When to seek medical attention

BG. I was diagnosed in December with PsA was put on sulfasalizine and naproxen. 2 weeks ago I was switched over to mtx and continue to take the naproxen.

My question is I have had ankle pain for a month now (which was part of the reason in switching meds). The rhumey noticed the swelling but didn’t really investigate it. It is becoming harder and harder to walk.and the pain is unbearable at times. But I am making due. I’m trying to find a new gp as I cant get into my current gp. So my option is go to emergency/ urgent care or a walk in clinic

I abuse the walk in clinic all time. However, there is much they can besides give you pain killers or maybe prednisone. Going to emergency room is only going to charge a vary large bill. I’d call your rhumey if they have an emergency line and get advise first.

You said you were put on MTX because of a change in symptoms. It takes time for any of these meds to start working. If your GP and/or your rheumy can't see you, then you definitely need to find a new GP. In the meantime, going to the ER if it's not an emergency can wind up getting denied coverage. I would go to the walk in clinic if you can't otherwise be seen.

Stoney this is partially why I am hesitant I know it will take a bit for the mtx to work. I did feel slightly better the day after I took the mtx. So in time I think it will help.

As for going to the ER. I’m in Canada. Coverage wouldn’t be denied nor would there be a big bill to pay. I also work in the hospital. The office I went to today was going to talk with the doctor tomorrow to see if he will take us on(my kids need a gp too). So I am going to try and hold out till then.

If it's interfering with you being able to function, I'd go to the ER or walk in clinic. It sounds like something prednisone might help, and that's basically what my ER usually does for me when I have to go in because my rheumy can't see me (as I tend to flare on weekends after overdoing it on Fridays LOL).

Nym's quite right. You may just need help getting over the hump then. I wish you luck with this today.

What you do depends greatly where you are at and relationship with your providers. The best thing is to discuss what to do with your rheumy before the need arises. The last thing anyone wants to become is a frequent flyer in the ER. They may well respect your disease and treat you (they may also make it difficult wanting to "observe" first a process that will have laying there or in the waiting room for several hours while they look for chinks in your story) The worst is they will give you a min analgesic and send you on your way. Standing orders, PRN orders or a call from your doc before you get there will prevent a lot of problems. Its all about relationship.

Frequent flyers without a relationship can have all manner of problems from being labeled drug seekers (the pain may be real but some folks are much quicker to seek pain meds), delayed treatment, to lack of treatment for other conditions.

Other than when I cut off my finger. I haven't been in an ER in 20 years and never for pain (I've been lucky AND I have standing orders for a flair) None the less when I showed up with my Kidney stones a few weeks ago. I giot the immediate pain shot and torodaol. a few hours later of course no stones, n and the doc says USUALLY we have folks out of here by now. I got another shot and an MRI. A few hours later the doc comes in and says well we have your records form the other hospital, your PCP and and Rheumy. You have no history of "need" for pain meds. They called the surgeon and kept me loaded until surgery 8 hours later (there wasn't an open OR until later that nite. I had a little talk with the ER doc couple days later when I dropped off a bottle of wine for her. She shared the protocols with me.They are detailed It really all comes down to how well folks tolerate pain. Put the simplest way I can basically, pain becomes a less important (or even non important) diagnostic tool for the frequent flyers.

Being treated by a Rheumy and then showing up in either the ER or Walk-in with a month old pain in your ankle without a call ahead is not good idea. Not saying you don't need some help, just be smart about it. (that being said it may be different in Canada)

Lamb I get what you are saying. I’m not seeking pain meds. I have those. I,m more concerned there may be a stress fracture or a physical problem going on that I am overlooking because I’m chalking it up to PsA pain and it will get better with the mtx in time. Hence the search for a new gp. But I will talk to the rhumey when I see her next about what I should do in these situations

I understand that you weren't seeking pain meds, that's why relationship is so important and why an agenda before getting to the ER/Walk-in is so important. Thats mostly what they do, they are not a substitute for real medical care. If your PCP is unavailable when you need her you really don't have one do you? I'd change in a heartbeat.

Ideally a call from her to either walk-in or ER has everything set to go looking for that possible damage etc if she can't see you. Both Walk-ins and ER's are "blinder medicine." Their goal is to stabilize and move on. They find some things, but they miss a lot. A little direction is always helpful

Denial of the disease is common. It’s perfectly ok to question the diagnosis. However, when the result keep pointing in the same direction, it’s time to move on.

Avoiding your Rhumey seems like a clear indication of a lack of a patient relationship. I know I hate mine, and that is why I went to my GP. I have little choice of the matter, since I only have branch of Rhumeys in my state.

I don’t deny the disease I accually diagnosed my self far befor I saw the rhumatologist As for the rhumey I have only seen her 3 times I don’t have a relationship with her yet. I am hoping the the gp I spoke with will take me on then I will have a place I can develop that relationship with

I do too. that's the start of real treatment................ I truly believe unless there is understanding between the doc and patient, and REAL conversation, nothing will happen. You might just as well self Dx and by internet drugs from India (assuming you get the real thing) if you can't. of course none of THAT can happen without an open mind.