Diagnosis is the key

Dear all,

I am 23 year old female working with an MNC. I want to share my experience with my disease and how I reached this far in combating it with the help of Dr (Col.) O. P. Garg. I have been suffering of TB since February 2009 (I vaguely remember the time). Every evening I had mild fever, around 99-100 and there was swelling in my ankle and wrist joints. Slowly, I started struggling with my swollen joints. You can imagine life of a working professional who has to work all day long on computer, with swollen wrist joints. I could not bend, pick up anything from floor, was unable to open bottle caps/lids, could not sit on floor, so on and so forth. I was becoming dependent for the small things during the daily course of life. I had seen a number of doctors but there wasn’t much help. I don’t blame them completely coz all my test reports were negative. My ESR was around 20 (which is a normal range), blood sugar, lft, kft, RA factor, Anti CCP, hemoglobin, X-rays, so on and so forth. No test revealed anything concrete. I had to leave my job for some time and was put on pain killers (the easiest way out). The increase in pain was taking a toll on me until I met Dr. (Col.) Garg. With the help of my past medical history and certain additional tests, he diagnosed my condition as TB of chest. It was slightly surprising for me and my family that how did my previous doctors missed out on the possibility of such a common disease. Dr. (Col.) Garg helped us in understanding the uniqueness and gaps in my case. The confusing aspects being

(a) absence of the most common symptom, cough, for this form of TB

(b) generally, the ESR levels of the patient shoot up to 50, which did not happen until recently in my case; my ESR levels remained around 20 for about an year, while I was carrying this disease.

(c) my first doctor highlighted the possibility of TB and had put me on test medicines for 15 days based-on Montu test and my chest X-ray; the medicines did not respond. But, Dr. (Col.) Garg insisted on investigating it further with CT Scan and MRI, which cleared the whole picture.

(d) the lymph nodes on my neck were swollen, which once again were ignored by my previous doctors; FNAC of the blood extracted from those nodes confirmed it was TB. Last but definitely not the least,

(e) swelling in my joints led to the biggest confusion of all. Most of my doctors confused it with Rheumatoid Artharitis or some other form of arthritis, until Dr. (Col.) Garg suggested otherwise. The biggest learning I derive out of this experience is that one should always visit the specialist at the earliest. It was only because Dr. (Col.) Garg had been experienced enough to have witnessed so many cases like mine, which led to a timely diagnosis by him. It took him only one-two visit to confirm my medical condition and start my treatment. I can’t thank him enough for showing me and my family a new ray of hope. My fever has gone and now I am waiting to permanently get rid of my joint pains, which may take a couple of months, until my medication finishes.

Anonymous- until I recover completely icon smile Diagnosis is the key

  1. I am a 29 years old boy currently working in an NGO in Nepal. I am working as a Livelihood coordinator for marginalized and socially excluded people. I was suffering from an unidentified problem since last 12 years before. I have a multiple joint swelling in lower limbs, seborrhea, hyper hydrolysis that is excessive sweating, my finger tips became bulbous as like this. My face skin surface became thick, oily and furrowed. I had shown different doctors beginning form my home town in Nepal. Most of them diagnosed me as a sero negative RA. I had taken many medicine suggested by them. I had taken HCQS, Leflunomide etc. I had shown different Aurvedic, Homeopathy, acupuncture specialist and also followed bee venom therapy as alternative medicine. My thinking was those alternative medicine will not have any side effects. However, I could not get relief from my problem. My previous doctor also suggested me that the arthritis and acne are different cases. So, I used to visit dermatologist and Rheumatologist (Physician) separately. Those medicine were able to reduce my problem in some extent but could not completely cured me. I have managed my study in more difficult situation and completed my degree.

