Initial Consult – Part 2

What should a person expect at their first appointment with a rheumatologist?  Prior to the appoinment, there’s quite a bit of paperwork – that’s covered in part 1.  Both of my the rheumatologists mailed the paperwork to me to complete beforehand, with the promise that my exam would be cancelled if I arrived without the paperwork.  Fair warning – that paperwork is important.

 

Arriving half an hour before your scheduled appointment is frustrating.  The doctor really isn’t keeping you waiting, though.  First all your paperwork is placed into your new chart (or, I suppose, rushed through data entry if the office is computerized).  Then the doctor takes time to review your information before meeting you.  Finally, then, it’s time for the exam.

 

Physical Exam

When you’re taken to the exam room, the doctor should review the paperwork with you, clarifying and confirming the information you provided.  Based on that info, the doctor will have ideas about your possible diagnosis.  He’ll ask you to clarify anything that’s not clear and likely scribble little notes all over your paperwork.  Then he will examine the body parts that you’ve indicated are a problem.

Your referring doctor should have sent a copy of recent lab results, and the rheumatologist will review them.  Most likely you’ll have your blood drawn again, and the RD will order additional tests.  It’s probably a good idea to ask the technologist who draws your blood to please send you a copy of the results (you’ll need to sign a release).  If your eventual diagnosis results in an ongoing relationship with the rheumy, you’ll be getting lots of bloodwork, and it might be nice to have your own file/notebook with all the reports.

At your initial appointment, you’ll probably have x-rays taken (many rheumatologists employ an x-ray tech and have a machine in the office).  X-rays will show if structural damage has already occurred, and these pictures will be used as a base-line to determine whether future treatments are effective (the goal is no new damage).

X-rays don’t show inflammation; they only reveal whether damage has already occurred.  MRI is more effective than x-ray in showing what’s currently going on, however this technology is expensive and many insurance companies won’t cover it.  It’s probably not a good idea to introduce yourself to a new doctor as someone who’s going to be a demanding PITA.  Just go along with whatever tests the doctor orders – at least this first time – unless there’s a compelling reason to do differently.

 

Once the exam is complete, your doctor should have an idea of what your diagnosis is.  However, that is not always the case.  Sometimes the rheumatologist can tell that there’s something autoimmune happening, but be unable to distinguish exactly which disease you’re dealing with.  Since many types of arthritis have identical treatment plans, an exact diagnosis isn’t always necessary.  We WANT to know what’s wrong, but it’s more important to begin treatment. Given time, the right diagnosis will appear.  Trust your doctor, and work with him.

More information about what to expect at this initial appointment can be found in a thread pinned to the top of the Arthritis Foundation’s RA Connect forum.

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3 thoughts on “Initial Consult – Part 2

  1. Hi;
    I’ve been having this deep, aching calf pain for months (not the first time) and my knee joints kill me when I get up from bending down. Have occasionally been swollen. The calf pain was coming only at night, but now it is there when I wake up as well. Sometimes I wake up and my hips and whole body feels stiff and achy. No pain in hands, fingers. Had some blood work done; Doc said most significant was that RA factor was at the top end of normal. He thinks I MAY have RA; having me do 800mg Ibuprofen for 5 days with no excersize to reduce inflammation, and if pain decreases I should excersize. I want to truly KNOW if I have RA and if I do, if I’m in for a terrible future. Any thoughts? So grateful for any feedback!

    Thanks

    Elka

    • Elka:
      First, I am not medically trained. I’m sharing my personal experience with RA. That said, I’ll address your questions.

      No, you’re not in for a terrible future if you have RA. There are many more treatment options available now than there were in the past. People who are diagnosed early and treated aggressively can live a near-normal life.

      You need to see a rheumatologist. Some rheumies can fit in new patients within a few days, but from what I’ve heard it’s pretty normal to wait 2-3 months for your first appointment. Your PCP can either write a referral or recommend someone.

      Stop eating sugar. One RA sufferer said that her doctor told her there are some new studies showing that sugar aggravates inflammation. Sorry that I don’t have a link to the data, but I tried it (as did a few others) and found that really does help. Some people also notice an improvement if they eliminate flour – hard to do if you eat baked goods, but if you eat eggs with fruit for breakfast, and meat/vegetables/fruit for lunch and dinner, it works pretty well.

      If you visit your public library, find the Arthritis Foundation’s book Guide to Good Living With Rheumatoid Arthritis. There is a chapter on stretches/exercises that are helpful and very easy to do.

      Rheumatoid Factor in your bloodwork is not the only diagnostic criteria for RA, so you really should see a rheumatologist.
      Hope this helps.

  2. For anyone recently diagnosed….

    Do not delay treatment, time is not your friend here. Months make a difference!! …

    RA will dissolve your joints like alka seltzer. The damage cannot be reversed.

    It can do this in just months….
    The suffering from those months will go on for years [Sad]

    The bio-logics work, Remicade, Humira, Enbrel, Rituxan etc. Pick one that fits your lifestyle.

    I don’t have time for the infusion process or I would have chosen Remicade. Why? It was the first on my Rhummy doc mentioned….

    When I told him I really could not afford to take time off for infusions he handed me a pile of literature for all the biologics and said he thought I would respond well to any of them. Read up on them and pick one.

    WHEN I ASKED WHY HE RECOMMENDED REMICADE…
    HE SAID “Infusion insures compliance”.

    So his choice had nothing to do with effective treatment, only that he knew the treatment was being received!!

    For me, the self injection was not and is not fun, but it does give me more control of my life.

    I chose to be very pro-active in my treatment.

    Loss of control of another aspect of my life was not something I wanted. So I attack RA the way it attacks me, very aggressively.

    If you are new to RA:
    Find a Rheumatologist that listens. They do not all do that.

    If yours is not seeking aggressive treatment without some very, very good reason to hold back… Find another doctor.

    There are many good ones, but even more mediocre ones. The mediocre ones don’t charge less, they just do less. The bad ones are easy to spot, when you find a good one, the mediocre ones will leap off the page at you.

    Ask a lot of questions of your doctor.

    Eyes itching from allergy?… tell your Rhummy doc. Autoimmune diseases change how your body responds to everything. Even things you have had in the past will be different…

    Tell your Rhummy doc!!

    Spend time on the Arthritis Foundation board, there are many years of live experience here. From snake oil to aspirin to biologics… Somebody has had real live experience with it.

    Hope, there is hope in RA treatment. It can be treated, don’t give up… OK? [Smile]

    Regards,
    Ray

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