How to Choose a Rheumatologist

Rheumatologists are specialists who treat diseases that affect your muscles, bones, joints, ligaments, and tendons, according to the American College of Rheumatology (ACR).e60dc2a1-f33c-4a05-9b50-8e3e8e5976296763f970-d7c1-4211-b0ea-d9381dcc7ed3 This includes various forms of arthritis, such as: Osteoarthritis Rheumatoid arthritis (RA) Psoriatic arthritis A rheumatologist can also help diagnose and treat tendonitis, osteoporosis , bursitis, and inflammatory back pain . In addition, rheumatologists treat systemic autoimmune diseases such as lupus , Sjögren’s syndrome , and scleroderma. When to See a Rheumatologist and How to Find One How do you know when the time is right for you to see a rheumatologist? “That’s a difficult question,” says James Udell, MD , a rheumatologist with the Arthritis Group of Philadelphia and Bucks County in Pennsylvania. “It’s easier to know with some other specialties. For example, if you can’t breathe, you see a lung doctor, and if you’re having loose stools, you see a gastroenterologist ,” he notes. But the symptoms people have when they need to see a rheumatologist are often vague. And rheumatic diseases, notes the ACR, can often be challenging to diagnose.e60dc2a1-f33c-4a05-9b50-8e3e8e597629768bc919-24e0-4f8b-856d-a04c3f2fa101 “It’s not uncommon for us to see a patient after he or she has seen multiple other doctors,” Dr. Udell says. As soon as you suspect you have a bone or joint problem , check in with a rheumatologist, suggests Udell. “The earlier we see a patient, the better they will do in the long run.” Most of us have joint or muscle pain on occasion, but if it doesn’t resolve, your primary care doctor may refer you to a rheumatologist. If you have a family history of autoimmune disorders or rheumatic diseases , the ACR suggests you consider an earlier visit to a rheumatologist. The sooner you are diagnosed, the sooner you can begin treatment and prevent joint damage. RELATED: Rheumatoid Arthritis Diagnosis To find a rheumatologist, you can: Consult with your primary care doctor. Ask your network of friends and family for recommendations. Use the ACR’s online searchable database.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f0ca4cac-17b6-4b2e-aee7-3dd5e0912d6c How Can Working With a Rheumatologist Help You? “Rheumatologists understand the biology of autoimmune diseases and are well equipped with information to target and treat them,” says Seth D. Ginsberg, co-founder and president of the Global Healthy Living Foundation , an advocacy group for people living with chronic illnesses. A family practitioner may not have the depth of knowledge about some of these syndromes. The best case scenario is having a primary care practitioner as well as a rheumatologist who both regularly coordinate arthritis care, Ginsberg notes. “As I was growing up, my pediatric rheumatologist used to send a report to my pediatrician after every visit. That made my file, back when they were kept in folders, very thick for both doctors. But it was important to have as much documented as possible,” he says. What to Look for in a Rheumatologist The right rheumatologist for you may depend on your specific needs and communication style. Here are some tips to help you find the best specialist for you: Consider the doctor’s personality and how well it meshes with yours. Find a doctor you can relate to and communicate effectively with. Look for a doctor you can build a long-term relationship with, since some rheumatic diseases may develop into chronic conditions. Consider having a loved one or friend join you at an appointment so they can help you decide if the doctor is a good fit. “I looked for a gentle, confident, wise, reassuring bedside manner,” says Ginsberg. “I was interested in someone I could relate to, have a conversation with, and explain my situation to in broader terms than just my aching joints. My wife came with me during the first visit and joined us in the exam room. Her opinion mattered, too,” says Ginsberg. Udell agrees that one of the first things to consider is the doctor’s personality and how well it gels with yours, especially if your disease is a serious, chronic one such as RA. RELATED: 10 Questions to Ask Your Doctor About Rheumatoid Arthritis The doctor-patient relationship should be nurtured as time goes on, Udell adds. If there’s an issue that the patient and physician don’t see eye-to-eye on, for example, they need to discuss it. Or you might want to be more aggressive about treatment options while your doctor wants to be less aggressive — this is also something important to discuss, he says. When You Know You Have the Right Match Traci Lynn Martin, a neonatal ICU nurse and expedition kayaker from Lee’s Summit, Missouri, found out she had RA and went to a few rheumatologists before she found the right chemistry. “The first person I saw I didn’t like,” Martin says, “because I didn’t feel like he was listening to me. He had a formula with questions and it wasn’t personalized. It was important for me to stay active, to be able to do my triathlons, and long distance kayaking that I had done my whole life.” Friends referred her to other specialists, but she knew right away when she found the right rheumatologist. “He sits down and doesn’t rush in and out and doesn’t leave the room until I am happy,” Martin says. “I walked out of there so happy after the first visit, I felt like I had someone who was listening to me for the first time since my diagnosis.” How to Prepare for Your Appointment With a Rheumatologist “What I would suggest for anyone who is getting ready to see a new doctor is to sit down before you go and write down on a piece of paper why you are going and what you are hoping to accomplish with your visit,” says Martin. “If you have everything written down when they come into the room, I think the doctors themselves will sit down and be a little bit more patient.” At your initial appointment, your rheumatologist will perform a thorough physical exam and discuss your symptoms with you. They may also run lab tests. To get the most out of your first appointment with a rheumatologist, in addition to bringing detailed notes of your symptoms, the Cleveland Clinic recommends bringing a list of questions.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294a268732-a076-4b19-b71f-5b295e61981f Common concerns may include: Pain relief options Medications Dietary changes Lifestyle modifications Also be prepared to listen and take notes, or record the conversation on your phone or another device. You’ll likely be hearing a lot of new information and having a record to go back to can help keep you from getting overwhelmed. RELATED: How to Have an Effective Appointment With Your Rheumatologist Red Flags to Watch Out for When Choosing a Rheumatologist Be wary of someone who doesn’t look you in the eye; eye contact is crucial, Ginsberg believes. If the doctor’s head is buried in your chart or electronic health record during your appointment, that’s a red flag. You want someone who relates to you, not your chart or lab results, he says. Another major red flag is when doctors, nurses, or other members of the office staff don’t respond to your phone calls. What to Do if You Struggle With Finding a Rheumatologist There has been a shortage of rheumatologists in America — as well as many other developed countries — for the last decade or so, says Vinicius Domingues, MD , a rheumatologist in Daytona Beach, Florida. But that doesn’t mean that you can’t get good treatment from your primary care physician if that’s what your situation requires. “The advancement in the medical community’s understanding about the causes and the treatments of arthritic conditions, as well as the evolution of telemedicine, has allowed primary care physicians to diagnose and treat most common forms of arthritis,” says Ginsberg. Dr. Domingues also recommends looking into support groups. “The American College of Rheumatology has good support groups. CreakyJoints , an advocacy, education, and support group for people living with arthritis and rheumatic disease, also has forums and resources that should be explored,” says Domingues. Additional reporting by Deborah Shapiro .

