Talking to doctors

[AreaCode707]

Brief background - I have rheumatoid arthritis, mainly in my hands, feet, and knees. It's not curable, but it's being treated, meaning I can type and walk again. I had a doc's appt early in March and she gave me a quick going over, then decided to give me cortisone shots for the swelling in my hands. I know just a little something about cortisone and, from what I can tell, there's a limited amount that the body can take, it builds up. I asked her about it right before she gave me the injections (anyone who wants to know what it was like can go stick pins a half inch into joints of their hands) and she didn't really explain, just kinda said it'd be alright, even though I asked her twice. Now, I know being assertive, especially in health care, is a good thing, but I tried and got rather blown off. So, with six cortisone shots in my hands now, I'm hoping I won't have to have anymore and not worry about it. Anyone (not likely) know anything about this specifically or have any advice? So far I can just tell that the pain's gone away a lot, and my hands no longer have that deformed look that they were starting to take on.

 

[MrDingleDangle]

webmd is a good place to start

 

[AreaCode707]

Was just there, but only got general information. There's more help on the arthritisinsight message boards, but it's a small site and not a large membership. Figured there'd be an off chance I'd get advice here, at least on how to be more assertive in talking to the doc.

 

Awww! You have rheumatoid arthritis at such young age?

I'm sorry I cannot help you here.

If you had an attorney friend, it might have helped in geting the doctor to listen to and comply with your demand or request.

 

[khstudios]

that b!tch doc just wanted some $cash$....

sry to hear bout ur problem ... =(
there's an http://www.arthritis.org/

might be some more info in there

edit: http://www.arthritis.org/conditions/DiseaseCenter/ra.asp

 

[rgwalt]

I'm really sorry to hear about this hotchick. Unfortunately, steroids (which is what cortizone is) do have a limited lifetime of effectiveness. They aren't very healthy to take long-term either. You may want to look into some alternative treatments (whatever they may be). Massage therapy may be able to do you some good. Also, as I understand it, there are some medications you can take that help, though I don't recall the names.

I'm sorry this isn't more helpful. What doctor did you see? Was it a doc at your school? Do you carry insurance? The reason I ask is that cortizone shots *aren't* expensive. Steroids are some of the cheapest drugs you can buy.

Ryan

 

[IGBT]

I hear a lot of good things about sam-e. It may help you..

 

[rgwalt]

One more thing... You are in Cali... You can legally use medical marijuana...

Nice...

Ryan

 

[gooseman]

I would suggest changing doctors.

 

[Jfur]

never stay with a doctor who can or will not explain things to you. I would hoinestly shop around -- it may take several tries but it will be worth it.

 

[Mats]

Propolis. It works for most people. It's a resin made from bees. Perfectly natural.

 

[Hayabusa Rider]

Hotchic,
Unfortunately MD's can be as real asses, as well as the rest of the public. The problem is this particular ass is treating you. In working with several MD type, my observation of the ones that act as yours does is this.

The medical "game" teaches physicians that they are superior to you. Why? Control. Somebody has to make the final decision and they are damned sure they are going to be the ones to make it.
Now this sounds undemocratic. It is. Unfortunately, most people know just a fraction of what a physician knows, and have zero experience. This is why docs get paid the big bux.

Also there is MANAGED CARE Arggghhh--- What this means in day to day terms, is that insurance companies and government agencies pay the bills. Therefore they largely control medicine. One of the unstated goals is to increase physician work loads. This means less doc time per patient.

What counts in a doc (assuming equal skill) is how they react to these pressures. You have an important question that needs to be answered. The above is to let you know some of what the MD treating you has going through her mind as speak to her.

Ok, cut to the chase.
When she is with you and you want to know something, get eye contact and smile. Why? Because you get her to stop thinking about the nest 5 patients she has to see before rounds/lunch/conference... you get the idea. Then ask your question and be specific. You have done some research, so frame your questions to reflect that. I have seen your posts, and I doubt you are going to come off as Ms Know It All. (Docs hate that too). Be yourself and maintain eye contact.

Perhaps you have done this before, and it this fails, say you need to know for your own peace of mind. If this fails, YOU must make the next step. You can either stay with her, or look for someone else.

Good luck

 

[Pliablemoose]

HotChic, I'm an ER RN @ a teaching hospital, & work with MD's that are in practice & millions upon millions of residents.

Make a list (really) and go through it point by point with your physician. If your doc won't take time to go over your concerns, find another one.

