Losing a Primary Specialist and Biologic Prescriber

Over the past few years, I’ve experienced losing a few treating specialists. None of these specialists directly treated my psoriasis. They were managing Crohn’s disease and thyroid disease. You may be thinking at this point, okay, but what does that have to do with psoriasis?

A lot, actually.

Managing psoriasis treatments

For example, two of my Crohn’s disease specialists moved. One went to a new practice and one moved out of state. They both prescribed meds that treated Crohn’s disease, as well as psoriasis. Lucky for me, I have psoriatic arthritis. I’m so lucky, right? Well, maybe, and here is why.

From the very beginning, my primary care physician (PCP) stated that biologics were not in her wheelhouse. She wanted someone with more training and experience to manage those meds for me. I understood her hesitation, but it did make things more difficult. This meant I would need a Gastroenterologist, preferably one who specialized in Crohn’s, a Dermatologist, and a Rheumatologist.

When I lost my first GI specialist, the Dermatologist I went to back then was not into prescribing biologics or managing psoriasis. Weird right? What they were into was pushing beauty treatments by the package.

Finding new specialists

Thankfully, my Rheumatologist was able to take over the prescribing of the biologic and testing for serum level and antibodies. However, she agreed to manage it as long as I found a backup GI. My GI at the time had moved practices and her former boss made it legally impossible to see “his” patients at her new practice. For the record, this isn’t legal, but in civil court, it can harm someone financially and drag on for years in the court system. So, I was forced to find a GI at a new office.

Word of mouth is a great way to find specialists. Thankfully, I had a friend whose GI specialist was wonderful. Unfortunately for me, I couldn’t find a decent Dermatology referral for psoriasis monitoring. It was maddening. My PCP agreed to monitor it, but if my skin were to become too much for her to manage, we would search for new options. Fair enough.

The overlap of chronic health conditions and biologics

Due to the turmoil, my Rheumatologist was keeping close tabs. She had me come for 8-week-checkups. This worked out well, as her staff would administer Humira, and she would monitor my arthritis and psoriasis. Yep, she was monitoring my skin, as well.

To recap: My PCP required a specialist to manage biologic prescribing for Crohn’s, psoriasis, and psoriatic arthritis. I lost my GI who originally prescribed the biologic and managed Crohn’s disease. My Rheumatologist took on prescribing the biologic, but required a backup GI in case of emergency, to manage the Crohn’s. Both my PCP and Rheumatologist were monitoring my psoriasis.

Yes, it felt, at times, like there were too many cooks in the kitchen. But I was also lucky in that my Rheumatologist and PCP shared notes with one another.

Create a plan B for your biologics

So, if you ever face losing or have lost the physician who manages and prescribes your biologic, my advice is simple. Form a backup plan.

These days, I keep up with new recommendations from friends and watch for new reviews of doctors in my area. Since losing my first GI Specialist, I’m now on the verge of losing my third. I’m hopeful that once she officially moves to her new practice I won’t have a problem getting in. But, I’ve been there and done that, already. So, I already have a backup plan for that specialist. And if I need new biologic management, my Rheumatologist will resume management.

The importance of having multiple specialists

I’m very lucky to have one specialist pick up where another left off. I also recognize that my story may be the exception to the rule by having two to three doctors watch over psoriasis, Crohn’s, and psoriatic arthritis at any given time. And not everyone is as lucky. This is why I recommend if you have multiple conditions to have more than one specialist who can manage specialty medications. I also recommend keeping an open dialogue with your specialists. It’s okay to ask if anything should change with your care with one doctor if they can be part of your backup plan.

Have you ever lost your specialist who managed your Psoriasis or biologic treatment?