    One day, one of my friends suggested me to Dr. OP Garg in my facebook. I visited Dr. Garg site and knew that he is a senior Rheumatologist in Delhi and has been working in this case since 25 years before. By visiting his site, I decided to visit Dr. Garg in Delhi. After a month I visited Dr. Garg in BLK hospital in Delhi. He examined me thoroughly. My x-ray showed new bone formation along long bones, my heart, lungs, and GI system all were normal. Based on this Dr. Garg finally diagnosed me as a case of complete form of patchydermoperiostosis also called primary Hypertrophic oesteoarthopathy (HOA). Now, I am happy that I am able to know the cause of my problem and it is due to the heredity. In my view, it is very important to diagnose the disease first. The treatment and future is guided by the world and the future research.

    After the diagnosis, other doctors in BLK were also interested to look me since it is the very rare case. Every Doctor asked me several queries about the disease. Now, I am searching in my family whether this type of problem were in my parent line or not.

    Dr. Garg started treatment after the diagnosis and my pain reduced significantly. I am a relived person. I know what is the real cause of my problem? I am very much grateful to Dr. Garg and BLK team and also suggested those patient who are suffering from this type of problem, please find your Rheumatologist as soon as possible and diagnosed the disease in time otherwise it may cause some deform and will damage your carrier and future.

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    Comment by Indra Adhikari on October 9, 2010 at 12:52 PM

  2. Sir i am suffering from writers cramp i took lots of medicines and also Botox i have taken recently as presbcribed by Dr Sumit singh in Medicity hospital , Gurgaon but there is no improvement

    i am suffering from simple writers cramp and i am not able to write properly and hand writing is not legible and my right hand starts paining when i write pls advise what to do in my case

    i am taking medicines also Liurosil -1 nos , Zapiz .5 – 1 nos and pacitene – 2 nos ( Three times of these medicines

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    Comment by rotan sintetis on May 4, 2011 at 5:44 AM

  6. Dr.I am diagnosed with HLA B-27 HLA B-7 positive.will this be cured or i have to stay on medicine for ever.i am 27 yesrs old.plz help

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    Comment by Kanchan sapkota on July 3, 2011 at 7:29 AM

  7. You are a case of AS, a auto immune genetic disease, in which inflammation mainly affects spine causing low back ache, In present times, your life can be made comfortable if you are and remain under a rheumatologist for regular follow up and monitoring. If you want to ask about cure, unfortunately, there is no none.

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    Comment by onkpg on July 3, 2011 at 9:40 PM

  8. Dear Dr.
    I AM 41 YRS OLD. MARRIED, BLESSED WITH TWO SONS. A DEFENCE EMPLOYEE RETIRED IN 2003 AFTER FIFTEEN YEARS OF ACTIVE SERVICE. WELL-BUILT PHYSIQUE. COMPLAINT OF LOW BACK ACHE FOR LAST 8 –9 YEARS. NEVER HAD A COMPLAINT OF REOCCURING FEVER. NO SUDDEN LOSS OF WEIGHT OR LOSS OF APPETITE. NO OTHER CONSTITUTIONAL EVIDENCE. HAD COMPLAINT OF MIGRAIN PAIN FOR 8 – 10 YEARS IN THE PAST. FAMILY HISTORY OF HIPERTENSION AND CARDIAC ARREST AND I HAVE BEEN DIAGNOSED WITH AS. FOLLOWING ARE MY REPORTS. PLEASE SHOW FORWARD PATH

