I'm waiting for the man

To begin with lets talk polyclinics. Following my whole-hearted backing of said clinics I went on to watch a news report that outlined how they are a part of the systematic disassembling of the NHS. The report suggested that they would work on a patient drop-in basis, with a high turnover of doctors, thus reducing waiting times and continuity simultaneously. Now, while I was acclaiming the lack of waiting time for my blood test, the lack of continuity of care I have faced at my local hospital has been perhaps the greatest hurdle I have faced in managing the UC. There is absolutely no way that the family GP should be replaced by polyclinics. And so, unless I need a blood test, I will never go there again...



On to hospital matters. Tomorrow I have an appointment with my consultant rheumotologist. I have found him to be the best doctor I have dealt with. I have only recently been under his care, as I asked for a second opinion earlier this year, and was sent to him (due to the associated arthritic symptoms I suffer). I asked for this after repeatedly being at loggerheads with my gastro-consultant and his narrow-minded god complex. Below I have outlined a brief timeline of my colitis and the list of Q's I am planning to ask. I will report back tomorrow.



Timeline



2002 - symptoms begin

2003 - Largest flare-up (May), treated with Mesalazine, which probably made it worse. Hospitalised and treated with IV steroids. Discharged with Mesalazine and oral Prednisolone. Relapse, medication reduced to oral prednisolone. Flare-up ended.

2004/5 - Intermittent flare-ups of associated arthritic problems. Treated with Prednisolone

2005/07 - Management of illness through lifestyle changes (e.g. stopping drinking alcohol). Mild flare-ups. No drugs. Acupuncture.

2008 - February: hospitalised with pneumonia. Treated with high dose of antibiotics (IV in hospital, oral on discharge). UC flared up following end of antibiotic course, end of March. Prednisolone (30mgs tapering on a weekly basis). Flare-up while on 5mgs lead to extended course. Flare-up after completion (first in colon, then arthritic June 7th – 12th). Back on Prednisolone, tapering 15mgs to 10 after one week.

Questions:

1. How likely is it that this flare-up has been caused by the Pneumonia Antibiotics?
2. Would it be sensible to stay on a low dose of prednisolone for a while to attempt to get back to a stable situation (i.e. 2005 – 07)?
3. If yes, what would be the recommended course of action? Can you prescribe me enough prednisolone?
4. Gastroenterology want to discuss with me moving onto Azathioprine (essentially due to the recent flare-up following the prednisolone course in April/May) – what is your opinion on this?
5. So, should I be considering immunosuppressant now?
6. I believe Azathioprine has a maximum 5 year course – what happens if UC/Arthritis flare-up after that?
7. Is Azathioprine useful in the treatment of the arthritic symptoms?
8. Should it come to surgery, will this also end the arthritic symptoms?
9. And my wife wants to know if there would be any benefit of moving to a warmer climate?!