Polymyalgia rheumatica

What is polymyalgia rheumatica? 

It is an inflammatory condition, with the characteristic features of serious muscle and joint ache and stiffness at different part of the body.

To date, the causes of polymyalgia rheumatica is still unknown. It could be genetic or environmental factor.

 The risk factors includes female , age over 60, European people and those who have giant cell arteritis.

Nonetheless, polymyalgia rheumatica is closely related to giant cell arteritis, which share a lot in common, that sometimes, we may even considered it as one.

What are the signs and symptoms ? 

The characteristic feature of this condition is severe muscle pain and stiffness at the body parts such as the shoulders (the early sign),  neck, lower back , buttocks and thighs.

There are also other non-specific symptoms associated with the muscle pain and stiffness such as
- headache
-fever
-night sweats
- tiredness , fatigue
-loss of appetite
- affected mood - depressed
- mild anemia

For most of the cases, the patient experience a sudden and rapid development of the symptoms. Sometimes, some may experience a gradual development of the symptoms over time. In common, the symptoms get worse in the morning, that can last for as long as 45 minutes.

As a result of the disease, you could suffer from doing daily activities, which could be as simple as standing up from a chair or dressing up yourself.

How do I know if I have polymyalgia rheumatica ?

You need to see a doctor. If you have a sudden unknown pain which limits your movement or disturb your sleep. The signs and symptoms of this disease could be very similar to other muscular diseases such rheumatoid arthritis or osteoarthritis.

The doctor will then carry out a few tests (eg. CRP, FBC, LFTs,) to help with the diagnosis in addition to physical examination and patient's medical history. Then, the doctor will try to rule out other possibilities before making a proper diagnosis as polymyalgia rheumatica

What is the treatment plan? 

TO reduce or ease the muscle pain, corticosteroid is usually the option such as prednisone.

High doses of prednisone are given in the beginning to dampen down the "flare-up" . Then tapering off the prednisone SLOWLY to dose that the symptoms are controlled. Therefore, this require frequent meet-up with the doctor to adjust the dosage.

Usually, patient will respond quickly to corticosteroid treatment. However, recurrence or relapse of the symptoms could occur once the prednisone is tapered off.

Therefore, usually the doctor will taper off the doses slowly , for instance every two weeks , until to a level that the symptoms are manageable. And, the treatment may then continue for one to two years to prevent the relapse. Other co-morbidities need to be taken into account as well.

In term of this disease, mostly the patient have to take corticosteroid for quite a long period of time, ranging from two years up to ten years ( or even lifetime) , depending on patient factor and disease severity.

Nonetheless,  long term corticosteroid treatment incur side effects which could be significant:
- moon face
- cataract
- weight gain (obesity) '
- thinning of the skin
- osteoporosis ( loss of bone density) [doctor may prescribe vitamin D3]
- hyperglycaemia ( increase risk of diabetes)  [need to assess blood glucose level periodically)
-increased blood pressure

NOTE: prednisone treatment should NOT be stopped abruptly.

Apart form prednisone, some other pain killers could be added to maintain or control the symptoms.

If patient seek for extra help in the pharmacy, OTC pain killer such as ibuprofen,  naproxen could be recommended.

What advice could we give to the patient ? 

- The corticosteroid treatment (prednisone) should be taken in the morning, with food.
- If the patient is diabetic, need to ask them to monitor their blood glucose level.
- Exercise + healthy diet advice  (especially those on corticosteroid treatment)
- Do not overstressed the body - have enough rest
- Patient can seek alternative treatment such as acupuncture, homeopathy , massage etc.

References 

1. https://www.southerncross.co.nz/group/medical-library/polymyalgia-rheumatica

2. http://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/basics/definition/con-20023162

3. http://www.bpac.org.nz/BPJ/2013/June/polymyalgia-rheumatica.aspx

The Hobitton Movie Set, Matamata

A place worth to visit twice. I would say. Or perhaps, at least once during your lifetime.

Are you a big fan for Lord of the Rings trilogy or The Hobbit ? Then, this is one of the mis-visit place for you. 

The Hobitton Movie Set 

Even you are not, my parents and me enjoyed the spectacular view there too. Simply amazing , especially in the spring (I believe).  I visited that place twice in 2013 winter and 2015 summer.

