Do you guys think I should switch GIs?

I've seen my gastroenterologist for years.

Here's what I really like about him. When I say "I want to try xyz", he always says, "well, the reason I didn't prescribe that before is because abc" (usually a perfectly fine reason), and then I say, "Well I want to try it anyway," he says, "Ok" and writes a prescription.

Here's something else I like about him: He definitely has the goal of keeping me on the least invasive first line treatment unless/until other options are absolutely necessary, which is my goal as well.

So I feel like I don't have to fight him on anything, and I know that struggling to get a prescription for something you think would help is a huge problem for some people.

Here are my concerns:

1. I think he may have some unconscious biases that may cause him to give me bad advice (well, maybe not *bad* -- just maybe not optimal). Example: In my first flare, I asked him about exercise. His response was to tell me that I should definitely not do anything like cardio that speeds up the digestion. Over time, I've grown to believe that's wrong. It's also not completely clear to me that other lifestyle advice he has given me is actually medically true or whether it is reflective of his age & beliefs.

2. Following on that, I wonder whether he's really up to date on the latest info. I'm going to see him next week to ask about Uceris and that will probably be the telling factor. I've been on Lialda since diagnosis and as far as I know, that's the latest mesalazine drug so it seems like he was at least pretty current with that (I guess).

3. I also am not perfectly sure that we communicate well. I am *positive* that he told me I needed to have a colonoscopy again last year and when I followed up with it, he kind of put me off until I really pressed him and then he said I don't need one for five to ten years after diagnosis unless there are other pressing reasons for it. Because I'm kind of arrogant about being the most compliant patient in the universe, I feel like I heard him right the first time and he changed his mind or realized he had misspoken. That concerns me.


Maybe the best outcome is for me to have this community in order to find out about VSL#3, and Uceris, and the possibility of gluten sensitivity or histamine, and alternative treatments such as fecal transplant. After all, he has yet to decline any request that I make (other than the additional colonoscopy, which I don't actually *want*).

Do you guys feel like having a GI who is well versed in everything about UC is really helpful, or would you rather have someone like mine who you can control or push around?

I vote for keeping him as well. Doctors don't really know anything about UC anyway. They don't know what causes it and they don't know how to "cure" it. All they know is how to treat the symptoms and they don't even know which one of those treatments will work in which individual. So, it is important to find one who goes the less invasive route and one who will listen to you and if you ask for a prescription to Uceris, or whatever, he does it. You can't really expect any more than that. As Kazbern said, each and every doctor has their own protocols for doing colonoscopies, pred tapers, and everything else but it is important that the patient knows enough that the doctor doesn't always know what they are talking about when talking about the other things you mentioned. Everyone, including both patients and doctors, has their own prejudices about different aspects of the disease. Sometimes we and they think we are right about something and discover later on that we or they weren't (hopefully).

I have both...a doc I can push but he sometimes pushes back. He's not very wishy washy but he will let me do what I want if I'm sure enough of what I want. Personally I would not like a doc who lets me do what I want, when I want. Because after all, we look to them for advice. But it's also important to have a voice in your treatment.

Overall, your doc seems like a good doctor tho. I would stick with him for the time being.

I'd keep him. I don't always agree with my GI but he writes all the prescriptions I need.

Post Edited (Andrina) : 5/17/2013 2:28:06 PM (GMT-6)

I gave up on my GI when I realized that he wasn't that interested in UC, he wanted to take the expedient route by prescribing more invasive drugs instead of seeing me tough it out on mesalamines, and he didn't get how crazy UC can make you when you first get it and it's not managed yet.

My second GI listened to me, respected my choices and told me his goal was to have me know my disease better than he does. He's a little procedure and appointment=happy but everyone has to make money, I guess.

My new GI in Chicago was selected because I found him mentioned on this site. I hope I have good luck with him.

Janey... so your telling me exercise doesnt speed up digestion?? i always thought that was the case?

I am in a flare now and because of advice i am not doing any exercise and its driving me mad grrr lol

Many thanks

Tom

I wish I could find a doctor like that. I keep getting GIs that want to colonscopy me after every major purchase by their spouse and treat me like an idiot if I ask a question.

derby county -- I agree with soystud -- it's not cut & dried, your body will be your guide. Some days I can't but many days I can. In theory, cardio speeds everything up, but in my experience, the body sends energy to the muscles being used (not 100% the case, and ymmv), and it hasn't appreciably affected my digestion on a short or long term basis.

Thanks everyone for your insights. I'm glad I asked.

While some GIs might peek into this site, maybe some would post under the guise of not being one.

We can get information about UC by many GI docs from papers they've written, studies they've done, books they've published, etc,available on the internet.

Obviously, Janey...we all agree for you to keep your GI.

Regarding exercise...running, bike riding, weight lifting....what your doctor said is true for some, but for you maybe it's not an issue.
There have been some here who have gotten worse from extreme exercise...it only makes sense to not rev the body to the point of reaction. And while your body will tell....many choose to not listen.

My doctor and I don't agree on some points...but a patient seeks different information than A GI. I'm relieved he started me on 5ASA meds, but there weren't as many choices regarding immunosuppressant/biologic meds. I don't know what he would have put me on if I were to start as his patient now in the state I was then. I haven't asked.

The grass isn't always greener on the other side...and it's possible your doc learns something from you every time you're in for an appointment. He may very well pass some of that on to other patients.

Just don't ignore the meds that do work for you or ignore symptoms that tell you to make sure you need to use them.

q

One alternative to switching doctors would be to schedule a consultation with another gastroenterologist for a second option. You may find that you like the new doctor and want to switch. If not, perhaps you'll come away with some new ideas/information/perspectives.

The consultation/second opinion should be with a gastroenterologist who is a specialist in IBD. If you do this, first collect all of your medical records (biopsy reports, etc.) and get them well organized so you can take them along. I realize that not everyone can travel, but I went to the Mayo clinic for a consultation and found it very worthwhile.