Opining Online

My first diagnosis of fibromyalgia was in 1992. Antidepressants helped, I sort of “got over it” and went on with life. I still had those “trigger points” in the shoulders, knees, shins, ankles, etc., but as long as nobody pinched or pressed there I was fine.  Then, in 2000, my PCM of the day, said (when I winced at her pushing on my lower shins and said that one doctor had said that was from fibromyalgia) that she didn’t “believe” in fibromyalgia. End of discussion. I’ve tried not “believing” I felt pain, but dammit, the pain was still there, as was the overwhelming fatigue. Since I was first diagnosed with it in 1992, the only thing I’ve found that really relieves the pain is a combination of Strattera and Lexapro.

I’ve not mentioned “fibromyalgia” to any other doctor since the one who didn’t “believe” in it because I don’t want to be classified as a nut case or drug seeker. Also, I do not believe that fibromyalgia is the cause of all my pain. I think I also have a pinched nerve or something that causes sudden, extreme, but thankfully short-lasting pain in my legs.

My main problem - as mentioned in “I am my own PCM” is the lack of opportunity to discuss multiple aches, pains, symptoms, etc., with my doctor in one single visit. Appointments are generally limited to “what, specifically, is bothering you today?” That really doesn’t lend itself well to “well… several things and could they possibly be related?”

I do have a verified diagnosis of arthritis and I wonder which pain is caused by that. I classify my wrist, shoulder, knee, and ankle pain to it… but shin pain? I dunno… and apparently neither do most doctors. Why does the shoulder and knee pain differ when somebody squeezes either body part (a typical occurrence at Southern family reunions) from the more ordinary “oh god, I’ve overused this joint today” pain?

Bottom Line: I don’t know what the hell’s wrong with me, but articles like “Drug Approved. Is Disease Real?” don’t help answer the question. Note that the addition of Straterra to my normal drug regimin has almost eliminated the need for Tylenol and Naproxen. The only drawback is the tendency of Straterra to cause dizziness. Unlike most folks, I have a benign brain tumor that (though dead through radiation) may cause dizziness.

hmmm…. what side effects of what up with do I put?

A while back I wrote about being my own PCM. There, I implied that was not a good thing. As I think upon it more, I’ve decided I was wrong. Not only am I my own PCM, I darn well should be. Who — besides me — is more interested in my overall health and well-being? I should leave that up to anyone else than me?

No. I have to take responsibility for myself and my health.

As I’ve experienced a few dizzy spells the last few weeks, I’ve decided to take a good look at my medications. There are 8 (eight!!) prescription drugs I take daily. Could it be possible that while there are no “serious” interactions among these drugs, that some combination is causing me to feel dizzy?

My Tricare Prime PCM relies on the computerized comparison of these drugs to determine “compatibility” and, I suppose the MTF pharmacy does also. Yet, my body is unique and may react differently than normally expected.

I’ve decided to do my own research into each drug I’ve been prescribed and then I will go over those results with my PCM, whoever he or she may be at the time I finish.

I think I’m getting better. I got an appointment at the clinic yesterday and am on a different kind of antibiotic.

I have a tendency to bash military health care at times, but I have to report two good recent experiences. First, a visit to the Urgent Care Clinic at Moncrief Army Community Hospital, where I was seen quickly, given some relief immediately and sent away with medicine - no extra trip to a pharmacy.

Unfortunately, the medicine didn’t work well enough, or the strain of the 850 mile drive home simply made me worse. So, the day after Christmas I call Barksdale and my description of symptoms (and the fact that they could electronically access the visit to Moncrief) got me an appointment yesterday morning.

I’ve learned that you don’t simply call and ask the appointment person for an appointment. They rarely have any, but they will always get you a call back from a nurse who has much greater appointing powers.

This makes twice, yes that’s TWICE in a row that I’ve seen my assigned PCM! Maybe things are settling down there and she will be around for a while.

It’s not like I planned it this way. I grew up with the idea that one had a family doctor they saw regularly for checkups, shots, broken bones, and skinned knees. That’s what I looked for when I was older. I have no opposition to specialists, but I would have preferred the continuity of seeing the same doctor each time I go. I really would like to have a primary care manager.That’s not happening under Tricare Prime. I’m assigned to an MTF (military treatment center) and since I’ve been in the plan - 2 years now - I’ve been assigned to five different PCMs. I had 3 visits with the first, 2 with the second, 0 with the third, 3 with the 4th, and one with the current one. Two of these assignments have lasted less than 6 weeks. Three of these visits were for actual illness, the others were to get medication refills. Each new PCM wants to “see” me before refilling scripts I’ve been on for years, or before putting me on an alternate generic because the DOD has made a new deal with a different drug company.

None of these doctors ever had the chance to get to know me, or for me to know them. The MTF has a nice electronic medical records system, but it’s time-consuming and limiting. The doctor or PA is facing the computer, not me.

Before a visit, I do or consider all the things Christine recommends in Preparing for a Doctors Visit. My list of medications includes OTC stuff, meds I previously took, who prescribed them, why I no longer take them, dates of the above, etc.Not only do I write out questions I want to ask, but I include objectives I want to meet during the visit. Those are most often, get a refill written or get a referral to a specialist. Never have I discussed long-term medical goals with any of them. They know as well as I that we may never see each other again.

The closest I’ve come to having continuity of care is always getting the same internist when I’m hospitalized (luck of the draw) and the ongoing relationship I had with my radioncologist. But who wants to go the hospital or have radiation treatments to get a little continuity of care?This is why I am my own PCM. As Christine writes, “You know your body best, and you need to be your own advocate in the doctor’s office.”