Greg's Story

Hi, my name is Greg Buckett, my mates call me Bucky, and this is my story..

In March 1988, at age 15, I woke up one morning crippled with pain, and within two months I was in a hospital bed. Every joint in my body was inflamed to the point where I couldn’t walk, straighten my arms or bend my legs. Even eating was extremely painful.

This 15 year old boy was an acute admission on 7 March 1988 with a history dating back over the past two months of intermittent arthralgia involving the wrists, shoulders, knees and ankles. It was initially considered that his problem was post traumatic, but the fleeting joint pains persisted, associated with a diffuse skin rash which was erythematous, involving the proximal areas of the lower limbs and buttocks which was associated with a fever in the mouth prior to admission. Shortly after admission his main complaint was not so much that of arthralgia but one of myalgia to the point of almost being bedridden.

His past history is unremarkable except for in 1986 when he was admitted with abdominal pain thought to be post-viral.

This young boy remained in hospital for a period of three weeks to one month during which it was noted that he had persistent fever up to 38.5º and fleeting arthralgia involving most joints. In view of the normal investigations it was considered that he most likely had a systemic form of Juvenile Rheumatoid Arthritis (JRA). He was commenced on anti-inflammatory medication in the form of Naprosyn which showed a mild improvement in his symptoms but resulted in abnormal liver function tests which took a week or two to clear. He was subsequently trialled on Clinoril 100mg b.d. with considerable improvement in his overall symptoms.

He was subsequently discharged on 31 March 1988 and reviewed in outpatients on 14 April 1988 at which stage he was pale and with considerably more joint pain than he experienced before. We have commenced him on Sulphasalazine 2 gms daily.

TAKEN FROM LETTER NELSON AREA HEALTH BOARD DATED 27 APRIL 1988

The next three years I spent in and out of hospitals, with many visits to different doctors. Over this time I was diagnosed with JRA (Juvenile Rheumatoid Arthritis) as you can see from my doctors’ reports I was given numerous drugs to try and help my JRA symptoms. These drugs allowed me to just function with day-to-day life but little did I know just how bad things were going to get. These drugs were really just a short term fix – and then the side effects from them kicked in!

My whole world collapsed …

He remained relatively stable until September 1988 where he appears to have relapsed through his Sulphasalazine presenting with hot, swollen joints in both hands and both knees and ankles. He was subsequently readmitted to hospital and x-rays of both hands taken at that stage showed early definite erosions particularly the radial aspect at the base of the 3rd proximal phalanx and possible earlyerosions affecting the 2nd and 3rd right proximal interphalangeal joints.

In view of the obvious deterioration he was started on IM Gold 50mg weekly and Prednisone 5mg daily, initially with the intent of stopping his steroid after a month or so. Since then however we have had several trials of steroid all of which have failed because of persistent flare-ups of his disease.

By the end of February 1989 he had taken over 1000mg of Gold and without Prednisone was non mobile. We have reached a stage where we would welcome a second opinion as to further management. We are not sure in this situation whether Hydroxychloroquine or more aggressive medication should be used in a young man of this age given the severity of his symptoms.

TAKEN FROM LETTER NELSON AREA HEALTH BOARD DATED 22 MARCH 1989
 

Off to Auckland Hospital I went with Mum to visit the arthritis specialist. A review of his comments ...

On examination today he was a rather pale, tall, thin lad who weighed 67kg. There was tender soft tissue in most of the PIP and MCP joints of both hands and the right thumb, wrists and elbows, knees, ankles and MTP joints.

1. He has systemic onset of Juvenile Rheumatoid Arthritis
   (Still’s disease).
2. His disease remains active. It seems to becoming a more common practice to add in Hydroxychloroquine 200mg/day in this sort of situation in the hope that a combined effect may be helpful. Should no progress be apparent at the end of three months, we would suggest continuing the Hydroxychloroquine and adding in D-Penicillamine in place of intramuscular Gold. We would reserve the use of immunosuppressant therapy at least until after he has had a trial of this.
3. It remains highly desirable to taper his Prednisone if at all possible.
4. We feel that he is in need of a rehabilitation programme as well as better control of his disease activity. There could be significant advantages for him in a reasonably lengthy inpatient admission to a specified rehabilitation unit such as Queen Elizabeth Hospital in Rotorua.

