PMRGCAuk
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The Lighter Side: 'Good' News? 'Uncle' MB's Medical Reports following DXA Scan & GP Letter ;-)

Greetings on a Wild and Windy Weekend in the UK, to You Lot of Polymalingerers and Pred-Taperers Worldwide :-)

You might like to know about the results of the latest medical investigations into my general State of Health on my 2-and-a-half-year Journey of surviving PMR - and after much 'nudging' of my medics for them to be done as a precaution..

First, the DXA scan results (synopsis):

"Risk Factors:

Mr Benjamin is aged 60, he smokes (not smart or clever), drinks more alcohol than is sensible (don't many of us, medics included?), and is chucking Pred down his throat for PMR (ok, we'll forgive him for that one).

Mr B has T-scores of -1.3 and -1.5 on his Lumbar Spine and Femoral Neck, and a Total Hip T-score of -0.5. Conclusion: Major Osteoporotic fracture risk (10 years): 7%. Hip fracture risk (10 years): 2%. He is classified as: 'This patient has Osteopenia'.

But, in an apparent spirit of defiant mitigation, Mr B. counter-claims that (q.) 'having played Rugby and Squash competitively, done Action-Man-type physical activities including tearing trees from the ground single-handedly, lifting wardrobes and getting into various punch-ups for the past 40 years, he has never experienced more than a bruised finger nail - let alone a bone fracture'. Mr B. wishes this to be noted on his medical records in questioning the validity of the statistical data provided in his DXA scan results as to his Osteoporosis risk, and in view of his personal health / fitness history. He says (q.) 'I am very good on my feet and never fallen-down unless under the occasional influence of a few-too-many glasses of Vintage Claret'. We reluctantly agree to Mr.B's explanation.

Notes / Recommendations:

No Treatment recommended for Osteoporosis (e.g. Alendronic Acid - Uggghhh!), but General Lifestyle measures are advised according to the Royal College of Physicians for patients taking Glucocorticosteroids: i.e. Get more Calcium and Vit. D. Suggest eating 6 whole, Scottish Salmon 3 times per week (raw, bones and all) and take a holiday in the Seychelles Islands 4 times per year to top-up his Vit. D levels with some warm, bright sunshine. That should fix him, 'Good and Proper'. If he's still taking the Preds in 3 years (and also still self-abusing with the fags and booze), do another DXA scan and give him a good telling-off if the results are worse and / or if he has been hit by a truck and finds himself in hospital with broken bones - or is declared 'DOA'. Further DXA scan recommended in 2-3 years if still on steroids, and / or if he does in fact get hit by a truck in the meantime. We hope not - he's actually a nice guy even if he does push things a bit".

(End of DXA scan Report letter)

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And, then, the GP's letter (synopsis)..

"Dear Mr B, I have spoken with your Rheumatologist re. your queries about needing a 'short' Synacthen / ACTH test to see if your Adrenals are functioning ok after getting a hammering from the dreaded Preds for the past 2-and-a-half years.

He says: 'Tell Mr B. to GET A LIFE AND STOP MITHERING, since these test results are notoriously inaccurate anyway, and in the context of PMR especially. Tell Mr B. not to 'chuck the B****y Preds away' as he would like to do, since although he's now on a meagre 3 mgpd Pred and 'on his feet', his Adrenals may still not be 100% awake and ready for Business As Usual. Only to say, take it steady and don't reduce by too much / too quickly in the meantime. If he's struggling to reduce further, just follow the advice on a certain PMR/GCA website. In the meantime, we will monitor his Bloods for essential inflammatory and other markers every 5 years (if we remember), or if he kicks-up more fuss in the meantime. Let's hope not... our insurers are plagued by this increasingly common type of complaint :-(."

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Ok, so that's it Folks. So, 'Good' News, or 'Bad' News? You decide, but I'll err-on the Positive Side - as always ;-)

Keep smiling on the PMR / GCA Journey!

MB :-)

75 Replies
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Ok Mr Mark; 🤔

my advice is “weight bearing exercise” to keep bone loss at bay! Within reason that is. 😬

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Thanks Maryanne, will do ;-)

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You are a glass half full boy! But we knew that anyway. I love your style! 🤗

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Don't think he is - more like a glass well filled guy...

