Everyone knows that specialist consultations are costly. Whether it is your first rheumatology consultation or subsequent reviews, it is wise to be prepared for every visit. There are 79 rheumatologists in Singapore and I have consulted 5 in the private hospitals to explore different treatment alternatives. I become more accustomed to the requirement and terminologies with each visit so here are my thoughts on what to do for your rheumatology consultation.
1. Prepare for Your Consultation in Advance
Keep a diary or record of your symptoms and medication, if any. There are plenty of mobile apps that you could download to be used as your symptoms diary, If you have had previous consults with other doctors, bring along all your medical reports. For women, it would helpful if you know the regularity of your menstrual period.
2. Learn How to Describe Your Symptoms
Being honest and open about your symptoms is very crucial to an accurate diagnosis and effective treatment plan. Go through the general list of symptoms of fibromyalgia and identity which identify with yours. Be as detailed as possible. You may want to use the pain severity scale and pain descriptor to help you in explaining.
Some common questions asked by doctors relating to pain:
Where are your pain areas?
This is very straightforward but do combine with the following questions on specific areas to help your doctor understand better. E.g. Shooting and radicular pain on my wrists and elbow for 1 year.
How does the pain feel like?
Use adjectives to help you describe the pain e.g. throbbing, stabbing, dull ache, shooting, radicular, burning sensation, tingling with or without numbness etc.
I didn’t know how to describe my pain during my first few consultations and I simply described the rhythm of the pain which helps as well if your doctor understands.
How long does the pain last?
Typically chronic is any condition that lasts more than 3 months. It helps if you are able to describe if your pain has been constant, progressive or irregular.
Is there any specific trigger to the pain?
Does your pain occur only in the morning right after you wake up or usually at night after an intensive day?
What do you do to relieve the pain?
Do you leave it and tolerate or take over the counter painkillers? Or do you try some home remedies such as ice pack, heat pack or brace?
3. Prepare a List of Questions
If this is an unprepared first consultation, you may be at a loss of what to ask. Preparing a list of questions or concerns may help you to understand and deal with your condition better.
Can I continue working out?
Usually doctors will advise you that you could as long as it is not off your limit. When I asked my doctor if I could play tennis, I was advised to start off with very light activities for a few months before proceeding to more intensive sports.
What can I do to help in relieving my pain before the medicine takes effect?
This is a very subjective question and it works differently for everyone. You may want to just listen out to what your doctor may suggest. My experience was doctors may prescribe you a strong painkiller as fire-fighting pills to stand by. One of my doctors advised me to go for light pilates and yoga which surprisingly works better than fire-fighting pills. Once you have dealt with fibromyalgia long enough, you will discover the answer to this question as your doctor will not know what works for you best.
DON’T JUST ASK
What are the possible side effects of this medicine?
There is always an exhaustive list of possible side effects. Besides, side effects are very subjective and I do feel that psychological factor does play a part in amplifying certain side effects.
Ask specific symptoms
Will I experience restless leg syndrome while on this medication?
Instead, highlight specifically the side effects that you think are your concerns. For example, drowsiness, insomnia, restless leg syndrome or nausea. Tell your doctors your main concerns and he may advise another alternative. However, do note that side effects are really subjective. Even if your doctor tells you that a particular medicine does not usually have a certain side effect, it does not mean there is zero chance of occurrence.
Ask in the event of extremities
During the course of treatment, if I can’t stand the side effects such as insomnia, what should I do?
If you are the kind who is very sensitive to side effects, prepare your doctor and ask for their advice on the next course of action. The last thing you want to do is to stop treatment abruptly or keep coming back for another consultation every other days.
Previously I started on a new medication with a new doctor, I was scheduled to come back for a review after a month. However, due to the adverse side effects, I returned every 2 days and the next course of action was simply prescribing me another medicine to mitigate the side effect or adjust the dosage and timing. If you have considered and preempted all these possibilities, you would have saved your time and money on another consultation prior to your scheduled review.
If you are aware that certain side effects will hit you strongly and cause you to stop treatment, highlight these obstacles to your doctor. It is not recommended to stop treatment abruptly especially if it is anti-depressant unless you are having serious and life-threatening side effects. In those cases, please go to the A&E immediately.
4. Pen Down or Record the Consultation
If you have experienced brain fog before, you may have difficulty grasping the medical jargons in a fast-paced consultation. In some cases, you may forget the information as soon as you arrive home. It is advisable to take down notes or better still, do an audio recording of the consultation.
According to the legislation in Singapore, you are permitted to do audio recording acting in own personal capacity. In the context of doctor’s consultation in which you are the informant, breaching of confidential information would not be an issue but out of courtesy, you may like to let your doctor know that you will be doing an audio recording beforehand.
I have done so for all my consultations and it has been very helpful for me. As we read more on fibromyalgia on our own, there will be times when we refer back to a previous consultation to get a sense of what was mentioned.
5. Establish and Keep To Your Regimen
After your first consultation, your next review is likely to be in a month time to see how you adapt to the treatment. Subsequent reviews could be every 3 to 6 months as your condition stabilises. It is highly advisable to establish a set of routines such as regular meals, fixed time for medication and habitual recording of symptoms or any form of side effects you experience in your symptoms diary. This record will be very useful for your next review.
In serious brain fog cases, some may forget that they have taken medicine for the day leading to skipping or double dosing. Having a pillbox is handy to prevent such circumstances.
If this is your first consultation, your rheumatologist will lead and guide you along. However, do remember that they see several patients a day, and their symptoms and tolerance may differ. Only you understand your body the most and it is vital that you provide these information even without being asked. Fret not, once you get comfortable and decided on a doctor, stay put and trust your doctor. Fibromyalgia is a lifelong treatment which takes minimally 3 months to start seeing effect. You will become more familiar with each visit and do ask your doctor all the questions you have regarding fibromyalgia.