My last few months....

By bucky badger Tuesday, October 21, 2008

It has been a few months since I wrote a share post so I thought I would write some of my trials and tribulations since my last post.  First my rheumatologist thought of switching me from Enbrel to Humaria since my inflammation never went away on the Enbrel and some of my joints are still swollen and painful.  I will use the Humaria pen for injecting myself similar to the Enbrel pen.  There are a few differences between the pens but I have found both are really simple to use.  The thing I cannot get over is the cost of these medications.  I mean really a third world country could supply food to a whole village for the cost of one month's supply of these biological medicines.  The worst thing about the medication switch (other than the severe pain) was going though the wait of getting the medicine approved through the insurance company, my rheumatologist getting the insurance company and Humaria company the correct paperwork and test results.  I had to wait over a month to get my first dose of this medicine.  Without the biological meds my RA went berserk.  My feet, hands, elbows, knees and fingers were so painful that I could barely function.  Work was the last thing I wanted to think about but I only missed one day during that month.  Don't get me wrong I am not complaining since I did get the medicine and my symptoms are starting to get somewhat better (I know there are plenty out there including my Mom that have trouble getting these biological medications) but I was feeling miserable without the medicine.   One thing I have determined from this is the biological meds have helped me deal with my RA in a way that no other meds have come close to helping.  I am worried about the long term effects of the biological medicines but at least I have "closer" to normal life with them now with my family and small children. 

 

My other thought from the past few months that I wanted to share is how my rheumatologist treats me as a patient.  I get really frustrated with my rheumatologist.  It seems like he has no clue what meds he has me taking for my RA and appointments take forever and a day.  I keep track of my medication, dosage, time I take them on an excel spreadsheet but he asks me what I am on and when I take them as if he has no idea what meds he has me on.  He commonly tells me I can't take a certain medication because I am on another medication that when he says it I am not even on it or have ever been using.  Why do I have a chart at his office?  The last time I went in tried to cancel on me while I was waiting in the lobby.  I took off work as a vacation day to see him and let me tell you I was more than a little upset.  He then seen me and told me that he was glad he let me keep the appointment since I was in so much pain and discomfort.  I know things come up where appointments have to be cancelled but this is not the first time they tried to reschedule when coming in for an appointment.  The receptionist at the desk told me that he does this all of the time to patients.  She went in and talked to him and he then seen me.   Am I being irrational in thinking that I deserve a rheumatologist who knows what medication I am taking, timely appointments so I can keep my job and keeping appointments that I have scheduled?  I almost feel like a number instead of a patient that pays for service.  I am not trying to be negative and I do appreciate the opportunity to visit a rheumatologist but I just feel frustrated.

10/21/08 2:35pm

Hey BuckyB,

glad to hear the meds are relieving some of the pain.  If the doc seems to be THAT distracted, then you should find a new rheumy.  What I've found in my search for one, even though I live in a pretty big city, the wait times to get in are so long! I mean, are there THAT many rheumatology patients and not enough doctors?  I seriously doubt they make rounds at hospitals, or do surgery.  Why does it take so long?  When I got DX a few months ago (July), the doc i was referred to by my PCP was out til October (appt was set up for last thursday, and i kept it, JUST IN CASE)....i can't believe, knowing that i hadn't been under trmt for RA that they didn't try to get me in somehow....c'mon.. i called around on my own (fortunately my ins co allowed me direct access to a specialist).  i did find one and they were booked out a month, but put me on the top of the cancellation list and i got in in 2 wks.  he put me on nsaids, re-tested me, and i've been going in every 4 wks.  I wasn't sure I was impressed because he's a man of few words, but he is thorough, i have to give him that.  when i see him, he goes over the notes in my last appt, recaps our last visit.  At first i considered finding someone else, but forget it, i'll stick with him. Even though we (RA folk) are a small percentage of the world's population (1%) we deserve the same care and attention as everyone else, right??  good luck.  i hope you do find a doc that cares about you and not his golf time! 

10/21/08 3:00pm

Thank you for sharing your experience with changing rheumatologists.  I live in a small community and we only have a few rheumatologists in my area.  I remember getting in to see my current rheumy that it took forever for my initial visit.  I am discouraged by my current rheumy but I must be a glutton for punishment since I keep going back.  I also have a hard time understanding my rheumy since English is not his primary language and anyone with this disease we get a lot of information dumped on us all at once during a visit.  I often leave my appointments feeling confused about what exactly what I should do to get myself better, what labs I need to go get completed, where to go to get labs, etc.  I feel I have been more than patient (no pun intended).  I guess I just wanted to know if my frustrations are warranted or if everyone felt this way about there rhuematologist.   

10/21/08 5:23pm

I'm happy to hear you may be getting better with a different med.  It can be a long road to find the right mix whether that's medicine or a good doctor.  When it comes to docs, I can not relate.  I have been very blessed to have a great one since he was the only one within 4 hours drive when I was diagnosed.  BUt in the meantime he has changed affilliations twice in 8 years because of the pressure to see more and more patients.  He did not like it, being forced to see 8 patients an hour was ridiculous.  He likes it now that he has 3 patients scheduled per hour.  I like it too.  There are several rheumys in my area now and I have heard many complaints about shoddy treatment from them too.  I think they are pushed to see so many patients that they can not possibly keep them all straight.  Hope something better works out for you.  I hate going to doctors but I would try another one.

