Last week was Anna's official switch to adult rheumatology. The rheumatologist and the resident were very thorough, and had a good knowledge of Anna's history. I liked them both. Anna's first thought when we left was that she missed her pediatric rheumatologist. But she has known him for almost all of her life, so this change will take some adjusting. Relationships take time.
One new thing for parents who are making the switch---and maybe you've already experienced this. I was asked to step out of the room for a little bit, so that the resident could speak freely with Anna about sex and drugs and alcohol. He didn't tell me what they were going to talk about, but Anna filled me in later.
Since Anna is an adult, and all medical decisions go through her (although I'm always available for consultation!), I was trying to be very intentional about mostly listening and not talking. There was a lot of information to listen to. Different doctors mean different perspectives and opinions. Dr. S. (the adult rheumatologist) is very concerned about Anna's Remicade dose, feeling that it is very high. Anna is at 15 kl/per kg, and Dr. S. feels that 10 kl/per kg should be the maximum. I did speak up to explain that we went that high because Anna's uveitis was in a stubborn flare. (I didn't mention that Dr. Foster in Boston recommended that Anna be on 20 kg/per kl---so I was thinking that at least 15 wasn't as high as 20!) Dr. S. would prefer to decrease the Remicade and increase the methotrexate. However, when Anna had labs done later (before the Remicade infusion), two of her liver enzymes were elevated, and I know this means that we may have to reevaluate Methotrexate in light of those numbers. Dr. S. is waiting to make any decision on these medications until Anna sees the retina specialist this week, to see the status of the uveitis and macular edema. It sounded like Dr. S. has a good working relationship with Dr. N. (the retina specialist), so that is good---they can talk about it together. They both seem to be brilliant doctors who know their stuff.
The MRI Anna had done in June showed that there has been more active arthritis in the TMJ since her surgery last year. Anna has been having problems with her one big toe for about six weeks (since she went on a day trip to Washington, D.C., and walked a lot). The doctors did not address these issues (except to ask if she ever takes ibuprofen for the toe issue)---I think they were more concerned about the Remicade dose. (And maybe we're to accustomed to a pediatric rheumatologist whose goal was medicated remission.) Maybe we (Anna) should be asking what Dr. S's overall goal is for Anna's arthritis.
This all happened days ago, and I spent the next few days with hundreds of thoughts swimming through my head---about this medication tightrope we are walking, and wondering if Anna knows all of these details and implications of the medications and their side effects, etc. (I'm thinking she probably does, since she's heard me talk about them, and maybe she will have more to say on the matter when I keep quiet about it.) This is all probably the normal thoughts of a mom transitioning and handing over the medical reins.
ANYway . . . . Sunday rolled around, and even during the singing time of our worship service, I still had all of these thoughts and questions and concerns about Anna's appointment going through my brain. And then we sat as the offertory was played. "Be Still My Soul." Played by a substitute pianist, who didn't know that our regular pianist had played that song just last week (different arrangement). And this made the third time this song penetrated my brain and my soul within the past week---a friend had posted the lyrics on Facebook. When these situations happen, I feel like God is telling me to sit up and pay attention. "Be Still My Soul, the Lord is on thy side . . . . "
As we get ready to move Anna to the college, I know from past experience (having gone through this with two older siblings) that we will have a candlelight worship service after we move our first-year students into their dorms. My husband (who works at the college) once explained to me (when they first began this tradition), that it's a service where the purpose is to remind parents that God has been faithful in the past as we have raised our children to this point, and He will be faithful to them for the next four years in their college journey, so we can trust Him and trust our children and trust the college (and let them spread their wings and fly!). It's an awesome service! No matter what the future holds for Anna (with college, relationships, medications, disease, etc.), we know that "through every change, He [God] faithful will remain."
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