    MRI REPORT
    MR IMAGING OF LUMBO – SACRAL SPINE WAS PERFORMED USING FOLLOWING PROTOCOLS ON 0.5 TESLA SCANNER
    • SAGITTAL T1, T2 WEIGHTED & STIR
    • AXIAL – T1 & T2 – WEIGHTED, STIR
    • CORONAL STIR
    • SAGITTAL T1, T2 WEIGHTED, STIR & AXIAL T2 WEIGHTED SEQUENCES IN DORSAL SPINE.
    THE STUDY REVEALS FOCAL AREAS OF ALTERED SIGNAL INTENSITY INVOLVING RIGHT SIDE POSTERIOR ELEMENTS – RIGHT FACET JOINTS AND ADJACENT PEDICLE OF L2, L3 & L4 VERTEBRAL BODIES. MILD EDEMA IS SEEN IN ADJACENT SOFT TISSUES.
    SAGITTAL DORSAL SPINE SHOWS SIMILAR LESIONS INVOLVING RIGHT SIDE BODY AND ADJACENT POSTERIOR ELEMENTS OF D5 AND LEFT PEDICLE OF D7, D10 AND D11 VETEBRAE.
    THE LESIONS APPEAR HYPOINTENSE TO MARROW ON T1 WEIGHTED IMAGES AND HYPERINTENSE TO MARROW ON STIR IMAGES.
    BRIDGING OSTEOPHYTES ARE SEEN AT L3-L4 AND L4-L5 LEVELS. OSTEOPHYTES ARE ALSO SEEN IN DORSAL VERTEBRAE. PATCHY FATTY MARROW REPLACEMENT IS SEEN AT PLACES IN DORSO – LUMBAR VERTEBRAE. OTHERWISE DORSO – LUMBAR VERTEBRAL BODIES ARE NORMAL IN SIZE, SHAPE AND ALIGNMENT.
    DEGENERATIVE CHANGES ARE SEEN IN L5 – S1 INTER – VERTEBRAL DISC AS EVIDENT BY REDUCTION IN THE BRIGHT SIGNAL OF NUCLEUS PULPOSUS ON SAGITTAL T2 WEIGHTED IMAGES.
    AT L5-S1 LEVEL – INTER – VETEBRAL DISC SHOWS DIFFUSE BULGE INDENTING THE THECAL SAC AND CAUSING NARROWING OF BILATERAL NEURAL FORAMINA WITH COMPRESSION OF BILATERAL NERVE ROOTS.
    AT OTHER DISC LEVELS, NO SIGNIFICANT DISC PROTRUSION OR NEURONAL COMPRESSION SEEN.
    VISUALISED DORSAL CORD, CONUS MEDULLARIS AND NERVE ROOTS OF CAUDA EQUINA ARE NORMAL.
    NO PRE OF PARA – VERTEBRAL SOFT TISSUE COLLECTION SEEN.
    IMPRESSION - MRI REVEALS FOCAL AREAS OF ALTERED SIGNAL INVOLVING RIGHT SIDE POSTERIOR ELEMENT – RIGHT FACET JOINTS AND PEDICLES OF L2, L3 AND L4 VERTEBRAL BODIES AND POSTERIOR ELEMENTS OF D5, D7, D10 AND D11 VERTEBRAE AS DESCRIBD ABOVE.
    - NEEDS FURTHER EVALUATION BY BONE SCAN.
    BONE SCAN REPORT

