It's never easy, is it?
Got a problem....
I saw my regular RD on Thursday. I've been seeing him for years. His plan: No new biologic until I decrease the pred. When I was in the hospital they had me on a large amount and discharged me with 60mg. I am currently down to 30mg. He feels that my immune system is shot and adding another immunosuppresent will just cause bigger issues. I am supposed to decrease the amount little by little. Possibly starting a biologic in Nov. Repeat the lung CT in Oct. to see where we stand there. My concern: I am supposed to go back on the 13th. I am already in a flare. How on Earth am I supposed to tesch full time while decreasing pred without a biologic to pick up the RA symptoms? OUCH! Nov. is a looong way away! Dr. knows that this will not be easy. Of course, he doesn't want me to work anyway. If the RA flares during this time, there is not much he can do. When you flare-you get pred. So, I am to call my pain dr. But, I can't teach doped up on pain meds. Dr. knew I was going down to Duke yesterday. He told me that if he did not agree with the drs plan, I would have to go down there for treatment and followups.
So-went to Duke. His plan: I've gone up the biologic ladder. We talked about all of them and he explained how each one is known to target the Ra, but also focus on different areas. Crazy huh? Ex: Humira has been shown to be helpful in eye inflammation. He reccomends going back to the start and using Enbrel. I used this the very first year it was available 1999-2000. I want off it to have my son cause back then it wasn't known the affects of the med during pregnancy. He feels that there is NO way I will be able to to teach and decrase the pred. He also feels that the pred is a much bigger immune issue-not the biologic. He feels that if I start a biologic immeadiately, we can decrease the pred much more quickly. He also did a lung CT yesterday. I was the last patient before he was leaving for the holiday weekend. So, he told me to call on Tuesday and we will talk about the results. He also feels that my treatment needs to be MUCH more agressive.
So-who do I go with? Duke is 3hrs away. But-it's rated in the top 10 in the country for RA. I really like the RD down there. He is about my age and we "click". But-my current RD is only 10min. away. I've been seeing him for years. I really like him and the practice. I don't want to burn bridges to the rd that is right down the road. Really, it's like a battle of "old school" vs. "new school". AARRGGHH.
Wow, that is a tough decision to have to make. It is so easy to pick the closest RD just because he's convenient. However, it is your "life" we're talking about here. This is a disease that is going to last forever. I guess I would give the closest RD another visit to discuss what you were told at Duke. Listen to his response and then make your decision.