Are you and your partner neglecting sex play? Learn how to add it back into your routine to boost your bond in and out of the bedroom. While "quickies" can be fun and spontaneous, skipping foreplay means missing out on a great way to connect emotionally and physically. According to Pepper Schwartz, PhD, a sexual health expert and researcher at the University of Minnesota in Minneapolis, foreplay is critical, elemental, and necessary. Foreplay, also known as "outercourse," is any sexual activity that occurs before intercourse. There is no single way to engage in foreplay, as it can mean different things to different people. It can involve kissing, caressing, cuddling, flirty texting or talking, massage, and oral sex. If you like it a little rough, biting, pinching, scratching, and spanking can be a turn-on. The goal is to increase sexual excitement, which can help prepare the body for intercourse. Foreplay is sometimes thought of as a warm-up for sex, but it doesn't necessarily have to lead to intercourse. Some couples find foreplay itself to be sexually fulfilling as a main event. The benefits of foreplay include lubrication of the vagina, an extended erection, and the prevention of premature ejaculation for people with penises. The female body pulls the uterus up when aroused, lengthening the vagina. This process, called uterine tenting, creates a pool area for semen, which is part of the reproductive sophistication of our machinery, according to Dr. Schwartz. As those muscles relax, the nerve endings start to get stimulated, paving the way for a more pleasurable experience. Research involving married couples has found that 1 to 10 minutes of foreplay was associated with 40% of women achieving orgasm during sex. That percentage rose to 50 with 12 to 20 minutes of foreplay and 60 with more than 20 minutes of foreplay. If you want more action in bed, you have to let your partner know what you want. But talking about sex can be easier said than done for some. Dr. Lyndsey Harper, a clinical assistant professor of obstetrics and gynecology at Texas A&M School of Medicine in Bryan, Texas, recommends two sentence starters to try when expressing sexual desire to your partner: "I want you to..." and "It feels so good when you...". If it makes you more comfortable, you can bring up your sexual needs outside of the bedroom. If you don't know how to bring it up, she suggests starting the conversation with something like, "Our sex life is really important, and I'd love for us to feel open talking about things. Would it be okay for me to share with you some things I like?" Communication comfort is closely linked to trust. To experience true intimacy and fun foreplay, trusting each other is essential, especially since our needs constantly change. Couples who find it difficult to communicate about their desires should consider seeing a couple's counselor or sex therapist who can help them navigate these discussions.
  • Foreplay is just play. Couples can engage in it however they want. According to Dr. Harper, it generally takes about 20 minutes of arousal for women to become fully lubricated and ready for penetrative sex. However, it is best to abolish the idea of "foreplay" and the "main event" of penetrative sex and work together with your partner to create a fun and intimate sexual life where everyone's needs are met.

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