I finally had my appointment with my rheumatologist on Saturday.
I get all of my medical care through the VA. I lost my private medical insurance when I was laid off from my job as a newspaper editor a couple of years ago. I’m an Air Force veteran, so once I was poor enough to meet the requirements, I was eligible for VA medical care.
At first I was a bit apprehensive about the VA — we’ve all heard the awful stories — but I was even more apprehensive about being without any sort of medical insurance. As luck would have it, it wasn’t long after I lost my job that the rheuma came back, announcing its arrival by making my hands twinge and ache.
I told my new VA primary care doc about my old RA diagnosis and how it had been in remission for years, but was now showing up again, like attic rats you thought you’d gotten rid of for good. Although my medical records from the mid-to-late 80s, compiled by the U.S. Army medical facility I went to while I was in Germany, were long gone, she ordered up a blood test and referred me to rheumatology without a hitch. I was most grateful.
Dr. McA, my rheumatologist, has been wonderful. My blood tests came back showing the Rh factor and a high sed rate, both of which backed up my claim of RA. Although during that first appointment I wasn’t experiencing any pain at all, when Dr. McA examined my hands and said he could see they were inflamed.
“They are?” I was fuddled.
He nodded. “They are. Look at the spaces between your knuckles. They’re puffy. And they’re warmer than the other parts of your hand.”
Wow. They were. I promptly fell in love with my doc.
Dr. McA listens. He explains what he’s doing and why, in words I can understand, but he respects me and doesn’t patronize. He talks to me as an adult. This doctor taught me more about RA during that first visit than I’d learned on my own in the whole first 10 years I had the disease — and believe me, I’d tried to learn all I could.
He always asks how I’m feeling. He reads my charts from the last time I saw him and asks specific questions relating to how I am compared to then. He discusses the results of the blood test I always have done a few weeks before my appointment, explaining what they mean and answering any questions I have.
The VA has computerized all of its patients’ medical records, so Dr. McA can see all my other charts and prescriptions from the other doctors who are participating in my health care. The most recent appointment I’d had was with a VA endocrinologist. His report detailed the actions he’s taking to bring my very, very low Vit. D level back up to normal. Dr. McA asked me about the appointment, then pointed out that, according to his computer, I’m scheduled for a bone density scan on Dec. 2.
Wow. So soon. I hadn’t even been told yet.
Several weeks before my appointment on Saturday I started a list of questions I didn’t want to risk forgetting. This is the first time I’ve counted down the weeks, days and even hours before my time with Dr. McA; but then it’s also the first time in many years that I’ve had to battle constant, aggravating and disheartening pain. I was a bit bemused over how many questions I thought of — probably none of which I would have remembered if I hadn’t written them down.
The end result of my visit with Dr. McA? The RA is active and severe, and it’s obviously ramping up. So it’s time to armor up. I wondered about perhaps trying some different RA meds, but he feels the Arava is working, and since I’m tolerating it and the sulfasalizine so well, there’s no reason to change. Instead, he told me to start taking the full dose of Arava, rather than the half-dose each day I’d been taking up to now. He wants to give it a few months, and see if it helps. But in the meantime, he’s also putting me on Voltarin, a NSAID, as needed to fight inflammation and pain. And because my hands are keeping me awake so much at night, he’s prescribed Elavil in a minimal dose. He says it should help me sleep and, as a possible bonus, act as an additional pain reliever that can work in concert with the tramadol and Voltarin.
He’s also referring me to physical therapy, which pleases me greatly. I want to learn specific exercises that can help me keep the joints in my hands and wrists strong. Other joints too, but right now, my hands are my top concern.
And finally, when I mentioned that I’ve noticed more blurry vision lately, he referred me to the VA opthalmologist for another eye exam. It seems like my eyes have gotten a lot worse over the last couple of years; the blurriness corresponds to the behavior of the RA. So having them checked helps to put my mind at ease.
When I first met him, I asked Dr. McA why he’d gone into rheumatology as a specialty. He told me that while he doesn’t have RA, he has two brothers and two sisters who do. He knows the pain and disability of the disease intimately, and it was because of them that he became a doctor, then specialised in internal medicine and rheumatology. He wants, he told me, to do all he can to slow the progression of the disease in his patients. He wants to do all he can to keep us as comfortable as possible. He wants to help us preserve our independence and mobility. And most of all, he hopes to be around when medical science finds a cure. That, he said, would be the greatest day of his life.
During my visit on Saturday he mentioned having visited Ghana in the past. I asked if he had relatives there. He laughed and said no, not directly, but that he works with Doctors Without Borders, bringing his expertise in rheumatology to the people of West Africa. That touched my heart.
So. I’m good for another three months. And you know? THIS is “socialized” health care. Sure, it’s not perfect, and there have been a few SNAFUS here and there since I started getting my care from the VA. Nor is it free — I pay an affordable co-pay for all my meds and if they asked me to, I’d try to pay even more. As much as I could afford. The VA medical system is a vast, government-run bureaucracy — the very idea scares the bejesus out of a lot of Americans — but it’s also providing me with the best health care I’ve ever had in my life.
If this is what health care insurance reform will look like, I’m all for it.