Thursday, June 22, 2006

If doctors are murdered, you know why......

I went to see the GP that day, running out of medicines, and hoping to get prescriptions for those heating rubs, and NSAID gels, and also something to help with my pain/cramps that got worse during the past few days because of my RA flare.

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
He did not give me anything that I requested. Reasons?
  1. 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!)
  2. "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!)
  3. 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?)
  4. 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.

Guess what he gave me?
  1. Diclofenac EC: That was fine, I need an NSAID anyway, but I also need other stuff!!!!
  2. Menthol gel 2%-Deep Freeze!!
  3. Advise to see an acupunturist.
I was just too tired that day to argue with him. I felt like yelling at him
"My joints are already *stiff and frozenP, I dont need DEEP FREEZE!!!"

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!

Heat, my dear doc, not FREEZE.

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.

Could doctors please listen to patients?

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".

But if evidence is different from what an INDIVIDUAL patient experiences, which should be prioritized?

And remember evidence based medicine is based on statistics, which shows what works for most people, and what is most likely to work , not what works for everyone!!

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

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Anonymous said...

Oooo, I got referenced. :)

Yup, this is why I say I am allergic to doctors (and have an avatar saying the same!).

This is also why my doctor's surgery won't let me see anyone but MY GP for anything to do with the chronic stuff. Darn docs never agree on anything.

Woman said...


BTW, I still got the DEEP FREEZE. Almost untouched. Only using it for burns and mosquito bites.

If someone offers me DEEP FREEZE this winter, I will kill them.

I also searched the literature and double triple checked with really good pharmacists and my rheumy..
The conclusion is I SHOULD USE the NSAID gel, the way I had initially suggested, and educate that doc! Rheumy gave me more than 1/2 dozen of gel, as he is worried that the GP still would not give me any.