THE OFFICE VISIT
We want to make your visit to the office as pleasant and as comfortable as possible. We strive to provide you with a relaxed and stress free environment and to keep any waiting time to a minimum.A new patient consultation requires a minimum of one hour and most follow up visits take between 10 and 30 minutes.
As a new patient, please bring your completed registration materials with you. If you have not been able to complete them in advance, please arrive early to allow adequate time to complete them in the office. We request that you inform us immediately if here has been any change in your insurance plan, referring doctor, or personal address, phone number or other important biographical information. Please bring your referral, if required, with you or confirm that we have received it. Please also bring any medical records needed from your referring doctor. Always bring an accurate and complete list of your medications, or the medication themselves.
We will often attempt to combine other services with the office visit. Sometimes they must be scheduled separately. These other services include joint and soft tissue procedures, X-rays, DXA scans, Nerve Conduction Tests and laboratory tests. All office visits include obtaining a history, performing a physical examination, reviewing records and results of studies, discussion of the problem, prescription of medications and other treatments, and coordination of further testing and services.
We want to make your visit to the office as pleasant and as comfortable as possible. We strive to provide you with a relaxed and stress free environment and to keep any waiting time to a minimum.A new patient consultation requires a minimum of one hour and most follow up visits take between 10 and 30 minutes.
As a new patient, please bring your completed registration materials with you. If you have not been able to complete them in advance, please arrive early to allow adequate time to complete them in the office. We request that you inform us immediately if here has been any change in your insurance plan, referring doctor, or personal address, phone number or other important biographical information. Please bring your referral, if required, with you or confirm that we have received it. Please also bring any medical records needed from your referring doctor. Always bring an accurate and complete list of your medications, or the medication themselves.
We will often attempt to combine other services with the office visit. Sometimes they must be scheduled separately. These other services include joint and soft tissue procedures, X-rays, DXA scans, Nerve Conduction Tests and laboratory tests. All office visits include obtaining a history, performing a physical examination, reviewing records and results of studies, discussion of the problem, prescription of medications and other treatments, and coordination of further testing and services.
DXA
PROGRAM
The Arthritis Care, PC Osteoporosis Management Program is designed to evaluate patients for Osteoporosis and to develop a comprehensive treatment plan. The program is accredited by the ISCD (International Society for Clinical Densitometry) and the staff is members of the American College of Rheumatology and the National Osteoporosis Foundation.
Patients are evaluated with a review of risk factors and potentially correctable variables. Bone mineral density (BMD) is determined using the GE Lunar Prodigy Advance DEXA using the latest fan beam technology. This test is safe and comfortable and takes only a few minutes and may be performed with the patient fully clothed. BMD is measured simultaneously in both hips and lumbar spine and, if necessary, the arm or even the total body. Costs are minimal and covered by insurance.
Results are reported in comparison to peak bone density (T score) and age and other variable matched controls (Z score).
This information allows for accurate determination of fracture risk and development of appropriate treatment strategies.
OSTEOPOROSIS WHAT CAUSES OSTEOPOROSIS? HOW IS IT DIAGNOSED?
• Is the most common skeletal disorder and a major public health concern
• Is defined by progressive loss of bone density leading to brittle bones and increasing bone
fractures (1.3 million/yr. in the US)
• Is more common in aging women, but also can occur in males and females of all ages
• Resulting fractures, pain and functional problems resulting from the fractures have great
negative impact on lifestyle and even lead to death
• Common areas for fractures are the spine, hip and forearm
• Early detection and successful treatment is available
• Age related (involutional)
• Lack of estrogen in women (Menopause, surgical or premature menopause, loss of estrogen
and the cycle for any reason, such as poor nutrition, weight loss)
• Lack of testosterone in men
• Hyperthyroidism and excessive thyroid replacement therapy in hypothyroldism
• Hyperparathyroidism
• Chronic steroid use in any form (systemic, inhaled, topical) often used in arthritis, lung,
skin and stomach and intestinal conditions
• Other medication use
• Poor diet, low dairy or calcium intake
• Lack of exercise and sun
exposure
• Malabsorption, liver and gastrointinestinal syndromes
• Chronic kidney disease
• Cigarette smoking and alcohol
The diagnosis is usually considered in the appropriate clinical setting. Risk factors are
reviewed and assessed for intervention or treatment separately. The diagnosis is confirmed by
directly measuring bone density. This can be done by several techniques, but the best test is
Dual Energy X-ray Absorptiometry (DXA). Safe, rapid, comfortable and reproducible, this
determines bone density in the hips, spine, forearm and total body, risk of fracture and need for
treatment.
