A checkup appointment at my rheumatologist (doctor who specializes in arthritis) always leads to some interesting discussions. Most of the time I try to “research” a topic beforehand, so that I am armed with the latest background information on whatever are my most pressing concerns at the time. When I launch into my questions (I always have a list written out), I have a better-than-even chance of holding a meaningful conversation with my rheumy. In turn, I get more out of the conversation instead of returning home with questions that even Google cannot answer. Understanding what he is really saying provides me with the sense that I am in control of my ankylosing spondylitis (AS), and not the other way around (AS controlling me?)
This recent visit was particularly enlightening because I informed him I was no longer taking Voltaren, my ‘go-to’ NSAID, due to concerns over the increased risk of cardiac incidents. I shared Health Canada’s advisory and my fears, which centred around my GP’s position that many physicians now avoid prescribing Voltaren for long-term usage (my rheumy fessed up that he too falls in this camp). My new anti-inflammatory drug (a Naproxen-based medication), he concurred, would also be his first choice as a good replacement.
I felt like we were actually “consulting” on how best to treat the patient (me). I wasn’t waiting for his wisdom to be delivered from the revered mount, which sometimes has been the case in the past.
This positive dialogue continued on a number of other issues, including my handling of a problematic knee and thumbs (osteoarthritis and other inflammation). He agreed with my assessment and self-medicating decisions during flare-ups. Then he ordered an MRI to figure out what is going on with this pain (I agreed; it’s a good decision).
I figured I was batting 1,000 at this point, so I broached a complex and controversial issue in the AS community on how to differentiate types of spondyloarthritis (inflammatory arthritis). Axial spondyloarthritis (Axial SpA) is when you may have back pain, but x-rays show no evidence of damage to sacroiliac joints. Within that group, there is AS (when x-ray changes are clearly present), and non-radiographic axial spondyloarthritis (nr-axSpA), when x-ray changes are not present, but you have symptoms.
His skeptical reaction told me that these differentiations are still a matter of some debate among rheumatologists. While my query as to whether I fall into one category or another was not dismissed outright, he was noticeably non-committal. It seems further meaningful work may be needed to bridge the patient-doctor divide. ~Fran