What makes a good appointment?

I had one of the best medical appointments of recent memory last week with my new rheumatologist. He talked, I listened. I talked, he listened. It was an actual conversation between two people on equal footing. Communication, understanding, and a dash of compassion made for one fantastic discussion about my healthcare.

Dr. Kraag started with asking me about myself. What a novel idea. Married? Kids? Job? Medical history? And he didn't outwardly groan when I mentioned I had a list of things to talk to him about. Hey, I was almost 2 months overdue for an appointment, there was a backlog of items on my list!

We talked about my Enbrel and how I thought it wasn't working. I have been on it for 15 months and am not much further ahead physiologically than I was before taking it. I am significantly behind financially - we only had a co-pay of 80%. In my new job, we can coordinate benefits, and I will be 100% covered. So, Humira is next on the list, pending approval from my medical plan.

We talked about Methotrexate injections vs. oral dosing. A big shout out to Laurie Grassi and her Frozen Woman blog, for posting about MTX injections and providing me with information on a study comparing the two methods of administration for this drug. The results of the study indicate a higher level of absorption through injection over oral dosing, without a significant increase in the number or severity of the side effects.

It seems odd that I would ask my doctor to self-inject another needle each week, but I did. The first dose took me 15 minutes to administer. 14 mins and 45 seconds was me counting to 3, and then starting the count again until I mustered up the courage to "take the plunge" as it were. Amazingly, it hurt much less then Enbrel injections as the needle is very fine. I won't go as far to say that it was enjoyable, however it was much more tolerable. Next week should be much better.

We talked about my joints, their damage and he took a look at all of the x-rays the hospital had on file for me. A picture is worth a thousand words, so I'll share a few of his observations with you:

"Do your wrists hurt? No? Well they should, you have no room in there."
"Wow, Lapner did a great job on your shoulder."
"Uh, hunh. Look at those feet. Well that's not good, is it?"

While this was hard to hear, it was great that he had direct access to my films and could pull them up instantly. My last rheumy was in an office, not attached to the hospital, so all he would see is the radiologists report. I think there is something to be said for seeing the pics first hand, in my case the x-rays are rather startling.

We talked about Vitamin D, Calcium supplements and Actenol. He was professionally surprised (read: shocked that my rheumy didn't have me on a preventative plan for osteoporosis, but didn't say much because they are colleagues). I was going for bone scans on a regular basis due to the 16 year use of Prednisone, however this is a reactive test, not a preventative treatment. So, now I am on 1000 mg of Calcium and Vitamin D, and taking one Actenol per month for to keep my bones healthy and strong.

I have a note for an ergo keyboard for work. I have a spring in my step. I have an appointment scheduled in 3 months. I have a plan of action I am excited about. I have a glimmer in my eye that soon, very soon, Prednisone and I may be parting ways on a permanent basis. I have a super new job. I have some hope that my health care moving forward will be proactive and preventative not reactive and palliative. This makes a good appointment.