One of the first doctors I saw for RA was a QUACK. I went to him once ... and I never went back. Your head, heart , and gut should all be in agreement. If ONE of those things is in question or confusion, it is time to move on.

She sounds absolutely horrible, totally out of line, and frustrating.

NONE of what you are experiencing is in your HEAD. You walk this walk w/ RA every moment of every day. RA is hard enough to deal with without a doctor that minimizes you in any way.

NO drug / treatment is going to get you to 100% and keep you there.... if you find one, please let us know bc we wld all like to be in on that one.

I feel much better when I do not work, can pace myself, take days off, etc. Why does she think ppl retire early or have to quit their jobs bc of RA? It's certainly not bc it is in our heads or bc we need psychiatrists. It's certainly bc we do not take a butt load of drugs and have tried everything else first.

You have the right to fire your doctor for any reason they do not meet YOUR needs as a patient, answer your questions, and address your concerns. We pay WAY TOO MUCH money, time, and effort on this disease.

If my physician is not doing their job I am OUTTA there. I have fired several. One doctor I went back to (prior to RA) just to tell him what an a## he was. He apologized and we discussed the situation, and then we moved on. But I called him on his unprofessionalism and he was never referred by the doctor again that directed me to him bc I reported his behavior to him as well.

Reading your post just made me mad.... !

I say fire her, move on and find a new doctor TODAY. She's not worth your time or money any more.

Whoa, I can certainly understand your frustration. Too many of us have to deal with people not understanding what this disease does to us, so we certainly don't need a doctor who seems to think it is in our heads.

I take Humira WITH MTX. My doctor has quoted me statistics that say most of us need a combination of something else with a biologic.

I know what you mean, about starting to think you're cured when feeling better. I wondered if I was in remission. That is why the discussion came up with my doctor. I wanted to quit the MTX and just try Humira. We did start reducing the MTX, but it became apparent that Humira, alone, was not enough for me. I think you were right to think your doctor would add something to your Embrel.

I, so far, haven't experienced the extreme fatigue that so many talk about, and my doctor has never asked me about it. But, I have no doubt that it can be part of the long list of possible symptoms. I've seen it mentioned here, and other places which describe symptoms. I know that specific stressful events have triggered flares. Ex. the death of a family member. As a retired teacher, I am well aware of the stress that goes with the job, both physical and mental. I retired because I could no longer be on my feet all day on the concrete floors. When one teaches primary kiddos, you never sit at a desk.

If you have other options, I would suggest that you explore them. Where I live, there are not a lot of choices without traveling to another city. I love my Rheumy, so I realize how lucky I am.

Good luck and hang in there.

Ok, my first round with Enbrel was like that - magic!
And my rheum said that the goal is to arrest the RA 100%!

Honestly, I'd go with your rheum and see what happens with Humira. It's similar to Enbrel and what if it does take care of way more RA than the Enbrel?

I totally disagree with the fatigue part. I think we all get lumped into one big group and that's ashame. See, many go years tired and hurting from RA. Then when they feel better, they can't remember the life before RA. THey just know they are finally better, a new "normal". You REMEMBER how you used to feel and you KNOW that you are fatigued!

But, do consider the humira. It might do the trick!

I agree with everyone here. Very frustrating when your doctor dismisses your issues so easily. I would give the Humira a go but start researching other rheumys to see if a second opinion is in your future.

Everything I read about RA says the same thing - you have to find the right doctor for you. I was lucky - I got a great one from the start. Most people, I believe, have to "kiss a few frogs".

My doctor always tells me that we are looking for the medications that give the best results with the least amount of residual damage. She, at no time, has stated that a medication should take care of 100% of your issues.

Fatigue is very real with RA. Pushing yourself physically can bring on flares. Stress can bring on flares. One of the first things my doctor asked me about was my working situation. She wanted to know what hours I worked, what I did, etc. Your doctor should definitely be considering your long hours and commute as a possible issue.

Greg - you are the manager of your health right now. You have the power to put anyone on your health team that you need. You also have the power to ask someone to leave that team.

