First rheumatology appointment

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I know this might seem like a strange question but can anyone tell me what I may expect to happen at my first appointment with a rheumatologist? Do they do any tests or is it just a history taking exercise? I have an appointment for February but have no idea what to expect. My GP did the routine blood tests, that is rheumatoid factor and serum protein and she's prescribed anti inflammatories and codeine but that's about it. Thanks in advance for your help.

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  • Posted

    My recollections of my first rheumatology appointment many many years ago was that they did send me all around the hospital to do a number of tests and it all took a rather long time (I remember, because the hospital was so big and the corridors all looked the same so I kept getting lost!)

    What I don't remember was whether all this happened in the course of one appointment or whether I had to go back for the results.

    I imagine I'd have had to go back.

    Actually, now I think about it, it's quite possible that my GP sent me to get the tests done, as with you, and then, when they were in, I saw the consultant rheumatologist.

    Sorry. That's probably too vague to be of much help.

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    • Posted

      Thank you Light. I know it's not easy to remember and sometimes we have so many appointments it's really difficult to remember which is which.
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  • Posted

    I have had a few referrals so therefore a few "first" appointments with different rheumatologists. They were all pretty different to be honest but the last one, and most thorough, did a physical examination, went through history, sent me for an immediate blood test and x-rays following the appt, so,I was there a good two hours. She also arranged scans of my hands, feet, spine  and abdomen. 
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    • Posted

      Now you spell it out, Sandy, I'd say mine did about the same.

      Because I have another rheumy while I'm away from England, I do remember noting a specific neurological knee-jerk kind of test my London one did that no one else had done before.

      Although my GP had said he was 'the very best' in my area, I have to say...yes, he was thorough, but he was so alarmingly impersonal that I felt like a lump of lamb being examined on a butchers slab.

      So donlt expect smiles or how-d'you-dos. Just follow protocol and you'll be fine.

      I'd also recommend taking someone with you and to take notes, preferably get that someone to take the notes,especially on a very first consultation, becuse there may be many questions you'd like to ask that you might have to wait another three months to get answered.

      Nothing more annoying than stepping out of the office only to realise that that one vital question never got answered.

      Worse, that it was answered but you were so overwhelmed with the complexity of it all, you don't remember what he said!

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  • Posted

    Thank you. The advice about taking someone is very useful. My husband will be coming with me but would normally wait in the waiting room so I'll get him to come with me to the consultation. It'll also prevent me from going through everything later.
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    • Posted

      Yes good idea about taking somebody. Also take a list of questions and a list of the areas that bother you. I did this but forgot to get it out! Lol I wanted to ask why my legs shake visibly and uncontrollably when I walk downstairs and forgot all about it, it was on my list of course, in my bag! Lol
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    • Posted

      That's exactly what I'm like. I had a telephone consultation booked a few weeks ago with my GP because I couldn't get an earlier appointment. I spent all weekend writing everything down eg how I was feeling and just how much pain I was in. Then forgot all about it and didn't say half the things I wanted to! But it's an excellent idea and I'll certainly do that.
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  • Posted

    At my first RA appointment, the Dr. gave me a physical examination and had blood drawn. We also discussed how I'd been feeling. 
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  • Posted

    Hi Matron, I live in the States, but my first appointment I actually wrote down my history for the past year and a half of how the pain started, when the weird flare ups began, how I relieved the pain through chiropractic and meds I was already taking for my back, and everything that had happened up to my appointment with him. I did take my husband with me, but I thought it best to write everything down so as not to leave anything out because I always forget stuff once I'm at the doctor's office. smile

    He actually read it all before he came in to see me and then took a look at my hands, feet, and had already seen my blood work that my primary care doctor had run which showed an elevated RA factor. He said it was a no brainer; I had RA. My Rheumy then ordered a ton more blood tests and x-rays for both feet and hands. He told me about the Leflunomide and how I'd need to have lab work done each month to check my liver while on this med, as well as supplementing it with Folic Acid daily.

    He went with the med he gave me because I do not have insurance and it's the only med that currently has a generic brand made. It's very inexpensive at just $19 per month.

