The dependence on rheumys is great when you have confidence in them. Intensely frustrating when you get a joker. I had the biggest joker ever for a while. Not content with yelling at me so loudly that when I exited his torture chamber a nurse was standing there with a complaints form, he then got his secretary to invite me back for an ‘informal chat’. The main purpose of this seemed to be to impress me by having me follow him around while he gave orders to his minions. He then evicted an old fellow who was having an infusion from a room - seriously! - in order to put me straight in private. It was the same old song ‘all down to OA’. I said ‘but the main problem is PsA, isn’t it’ and he whispered ‘yes’. I thought I’d inadvertently wandered onto the set of Monty Python. I do have a soft spot for eccentrics, but not when they’re jeopardising my health. So I got a referral to a different rheumy and waited 6 months for the appointment. Since then it has been relatively plain sailing, with just a few hiccups.
These ‘bad doctor’ stories, you hardly dare tell them do you? There’s always the fear that you won’t be believed. Plus it seriously damages our trust in the profession and indeed any optimism. However most of the rheumys I’ve seen have been highly professional and skilful. I’ve now braved 2 referrals in order to get better care and have trod very carefully indeed if asked why I’ve switched. It’s a quick, blame-free explanation accompanied by what I hope is a look of joy and wonderment at being with the new doc. Mumbling also works I find. Then I present my symptoms in as objective and succinct a manner as I can manage.
You know all this I’m sure, you know how to manage these things. But your experiences to date must have knocked your confidence in doctors. I hope that your current rheumy does indeed turn out to be the business. It definitely sounds as if ‘wait and see’ is worth it this time. Good luck Jon Sparky.
Poo- My new one specializes in PsA, was on the International GRAPPA Board to determine the best course for Diagnostics and treatment of PsA, she is also published. I wanted to get reevaluated, but I was a little disappointed when she would not even discuss the US imaging that was just done 2 weeks before the visit, the other thing that sent up a red flag was the eye rolling when I described my ailments, like I either made them up or were fabricated by the other doctors. I will give the doctor respect, if they also treat the patient with respect, that has to be the foundation for a good Doctor/patient relationship. I really get turned off when the doctor is to egotistical, which is quite common in the profession. I respect what they have gone through, but I expect them to be current with the latest developments on the disease, or at least be receptive to hearing about them.
I forgot, another thing my new Rheumy was pissed about, my last Rheumy had given me Remicade and didn’t have me do the requisite blood tests, TB etc. She has a blood draw in her office so she quickly ordered it, saying that it could jeopardize the the insurance approving the treatment.
Wow, I hate doctors that yell at you… It is a little harder to get specialists in the UK, I guess? My latest Rheumy saw me the same day I called! But maybe she pissed off the patients so she has a lot of openings?
I’m thinking it’s easier to get to the necessary doctors in the UK. I just told my GP to refer me and he did. And I get seen and treated for nothing other than the tax I pay and of course the journey of 200 miles each way. But gosh do I feel I’m in the right place. I’m heard, treated nicely and can phone them whenever and they respond within 24 hours. Most of all though I know I’m with the best in the UK there is. It certainly makes me panic less.
Your rheumy seems to have what’s necessary but it sounds like she needs to up her beside manner!!!
Well that is good that you have the doctors, 200 miles is a long trip, but I guess it is not to often…
Yes, she is a little in your face, but hopefully she will come around. I think was more pissed off at the previous Rheumy’s for making a mess of the reports…
Went to see my Pain Management Doctor about getting another Radio Frequency Ablation of my SIJ’s, I showed him the MRI report, he said “often times nothing will show up on the MRI” then I showed him one of the images, he said “Why are they calling that normal?”, I shrugged…
Hopefully insurance will pay for the ablation, otherwise he just charges me $500 for the cash price to do it without insurance, I come in at the end of the day. I think he bills the procedure at around $8,000.
Had another Remicade infusion today, it went well. I also met with my Rheumy, showed her the MRI images I was concerned about, one was a side view of the SIJ showing erosion, she said she thought it was fecal matter, what a crappy thing to say… I told her I did not think I had fecal matter in my SIJ’s, anyway she is going to call the radiologist to re-evaluate the “normal” images…
All in all it was a good meeting, she increased MTX injections, to try and help the Remicade last longer, right now it is wearing off after 6 weeks.
Okay Poo_Spine, @Jon_sparky Actually I think she made a good call. Thats what it looks like to me too. In fact I dare say its “textbook” in fact heres the text book . Don’t let the fact its a dog throw you. Its the best image I could find The overlying gas and fecal matter often obstruct a clear view of the anatomy. If you had a uterus, I’d be even MORE suspicious., as it displaces things even more. Your docs a good one in any event - make SURE you keep her
You do realize this is a MRI slice? Nothing is overlayed, as far as I am aware the smal and large intestines are not between the spine and the outer skin… I admit that it may be confusing if you are not looking at the sequence of slices, so I will show some more in the sequence. She is a good doctor.
This is the image before the one in question, you will notice poo is below the spine not above it…https://s19.postimg.org/vgft1dxcz/IM000023.jpg https://s19.postimg.org/d259xel2b/IM000022.jpg
I know I thought of that come back line when I was driving home, it would have been funny to say, thought my Rheumy does not seem to have that much of a sense of humor…
Thanks for the refresher. What your picture doesn’t show however is that at At the level of the middle of the sacrum, the sigmoid colon loses its mesentery (which gives it it’s shape) and gradually becomes the rectum, which, at the upper limit of the pelvic diaphragm, ends in the anal canal The rectum, about 15 cm long, widens below as the ampulla, which is very distensible. Although variable in shape, the rectum follows the sacrococcygeal curve. At the anorectal junction, the gut curves backward and its concavity is held by the puborectal sling, which can be palpated per anum. The rectum presents three or more lateral curvatures, which correspond to transverse rectal folds in the interior of the gut. The fact is poop problems are the single largest cause of back pain because of the relationship of the rectum to the sigmoid colon and positioning in that area.
One of the most difficult things I dealt with learning to look at imaging especially MRI slices was to convert the flat photos into 3 dimensional images in my mind… adding the surrounding structures organs nerves etc to that picture was somewhat simpler do to time in the anatomy lab.
No idea about the imaging, but interesting you say poop problems are the biggest cause of back pain - whenever I have lower back pain, nowadays I automatically assess what I’ve been eating and how my tummy is.
It took me a long time to see this pattern, and I thought it was probably just me, around 80% of my lower back pain appears to be bowel inflammation (still part of the disease - not suggesting bad diet or garden variety constipation/ IBS are the cause).
Addressing the bowel inflammation really does solve at least 80% of the lower back pain for me. Though, I will admit, the bowel inflammation is a harder beast to tame in many instances than the joints… hello med-high dose steroids.
Being very stubborn in nature, Here yet another image, to show the location of the MRI slice. https://s19.postimg.org/eakfaxf6r/IMG_0347.jpg
The image in question is higher then the area where it passes by the illiac bone, there is only muscle and dermus layers on the back side of the upper SI Joint. I could see your point, where it can get confusing, be when you look at the sequence of images, there is no question in my mind that I am viewing the SIJ. I do not have the capability to show all the images, a video would be best. As far as I can tell, no poo that close to the upper SIJ…
I told her I did not think I had fecal matter in my SIJ’s, anyway she is going to call the radiologist to re-evaluate the “normal” images…
