GENERAL QUESTIONS:
“Where is your office?”
The general rheumatology office for Dr. Baldwin and Dr. Shaw is located at 1990 Fort Street - Suite 401 in Victoria, BC. Our building is on the corner of Fort and Foul Bay, across from the Save-on-Foods.
The vasculitis clinic on Tuesdays, is located at the Victoria Arthritis Centre at 2680 Richmond Road in Victoria, BC at the corner of Richmond Road and King, which is up the road from the Royal Jubilee Hospital.
“I’ve been referred to you. When will I hear back about a scheduled appointment”
Dr. Baldwin and Dr. Shaw triage all appointments within 1 week of receipt. Patients are typically notified of an appointment within two weeks of this. We prefer to use email to schedule appointments. To expedite the booking of your appointment, please notify our office of your correct email address to allow us to contact you ASAP about your scheduled appointment.
Important information for Dr. Baldwin’s patients: Dr. Baldwin’s prefers to use an electronic “econfirm” system for appointment notification and confirmation. Please ensure you notify our office, preferably through email (though phone message is accepted) confirming your cellular phone and email address as well as providing us with verbal consent to use the econfirm system. This is a faster and more efficient way for us to notify you of your appointment, and for you to confirm your appointments.
“How do I prepare for my appointment?”
Please wear loose fitting clothing and/or bring along a pair of shorts and a t-shirt to change into. Arrive at your appointment 15 minutes prior to your scheduled time. Please bring a list of your medications, including names and dosages. Please prepared to complete some paperwork on arrival.
“I have a telehealth appointment, but I cannot find the link. What do I do?”
Please check the above tab under “virtual care” for further information. Ensure you check your spam and/or junk mail for the link.
“What happens if I forget to attend my appointment?”
Due to a shortage of rheumatologists on Vancouver Island, there is currently an extensive waitlist for rheumatology consultations. If you are unable to attend your appointment either by telehealth or in person, we require at 48 hours week notice, so that we can assign your appointment slot to another patient. In the absence of extenuating circumstances, failure to attend your appointment without providing at least one week notice will result in a no-show fee to be paid prior to your next appointment. If you are unable to attend your in person appointment for any reason within 24 hours of your appointment, we will automatically contact you via telephone for a telehealth appointment. Patients who fail to attend their appointment on 3 separate occasions, will be discharged from our practice.
“My lab requisition has expired. What should I do?”
Please contact our office if your lab requisition has expired. Due to high call volume, we are not always able to return calls in a timely fashion. For this reason, it is important to confirm that your requisitions and prescriptions are updated at your follow-up appointment.
“My prescriptions require refilling. What should I do?”
Please contact our office to schedule an earlier appointment for a prescription refill. Unfortunately, due to high call volumes, we may not be able to provide prescription refills over the telephone. The pharmacy is often able to provide you with a temporary prescription until you can be seen by a physician. If you are unable to get into our office in a timely fashion, please arrange an appointment with your family physician for a temporary prescription refill. It is important to confirm that you prescriptions do not need updating at your follow-up appointment. Please note, that Dr. Baldwin and Dr. Shaw are unable to provide prescriptions for conditions unrelated to your rheumatic disease - please obtain these through your family doctor, a walk-in-clinic or the prescribing physician.
COVID-19 RELATED QUESTIONS:
“Masks are no longer mandated by the provincial government. Do I still need to wear a mask in the office?”
You are no longer required to wear a mask in medical clinics but we respect your decision to wear a mask and masks are available through reception.
“Am I at higher risk of COVID-19?”
Studies show that patients with co-morbidities may be at higher risk and may have a more severe course. In patients with inflammatory diseases, prednisone and uncontrolled inflammatory rheumatic disease, and use of Rituximab are the greatest risk factors for morbidity and mortality related to COVID-19. There is insufficient evidence to support discontinuation of disease modifying anti-rheumatic drugs and patients are encouraged to continue their medications. We encourage patients to follow public health precautions in their health region.
“What do I do if I test positive for COVID-19?”
If you test positive for COVID-19, you may qualify for antiviral therapy but this depends on your level of immunosuppression, the severity of your symptoms, and your other comorbidities. Whether or not you hold or continue your medications is also determined on a case-by-case basis. Please contact the VIHA COVID-19 pandemic clinic directly at 250-737-2030, ext 44685. For further information on on treatments for COVID-19 please visit: https://www.islandhealth.ca/learn-about-health/covid-19/outpatient-covid-19-therapeutics-clinic.
“Can I get a 4th dose of the COVID-19 vaccination?”
Public health is now offering 4th doses of the vaccination. Please contact public health for the date of eligibility.
”I have tested positive for COVID-19 and I have symptoms. Should I take the monoclonal antibody or anti-viral treatment and how do I arrange this?”
You should contact the COVID-19 pandemic clinic and/or the BC CDC to discuss this with a healthcare specialist about which treatment is recommended. Typically the prescription is arranged through that clinic. The evidence is best when used within the first 5 days of symptoms and is shown to be effective in preventing hospitalization and death.
”Do I need to stop or hold my medications, prior to my COVID-19 vaccination?”
The short answer is, maybe - it depends on which medications you are on. Please click on the following button to review a document with general recommendations. If you are unsure, please leave a message with our nurse, or if possible, wait until your upcoming appointment with your rheumatologist:
MEDICATION RELATED QUESTIONS:
“What are disease modifying anti-rheumatic drugs (DMARDs)?”
