask me the question. Are you expecting three hundred Prednisolone tablets? It sounds huge number. I don’t know. Am I? To be safe I nod and, after checking that I am who I claim to be, they hand me the bag. It’s a huge thing like the sort the old used to get when I was younger. Prednisolone tabs by the packet load. Tubs of Calichew. Boxes of Omeprazole. And my favourite, the one you take weekly, standing up, Alendronic Acid.

I set off up the road. There’s late autumn sun shining on me but I don’t notice. Am I gripped by fear and apprehension? Not yet. The polymyalgia is still riddling my proximate muscle group, wrapping itself round my neck and making everything feel appalling. It feels like it’s time to give up.

There had been arguments at the doctors. I’d visited my local GP who has a surgery a ten minute walk down the road. I was convinced that this was some sort of reaction to statins, just like it says in the statin small print that comes inside the box. May affect some people. Me. All I had to do was give up my Simvastatin, wait a bit for the stuff to clear the system and everything would settle down. Only it had been eight weeks so far and things were now worse than they had been. Hard to get out of bed in the morning. Impossible to sit in a car for longer than ten minutes. Pains when squatting. No, couldn’t squat. Aches now starting in my upper arms. Hell on earth when I tried to sleep.

So it clears once you are up and about? It does. And returns when you sit still for a time? Yes. Getting worse? Certainly. On a scale of 1 to 10 how bad is it? With 10 being dreadful and 1 being clear. 7. Mmm. I think it’s this. She turns her screen to face me and there’s a description of Polymyalgia Rheumatica. I’ve never heard of it. It sounds like something you are born with, a disease of the nerves, something that creeps up out of the genes. A thing others develop. It usually affects older women, especially those over 70, the GP gently tells me. But I think it’s what you’ve got. She looks concerned.

I agree to two blood tests a fortnight apart. If my ESR and CRP rates show elevation then that indicates inflammation of the muscles, a PMR pointer. I see the nurse and take the first one. I don’t look as the blood enters the syringe. I’ve passed out before while casually gazing. Had to be brought round by nurses applying cold compresses. Once while having an ingrowing toenail excised fainted and had to be revived with oxygen. I have learned simply not to stare. Usually does the trick.

When the results come in they show elevation. The first test throws up an ESR of 19 and the second of 40. The CRP shows first 28 and then 30. On my return to the surgery the GP tells me that she’s pretty sure this is Polymyalgia but that luckily there is a treatment. And one that works every time. She doesn’t actually say there’s a miracle cure available but I can hear the words hovering somewhere above her head. I am given a prescription for prednisolone and then warnings about how prednisolone is a steroid and that steroids have side-effects. But remember that the condition, the PMR, is far worse than any possible side-effect and the steroid will see that off, says the GP. She sounds like she means what she says but I am unconvinced.

Can I have some more pain killers to get me through the night, I ask? I’ve been taking everything from Naproxen, a sort of super ibuprofen, to heavy dose Co-codamol. These knock you out, get you through the dark hours but during the day leave you in a permanent fog. You won’t need them, she says, smiling. Hard to believe, that answer. In fact I simply don’t.

So here I am, crossing Newport Road with my drugs bag. And my PMR description print-outs and my instruction leaflets and the notes I took during the consultation. And a load of fear getting in the way of everything. Putting the things down my throat comes next.