I normally like going to my many doctor's appointments. At least I did before my current migraine crisis. I'm talking like 2021 and before. My primary doctor, Dr. M, is cool. He's always aware of what I'm going through and knows that I'm a registered nurse but still treats me as a patient first and doesn't just assume I know everything he's talking about. I go to him for anything new and for my annual health checkups. He's handed off my diabetes to an endocrinologist, he's handed off my migraines to a neurologist, and he's handed off my depression to a psychiatric nurse practitioner. That doesn't really leave him with much beyond my allergies, my urinary difficulties, and my GERD. Basically new stuff and non changing stuff.
My primary neurologist, Dr. W, is cool too. He's always happy to listen to me and make an ongoing plan to improve my migraines. He's a specialist in migraines but isn't so cocky that he couldn't suggest I get a second opinion. I LOVE that about him. He will remain my primary neurologist even though I'm seeing another one because Dr. W is local and my new neurologist isn't.
My endocrinologist, Dr. H, is great. He's probably the oldest of my care providers. He's incredibly reasonable dealing with 'what IS' and not 'what SHOULD BE'. For example, I don't exercise. He mentions it at every visit and reminds me that I should try to exercise... but he doesn't harp. I know that he's required to do that and is therefore just checking it off a list of things he has to do every visit. Like mentioning smoking. The thing is that he deals with me as I come to him. I've had problems with eating, especially after I started taking Depakote. He didn't harp on changing my diet, he just reminded me that it was the best way to deal with it while simultaneously changing my medication to keep up with my eating difficulties.
My psychiatric nurse practitioner, NP M, is just as good as any of my other providers all while being the youngest member of my care team. She isn't afraid to consult with other members of her team and again... I like that. I like that my care providers are willing to get help when they need it instead of just assuming they're doing everything right.
And finally my new neurologist, Dr. C. I've only seen Dr. C twice, but I really like him. He's a bit younger than me. Maybe in his late 30s or early 40s. Not young, but it's a reminder to me that I'm on the older side of normal now. Anyway, he has great bedside manner. Our first visit was me primarily telling him my migraine history and only about 10 minutes with him discussing migraine treatments. He took me off of the Depakote, started me on Qulipta, and said I could follow up with either him or Dr. W, whichever I was comfortable with. The Qulipta worked fine and I set up an appointment with Dr. W in mid February but while he was happy with my improvement he didn't prescribe anything new. He said I should just continue with Dr. C's plan of care. And that's fine. I set up a follow up visit with Dr. C and it turns out it was a godsend that I saw him at the end of March.
The reason it was good is that my migraines CONTINUED to improve. As I mentioned in my Ready to be Ready post, I'm going more days without migraines than with. In February I only had 3 migraine days that I couldn't have worked through and in March that dropped down to 2! My goal, before returning to work, is 1 migraine day a month that I'm unable to work through.
So, when I saw him I was able to say that I'm 80% of the way to my goal. I'm ALMOST good enough! He was just as excited as I was. After we caught up on the specifics, he said that Qulipta can continue to improve its effectiveness for several months. Because of that he suggested no changes to see if Qulipta can continue to improve and get me to my goal. He discussed a couple other possible next steps including Vyepti which is an infusion medication like Qulipta but can be taken at the same time and only needs to be taken once every 3 months. It's not my favorite option as it's something I'd have to go to an infusion center, or my doctor's office, for. He also suggested trying Botox again as since I've tried it, they've improved where to specifically inject and again, it's a treatment that works well with Qulipta. I told him I'd be nervous about trying Botox again only because during my first bout of Botox my migraines started this episode of getting worse and worse and worse. I know it WASN'T the botox doing that... but I'll still mentally associate the two.
I then asked if he'd be okay with starting the Zonegran we'd talked about at our first visit. This is an anti-seizure medication that works much like Topamax but without the cognitive side effects. A reminder, I tried Topamax years and years ago. It did work to improve the migraines but it also left me with a difficulty in speaking. So my thinking was that this might be that next medication as it's worked before and now shouldn't screw up my ability to communicate. Dr. C was happy to prescribe that and said the only reason he didn't suggest something now was that he didn't want to bombard me with medications. We were both happy to learn that I'm perfectly happy to be bombarded so long as we aren't moving too fast.
I let him know that I was excited about this as it fit my roadmap I'd been planning. Start a new treatment in early April, find out that its the improvement I needed after assessing it in 2 months, getting permission to return to work in June, applying for jobs that month and hopefully getting hired and starting in July. I swear, he was just as excited as me.
It was during this part of the conversation that I let him know I was in between insurance providers. I let him know about the Qulipta refill getting late and that it would also affect my Ajovy prescription. I told him I was okay with the delay even though it wasn't ideal but... what option did I have.
It turns out, he had a VERY good option. Give me the drugs. He knew without me having to say it that that drugs were too expensive to pay for out of pocket, even for a single month. So he went back to his office, got some samples, and gave them to me. Enough Qulipta for the pharmacy to get another pre-approval and get me the new month's supply and TWO doses of Ajovy.
I was overwhelmed that he'd care that much. I asked him if he was sure it was okay, as I didn't want to take from someone else that could use it. Both Dr. C and his medical assistant that was in the room taking dictation said that it was no problem as the drug reps gave out a lot of samples and would even come with more if they needed.
So. Doing nothing, I might get better enough to return to work. Adding Zonegran should get me better enough to return to work and I'm starting that tomorrow (the Brown's pharmacy sent me a text that its ready to pick up). So now we begin. Near the end of May, I'll do a full re-assessment. If I've only had one migraine day in each of April and May... I'm ready to start applying for jobs. And that is the best fucking news I can imagine.
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