Tuesday, January 8, 2008

Update After New Rheumatologist

So I saw the new rheumatologist today.

Dr. Wernick is the director of the Providence Arthritis Center in NE Portland. He almost never takes new patients, I'm told, but my internist was able to get me in by dropping her mentor's name and piquing his interest over the phone with my positive parvovirus test. My internist says he's among the best, if not THE best, rheumatologist in Portland.

I liked him a LOT better than my old rheumatologist, but man, it was a long appointment. They didn't tell me until I got there that it was scheduled for 2 hours, and it was over three hours later that I left his office.

First, a resident took my history and went over the incredibly detailed six-page intake form I'd filled out. We discussed my symptoms and she did a brief physical exam.

Then she went out to bring in Dr. Wernick, and it was a little like Gray's Anatomy in that the resident regurgitated the pertinent details that I'd given her, including pulling out test results that were worth mentioning. I have a very complicated medical history for this illness, and I had to correct her on minor points a few times (which Dr. Wernick had told me to do).

By the time he was ready to do the physical exam, he had already taken two pages of notes, which he said had never happened before. (I'm sure he was exaggerating, although I do know my history is very complicated.)

He did ask why I came to him instead of returning to my previous rheumatologist, and I told him that the other rheumatologist had told me when he referred me to a hemotologist that my problem was not rheumatological but when I checked out fine (possible MGUS) despite the monoclonal proteins, my internist and I both agreed I needed a different rheumatologist.

Dr. Wernick says he often gets referred the "mystery cases," and I definitely qualified on that count!

He did the physical exam, which was pretty standard. What impressed me was that when he looked at the knuckles on my hands, he compared them to each other and asked whether I was right or left handed. I've been told before that I don't show any noticeable joint swelling, even though I've tried to show these funny padded areas between some of my knuckles (the ones closest to the hands). Dr. Wernick, however, noticed them on his own, noticed they were more prominent on my right hand, and pointed them out to the resident as noticeable joint swelling. I felt so validated. :)

Anyway, his conclusion was that I had more than the necessary four criteria for a lupus diagnosis. However, he noted that parvovirus can mimic lupus and the effects of it can last a couple years in adults.

He says it would be really unusual for me to come down with both parvo and lupus at the same time, but that it was possible. Essentially, he said, he would treat them both the same at this point so it doesn't really matter which one it is.

He wants me to continue taking the low dose of Prednisone I'm currently on (10mg), and prescribed an NSAID that I don't remember the name of but he promised wouldn't cause me another ulcer. (Yeah, I've heard that one before!!)

He said it would be safer for my stomach than the ibuprofin I've been taking on the sly to help with some of the joint pain. He also wants me to take 1200 mg of calcium and 800-1000 mg of Vitamin D to avoid bone degeneration from the Prednisone.

He also ran some more blood tests and yet another urine analysis. I go back to see him again in two weeks (Jan. 22). (The receptionist promised me it would just be a 20-minute appointment and not the entire morning again!!)

Dr. Wernick did say that if it does turn out to be lupus, it doesn't appear that my kidneys are involved and that means the prognosis is very good and the disease should be very manageable. Although since lupus is a chronic disease, we're still hoping it's simply parvovirus because that will, eventually, go away completely.

In theory, at least. Time will tell, I guess.


Laurie said...

Wow, sounds like you found the right doctor! And that you're getting closer to isolating what you need to do to manage your symptoms. Good to hear!!!

SharonMV said...

Yay! I hope my enthusiasm does not seem out of place - but it's so great that you have a diagnosis! It would be better not to be sick of course. It sounds like your rheumy is a good doctor & knows his stuff.

As for the NSAID, I was wondering why you weren't on one. It sure makes a difference in the pain levels & stiffness for me I've add ulcers in the past too. Some NSAIDs are easier on the stomach. I also take an anti-ulcer med every day.