Recently I gave in and went to see a rheumatologist after more than 3 months of intense morning stiffness and swelling of my hands (especially around the PIPs and MCPs) and wrists which improved during the day but never went away. It had gotten to the point where I could no longer open small lid jars (decreased strength), do my push-ups or pull ups (pain and limited wrist motion), and OTC products (Tylenol, Advil, etc) weren’t working. I can’t take Aleve due to the severe esophagitis it induces. I didn’t want to write a prescription for my self-diagnosed (without) lab arthritis.
BTW, all the lab work came back negative with the exception of a slightly elevated sed rate and very weakly positive ANA. The rheumatologist was impressed with the swelling, pain, and stiffness and was as surprised as I by the normal lab work. He thinks (and I agree) that I am in the early presentation of rheumatoid arthritis. He wrote a prescription for Celebrex and told me to continue with the Zantac I was already taking (thanks to the Aleve). The Celebrex is helping.
So I was happy to see this article (full reference below) come across by twitter feed. H/T to @marcuspainmd: Useful review of NSAIDs effects & side effects for arthritis pain: Read more »
*This blog post was originally published at Suture for a Living*
Patients don’t choose the days they get sick.
There are several studies, specifically dealing with heart attacks, showing that the mortality rate increases when a patient visits the hospital during the weekend.
It appears that the same goes for upper GI bleeding. MedPage Today discusses a recent study showing that “patients with nonvariceal upper gastrointestinal hemorrhage had a 22% increased mortality risk on weekends, and those with peptic ulcer-related hemorrhage had an 8% higher risk.”
Staffing issues, leading to delayed endoscopies, appear to be chief culprit. Minutes count in cases of GI bleeding, so the delay is a likely explanation for the higher mortality rates.
Especially in community hospitals, doctors often cover for one another, and in general, there are less physicians available. Short of having more doctors on call, a prospect that faces long odds as hospitals are loathe to pay specialists for additional call, I’m not sure what can be done to rectify this statistic.
One suggestion is to have so-called “bleed teams,” where staff can be quickly mobilized to respond solely to acute GI bleeds. But again, this likely would require more staff, and it’s dubious that hospitals are willing to bear the additional cost.
**This post was originally published at KevinMD.com**