I had the final visit with my current rheumatologist today. If you haven't been keeping up, let me recap: I started seeing this particular doctor in January. I have been unhappy with his level of involvement from almost the first visit. I decided to change doctors when my current rheumatologist took over a month to give me results of an important blood test despite my having called and left several messages. Then when I saw him again, he wanted to make important decisions about my treatment based on results that were six weeks old from a blood test that had been done only a month into the treatment plan. In March, I made an appointment with a different doctor, but because the waiting lists for specialists in this area is so long, the first appointment I could get was at the end of July.

About a month ago, I injured my right knee while walking. I heard a pop and then there was bruising and swelling. It was somewhat better in a few days, but every time I am more active - for active, read yard-work or walking in the park - the swelling and pain increase. At today's visit, I told the doctor about my knee and he performed a couple of tests, then sent me out for x-rays. I won't have the results until tomorrow, even though he promised I would hear from him this afternoon. He gave me the results of my last blood test, which showed that my inflammatory markers are trending downward, which means the plaquenil is working. He does not think that the injury is related to my RA, though he believes my elevated inflammation is slowing my healing. He thinks I have a torn meniscus - we'll see what the x-ray shows, if anything. He wanted to order an MRI, but knew that the insurance company wouldn't pay for it without exhausting cheaper options first. And for the first time, today, he talked about my chances for remission, which he thinks are pretty good.

It was a good visit in some ways. I asked him about my hair loss, which hasn't been too bad, but seems to have accelerated lately. He said that in his experience with plaquenil, it usually levels out after six months, and I am in my sixth month of treatment. Since my markers are improving I will keep taking plaquenil at present, though if I get bald spots, I'll have to revisit this. He mentioned that my hair loss might be due to the huge level of stress I've experienced in the last three months rather than the treatment anyway, and suggested adding folic acid and a B vitamin complex to the supplements I take. But it was also a frustrating visit, because he again failed to address my issues with pain. He insisted that pain management is not what he's here for - he is here to treat the cause and not the symptoms. I told him that my finances prohibited going to multiple providers with a co-pay and bills for each one. He was unsympathetic.

He gave me good news today, but I don't regret my decision to change doctors. If I hadn't been proactive to start with and insisted on continuing the plaquenil rather than switching to methotrexate at the beginning of April, I wouldn't be where I am with healing. No doctor is perfect, I know that, and I will need to be vigilant about my treatment no matter who I see, but his utter lack of engagement and empathy is distressing. I think the lesson that I'm taking away from this is that no one else can know my body as well as I do and no one else is going to fight for me the way I can. I have to take care of myself.


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