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Ha, PMRpro, trust you to up the ante ;-) :-D

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I have a reputation to keep up with ;-)

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Sorry for the pedantic grammatical correction PMRpro - but did you mean: 'I have a reputation, with which I have to keep-up'? DL would be proud.. ;-) :-/ :-D

On a separate note, and as Donald JT would say: 'what the h**l's going on in Italy with these fake referendethings?'

Happy Days.. :-D

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It is the reputation I'm attempting to keep up - not me...

What "fake" referenda? The Italian two have been officially approved. One had a minimum percentage participation to be meaningful which it had achieved by 5pm, the other didn't. 'Twas Catalonia that was fake (if that is what not being gubmint approved translates as...)

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That's ok then! Not sure if DJT knows the difference between any European countries.. :-)

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I'm pretty sure he doesn't..... :(

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I'm pretty sure he doesn't either...

95% of the more than 50% of the population who voted in the Italian referenda voted to have increased autonomy for Lombardy and the Veneto, same as what we have.

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Thanks Jane :-). I was bullishly expecting a 'Normal' result but hey ho, not really too bad in the circumstances.

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Ah, Polymalingerers - love it !!!!

All sounds good to me (well, as good as it gets having poly the parrot hanging around!)

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Thanks Piers, I agree, all considered. :-)

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Hi mark mixed news but I would say more positives than negatives. Your determined cheerfulness is something I am trying to emulate. As a “realist” at best, I have some work to do. Glad you at least know where you stand with your bone density.

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Thanks Lyndsay(?). Well, I always try to think how much worse things could be. I agree, better to know than live in uncertainty? ;-)

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Twit, twoo - you are a hoot.

I enjoy your wit! You have really brightened up my morning.

All things in moderation at your age!

Enjoy yourself but I think you will anyway.

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To poach a phrase, Strong and Stable.

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Thanks Snazzy, that's how I like to think of myself (although a few others amongst You Lot might disagree...!) ;-/ :-D

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Always smiling from your posts Mr Mark! Thank you for adding cheer to our poly filled days.... clever one you are! Have a most wonderful day! 😄😎👋😃😀

Kathryn

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Poly filled days. I like it 👋xx

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Thanks Kathryn - I'd rather raise a few smiles here, even if it's not the best of news ;-)

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Well a bit of a mixed bag but delivered with aplomb!! Always a challenge and delight to sieve the truth from the mirth!! Seriously -onwards and upwards!! Best wishes Jackie 👍😃

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Ah ha, Jackie, so perceptive, as always :-). Many thanks x

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Hi,

Positive result, I would have said considering lifestyle and general stupidity of mankind!

......or should that just be man?

You may have been a sportsman which no doubt helped with cardiovascular exercise and bone density- but in some sportspeople the density is more pronounced in certain areas of the body than others! Although I’ll grant that SOME rugby players have fantastic physiques - o’er Missus look at them biceps! Sorry not politically correct!

My adrenals didn’t spark until I was down to 3mg so don’t despair m’dear - you will get there - don’t get impatient. Everything comes to he who waits......and all that rubbish!

I’m going to put my Auntie’s hat on now and be serious........so sit up at the back and listen ...

ditch the fags mate - they’re no good for you!!

and if you thought that was bad, do something really radical.............

give the collapso vino a break for a month to give the adrenals a chance to splutter into life.

I can hear the sobbing from here.😰😰😰😰😰

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OK OK OK DL. So, DL:1 MB:0 (as usual). But seriously (what, me?), thanks for the wisdom and thoughts. I can't disagree....

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Brilliant answer Dorset lady 😂 Lindsay

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I agree with Auntie DL...no cigarettes, no alcohol, lots of exercise. Enjoy life in new ways!

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Thanks Aunty Sandy... I'll try ;-)

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As a member of the club who chucks preds down their throats I also have ostepenia in one hip. I am taking AA and so far so good. Carry on MB.

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Ah, thanks bunnymom :-)

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Bunnymom, AA for osteopenia?

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Yes ma'am

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I am such a Pred head this morning. Who is this guy???

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Which guy??? who said that?

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Why. are you writing to me????!!!!!

