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Old 07-17-2013, 02:43 PM   #1
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First appointment help.

Hello, my name is Kaitlynn and I'm 20 years old. I have been dealing with RA for 3 years now, but just got my positive blood work about a year ago. My affected joints are my fingers, elbows, wrists, knees, ankles, and occasionally my toes. My knees and hands are the absolute worst. The pain in my knees is enough to make me tear up and I'm no wimp! I meet with a rheumatologist finally on August 7th and I'm anxious for my first appointment (I just saw a family doctor previously). I'm currently taking Mobic (Meloxican) and they prescribed me Tramadol as well, but it makes me sick so I've only taken 4 this past month. I've tried two other NSAIDS previously that did nothing - Sulindac and I can't remember the other. It seems like I'm always having flare-ups. Is there anything specific I should ask? What can I expect at my first appointment? Thanks!

 
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Old 07-17-2013, 06:51 PM   #2
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Re: First appointment help.

I would expect your rheum to take a thorough history of your RA symptoms and course, as well as general health history. He/she may do additional blood tests and want xrays of all joints that hurt, possibly MRI of worst ones. The goal, since you have been diagnosed, should be to get you on adequate treatment to make you more comfortable, able to function, and prevent future joint damage. I don't think there will be any big surprises. I would take a copy of all your previous labs and xray reports unless your PCP is sending those to the rheum. Good luck, and I hope you feel better very soon.

 
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Old 07-25-2013, 12:07 AM   #3
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Re: First appointment help.

Quote:
Originally Posted by Kaitlynn View Post
Hello, my name is Kaitlynn and I'm 20 years old. I have been dealing with RA for 3 years now, but just got my positive blood work about a year ago. My affected joints are my fingers, elbows, wrists, knees, ankles, and occasionally my toes. My knees and hands are the absolute worst. The pain in my knees is enough to make me tear up and I'm no wimp! I meet with a rheumatologist finally on August 7th and I'm anxious for my first appointment (I just saw a family doctor previously). I'm currently taking Mobic (Meloxican) and they prescribed me Tramadol as well, but it makes me sick so I've only taken 4 this past month. I've tried two other NSAIDS previously that did nothing - Sulindac and I can't remember the other. It seems like I'm always having flare-ups. Is there anything specific I should ask? What can I expect at my first appointment? Thanks!
Good luck at your appointment! Ask for copies of your blood work and other tests. Also, make sure there is an easy way to be able to contact your doctor. Mobile phone, email, etc. Usually they do X-rays for baseline to see where you are at. As well as blood work to check for everything you could imagine. Tramadol makes me sick too, but I need it. I find that I have to eat a meal to take it and I'm fine. Not just a few crackers. A meal! So try that maybe? I would have a hard time without my tramadol. Again, best of luck to you. I hope you can get the answers and treatment you need. My Rheumy is two hours away, one direction. But. It is worth it to get proper treatment!

 
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Old 07-25-2013, 07:20 AM   #4
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Re: First appointment help.

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Originally Posted by NamasteRi View Post
Good luck at your appointment! Ask for copies of your blood work and other tests. Also, make sure there is an easy way to be able to contact your doctor. Mobile phone, email, etc. Usually they do X-rays for baseline to see where you are at. As well as blood work to check for everything you could imagine. Tramadol makes me sick too, but I need it. I find that I have to eat a meal to take it and I'm fine. Not just a few crackers. A meal! So try that maybe? I would have a hard time without my tramadol. Again, best of luck to you. I hope you can get the answers and treatment you need. My Rheumy is two hours away, one direction. But. It is worth it to get proper treatment!


Thank you! I have to eat meals with every medication that I eat because I have stomach issues and I've never been able to take medications very well. It does help to eat certain foods before taking it. My rheumatologist is an hour away one way, but if I don't like him then I'll be going to Iowa City which is about 2.5 hours one way. They are a great hospital there though so I'll probably end up doing that if I'm not 110% satisfied with the one I see on the 7th. Thanks again! Take care.

 
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Old 07-25-2013, 07:22 AM   #5
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Re: First appointment help.

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I would expect your rheum to take a thorough history of your RA symptoms and course, as well as general health history. He/she may do additional blood tests and want xrays of all joints that hurt, possibly MRI of worst ones. The goal, since you have been diagnosed, should be to get you on adequate treatment to make you more comfortable, able to function, and prevent future joint damage. I don't think there will be any big surprises. I would take a copy of all your previous labs and xray reports unless your PCP is sending those to the rheum. Good luck, and I hope you feel better very soon.

Thank you! I figured that's what it'd entail, but I wanted to make sure. I'm not up for any more 'surprises' - thanks again and take care.

 
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Old 07-25-2013, 07:33 AM   #6
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Re: First appointment help.

I find it helpful to make a one page summary that is brief, concise of your symptoms, when they started, what helps, what joints are affected most, etc. Something in list, outline, or bullet point form, not narrative to give to Dr. Also list what tests you know you had and neg or positive results as a summary. Include family history as well. That saves time on history taking and allows more time to discuss treatment options. Hope it goes well!

