July 07, 2012

The last two rheumatology appointments for Maddie she has seen a nurse practitioner instead of her rheumatologist. I understand there are only 2 pediatric rheumatologists in all of San Diego, Riverside, and Imperial Counties (over 3 million people). But, I just don't feel comfortable with anyone other than her doctor. The nurse practitioner mainly deals with fibro patients and his exams clearly reflect that. He's thorough but at the muscular level, not examining the joint inflammation as closely. 

This last visit I told the nurse practitioner Maddie had just come out of a big flair and more joints were involved. He called in the rheumatologist to consult just as he did the previous visit, adding to the doctor's already jam-packed schedule. I am so glad though, because the treatment plan the nurse practitioner was suggesting (MTX weekly) was far more invasive, I feel, than what the doctor suggested (as soon as a flair begins, start a large dose of prednisone for 2 days and taper off for 4-6 weeks). Maddie's flairs are typically months apart so the last thing I want is for her to be on constant immunosuppressant drugs. We tried the prednisone route last year for a really bad flair and it worked really well, without a rebound. So I left the office with a prednisone prescription and if Maddie has a flair I give her the steroid. Sounds like a plan.

When I made her next appointment I respectfully requested she see the doctor, as he's had to come in on a consult anyway both times we've had appointments with the nurse practitioner.  

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