Tiffany Archibald 00:01
Let’s talk about kidneys takes a deep dive into the chronic kidney disease patient journey. We’re here to inspire meaningful conversations and to help people living with CKD gain a full understanding of their disease. Being diagnosed with kidney disease and having your very first visit to a new physician office can be a big deal. This is to what to expect during your initial visit to our offices, where we are here to make your experience comfortable. Hello, Dr. Wiederkehr. How are you today?
Dr. Wiederkehr 00:32
Great. Thank you.
Tiffany Archibald 00:33
Good. Well, we have another awesome podcast ahead of us. And I think it’s super informative. It’s going to let the audience, specifically the patients, know what to expect at their first visit with a nephrologist. So that is today’s topic what to expect at your first visit with a nephrologist. So, first question, why have I been referred to a nephrologist?
Dr. Wiederkehr 00:59
Well, that’s it’s a great question. And you wouldn’t believe how many patients actually asked me exactly that question. Why am I here? You know, it’s sometimes it’s clear, but sometimes it’s not clear. I want to say, very often, it’s a test that was abnormal in your blood work, or in the urine test that was showed up as not being a normal in the normal range. And your primary care physician, he or she feels that you need to be seen by a specialist. That’s the common reason. But sometimes it may not be in your kidney function. It may be something that’s related to the kidneys. And it could be for example, blood pressure. Blood pressure may be low, but typically too high and cannot control it, or it’s a roller coaster blood pressure, goes up and down doesn’t stay in range. It could be something simple, but tedious, such as kidney stones that make your life miserable. And so it could be a variety of reasons. But typically, it’s something that either a kidney function, or something that’s related to your kidneys.
Tiffany Archibald 02:01
Okay, so today, we’re going to walk the patients through what to expect at the first appointment.
Dr. Wiederkehr 02:08
The first appointment is always a little bit longer. You can expect to be present for about an hour. Because we, I need to get to know you need to discuss some things that I couldn’t quite understand from your records. Something that’s specific about your kidneys that nobody asked you before. And so we have to kind of make a picture of your kidney health. And also, it’s typically during the first phase that we have to understand your other conditions as well, and how they may affect your kidneys. So it’s much more broad, comprehensive. Because the kidneys obviously are not just one organ, isolated, they’re part of your body. We run typically blood tests and urine tests, and very often we need to get an ultrasound of the kidneys. We don’t do this in the office, so you will be able to arrange for you to have that done at an outside facility. And sometimes a kidney biopsy, but that’s not typical.
Tiffany Archibald 03:17
Okay? And so do I need to bring paperwork to my first appointment,
Dr. Wiederkehr 03:22
Bring your paperwork. Even though I would say much more important is to bring your medications. Because sometimes your records may say one thing, but turns out the medications have been changed, it was not written in your record, was not changed your record, so bring all your medications. There’s also a form that’s about four or five pages. That’s your health history, where you write down the important things about your health history, like your previous surgeries, your medical conditions and what’s important very often is your family. You know, mom and dad, are they doing great? Or Oh no, my dad had kidney problems. So that really helps us understand where you may be. Okay.
Tiffany Archibald 04:05
And so at that first appointment, will you automatically know all of my problems? Are you looking at my whole health history prior to or is it something we’re discussing along the way?
Dr. Wiederkehr 04:16
So it’s a combination. But the nice thing about practicing and living in 2022 is that we have electronic health records, which makes it very easy for me to look up your records. When that’s all personal information that’s protected. It’s not public information. But as a physician who’s seeing you for a reason I’m permitted to access your records. I always look at your records the day prior. I spend a lot of time looking through your records so I understand where are you coming from? What’s going on now? What do I need? Where do I come in? But it’s not always the whole picture. Sometimes reading the records, it’s like, why would it be this way and not that way, and so really meeting with you, and I spend a lot of time just talking to you, because I need to get all the information and surplus from your perspective too.
Tiffany Archibald 05:09
Yeah, maybe there are things that’s left off what’s, you know, written down?
Dr. Wiederkehr 05:12
So expect to have a lot of conversations because I need to get to know you.
Tiffany Archibald 05:18
Okay. And are there any additional tests that are going to be needed at my first appointment?
Dr. Wiederkehr 05:24
So typically, yes, but again, the advantage of having access to your records, if you just had a blood test done a week ago, and it was abnormal, that’s why you’re seeing me, I don’t repeat the same test. So I can really focus on what has not been done and what I need to do in addition. Very often, it’s maybe an additional blood test. Very often it’s urine tests so make sure you can give us a urine sample. And often, it’s also imaging of the kidneys. That’s typically an ultrasound, sometimes a CT scan. So there’s things that we need to get done, usually not urgently, but we have it arranged at an outside facility.
