Desperate for some advice

icklepinkstar

Hi, I'm new here and am looking for some advice for my dad. He's suffered from arthritis in his big toes for several years now, experiencing flare ups every 4-6 months, depending on weather, exercise, diet etc. He goes to the GP every time he gets an episode and usually (after taking bloods to rule out gout) he is prescribed anti inflammatories and it settles down after about a week. Two weeks ago, however, he suffered a flare up which has been excruciating. It's lasted longer than ever and been more painful - he's had to use crutches to get around and has been unable to do much. It's really getting him down. He's been to the GP three times about this recent flare up - AGAIN bloods have been taken and Dad had a phone call yesterday to AGAIN rule our gout. He now has to wait for yet another appointment to discuss next steps - the ibuprofen that has been prescribed is having zero effect.
My dad's case is complicated by the fact that he was diagnosed with prostate cancer in March. He has been on hormone treatment to reduce his testosterone levels since May and in July started a treatment called Abiraterone which has to be taken with a steroid, Prednisolone. My dad thinks it may be this new treatment that has exacerbated his arthritis. Does anyone know if this could be the case and if not, what my dad could do to recover from this flare up? I am in despair with his GP - surely he could prescribe some analgesics? Dad CAN'T give up this cancer treatment, we were SO lucky to be able to get it.

Any help at all would be very much appreciated,
K

dreamdaisy

Hello, I am so sorry to read about your Dad and the battle he is currently undergoing. What a huge strain for him, you and the other members of your family.

I need time to think over what you have told us - if the blood tests are negative for gout (and inflammatory arthritis?) then osteo-arthritis may be the case. Anti-inflammatories work well for some people with OA and to date they appear to have done for him. I am familiar with pred, I took it for about four years but have now weaned myself off it. What I cannot recall at the moment is whether that's a usual treatment for OA: I'm struggling a little myself tonight what with one thing and another but if I have any bright ideas I'll come back later.

I wish you both well. DD

stickywicket

Hello K. I, too, am sorry to hear about your father's difficulties. I'm afraid I don't know anything about the anti-prostate cancer drug. I guess it might be exacerbating his arthritis but also it might just be the arthritis getting worse of its own accord. It happens sometimes and it tends to happen quite frequently when we are stressed as, indeed, your Dad must be right now.

Prednisolone is often used to treat auto-immune forms of arthritis. I don't think it is used to treat osteo but, although I'm not a medic, I can't see that it would make it any worse.

Has your Dad's GP not prescribed any pain relief other than the anti-inflammatories? If not, I wonder why not. I think he would be the best person to put your questions to. I'm sorry I can't be of any real help.

valval

hi sorry we are not much help to you as others have said sounds like oa and i do not know much about this but know doc treats it and pain meds with anti- inflams what they usually use so it back to doc but go with him and make sure doc knows how much it affecting his quality of life (because we all tend to go in and when doc says how are you we say ok thanks) good luck val

frogmorton

Absolutely the Gp could be prescribing some pain relief!!

The poor Man!

Maybe he will let you accompany him on his next visit to the Gp so you can support him. 2 are far more powerful than one in the doctor's surgery.

In the meantime he could ask the pharmacist for help - there are over the counter meds he may be able to take in the short-term..

Has he tried heat or cold as well? That is a hot water bottle (or wheatbag) or an icepack??

Love and luck

Toni xxx

barbara12

Hi icklepinkstar
I am so sorry to hear how much pain your father is in, I know that you can get such sever pain from your big toe due to all the nerve, he sounds in agony.
All I can say is that he has to get over to his GP how bad the pain is, I know its hard but they see so many patients in pain it means little to them at the end of the day.
If he get some good pain relief he wont be has stressed , and the less stress he has the better.
I do wish you well, and I feel for you having to see him in pain, I have gone through this with my parents, so please dont forget to look after yourself, and we are always here if you need to get everything off your chest.xx

kellerman

I'm not very awake today...actually I haven't been for a week so had to read your post twice.
From what I understand your Dad has to take the preds with his cancer treatment. This is common but shouldn't effect his OA.
Mine has just started to affect my feet by joining in with the rest.
I don't understand why he hasn't been prescribed any pain relief. Its a good idea to go to the GP with him as the poor man has enough to deal with.Good luck to him and keep us updated please.May

icklepinkstar

Thank you all for your replies and kind words - I'm doing ok but my mum, who is with my dad 24/7, is finding it a bit tough, especially with him in pain. The GP has now sent a letter for a referral to an arthritis specialist so hopefully this will get to the bottom of the sudden increase in intensity of my dad's flare ups. BUT this will not happen quickly so I will encourage my dad to go back to the GP to ask for help with pain relief. We don't know much about arthritis treatment as it hasn't been too bad in the past and we thought that just anti-inflammatory medication was the standard treatment offered. If dad can also ask for some additional pain relief while waiting to see the specialist, we will make sure to do so.
He is scheduled to see his oncologist next week as well so maybe they will be able to help also.

I will post back with updates.
Many thanks,
K

stickywicket

Anti-inflammatories and painduller are the standard treatment for osteo arthritis and they are prescribed by a GP. Rheumatologists usually deal with auto-immune types of arthritis, such as Rheumatoid or Psoriatic. I think your GP is just being thorough and making sure your Dad doesn't have an auto-immune form.

