The Doctor Will See You Now

He's young. REALLY young. Image found here. 

I met my new rheumatologist yesterday. I told him that I was beginning to feel unwanted since my last two rheumys retired. He laughed and commented that he didn't plan on retiring any time soon, and judging from his youthful appearance, I would guess he's right.

It's hard work establishing a new relationship with yet another doctor. I showed up clutching a manilla folder holding several items that I thought would be useful in our discussion: a medication list, a laundry list of new symptoms and questions,  copies of a few medication studies to discuss, and a picture of my hands at their most red and inflamed.

After we shook hands and exchanged greetings, he acknowledged the folder in my hands. "Looks like you've come prepared, good! I'm prepared, too."

I blinked. What?

"I've been reviewing your chart. You've been with us here at the clinic for awhile, haven't you?"

Um. Yep, I sure have. Since.....

"2004. Wait, it looks like you were coming in with symptoms earlier than that.....I would guess 2003."

Yikes. He DID do his homework.

"I've had a chance to review your labwork and imaging studies as well as your medication history. Looks like we have a lot to discuss. It's a good thing we have a whole hour to get through it all and come up with our plan."

An HOUR?!?

He began by a thorough physical exam, palpating and auscultating and assessing and manipulating and reflex tapping and well, y'all have been through the drill, then rolled his chair up to the exam room computer. "Can you see the screen? Let's start by taking a look at your earliest appointments in rheumatology."

What followed was the most in-depth conversation I've ever had with a physician. I was amazed. Also slightly depressed after seeing the ridiculously long appointment list scrolling by on the computer screen.

Here's the plan that Dr. Young Guy and I came up with: We're going to taper then discontinue the use of two of my current meds - methotrexate and cyclosporine.

Why? I asked him.

"Do you think they're very effective for you right now?"

Let's see.....my hands hurt and they're getting worse....and now my toes and feet hurt like heck.....my energy levels are in the pits.....hm....I would say that would be..... NO.

"I don't think they're doing you much good right now, either. So we'll keep you on prednisone, and we'll re-start plaquenil since I want you on some kind of DMARD, but we'll gradually get rid of the MTX and cyclosporine. Then let's see how you are doing. If your symptoms flare after the meds are out of your system, then let's look at some other, newer medications."

Such as?

"Well, there's rituxan, for one."

Funny you should mention that....(I pulled from my folder a three page study which focused on the use of rituximab in Sjogren's syndrome.)

"Yes, I've seen that study. Rituxan can be very useful in severe Sjogren's. But before I prescribe one of these big gun meds, I want to be absolutely certain that it's appropriate. So I want to have you completely off these other meds before we consider it. And, of course, there's other drugs we could consider as well."

He sat back in his chair and looked questioningly at me. "Are you with me here? Have we got a plan?"

I sat quietly for a moment.

Well, now, I thought. This young man obviously knows his stuff. He's thorough and willing to listen to what I have to say. He came to this appointment after having reviewed my chart and diagnostics. He's congenial and actually asked what some of my hobbies and interests were. And after I answered, his response was that he LOVED pie. And rubbed his hands together gleefully.

A guy that loves pie? Obviously a gentleman with good judgement.

OK, I said. I'm in. But I should warn you, I'm not a happy camper when I flare, and I hope this doesn't trigger a whopper one.

"I hope not, too. I have a feeling that it won't, but should anything happen at all just give me a call or drop me an e-mail and I'll get right back to you. I think we'll be seeing a lot of each other." he said with a smile.

I think so too. He may be a keeper.

Hm. Next appointment: apple, pecan, or banana cream?