Have you heard the horror stories of people changing doctors and, because they’re well-controlled and thus have good labs, being told that they’re fine and can’t have their meds that make them fine? I have been so apprehensive about having to find a new rheumatologist that I told my husband to budget airfare for me to fly back to keep seeing my old rheum.

But that’s not realistic. I searched, and thanks to Carla’s recommendation and discussion with my (previous) rheum, found somebody who sounded like a good fit. She relies heavily on lifestyle modifications (in addition to meds) for best control, which appeals to me and still sounded credible to my doctor. Plus no nonsense about having to wait months to see a PCP, then more months to get in once you have a referral. Her website boasted that she accepted self-referrals and people are seen within two weeks. So once I had things squared away and was ready to make an appointment, I looked her up again… and discovered that was no longer an option. ACK!

That meant first finding a PCP so that I could talk that person into a rheumatology referral. My top three choices must be lots of people’s top choices because they weren’t taking new patients. My fourth choice was booked out six months. I finally settled for whoever could see me the soonest – and from my limited two-appointment experience, can tell that it will be best if I put everything in writing because this doctor didn’t remember what was said from one appointment to the next (which makes me wonder about the accuracy of her notes). But she did write a rheum referral, so I can live with it.

In what world is it okay to take so long to see a doctor? It didn’t used to be this way. Starting in February with phone calls, it took until August to get in – and I’m told that’s really fast. There are some places it takes over a year. Anyhow, my husband and I scheduled a bunch of things around timing of this appointment. I did all the paperwork. I did all the online stuff. I dutifully confirmed my appointment when they sent out reminder messages.

At long last, the appointment day arrived. When I checked in, it took a long time. The receptionist looked so quizzical as she typed away at her computer that I finally commented, “You look puzzled. Is there a problem?” To which she replied, “It looks like your appointment was cancelled because you didn’t confirm it.”

But. But. I DID confirm it. Their little text message was 1 to confirm or 2 to cancel. I confirmed and received a message back thanking me for confirming the appointment. She went and talked to someone and was told they’d have to reschedule.

And I bit my tongue to keep from snapping, “If you think I’m going to re-schedule with a place that arbitrarily cancels people’s confirmed appointments, think again!” Cuz I need my meds refilled and know it would take forever to get in with anyone else. Instead I explained what I had done to confirm and she went and got somebody else. That person looked at her computer screen and pointed out exactly where their computer documented the date on which I confirmed my appointment. They can’t figure out why whoever cancelled didn’t see it

So the receptionist went in back again and pleaded my case and they squeezed me in. Forty minutes late, but they did see me and didn’t short-change my time, either.

Finally I was called. The MA kept talking as she was walking away from me, which I found highly annoying (probably about as annoying as she found it for me to not answer her questions because I didn’t know what she’d said). After marching me all the way down the hall, she plopped me in a chair and immediately hooked me up to their automated BP cuff. She then left my arm flopped down at my side, pressed “go” and walked away.

• 1) automated cuffs are noted for being inaccurate
• 2) the patient is supposed to rest for three minutes, not be raced down the hall and immediately tested
• 3) the arm is to be supported at heart level

And I was still pretty upset about my appointment being cancelled plus annoyed at her for mumbling and then not appearing to know how to take blood pressure. Under the circumstances, I think 130/110 was perfectly acceptable.

After that the PA came in for the initial assessment. She was great. She listened. I think it helped that I’ve kept track of dx and med dates. At my very first appointment back in 2007, the 12-page questionnaire asked for names, doses, and dates for all meds taken in the past. That told me I probably needed to keep track, so every time a new DMARD was added or changed, I kept track and was able to provide pretty detailed data.

Unfortunately it turns out that even though I signed a records release for my PCP months ago so that she could request those records and forward them to the rheum, something fell through the cracks. Thank God for patient portals. I was able to log in and hand the PA my phone and she had access to all my old chart notes and test results. She even had a cool app that let her take a photo of my screen with her phone and directly import stuff to my new chart.

Eventually the PA left to brief the rheum, and the rheum came in. She only ordered seven vials of blood (old rheum ordered 21). We have a plan. Prescriptions were written (difficulty actually filling those prescriptions is a separate post). Lab results were slightly different but similar enough that my new doctor decided we’ll continue same treatment plan as I’ve had.

So, Yay! Going to the new doctor with details of med history, plus access to old chart notes was beneficial. I have a new rheumatologist who I like.

Hope life is treating you well 🙂

What is it? Double vision is exactly what is sounds like: a person sees two images when there is only one. There are two types, and the names give a hint as to what they are: monocular and binocular.

Monocular is double vision when one eye is closed. 

