Praise then darkness, and creation unfinished

I went to my doctor today, for an annual physical and so she could write the next Ritalin prescription.

So: I had a fasting blood test last month, and the glucose number was high enough that she is ordering a re-test and an A1C test, which means another morning trip to Somerville on an empty stomach. My "bad" cholesterol is high, but not high enough for her to be prescribing statins right now. My "good" cholesterol is also high, but apparently that's less protective in older patients, and I'm approaching that age.

I also asked her to look at my calves, because I frequently have swelling by the end of the day, especially in the left calf. She said it sounded like a vascular issue, then measured the circumference of both my calves. The left calf is noticeably bigger, which supports the idea that there's some kind of vascular issue.

What I'm supposed to do for that is try to reduce my sodium intake, and try wearing compression socks for at least a little while each day. Reducing sodium intake means I'll be looking at ingredient labels for quantities--right now, I'm mostly checking to make sure that various things don't contain any of the various things that we know that one of the three of us needs to avoid.

Carmen also did a breast exam (no longer part of the standard physical exam, but she asked if I still wanted one, and I said yes), and looked at my back for any suspicious moles or freckles. Also, before the appointment they asked if I was OK having them check height and weight, and I said yes, then asked the assistant how tall I now am. Five feet two inches, confirming what I think is what the neurologist's office said, which is an inch or so less than when I was 30.

( grumbling about paperwork and MyChart )

This was the quarterly check-in so she can refill the Ritalin prescription, and cover anything else non-urgent.

I talked about how my gut is doing, and that I'm trying to reduce my use of naproxen (and NSAIDs generally) at the advice of the GI doctor. So far, that has meant waiting a little while before taking a naproxen because something hurts, and not taking it preventively for short walks. Airports, yes.

Carmen said there aren't a lot of good options, and recommended a turmeric supplement that someone she used to work for, who also did Ayurvedic medicine, recommended. I expressed some general skepticism, and specifically how much turmeric people had to eat to benefit. The recommendation is for a supplement that you tuck in next to your gum, so it's absorbed directly into the bloodstream. Carmen said "you can get it on Amazon," and Adrian pointed out after the visit that I should check the inactive ingredients carefully.

She also asked about my breathing, and I told her that recently, I've coughed up less phlegm after using the flutter valve, without having more trouble breathing. Less crap in my lungs is good, of course, and this means I won't worry much about skipping the flutter valve for things like travel and dental work. However, I'm basically sticking to the same twice-a-day schedule at least until the next time I see the lung doctor.

I also told Carmen about the strawberry allergy, and what symptoms I'd noted. I mentioned that I'm also probably allergic to stevia, and she made a note of both allergies.

The next appointment, in about three months, is for a physical exam, so longer and in person. At 1:30, so I can get lunch in Davis Square, weather allowing.

I just had a telemedicine appointment with the gastroenterologist. Her office called at about 9:30 this morning, to ask if I was available for a 10:30 appointment, and I said yes.

The diagnosis is collagenous colitis, which I already knew from MyChart. The good news is that it's both benign and curable. The treatment will be nine weeks of budosenide pills, starting at three/day for the first six weeks, then two/day for the next three weeks, and a final three weeks of one/day. Those are to be taken with food, and in the morning because it's related to steroids and can interfere with sleep. [I mis-remembered, it's a total of 12 weeks of these pills.]

The most common risk factors for this kind of colitis are being a woman over sixty, and regular use of NSAIDs. Therefore, Dr. Morgan wants me to talk to Carmen about whether there's a plausible alternative to me taking naproxen almost every day, but she did say there may not be, since tylenol doesn't work the same way and may not be effective for the hip and knee pain I'm using it for.

I asked about continuing the Imodium and the fiber capsules, and Dr. Morgan said I could stop using them when the budosenide starts to be effective for the diarrhea, which might be within a week. I told her that the combination of Imodium and fiber is working well enough that I may not notice a difference, so the tentative plan is to wait at least a week, then pick a day or two when I won't need to go out, and try stopping the Imodium. (Adrian pointed out that I'm currently taking two pills twice a day, so I could try halving the dose and see how I feel. That sounds plausible, but I'm going to ask Dr Morgan if she thinks that's worth doing.

Also, a significant number of people with collagenous colitis also have celiac, so she wants to test me for that. I asked, and it's a straightforward blood draw, which I can do at my convenience: I don't need to wait until after getting blood drawn to start on the new medication.

She is sending the prescription to CVS, and told me to call her office if there's any problem with the insurance company.

ETA: I looked at the doctor's visit notes on MyChart, which reminded me that I should be checking my blood pressure about once a week while taking the budosenide.

I had a colonoscopy this afternoon. The preparation was not fun, though not as bad as I'd feared; the main problem is that I am short on sleep. The worst part of the colonoscopy was the nurse placing an IV, because I was dehydrated (as expected in this context), and what would otherwise have been the best location is bruised from having blood drawn Monday.

I already have results back via MyChart, and since the colonoscopy was done by GI doctor who recommended I get one, I know she has the information. It looks basically OK--no evidence of inflammation and no polyps--but they did detect internal hemorrhoids. She "randomly" biopsied eight locations, so they can look for microscopic colitis, and I will probably have those results in about two weeks. The recommendation is to wait for the pathology report and then see her again.