Keep us informed about what happens. Best of luck to you!!

Linda

I'm still stressed from the appointment. It was as though my pain and fatigue issues ruined her day and she resented me for it. I could tell she was having a bad day and was overloaded with patients but to dismiss my issues is unacceptable. To not even entertain the idea that my job or commute can be a possible source of my flare problems is also unacceptable.

My wife thinks it's part my fault because every time I go there I complain about my pain and I'm not positive. That may be true but I'm not going to tell the doctor everything is great and lie about it. She needs to know how badly I'm hurting.

I'll be getting the 2nd opinion for sure. I hate to start over but I can never seem to get my point across to her and often when I tell her about a symptom I'm having she pretends she doesn't hear me and tries to push the appointment along. She basically ignores what I say unless I push the issue and if she doesn't have an answer she tells me to see another type of doctor.

The question is can I get in to see another doctor before she takes me off Enbrel? I'm not saying her Humira idea is a bad one but I feel I should get the 2nd opinion or switch doctors before I try anything else. Plus not once has she considered adding another DMARD to see if I do better on a combo of meds. That seems odd to me.

Wow, this post also made me furious. The Dr gets paid to deal with patients., not to complain about the stress. Let her have one day in our shoes and her view would change. I'd definitely seek another opinion. Trust between a Dr and patient is crucial.

I saw my Dr before my first Remicade Infusion today and we talked about how severe the fatigue is and she said that the Remicade should really help that (not that I need a psychiatrist).....although she said I would need up to 6 months to notice a full benefit but that some notice relief as soon as the second one.

I'm sorry you had to deal with that today....Awful

Oh boy, sorry to hear about your disappointing appointment. Wow and she was out of line when she said that she had a lot on her plate. That is just wrong. I am sorry. And I don't get this at all when she said you should see a psychiatrist for your fatigue....WOW.
If you are not satisfied with your doctor and you have other options I would find another doctor. In my mind you have to believe in your doctor and your doctor has to believe in you.
Best of luck to you.
Tammie

Many doctors are rated online now... you can rate this rheumatologist and save someone else the heart ache.
My husband doesn't get involved with my relationship with my doctors. He doesn't have RA nor knows how i feel daily.

if this helps any none of the rheumatologists i have had have wanted to converse about my fatigue. none.

they have wanted to talk about pain as related to: synovial fluid, swelling, erosions, bloodwork, ambulation, efficacy (can I stand, sit, walk, lift my arms over my head, hold anything in my hands, bend my knees) , cortisone injections (simple ones)

fatigue? no
sleeplessness? no

I know I should say yes, but that's just not the case. now and then they would listen as fatigue related to methotrexate dosing (finally) but in relation to the disease, nope.

this woman sounds like a goner. it can take a few to hit the right one.

in terms of biologic therapy some docs only want to go 3 months before switching. I did 6 months to a year minimum before moving on. you can insist right back that you would like to continue another 3 months. it's ok, you know? you can state what YOU want.

also sometimes doctors do better when you state what your intentions are and what you need and want. i do believe that some of them can be daft with the caseload they have. they can't always treat fatigue but they can document medical necessity if you intended this to be the time to talk about your exit from work (not sure).

hang in there

depot

Can I Use a five-letter word on this forum, that rhymes with "itch"" It was the first one that came to mind. I could go uptown a bit and use "harridan", "shrew", "quack", "unprofessional", "uncaring", "misinformed" and a few others.

This link http://rawarrior.com/new-way-to-report-response-in-rheumatoid-arthritis-clinical-trials/ from the RAWarrior website, a well-researched and respected source of information, discusses the concept of ACR20, where a 20% reduction in symptoms is enough to prove that a biologic is performing better than a placebo, and 20% improvement justifies keeping the patient on said biologic.

20%.

Ideally you get more than a 20% improvement, but the idea that everyone should see 100% effectiveness is wrong. Loony, unscientific, and uninformed, too. I'll add "mean" to that as well, because it sets up an unattainable standard. She's trying to bring all the worst parts of NCLB to medicine, to put it in teachers' terms.

