Had my 2nd opinion rheumi appt today. He's the son in a son/father rheum office. I liked him quite a bit. He agrees with the diagnosis of AS. Great. He says that my MRI's are consistent with sacroilitis, so an alternate explanation rather than a stress reaction from running. He says the most crucial treatment is medication. He says there's no proof of sleeping positions making a difference with AS. He says a physical therapist can be helpful once I am training, and he doesn't need to be an AS specialist, but at least well read on the position. He said that Glucosamine w/Chondrotin doesn't directly address AS issues, but it was up to me whether to continue taking it. We are going to try to preauth for a TNF blocker, the more aggressive drug, since it takes some time for that drug to kick in fully, and just see what my insurance's authorization requirements are for it. Regarding my question if a flare up = permanent damage, he says there is current research being done to see if inflammation can be decoupled from degeneration, but the jury is largely out. But if I monitor my pain carefully, then we'll catch any flare ups early and minimize damage and time off. He asked me what the worst case scenario for this condition is. I said your spine can fuse in a stooped position and then you can get in a car accident and your spine would snap. He laughed. He says that this condition tends to fissle out over time for patients, that fusion of SI is likely long term, and that typically provides great pain relief for patients. He seemed to think that SI joint fusion wasn't a deal breaker for runners, but conceded that this may only be true for recreational runners when I expressed doubt in that assessment. Recreational runners - hey that's what I used to be, and it may be what I am headed toward. But I will get competitive again if I can. 12 days until exercise. Pain of 1 when he manipulated me, and of 2 when I then rolled off the table, which put me in a foul mood for about 5 minutes. I'm fine now :)
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