Today, I Could Put on My Shoes!

Throughout this illness, which appears to be Poststreptococcal Reactive Arthritis (although it could be something else), my health has been quite varied. (Also, I have filled in some medical detail after the symptoms descriptions; mostly to clarify what PSRA is, and how and why my treatment is progressing the way it is.)

No, these aren’t my shoes, but … dang … [Enunciate the last bit the way Will Smith recommends Beatrice (Edgar’s wife) hire an internal decorator in Men in Black.]

For example, here’s how the past few days have gone:

Thursday: Ibuprofen taken at night allowed me to move fairly well in the morning. As soon as I woke up, I took my prednisone, and within a couple of hours, was able to hobble about without much pain. I had a doctor’s appointment mid-day, but worked at the office and from home around the appointment, and felt very good. By late afternoon, I had a fever, and needed to take a short nap. Still, I managed to get to and lead our small group Bible study, with Nichelle driving. I felt good, and didn’t take any extra medication at bedtime, when the prednisone was definitely beginning to wear off.

Friday: Not taking the ibuprofen seems to have been a big mistake. I awoke at about 5:00 a.m. with serious pain and movement issues. I could barely move my legs, and couldn’t use either hand. I waited until 6:00 to take the increased dose of prednisone Dr. Eranki prescribed, but it took hours to have a noticeable effect. I did go to work, but didn’t make it into the office until 11:30 a.m. Due to the pain and swelling in my left middle finger, typing on my left hand was reduced to 1-finger. Still, in the evening I felt very good. Nichelle and I were able to attend “Run for Your Wife,” a TCAN Players [hilarious] comedy play featuring co-worker Laura Crook.

Saturday: I felt good for a few hours in the morning, but spent most of the day fighting the low fever, playing some games with the kids and hanging out in Azeroth, spending an inordinate amount of time trying to beat a seasonal instance.

Sunday: Good in the morning. I was able to drive to church early for my Geek work (A/V), and even ran a couple of quick errands in Nashua after the service (pharmacy; gas for the mower). By mid afternoon, the fever was back, and I spent a couple of hours starting at supper time just sleeping. Afterward, I felt pretty good.

Today: Today I was able to move my legs well enough to put on shoes and socks for the first time in several weeks! (After taking prednisone a few hours earlier.) The biggest problem today is my left hand. I do have a low fever, but it’s only about 1/2 a degree above normal, which to me is starting to feel normal.

By this evening, my movement ability had dropped a bit, but not much, but I became febrile again enough to notice. Oh, well, today was better than usual.

PSRA Details / Symptoms / Concepts

Tomorrow will mark my fourth week since the onset of obvious symptoms, and I had noticed some minor symptoms before that. Wow!

Poststreptococcal Reactive Arthritis is only a probable diagnosis. I will have an echocardiogram in a few weeks, as well as another Lyme disease titer, to rule out Rheumatic Fever and Lyme disease, respectively.

However, PSRA does seem to fit the symptoms. Neither PSRA nor rheumatic fever are testable conditions; they are syndromes—collections of symptoms—and the symptoms must be weighed carefully to figure out what the overall diagnosis should be.

The biggest meaningful symptoms or test results have been a positive blood test for a recent strep infection, the swelling and joint pain in my legs, hands, and shoulders, the fever, and vast number of negative tests for heart problems, liver function problems, active infections, etc.

Note that arthritis essentially means joint pain, so the reactive arthritis (assuming that it what I have), is not the type of arthritis that we all tend to develop as we age. (There is some x-ray evidence of that happening in my back, which is completely normal for this point in my life, and has not affected me in any way.)

I have a few days to go on my antibiotic treatment, and have already started tapering down the prednisone. Today has been my best freedom-of-movement day so far, and I hope that trend will continue. The guys in my at-work Bible study laid hands on me and prayed for my recovery today, which was very moving.

Gas at $23 a Gallon (No, Not Here)

Now that I have your attention (the headline is explained below), let me tell you about my nephew Mike Matheson and the missions trip he is leading to Guinea-Bissau …

Missonary Kid/MK Minister/My nephew Mike Matheson. (I warned Mike I’d get even someday for the time he swiped my camera at my Mom’s wedding and put all sort of shots like this one on it.)

Mike Matheson is a missionary kid (MK) who married another MK and now works as a minister to MKs and their families with Wycliffe Bible Translators, at and around the JAARS (Jungle Aviation and Radio Services) center in Waxhaw, North Carolina.

