Tuesday, January 16, 2007

New Doctors, Young Doctors. Old Doctors.

I went to Georgetown Hospital today to see the mighty specialist. And I liked her a lot.

Georgetown U is (oddly enough) in the middle of Georgetown, which to those of you who do not frequent this realm, is a kind of cozy upscale Greenwich Village comme Rodeo Drive area. Which also means that the streets are narrow and there's constant renovation going on, gentrifying the gentrified and (like every college campus I've ever been on) they're building new and renovating old on campus. So, navigating toward the hospital entailed a number of detours through Very Nice Neighborhoods With Very Narrow Streets. I passed the Very Exclusive Schools of Georgetown Visitation and the Washington International School.

They sent me a notice last week of the time and place of my Appointment with Her Majesty. They got my name wrong (wrong first name, hyphenated maiden and last name) and when I arrived this morning, they informed me that I was an hour early. I whipped out the offending letter, and the woman cried out, "Oh Lawdy, Lawdy! Who do they have working downstairs??"

The parking lot is in the midst of renovation, so they had valet parking, which was rather nice, so I didn't have to traipse all over creation dragging my oxygen with me. And it was COLD. It was 60 degrees last night at midnight, and it was 40 when I walked out the door today.

And I am a bit spoiled, because Georgetown is not new. My PH clinic is in a very new, very architectural building, with curved walls and generous open spaces everywhere. Georgetown does have a magnificent reputation, but the doctor's building looks like a mid-60's government building with many tiny offices strewn warren-like across a floor like empty shoe boxes at a PayLess store.

Anyway, so I spent the first hour (which was evidently not my hour to spend, but I took it) talking at length with a resident in rheumatology, describing my symptoms (and non-symptoms) and the course of the last year (yes, today is the actual first anniversary of my Big Diagnosis). She was very sweet and very thorough.

Then she left, and I pulled my phone out of my bag and began to listen to Nathaniel Philbrick's "Mayflower," which I have as an Audible book on my phone. I wrapped myself up in my paisley wrap and promptly fell asleep. About ten minutes into my nap, they came bursting through the door, young doctor (not) Malone and Dr All That And A Bag Of Chips Her Own Self.

We chatted about my symptoms, my tests, her experience with PH patients. She was at one point the consulting rheumatologist for the lung transplant program at the University of Pittsburgh, and had some interesting observations.

Until recently, PH was classified as Primary Pulmonary Hypertension, which meant that it had no other condition associated with it as a cause, and Secondary Pulmonary Hypertension, which has some underlying disease process (including autoimmune and connective tissue diseases) contributing to the PH. More recently, however, this was changed, because there's basically very little difference in the way that PH is treated, no matter what the cause. Dr All That says that when she was at Pittsburgh, she saw many, many transplant patients who were diagnosed with Primary PH, but had several of the indicative symptoms of Limited Scleroderma (Reynaud's, Esophageal reflux, calcinosis and ulcers on fingers, etc).

She tends to think that my PH is probably caused by Limited Scleroderma, but she can't be sure of it because I have some very general symptoms that could or could not be indicative of it. She wants to see some other test results before she pronounces firmly, and she also wants me to get completely off the prednisone to see if the pericardial effusion returns. This would indicate whether the improved pulmonary artery pressure is causing the effusion to wane, or if it is indeed the prednisone.

She did like my pink saddle oxfords. Too cold for boat shoes.


pooks said...

Good grief, I've been lusting over that paisely shawl.

When do you see/hear from Dr. Thang again?

The Admiral said...

She wants to wait to Make Pronouncement until I'm completely off the steroids, to see what happens then. And I see my regular Mrs Rheumy next week, and may taper down the steroids even more.

I go to the PH clinic again in April, so I think I'll not see Dr All That until after I see Mister PH.