Do as I say, not as I do!

February 12, 2018 at 4:29 pm | Posted in arthrits, arthrits, rheumatoid arthritis, fibromyalgia, joint pai, joint pai, Me, rheumatoid arthritis, rheumatoid arthritis, rheumatoid arthritis (RA) | 6 Comments
Tags: , , , , , , , , , , , , ,

I’m sure I’ve banged on at least once or twice on this blog about how important it is for the patient to manage their own illness as much as possible, and how important it is to keep a track yourself of your blood test results etc.

Weeeeeell, I’ve had this dratted disease for over ten years now and for quite a lot of those years I assiduously kept track of my blood test results, which never showed anything in all that time. And eventually, what with a change in the system that meant we only see the Rheumy nurse once ever three months, and they stopped issuing booklets with the results in, and given that the results never showed anything, I stopped looking. They’re available to me on line but I just didn’t bother.

So, fast forward to my last flare, not that long ago, a couple of weeks ago in fact, when the doc told me my bloods were up and I said ‘But that never happens’, turns out it happens more often than i thought.

I mentioned in that last post that my hospital appointment had been cancelled, and they originally said the next date was July (!) but then I got a call to say they were putting in a clinic to make up for the cancelled one, and that was last week … so off I toddled dutifully to the hospital. As could be virtually guaranteed, although my knee played up slightly the day before the appointment, it was fine on the day –  thankfully the steroids had done their job!

So I went in and found the previous registrar has now moved on to bigger and better things and a charming young lady doctor was there instead. I told Dr Delightful that I’d had a flare the previous week but now things were much better, and that surprisingly my bloods had actually been slightly up, which never happened!

‘Oh no,’ said Dr. D, ‘that’s not right.’

‘Huh,’ i said intelligently, ‘well that’s what the GP told me.’

‘Oh no,’ she said, ‘they have been up since last May.’

‘WHAAAAAAAAAAAAAAT?!’

‘Yes indeed, in fact in August the ESR (normal range up to 12) hit 35, which is pretty high.’

Oh look, August, what a coincidence – July was the previous time I had a flare and the GP decided in his infinite wisdom not to issue steroids, but just to give me opioid  painkillers (which were useless.) So then the bloods are way up in August and what does the GP do about it? Makes a note on my records that says ‘abnormal but expected’ and leaves it.

(I didn’t find that out until today when I went online to check up n my notes and see what all these results had been.)

I think what happens is that the GP sees the other tests are normal and goes, ‘Oh, it’s only ESR …’ <Sigh>

Anyway, Dr Delightful decided this really wasn’t on and ‘under control’ does not mean having two significant flares per year, so she has increased the dose of methotrexate to 20 mg instead of the previous 17.5 mg.

Here’s the thing though – I’ve had two flares a year for ever – including the last two or three years when I’ve been at 17.5 mg methotrexate but the bloods were OK . The previous registrar was never interested in putting up the MTX … was it because the bloods were OK and I wasn’t flaring when I went to the hospital, or is it just a difference in attitude between the two doctors? I guess the only way to find out is to wait and see … IF I start taking the increased MTX and my blood results go back to normal but I’m still having significant flares, will Dr Delightful say, ‘Oh, no, you’re fine, stick at this dose’ or will she say, ‘Well if you’re still flaring, we’d better put it up or try something else?’ I’d like to think the latter but I have my doubts.

It seems to me there is far too much reliance on blood results and not enough on patient experience, but what can you do?

Advertisements

Bloodless penguin – and more surgery hassles

September 24, 2013 at 9:57 pm | Posted in rheumatoid arthritis (RA) | 3 Comments
Tags: , , , , , , ,

I mentioned to the facilities manager as I left work this morning that I was off for a blood test. When I saw him later he asked, ‘So did they manage to confirm you had blood then?’ Well – actually it was a bit of a struggle! The first attempt to prove I had blood was a dismal failure – in went the needle, out came … nothing. The rhuemy nurse waggled the needle about – nothing happened … except that it hurt … she waggled it about some more … OUCH! We mutually agreed that perhaps trying another spot would be better. It wasn’t. Hmm … I’d walked in rapidly and everything, the blood should have been flowing … but perhaps the problem was that it had all rushed to my head a moment before! 

‘Why would it do that?’ I hear you cry. Because she’d just told me that the system of monthly blood tests was changing – in fact it was going. The new guidelines from the hospital are that we only need three-monthly blood tests done by the rheumy nurse. Well OK … that’s fine by me… but here’s the rub. 

At the moment I go in for my blood test, have a chat about my arthritis and general health, query anything that’s bothering me rhuemy-wise (usually not a lot, ’cause I’m lucky most of the time!) and book the next appointment. Now the appointment times are being reduced, so I will only see her every three months and have less time for a chat about how things are going because she will have less time per patient, even though she’s not seen us for three months. On top of that – she can no longer book the next appointment – because, mind-bogglingly, ‘the system’ won’t allow booking three months ahead!

I do wonder how much this has to do with the computer system and how much it has to do with the fact that the further in advance appointments are booked, statistically the more patients are likely to fail to attend! So now, instead of a simple month-by-month process of blood tests and booking, I have to remember to do an extra thing – phone about three weeks before my next test is due and book it.

Well, that’s not so bad – after all it’s only three-monthly, isn’t it? I’m still spending less time than I was before attending monthly? Not so fast … I am also supposed to attend in the two intervening months for a 2.5 minute appointment with a phlebotomist, who will just have time to say ‘Hi’, take the blood and throw me out again – but on top of that, that won’t even be an appointment but a ‘walk in’. So if they’re not busy (hah, what are the chances of that, especially as I happen to know they’re short staffed) I could get seen straight away, but if they are busy I could be waiting who knows how long.

I told my nurse I would probably simply not bother attending the phlebotomy walk-ins and she said she thought I would not be alone – she’d heard the same from a number of patients! Of course you could say, and quite rightly, that we’re putting our own health at risk doing that and the service is there … but in six years I’ve never had a blood issue, and I do have a full-time job and I don’t have time to sit about for an hour waiting for a blood test, so … we’ll see.

Anyway, back to today’s blood test – when she scraped me off the ceiling and calmed me down and got the blood flowing round the body again, she was finally able to draw blood … which, I hope, will be fine as usual!

It went well!!

August 17, 2009 at 4:34 pm | Posted in rheumatoid arthritis (RA) | Leave a comment
Tags: , , , , , , ,

Well … I saw the rheumy nurse on Friday … and thankfully it was NOT the same one that I’ve seen in the past, and this one was a) human b) non-patronising c) cheerful and, perhaps most importantly, d) helpful! OK, so she read the doctor’s notes all wrong to start with and got in a bit of a muddle, but I’ll forgive her that given the points above! Although, as suspected, having an appointment in August was a bit of a waste of time in a way, at least this nurse says definitely now she’s met me she’s happy for me to phone in September and say if I feel the MTX needs increasing, in which case she will increase it.

Interestingly this nurse is someone that one of my friends has seen in the past and thought was awful … obviously a personality clash, just like the one I had with the previous nurse I saw. At least I’ve been lucky enough to change.

We also discussed this whole three months/ six months between appointments thing and although the news wasn’t good, at least she was frank about it. What it boils down to is they’re underfunded and under-staffed and while they’d love to see me every three months, it ain’t gonna happen. However, they have apparently improved the helpline (hoorah for that as it was rubbish when I used it last!)

Blog at WordPress.com.
Entries and comments feeds.