ETA: Also, I had to take my N95 off for the colonoscopy, because it was done under sedation. The sedative was given via IV, but they had a tube feeding oxygen into my nostrils, and the anesthesiologist needs to be able to see that the patient is continuing to breathe properly. I gave them the mask when I lay down, and they gave it back to me (in a zip-lock bag) when I woke up.

The advice the GI doctor gave me on Monday seems to have done the job: my gut has been behaving since the visit, which is five days so far:

The doctor told me was to take the imodium (anti-diarrheal) twice a day whether or not I have symptoms, and start taking psyllium (metamucil). I was surprised, because psyllium is generally referred to a laxative; I suspect that's why Carmen didn't think of it. Assuming I'm still fine on Monday, I'll be sending her a MyChart message

I've taken one/day for five days, which seems to be enough. The package instructions are not to take it within two hours before or after other medication, because it can interfere with absorbtion. I'm already taking other medication on something resembling a schedule, which means this one has to be at or a little after 6 o'clock, unless I want to fiddle with the timing on something else. The schedule includes "right after I wake up" and "after breakfast." )

!markdown

So, the follow-up test for C. diff was also negative, and the pills Carmen prescribed in the hopes that they would improve my symptoms had no apparent effect. (That was dicyclomine, 10 mg, twice a day.)

With that information, I am trying to make an appointment to see a gastroenterologist. The current state of things is:

• I have a new-patient appointment at Brigham and Women's Hospital on September 22nd, and am on the waiting list for cancellations.


• To get an appointment at Beth Israel Deaconess (where my neurologist practices) as a new patient, I had to fill out a form, and they say they'll probably get back to me in 2-5 days. (Mt Auburn is a different system, despite them both being Lahey Health.)


• The scheduler at Boston Medical Center told me yesterday that they are currently scheduling in July, but can't do anything without an order faxed from my doctor. Once they receive it, someone will contact me. I asked Carmen's office for that yesterday afternoon, and the receptionist said they'd do it right away. If I don't either hear from BMC, or see evidence of the order on my (new) account on their MyChart tomorrow, I'll check with them and if necessary call Carmen's office again. That's a hospital requirement, even if the patient's insurance doesn't require one.


• Mass General Hospital _also_ needs a referral from my doctor to do anything, and they just said they're scheduling 6-9 months out. I'm holding off on that for now, rather than confuse anyone by having two requests for referrals pending at the same time.


• Mount Auburn's website showed me doctors and a shared phone number when I picked "find a provider" on their webpage. I called just after 5:00, and will need to call back in the morning.

Also, after I cancelled my trip to Montreal because I was worried I would suddenly need a bathroom while I was traveling, yesterday, which would have been my travel day was fine. However, today and Tuesday weren't.

I finally tried the hypertonic eye drops (5% saline) my eye doctor recommended months ago. They definitely help, but there seems to be a bit of a lag before they take effect. If so, I'll be dealing with the not-as-good vision first thing in the morning indefinitely. But shortening that period, then and at the end of the day, is useful.

These eyedrops are to get my eyes back to the right shape more quickly when I get up, after lying down for several hours. (The problem is with my corneas.) They seem to be reacting to gravity, so without the eyedrops, my vision gets back to more-or-less normal after sitting or standing for a while.

The doctor had recommended I start with eyedrops that are 2% saline, but both CVS and Health First pharmacy only carry the 5%. The drops sometimes sting when I instill them, so I may order the 2% and see if they work as well without that brief discomfort.

I'm still having intermittent diarrhea weeks after finishing the Dificid (antibiotic), so I just called and rescheduled my MRI from tomorrow to March 1st.

The actual rescheduling is no big deal, this is an MRI because I haven't had one in over a year, rather than because of new or worsened MS symptoms. But I'm tired of postponing my life, a week or two at a time.

Also, I just sent my psychiatrist a MyChart message about needing a mirtazapine refill early.

1) Carmen called this afternoon, to see how I'm doing. She'd been waiting for test results (from the recent stool sample), and saw them this morning. She said she's glad she didn't go ahead and prescribe another antiobiotic, which I agreed with, but was "hoping redbird is pooping better." I told her that I am doing better, but am not yet confident we're out of the woods, and we agreed that we could talk more tomorrow, during my already-scheduled telemedicine appointment.

2) I used MyChart yesterday to ask how to update my insurance information before a telemedicine visit. They told me how to upload my unsurance card, so I did that, and the person I was talking to is updating my information. (MyChart,or at least this version of it, lets the patient see their current insurance info, but not change it.)

This is via MyChart, with the usual "has not been reviewed by care team" note:

Negative for Campylobacter Species antigen.

This result is listed as "normal," but I don't think it was high on the list of possibilities.

Second result just showed up,

Negative for Shiga toxins, EIA w/RFL to E. Coli O157 culture.

Also listed as normal. That top line means "with reflex to," meaning run an E. coli test using the same sample if the first was inconclusive. Thanks for the correction/explanation, gatheringrivers