Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
Went to a third rheumatologist today. The first was simply not a good doctor and the second was arrogant. The doctor I met today was extremely nice and knowledgeable and was not intimidated by my knowledge of this disease or by me sharing case studies with him. He made me feel like part of my treatment. Made me feel like I had a say in my future by saying he would help me apply for early retirement and switch careers if the future if it need to (those were my words actually but he agreed to do that process with me down the road). When I asked about my CRP level being normal while I'm feeling more inflammation than ever he also said he treats the joints, not the blood! My first rheumatologist spent the whole appointment looking at my blood work on the computer screen especially when I had a question she couldn't answer. This new doc actually used his computer to take notes about me. Lot's of them. Even his secretary was nice! Plus he personally returns phone calls and I had 2 phone conversation with him before we even met!
This new doctor believed fatigue to be a symptom and problem of RA. He did wonder if I was ever checked for sleep apnea but still stated that fatigue is part of RA. He also believed that rest and sleep is very important and immediately asked how I felt when I was on vacation unlike the other doctors who said "everyone in the world feels better on vacation"! Up until now I've been told get flares because I anticipate them, I'm tired because of some medication I've been taking for 20 years without a problem. or my anxiety is preventing my mind from accepting my disease so I'm not handling it well and cause my own fatigue and pain! WTH? I'm done listening this garbage from doctors that never walked a mile in my shoes, let alone ten feet! The next time some doctor blames me for thinking myself into fatigue or a flare I'm gonna report them to the Connecticut Department of Health, Medical Examining Board and let them know I'm doing so! This disease s*cks and they way I've been treated and talked down to s*cks even more!
Getting back to my story - The meloxicam I take really helps so the new doctor doubled it. He did say he doesn't believe in masking RA pain so would only prescribe tramadol to take the edge off pain. He said masking pain is not good because when a joint loses motion it's done so I guess he was trying to say we could actually do some damage if we got gooned up on pain meds. Tramodol is fine for me at this point anyway. I had a prescription for hydrocodone 4 times daily for 4 months and near the end it barely worked while tramadol was still effective. I keep a stash of the strong stuff for emergency anyway or I can always get something from my physiatrist.
Oh and he's a realist like me. He knows no drug works 100% and won't BS me and say it does like the other 2 docs. He realizes that sometimes 60-70% progress is a very good thing. I told him I want to know what to expect realistically so I can deal with the rest. He was on board with my line of thinking.
One concern was his small office. He is s a one person outfit with a secretary/assistant. I'm not sure why as he's quite bright but maybe he prefers it that way. His office is right around the corner from Yale New Haven Hospital/Medical School but he has an office a bit closer to me and does Saturday appointments!! Does he walk on water?
Besides not being part of a larger practice, like I'm accustomed to, or prescribing true opiates I think this doctor may be what I'm looking for. He likes Enbrel and feels if I can't tolerate the methotrexate (which wipes me out ) then he would want me to try Arava. I just read the side effects on Arava and I don't like what I see. Does anyone have any experience with this med? I can probably adjust to 10 mg MTX. Would I be better off sticking with that?
This new doctor believed fatigue to be a symptom and problem of RA. He did wonder if I was ever checked for sleep apnea but still stated that fatigue is part of RA. He also believed that rest and sleep is very important and immediately asked how I felt when I was on vacation unlike the other doctors who said "everyone in the world feels better on vacation"! Up until now I've been told get flares because I anticipate them, I'm tired because of some medication I've been taking for 20 years without a problem. or my anxiety is preventing my mind from accepting my disease so I'm not handling it well and cause my own fatigue and pain! WTH? I'm done listening this garbage from doctors that never walked a mile in my shoes, let alone ten feet! The next time some doctor blames me for thinking myself into fatigue or a flare I'm gonna report them to the Connecticut Department of Health, Medical Examining Board and let them know I'm doing so! This disease s*cks and they way I've been treated and talked down to s*cks even more!
Getting back to my story - The meloxicam I take really helps so the new doctor doubled it. He did say he doesn't believe in masking RA pain so would only prescribe tramadol to take the edge off pain. He said masking pain is not good because when a joint loses motion it's done so I guess he was trying to say we could actually do some damage if we got gooned up on pain meds. Tramodol is fine for me at this point anyway. I had a prescription for hydrocodone 4 times daily for 4 months and near the end it barely worked while tramadol was still effective. I keep a stash of the strong stuff for emergency anyway or I can always get something from my physiatrist.
Oh and he's a realist like me. He knows no drug works 100% and won't BS me and say it does like the other 2 docs. He realizes that sometimes 60-70% progress is a very good thing. I told him I want to know what to expect realistically so I can deal with the rest. He was on board with my line of thinking.
One concern was his small office. He is s a one person outfit with a secretary/assistant. I'm not sure why as he's quite bright but maybe he prefers it that way. His office is right around the corner from Yale New Haven Hospital/Medical School but he has an office a bit closer to me and does Saturday appointments!! Does he walk on water?
Besides not being part of a larger practice, like I'm accustomed to, or prescribing true opiates I think this doctor may be what I'm looking for. He likes Enbrel and feels if I can't tolerate the methotrexate (which wipes me out ) then he would want me to try Arava. I just read the side effects on Arava and I don't like what I see. Does anyone have any experience with this med? I can probably adjust to 10 mg MTX. Would I be better off sticking with that?
My doctor and I have decided to not go with Arava due to the side effects. I tolerate the Methotrexate right now - so we will take it one day at a time on that. She thinks that the Arava would bother me due to other health issues that I have. But, I am sure there are those out there who have good results with Arava. Again, we are all different.
