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Digging holes and weaving tapestries: two approaches to the clinical encounter
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  • Published on:
    Predicated improvement on steroids
    • Philip D Welsby, Assistant Editor, Postgraduate Medical Journal 1, Burnbrae, Edinburgh EH12 8UB 0131 339 8141

    Predicated improvement on steroids
    Philip D Welsby
    Assistant Editor, Postgraduate Medical Journal
    1, Burnbrae,
    Edinburgh EH12 8UB
    0131 339 8141

    John Launer’s recent On Reflexion details his heart block and lessons therefrom1. Might I be permitted to offer a similar lesson?
    Ten months ago I was asked “How are you today” Mostly this is a meaningless question, almost rhetorical, used by people to acknowledge your existence in a caring way. I was able to give a quantitative rather than vague qualitative response. “I am now well thank you, on 15 (of prednisolone) having had an ESR in the 80s and a CRP similarly raised.
    I was very fit (at age of 72) with a resting pulse of 60 attributed to daily gym attendance, but then developed a less that definite pain and a less than definite stiffness in my shoulder and pelvic girdle. I correctly suspected Polymyalgia rheumatic and was put on 15mg of prednisolone. Having read the books my girdle symptoms responded within 24 hours (and thank you for your interest). I tapered down to 3mg when I developed a headache, mostly occipital, and less than definite masseter claudication (I became aware that I had such muscles and noted discomfort when playing the clarinet) along with less than well localised temporal tenderness. You all know that this was Temporal Arteritis, another manifestation of Giant Cell Arteritis, and s...

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    Conflict of Interest:
    None declared.