Need to improve my relationship with my new consultant. Advice?

[yaf_user681_24538]

I had three months off last year with severe chest tightness and shortness of breath. A previous consultant put me on spiriva, serevent and singulair, and I've been very slowly getting better over the last four months.

Thing is, I don't wheeze, I never have a particularly low PF or see a correlation between PF and symptoms, allergy tests are clear, a histamine challenge reported that I only have mild asthma and spirometry is always normal. My new consultant has looked at the evidence and drawn the very logical conclusion that I don't need to be on all those hardcore pharmaceuticals. A the last appt he told me to start giving them up.

First I quit serevent and found I had frequent attacks that were mild but difficult to shift. I caved after two weeks because I hated getting ill again. Then I quit spiriva. After a week I had a more severe attack and started taking it again.

My next appt with the consultant is in a month and I'm getting stressed already. He's practically accused me of lying already for reporting symptoms that he can find no evidence for. I'm worried he won't believe when I tell him the effects of giving up the meds.

Anyone got any advice for how I can improve this relationship? I really need his help but I just come across as hysterical when I try to communicate how this affects my quality of life.

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Take a copy of the new national strategy for COPD, the asthma chapter clearly states that not all asthmatics wheeze. Also i would recommend ringing his secretary and asking if you can see him sooner as your breathing is getting worse. If she says no, ask her to give him a message and could she get back to you with what you need to do, explain you asthma is getting worse.

Your new consultant needs to realise you getting worse and unless you make a fuss they wont see this.

Plumie

[Skee-skee]

In addition to what Plummie said- could you make a note of what you want to say- and just hand it to him. It is often easier to have a written summary than waffle. Could you take someone who is a calming influence with you? (I have been known to take my mum and I'm 29). Do you keep a symptom diary (including things other than just peak flows) that you could take a long?

I like you and Plummie never wheeze but my spirometry (and PF) varies a lot. Also when bad expiration is always much longer than inspiration. I think about 10% of asthmatics never wheeze.

If this new consultant doesn't think it is asthma, what does he think it is? Incidentally why did you change consultants? Could you go back to your old consultant? What does your GP think?

[yaf_user681_24538]

Plumie and Bryony, thanks for your advice and questions. Wheezing aside, my airways just aren't particularly reactive. I've been in A+E with a PF of 450 and 89% O2. On top of that, I only had a mild reaction to the histamine challenge test. That must mean I'm only mildy asthmatic, right?

It's interesting that you mention the long expiration, though. My breathing slows right down as the pressure increases and breathing out takes a lot longer.

I think it would be a good idea to write down exactly what's happened over the last few weeks as I've tried to give up the serevent and spiriva. I've got the consultant's email address so I can send him an update now instead of waiting for the appointment. No need to go through a secretary

He thinks I have mild asthma, but also thinks I've had ""something else"" he can't diagnose because it's now getting better, hence I should come off all the meds. Last time I saw him I felt ok as the weather had just turned springy. I need to see him on a bad day, but that never seems to happen!

I didn't really have a choice about changing consultants. I was referred to a regional centre of excellence by occupational health, and you can't really go against their advice without it looking like you're not interested in getting better. In addition, I didn't really have one consulant at my local hospital, I had to explain my unusual case anew every time I went. At least the new man gives me time to explain what's up.

I'm optimistic he'll help me sort this out. I just need to build a good relationship with him. Making a very low-key, unemotional fuss will hopefully be the way to do it.

Thanks!

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Zed,

Ask him if one of his team would be willing to see you the next time you are suffering from the symptoms. This is what we try to do as it is well know that when you go to clinic you are always well. If you can get intouch with someone specifically as soon as you start to become unwell & they see you say within 12 hrs depending, that might help.

A