DMARDs are drugs that are used in the treatment of autoimmune conditions. Unlike Tylenol, anti-inflammatories and narcotics and other pain medications, these drugs have been proven to shut down the inflammatory pathway and prevent end organ damage such as joint deformities and renal dysfunction. These drugs are often thought of as immune suppressing.
“I am not tolerating my medications or they make me feel unwell. What should I do?”
The majority of patients tolerate disease modifying anti-rheumatic drugs very well, however, a minority of patients may experience mild or serious side effects. For this reason it is important to go for regular labs as requested by your rheumatologist. If you think you are having side effects please ensure you have gone for a recent set of blood work and contact our office for further instructions. If you must discontinue your medication, please ensure you let us know so that we can schedule your appointment sooner.
“I am going for surgery. Should I stop my medications?”
It is important to discuss any upcoming surgeries with your rheumatologist. For joint replacements, biologic medications should be stopped 2 half lives prior to joint replacement but can typically be restarted once the incision is healed and staples are removed. For all other surgeries, the advice can be variable and dependent on the type of surgery and your disease. Please discuss this with your surgeon and rheumatologist.
“I have an infection and I am on antibiotics. Should I stop my medications?”
As every case is different, please contact our office if you have an infection requiring antibiotics. In many cases, disease modifying antirheumatic drugs can be continued alongside antibiotics with close monitoring of labs. Your rheumatologist or our nurse, will provide further direction.
“Can I have vaccinations on my medications?”
Patients on biologic drugs should avoid live vaccines. In Canada, most vaccinations are not live and therefore, this is not usually an issue. If you are on a biologic, it is advisable to get vaccinations as far away from your biologic as possible. ie. if you are on a monthly injection, consider getting it done two weeks before and after your injection, if you are rituximab, consider getting it 3-6 months before or after your dose. If you still have questions, please contact our clinic RN for details.
DISEASE RELATED QUESTIONS:
“What is an inflammatory arthritis?”
An immune condition in which the body’s immune system attacks the joints rather than the bugs/germs. The condition manifests as joint pain, swelling and prolonged morning stiffness that improves with activity and worsens with rest. Rheumatoid arthritis, psoriatic arthritis, reactive arthritis, lupus and vasculitis, can all have inflammatory arthritis as part of the symptoms. Osteoarthritis or mechanical pain, is worse at the end of the day and with activity.
“I think my arthritis is flaring. What should I do?”
Inflammatory arthritis flares typically manifest as pain, joint swelling and prolonged morning joint stiffness that improves with activity. If you believe you are flaring, please contact our office as soon as possible. Due to high patient volumes, we are not always able to see patients in a timely fashion. If this is the case, please contact your family physician or a walk-in-clinic for interim management.
“My pain is uncontrolled, what should I do?”
Rheumatologists are experts in the management of inflammatory diseases. Rheumatologists are not pain control experts. If your pain is accompanied by prolonged morning stiffness (more than an hour) and joint swelling, it may be inflammatory. Pain that is worse with activity and at the end of the day is not inflammatory. Please follow-up with your family physician or a walk-in-clinic for pain control.
“Are there any lifestyle changes I can make to treatment my inflammatory arthritis?”
To date, despite the hype around the anti-inflammatory diet, there is no evidence for dietary changes in inflammatory arthritis. Cercumin, MSM, and chondroitin, all have very weak evidence for their use. However, smoking is a very well documented risk factor for rheumatoid arthritis outside of the risks of cancer, heart disease and stroke. We strongly encourage our patients to quit smoking and we can provide supportive counselling with our clinic nurse to help facilitate this. Please ask our front desk for more information. UV light, is a risk factor for lupus and we encourage our patients with lupus to wear SPF 60 sunblock to the face, chest, and arms daily, regardless of the season (but please ensure you take supplemental vitamin D as vitamin D is required for bone health and its production is stimulated by the sun!).
“Can I still exercise if I have an inflammatory arthritis?”
Yes! Please do! We encourage our patients to be as active as they can tolerate. It was previously thought that patients with inflammatory arthritis should rest their joints but this thought is very much out of date. We now know that the more active you are, the stronger your joints. If you are having difficulty exercising due to pain, we recommend referrals to both PT and OT; both of these are available through the Victoria Arthritis Centre and through various community physiotherapy clinics and referrals can be arranged through your primary care provider.
FERTILITY/PREGNANCY RELATED QUESTIONS:
“Will my disease or medications affect my fertility?”
In most cases, the answer is no, your disease will not reduce your fertility. With regard to medications, cyclophosphamide is the only medication that may reduce fertility. The greatest concern with medications is the risk of miscarriage and congenital abnormalities. Thus, it is important to discuss family planning with your rheumatologist prior to embarking on this journey. Consider your rheumatologist your ally and involve us early!
“Can I become pregnant or go through IVF on my medications for my rheumatic disease?”
Please note, your rheumatic disease does NOT affect your fertility/ability to become pregnant. Patients wishing to pursue pregnancy will need to consider their disease, how active their disease is, and the medications they are on. Some diseases can increase your risk of complications if you do become pregnant or go through pregnancy. Some (not all) medications increase the risk of congenital malformation or miscarriage. If you are thinking of becoming pregnant, the evidence suggests that both disease and pregnancy outcomes are better if your disease is well controlled and in remission without changes in your medications for at least 6 months. If you are thinking about becoming pregnant or go through pregnancy, please discuss this with your rheumatologist, so that your rheumatologist can discuss with you this risk and alter your medication regime accordingly. In British Columbia, we are also fortunate to have a Pregnancy and Rheumatic diseases clinic where you may be referred.