As far as your wife's comment goes, if this doctor can't deal with the fact that people hurt, she should have picked a field other than medicine, and definitely a specialty other than rheumatology. I'm sure she could get a gig as a greeter at Wally World, plaster a big &#!$-eating grin on her mug, and not have to listen to it anymore. This is your doctor. Feeling like you have to minimize the pain she is trying to treat does you NO GOOD AT ALL. Save the game face for other situations- there are plenty where it is appropriate.

As far as the referral to the psychiatrist, wow. Just wow.

Lucky for you, you live in a highly populated area, full of towns big enough to harbor a rheumy or two, and with a plethora of teaching hospitals. There are some New Englanders on this board- maybe someone could PM you with a suggestion or two.

I can think of many reasons you might want to shop for a new one, but here's the biggest: disability. You are seriously considering taking disability, and you will have to have paperwork from an M.D. Someone who doesn't believe fatigue is part of this, will say that you should get 100% relief from Enbrel, etc., etc., is not going to be helpful if you decide on this path.

I like what Sun said in the first post about your head, your heart, and your gut all having to be on board with a doctor. The profession of medicine has changed, and mostly not for the better. The big boys who collect and count the money are happy, but it isn't working well for either patients or doctors. I completely understand that our docs aren't having a lot of fun. Neither are we. But we can't take it out on each other. This is the long haul.. Find someone you respect, and who respects you. Every office has bad days- we all do- but there are many ways to deal with a bad day. Shaming and blaming patients isn't one of the better ones.

So sorry to hear about your Rheumy. I think it is terrible to be stressed out by your doctor... I have been there and had to fire my PCP and find a new one. Sometimes it can hard to find a good Rheumy the first time around as some of us on this board have found out. Also the doctor you have now doesn't sound as if she wants her patients to go on disability.
As for my Rheumy she stated that most of her patient have done the best on Humira. She started me out on MTX, Plaquenil, and Folic Acid but when those meds didn't keep the inflammation down she added Humira to the mix. Well me and the Humira didn't go well together. But to be honest the Humira was working very well on the pain and fatigue but the last few months I had used it I had an allergic reaction to it. Hope you find a great rheumy and get to feeling better real soon.

You guys are great! Every once in a while I will call her attention to statistics and she will say "that a small number improve" or something like that. That's great. I hope I'm one of them but I also want to know the facts and not be filled with false hope. When I'm sitting there in brutal pain and she tells me that my pain exists because I anticipate it, not because of my life style or the fact that I may fall into the majority that only see 20% improvement really burns me up. I never asked her to sugar coat anything and I think I'd fare better in the long run being told the truth about my condition. Maybe then I can find the best treatment options that will lead to true improvement of my symptoms. In fact she always does that to me. My Vectra DA score puts me in the severe range yet she refers to it as mild. On other days when pressed for the truth she'll admit I have moderate-severe RA. Which is it? I think I have the right to know. It is my body and my condition after all!

I think you should at least check out other Rheumatologists. Her people skills seem to be lacking. If everything else she has been doing is not bad enough, telling me I needed a psychiatrist because I have fatigue issues would have sent me running to somebody else.Yes you do need a 2nd opinion.

As many have said - you deserve better.

Wow! I think I would have to find another rheumy if that had happened to me. Just saying. I was having problems with the office staff of my rheumy with not returning phone calls. But they hired someone to just take care of the phones and things are going much better. My rheumy always takes the time to listen to me and to offer suggestions or to tell me this is another problem with RA. Good luck to you and will pray for you to feel better real soon.

I can't possibly add anymore to the wisdom already shared here. But I totally agree you need to fire this person! You have enough to deal with, and you shouldn't add a horrible doctor to the mix.

I just have to say that my rheumy always validates my fatigue and sick feelings. I bring it up at every visit, and he always says it's my body being in a diseased state, like when you have the flu. Our bodies are fighting off the disease, and the result is the fatigue, etc.

Best of luck to you in finding someone great. Don't give up the search. I fired one here in town and now travel an hour to my wonderful rheumy. Totally worth it.