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Disease Flares
Right heel ulcer
Despite sed rate being in excess of the limit of 15 mm/hr that the Rheumatologist told me on 1/26/99 was problematic, he continued to decrease prednisone. The sudden loss of circulation to the legs didn’t raise a flag of caution or concern. Increased pain, after being pain-free when prednisone was started at diagnosis of GCA/PMR, was not a concern to him. The pain was addressed by prescribing pain medication instead of increasing prednisone to see if it might have a favorable impact on both legs circulation and increasing pain in the head and other places in her body.
Prednisone was not to be increased until the sed rate made a spectacular jump to 50 on 9/23/99, two months after legs circulation was significantly impaired. By that time an ulcer had formed on her right heel requiring the care of a Podiatrist, a Cardiologist, a Dermatologist and the Wound Care Clinic’s hyperbaric oxygen (HBO) chamber, in addition to the Vascular Surgeon already involved.
Prednisone was finally increased from 6 mg/day to 15 – two weeks later she could walk around the block whereas she could hardly walk 20 feet earlier. The episode of legs claudication and subsequent ulcer led to my doing some serious research of medical articles to learn more about GCA inflammation. I found that GCA can be present in any large artery – it isn’t confined to the cranium or the aorta. Sharing these articles with her doctors seemed to have little impact on her treatment or their view of her conditions.
After discovering so much information published about GCA inflammation affecting arteries anywhere it is difficult to understand how tenacious the doctors were in holding to their convictions that GCA wasn’t involved in these arterial blockages. That tenacity continued throughout her nine year treatment. Only the Cardiologist identified the diminished circulation as being caused by GCA.
The cycle of undertreatment continued resulting in the same heel ulcer condition occurring months later on the left foot in the same location. This and left arm claudication will be discussed later.