TAKEN FROM LETTER AUCKLAND HOSPITAL DATED 4 APRIL 1989

 

With the drugs keeping my disease under control, I managed to get some low impact work in a retail store. This was short lived though, as things unexpectedly flared up again and I ended up on the sickness benefit. This was one of many low points in my life, fighting the effects of JRA. Things carried on this way until 1991 when my weekly Gold injections started to take effect, which saw my JRA go into remission for three years. I was able to cut back on all drugs and start a new life. I got work on a deep sea trawler fishing off the New Zealand coast. Finally my life was getting back to normal, until, in November 1994, I had a sudden relapse and was forced to leave the boat, going straight back into hospital.

When last seen his left knee was particularly swollen. I decided to continue on with the original plan and injected the left knee via a lateral approach with 40mgs of Kenocort.

TAKEN FROM LETTER NELSON HOSPITAL DATED 16 NOVEMBER 1994

For the next two years, life was full of chronic pain, walking with crutches and not being able to work. Then in 1996, at age 23, my doctor recommended a hip replacement. There was no way this was going to happen to me! So I started looking at alternative treatments.Anything and everything was tried but nothing seemed to work. I tried it all, from copper bracelets to drinking cider vinegar, even several different specialised diets.

At the age of 25 I became one of the youngest people in New Zealand to have an artificial hip replacement due to arthritis. The drugs just kept on coming, with the side effects at times worse than the disease.

The skin lesion that he developed recently appear to be slowing down and although he still had one or two small lesions in the last week the frequency of the eruptions has definitely diminished. I suspect following our discussion that they are probably related to the Gold and as such this has been discontinued and may at this stage be the reason for his ongoing problem.

With regards to ongoing treatment of his rheumatoid, he has in the past received Sulphasalazine, intramuscular Gold and Plaquenil and at this stage with ongoing problems, he should be considered for Penicillamine perhaps initiating therapy at 250mg per day for a period of a month and assessing activity following which he could increase by 250mg per month up to 750mg before an overall reassessment is warranted.

TAKEN FROM LETTER NELSON HOSPITAL DATED 8 MAY 1995

 

He underwent arthroscopy of his left knee for pain and clicking on the 11 November 1996.

Apart from a moderate synovitis there was no significant abnormality and I have instilled some steroid which has settled things down.

Today however, Greg complains of significant pain in his left hip present during the day and night. He is having to use two sticks to get around.

Examination reveals moderate wasting of his left thigh, a range of movement 10 to 130, 40 degrees of abduction, 25 of adduction, 15 to 20 on internal rotation and 30 of external rotation.

X-rays of his hip show on the left side marked inflammatory change with complete loss of joint space, erosions and some early femoral head collapse.

Greg has a very significantly damaged left hip and I suspect that some of his knee symptoms were probably coming from the hip joint.

I suspect that the hip will collapse further relatively quickly and I think that he is going to require surgical intervention here before very long. The options are either a fusion or a total joint arthroplasty. One normally would like to avoid joint arthroplasty in a 25 year old as this inevitably leads on to subsequent loosening and further revision surgery, but the fact that Greg has active disease does suggest that his activities are likely to become restricted through further joint involvement over time and in balance, this is probably the best option for him.

TAKEN FROM LETTER NELSON HOSPITAL DATED 27 NOVEMBER 1996

Off I went to Nelson Hospital and had my hip replaced. This did not go as smoothly as we had hoped. During the operation they unfortunately split my femur while hammering in the new shaft. I was taken back to theatre two days later so they could wire up the damage.

Recovering with leg in traction and no hip for 8 weeks.

Recovery was slow, but with the help of the drugs I was eventually back up and walking about. Then things went from bad to worse. In April 1999 I was admitted back into hospital with acute septic arthritis of the left hip. They opened up my hip and cleaned out all of the infection. I spent the next six weeks injecting antibiotics into my arm every six hours, and then headed north to Auckland to start my new job as skipper of a passenger ferry.

Unfortunately, the infection in my leg returned and my artificial hip had to be removed so back to Nelson Hospital for another operation.This left me in hospital flat on my back in traction with no hip from 14 June 1999 until 2 August 1999. This was the longest 48 days of
my life.

Greg has had a hematogenesis infection of his left total hip replacement, which required removal of the prosthesis, insertion of Gentamycin beads and 6 weeks of antibiotics.

LETTER FROM NELSON HOSPITAL DATED 30 AUGUST 1999

 

Life carries on with new hip and back at work, still taking the different drugs.