10/22/08 9:37am

Your Rheumatologist sounds alot like my primary doctor. I don't think he keeps a chart. Thats one reason it took so long to get diagnoised. I went in complaining of pain. He sent me for x rays and blood test. He also put me on a new blood pressure meds. I came back to get the results. Went through all the question on where it hurts and how long it has been hurting again. Before the apointment I called to make sure all the blood work and x rays were there. They said yes. He told me I need to get x-rays and blood work. I told him I called and my x-rays and blood work are in your office. "Oh, just a minute" He walks out of the room and comes back with my x-rays and blood work. Then I asked him how is my blood pressure doing. He looks at the chart, says I need to be taking something for my blood pressure. Does not read that I have been taking meds for years for it. Only this time it was a new medication. Probably my biggest complaint is my doctor is very shy. He is also hard to understand for me. He is from India like most of our doctors where I live. If I could watch his lips I think I might make out what he says, but he is too shy. I will say even with these faults he is better than any of the primary doctors in my area. We do not get good doctors in the high desert.

My rheumatologist so far seems excellent. He speaks perfect English. He sits down in front of you and answers all my questions. He and his staff have a memory. He knows what I was like the last time I was in. He can see the progression of my disease. He called me in two weeks early to start treatment when he got my blood work. He seem truly concerned. He asks if you have any problems getting apointments. He does not want anyone to wait long to get in. He knows the importance of early agressive treatment.

I do worry about insurance getting in the way of proper treatment. What did you have to do to get the insurance to aprove your drugs? Did they cover 100% of the payment? I am worried that my RA is progressing so fast.

10/22/08 4:06pm

I really didn't have to do anything for my insurance company to approve the medicine, I just had to stay on my rheumy to get them the prescription, test results and required information to my insurance company.  I called my insurance company and Humaira and asked them what they needed from me and answered any questions they had for me about my personal information and then my insurance company contacted Humaira and my insurance company sent me the medicine next day air.  Yes my insurance had to work with Humaira to see how much they would pay for the drug.  I then got a quick assist card (I can't remember the name of the card) to pay my co-pay for the first few months.  So the first year I will have to pay little or no money for co-pays.  After that I don't know where it will leave me.  I have to investigate the co-pay and how much I will owe after that time period passes on my quick assist card. 

 

I feel very frustrated when I go in for treatment and I have tell my rheumy and the nurse what I am taking.  It seems like my rheumy has no clue what I am taking and he must not review my chart at all before I am seen.  I now just walk in with my spreadsheet I created, with all of my meds and dosages, and hand each of them a copy which they promptly put in my chart.  I don't mind taking responsibility for my well being and care but I think it should/could be a two way road with my rheumy helping me along the way.

 

The kicker is I was on methotrexate and I had to get liver labs completed every few weeks.  I received a letter from my rheumy one month showing abnormal liver function on a lab I took 5 weeks earlier.   I experienced a small amount of liver damage from taking methotrexate and I am still experiencing abnormal lab results for liver functions today.  I was just astounded that I never received a phone call and it took that long for me to get a letter to stop taking methotrexate since it could be damaging my liver.       

10/22/08 7:28pm

I guess it could be worse. I wants had a doc that came into the exam room with a fist full of percriptions that he filled out before he even seen me. It was that way for my whole family. It not right but many of us live in areas where competant doctors are hard to come by.

 

I am also on Methotrexate and worry about liver damage. I have only been on it for 12 days now. So far no problem except my husband feels he lost his drinking buddy. I some times give in and drink when I know I shouldn't. I have been a heavy drinker in the past, so I not sure how great my liver is anyway. Some thinks I have read said two drinks a week is fine. Other things said a few drinks a year on special ocassions only. Two drinks would never be enough, so I am better off without any. I think I need to mention my past drinking to my doctor. I have also been on some large doses of NSAIDS for years.

 

Keep us updated. I am interested in how you do.

10/24/08 12:17pm

Hi Bucky!  It's so good to hear from you!  Your rheumy sounds like a jerk.  Really.  Although having grown up in a small community I know switching to a new doc, especially a specialist, can be challenging.  Might be worth the effort though.  What a dink!  You aren't crazy, he's the one that should be tracking all that stuff. 

 

I am however glad you are experiencing some relief.  Just noticed I have the WI v IA game tivo-ed.  I'm off today recovering from dental work so I might have to check it out.  Don't tell me who wins.....being from IA, I'm sure it's us anyway. *wink*

 

Stay cool!

10/28/08 9:48am

Hello Amy,

 

I don't think my rheumy is trying to be a jerk but very unprepared. Yeah it can be challenging finding a new specialist in my small community but finding one that my insurance will work with is proving to be even more difficult.  As a last resort I think I am going to call my current rheumy and explain my problems that I have with my treatment.  If I don't feel that progress is made with my conversation than I guess I move on.

 

I don't even want to think of that IA vs WISC game.  I traveled to IA for the game and as you may have seen it was not a good day for WISC fans (I waited a few days before posting this so you had time to watch it). 

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By bucky badger— Last Modified: 10/26/11, First Published: 10/21/08