HOW IS IT TREATED?
• Eliminate risk factors
• Treat other associated problems
• Exercise, calcium, vitamin D and other supplements
• Use of the appropriate bone building medications -
• Hormone replacement, Evista, Calcitonin, Fosamax, Actonel, Boniva, Forteo, and new agents
The Arthritis Care, PC Osteoporosis Management Program is designed to evaluate patients for Osteoporosis and to develop a comprehensive treatment plan. The program is accredited by the ISCD (International Society for Clinical Densitometry) and the staff is members of the American College of Rheumatology and the National Osteoporosis Foundation.
Patients are evaluated with a review of risk factors and potentially correctable variables. Bone mineral density (BMD) is determined using the GE Lunar Prodigy Advance DEXA using the latest fan beam technology. This test is safe and comfortable and takes only a few minutes and may be performed with the patient fully clothed. BMD is measured simultaneously in both hips and lumbar spine and, if necessary, the arm or even the total body. Costs are minimal and covered by insurance.
Results are reported in comparison to peak bone density (T score) and age and other variable matched controls (Z score).
This information allows for accurate determination of fracture risk and development of appropriate treatment strategies.
OSTEOPOROSIS WHAT CAUSES OSTEOPOROSIS? HOW IS IT DIAGNOSED?
• Is the most common skeletal disorder and a major public health concern
• Is defined by progressive loss of bone density leading to brittle bones and increasing bone
fractures (1.3 million/yr. in the US)
• Is more common in aging women, but also can occur in males and females of all ages
• Resulting fractures, pain and functional problems resulting from the fractures have great
negative impact on lifestyle and even lead to death
• Common areas for fractures are the spine, hip and forearm
• Early detection and successful treatment is available
• Age related (involutional)
• Lack of estrogen in women (Menopause, surgical or premature menopause, loss of estrogen
and the cycle for any reason, such as poor nutrition, weight loss)
• Lack of testosterone in men
• Hyperthyroidism and excessive thyroid replacement therapy in hypothyroldism
• Hyperparathyroidism
• Chronic steroid use in any form (systemic, inhaled, topical) often used in arthritis, lung,
skin and stomach and intestinal conditions
• Other medication use
• Poor diet, low dairy or calcium intake
• Lack of exercise and sun
exposure
• Malabsorption, liver and gastrointinestinal syndromes
• Chronic kidney disease
• Cigarette smoking and alcohol
The diagnosis is usually considered in the appropriate clinical setting. Risk factors are
reviewed and assessed for intervention or treatment separately. The diagnosis is confirmed by
directly measuring bone density. This can be done by several techniques, but the best test is
Dual Energy X-ray Absorptiometry (DXA). Safe, rapid, comfortable and reproducible, this
determines bone density in the hips, spine, forearm and total body, risk of fracture and need for
treatment.
HOW IS IT TREATED?
• Eliminate risk factors
• Treat other associated problems
• Exercise, calcium, vitamin D and other supplements
• Use of the appropriate bone building medications -
• Hormone replacement, Evista, Calcitonin, Fosamax, Actonel, Boniva, Forteo, and new agents
X-RAY
NCS-nerve conduction study
Nerve Conduction
Studies at Arthritis Care What are Nerve Conduction
Velocities?
