Frequently Asked Questions

Whether you are a new patient or an established patient, you may have questions about your care. You may be curious about what your first appointment will be like or have questions about when to hold your medications. Below are answers to the most common questions we receive.

Do I need a referral letter to be seen by a doctor at Nanaimo Rheumatology?

Yes, a referral letter is required before you can be seen at Nanaimo Rheumatology. Please ask your referring physician to send the referral directly to our clinic.

I’ve previously been seen at Nanaimo Rheumatology. Do I need another referral letter to come back?

If you have been previously seen at our clinic and are returning for follow-up care, a new referral letter may not be required. Please contact our office to confirm your situation.

Are there geographic limitations to who can be seen at Nanaimo Rheumatology?

We accept referrals for new patients living between Ladysmith and Qualicum Beach. We also accept referrals for patients living in Tofino and the surrounding area, which we can book in our travel clinic in Tofino.

Patients south of Ladysmith can be referred to a rheumatologist in Victoria. Patients north of Qualicum Beach can be referred to a rheumatologist in Courtenay.

How long is the wait list?

Wait times depend on the urgency of your condition. Please refer to Triage for how we assign urgency.

After your referral is received and triaged, we send a response to the referring doctor within 1-2 business days stating expected wait time. Please do not contact our office regarding your referral. If your situation has changed, please contact the physician who referred you. Please note we do not have a cancellation list.

Have you received my referral?

When we receive a referral, we send a response to the referring physician within 1-2 business days. We indicate whether the referral was accepted and how long the approximate wait time will be. Please contact the referring physician if you have questions about whether your referral was received and what the expected wait time is.

What can I expect at my first appointment?

One week before your appointment, you will receive an email reminder with important forms to fill out. It takes 10-15 minutes to complete the forms. You cannot save the forms, so set aside enough time to complete them at once. The forms will collect information about your past medical history, medications, allergies, social history and relevant symptoms. If you cannot complete these forms online, arrive to your appointment 15 minutes early to complete the forms.

Our health care team will review the responses on your form, as well as the information provided in the referral letter. We will also review relevant blood work and imaging to prepare for your appointment.

Our clinic typically runs on time. Plan to arrive 10-15 minutes early to find parking. We are located near the hospital, so parking can be hard to find. There is a parkade in the Colville Medical building for $1 per hour. The parkade is a few blocks from our clinic.

During your appointment, the doctor will take a focused history and perform a tailored physical exam. The doctor may perform an ultrasound in select cases.

What is the no-show policy?

Cancellation or rescheduling of appointments requires 24-hour notice. If you provide less than 24 hours notice, you will be deemed a no-show. Repeated no-shows will affect your ability to schedule future appointments at our clinic.

If you are late for your appointment, your appointment will be shortened to accommodate other patients with appointments.

How can I get my prescription renewed?

Prescription renewals are managed during your scheduled appointments. If you require an urgent renewal between visits, please contact our clinic and we will do our best to accommodate your request. Please call early and provide at least 1-2 weeks notice.

Do I need to hold my rheumatic medications for surgery?

Leflunomide, sulfasalazine and hydroxychloroquine do not need to be held for surgery. Methotrexate can be continued throughout surgery, as long as your kidney function is normal.

Biologics should be held before major surgery. Major surgery includes hip and knee replacements.

JAK inhibitors (tofacitinib, upadacitinib) should be held 3 days before surgery.

All other biologics should be held one dosing cycle before surgery. For example, if you take etanercept every week, you should hold this one week before surgery.

Do I need to hold my rheumatic medications when I’m sick?

Hydroxychloroquine is a mild medication and does not need to be held for illness.

All other medications (methotrexate, leflunomide, biologics, etc.) should be held if you have an infection requiring antibiotics. They can be restarted once you are feeling better and have finished your course of antibiotics.

Rheumatic medications do not need to be held for mild viral illnesses, such as a mild upper respiratory tract infection.

Do I need to hold my rheumatic medications when I get a vaccine?

Some vaccines may be less effective when taken while on rheumatic medications. Some medications may need to be held around the time of vaccines.

For the COVID vaccine, the following medications do not need to be held:

  • Hydroxychloroquine
  • Sulfasalazine
  • Leflunomide
  • Azathioprine
  • Tocilizumab
  • IL-17 inhibitors (Secukinumab, ixekizumab)
  • Guselkumab
  • TNF inhibitors (Adalimumab, etanercept, certolizumab, infliximab, golimumab)

Methotrexate: Hold 1 week after the influenza and COVID vaccine

JAK inhibitors (tofacitinib, upadacitinib): Hold 1 week after COVID vaccine

Rituximab: Receive vaccine one month prior to next infusion (4-5 months after lastinfusion)

Prednisone: Wait to get vaccine until taking less than 20 mg of prednisone