    THREE PHASE SKELETAL SCINTIGRAPHY
    TRACER: Tc99m mdp – BONE SCAN
    PROCEDURE: STATIC IMAGES 2 HOURS AFTER I.V. INJECTION
    PERFUSION AND BLOOD POOL IMAGES SHOW NORMAL UPTAKE OF TRACER IN THE LOWER LUMBAR REGION.
    THE DELAYED WHOLE BODY SCAN SHOWS INCREASED ABNORMAL TRACER UPTAKE AT THE FOLLOWING SITES:
    STERNUM
    SPINE – D8, D11-12, L2-5
    REST OF THE SKELETAL SYSTEM SHOWS UNIFORM DISTRINUTION OF TRACER IN THE AXIAL AS WELL AS IN THE APPENDICULAR SKELETON.
    BOTH KIDNEYS AND SOFT TISSUE SHOW NORMAL TRACER UPTAKE
    IMPRESSION: SCINTIGRAPHIC EVIDENCE OF ? SKELETAL SECONDARIES AT THE ABOVE MENTIONED SITES
    C.T SCAN REPORT OF BOTH SI JOINTS
    SPIRAL CT SCAN DONE FOR SI JOINTS WITH 3D CONSTRUCTION
    REPORT. BOTH SI JOINTS MARGINS SHOWS IRREGULAR OUTLINE WITH AREAS OF BONY FUSION WITH LOSS OF JOINT SPACE WITH S/O ENDSTAGE SACROILITIS.
    NO ASSOCIATED COLLECTION / ABSCESS SEEN ALONG THE SI JOINTS.
    ULTRASOUND REPORT
    LIVER AND P. VIEN (N) PV – NORMAL
    GALL BLADDER AND C.B.D NORMAL
    PANCREAS NORMAL
    RIGHT KIDNEY NORMAL
    LEFT KIDNEY NORMAL
    SPLEEN NORMAL
    RETROPERITONEUM NORMAL
    PERITONEAL CAVITY NO FREE FLUID
    URINARY BLADDER NORMAL
    PROSTATE NORMAL – MEASURES 15 GMS
    THYROID – B/L LOBES NORMAL
    ISTHMUS NORMAL
    REPORT OF DIGITAL X-RAY OF L.S SPINE A.P LAT WITH S.I (C.R)
    CALCIFICATION OF INTER – VERTEBRAL LIGAMENTS ARE SEEN
    I.V DISC SPACES ARE NORMAL
    D.L AND L.S JUNCTIONS ARE NORMAL
    SCLEROSIS OF THE S.I JOINTS ARE SEEN.
    IMPRESSION ANKYLOSING SPONDYLITIS.
    BLOOD TEST REPORT
    HAEMOGLOBIN 13.6
    TLC 9600
    NEUTROPHIL 74
    LYMPHOCYTE 25
    EOSINOPHIL 01
    MONOVYTE 00
    BASOPHIL 00
    ESR (WEST) 15
    MCV 85
    MCH 29.8 PG
    MCHC 35.1%
    NA* 149
    K* 5.4
    CL 93
    Ca* 1.33
    SERUM CRETANINE 0.8
    URIC ACID 5.6
    S. ALP 190
    PLATELETS ADEQUATE
    WBC WITHIN NORMAL LIMITS

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    Comment by Avineesh on July 22, 2011 at 2:37 PM

  9. @Avineesh, Very sad that you are suffering with the Ankylosing spondylitis, But you have to be positive and fight with the disease witha high morale. You should consult a Rheumatologist personally with all yr reports.

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    Comment by Dr. OP Garg on July 25, 2011 at 11:37 PM

  10. Sir

    My age is 26,sex male .I am suffering from back pain from last 5 years.My doc advice me to go for HLA B27 test and my test came HLA B27 +ve

    Can you please advice me about the treatment and please also tell me is there is any thing serious.I am very much scared.

    please guide me

    Thanks and regards

    Deepak Sood

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    Comment by deepak sood on September 6, 2011 at 8:55 PM

  11. Dear Deepak, if your backpain is associated with marked early morning stiffness, if your ESR and CRP level is high, then you may be suffering with a type of arthritis called Ankylosing spondylitis which can be be adequately managed by a Rheumatologist, I adviced you to consult a Rheumatologist for appropriate care.

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    Comment by onkpg on September 7, 2011 at 5:19 PM

  12. Hi, I am 41 years old and have been diagnosed with undetermined autoimmune disease. I have been suffering off and on for years with excema and now it has definately taken over my face, neck, back and arms almost daily unless on prednisone. I have been to the first rhematologist that told me I only had some swelling in the joints and I was fine. Then after another year of seeing the allergist, dermatologist, endochronologist and family doctor with not many answers I decided to see another rheumatologist. He then said he was 100% sure I have an autoimmune disease but wasn’t sure if it was lupus, or scleroderma or possibly both. I have now tried planqenil with visual side affects and now methotrexate with folic acid. I know that this too is not working. I have also tried taking vitamins like fish oils, flaxseed, and dhea. I thought i had things under control, but that only lasted a few weeks maybe even a couple of months with some bad days in between. Now however, I am really struggling and prednisone isn’t kicking it like it used to. I am a very positive person, but I can tell you that this has been a battle. I see the doctor tomorrow and I want to be sure I ask all the right questions and be more proactive. I have been told by my allergist and now the er doctor (two weeks ago a reaction, we think from the flu or tetnas shot?) (Another unknown issue) that I cannot make my body break out like that and to ask more questions. Please help me ask better questions so I can move forward with whatever this is.
    Thank you,
    Laura

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    Comment by laura on October 13, 2011 at 4:02 AM

  13. Dear Laura, I am really sad that you are suffering so much. But to find out what exactly you are suffering with I need to see all your investigation reports and to interview you and examine personally to be able to help you. You seems to be suffering with one of the connective tissue disease or psoriasis alongwith psoriatic arthritis. But you know, it is only presumption untill i know all the facts about your problems.