And, the development of the infrastructure for tourists have changed , I would say, quite markedly. The Shire Rest Cafe and Store  are now both full with people. Maybe, there are less tourists during ht winter. But, the renovation made the place look fresh and welcoming.



It's easy to book a tour to The Hobitton Movie Set. Just go to the official website.

http://www.hobbitontours.com

 Or you can purchase the ticket when you reach Matamata I-site, Rotorua or The Shire's Rest ( the closest destination you can drive to). Then, you will have to sit the bus provided by the company to go into the movie set ( which is a private farm ).

Last time when I went , the ticket was 75 dollars per person for adults. However, I think they increase the price to 79 dollars. But , you can always check on the website to confirm.

SO, my suggestion would be parking your car at Matamata I-site and purchase your ticket there. The time for tours are quite frequent which you can join depending on the time you reach. This is because the weather is quite unpredictable in NZ , so I would prefer to buy the ticket on the spot so that I will not have too visit there in a bad weather. It spoiled the mood to take pretty photos, isn't it ?

However, if your trip in NZ is scheduled, then you have no choice but to book the ticket online. Because it may be fully booked out if it is the peak season. Still, in my opinion, buying ticket on the spot would be better, as I said, the weather changes quite rapidly, so you may have one hour showers and then the sunlight will be shining welcomely the next hour. So, just get there and look at the sky. Or, you just need to pray hard it does not rain.

The second time I went to Hobitton Movie Set, I planned to take Evening Banquet Tour. However it was fully booked ! Can you believe that :(

Pffff. Too much nagging on ticket purchasing.

Trust me, you will be surprised by the crowd visiting the Hobitton Movie Set.

If you are a die-hard fan, please bring your own costume and take photo there. It would be superb. You could be a Hobbit walking out from the Hobbit home.

Each trip got a small group of tourists guided by the tour guide. Most of them volunteered to work there. That;s what I had been told three years ago by the tour guide. They all are well trained, or already knew the Movie set so well that they can explain to you the scene in the LOtR movies or The Hobbit - making you re-live all those scenes in the movie.

The view is stunning, especially during my second visit during the summer. Your eyes will be your best camera to capture the memories. But physical evidence of your existence is equally important too. Therefore, snap as many photos as you could. You need to be quick though. As I mentioned, there will be a lot of tourists there, so the tour guide could not allow too long time staying at one spot as the other groups are waiting.

At the end of the trip, you will be offered crafted beer or ginger beer in The Green Dragon Inn. Love the place and the beer too.

Cheers

The Green Dragon Inn 

Fist time here ! 

The million-dollar tree

My first trip there was with my friends after our placement in Rotorua. We drove there. And, yes , it was raining that time. The road became a bit muddy. And we need to carried an umbrella ( provided by the trip) . But, we felt thankful, as the sun decided to push apart the clouds and shine for while, just enough for us to snap some photos.

That time was winter time, there were not super crazy number of tourists. Or perhaps , it was a rainy day. We managed to sneak in behind the bar in The Green Dragon Inn to take photos too.

The new parking lots 

The dragon . hiding in the bush 

Party time 

Our parents working hard for the kids 

Family photo 

Welcome to our Hobbit home 

Looks yum ! too bad we can't eat them 

Our tourist group 

Be ready, you could be someone photobomb anytime 

Our beloved parents having some rest 

Welcome to Hobbiton 

Another group of tourists 

The second time there, we have more outdoor time enjoying the view and having a nice walk around. Everyone is happy, under this superb weather, and listening to the explanation from the tour guide. 

It was totally crowded. Remember to queue up for your photo shooting. Everyone deserves a nice photo for memories. 

A different kind of feelings revisiting this place. Nostalgic. Love. Happiness.

Something had changed, new props added to the Movie Set, making it more attractive. LOtR trilogies is a legend, and hopefully, this set can bring satisfaction to those fans to quench their thirst for the movie too. 

Maybe, I will come back for the third time, with my kids in future.

 One day. 

(p/s all photos captured by iPhone 5. If you got some high-ends camera, or you are an avid photographer, you definitely get much much nicer photos than ours! :) )