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I k-now Nuutheenggh.... :-D

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This guy is our resident comedian and honorary 'uncle' Daft as a brush but more entertaining 😉

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OMG Hollyseden, I didn't realise I have 2 jobs here! :-D Thanks for the lovely thoughts.. :-)

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You are very welcome 😊

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Joke Hollyseden!!!

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Phew.... ;-)

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Yup These jokes are catching 😂

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I've no idea May... ;-) :-D

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OK - could be worse. I would listen to DL if I were you..

Best of luck - we all need it.

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Not much chance of that, I've been trying for the last 2 & half years to knock some sense into him!

But I'll give it a rest for the afternoon, off to watch some gorgeous rugby players in HD!! Whayhaaaay!

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Thank goodness for that... ;-) :-D

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Mr Benjamin

An all round action man! I picture you sitting in your chair in the garden with a drink in hand singing ‘I was born under a wanderin star’. You have come so far down the PMR road but don’t be getting too excited. We don’t want you ripping your shirt when you buy it. No rabble rousing or falling into bushes now. You can almost see the top of the finishing post over the hill but don’t forget. Little steps, little steps. We all want only ladders for you. The snakes can stay in the bushes xx

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Ah, bless you Elaine, many thanks :-) Lovely idea about the snakes...! :-D

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Amusing as always....how’s book coming along?

My doctors have been trying to get me to take those AA tabs for years since dexa scans not too brilliant ...so far no breakages or fractures but overdosing on calcium Vit d and magnesium.... etc

best advice and definitely cured my backache is spend most of the winter somewhere hot ....and as for weight bearing is that your own or someone else’s....maybe new hobby is fishing for those extremely heavy salmons ?!

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Thanks shella :-)

All being well, THAT silly book will be on sale by early December. I'll keep you all posted ;-)

When I got the DXA results it did occur to me that I perhaps should have taken the GP-recommended AA from the start. But then again, I've heard so much about its side effects that I don't regret not taking it. And in any case, I've read that a DXA in isolation isn't conclusive as to causes of low BMD - and that tall / slim people (like me) tend to have naturally lower BMD in the first place.

I might be constructing my own logic around this - main thing is to be more aware of Lifestyle and risk factors for the future. And I agree, Winters in sunny climbs if I get the chance.

As for the salmon fishing...! :-D

MB :-)

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AA and its ilk no longer recommended for osteopenia. Eat right, do weight bearing exercise and add Vitamin K2. No meds with horrible potential side effects needed.

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Mark, the finish line is just around the corner.....don’t delay it, take DL’s advice. We are all on the side lines cheering you on. x Jan

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Thanks Jan, lovely thoughts :-) x

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MB, you are a treasure. Almost worth the PMR to read your posts. Cheers to you.

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Blimey coda, steady on now! ;-) :-D

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What a read Mark! I feel better now. (Previous whinge on new poorly).

Can you experienced PMR Warriors tell me what’s wrong with AA. My Dexa scan said there was nowt wrong with my bones and within 6 months me pelvis nearly fell off due to Osteoporosis. I needed extra scaffolding for the hip implant as there wasn’t owt to fix it too and I was on the AA then being naive and trusting everything a Doctor gives you makes you better.

I too echo MB’s history of self abuse being in the military and then the NAFFI. Consuming copious amounts of Booze with duty free fags and heavy lifting of barrels crates and all thing leisure related in between dangerous sporting activities was compulsory for 25 years of my career. I don’t see how any of this behaviour has contributed to my demise? I am a reformed person now and just do drugs to get the same highs. Prescription ones that is.

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Thanks Estelle :-)

On your first question, I can only guess that some of these examinations don't give you the full picture in context - one way or another.

On the whole AA thing - only to say I've read a couple of alarming studies that de-bunk the idea that it 'strengthens' bones. But since I'm not a medic, better not comment further... ;-/. I'll leave that to the Aunties... :-)

I just wonder if some health conditions are simply a matter of a 'roll of the dice', and not necessarily attributable to past or present Lifestyle?

That said, better not get out of my depth here! ;-)

MB :-)

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Hi,

I took AA for 4 years along with Pred and had no problem with it whatsoever! I was susceptible to Osteoporosis through family connections and early hysterectomy, and thought it sensible.

Many doctors prescribe it without checking it’s actually necessary, so that’s why we always say check it out first before you agree.

