I <3 My Rheumy!

In the spirit of Mom With A Stethoscope’s recent anti-rant (read back through all the posts, not just the summary that’s linked) I’d like to say:  I love my new rheumatologist.

  • There is a plan.
  • I get to know what that plan is.
  • I am comfortable talking to her.
  • She listens to me.
  • She looks at the paperwork I fill out for her.
  • She advocated not paying a bill.
  • She doesn’t spring surprises on me.
  • She gives me information (I don’t have to pry it out of her).
  • Once she considers me stable, I won’t have to see her as frequently.
  • She’d like to reduce my number of meds.
  • She gives me hope that I can get my life back.

“What,” you may ask, “led to this outburst?”  I had another follow-up with my rheumatologist yesterday.  She is wonderful.

Before ever entering the exam room, she looks at the two-page questionnaire that’s required at every visit.  What takes place during the visit is based largely on the information provided on that questionnaire.  This has been true at every follow-up appointment, not just yesterday.  (It seems like a no-brainer, but I’ve seen doctors who don’t do this.)

Yesterday I was feeling pretty good.  She could tell.  I told her that I hadn’t expected the methotrexate to work so quickly, and she replied even though it can take up to six weeks, there should be some response in two weeks.  When I held up my hands to show that the swelling has in my hands has gone down enough that I can wear my rings, she admitted that she hadn’t expected it to be that dramatic.

I told her that because of our car wreck last summer, my medical insurer is denying all my claims and telling me to submit those claims to auto insurance (even routine lab work ordered by the rheumy).  She advised me not to pay the bills myself.  Insurance isn’t likely to reimburse me if I pay a claim they’ve denied, but her office and the lab will jump through the hoops necessary to get payment so long as the bills are unpaid.

If the mtx continues to cause nausea, she’ll switch me to injectible.  Her idea, not mine.  I really think she would have made the switch immediately if I’d said, “oh good, let’s try that.”  It gets better every week, so I’m okay sticking with the pills for now.  Immediate response to little details is really nice.

There is a plan for my treatment.  She actually said, “Here’s the plan…”  My head would be spinning, and I honestly don’t know if I could take it all in if I hadn’t done so much reading about RA.  But I have, so it works.  If I hadn’t, I think I could say, “Whoa, slow down,” if I needed to, and she’d back up and provide more detail.

Yesterday she mentioned paving the way for insurance to approve a biologic.  She did that last month, too.  The idea of a BRM terrifies me, so I appreciate having time to get used to the idea.  No surprises.  Hopefully, if the time ever comes, I’ll be ready for that step.

She doesn’t want me taking so many pills.  Once we’re both happy that everything is well controlled, we’ll see about decreasing the number of medicines I need to take.

She understands my frustration with monthly appointments.  Since I expressed this to the nurse, not the doctor, it means that the nurse is listening and she communicates the extra information to the doctor.  Once I’m stable – doing well and not changing doses – quarterly follow-up will be okay.  Not so very long ago, I would have been appalled at the idea of four doctor’s appointments in a single year.  One appointment every-other-year was frequent enough.  Now I’m looking forward to only four appointments a year.

She increased my methotrexate to 15 mg.  The goal isn’t just “pretty good” or “mostly okay” or “much better than before.”  The goal is NED.  No evidence of disease.  She’s the only one who’s ever said that’s possible.  It gives me hope.


New Rheumy

fw2What a difference between my new rheumatologist and my first one!

Everything was different yesterday!  More like a ferris wheel instead of a roller coaster.

People talk about doctors running behind schedule, being left in the waiting room for hours.  Not this doctor – at least not yesterday.  I was taken back to the exam room ten minutes early.  While the nurse took my vitals, the doctor reviewed my paperwork.  That’s an efficient use of time!  The doctor walked into the room already familiar with my history.

And she smiled.  The last guy was always too serious.  It’s got to be hard working with a bunch of people who are in excruciating pain.  I understand that autoimmune diseases are serious.  But the world still spins on its axis, and life goes on.  We have to make the best of it.  A smile goes a long way!

My previous rheumy sat down and discussed every single one of my answers on his five-page questionnaire.  That was nice.  I knew that he hadn’t missed anything.  My new rheumy’s questionnaire is just three pages, and she only asked about things for which she wanted more information.  It takes less time to ask a few pointed questions than to meander through five pages of history, but I didn’t feel that she skipped anything.  In fact, some of her questions gave her more detail than my former rheumy ever had.

The old rheumatologist told me what he was thinking as we went along:  “Symptoms x, y, and z could mean this or that is going on, so we’ll look at these things…”  This new doctor didn’t offer any of that information (I really appreciated that about the old guy).  I’ve learned a few things about autoimmunity in the last two years, so I didn’t have all the “what’s going on?” questions this time.

My new rheumy uses a computer, in addition to paper charts.  The old one didn’t.  My former doctor spent a lot of time writing notes all over my questionnaire.  My new doctor spent the interview time typing into her computer.  She types fast!  The room was arranged with a chair for the patient beside the little work-desk, with the keyboard on the desk and the computer monitor on an arm extending from the wall.  This arrangement let the doctor face both me and the computer screen at the same time.

After the history, the doctor left while I slipped into a gown.  This new doctor’s exam chair is cool!  It was probably more expensive than a plain exam table, but very nice.  Next time I’ll get a picture.  It’s a comfortable height to sit down; no scrambling up like you’re a mountain climber!  The height is adjustable, like a dentist’s or barber’s chair, so the doctor doesn’t have to stoop over to do the exam.  Also, the chair reclines so although I was sitting upright for part of the exam, she tipped the chair back for part.

The exam itself took way less time.  Two DMARDs and an NSAID are doing their job, so there were no swollen joints to examine.  Not that she didn’t try.  I was feeling pretty good, though, and nothing was even tender.  Except for my feet.  I was right about that – it is plantar fasciitis. The tender-points test was so quick that I almost didn’t realize she was doing it – the former rheumy took a long time with that one.  My previous rheumatologist looked in my mouth for saliva and sores; my new rheumy never asked about sores and took my word for it that I have plenty of saliva.

Rheumatologist #1 had an x-ray machine in his office, so I was marched down the hall early in the appointment, and the doctor was able to view the x-rays before I left.  My new doctor sent me elsewhere for x-rays, so she won’t see them until today.  In comparing these two doctors, I don’t think one is better than the other.  They’re just different people with different ways of doing things.

Initial exam at the first doctor’s office took nearly four hours.  My new doctor did most of the same stuff in ninety minutes (plus a few minutes to go get the x-rays).

I phoned my husband after the appointment and told him that I really like my new doctor.  He was happy to hear that, and is hoping that now I’ll start feeling better. This has been pretty hard on him.

One thing that I really liked about the first doctor was that he told me what he was thinking.  My new doctor didn’t do that.  I take that back.  As I think about it, she did mention a few things here and there, but not a summing-up-at-the-end, “here’s what I want to look for.”  She renewed all my prescriptions, and said there’s something autoimmune.  She’s not sure what, and wants to find out.  She did mention Hashimoto’s, maybe gluten intolerance.  From the boatload of labs she ordered it look like she’s strongly considering SLE or MCTD – which the first guy mentioned but never ordered the tests.

One things about autoimmune disease without being on prednisone – skipping meals for a fasting blood draw is no problem.  Not as enthusiastic about skipping my meds this morning, but I’ve taken them without food and won’t do that again.


Stay tuned – lab results should be here next week and maybe we’ll have an answer.