Currently he’s co-leading a group to Guinea-Bissau, which is on the western coast of Africa. Gasoline there was averaging $23 per gallon … until supply ran out completely. (Yes, the whole country seems to be without gasoline at the moment.) Thankfully, the driver they needed for part of their trip managed to save up enough gas ahead of time to get them where they needed.

I highly recommend reading up on Mike’s trip, which has been updated whenever e-mail access allows, at the Guinea-Bissau Team BLOG and the GB Team Notes Page. You can follow the exploits of Mike and Beth and Leigh at their main ministry page.

Mike grew up in Brazil, and Beth in the Philippines. They are among the most caring people we’ve ever met, and have a real heart for working with the unique needs of MKs and their families—which they are singularly qualified to understand. (Nichelle and I think so highly of them that they are our designated choices to inherit our brood if we both kick.)

You can read more about the Republic of Guinea-Bissau via Wikipedia or the CIA World Factbook.

Poststreptococcal Reactive Arthritis (Probably)

BLOG readers begged for Calvin and Hobbes …

At the moment I feel sleepy but almost good, after a feeling very miserable all morning, and sleeping most of the rest of the day.

My rheumatologist, Dr. Eranki referred me to an infectious disease specialist, Dr. Strampfer.

We discussed all sort of symptoms and possibilities. He fell for our typical joke of, “I’ve had this pain in my neck for 16 1/2 years,” almost recording that as a symptom.

The two front-runners are Poststreptococcal Reactive Arthritis (PSRA) and Rheumatic Fever. Although the diseases present slightly differently, there is still debate among some doctors as to whether they are indeed separate diseases, and not merely different manifestations of the same thing. Rheumatic Fever can lead to heart damage, which I don’t have, although I may get long-term antibiotic treatment if Rheumatic Fever is considered a probable diagnosis.

Poststreptococcal Reactive Arthritis, however, is fascinating, and perhaps a better match. I had one blood test in which my ASO was elevated, showing a past Group A beta-hemolytic streptococcal infection. One of the ways in which PSRA differentiates from Rheumatic Fever is that the joint pain in PSRA responds very poorly to normal anti-inflammatory drugs, like ibuprofen, which has, indeed, provided me nearly no relief. Another strike against Rheumatic Fever is the lack of Sydenham’s chorea symptoms—“rapid, uncoordinated jerking movements affecting primarily the face, feet and hands.” (Although I have been described as an uncoordinated jerk, that isn’t quite the same.)

Other possibilities include Human Parvovirus B19, but it seems not quite as likely. Likewise, my retest in a few more weeks for Lyme disease will be carried out, although we don’t find that as likely, either, it’s very important to diagnose as early as possible, as it can cause very serious long-term damage if untreated.

Today I am back on prednisone (a corticosteroid), for a longer-term treatment. It’s offered the first significant relief in about two weeks. I cannot express how wonderful it is to be able to stand and sit without being in serious pain while moving, nor just to be able to sit or lay down for a while without being able to get comfortable. I still limp quite a bit, but my stride has gotten longer than 6 inches, and each step isn’t accompanied by pain. The fever continues, albeit more intermittently, making this day 21 with a fever, blowing away whatever my childhood chicken pox fever record was. I have been very sleepy today, but I think it’s just my body catching up on rest after being in constant pain for nearly three weeks.

But … by the next morning (18 hours later), the prednisone has mostly worn off. The fingers in my left hand are almost impossible to move, and my stride is much shorter again. :: sigh :

Walking? Nyet.

This comic from Bloom County keeps coming to mind. (Copyright 1983, the Washington Post Company. Used under the “Get with It, This Is the 21st Century” interpretation of the Fair Use clause.) See

Today I received numerous answers from my doctor; unfortunately, they were all along the lines of “Those results were negative,” or “I don’t know.” I do know that I’m still running a fever (even after 5 days of antibiotics), but it seems to be slightly more controllable with medication, and it is nearly impossible for me to walk, even with Vicodin helping to manage the pain.

On the bright side, my echocardiogram concluded that the enlarged heart shown on my chest x-ray was simply a test anomaly. This also concluded that, if I do have rheumatic fever, it hasn’t done any damage to my heart. Still out there is the possibility of Lyme disease.

One ironic thing is that I have a severe vitamin D deficiency—just like what incapacitated Nichelle for many years. (See, there would have been ROI on that cube with a window view I recently requested at work.) However, the vitamin D deficiency isn’t likely to be the cause of my symptoms, as it wouldn’t cause the localized swelling, nor fever, and wouldn’t have set in so suddenly. (It’s also easily treated.)

