Since I was traveling down to see my son graduate from High School (and there was much rejoicing), I went to see my Rheumy (I live in OKC now, but my Rheumy is in South Texas). What a huge difference! I discussed all my questions and concerns with her (including my last appointment with the free clinic here in OKC that went so horribly wrong), and she was aghast.
I love my Rheumy. She cares. She listens. She explains - in detail - exactly what I need to know to treat everything wrong with me - and that list is legion.
I am now going up on my injectable MTX to 1 cc each week (from .7cc weekly), am adding a liquid sublingual form of B12 and folic acid to help with my seriously waning energy instead of the simple folic acid pills I've been taking, and she gave me a stern talking to about pain management. Apparently, I need to stop being so paranoid about getting hooked on the pain meds and take the stinking things when I need to. I told her that I try not to take them unless I am bedridden, and she said to take one each night at bedtime if my knee pain is enough to keep me squirming in bed, and to take more (up to one every 4-6 hours) any day that I am hurting enough to warrant it. She is renewing my empty prescription for cyclobenzaprine, as my upper back is in constant spasm. As my lower back pain is starting to cause shooting pain alternated with numbness through my behind and back of my legs, she took an xray to see if my 4 herniated discs have now evolved into spinal involvement of my PsA. I'm also going up to 25 mg of amitriptyline (from 10mg) so that I have a hope of getting some sleep (and to work with the nerve pain in my lower back). She also gave me a prescription for Diclofenac, which is an NSAID that works better for me, but cautioned me to only take it when I am really bad, and for the other days to stay on the Naproxyn. Apparently there can be some blood pressure and blood sugar complications with Diclofenac. Finally, I asked her about the whole pre diabetes vs. diabetes thing. She took one look at my a1c, informed me that I am flat-out diabetic, that I definitely need to be on the meds the other doc prescribed (though she would have given me 3 months to try and control it on diet/exercise). She told me where to look to find the right diet, but cautioned me about doing much exercise until we can get my pain/inflammation under control. I am to either ride a stationary bike or walk in a pool for now - and nothing else - and starting with a very short amount of time, then adding time on every few days. Guess whose getting a membership to the Y?? That's right. I am. :) She also told me she would personally kick my butt if I even tried walking the 2 miles a day the clinic doc in OKC insisted that I do (as I hobbled out of his office using a walker because my knees were so bad).
My Rheumy is VERY concerned that the clinic is not taking my PsA seriously (nope, they aren't), as evidenced by the fact that I have been waiting since December to get started back on Remicade, and am waiting for the clinic to get the paperwork sorted out with the Patient Assistance Program. She told me that if they hadn't gotten it taken care of by now, it is likely they will NEVER do it, and that I should start going to the other free clinic in OKC immediately. So I'm switching. Hopefully, since they also have a free Dermatology clinic, they will take biologic treatment for PsA and PA a little more seriously, and will get whatever needs to be done done so that I can get on the right meds.
So I now feel greatly relieved that I am doing what I need to to treat my PsA and PA. I also feel rather vindicated in my disgust/dismay at what the clinic doc said to me (which makes me a small and disagreeable person, but I guess that's just the way things are).