Your Dad can certainly have both different anti-inflamms (if the current ones aren't working) and also additional pain meds, cancer treatment permitting. This is a hard time for all of you. No point in allowing it to be any harder than it has to be. I think you're absolutely right to ensure the oncologist is fully up-to-date with all that's happening, including meds. Thank you for offering updates. I hope things improve.

icklepinkstar

Hello all,

I said I would post an update for everyone who was kind enough to respond to my plea for advice so here it is

Turns out that Dad has rheumatoid arthritis in his feet which is being treated currently with ibuprofen from the GP. Due to the very painful episodes my Dad experienced after starting cancer treatment, his onco had advised that he put that on hold until we figured out why the arthritis has flared so much - Dad still has aching feet (in one or the other, never both!) most days since the flare up. He has been referred to a rheumatologist to look at the arthritis and the onco has referred him also to a vascular consultant as my dad's foot is very swollen and he thought it may be due to poor circulation. Since my dad has been off the cancer treatment, his arthritis pain hasn't improved so if the onco agrees, he'll be back on it this week, phew!

It still leaves my dad with the constant aching which has not been reduced by the anti-inflammatories. It seems the GP is reticent to prescribe anything more til he's seen the consultant, which could be a long wait! I guess the bottom line is, my dad's RA has become worse (either through time or something else) and we're waiting (always waiting!) to see the specialist who, I am praying, will be able to suggest something to alleviate the pain. I have downloaded the leaflets from this website on managing pain to send my dad so I hope this helps. If anyone has any other tried and tested methods they use to alleviate the pain of RA, I'd be really grateful to hear them....my dad will try anything once!

Thanks again for your replies and concern, it's lovely to find people who might understand what my dad is dealing with.

Kate

dreamdaisy

Hello ickle, it's lovely to hear from you again but how sad for dad, RA on top of everything else. :roll: Ye gods, life is stupidly tough at times, isn't it? I hate to be the bearer of bad-ish news but to be honest not a great deal can be done to ease the pain involved with arthritis. Some of us on here use the phrase 'pain dullers' because that is all they are, they reduce the sharper edges thus enabling us to get on with life in a slightly better manner. Another useful way to cope with the pain is employing distraction techniques, I read, do puzzles, watch telly, come on here, anything to take my mind away from what is hurting. It does help.

I hope your dad can see a rheumatologist soon - please bear in mind that GPs know a lot about a little, you now need the reverse, someone who knows a lot about a little. There are many meds available to help RA but obviously the cancer meds need to be taken into account too. I hope I have my facts right re your dad, I'm struggling a bit today and my concentration is not too good! I wish you both well. DD

stickywicket

Thanks for the update, Kate. Your poor Dad! He has a lot to put up with right now and it must be tough on you, too.

I guess it will be a bit of relief to get him back on his chemo. (Not that anyone looks forward to that.) Methotrexate, one of the first meds usually tried for R.A. is, in fact, a chemotherapy drug but, of course, there are a lot of ‘ifs’ and ‘buts’ come into play. It might not always be used in every form of chemo and, for R.A. it’s used in very much smaller quantities. However, only rheumatologists can prescribe these meds, not GPs. I hope your Dad won’t have a long wait to see the rheumatologist. Maybe his oncology team could pull a few strings?

Whether your Dad’s swollen feet are due to the arthritis or circulation difficulties keeping things moving should help a little and maybe elevating his feet when he’s sitting down also. I’m sure the AC exercise booklet contains some for feet but, basically, twiddling the toes, rotating the ankles (both ways) and raising and lowering the foot from the ankle should all get the circulation moving a bit.

I tend to use DD’s methods for distracting myself from pain. Anything that I can get absorbed in helps. When it’s really bad I play computer games. (The only time I do.) The worst thing one can do is sit and think about it but it can be very hard not to at times.

ichabod6

Predisolone is itself a very effective pain duller.
Please bear in mind that medication is only one of
several techniques or approaches to self manage
a long term health condition. The distraction and exercise
mentioned by other posters can be very helpful.

frogmorton

Hi Kate

I am glad your Dad has at least got a diagnosis now and knows what he is up against :?

GPs dont tend to prescribe the Disease modifying drugs he will need to help damp down the symptoms (of which swelling is a definite one!)

My only advice is as soon as you know who the rheumy will be to get on to his/her sec and ask for a cancellation appt at short notice.

Love and luck

Toni xxx

kellerman

Hi Kate
As far as I know pain dullers shouldn't affect the cancer treatment but maybe the GP is being careful. Ths cancer treatment will have affected your Dad's immune system dramatically.
Its going to be a case of the onclogist and rheumy agreeing on whats the best thing to do now.
The pred should have helped but maybe the dose isn't hefty enough.
See if you can push the oncologist to hurry up this appointment. If it means being pushy do it.
Your Dad deserves a better quality of life than he has at the moment.
The poor man is fighting two illnesses....both of which require potent meds to control.
I do hope you get something sorted sooner rather than see your Dad suffer in this way.
May