    The lab work and xrays were NOT inexpensive though. But worth doing so that I knew what I was up against. He was checking for any joint damage and did not find any, which was great news.

    He made a follow up appointment with me for 3 months, as he said that is how long the med would take to start making a difference.

    Sorry this is so long, but that was my experience. smile

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    • Posted

      Thank you so much for your reply. Even though I'm in the UK it was useful because the pattern of the consultation will probably be the same whichever country the patient lives. I'm pleased they didn't find any joint damage on your X-rays. Fingers crossed I'm the same. It will be 3 years in February when I started with pain in my shoulder so I hope there's no damage. I like your idea of writing things down and letting the rheumatologist read it first. I intend to try that. Thanks again.  😊
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    • Posted

      Yes.... a base line x ray of at least the hands is vital. Then you'll have something to measure the effects of the drugs and the progress (or lack of it, we hope) of the disease against.

      Also, re what someone up top said...

      Monthly blood tests might be a bit steep in frequency, but I guess at the beginning it's good and it would also depend on what your dosage is.

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    • Posted

      Hello Light!

      Yes, I too thought that once a month was too much (as well as expensive since I don't have health insurance) but my Rheumatologist insisted the first 3 months had to be done that way and if I chose not to have them, he'd refuse to see me. (roll eyes here). So I'm hoping that if my blood work remains good, after January I won't have to do them monthly but maybe every 3 months instead.

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  • Posted

    When I went to a rheumatologist , she asked me a lot of question and thank god that I have all my paper work from a different doc so she went and looked at them ..she sent me to go and get my blood draw which they had to do like 13 tubs of blood ..Then I went to do x -rays of my hands , feet , knees , ankles , wrist ..Then to a eye doctor too ..I did all of these in different days ...
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  • Posted

    Thank you all for your replies you have given me some very good advice.
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  • Posted

    I recently was diagnosed with early onset inflammatory RA. The first meeting was to make sure I had blood tests and also to give me a kenalog injection to bring down the inflammation. If, like me, you are taking anti inflammatories, these will increase the CPF reading for inflammation. I didn't realise I was being placed on a trial (it seems most of the clinics are being paid to put RA people on clinical trials and this has to all be completed within a 12 week schedule) so thee is a standard staged approach. First of all you will be asked to meet with the rheumatologist and discuss your illness and rate it on various scales. You. Ay need a steroid injection and they will request both blood tests and X-rays of the hands and feet to see the erosion. Just make sure you receive copies of all this information because it is about YOU. They will make suggestions about medication and will likely tell you you must have methotrexate AND some combination drug. Now, this is where it gets tricky becUse you must make sure you understand these drugs. My experience was one of being told I absolutely MUST take them otherwise I would just get worse. Well, that was in September and we are now in December and I haven't wanted to start on the drugs because I don't like the sound of them. In actual fact, my last 2 blood tests have shown a massive 'natural' drop in the CRP and the ESR and an increase iron (you are likely to have iron deficiency anaemia and they are likely to prescribe tablets but you can take natural iron supplements like Floridix) and my sense was had I been  on medication they would have said the drop was down to the meds. I also took someone with me and they were basically very rude to her. Despite the fact she works with people with RA the consultant treated her like she was an imbecile. Needless to say, don't be cajoled into anything and make sure you are clear about all your options. I have now dropped the lot and gone to Chinese Medicine. I feel like a new person altogether and have decided to stay with that. Completely different approach that is both holistic and works on the body not just the disease. It is worth looking at because my consultant warned me away from Chinese herbs which led me to think there may be a reason for doing that. I now realise there was an option for me (not anyone else if this isn't their thing) but I just feel 100% cared for and my body is just back to normal!!!! So never be afraid of checking the alternatives. Just to add, I have religiously stayed with a diet of high omega 3 (3500mg per day) iron and vit B alongside my chinese herbs and acupuncture. Every day gets better!!!
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    • Posted

      Thank you Iyy you have given me a lot to seriously think about. My letter for the appointment states the consultation will last approximately 30 minutes. It doesn't say anything about X-rays so I'll wait and see. I am not very keen on taking Methotrexate but I am struggling with my anti inflammatories as they give me abdominal pain despite taking Omeprazole. 
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