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    Comment by onkpg on October 20, 2011 at 6:40 PM

  14. Hi Sir,

    I am surya from hyderabad and my age is 30 years. I went to a ayurvedic docter,he said that I have symptoms of arthiritis.Now i was undergoing for ayurvedic treatment.

    I have few questions :
    Can the disease be prevented with ayurvedic treatment or shall i go for allopathy.
    If the arthiritis is in initial stages can it be cured or prevented.
    I have another question raised in my mind whether to marry or not after knowing that I have arthiritis problem.
    Please suggest a good docter for arthiritis problem.

    I will be very much thankfull to you, if you answer to my questions.

    Thanks & Regards
    Surya.

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    Comment by Surya on October 27, 2011 at 3:57 PM

  15. Thanks for spending your time with me over the phone today. I hope to see you soon when we visit India soon.kavita

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    Comment by kAVITA SAINI on November 4, 2011 at 9:20 AM

  16. Dear all,
    This comment is dedicated only and only to one of the best doctors I have met till date. As for me, I am from Haridwar and have been suffering from RA for the last 10 years. I have been on Methotrexate, Leflunomide (Arava) and HCQS for the same duration and my RA has been under control for the first about 5 years. Its since last 4 years that I started having a little fever. Initially, I thought that it must be some sort of cold or mild infection and took Crocin (Paracetamol) for that and it responded too. Then the frequency of fever gradually began to increase and I started having fever almost daily. I was under the treatment of the best rheumatologist in India from the very beginning. I told him about the problem too but all he had to say was that it was NOT due to RA and that I should see some General Practitioner. Well I did exactly that but even he could not find any abnormalities (all of my test were normal except for some raised ESR). I consulted my rheumatologist again but again he gave me the same response “Its NOT because of my RA”. It was a frustrating journey all this time when no one could do anything about my fever and leave alone diagnosing what was wrong with me.
    Finally, I was prescribed an extremely costly treatment of RA (Etarnacept injection) by my rheumatologist saying that my RA is now not controlled by other medication. It was all the more frustrating now. Then someone told me to see Dr O. P. Garg in New Delhi. With little hope, I went to see him expecting the same response from him too. What I found was entirely different. He had a systematic and practical approach. First, he ruled out all other conditions which could cause fever and finally, he concluded that my fever was due to RA only. It is since then that I am on his treatment (NOT the costly Etarnacept injections) and I am extremely happy to tell you that I no more have fever and it is completely cured now. I have been on regular touch with Dr. O. P. Garg regarding my progress on phone and he is very polite and patient every time in responding to all my endless queries.
    In this era of super specialization among doctors, it is very difficult to find a doctor who is not just a good specialist, but a good clinician too who understands the patients problems considering the broader picture. I think I have found just the person and would like to recommend him to all the RA patients. Thank you Dr Garg.

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    Comment by Beena Agarwal on November 17, 2011 at 12:45 AM

  17. Thanks for your kind words, Beena.

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    Comment by onkpg on November 18, 2011 at 1:14 AM

  18. Hello sir,
    Sir, my father has been suffering from RA since 1999. He is on various NSAIDS and DMARDs since then prescribed by various doctors from PGI Chandigarh and other orthopedicians but now his disease is not under control so we are recommended to see rheumatologist. sir, we want to fix appointment for your kind advice. Please give us a brief time slot from your precious time (on 30 nov or 1st dec if possible) venue also.

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    Comment by Shravan kumar on November 27, 2011 at 11:49 AM

  19. Have already given u an appointment on Facebook

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    Comment by onkpg on November 28, 2011 at 10:25 PM