He hurt Ken badly, bringing him to tears during the exam. He did apologize profusely about five times. He asked all the usual questions, and he told us that he had actually spent several hours reviewing Mayo notes and conferring with Dr. N. the staff rheumatologist, who was, he assured us, "very good doctor and very experienced." I thanked him for taking the time to read the notes. He nodded seriously. After about 15 minutes he said, "I have ideas. But I am calling Dr. N."
More than a half hour later, Dr. N. entered the room. Ken, meanwhile, had left. He was too agitated and too uncomfortable on the tiny exam table, and I hadn't been able to convince him to stay put. I called his cell phone. Dr. N. was not amused. A small dapper man in his 50s, he asked me questions and tapped his foot. I wasn't too impressed with Dr. N. either.
After more questions, he said, "Dr. Z. and I independently reviewed the records sent from Mayo. We each came to the same conclusion. Not everything fits, but many things do. We think you may have
a very rare disease, Remitting Seronegative Symmetrical Synovitis with Pitting Edema, or RS3PE for short."
Ken and I just stared. What? He went on, "Rheumatoid Arthritis, or some other rheumatic disease is really not the disease. It is a symptom. What really sent us in the direction of thinking you have RS3PE is the comment someone put in the Mayo notes, that your hands looked like baseball mitts when you came out of the surgery to remove the pheochromocytoma."
I nodded, saying, "Yes. I said that to the doctor at Mayo. Ken's hands had been badly painful and quite swollen for weeks. But in the recovery room, well, it was shocking."
"Yes," said Dr. N. "Very descriptive of you. So let me tell you the symptoms of RS3PE." And he listed them.
- Symptoms that appear to be seronegative rheumatoid arthritis (RA). ("Seronegative" means that the symptoms are of RA, but the lab work does not indicate RA. The Mayo rheumatologist said they suspected seronegative RA.)
- Extreme pain in shoulders and hands and often other joints.
- Pitting edema (swelling) particularly in hands or feet.
- Fatigue and general illness.
- Severe weight loss.
We nodded. I asked, "What do you mean, 'coincentidental? How are the pheochromocytoma and the hand swelling connected? I have lost track of how many times one of us had said to some medical doctor, 'These two things just have to be connected, somehow.' After a while we stopped saying it because our comment never led anywhere."
The two doctors glanced at each other, and then Dr. N. added the sentence that made my mouth drop open. "RS3PE is associated with tumors. Nobody knows why."
And I exclaimed, "Get out!" (I think Dr. Z. thought I literally was telling Dr. N. to get out of the room, because he looked at me in surprise.)
And the St. Luke's rheumatologist, the doctor who saw Ken's hand and their swollen condition about a day after the tumor came out, and the Menominee Falls rheumatologist, and the Marshfield rheumatologist and the Mayo rheumatologist did not make the connection? But two doctors at the Veteran's Administration did? Dr. N. turned us back over to Dr. Z and left. I wanted to hug the serious young Dr. Z, but I was trying not to cry.
The bad part of this is that it is so rare that he admitted he really did not know what to do next. "Usually," he said, "prednisone is the treatment that works well. We have already been researching when we read the Mayo notes. But you have had prednisone with no effect."
They are going to do further research and talk to Ken in a month or so if not before.
I later did some research on the Internet. RS3PE occurs most often among white males over the age of 60, particularly those who live in rural areas.
Usually when prednisone does not work, a cancerous tumor is found upon further investigation.
I do not know what to think.