what do i do?

who would have thought a day of 3 specialist appointments would have ended so terribly.

i saw a gastroenterologist with my barium meal results. with possibly delayed gastric-emptying or gastroparesis, i would need a OGD with possibly a biopsy to rule out anything structural/mechanical that the barium meal cannot reveal. if the scope cannot explain it, then i would have to do a gastric-emptying scintillography.

i then saw my rheumy. my bloods are all fine and dandy. my Hb level is at record high- 13.2! my anemia has been definitely resolved, but because we did not do an iron panel, so we do not know my ferritin levels. she says i am in a ‘remission-like’ state because of the lack of active inflammation and a pathetic ESR of 14. but i told her straight that i could differentiate a clinician’s and a patient’s point of view of what a remission is like. i told her a lot about my musculoskeletal pain, the ones in my back that trouble me so much i finally bought a TENS unit. i told her my pain management is very poor, that the combination i take doesn’t work much for me- 3 types of medications in all. tramadol+sulindac+Panadeine(paracetamol with codeine) or Anarex(paracetamol with orphenadrine). i also told her that i have been taking sulfasalazine but not methotrexate due to my upper GI issues.

her verdict? i might have a chronic pain syndrome, most probably fibromyalgia on top of RA. at the same time, she wants me to stop my DMARDs and NSAIDs until i get clearance from my gastroenterologist. she gave me gabapentin and eperisone(Myonal), plus tramadol to tide me over while the upper GI investigations are ongoing. i do not have a good feeling about this because of the flares.

the last i saw was my cardiologist. i made an earlier appointment with her because i was symptomatic. my effort tolerance and exertional dyspnea was worsening. i found it odd despite my anemia resolving (no, resolved!)- i was symptomatic when i was anemic of course. my basal heart rate used to be 90 odd into 100 bpm. now, it’s down to about 70 bpm. so i monitored my heart rate whenever i got breathless, and i realised to my aghast, i didn’t turn tachycardic when i was breathless! that was confirmed when i did a treadmill test at my workplace. it was congruent with my suspicions. we did an echocardiogram. when my lovely cardiologist compared my new results to my last one which was only done about 1.5 years back, i think she was rather taken aback. because when she called me into the room, she wasn’t her usual self. she was fixated at my echo results and the difference it revealed. neither of us expected it. she told me that my left ventricle is dilated, and she couldn’t explain why. she knew i had co-morbids, so she asked me for my list of medications i’m currently taking. she also asked whether i was taking any cardiotoxic drugs. i wouldn’t know! she spoke to my rheumy, they agreed on stopping the drugs, but it wasn’t made clear to me what needs to be stopped. she said that i NEED to do another echocardiogram in 6 months to monitor the progression or status of my left ventricle. probably because the numbers are nearing limits of dilated cardiomyopathy.

her verdict? stop all drugs in an effort to prevent any aggravation of my dilated left ventricle, because no one really knows what causes it. i didn’t have time to discuss things with her. so do i stop ALL drugs? i mean my rheumy already stopped my DMARDs and NSAIDs, but is giving me gabapentin, eperisone and tramadol. what about my psychiatric medications?

pardon me, but all these were way too much for me to handle in one day. it’s like, everything turned upside down in just one day. what’s going on? what am i going to do? what will i do if my body goes flare crazy? what will i do if my dyspnea gets worse? what if i cannot hold myself together as i try to cope with these changes?


i’m pretty much a mental wreck right now. i hate losing control. and this is exactly what it is right now.



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