Nerve Conduction Velocity (NCV) studies are a relatively simple, well tolerated, inexpensive and accurate test performed at Arthritis Care to help to determine whether a nerve problem is the cause for, or contributing to, pain and other symptoms, such as numbness, tingling or weakness. As we evaluate patients for arthritis or other rheumatic problems, it is important that we differentiate any involvement by nerve disease, since this will significantly change treatment options. In addition, many rheumatic conditions also cause neurologic problems that need to be identified in order to be effectively treated.
These are just some examples of treatable nerve conditions that frequently occur in a population of rheumatic disease patients that can be Identified by NCV:
• carpal, Tarsal and Cubital Tunnel Syndrome (Impingement syndromes)
• Peripheral Neuropathy
• Sciatica
• Pinched nerve roots in the spine (Radiculopathy)
• Nerve disease in Rheumatoid Arthritis, Lupus and other connective tissue diseases These, and other nerve problems, often present with the following symptoms that must be differentiated from arthritis symptoms:
• Pain - Burning, aching, sharp
• Numbness and tingling
• Weakness
Test Overview
Nerves (motor fibers) control the muscles in the body using electrical impulses which results in muscle contraction and movement. Nerves (sensory fibers), using electrical impulses, also provide information to the brain as a response to peripheral stimulation and result in various sensations, such as vibration, light touch, pressure, heat sensation and various types of pain, such as deep visceral aching, sharp pain, burning and others. Diseases of nerves anywhere along their course from the brain to the periphery can lead to altered function of the nerves and can be characterized by motor and/or sensory abnormalities such as weakness, tightness, spasm, numbness, tingling and various types of pain. The location and distribution of these abnormal symptoms suggest the underlying problem and can be corroborated by NCV'S.
Nerve Conduction Studies measure two primary parameters of nerve function:
Nerve latency - the time in milliseconds that it takes for the electrical nerve "message" to
travel between two points. A prolonged
latency suggests a sick nerve that conducts too
slowly.
Nerve amplitude - the strength in millivolts of the electrical nerve message. A diminished
amplitude suggests a weak electrical discharge from a "sick" nerve.
Nerve Conduction Studies measure latencies and amplitudes of both motor and sensory fibers of several nerves in the arms and legs, including the median, ulnar, peroneal and tibial nerves.
How to Prepare
Tell us if you are wearing a pacemaker. You do not need to restrict your food or fluids, but you should not drink anything that contains caffeine prior to the test. Do not smoke for at least 3 hours before the test. Wear loose fitting clothing that permits access to the muscles and nerves to be tested. You may be given a hospital gown to wear.
How It Is Done
Nerve Conduction testing may take from 15 minutes to 1 hour or more, depending upon how many areas of the body are studied. Surface electrodes are placed over the skin at both ends of the nerve to be tested, one to stimulate the motor and sensory fibers and the other to detect the nerve response at the other end. Needles are not used. There are no risks associated with nerve conduction studies. There is no risk of infection. The testing can be minimally uncomfortable with a sensation of electrical tingling and mild pain as well as involuntary muscle twitching each time the electrical pulse is applied. This makes some people nervous, but the discomfort is minimal and fleeting. Keep in mind that only a very low voltage electrical current is used, and each electrical pulse is very brief (less than a millesecond). The voltage of electrical pulses is not high enough to cause an injury or permanent damage.
Results
The results of the Nerve Conduction Testing will be discussed with you at your office visit. Prolonged nerve latencies and/or diminished nerve amplitudes are strongly suggestive of disease of the identified nerve in question.
This may suggest a peripheral neuropathy such as is often seen in diabetes or other endocrine diseases, but peripheral neuropathies are also seen in Rheumatoid Arthritis, SLE and other forms of connective tissue diseases. The abnormal results may indicate a radiculopathy, or an irritated or pinched nerve root(s) in the spine, often seen in arthritis of the spine and disc disease. The results may demonstrate an impingement syndrome, the most common of which is carpal tunnel syndrome. The results will help to determine the best treatment for the cause of your symptoms.
