Diabetes Talking

Question:

Hi everyone, A strange predicament I am in today. Having quite a flare-up in the last week which seems to be gradually getting worse but a) it’s the weekend and b) I haven’t been able to get a hold of my neuro to date. I saw my GP today who gave me a rx for predinisolone which I have taken before (same dose and all – issued by my neuro) but my GP has asked that I wait at least until Monday to see if my neuro calls and confirms that it is OK with him. I, on the other hand, am feeling things getting worse by the day and so would be more inclined to start the course now and worry about my neuro’s potential irritation at being circumvented by my GP’s availability later. What does everyone else think? Should I do the "ethical" thing and wait? Will 3 more days not really make a great difference in relieving the symptoms if I start the prednisolone earlier??? Or should I be saying "what the heck it’s my health, stuff ethics"?!?!?! Ridiculously I feel, I am actually thinking about this and probably not just doing what I should to curb a pretty bad flare-up. Opinions … Thanks, Robert Wagner

Response:

I am a GP who finds myself sometimes in this situation.  The consultant (neuro) is a source of guidance and help in devising a long term plan of care.  If he has helped you and your GP to find a course of therapy that is effective for you for your flares, then there is no real reason to re-refer for each flare.  Certainly his advise should be sought if your response to the acute treatment is not what is expected, or what you experienced before, or if the flare is different or worse than others you have experienced.  I can’t tell you to do anything that your GP hasn’t recommended, but I would tell my patient to start on the regimen, and let me or the consultant know in a couple of days if response isn’t as expected, or for any problems Terry Thompson, M.D. – Hide quoted text — Show quoted text -Robert Wagner wrote: > Hi everyone, > A strange predicament I am in today. Having quite a flare-up in the last > week which seems to be gradually getting worse but a) it’s the weekend and > b) I haven’t been able to get a hold of my neuro to date. I saw my GP > today who gave me a rx for predinisolone which I have taken before (same > dose and all – issued by my neuro) but my GP has asked that I wait at > least until Monday to see if my neuro calls and confirms that it is OK > with him. I, on the other hand, am feeling things getting worse by the day > and so would be more inclined to start the course now and worry about my > neuro’s potential irritation at being circumvented by my GP’s availability > later. What does everyone else think? Should I do the "ethical" thing and > wait? Will 3 more days not really make a great difference in relieving the > symptoms if I start the prednisolone earlier??? Or should I be saying > "what the heck it’s my health, stuff ethics"?!?!?! Ridiculously I feel, I > am actually thinking about this and probably not just doing what I should > to curb a pretty bad flare-up. Opinions … > Thanks, > Robert Wagner

Response:

Are you nuts?  Your nervous system is being attacked and some MD is worried about stepping on the toes of some other MD.  Do what is best for you.   John the houseboy

Response:

Hello Robert, I was curious if your neuro has prescribed any of the ABC treatments for you yet?  How many cycles of Methylprednisolone have you had? If they have produced GOOD results short term, this is a good thing.  But if they ever should NOT show you any Immediate results, time to be honest to your neurologist. I would like to suggest you ask your Neurologist about IV Immunoglobulin treatment.  It is not new in the medical community, but it is fairly new to MS treatment.  It has helped my MS roommate greatly with his fatigue and he walks practically "NORMAL" for the next 3 months! I hate to alarm anyone who has firm faith in Corticosteroid treatments, but in the long term, they can be quite harmful-ie. development of osteoporosis, Diabetes, adrenal gland abnormalities, etc. Please express your concern for these long term side effects to your DOCTORS! There are OTHER treatments such as IV Ig that won’t HARM you! It doesn’t hurt to put out suggestions and alternatives.  The more we learn, the more in control we are! Janet Gaitor Portland, Oregon Co-Founder/Co-Producer Living With Disabilities http://www.medsupport.org – Hide quoted text — Show quoted text -Robert Wagner wrote: > Hi everyone, > A strange predicament I am in today. Having quite a flare-up in the last > week which seems to be gradually getting worse but a) it’s the weekend and > b) I haven’t been able to get a hold of my neuro to date. I saw my GP > today who gave me a rx for predinisolone which I have taken before (same > dose and all – issued by my neuro) but my GP has asked that I wait at > least until Monday to see if my neuro calls and confirms that it is OK > with him. I, on the other hand, am feeling things getting worse by the day > and so would be more inclined to start the course now and worry about my > neuro’s potential irritation at being circumvented by my GP’s availability > later. What does everyone else think? Should I do the "ethical" thing and > wait? Will 3 more days not really make a great difference in relieving the > symptoms if I start the prednisolone earlier??? Or should I be saying > "what the heck it’s my health, stuff ethics"?!?!?! Ridiculously I feel, I > am actually thinking about this and probably not just doing what I should > to curb a pretty bad flare-up. Opinions … > Thanks, > Robert Wagner

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Response:

You should get a more aggressive GP and/or neurologist that has someone back him up when he’s unavailable!!! There are LOTS of times and issues over which time cannot be harmful but a true exacerbation is not one of them. Prednisone, solone, etc., don’t make you any better. They minimize the potential for permanent damage!! Take the damn stuff. Talk to your doctors later and let them know that you were not happy with their care of you during this episode (I mean, come on, when is it convenient to have MS?), and if you don’t get assurances that it won’t happen again, change doctors. (Now you’ll know what questions to ask, huh? Patients should at least TRY to learn as much about their doctors as they usually do their health. They’re not unrelated!)

Response:

Excellent opinion! On 9 Jan 1999, John van Veen wrote: – Hide quoted text — Show quoted text -> Are you nuts?  Your nervous system is being > attacked and some MD is worried about > stepping on the toes of some other MD.  Do > what is best for you.   > John the houseboy

Response:

I do agree with you 100% (after all I’ve read, it would seem the last people to believe research findings are neuros!) but I am not fond of prednisolone and as my symptoms over the last few days have fluctuated wildly, I don’t know what to do. My GP is fairly aggressive but feels he should defer to my neuro who appears to be of the "older school" in thinking. I did manage to catch my neuro who thought that it might not be best to take prednisolone (because yesterday my sx were better again! Today not though) but also did not seem to recognise that prednisolone, in reducing inflammation, does reduce the potential of permanent damage – something which I have read it has been found to do. I think I’ll just take it now and worry abvout my docs later. It doesn’t seem to be going away anytime soon. I wanted to thank everyone for their advice (and support also). Always good to know there are people out there who make sense and who take the time out to listen. Thanks again, Robert In article <Pine.GSO.3.96.990109134536.8566F-100…@apollo.sfsu.edu>, Paul – Hide quoted text — Show quoted text -Flavell <flav…@sfsu.edu> wrote: > You should get a more aggressive GP and/or neurologist that has someone > back him up when he’s unavailable!!! > There are LOTS of times and issues over which time cannot be harmful but a > true exacerbation is not one of them. Prednisone, solone, etc., don’t make > you any better. They minimize the potential for permanent damage!! > Take the damn stuff. Talk to your doctors later and let them know that you > were not happy with their care of you during this episode (I mean, come > on, when is it convenient to have MS?), and if you don’t get assurances > that it won’t happen again, change doctors. (Now you’ll know what > questions to ask, huh? Patients should at least TRY to learn as much about > their doctors as they usually do their health. They’re not unrelated!)

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