Re: Visit to Rheumy-sue

[Guest guest]

Sue,

I¹d think that your decreasing WBC count and your doctor¹s suggestion to

take you off of arava would be considered failing arava, making you eligible

to try Enbrel. You said that mtx also decreases your WBC¹s so maybe this

is the answer to getting to try Enbrel.

Do you have any other RD¹s in your area that aren¹t teaching? Personally I

wouldn¹t mind a student seeing me providing the RD also saw me at each

visit. I wouldn¹t allow a student to do a joint injection, but to do the

general assessment, it would be fine. It¹s not selfish to only want the

best. We have serious diseases and want the best care.

a

> Yes, Tess, I go to Wake Forest University Medical Center in Winston-Salem,

> NC. My endo is also there. Sometimes when I see him, he brings in a medical

> student, but only to watch. He's a teacher also, but I don't think my rheumy

> is. My opthalmologist, though in another city, went to medical school there.

>

> I guess I'm selfish because I want the best, which means I'd just like to

> see the rheumy only.

>

> I asked the last fellow about Enbrel, and he said I hadn't failed at mtx

> yet. I think they have a certain protocol they have to follow in order to

> satisfy the insurance companies.

>

> And I'm sure the lowering wbc count is from the mtx and Arava, since both

> are suppressing the immune system. But I am on such a low dosage of each.

> I'm afraid that the pain will come back when I drop the mtx. I normally take

> it on Wednesday morning.

>

> Take care, Sue

>

[Guest guest]

I guess both the mtx and Arava are causing the WBC count to drop. It started

its decline when I was just on 15 mg of mtx a week. So he prescribed Arava

instead of increasing the mtx again. It's been declining ever since, even

though the mtx had been decreased to 7.5 mg.

I didn't want to stop Arava because it's helped me so much. The mtx just

didn't do it for me by itself. It will be interesting to see what the Arava

alone will do. I hope it will keep the pain at bay and also not cause a

further decline in white blood cells. I've been lucky so far and haven't

caught any infections.

My rheumatologist does not teach, I don't think, but I guess he works with

medical students sometimes. That's the first time I've had a student see me.

One advantage is that he took oodles of time with me.

But last year when I was turned over to the Fellow, I think that the rheumy

kind of lost touch with me, even though he did come in briefly for each of

my visits. My next appointment is with him and the new Fellow, so I just

feel as if he's abandoning me again. I'm tempted to call and tell the

receptionist that I want to see just him. I would like some continuity in my

treatment. But maybe I'm just being unreasonable.

Sue

on 11/20/02 7:30 PM, a at paula54@... wrote:

> Sue,

> I¹d think that your decreasing WBC count and your doctor¹s suggestion to

> take you off of arava would be considered failing arava, making you eligible

> to try Enbrel. You said that mtx also decreases your WBC¹s so maybe this

> is the answer to getting to try Enbrel.

>

> Do you have any other RD¹s in your area that aren¹t teaching? Personally I

> wouldn¹t mind a student seeing me providing the RD also saw me at each

> visit. I wouldn¹t allow a student to do a joint injection, but to do the

> general assessment, it would be fine. It¹s not selfish to only want the

> best. We have serious diseases and want the best care.

> a

>

>

[Guest guest]

I don¹t think you¹re being unreasonable Sue. Maybe you should call the

receptionist and let her know how you feel. Maybe you¹ll get some insight as

to what¹s in the future, such as this Fellow only being there for a few

weeks. If this is going to be how it is all the time and you¹re not happy,

you really should let them know so it can be corrected. Remember it is YOU

that hires the doctor not the other way around and it¹s very important to

feel comfortable with your care.

I understand not wanting to stop Arava when it¹s helping so much, but it¹s

causing your WBC¹s to drop so much, it just isn¹t good. Plus that there is

the possibility that replacing Arava with Enbrel could also help. Enbrel

also works better with MTX, so maybe that combination would be better suited

for you. Just keep and open mind and talk over your options with your

doctor. If your count keeps dropping, you may not have a choice. I hope it

stabilizes. It stinks to find something that helps and then have side

effects that make it impossible.

a

> I guess both the mtx and Arava are causing the WBC count to drop. It started

> its decline when I was just on 15 mg of mtx a week. So he prescribed Arava

> instead of increasing the mtx again. It's been declining ever since, even

> though the mtx had been decreased to 7.5 mg.

>

> I didn't want to stop Arava because it's helped me so much. The mtx just

> didn't do it for me by itself. It will be interesting to see what the Arava

> alone will do. I hope it will keep the pain at bay and also not cause a

> further decline in white blood cells. I've been lucky so far and haven't

> caught any infections.

>

> My rheumatologist does not teach, I don't think, but I guess he works with

> medical students sometimes. That's the first time I've had a student see me.

> One advantage is that he took oodles of time with me.

>

> But last year when I was turned over to the Fellow, I think that the rheumy

> kind of lost touch with me, even though he did come in briefly for each of

> my visits. My next appointment is with him and the new Fellow, so I just

> feel as if he's abandoning me again. I'm tempted to call and tell the

> receptionist that I want to see just him. I would like some continuity in my

> treatment. But maybe I'm just being unreasonable.

>

> Sue