Nerve Conduction Velocity (NCV) studies are a relatively simple, well tolerated, inexpensive and accurate test performed at Arthritis Care to help to determine whether a nerve problem is the cause for, or contributing to, pain and other symptoms, such as numbness, tingling or weakness. As we evaluate patients for arthritis or other rheumatic problems, it is important that we differentiate any involvement by nerve disease, since this will significantly change treatment options. In addition, many rheumatic conditions also cause neurologic problems that need to be identified in order to be effectively treated.
These are just some examples of treatable nerve conditions that frequently occur in a population of rheumatic disease patients that can be Identified by NCV:
• carpal, Tarsal and Cubital Tunnel Syndrome (Impingement syndromes)
• Peripheral Neuropathy
• Sciatica
• Pinched nerve roots in the spine (Radiculopathy)
• Nerve disease in Rheumatoid Arthritis, Lupus and other connective tissue diseases These, and other nerve problems, often present with the following symptoms that must be differentiated from arthritis symptoms:
• Pain - Burning, aching, sharp
• Numbness and tingling
• Weakness
Test Overview
Nerves (motor fibers) control the muscles in the body using electrical impulses which results in muscle contraction and movement. Nerves (sensory fibers), using electrical impulses, also provide information to the brain as a response to peripheral stimulation and result in various sensations, such as vibration, light touch, pressure, heat sensation and various types of pain, such as deep visceral aching, sharp pain, burning and others. Diseases of nerves anywhere along their course from the brain to the periphery can lead to altered function of the nerves and can be characterized by motor and/or sensory abnormalities such as weakness, tightness, spasm, numbness, tingling and various types of pain. The location and distribution of these abnormal symptoms suggest the underlying problem and can be corroborated by NCV'S.
Nerve Conduction Studies measure two primary parameters of nerve function:
Nerve latency - the time in milliseconds that it takes for the electrical nerve "message" to
travel between two points. A prolonged
latency suggests a sick nerve that conducts too
slowly.
Nerve amplitude - the strength in millivolts of the electrical nerve message. A diminished
amplitude suggests a weak electrical discharge from a "sick" nerve.
Nerve Conduction Studies measure latencies and amplitudes of both motor and sensory fibers of several nerves in the arms and legs, including the median, ulnar, peroneal and tibial nerves.
How to Prepare
Tell us if you are wearing a pacemaker. You do not need to restrict your food or fluids, but you should not drink anything that contains caffeine prior to the test. Do not smoke for at least 3 hours before the test. Wear loose fitting clothing that permits access to the muscles and nerves to be tested. You may be given a hospital gown to wear.
How It Is Done
Nerve Conduction testing may take from 15 minutes to 1 hour or more, depending upon how many areas of the body are studied. Surface electrodes are placed over the skin at both ends of the nerve to be tested, one to stimulate the motor and sensory fibers and the other to detect the nerve response at the other end. Needles are not used. There are no risks associated with nerve conduction studies. There is no risk of infection. The testing can be minimally uncomfortable with a sensation of electrical tingling and mild pain as well as involuntary muscle twitching each time the electrical pulse is applied. This makes some people nervous, but the discomfort is minimal and fleeting. Keep in mind that only a very low voltage electrical current is used, and each electrical pulse is very brief (less than a millesecond). The voltage of electrical pulses is not high enough to cause an injury or permanent damage.
Results
The results of the Nerve Conduction Testing will be discussed with you at your office visit. Prolonged nerve latencies and/or diminished nerve amplitudes are strongly suggestive of disease of the identified nerve in question.
This may suggest a peripheral neuropathy such as is often seen in diabetes or other endocrine diseases, but peripheral neuropathies are also seen in Rheumatoid Arthritis, SLE and other forms of connective tissue diseases. The abnormal results may indicate a radiculopathy, or an irritated or pinched nerve root(s) in the spine, often seen in arthritis of the spine and disc disease. The results may demonstrate an impingement syndrome, the most common of which is carpal tunnel syndrome. The results will help to determine the best treatment for the cause of your symptoms.