I see an infectious disease specialist tomorrow, and I see my rheumatologist again on Thursday; we hope for more definitive answers. So far a large number of things have been ruled out. I’ve had so much blood and fluids drawn in the past week, that my weight has dropped 3 pounds.

I am grateful for the dedication my ever-growing medical team has shown. My fellow church members and family members are praying for my recovery. My wife and children are incredibly helpful. Nichelle keeps life manageable, and the kids typically function as my extended arms and legs, without complaint.

I have gotten much support as well from my co-workers. Many have called or e-mailed to see how I am doing. “Tovarich” Gary Dlugy is going to feed my tarantula, Susan (named after one of our VPs at Kronos). Sarcasm master Joe Royal sent these words of encouragement, which would have left me rolling on the floor if I’d been able to do such a thing:

Things are a little dull without you. Meetings start on time and stick to the agenda. Management is starting to be worshiped. It’s becoming a very unproductive work environment.

Day 13

Nichelle and I are reprising the roles we had when she was so ill, albeit we have swapped who we are playing. I get to play the part of “Nichelle, the inexplicably sick one,” and she gets to play me.

Today is Day 13 with the still-unexplained fever, leg pain, phalanges pain, and swelling. (The swelling in my leg and foot has become quite “interesting.”) None of the tests I’ve had (and there have been many) have found anything conclusive. I will see a rheumatologist soon (I hope before my currently scheduled appointment of July 8 ), and continue to work—much—with my own primary care office.

The forecast seems to call for uninterrupted fever, with a scattered chance of more severe pain, and increasingly widespread swelling.

For example, yesterday I went to church, and Nichelle drove us to Randolph to celebrate Debbie Civil’s 18th birthday and high school graduation. (Debbie is a blind girl in a wonderful Christian family who used to, along with her siblings, ride our bus to church at New England Baptist.)

The Civil Family and the Wilcox Family. Debbie is the second person to the right of Nichelle. (At this point I could even squat down for the photo, albeit stiffly.)

I hobbed about, but felt pretty good, and was able to walk almost normally for a couple of hours in the afternoon. On the way to the party I slept; on the way back we stopped at the Natick Mall to see the completion of a 7-foot-tall R2-D2 (which we contributed to on Saturday). In the very short walk through the mall, my leg got worse. By the time I went to bed, the pain and swelling was worse.

I offed to take this home for them, but they didn’t think it would fit in our van. (See the swelling in the leg?)

I awoke at 5:30 a.m. with my leg in considerable pain, my temperature up to 100.9 (at 101.5 my doctor’s office wants to know about it), and that awful everywhere-hurts-because-I-have-a-fever feeling. I was also really hungry. I gobbled acetaminophen and ibuprofen (and cereal), and then slept virtually constantly until noon.

Today I’ve managed a little bit of work, but the fever and finger pain is still there, so I haven’t accomplished very much. I am trying to let my body get the rest it needs, it just doesn’t seem to be helping much.

In addition to work, I’ve just got to get better for our church trip to Strategy Zone on Saturday.

What’s Wrong with … Doug?

Okay, here’s the deal …

Last Tuesday (May 27) I was falling asleep in a meeting. Now, bear in mind, I often fall asleep in meetings, but not usually in meetings of only a few people and where I am one of the key participants. I excused myself and went home sick.

(As I think about it, a week earlier I had been complaining that muscle pain all across my upper back—I thought from weight lifting—had lasted more than a week, and when I sat down to do chest flies, I discovered I couldn’t put much pressure on my left arm in the direction required.)

The next few days I took half days off, plus one full day, fighting a low fever (1 to 1.5 degrees above normal), working when I didn’t feel in that brain-dead state that fever brings on.

Meanwhile, I started having more and more stiffness in my legs, especially after sitting down for a while, and developed a pain in my fingers, particularly around the proximal phalanges.

Thursday I got in to see one of my two N.P.’s at Nashua Primary Care, and she explained that it was probably viral, and ordered a slew of blood tests, including a Lyme disease titer, because a number of the symptoms matched Lyme, even though we had not observed a tick bite or the infamous bull’s-eye rash from one. The only abnormal result was a slightly elevated sed rate, which indicates inflammation of some kind. However, Lyme disease antibody tests can be negative for several weeks even when symptoms have begun to present, so I have a retest in three weeks.

