Tuesday, November 14, 2017

Medical update...

Today was my GP appointment, something that was delayed this month and which couldn't have come a moment sooner.  It was hard for me to wait.  And, of course, I went over on my appointment.  I really need help with being more timely.  SIGH.

The first bit I want to discuss is going over the problem with the wretched constant shocks in my palms and fingertips.  I learned that it is unusual to be bilateral (both sides), so that probably points primarily to neuropathy, something which I am 99.99% sure it is.  I was glad to learn that she did not think it related to either the migraine or the sumatriptan.  

The first two options were the ones I thought we might come to as a decision.  However, my GP offer two more to the pot:

Option #1: Waiting to see how the increase of gabapentin goes.  My GP said that we might expect to go to 600 mg thrice a day if the increase from 400 mg to 500 mg doesn't stop the constant neuropathy.  I had a great decrease in overall neuropathy after we increased from 300 mg to 400 mg.  So, a part of me is hoping a one- or two-step increase might do the trick.

Option #2: Add an SNRI to the mix to see if it would make a difference in my neuropathy treatment.   I have been reading up on Cymbalta because that is most often mentioned in the nerve pain support groups I participate in on Facebook.  I am of two minds about trying Cymbalta, because of its side effects and its addictive nature.  My GP said that I could try Cymbalta or I could try Effexor. She gave me the homework to research Effexor and ask about in my support groups since I am not familiar with it the way that I have learned about Cymbalta.  Either one should work and the choice to try either one is up to me at this point.

Option #3: Have an MRI of my head and cervical spice to be sure that there is not something else that needs pursuing.  I have been worried about this ever since I had the pacemaker implanted, but my GP took the time to look up how we would do an MRI with my pacemaker. I would go to the pacemaker clinic and have my pacemaker put in MRI-mode (sort of like putting it to sleep). Then I would go have both MRIs. Afterwards, I would go back to the pacemaker clinic and have the pacemaker put back into normal mode (wake it up). It sounds doable. Just a VERY long day. And this WIMP would still worry about being in the MRI machine. So, I was a bit thankful that it was too late to call Parkview Scheduling today. I will note that hospital MRIs are more expensive than stand alone clinics, but I do think that I should get them done at Parkview because of the pacemaker complication.

FOUR: See a neurologist. Since I have had less than positive care from neurologists in Fort Wayne, I am not so much interested in that one. I also know there is not a whole lot more to be done at this point. However, I spent some time reviewing the doctors on my plan. There is one I have seen before once, who is female. There is another who has Parkview privileges and who has good reviews, but is male. The one my GP recommends is out of network. I am considering trying him, even though it is much more money, solely because several of her patients really like him. All that is to say, I have done some homework and am open to dipping my toes in the neurology waters again.

That covered my body shocking itself, but there was ever so much more to address.  My cardiologist is still leaning away from my heart being being behind the shortness of breath and the breathlessness.  I really wanted him to do an evaluation of my heart function, since the BNP test results were high, but all he did was offer to do another echocardiogram if I wanted one done.  Yes, well, I felt condescended to with that and will not be asking for one.  I'll wait until he wants it.  I do wonder if I can have the blood work repeated.  In any case, I was very, very, very thankful that my GP would like to be cautious and rule out Sjögren's Syndrome affecting my lungs at this point. So, she ordered a high resolution CT scan of my chest. Part of me really, really wants an answer. But that would be just about the worst answer I could get at this point. So, I suppose I am crossing my fingers for a normal reading.

What I haven't really written about is that I have been 99.99% certain that I had plantar fasciitis in my right foot.  It got so bad that I stopped walking on the treadmill 15 days ago and started a comprehensive scope of treatment: twice daily ice, thrice daily stretches, twice daily exercises, compression sleeves, anti-inflammatory medication, and rest.  It turns out the plantar fasciitis is much better, but the way that I have been walking compensating for the severe pain means that I now also have tendonitis in my right ankle. SIGH. Tomorrow I start a 10-day course of prednisone to deal with the pain and continuing inflammation. My GP said that I will probably be in the least amount of pain since my body started attacking me. However, she already warned me that she will not be giving me a monthly pack of prednisone.  My fervent hope is that the BIG GUN of the prednisone pack and continued icing and rest will get me back to walking on the treadmill on the 26th.

Who knew that torturing myself on the treadmill would have helped my beleaguered mental state?? I find that I miss it and I deeply, deeply miss not being able to work on trying to mitigate the incredible weight gain from taking gabapentin. I walked for 9 months in the neighborhood and only continued to gain weight. Two months on the treadmill and I had started a downward trajectory on the scale.

No more. The increase in gabapentin and the lack of treadmill torturing has me gaining weight again. SNIFF. SNIFF.

We also did a fall assessment worksheet from my Medicare Advantage Plan.  I dislike jumping through hoops, but I have been working on finishing up the 2017 Healthy Rewards for my Medicare Advantage Plan. So, far, I have earned $40 in gift cards (I chose Amazon since that is where I get my theanine) by doing the eye exam, the flu shot, and (today) the fall risk assessment. On December 8th, instead of my normal monthly visit, we are going through the Annual Check Up visit even though I see her every month. That will earn me another $15 in rewards.

With the $40 so far in my Amazon account (I just redeemed three rewards), I am going to get something for my tub to help me be more stable in it. My GP recommended this mat because it is what she uses. I ordered it since it is user-tested by my GP. She also has those stick on ones, but my GP said that they do not provide the stability that the mat does. I also like that the mat can be taken out and cleaned when my tub is scoured.

My GP gave me a lesson on balance.  Balance is affected by 3 things: 1) eyes, 2) ears (inner ear), and 3) feet. If one of those is unavailable/compromised, the other two should compensate for the loss ... unless one of those is also compromised.

We talked about how I often fall in the shower when my eyes are closed (washing my face and rising my hair). She surmised that I am not getting a good enough feel of the ground beneath me because of the neuropathy I have. This theory is mostly likely correct because I feel most secure in the tub the first week after the Household Magicians clean it. It is like I am standing on Gibraltar. A few showers later I no longer feel secure. The mat should help with that.  I am hoping it does.

We also went over a few other smaller issues.  I had been saving up a lot since I missed my appointment the first week of November.  Next month, I hope to be just on time since we are doing the annual exam.  Although, if I have test results before then, I would like to hear about them.  Even with that, though, I do want to stick with one hour.

I will note that my blood pressure during my visit was 80/60.  The nurse kept thinking that it was an error.  I laughed and told her that is what can happen with NCS.  Funny how that doesn't even worry me anymore.  A part of me was actually glad I had a really low day, because doctor's office syndrome ususally makes me the opposite with all my worrying.  This way, I have something more like the readings I have at home.  Still, I wonder what drove it so low today.

Finally, I will say that I made my doctor's life better in one way.  I had told her about the Awesome Note app, which I adore, because of the stress of having to try and restore all my notes.  She went looking for a similar app and found a free one that she likes.  So, now she had more organization in her life and an even better use of her smart phone.  I really like that she share that little blessing with me because she's been a huge blessing to me.  I like knowing I've been a small one to her.

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