Binocular is standard vision with each eye separately, but double vision when both eyes are working together. If you close your left eye, you’ll see one image. And if you close your right eye, you’ll see one image that is in a slightly different location. When viewed together with both eyes, our brain merges the two images into one. But sometimes the eyes don’t work together quite right, so the separate images from each eye don’t exactly align. Things might simply look blurry if the images are only offset slightly, but if there’s enough offset people can actually notice two images instead of one.

It’s important to note that most double vision (aka diplopia) is temporary. That doesn’t mean that you should ignore it and wait for it to go away, because it can be indicative of something serious that needs to be treated.

Cause: There are myriad potential causes of double vision. Partly, the cause depends on the type.

Monocular double vision can be caused by cataracts, astigmatism, dry eyes, and even glasses or contacts that don’t fit properly. Obviously treating the cause will alleviate the problem.

Binocular double vision can be caused by something as simple as misaligned eyes (strabismus), or by something more serious such as neurologic disease like MS or myasthenia gravis; by problems like stroke, aneurysm, giant cell arteritis, or brain tumor; or by complications of diabetes/thyroid/Lyme diseases.

Tests: Obviously, given the possible seriousness of causes, it’s important to identify and treat the underlying cause of double vision. In addition to discovering the cause, tests will determine type and extent of the problem.

MRI can look for signs of thyroid eye disease or MS or tumor. Blood tests can check for thyroid disease, Lyme, and diabetes. Neurologic exam will test for nerve damage that might affect the eyes. The eye doctor can use a Hirschberg Red Lens test to check the eyes’ alignment. There are others, but these are at the top of the list.

Treatment for double vision is to first treat the underlying cause if they can determine one. Some double vision can be corrected with surgery – cataract removal or nerve repair. Sometimes they can add prism via a sticker on your glasses prescription to see if the prism will correct your problem. Long-term, prisms can be ground into your glasses prescription. Those bend the light before it ever hits your retina and trick your eyes into seeing just one image.

***

Long long ago I visited the eye doctor to change from glasses to contact lenses. Since I was teaching swimming lessons, it seemed prudent to be able to see all my students no matter where in the pool they were. The exam went well, the doctor fitted me with a pair of trial lenses, and I was very happy as I got up to leave.

But then things deteriorated as I kept running into the wall on my way down the hall to leave. Things looked quite disorienting.

Back to the exam room I went so they could figure out what was going on. After a number of additional tests, the doctor determined that I had double vision. You might wonder (as he did) why I didn’t notice. Well, first off, it was more noticeable at a distance than up close. And second, the view from my window was beautiful and didn’t really make it noticeable that things were overlapping. Who counts trees?

But the main reason I hadn’t really noticed is that over time I had bent the frames of my wire-rimmed glasses to create my own correction. The doctor was quite puzzled why I hadn’t noticed until he asked to see my old glasses and discovered how askew they were.

Fast forward fifteen years and my eye doctor couldn’t fit our family in. I don’t expect a same-day appointment, but if we call in October to be seen over Christmas break, I would hope to get in sometime in December or early January. They didn’t have any openings until mid-February and that wasn’t the first time that appointments had to be booked three to four months in advance. For me, I don’t care. I can schedule ahead. But a college student who realizes a need for stronger prescription while away at school and wants to be seen while home on break should be squeezed in if they want to help their patients. I really felt like they didn’t care about my son so we called around and found someone who was able to schedule my kid – and since I was driving him, we scheduled me, too.

Even though I had been so happy, for years, that the eye doctor had figured out how to correct my vision, it turns out that he was negligent. As noted earlier, double vision is a huge cause for concern. When somebody has double vision, optometrists are not supposed to just throw prisms in glasses like he did. Standard of care is testing to figure out what’s going on. My new eye doctors were appalled that no testing had been done and insisted on those tests before writing a new prescription.

Eventually tests ruled out a few things, but didn’t find a cause. Sadly, things have gotten worse. I can blink and shake my head to get the images to merge, but they split again unless I’m really concentrating. Weirdly enough, people rarely split into two images – I suspect the movement keeps me concentrating enough to focus. Anyhow, I’m back to not driving because it looks like cars ahead of me in my lane are flying up into the air over oncoming traffic while oncoming traffic is veering into my lane headed straight at me.

Nobody wants me on the roads until I get new glasses.

We’re in Texas now and I’ve found a great eye doctor. She’s highly recommended. She listens to me. She explains well. And now I’m waiting because apparently they don’t like to write for more than 4 (somethings – she didn’t state any units so I don’t know what those are four of), and I’m measuring 8 and 12. She wants my old records before writing a new prescription. Meanwhile, I sit at home – still working on the unpacking process because we own too much stuff – wishing I felt safe to drive cuz even though we have really nice walls, but sometimes I get tired of staring at them and would like to go elsewhere.

Hope you are doing well.