Monday had me phoning the doctor’s office again, explaining that the difficulty walking had gotten much worse beginning on Sunday. Questions and answers went back and forth throughout the day and the next morning, but around noon Tuesday (day 8 of fighting the fever), after confirming some swelling in my left leg (which I was completely oblivious of, but which Nichelle spotted right away), they referred me to the emergency department at Southern New Hampshire Medical Center. (I wasn’t even up to playing World of WarCraft on Tuesday morning. Tragic.)

(Enterprise E sick bay drawing courtesy of

The primary reason for going to the E/R was because such swelling can be caused by a DVT (I would explain, but that would save you the fun of some Wikipedia research) or a blood clot in the lungs.

More blood was drawn. Twice, actually, the first batch turned out to be unusable. (I warned them not to expose it to sunlight or tachyon radiation …)

Nichelle dropped me off, and brought everyone by when she picked up Isaac and David from school. Shortly thereafter, as I was being wheeled to the Radiology department (my first trip on a gurney since infancy), both Isaac and David asked, “If you die, can we have your World of WarCraft gold?” Weasels.

The ultrasound and X-ray didn’t turn up any clots; however, the chest X-ray showed an enlarged heart (and you all thought my heart was two sizes too small), so in addition to still having a problem with whatever is causing me to be unable to walk, I’ll be visiting a cardiologist soon.

Admit it, this is more like what you expected.

The hospital gave me a tapered dose of prednisone, which, for 23 hours, allowed me to hobble a lot faster. It was a delight to wake up this morning and be able to move my legs with almost no difficulty, especially as on Tuesday I was nearly completely crippled, and the pain in my hands was so bad I couldn’t even open a soda bottle. But around 5:00 p.m. today the leg pain when moving set in again, and I was back to smaller steps (although not nearly as bad as Tuesday).

I have an appointment to see my own N.P. tomorrow night. I’ll have a cardiology appointment as soon as my doctor’s office can arrange one. (They are remarkably adept at getting a squeeze-in consultation; I’ve seen them turn an 8-week wait “even if your doctor refers you” into a three day one.) Possible causes for the enlarged heart are an infection in the past that caused tissue damage, or—as I learned about through my own research today—a completely benign condition called Athlete’s Heart Syndrome (see also this article) which sometimes develops in people who do a lot of cardiovascular types of exercise.

Ignoring the enlarged heart and going back to the original symptoms, I called my sister Cindy last night and learned that my niece Jenn had exactly the same symptoms, and is currently recovering finally after a round of antibiotics. The only test that she had come back positive was one that indicated an exposure to strep at some point. This matches a bacteriological diagnosis, rather than a viral one, but her case baffled her doctors for a while, and, they too suspected Lyme disease.

The weasels just want my gnome engineer Mortalan character’s gold if I kick.

Being sick like this has made me appreciate much more how difficult it is for those with movement-related disorders or painful problems like arthritis. I also have a much better understanding of just how difficult it was for Nichelle all those years when her vitamin D deficiency left her debilitated.

Still, I find many blessings. Kronos’ sick time policies are excellent, and the superb insurance for which they are paying means I do not have to worry about the medical bills. I can work from home to coordinate with going to appointments or on those mornings when I’m not sure how well I’ll feel, and keep up with work e-mail, etc., even when too sick to go in. I get to experience my children’s delightfully twisted senses of humor in a time that might have been stressful to them. Nichelle is a constant help to me as well. I continue to benefit from (and am particularly grateful for) the large amount of time coordinating my case that my N.P.’s Celine Fortin and Rebecca Cooper-Piela and my “nurse-on-the-phone” Fran have put in.

I am glad God doesn’t want my life to get too boring.

(The saga continues on the post entitled Day 13.)

The Photos I Promised

NaNi, on her second day riding.

This is the scene that made Nichelle all teary-eyed, NaNi taking off up the street with Isaac. (We threatened to send her off with a Brides magazine in one hand and a college application in the other.)

Cuteness, as usual.

The two weasels (Nichelle and NaNi) went to DisneyWorld without us.

Phil taught Naomi to blow bubbles. I couldn't even chew gum without swallowing it until I was 6.

Sky Venture, Indoor Sky Diving, Nashua, New Hampshire.

Isaac at Sky Venture, Nashua.

Indoor skydiving: This flight suit makes me look fat.

There’s a really amusing story that goes with this picture, but I need to wait a few years for Nichelle’s anger to calm down before I can tell it.

Isaac and David with Jim, a former sailor who served on the boomer USS Henry Clay. This was taken at the Submarine Force Museum in Groton, Connecticut, home of the world’s first nuclear submarine, the USS Nautilus.

Isaac and David at the helm stations of a nuclear submarine.