So, I went to the PM today for the first time.
I went in with only my list of medications, because I have not had any MRI/Xray/CATscans or anything done in the last 3 years.
I told him my entire story and how I have progressed, and how the pain affects the bipolar and the other way around too.
He asked me about tests that he thought should have been run, and I didn't remember if they had been, and he was going to have to request them from the rheumatologist.
I told him about how the rheumatologist last said that he felt that the inflammation was under control and that is what the medications were there for and the pain I was still having is separate and he did not feel that he should through any more pain medications at it. It was not going to go away but, over time, I would acclimatize to it.
I showed him the medications I was taking and told him about how the pain treatment was not working out.
He asked me about other Rheumatoid arthritis-type conditions that I might have been tested for, and the treatment would be slightly different. He asked me about other treatment options for RA that might create less pain. I did not have an answer for most of that, but told him what my rheumatologist told me when I asked about other treatments.
He poked at my knees and ankles and elbows and wrists (don't know exactly what he was looking for, because I didn't jump everywhere) He did a vibration test on my knees and wrists.
He agreed with me that I should pursue a 2nd opinion on RA conditions and treatment options. The office is going to set me up with one that will work with my insurance.
He agreed that the MO+TY+vicodin mix was not working well for me. I am taking too much MO and TY and not doing enough to protect my stomach.
He suggested (actually made it a condition that I would take it OTC w/o script to get other meds) Omeprazole 20mg daily(generic prilosec?).
He added Tramadol 50mg daily (starting, possibly increasing to 2x daily) to be 1st wave pain med. This should decrease or eliminate TY and/or MO daily. I have not taken the first one, or even looked it up yet. So I don't know anything about it. I don't know it it will react with the bipolar symptoms yet.
He also added a topical gel to be a breakthrough medication on knee joints only. It is Pennsaid 1.5% topical soln. He said 40 drops in palm of hand, rub into each side of knee (front/back/sides each) for 6 hours of pain relief. He says it is very strong. Also haven't looked this one up.
I went to fill the scripts and the gel costs $50 after insurance.
It was interesting to note that when the PM walked in the room he immediately recognized my husband, who was with me, from working together at the hospital a few years ago. Rob likes the PM's reputation, so that's good.
They are going to track down the test results and talk to my rheumy, then schedule a follow-up with me to discuss results. They are going to refer me to a 2nd rheumatologist for an opinion on condition and treatment. I continue with the PsyD weekly for now.
I think I am happy with the results, but I feel like I don't know enough about that happened to really make a decision. I need to gather information and see how these meds work for a few days. I know that I wanted to walk away with a different pain treatment plan, and I have that.
What is your take on all this?