For Sally Gunning, a kayaking trip last fall became a line of demarcation-good health on one side, pain and a difficult diagnosis on the other. A novelist who lives in Brewster, Massachusetts, she returned home from the trip with intractable pain in her neck and shoulders. "I was in agony, sleeping only an hour at a stretch," Gunning recalls. "I had a miserable winter."
Eric Woodard, MD, Chief of Neurosurgery at New England Baptist Hospital, confirmed that Gunning had suffered nerve damage and prescribed physical therapy aimed at stabilizing her spine. But her hands had become seriously painful, and her wrists swelled. Were those symptoms, which kept her away from her keyboard-and her livelihood-part of the nerve damage or an arthritic condition?
She returned to the Baptist in February 2009 for an answer-this time from Monica Piecyk, MD, a rheumatologist. "I told Dr. Piecyk that my physician had performed tests that checked for rheumatoid arthritis, and they had come back negative," says Gunning who was wracked with fatigue and recalls mornings when it took two hours before she could move her hands.
"That was the worst part," she says. "Because my hands weren't working, I couldn't work." The fact that the manuscript for her next novel, The Rebellion of Jane Clarke, was due a her publisher that summer only added to her anxiety.
Piecyk confirmed that the fall kayaking excursion had not been the major cause of Gunning's troubling joint symptoms. "Her blood tests were negative for rheumatoid arthritis, but that is true in up to 25% of cases," says Piecyk. "The clinical picture is most important in diagnosing rheumatoid arthritis. The symmetrical involvement in Mrs. Gunning's hands and wrists was characteristic of rheumatoid arthritis. In addition, we tested her C-reactive protein [CRP]-a marker for inflammation-and it was 50. A normal CRP is 10."
Piecyk immediately prescribed low-dose prednisone-a steroid that effectively treats inflammation. "It was the quickest way to get Mrs. Gunning feeling better," Piecyk explains.
Within three days, I came to life," says Gunning. Piecyk then carefully transitioned her patient to methotrexate, a disease-modifying drug that is often the first-line therapy for rheumatoid arthritis. Gunning has responded well and has continued to do so.
Piecyk was concerned that the arthritis could have had permanent impact in the form of joint erosion, so she ordered a full set of x-rays and promised to call with the results. When she did, Gunning realized that Piecyk is a physician who truly cares about her patients.
"Dr. Piecyk said 'I have good news: there's no sign of erosion and no joint damage, which means we have a clean slate,'" Gunning recalls. "She is so reassuring. When she told me that I definitely have rheumatoid arthritis, she said I had a good chance of living a symptom-free life, and that would be our goal. It helped my attitude. It meant my life wasn't over."
Indeed, Gunning needed to get her book written. Piecyk referred her to an occupational therapist (OT) to see if any mechanical adjustments would help her work more productively on the computer. The OT suggested wrist splints, which Gunning used for a while, and voice-activated software.
"I can use the keyboard now, but I still depend a bit on the voice-activated software," says Gunning who, inspired by her family's long history on Cape Cod, had previously written two historical novels, The Widow's War and Bound. "Working on this third book, all the fun had gone out of writing, but it's coming back."
She feels that, with Piecyk managing her care, she will lead the largely symptom-free life they talked about when she was first diagnosed. "I'm optimistic now," says Gunning.