It is my aim on this page just to give you some idea as to what to expect and how to prepare for you visit. Your family doctor will have suggested a referral to the clinic based on his need to further understand your medical problem. Now that may have been a painful joint, swelling stiffness, difficulty moving a joint, or even more widespread pain. The concern may also have been regarding the results of the blood tests or an X-Ray.
Your doctor will have sent the referral and the moment our office receives the referral, I usually within a day or two, review the referral and then based on the information given, I will send a reply back to the referring doctor with an indication as to how long it will take before we can book the appointment. I may also ask for some additional tests or X-Rays to be done before the appointment in order to have all of the necessary information available at the time of the visit.
The office will contact you, schedule an appointment that is convenient with you.
Please write the appointment details down, store them in an electronic scheduler, we all make mistakes with dates and times!! If there are any forms that I require you to complete, the staff will tell you and direct you as to where the forms may be located, usually under Forms on the Resources Page.
One of the commonest questions I am asked initially is “What is Rheumatology and what is a Rheumatologist”?
Rheumatology may be one of the least understood areas of medicine.
The use of the word “rheum” does not help. It originates from the Greek word meaning “that which flows”, and was first used in the 17th Century to refer to arthritis as a condition which flows throughout the body. The terms rheumatology and rheumatologist came into being in the 1940’s, showing how young the field of rheumatology truly is.
Rheumatic conditions are very common. Nearly a third of the population has some form of arthritis, while 1 in 5 will seek help because it is so severe. Nearly two-thirds of those are under the age of 65. Despite how common rheumatic diseases are, there are less than 400 rheumatologists currently in practice in Canada, and approximately only 40 for the entire province of Alberta.
Rheumatologists see over 100 different types of diseases. We are known for seeing arthritis, and – as you visit our website – you will see there are many different types of arthritis. However, we also see many other conditions including gout, myositis, scleroderma, and vasculitis to name only a few. Most of these conditions are linked by the fact they are autoimmune diseases which cause inflammation in the body.
In the last decade, rheumatology has become a very exciting field for rheumatologists and their patients. Significant advancements have been made in the treatment of a number of our conditions, meaning patients with rheumatic diseases are experiencing less pain, less inflammation, less permanent damage and better quality of life. It is an exciting time in rheumatology and we expect even more exciting discoveries and therapies over the coming years.
Preparing for your visit
I think we as Doctors fully understand the frustrations patients have at the process of being referred for a Specialist opinion. The system at times can seem unwieldy!!
Delays, more forms, not certain where the referral is! “You mean I have to drive to Edmonton, is there not someone nearer”???
Remember, that just about all doctors have been patients as well!!
For the size of the Province in terms of population, and the vast geography of Alberta, we have a shortage of manpower particularly in the rural areas! There are now no full time Rheumatologists in the rural areas and considering the population density we should have specialists in the North, South of Calgary (we now have two Rheumatologists in Lethbridge!) and in and around Red Deer. As a consequence, for those living outside of Edmonton and or Calgary, your visit will entail some travelling! I am doing clinics in Grande Prairie, on average once a month, but if I feel the problem is in need of a more urgent consultation, and the office ladies tell you that I need to see you in Edmonton, there is a very good reason. please try to understand, long wait times are not in anybody’s best interest.
Wait times are very simply determined, there are so many hours in a day and the wait times do depend upon how many referrals are coming into the office, I do try to sort them out on the basis of the information received by your referring Doctor, at times we do need more information so please understand if we ask for more information. None of us enjoy long wait times, we do our best to get to people as quickly as possible but not at the expense of being as comprehensive as possible with all the referrals.
I hope the following will help prepare you for the visit.
Please be sure that you have the correct time and date, use a calendar with a reminder on a mobile phone. If you are booked for the first appointment of the day, do not be late,you will be rescheduled. A delay first thing in the morning will ensure everyone else’s appointment will be delayed. Take your mobile phone, if you are stuck in traffic call the office, we will try to help the situation. Plan your trip anticipating traffic and unexpected delays.
Please check our location, driving times may vary depending upon the time of the day.
There is ample free parking at both locations, the Superstore location in Edmonton is large, prepare for a walk, especially in Winter.
- Healthcare card
- List of medications you are taking
- Any forms we asked you to bring or to complete
- Please mention any allergies
In Edmonton and Grande Prairie, if you have been referred for an Ultrasound examination, I need access to that area.
Who am I to tell you about our climate!! It never fails to surprise me!!
Layers are easy, thick bulky items of clothing can restrict access.
Bring or wear a pair of sport pants, yoga pants, a sleeveless undershirt or Yoga top, sports bra for the ladies etc. so that we can expose and get comfortable access to the body area of interest.
Especially in Winter we will ask you to leave outside shoes in the waiting area, feel free to bring a pair of home shoes with you. I often perform a scan of the feet and the toes so again, I will need access!!
I will ask some questions about you, your family, any illnesses in the past and we will expand on the current problem for which you have been referred.
I will perform a physical examination especially of the Musculoskeletal system and if you have been scheduled for an Ultrasound we will proceed to do that.
Most people have had a scan, a joint or soft tissue scan is similar. It is harmless, the sound waves do not cause harm. A jelly is used to assist the image, it is not irritating or toxic and will not stain your clothes, just a bit cold initially.
The aim of the procedure is to look for evidence of:
- Inflammation in a joint or many joints
- Damage to joints or ligaments and tendons around joints.
The images will appear on a screen and I will go through what I see with you.
After the examination and the scan, I will go through the findings with you, prepare a report as soon as I can for your referring doctor and send them to him/her. If a follow up is needed, we will schedule that.
If an injection into the joint is required, it may be possible to perform that on the same day or that will be done at a second visit as that often requires additional preparation and changes to the Ultrasound scanner.
It is also possible that based on the examination and the scan, additional blood investigations or additional radiological imaging may be required. That will either be arranged by your referring doctor or I will arrange that at the time for you.
Joint and soft tissue injection
I do not think I have met anybody who enjoys a needle, never pleasant but at times very necessary and very helpful. I can relate, I have had my fair share of them as well.
Injections are widely used in many of the Rheumatic disorders and also in disorders of tendon and ligaments. They have also been used for many years. Generally, they are of two types.
Injection just of local anaesthetic (freezing agent) is used in areas of muscle pain or soft tissue pain. Also used to ‘test” if a particular area or structure is the cause of the pain. It the injection resolves the pain then we are often fairly certain that that area or structure is the cause of the pain.
Injection of a steroid solution and local anaesthetic, this is widely used in and around tendons, ligaments and also into inflamed joints. Now injections into ligaments and tendons are often of help, usually in the short term, and must be followed, usually by some form of rehabilitative exercises preferably supervised by a physical therapist! There is evidence to suggest that repeated injections into some areas on a regular basis are not advisable and may be injurious in the long term. With regard to the rehabilitative programs, we are blessed with many facilities in the city and I will also discuss rehabilitation with you and we have some useful links in the Page on Physical Therapy and Rehabilitation.
Injection of a steroid and local anaesthetic into an inflamed joint is extremely beneficial depending upon the condition and helps to settle inflammation quickly given any other forms of treatment time to act. Finger Injection
Virtually all injections performed in my clinic are done under Ultrasound guidance.
This does involve:
- Cleaning the affected area
- Preparing the scanner and probe
- Preparing the injection solution
- Recording the images to ensure the correct area has been engaged.
There at this point a few circumstances where I will refer you to radiology to have the injection and these sites are more complex and require an assistant.
- The hip
- The spine
- The sacroiliac joints