Tiffany Archibald 06:05
Okay. And I know you mentioned this earlier about bringing my medications to my first appointment. Talk to me about why that’s so important. I know, I know, some people may have a whole bag of medications. Some people may want to memorize it offhand. But why is it important to actually bring them to the appointment?
Dr. Wiederkehr 06:24
Because sometimes not Well, first of all, I need to double check. But sometimes you may be surprised that you find a medication that you are supposed to take, and you didn’t realize you were not taking it. So it’s really a review, a comprehensive review, between you and me, about what am I taking? What am I supposed to take? Why do I not take this medication anymore? Oh, this one always gave me a bad headache. That’s why you stopped it. So maybe listed in your medication record, but you’re telling me now that you actually not taking it because we have side effects. So going over each medication is very important.
Tiffany Archibald 06:59
Okay. And then is there an exam that is going to be done at that first appointment? I know you said the first appointment was gonna take typically about an hour to sit there and go through and get to know you and go through your health history. But is there a physical exam that takes place.
Dr. Wiederkehr 07:15
We examine you as a patient, but it’s a focused exam. So your primary care physician may have you get into a gown and do a much more thorough exam, but with the nephrologist it’s a more focused exam. We really want to focus on the kidneys and organs that are affected by the kidneys, like the heart, lungs, check your legs, to see if you have good circulation, if you have swelling. So there’s a couple tests, exams that we do, but it’s typically much more focused on what your primary care physician will do.
Tiffany Archibald 07:48
Okay, once I start seeing a nephrologist, are you going to replace my primary care doctor? Or will I go back to my primary care? Can you explain how that would work?
Dr. Wiederkehr 07:59
So the answer is never. I will not replace your primary care physician because I am basically a specialist that specifically looks at your kidneys and things related to your kidney function. But your primary care physician is still the main person, a captain of the ship that steers you the right way. And primary care physicians do things that we don’t do in our nephrology office. They check some bloodwork that we don’t typically do like your cholesterol. Very often your diabetes numbers, we don’t do that typically. And also, things like make sure you update on your shots, cancer screening, make sure that’s all happening. So I’m part of your team, but I’m not replacing your primary care physician. It’s very important.
Tiffany Archibald 08:45
Okay, so let’s talk again about medications. I know that when I first started seeing a nephrologist, I was already on, I think, one or two blood pressure medications. So if I leave your office and you recommend or you prescribe another blood pressure medication, does that have to be approved through my primary care physician? Are you guys going to communicate?
Dr. Wiederkehr 09:08
We always communicate and no, we don’t have to get it approved. Because when your PCP sends you to me, he or she trusts that I’m seeing you for that special reason, and that I will make the changes as I find appropriate in my expertise. So I’ve never had a situation where a primary care physician would object to it. Very rarely is an ambivalent situation where it’s not quite wrong or right or wrong. And I would reach out to the PCP and talk to him or her. And if that happens, you will know immediately what the situation is. But much more importantly, we always communicate with your PCP. In this day and age it is so easy with electronic health records and messaging. By the way, all these the interaction of communication with your PCP is completely private. It’s protected, and by law protected, so everything, anything that I’m doing that you PCP does, we communicate with each other, but it’s always through secure channels.
Tiffany Archibald 10:12
Okay. So after my first appointment, when will I be scheduled to see you again.
Dr. Wiederkehr 10:19
It really very much depends on what the situation is, what you have. If you have something that’s more serious, that needs more urgent attention, I’ll see you back very quickly, one or two weeks. I may even call you between that to make sure we’re in the loop and in close communication. But it may also be something that you’ve had for years, and your primary care physician just feels like let’s just make sure the specialist is okay with this. And I may see you maybe just once a year, just to kind of stay in the loop and keep an eye on things. So it really depends. But I think as a rule, if you’re a new patient with us, I will see you back in two to three months if it’s something that’s not urgent. And then less often depending on what it is. But the initial follow up is typically sooner to discuss all the results.
Tiffany Archibald 11:07
So one thing I think will really hit on is the importance of being part of your care team. I know with my experiences over the last, you know, 16 years with CKD and two transplants, I am zoomed in on communication with my health care team. One of the great medical professionals that Dallas Nephrology has is called a patient navigator. So can you explain what a patient navigator is and how that is an intrical role to your care team?
