Hi everyone,
I'll make this as short as I can. I had an appointment with my rheumy last week. He was very busy so I saw the nurse practitioner. I told her prednisone wasn't working and the medrol pack didn't work and so far hadn't seen any results with mtx and plaquenil (after being on them 3 and 4 months).I also told her I was sick every day from the meds. She looked at my recent MRI and said "we've got to treat this more aggressively" then talked about Humira and Enbrol. She looked at my hands and noted that they were inflammed but said my knuckels were still hard which I take it is a good thing. Then she excused herself to confer with my rheumy before deciding what to do. She came back a few minutes later and said I would be taking a medication 'holiday'. No meds for one month. I'm wondering if this is a mistake. Don't get me wrong. I, like most of you, HATE these meds but I'm a little worried.
Any thoughts?
For me, it took almost 6 months of MTX to see a positive result, but it was eventually very effective. I'm on Humira now and the same thing seems to be tree; it took a long time to "turn on" but eventually worked well for me. Some of the RA medications take a lot of patience since they act very slowly and the dosages can vary by quite a bit. The med holiday may just be to clear your system before starting something new; it's not good to take some meds together...you should ask.Alan is right they may what to see if the meds are also making more problems instead of helping. There are many here that have found the meds can sometimes cause more problems. It took a year for the meds to really start kicking in for me. memeI'm leaving next Saturday for a 3 week visit with my boys in Oregon. I'll see the rheumy as soon as I return. In the meantime I'll take advantage of my new feeling of 'well being' such as more energy and not feeling sick to my stomach.
As soon as a nurse practioner walked in the door and started doctoring me, I'd walk out and get another rheumy. NP's aren't doctors
Susan,
I've been feeling uneasy since I saw her. I'm calling the office this week and insisting that I see the rheumy next visit.
My nurse practioner is excellent at my Rheumy's. They have a policy that every third visit you absolutely see the Rheumatologist. But this woman knows tons about RA and she takes more time to explain things to me than the doctor. She also checks things out with the Rheumatologist who is always in the office at the same time as her. I feel like my quality of care is improved with her, not lessened.
The problem is that there are not enough Rheumatologists in the field. They are dwindling because they don't make the same kind of money that say a Cardiologist does because they can't charge for surgeries and other tests.
Really, these docs, for the most part are amazing. Most of them only collect their office fees, blood work and shots. Yet they are real specialists, having gone to schoold for 6 years beyond your General Practioner.
The nurse practioner can be a real asset to your treatment. They are highly trained. Now, you can get a bad one. But don't write them off because they don't carry a M.D. after their name. They see hundreds of patients and they have gone to school just like the doctors have.
I am really grateful for mine. She is very personable and won't leave the room until everyone of my questions is answered. I can talk to her more easier than the doctor. And, when I have to go in for those in between visits, I am most likely going to get her. That has not stopped me getting quick and effective treatment.
Your medication holiday may be to clear out your liver. These medicines are hard on your liver and some on your kidneys. If they think they are building up, this is the first thing that they are going to do. And, it is the responsible thing to do. Now, if you immediately start having problems, then call the nurse and let them know. That's why they are taking you off the medicines to see how your body acts. It's up to you to communicate what happens.
A month's time is not that long. If it was 2-3 times that long, then I'd worry. Just be sure you contact them when symptoms are out of control. This is going to help guide them to treat you better.
Did they also do blood work recently that might be showing something?
I agree with Deanna, but I guess it all depends on the NP. I've been seen by NPs with my GP, my Ortho and rheumy and they all are more patient, listen better, ask more questions and in consultation with the RD get the job done. If the NP has experience, time and more importantly, less ego, I'll take the NP.I LOVE my NP.
She is far more aware of my condition, knows my joints better and is more willing to work with me. My RD is wonderful, but he isn't her. My RD is always available for consultation, and he talks to me about every 4th visit, but my care is assigned to my NP.
My PCP is also a NP. I've been going to her for about 15 years, and before her I saw another NP all at the same PCP office where I have gone for 23 years. all things being equal, I feel I get better, more thoughtful care from an NP.
Its funny, if I need to see the dr, I can ALWAYS get right in to see the NP, because there are people who simply feel that its better to see the dr. Great care, no wait. I can get a same day appointment..
NP's have at least a master's degree, beyond the 4 year BA RN. They are allowed to prescribe and in some cases do certain kinds of surgery.
I have worked very closely with NPs and PAs, as well as doctors, and I have seen them as a patient in a variety of settings. They do have to work under an MD, and the MD signs off on all of the charts and some perscriptions. But you can get a lousy one the same way you can get a lousy doctor. Mostly though, my experiences have also been very positive. Prob. the med holiday is to see if the symptoms your having was from the meds or RA. Usually MTX is taken with one of the biologics. You should always ask why though. Maybe you can call and have the nurse find out for you.My rheumy is wonderful. He's gentle and kind, and takes as much time with me as I need. I'd always seen him, this was my first time with her.
She said my blood work looked fine. I'd had some problems with low white blood counts and anemia, but everything is within the normal range at this point.