Saw Dr. Lorenzo again on Friday (May 28). Although I said I was biased for the IV because it meant fewer objections, he asked if I wouldnt prefer the arm-injected Enbrel because it was a very small needle. He or Kat said ant bite. He can send a nurse to administer the injections. I guess the medicine is so expensive that that is part of the service. I was persuaded.
Left foot wasnt good this weekend. Yesterday I told Kat ``let's get those damned injections na!''
He's prescribing two injections a week for a month and said we can probably reduce to 1 a week after that. When we talked about the ``bridge'' concept, he said there is room for flexibility and we could try it. I'll remain on 5 tablets of MTX a week.
This all assumes I'm cleared for TB. Will take that test by tomorrow.
Monday, May 31, 2010
Thursday, May 27, 2010
Doctor Leong
Saw Dr. Leong Keng Hong on Monday (May 24) in Singapore, and then again on Tuesday, after blood tests I took in between.
He said he also thinks I have AS. He said it seemed very early because there is no fusing yet, though he pointed out inflammation in my right (?) sacro-iliac area. Not damage, just inflammation. Kat liked that he said it's very common. I asked him how many he's handled and he said either 100 or 200. That compares to 10 for Lorenzo.
Dr. Leong said it seemed like I respond to the methotrexate though he would increase the dosage faster. He says his maximum would be 10 tablets, or 25 mg. That's double where I am now, though I think Lorenzo's max. is lower, closer to 20 mg.
I'm wondering now why we havent increased faster. I last saw Dr. Lorenzo at the end of March and he said I should see him again in two months, which is about now. I dont remember him saying I should come back earlier if the dose wasnt right yet, though I remember him saying at the start that while it may take 4 to 6 weeks for methotrexate to first take effect, increased dosages should take effect faster because it's already in my system. Why two months, then? Did he say I should? Did he forget to say I should? Or did he not say so at all? Was I not listening? Was I too busy with elections to think twice?
Be that as it may, feet are feeling really good this week. Maybe two months is exactly right.
For me the newest thing Dr. Leong said was that, if I wanted to get my symptoms ``under control'' faster, I could use biologics as a ``bridge'' for three to six months. To an extent, this could just be a nuance of what Lorenzo has said. But he certainly said it with what seemed to be more confidence. I'd take it together with MTX and continue taking MTX after. If I remember or understood correctly, that's different from switching to biologics, when I'd drop MTX altogether.
I'm tempted, Kat is convinced. I know that sometimes or in some ways she's more affected by this than I am. I know she's saddened and worried when she sees me in pain, or easily tired, or frustrated. Doctor Leong did say that men -- who are more susceptible to AS than women -- put up with or allow themselves to get used to some of its symptoms. (He said this is one reason it's often diagnosed later than it could be.)
She asked and he said there's no downside to biologics and that, unlike MTX, which requires monitoring of the liver, it has no negative side effects. Some material I've read on the internet is less sanguine, though not much less.
Having confirmed that ``as long as the medicine. . . are prescribed. . . you will be reimbursed in full'' (April 6 e-mail from Karen Lim), cost is not a concern. It's needles. (Kat asked if I wasnt worried about the drug coursing through my veins, stressing she wouldnt like the idea. I said it was the getting in rather than the coursing in that worried me.) And this gnawing desire to know whether MTX could have done it, or can do it still.
We see Dr. Lorenzo tomorrow afternoon. we'll decide how to proceed. We'd review with Dr. Leong at some point and then probably at least once a year.
He said he also thinks I have AS. He said it seemed very early because there is no fusing yet, though he pointed out inflammation in my right (?) sacro-iliac area. Not damage, just inflammation. Kat liked that he said it's very common. I asked him how many he's handled and he said either 100 or 200. That compares to 10 for Lorenzo.
Dr. Leong said it seemed like I respond to the methotrexate though he would increase the dosage faster. He says his maximum would be 10 tablets, or 25 mg. That's double where I am now, though I think Lorenzo's max. is lower, closer to 20 mg.
I'm wondering now why we havent increased faster. I last saw Dr. Lorenzo at the end of March and he said I should see him again in two months, which is about now. I dont remember him saying I should come back earlier if the dose wasnt right yet, though I remember him saying at the start that while it may take 4 to 6 weeks for methotrexate to first take effect, increased dosages should take effect faster because it's already in my system. Why two months, then? Did he say I should? Did he forget to say I should? Or did he not say so at all? Was I not listening? Was I too busy with elections to think twice?
Be that as it may, feet are feeling really good this week. Maybe two months is exactly right.
For me the newest thing Dr. Leong said was that, if I wanted to get my symptoms ``under control'' faster, I could use biologics as a ``bridge'' for three to six months. To an extent, this could just be a nuance of what Lorenzo has said. But he certainly said it with what seemed to be more confidence. I'd take it together with MTX and continue taking MTX after. If I remember or understood correctly, that's different from switching to biologics, when I'd drop MTX altogether.
I'm tempted, Kat is convinced. I know that sometimes or in some ways she's more affected by this than I am. I know she's saddened and worried when she sees me in pain, or easily tired, or frustrated. Doctor Leong did say that men -- who are more susceptible to AS than women -- put up with or allow themselves to get used to some of its symptoms. (He said this is one reason it's often diagnosed later than it could be.)
She asked and he said there's no downside to biologics and that, unlike MTX, which requires monitoring of the liver, it has no negative side effects. Some material I've read on the internet is less sanguine, though not much less.
Having confirmed that ``as long as the medicine. . . are prescribed. . . you will be reimbursed in full'' (April 6 e-mail from Karen Lim), cost is not a concern. It's needles. (Kat asked if I wasnt worried about the drug coursing through my veins, stressing she wouldnt like the idea. I said it was the getting in rather than the coursing in that worried me.) And this gnawing desire to know whether MTX could have done it, or can do it still.
We see Dr. Lorenzo tomorrow afternoon. we'll decide how to proceed. We'd review with Dr. Leong at some point and then probably at least once a year.
Subscribe to:
Comments (Atom)