I reviewed Greg in clinic today. His left hip is fine after he underwent re-implantation secondary to infection. Unfortunately his left knee has quite a large effusion and pain and I have injected this with some steroids today.

TAKEN FROM LETTER NELSON MARLBOROUGH HEALTH SERVICES LTD DATED 2 MAY 2000

 

Greg’s left knee has become swollen and painful again some 3-4 months after his last steroid injection. His X-rays today show a few small erosions around the medial joint but otherwise well preserved joint space.

I have injected the knee again today with some steroid but it is obviously only a short term measure and I suspect he will need to have his medical therapy re-evaluated and/or consider synovectomy in the future.

TAKEN FROM LETTER NELSON MARLBOROUGH HEALTH SERVICES LTD DATED 2 MAY 2000

 

I feel that he should be offered Methotrexate and I have initially started him at 7.5mg weekly. He needs a blood screen repeated at monthly intervals in order to make sure he is not developing leucopenia.

I thought it was reasonable to run him on Methotrexate at this dose for a period of two months and then look at his inflammatory markers and whether he is symptomatically any better on the new medication.

TAKEN FROM LETTER NELSON MARLBOROUGH HEALTH SERVICES LTD DATED 16 AUGUST 2000

 

The other concern was that of the ongoing abdominal pain which seems to have been present for two years, exacerbated an hour or two after meals and certainly worse after a large meal. The discomfort is now present all of the time and at times prevents him from sleeping.

On examination, there does tend to be suggestion of fullness in the right side of the abdomen at the level of the umbilicus.

TAKEN FROM LETTER NELSON MARLBOROUGH HEALTH SERVICES LTD DATED 1 NOVEMBER 2000

 

At 28 years of age things took another turn for the worse, My left shoulder started feeling much the same as my hip before the replacement operation. So back to the hospital to have my shoulder replaced.

I reviewed Greg Buckett at clinic today. The CT scan shows a gross erosive arthropathy of the left shoulder and I think that without intervention this will go on to significant collapse, deformity and loss of function. I don’t think there is really an alternative here to going ahead with total shoulder replacement and I have arranged for him to come in semi-urgently for this.

TAKEN FROM LETTER NELSON MARLBOROUGH HEALTH SERVICES LTD DATED 18 MARCH 2002

New Beginning

With my new shoulder now working as best I could hope for, and life getting back to normal, I got to thinking how I could best support my mobility and keep active.

I got talking to a guy I met who is involved in a nutraceutical manufacturing company based in Nelson. He suggested I try taking Glucosamine Sulphate and Omega 3 fish oil, and that I should take a large dose for a few months to see if it would be of benefit to me.  I did my own investigation work on the internet and decided I had nothing to lose as fish oil ( Omega 3), and Glucosamine Sulphate which is made from crab and shrimp shells seemed to be well tolerated.

I was given a whole box of these capsules to try, and started taking six 1000ng Glucosamine Sulphate Capsules and four 1000mg Omega 3 capsules twice a day.

This is much higher than any brand was recommending but I figured it was worth a try

I now work as a commercial crab fisherman and have a physically demanding job pulling up by hand 120 crab pots a day. After a few months of taking Glucosamine Sulphate and Omega 3,  I started to notice my energy levels improving and I felt a lot freer in my joints.

Then from late 2002 I started getting back into some of my sports like water ski-ing, both recreationally and competitively, mountain biking, hunting, diving, tramping and camping. I was also able to reduce the dose of Omega 3 and Glucosamine Sulphate I was taking to just four capsules of each per day, but from time to time, if I feel the need I increase the dose if I feel I have overdone the exercise or lived too much of the good life. I find that alcohol and the type of foods I eat can affect me badly, so I recommend a healthy lifestyle with plenty of fruit and vegetables, not too much alcohol, plenty of water and exercise.

It is important to understand that my problems will never go away, I have had to learn to live with them. But what I have been able to achieve is a quality of life that allows me to do most things and keep mobile. It has really given me a quality of life I never thought I would have.

Back doing what I love best

Its now 2006. Over the past 4 years I have had many people come up to me and ask how I manage to keep going with my active lifestyle. After explaining to them my discovery of Omega 3 and Glucosamine Sulphate, nine times out of ten they ask me if I could get some for them or a friend, etc. I got to thinking that because I believe in these health supplements so much that maybe I should endorse my own brand “O2B” which is what I have done. I use the same source of Omega 3 and Glucosamine Sulphate as my friend was giving me.