Don't know what I should do...

I was at the foot surgeon's office yesterday. I have a bad bunion and bone spurs on my left foot that needs to be removed and we were discussing surgery. Ok, that's fine. Here's the problem -- because I'm on Remicade & MTX, which as we know lowers our immune system, the surgeon feels that I need to be off of work (and my foot) for 4 weeks. Uh, hello? I had this same surgery done 20 years ago (right foot) and I was back to work (funky wooden shoe included) within a week. I told him that. His response was, you weren't on these medicines then. When did my medicines start defining me and my health? I haven't been sick, my blood tests come back just fine, etc.

My rheumy told me that I would have to stop the MTX 3 weeks before surgery -- fine, I can do that. I just had my infusion last week, so I'm covered there. I don't get it -- I've never had a problem healing or with infections and what makes them think that would change, even with these med's? I slammed my finger in the car door a few weeks back -- went to the doctor (gal's I worked with made me, thought I needed stitches), it healed within 2 weeks, no stitches, no infections, it's fine.

Purely rhetorical question here -- if I was to totally stop all med's...period, would my immune system ever recover?

We also noted that my AS has attacked the joint at my big toe (since my right foot is not affected the same way, its not my RA), biologics and MTX notwithstanding. So what's the point of me taking this stuff anyway?

I did get the surgeon down to 2 weeks minimum off my feet, but still...I think he's way overboard in concern. Am I being too naive here? I'm so upset about all of this, totally knocked me sideways. I'm supposed to call him back today with a yes/no on the surgery date. I'm so conflicted about all of this.

Geez, I hope some of this rambling and ranting made sense. My apologies if it didn't.

Thanks for listening...

starrnr said...
I was at the foot surgeon's office yesterday. I have a bad bunion and bone spurs on my left foot that needs to be removed and we were discussing surgery. Ok, that's fine. Here's the problem -- because I'm on Remicade & MTX, which as we know lowers our immune system, the surgeon feels that I need to be off of work (and my foot) for 4 weeks. Uh, hello? I had this same surgery done 20 years ago (right foot) and I was back to work (funky wooden shoe included) within a week. I told him that. His response was, you weren't on these medicines then. When did my medicines start defining me and my health? I haven't been sick, my blood tests come back just fine, etc.

My rheumy told me that I would have to stop the MTX 3 weeks before surgery -- fine, I can do that. I just had my infusion last week, so I'm covered there. I don't get it -- I've never had a problem healing or with infections and what makes them think that would change, even with these med's? I slammed my finger in the car door a few weeks back -- went to the doctor (gal's I worked with made me, thought I needed stitches), it healed within 2 weeks, no stitches, no infections, it's fine.

Purely rhetorical question here -- if I was to totally stop all med's...period, would my immune system ever recover?

We also noted that my AS has attacked the joint at my big toe (since my right foot is not affected the same way, its not my RA), biologics and MTX notwithstanding. So what's the point of me taking this stuff anyway?

I did get the surgeon down to 2 weeks minimum off my feet, but still...I think he's way overboard in concern. Am I being too naive here? I'm so upset about all of this, totally knocked me sideways. I'm supposed to call him back today with a yes/no on the surgery date. I'm so conflicted about all of this.

Geez, I hope some of this rambling and ranting made sense. My apologies if it didn't.

Thanks for listening...

Listen to the doc, it's harmless.

Docs have shown many times that they do not know what they do, but I think this issue is harmless. I beleive nothing worst can happen if you just listen him/her.

With all the medical lawsuits these days, the doctors have to cover their behinds. Even though you say you heal well, he does not know that but is looking out for your best interest and health (and his medical practice as well.)

I think Ducky has a great suggestion in asking to take it week by week. You just never know. Your system is different taking these DMARDS and biologicals - even if just a little, like it or not.

Yes, your immune system should change back to stronger after being off the Remicade eventually, but it does/can take some time. I was on Remicade for almost 2 years - I have always had a weak immune system, I had to stop taking it because it broke mine down so bad I was constantly sick (seriously sick, not minor colds, etc.)  After being off it for 16 months, I can finally say (knock on wood) my immune system seems to have leveled off and improved (but I was extremely sick for an additional 9 months after stopping the infusions.)

Good luck. Let us know what happens. ***

I guess I can understand the doctor's concern, but I understand your side as well.  Is it possible for you to telecommute for a couple of weeks?  That way, you wouldn't be on your feet at the job, but sitting in your nice and comfy home behind a computer. I don't know what you do for a living, but if it's a profession amenable to teleworking, that might be another solution.

Best of luck with whatever you decide to do.

Elcamino

Hi all, sorry for the late reply. I appreciate the comments. Let me clarify about the time thing with regards to the recovery. Normally, he would have me off for 2 weeks. However, because of the med's I'm on and "his" fear of my susceptibility to infection, he wanted me to be off for 4 weeks. I'm sorry, but that's just unacceptable to me. If I had a known pattern of getting infections over the past 3 years from the Enbrel, MTX and now Remicade, I could understand this and would certainly think twice about having any type of invasive procedure. I'm 'healthy' so to speak and just didn't like it that he was basing this on his limited knowledge of my medicines. I've had several procedures done by him in the past - 'pre-meds' so this isn't a first time visit.

Unfortunately, I can't work from home -- although I do work in an office, it's just too complicated to try and telecommute - besides, I have dialup here in the sticks and it would take all day to send stuff back/forth to the office. The other thing that's a problem, is we're gearing up for quite a few projects to start and it's just a mess to crash teach a temp.

In any case, I've put off the surgery until the winter time (my husband suggested this). Then, I can sit home with my foot up for 2 weeks while its pouring rain or snowing. Hopefully that will help me be less antsy about staying home. I will get one of those walking boots prior to going back to work and will still have to stay off of it as much as possible - but that's ok. Even the procedure has changed since I had it done on my other foot. He uses pins that dissolve rather than those that stick out and need to be removed later (like I had years ago)- that also removes chances for infection.

To answer the question about taking it week by week, yes, we would be doing that as well. If I'm not ready to return after 2 weeks (for whatever reason), then I stay home. My boss and I talked about that exact scenario.

I do listen to my doctors -- however, when they make assumptions about things that they shouldn't, that's when I question them. I think it's my only defense since everything else seems to be out of my control!

Thanks for your comments and suggestions - I really appreciate them.

Hey Ducky -- I'm guessing he is trying to be safe and cautious. I should probably cut the man some slack, ya think?! At least I did get him down to the 'normal' amount of time off and a 'we'll play it by ear' attitude for the rest. I'm hoping to have it done right after Thanksgiving or right after Christmas. I need to be able to be up and on my feet (completely) by February -- I have a lot competitions that start in February that require me to be on my feet!

Ah the joys of it all!!!

At the risk of offending who know's how many people, I'm a trapshooter. I only shoot at targets in a safe manner with a bunch of educated, safety conscious men and women! LoL The shooting season typically ends just around Thanksgiving and picks up again in February. Weather conditions just make it miserable to shoot. In any case, that's why I need to be up and at 'um by Feb. I'll definitely keep ya posted. Thanks so much!