Saturday, October 11, 2008

Yay, Second Opinion

Someone tell me why pre-1990 doctors' offices are not very accessible, either the rooms or hallways. Is this because it was anticipated that no one visits offices in a wheelchair or scooter? And someone tell me why post-1990 offices are not very wheelchair accessible either. I mean, there's really not enough room to get around the scooter. I'm stuck in the middle of the room like an extra piece of furniture.

I went to another rheumatologist yesterday for a second opinion, just to make sure we weren't missing anything in terms of either diagnosis or treatment. He said definite spondyloarthropathy, though which subset of this general category isn't quite clear yet. And he agreed with trying to stay on NSAIDs for pain relief, possibly considering TNFs in the future, though it's risky because of my pneumonia history.

It was good to have someone take a step back and reevaluate this information who's not been on the roller coaster of multiple back and health problems with me over the past five years. I don't know why, but it makes me feel better to have a firmed up diagnosis (some of the secondary diagnoses still apply). He did run some additional tests just to make sure there are no other additional problems. The doctor said my ESR is much higher than it should be and that doesn't have bearing on the diagnosis.

I am happy to report that my knee is doing so much better and has stopped grating back and forth in the way that it had. I've had mild crepitation for years, but this was an abrupt and painful, gaaah feeling when I moved my knee. This makes me wonder if I'd just injured it temporarily.

When we were discussing TNFs versus NSAIDs, I mentioned that I get to the point of passing out from pain and he looked at me doubtfully. While he was dictating notes in the hallway, he stopped the recorder a few times to ask questions (I don't feel objectified when it's interactive and when it's a very small office without a lot of patients there). He dictated something about "dizziness with pain," then a little later stopped and asked why I am on atenolol--I said tachycardia, and he looked surprised. I didn't think to say tachycardia followed by syncope if I don't control the pain. Argh, none of them quite get it. Why do I "need" for them to? Maybe I don't. A better diagnosis was what I was looking for.

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