 
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Old 07-25-2013, 07:36 AM   #7
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Re: First appointment help.

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I find it helpful to make a one page summary that is brief, concise of your symptoms, when they started, what helps, what joints are affected most, etc. Something in list, outline, or bullet point form, not narrative to give to Dr. Also list what tests you know you had and neg or positive results as a summary. Include family history as well. That saves time on history taking and allows more time to discuss treatment options. Hope it goes well!
They sent me an entire packet of paperwork I had to fill out and take with me including where the pain/stiffness is and when it started, along with all the medications I've attempted and family history. I'll probably bring a list as well so I can have one with me.

 
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Old 07-28-2013, 06:18 PM   #8
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Re: First appointment help.

Hi Kaitlin,
Sorry to hear you are in pain. I felt that way too when my arthritis began, but I got early treatment and my pain in under control. Everyone responds differently to any given nsaid. It this one isn't working, try another. They also tend to stop being effective after a few years(you will definitely know the difference!). Talk with your doctor if you think it is quitting. When I think my pain is more than just a temporary flair, I test it with top dose of motrin for a few days. If it is better on Motrin I know the current medication is no longer effective. I have tried nearly all the available nsaids over the last 22 years, so you know my experience is well grounded. My first diagnosis was RA, but after a couple of years it didn't get worse and my doctor changed the diagnosis to undifferentiated connective tissure disease which is a milder inflammatory arthritis that can change and develop into RA, sjogrens, or others. At the same time my doctor put me on nsaids I started with hydroxychloroquine. I also was put on doxycycline for rosacea, but doxycycline is also used for RA (also minocycline) and has been proven effective if used in the early stages. i think it is probably the reason my disease has not been as severe and the diagnosis changed. Not every doctor uses the doxycycline or minocycline, but I would ask if they think it might be helpful in your case. Its cheap, safe and for some people effective. Chances are your rheumatologist will start you on a dmard (disease modifying anti-rheumatic drug), so don't be surprised. I don't know your age or marital status, but I have had success with misoprostol when my anti-inflammatory occasionally roughs up my stomach. I don't take it always-just for a few days here and there as needed. I mentioned age/marital status because misoprostol can cause abortion, so is not appropriate for everyone.

Good luck on your appointment. I hope you find a doctor as kind and caring as mine. He listens to me and involves me in the decision making.

Margarita

 
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Old 07-31-2013, 03:56 PM   #9
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Re: First appointment help.

I am glad Kaitlynn asked about her first appointment as my husband was referred to a Rheumatologist last week after his family doctor said his bloodwork indicated inflammation. About a week ago, his right hand swelled up. At first, he thought he had overused it doing yardwork, but it continued to be swollen with minor pain. He just happened to have an appt. with his Dr. a few days later and he showed him his hand at which point the Dr. mentioned doing the bloodwork. He called with the results and referral info. and my husband will be making his appt. with the Rheumatologist. A little background...husband has had episodes of gout about three times a year beginning about four years ago. About six months ago, he noticed pain in his feet and ankles and attributed it to gout, treating it with Aleve which seemed to help. Ankle issues about a month ago again and then the recent hand thing. Other than those things, nothing significant. He is 57 years old with a family history (maternal side) of heart issues (three stents of his own seven years ago). Not complaining so much of pain, rather that he cannot make a fist with his right hand. It is worse in the morning and seems to get better later in the day. Sound familiar? I don't know anything about RA. Thanks for anything you can tell me.

 
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Old 07-31-2013, 04:09 PM   #10
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Re: First appointment help.

Margarita: When you say you were treated early, what exactly does that mean? I read somewhere that waiting after 12-24 months of noticing symptoms to see a doctor, RA is harder to treat. Does that sound correct? My husband's symptoms started last Jan. or Feb., so he is about six months into it when we look back. I don't know if the occasional episodes of gout dating back four years would be tied to this as they lasted about a week each time and then were gone. I think gout is considered in the autoimmune family too.

 
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Old 07-31-2013, 04:55 PM   #11
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Re: First appointment help.

[QUOTE=lc58;5206176]Margarita: When you say you were treated early, what exactly does that mean? I read somewhere that waiting after 12-24 months of noticing symptoms to see a doctor, RA is harder to treat. Does that sound correct? My husband's symptoms started last Jan. or Feb., so he is about six months into it when we look back. I don't know if the occasional episodes of gout dating back four years would be tied to this as they lasted about a week each time and then were gone. I think gout is considered in the autoimmune family too.[/QUOTE

I was seeing my rheumatologist for the last appointment for an unrelated shoulder problem when I asked about a joint that was bothering me. He checked it and it wasn't much to worry about, but within a month both hands and feet as well as my knees were aching. I went in that week, had a thorough exam and a ton of labs. I was started on antiinflammatories, to start,then when they weren't enough started me on plaquinal which has worked really well for me. I also take doxycycline for something else, and the combo has kept my inflammation under good control. I am fortunate to have started treatment so promptly. So many people wait years dismissing their pain as normal aging and end up with joint or organ damage.

Margarita

 
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