Wow he’s really struggling coming up that hill.”  I was watching my eighty-something father-in-law labor up the hill to our house.  In context, you need to realize that, “Grandpa” is normally one of the most vigorous elderly guys you’ll ever see.  He generally comes blasting out of his room in the morning like a man on a mission.  After breakfast he may head down the hill to the barn and chop some wood, spray the poison ivy, or any number of other projects.  Even much younger folks are usually huffing and puffing after making their way back up the hill to our house.  But Grandpa was pretty used to it and usually took it in stride.

That’s why it seemed odd that he actually looked old as he slowly made his way up the hill, pausing a couple times along the way.  When he got in the house he quickly eased into a chair and looked spent.  On asking him if he was alright he responded, “I don’t know; I guess I’m just getting old.  Getting up that hill is really getting tough.  My thighs and shoulders are sore as can be.  I can barely get moving in the morning.”  I’d noticed he certainly wasn’t rocketing out of his room of late.

Given that he was eighty, there were concerns that maybe age had finally caught up with him.  Or maybe he had some hidden cancer, or late-onset rheumatologic disease, or any number of other problems.  With how he felt, it wasn’t hard to get him to come in for a check-up.  Most of the tests came back pretty unremarkable, but an old, simple blood test, the sedimentation rate, was very high.  It’s a non-specific test, but together with his other symptoms and the normalcy of most of the rest of his tests, it pointed to a diagnosis we see a couple times a year: polymyalgia rheumatica (PMR).  The clincher would be how he responded to a low dose course of oral steroids.  They tend to work like magic with PMR and that can help confirm the diagnosis.  Sure enough, a week or so after starting the steroids, we had the old “young” Grandpa back, motoring up the hill like it was nothing.

PMR is an uncommon, but occasional, illness involving the rapid onset of soreness in the large muscles of the thigh and shoulders with a sense of weakness and fatigue.  Sufferers are almost always over age 50 and more than twice as many women as men get it.  The cause is not known and is thought to possibly be autoimmune.  As noted, steroids work wonders for PMR and are slowly tapered over many months.  The entire course of PMR averages about three years.  It’s one of those diagnoses you don’t want to miss since it’s so debilitating to have, but so very treatable.

Interestingly, about 15% of people with PMR also have a condition called giant cell arteritis (GCA), which has also been called temporal arteritis.  GCA involves inflammation of arteries, most commonly the temporal artery up on the head.  GCA causes a substantial temporal headache, and if untreated (with higher dose steroids), can even cause sudden blindness.  Grandpa actually had some temporal pain that came and went.  In the end we had him get a temporal artery biopsy (which happily was normal) so as to not miss this potentially blinding malady.

Unlike almost 50% of individuals with PMR, Grandpa did not experience a relapse.  Several years later, he’s still going strong.  The only minor glitch – I hear him all too enthusiastically recommending prednisone to any of his older friends with aches and pains: “I’m telling you, get your doctor to put you on some prednisone – it fixed me right up in no time.”  But it’s a small price to pay to have him back as a young Grandpa.

Andrew Smith, MD is board-certified in Family Medicine and practices at 2217 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835

 

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