Frequently Asked Questions
Whether you are a new or a returning 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 click here for details.
When we receive your referral, we send a response to the referring clinician within 1-2 business days. This response tells the clinician the expected wait time.
If you have questions about your referral, please contact the clinician who referred you. Please do not call our office.
Please note that we do not have a cancellation list.
Have you received my referral?
When we receive a referral, we reply to the referring clinician within 1-2 business days. We tell the referring clinician whether the referral was accepted and how long the wait time will be.
Please contact the referring clinician if you have questions about whether your referral was received and what the expected wait time is.
I’m having a flare. What do I do?
If you think you are having a flare, please call the office. Our front desk staff will ask you questions to help determine if your symptoms are from a flare of your rheumatic disease.
Not all pain is a flare; pain can come from many different sources. The most common is osteoarthritis. A flare of inflammatory arthritis is indicated by joint swelling. Often, the inflammatory marker (CRP) is high.
If your symptoms are concerning for a flare, the staff will offer you an urgent appointment. We have six urgent spots every week from Tuesday to Thursday.
What is the no-show policy?
When you book an appointment, this time is specifically reserved for you. There are long wait times and difficulty accessing rheumatology care. Taking an appointment space and not attending it affects everyone waiting for care.
We kindly ask that you provide at least 24 hours notice to cancel or reschedule appointments.
Our no show fee is $150 for new consults and $100 for follow ups.
If more than one appointment is missed, future appointments will not be offered.
If you are late, your visit will be shortened to accommodate other patient’s appointments. If you are very late and miss your appointment time, you will not be seen and marked as a no show.
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 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 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?
Rheumatic medications do not need to be held for mild viral illnesses, such as the common cold.
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.
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