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That makes sense DL... :-)

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I had an early Hysterectomy at 32 but had HRT. I haven’t had any problem with AA that I know of but I will ask the Dr what good it’s doing if my hip deteriorated so much in 6 months with only 6mg Pred and 2yrs on it.

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Hi,

Mine was aged 37 but I wasn’t on HRT as they left one ovary. Some people do seem to have problems with AA, so best to chat with GP. Mine agreed that as I’d been on for 4 years, and it stays in your body for a long time that it was probably enough, and by then I was down to very low dose of Pred.

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Might review the AA with the Dr considering the past year. Got to have something to do with roll of the dice or we’d all be the same and suffering everything together.

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You are a very brave Man sir. Nuff Said!

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From one polymalingerer to another.....Oh Mark Mark so glad you pop your head and weird thoughts into this forum every now and again. Sorry your news is a bit mixed but like us all you will get through it. You are indeed a funny man and we all need lots of humour on this PMR journey. Oh look at the time its WINE o'clock......get the bottle out ! Good luck Maz.

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Many thanks Maz :-)

Well, yes, 'mixed' news re. the DXA but not too bad, all considered. The bones might be on the thin-ish side but the SOH isn't! :-D. Always a privilege to raise a few smiles here, more to come...

As for Wine o'clock, taking it easy since the Aunties are probably snooping around (as always). Hang-on though, it's 7.30 p.m. so just a slurp or two before dinner... Cheers! ;-) :-D

MB :-)

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Your bones aren't "on the thinnish side" - those are perfectly respectable t-scores for our age and not much different to mine. HeronNS had a t-score of -2.0, which was deemed worthy of intervention (which she declined) and in a year improved her score with diet and exercise to -1.6, no intervention required.

Almost all of us have osteopenia - that just means less dense than a 20 year old. But osteopenia runs from a score of -1 to -2.5 where osteoporosis starts. But lower bone density doesn't automatically mean you will get a fracture - people with low bone density don't get fractures, people with supposedly normal bone density do. The figures they quote are totally arbitrary - "Where shall we draw the line? What about here?????"

Too long on AA and you could well make things worse as it may create denser bone, but after a couple of years it seems to form cracks and become brittle in some people. There are a couple of ladies who have been on the forum who have developed the spontaneous femoral fractures that are known to be a problem. It isn't nice...

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Thanks PMRpro, you've made my day! :-) x

Well, I have to admit that despite my (usual) bravado I was a just a bit concerned about the 'Osteopenia' verdict from the T-scores / letter given my history of zero fractures, doing sports, only one exception family wise(but for good reasons in her context), generally good diet, Lifestyle etc. I did also read somewhere that some people's BMD is naturally lower than others at any age', and (q) 'tall / slim people can often fit this Osteopenic category'. I'm tall and slim, relatively light-boned (despite my legendary reputation for being a 'Strong / Action Man'). My friends don't call me 'Swivel Hips' for nothing.. ;-) :-D

As you say, T-scores are compared with the benchmark for a normal, 'healthy' 20-30 year-old (if I'm correct?), and it's probably the Z-scores that are more relevant in context, i.e. age 60+? Mine are: Lumbar Spine -0.9 ('Osteopenic'), Femoral Neck -0.3 ('Osteopenic') and Total Hip -0.5 ('Normal').

It makes sense that the ageing process can skew these types of results. It just irritates me that they don't provide more qualitative info about interpreting them in an individual patient's context - just a set of data and the usual 'copy and paste' standard advice (a bit like with steroids and AA..?) :-/

Ok, rant over, thanks again

MB :-)

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Nah- z-scores are REALLY meaningless. No idea why they quote them!

I hadn't commented before because I looked and thought "that's OK". Ask Heron for her programme - it worked a treat.

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Ohhh... really?! (Z-scores). Thanks again - will contact Heron :-)

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sending private message

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Ok, thanks :-)

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z-scores just compare you to the rest of the population of your age as opposed to the peak bone density of 20-year olds. If all of your peers have low BMD, you will look good against them, doesn't mean it is ideal though!

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Well Hello Swivel Hips....this I would like to see so how about a little video for all us PMR ladies to watch.....admire...laugh etc etc

Go On Mark B be a devil.......Maz

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Ha Mazz, I'll see what I can do! ;-) :-D

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