You're right to have some concerns about the steroids, we used to administer/prescribe them frequently, but the side effects can be significant. Also, NSAID's (celebryx, ibuprofen, naproxen, etc) are a centrally acting mucolytic & can cause ulcers in an otherwise healthy individual, lesson: don't take them without food in your stomach, ever...

You wouldn't believe how many young people show up in the ER puking up blood after NSAID's have helped wear a hole somewhere in their GI system.

 

[Fangorn]

Hayabusarider, where do you come up with that crap? Whats up with this angst against this perceived "medical game"???

Hotchic, your doctor should be more forthcoming about the cortisone injections. They are very effective antiinflammatories, their effects do not generally decrease with time, rather, its the course of your rheumatoid arthritis that usually progresses unfortunately. Your body produces significant amounts of steroids every day. Cortisol is one you may hear about a lot. The steroids are all produced in your adrenal glands and is a natural substance. Other types of steroids/sterol derivatives you may know are estrogen, progesterone, and testosterone (sound familiar? They have to come from somewhere!) I don't think that you're receiving huge doses of steroids, but you do need to know about the significant side effects of steroid use, such as osteoporosis, femoral necrosis, unmasking of diabetes, psychosis, etc.

I think the real point of this thread is to comment on your physician's poor communication skills. I agree that they were lacking, and if this happens on a consistent basis for you, I would recommend seeing someone else. Remember that doctors DO know more than you. Would you trust your health to someone who DIDN'T go through premed, med school and a residency? These three can take from 8 to 15 years to complete! Find a doc whose personality and communication skills match yours. I'm a Canadian, I'm aware of some of the significant differences between the two but not all.

Good luck!

 

[Azraele]

This may sound off the wall, but have you tried acupuncture?

 

[911paramedic]

never stay with a doctor who can or will not explain things to you. I would hoinestly shop around -- it may take several tries but it will be worth it.

Ditto. When I have patients in my ambulance and I ask them why they are taking certian meds they say things like "because the doctor told me to" It is unbelievable sometimes. I know why they take them and explain it to them while I am doing my Tx on the way to the hospital. They usually thank me for explaining it to them and end up with a better understanding of their meds and problems. It only takes a few minutes to explain it to them but Dr's are really pressed for time and forget that their patients are people.

BTW, I had a cortisone shot in my shoulder many years ago and it sucked getting it, but better after, like you said.

 

[StageLeft]

A LOT of doctors LOVE to just brush off questions. I think it's extremely insensitive of them. Naturally people are going to worry about medical procedures and far too many doctors just get you in and out hardly caring about you or your concerns.

 

[Hayabusa Rider]

Fangorn, notice the "game" in quotes. Like the advertising "game" or any "game" in this context. If you have issues, there are professionals who can help you. Sheese

Oh perhaps since I have been part of medical teams in teaching institutions, and have had 20+ years of personal professional interaction with physicans, and have many friends who are physicians, and relatives, and so on, gives me an inside perspective that you lack.

Next bitch?

PS. FYI when I was watching the interactions between medical students and residents, I noticed how Darwinian the who process was. The students tried to trap the residents, and sometimes it was just plain ugly. This did not always happen, but it was Clash of the Titan Egos almost every day. I happened to go out with the sr. resident and we had a nice long chat which was very illuminating as to how this process works. Usually this attitude diminishes as the individual matures. Not always though, and conditioning is hard to break completely. As far as control goes, IT IS AN ISSUE if you like it or not. I have seen so many stupid things done by patients it is incredible. The physician who lets a certain type of patient gain the upper hand in their relationship can indeed do harm. You think it is all fun and games out there? Or perhaps you are one of those aforementioned medical students, or pre-med.

The purpose of mentioning it at all was so HotChic would be aware of what might POTENTIALLY be going on behind the eyes of her physician so she could approach her most effectively.

I hope you never watch sausage or law being made either. It might disallusion you to the point of desperation.

 

[AreaCode707]

Thanks for the help guys, I'll definitely put it to use.



<< NSAID's (celebryx, ibuprofen, naproxen, etc) are a centrally acting mucolytic & can cause ulcers in an otherwise healthy individual, lesson: don't take them without food in your stomach, ever... You wouldn't believe how many young people show up in the ER puking up blood after NSAID's have helped wear a hole somewhere in their GI system. >>



!!! I should've explained a little more at the beginning - I'm on metholtrexate, plaquenil, naprosyn, as well as tagamet and folic acid to counter side effects. How much is enough to eat to be able to take the naprosyn safely? I hate eating in the morning - can I get away with just a cup of yogurt?