So glad you had a good experience with this doctor, Greg. It makes a huge difference, doesn't it?
Linda
Ditto on the blame game---just had to stop another med & hoping I don't have to deal with the same rheumy & have her shake her head back and forth again while I'm telling her why I couldn't tolerate it. So unprofessional and plain rude, and when she was out of ideas turned it around on me also, said I'm not trying hard enough to overcome the pain, need to make healthier choices, blah blah blah.
Interesting since most recently I worked almost 5 months with my hand wrapped because I had to wait for surgery, have had 2 major spine surgeries & went back to work full time, raised a family, exercised daily, etc etc.
Get to irritated with stories like ours. Glad you landed a good one, only wish he was in "the OC" California so I could make an appointment. Hoping my next rheumy will be a winner.
Beechfeet, what does that even mean when a doc says we aren't trying hard enough to overcome the pain? I didn't know it was something we had control over so easily. She acts like you can switch a light switch or and it will turn off. Or maybe she thinks it's like playing basketball and that if you practice you'll make the shot. That is so absurd. I can't even say what I'm thinking!
There's a Humira commercial on right now as I write this. Every person in it appears at 100%. Isn't that false advertising?
I'm happy to hear of your good doc visit. It's been a long road filled with anxiety to get to this point. Hopefully your persistence will help show others that they can in fact search out and find the right doc.
And the small practice - so what! I can easily see a good doc wanting to run his own small practice and not have to conform to a corporate way of doing things. Around here a big medical company has taken over the local hospitals and all but a few of the small doctor offices and clinics. Weather that is good or bad for me the patient I just don't know yet. My Rhuematologist office is its own entity being a large Arthritis Research Center and hold their own I guess with the help of the big drug companies funding their research and clinical trials.
It sounds like you are on the right track now - if nothing else this doc seemed to listen to you and at least acknowledge your concerns - a big step from the first one!
I think it's great you finally have a doctor that is focused on what you are. He probably has less in staff and such because he refuses to work with government insurance or meet quotas, etc.
No one thingk it's concerning that the strongest pain med he prescribes is tramadol? I mean he has a point that the most he would want for his patients is to take the edge off. He feels if we can't feel the joint we are more prone to damage it. Personally, I'm fine with tramadol for now. I was on hydrocodone for months and it stopped working for pain and made me tired. For some reason I don't have tolerance issues with tramadol probably because it has a dual mode of action and is completely synthetic. Anyway, just curious how others feel and what their doctors give them for pain.
HOWEVER - he fully supports using a pain management doctor.
This new doc you saw probably keeps life simple by not much in the way of controlled drugs.
I've found most don't prescribe pain meds. Besides masking pain the government strictly mandates those who do. The changes for doctors prescribing are strict & time consuming.
Huge difference around my area since the government started this.
When changes were anticipated few yrs back my PM explained to my husband & I just how difficult it would or could be for doctors.
He enjoyed talking politics with us, yes strange.
Yet if say you developed a condition causing you so much pain it was not acceptable I'd hope he would refer you to someone to manage it who prescribes or accept that you want your pain managed.
For now I don't think it's an issue. There is the fact there's better response when a doctor gets to know & builds that trust with a patient. Much like we want to trust that doctor.
Since I have a PM doc who does all my spinal procedures I ask my new Rheumy if he had a problem with my PM prescribing if needed.
He said no as long as I took as instructed. Since he knows my PM & how long I've been with the practice he has no concerns.
I came across a doc. that was helping at my one doctors practice. He explained that the office was so busy he offered to give the 2 doctors a hand. Knew them both personally. He stated he had his own practice but grew fed up with how time consuming it was & how finding good trustworthy staff a lone was a headache. Admired the relationship the staff & doctors had as well as the patients.
You never know.
I'm sure there's a reason your new dr has a small practice.
If you feel that comfort zone during a visit perhaps consider asking him if your still curious.
He doesn't work out of another office? Some work out of more then one.
I can't answer about the meds but they all appear to have side effects enough to cause concern. Bad part is everyone responds different to meds. So we never know until we try it.
Addressing him with these concerns may give you further insight on this doctor.
I like him already. No blame game with all the BS that comes a long with RA. The other doctors comments blew my mind.
I would not have a lot of trust or faith in a doctor who cannot or will not acknowledge what concerns the patients.
We all know these doctors here this from other patients.
What excuse do they give each of them?
It's hard to find that "one" you can have faith in.
We both got lucky & I could not be more happy for you.
Sometimes we have to cross a bridge when we come to it.
After dealing with doctors that have denial issues & no compassion it's hard to be patient. Looking at the doctors I deal with or have dealt with things change once I'm established & we do get to know each other.
I'm hoping & wishing nothing but the best for you with this new doc.
Sammy
I was on Arava recently it didn't really do anything for me. As far as the side effects they are all pretty much the same in my mind anyway. The DEMARDS and the biologics they all have their side effects. I don't believe any of us like the possible side effects. In my mind and this is for me personally the meds have side effects yes but what else do we do if we don't take some kind of medication. I don't know. If anyone has any other solutions I will listen. I am not into the essential oils, mega vitamins or snake oil or whatever those kind of options are.
I am so glad that you had a better experience with your last appointment. I have a great rheumy, she listens to me, we talk and then we attack the disease together. In the end she is indeed the expert on this but she doesn't dismiss any of my concerns or wishes. Wishing you continued luck!!!