Wednesday, January 05, 2011

This Should Be Interesting

I mentioned a bit ago that my primary care physician was giving up his practice and moving on to be a hospitalist--and this has happened.  On Monday, I got to meet my new PCP at my annual physical.  While she is nice--and I have to give her the benefit of the doubt, as I won't be completely comfortable with her for a couple of years--it just isn't the same as what I have been used to.  I have come to the conclusion that I have probably 'manipulated' my former doctors a little, and this lady won't be manipulated.  I certainly hope this doesn't stir my Finnish stubbornness into rearing its ugly head.  ;)

Some changes are in place already:  I am now off of calcium supplements and have to get it from food, I will be taking a Vitamin D supplement daily, and will be weaned off of my Premarin.  While my old PCP would always say "I work for you," this new doctor is more apt to make pronouncements.  (I don't mean to make it sound as if she acts like she knows better, it's just that she states her case for her opinions very strongly--and I don't know, yet, whether or not she is open to a free discussion of different opinions.)  She is very against my being on Premarin this long and wants me off of it within the next three years.  My old GYN and PCP were much more conservative in their accepting of the studies and continued to keep me on estrogen because the study results seemed to change drastically every couple of years.  This doctor basically feels as if I need to 'suck it up' in terms of having to deal with menopause symptoms--something I have not had to do since my hysterectomy.  I'm hoping this won't be a sticking point between us--but we'll see.  Of course, the weight and exercise issue came up and while she tried to be empathetic, I don't believe the woman has EVER had a weight problem in her life.  I seemed to get the feeling that she looks at weight problems as a will-power thing and 'just saying no' to overeating.  (Believe me, if it was as easy as will-power and just saying no, I wouldn't HAVE a weight problem.  I know this.)  To her credit, she didn't give me any ultimatums and doesn't want me to try anything so drastic that I can't keep up with it.  The plan of action is for me to NOT eat 200 calories a day that I now consume and BURN 100 calories--this should help me begin a slow and steady weight loss.  Unfortunately, I find that I don't eat at regular times--thank you shift work--and can't decide what I have to cut out of my life.  I'm sure it will come together, though, and like when I quit smoking, it will finally 'click' with me some day.

A few days ago I also got the news that my dermatologist is leaving in July.  Oh yay.  My new PCP let me know--in no uncertain terms--that I need to find a new dermatologist because she will NOT supervise my Enbrel.  (Again, I want to give her the benefit of the doubt, but I have a feeling that she might be one of the people that can't understand why someone would use Enbrel and jeopardize their health just because of 'skin problems.'  I don't know this to be true--and hope it isn't--but she was very, very adamant that she won't supervise my Enbrel and won't prescribe it to me.)  As of right now, there doesn't seem as if anyone new is coming into the area and I'm not going back to either of the two we already have.  My old dermatologist was NOT prescribing biologics when I left him and he was sending his patients who wanted them to the other guy in town--a doctor who I saw when The Oldest was 2-years-old; and he was older than dirt at THAT time, 30 years ago.  So, it looks as if I will have to leave town to find a doctor to continue prescribing Enbrel to me.  And by leaving town, I mean driving many hours to another state to find a doctor.  This shouldn't be a problem, though, as we WERE doing the same when The Youngest needed Botox injections while she was still at home.  This will just be one more scheduled road trip for us every three months or so.  Sometimes it isn't easy to live in the armpit of the Earth.  ;)

So, for the most part, I am okay with my new doctor.  She seems as if she would be happier if I could control some of my health issues in more natural ways rather than with meds, and I have no problem with that.  I have to figure out how I can get enough natural calcium in me on a daily basis without supplements, as I HATE milk and really don't do much in the way of other dairy, either.  But, if this works, maybe we can address my potassium and iron supplements and see if I can get off of them, too.  She is very much wanting to see my weight go down so that I can get off of one of my blood pressure meds--something that I would welcome a whole lot.  As she could not hear the bruit in my carotid*, we'll have to see what the ultrasound shows and whether or not the 'sludge' is going away.  If the artery is clearing/cleared, maybe I can go off of the statin, also.  (I'm not sure this could ever happen, but I can hope.)  All of this is definitely a work in progress and probably will take years to straighten out--I think I will only be seeing the doctor once a year (as long as nothing changes drastically) and see the physician's assistant the other times I go in during the year.  I really hate going through all of this, but I have to suck it up and deal.

*I guess bruit can be transient and that is why it is necessary to do the ultrasounds on a regular basis.

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