Dr. Wiederkehr 11:40
Right. So DNA in the last two years or so, we really ramped up or navigators. A navigator is typically a nurse who keeps all the other loose connections together. And make sure it’s not loose and we’re all part of the same team. She makes sure that if you have an appointment, a follow up, it actually happens. If for some reason you miss an appointment, she will probably call you and say, you know, what’s going on, make sure you follow up. And also, I think it’s also somebody who basically has a checklist and makes sure all the things that need to be done, will be done. For example, a dietitian. With your CKD, with a chronic kidney disease, you really would benefit from seeing a dietician for what can I eat? Or should I not eat? How do I help my kidneys? So in a busy appointment, where we have to talk about so many things, we may not talk about the dietitian, and the navigator will say, Dr. Wiederkehr, the patient, I think needs to see a dietitian. Oh, yes, absolutely. I’m glad you brought it up. So the navigator, really makes sure we don’t forget anything, makes sure you follow up, makes sure you have your appointments, just kind of keeps track of everything. And we’ve been doing it now for about two years and it’s been extremely helpful.
Tiffany Archibald 13:01
Alright. So there’s essentially no reason why a patient shouldn’t be involved in their care, because that is the most important part of your whether it’s your road to recovery, maintaining your kidney functioning is being involved in care. Do you agree with that?
Dr. Wiederkehr 13:17
Yes. Make sure part of the healthcare team, the most important person of the team is you. And communicate and talk, you know, use the portal, but communicate with us and make sure you’re involved and concerned. And if something’s not right, make sure we know about it. Conversely, if you’re really happy about a medication or a test, and you want to communicate with us, let us know. So it goes both ways. I think the more we communicate and work together, the better it is for your health.
Tiffany Archibald 13:59
Okay, and so you mentioned the portal, you mentioned communication. So one of the components to that healthcare team is registering for the Follow My Health app. That is our patient portal that is offered through Dallas Nephrology Associates. I know that when my medications are changed, when I’m waiting for lab results, and I know the physician is seeing other patients, I can easily log in and, you know, see my results, see any medications update my blood pressure reading. So can you talk to me how you have patients utilize the portal as well?
Dr. Wiederkehr 14:28
Yeah, I think the portal is really crucial. It’s so important. And you know, it sounds a little tedious because in a perfect world, we all have one portal, one place to go to, one username, one password, but not quite yet. But we do have a portal that’s DNA specific for my health. And yes, you have to set up it’s easy. We actually have a QR Q reader, QR reader and set up one time username password. And once you’re on that portal, you can quickly communicate with me any concerns, any changes, any side effects, blood pressure medication doesn’t work. I know immediately. I don’t have to wait for three months, when you come back and tell me, hey didn’t work. That’s three months that we lost. So communicate with me. The portal has really made it so much easier. And also you can look up your own bloodwork. We try to mail out the bloodwork to you. On the portal, you see your lab results. And if there’s a question, you send me the question. And remember, anything that’s on the portal is private. It’scompletely protected. Unlike an email. So don’t use emails. Because it’s not private. It’s not protected. Use the portal, everything on the portal is private, your information.
Tiffany Archibald 15:44
Okay. And so that kind of wraps up the questions that we have for you. But I think that we need to really hone in on three main topics that we discussed during this podcast that patients need to take away. So can you think about those three most important things from what to expect on their first visit with the nephrologist, because that’s kind of the beginning of their care.
Dr. Wiederkehr 16:12
Sure. I think number one, please come. There’s a reason why your primary care physician was concerned and wants an evaluation by specialists, so make sure you come and see us. The second point is bring your medications. And it’s because I need to see. Sometimes it’s not clear from your records. Things may have changed, and it’s not been changed your record. So seeing what you’re taking really helps me understand what is your current medication regimen. You may also find out that you have a medication in your bag that Oh, I forgot about it. Or taking it or maybe you know what, this one, it’s on my record, but I’m actually not taking it because when I take that I get a bad headache. So bring medications, even if it’s not organized, we need to see your medications. And then the third point is to always stay in communication. I think there’s nothing more important than feedback. I need to know what’s working, what’s not working. Don’t wait for your next visit. Be engaged, be involved, be really part of the team. Again, you’re the most important person of the healthcare team. And we try to help you so communicate with us, use the portal, let us know if things go well. If they don’t go well. Just stay in communication.
Tiffany Archibald 17:31
Okay. Well, that wraps up today’s podcast on what to expect at your first appointment with a nephrologist. Dr. Wiederkehr this has been awesome. I think you you have really given us a wealth of information to share with our patients, caregivers, other professionals. So thank you so much for your thank you.
Dr. Wiederkehr 17:49
It’s been a real pleasure. Thank you.
Tiffany Archibald 17:51
Thanks for tuning in today learn more about Dallas Nephrology Associates at www.dneph.com. And if you found the information valuable, be sure to share with those who are impacted by chronic kidney disease.