I told the locum doc I needed something to tie me over the post RA flare period, as the pain and cramps are very disruptive. I already have Alexander Technique lessons which seemed to help, but when the flare is there, everything cramp up.
The doctor (not my regular one) insisted that I go for acupunture, when what I asked for were:
- Celebrex or naproxen (which seems to give me less stomach irritation if celebrex is unavailable)
- NSAID gel - which I use when flares are better, it enables me to stop oral NSAID sooner
- heating rubs- great to kick start those stiff joints in the mornings
- Another medicine for those neuropathy like pains and cramps, as amitryptiline works, but the side effects was too much for me
- Diclofenac is shown to be milder than naproxen on the stomach. I would be fine with EC diclofenac. (Yeah, studies show slight advantages, but then again, studies also show that sensitivity is quite an individual thing. EC gives you some marginal protection of stomach irritation, that is all! EC diclofenac is fine, but why insist on changing my prescription when I say it works best for me??? I have been using NSAIDS for more than 10 years!)
- "Some rheumatologists" have told him that NSAID gels will make stomach symptoms worse when taken with NSAIDS. (stupid guy, I use it to cut down NSAIDs use, when the symptoms are subsiding and the gel is enough to stop one joint or two from giving me problems. Overall, used in the right way, I cut down stomach problems!)
- Most heating gels contain salicylates (fine, that is true, but it works damn well in the cold mornings!! So, what is the GREAT danger? Stomach problems again?)
- If amytriptiline does not work for me, nothing does. No point trying other stuff, go for acupunture. (That was plain bull shit!!! I corrected him that it did work, but the side effects were too much! He could have try starting me on others like neurontin, prebagalin or even other medicines from the amytriptiline's class!!)
Despite my pleas that I had try acupunture before, and did not find great benefit, acupunture will take a few session to fully work, and I got to queue for a date to see the acupunturist (which will take more than 1 month, at least!!!), I did not get what I needed.
- Diclofenac EC: That was fine, I need an NSAID anyway, but I also need other stuff!!!!
- Menthol gel 2%-Deep Freeze!!
- Advise to see an acupunturist.
When I got home, I decided to try the Deep Freeze, anyway, since this very self-confident doc insisted it is good for me. It did not work for me!!!! I need heating rubs, heat pads! That works!
And the acupunture? I got to wait. They will get back to me again.
Meanwhile, I got to go to the pharmacy, and buy my own DEEP HEAT.&*&@$"&^ I am already damn broke, and trying to raise money for my PhD examination fees!
What happens to the deep freeze gel? It is nice to apply after shaving (great for hubby).
And my cramps? I just got to bear with it, and visit again when my regular doc comes back.
Well, I guess he is not that bad, that young doctor has been following the news (about acupunture), and try to practise "evidence based medicine, EBM".
Anyway, that Mayo clinic study about acupunture which could had influence his decisions had a sample size of 50 patients. My treatment should not be dictated by the fate of the twenty something patients given acupunture for a few weeks. (what happens to them after that???)
Get it??? If you still don't get it, it is fine. I can give you a talk about evidence based medicine. I still have some old slides, from the good old days where I used to work, and gave these talks.
Read the full paper, doc, not just the headlines.
If you want to read more about how we struggle with the docs and the medical system, look at LINZ's scary experience
Medical; Patients; ; chronic pain; fibromyalgia; chronic fatigue