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1. How can The Hirsh Center help you?

Our board-certified rheumatologists can help by:

  1. Making the correct diagnosis
  2. Treating the condition
  3. Recognizing the complications at an early stage
  4. Preventing further damage (e. g. joint deformities)

2. What is a Rheumatologist?

A rheumatologist is a medical doctor who has completed a three-year Internal Medicine residency followed by a two-year sub-specialty in Rheumatology.

3. What do Rheumatologists treat?

According to the American College of Rheumatology, rheumatologists treat more than 100 different diseases. Rheumatologists are specially trained to deal with different arthritic conditions, sports injuries, chronic joint diseases, autoimmune disorders, metabolic bone diseases and soft tissue rheumatic conditions.

4. What is the difference between a Rheumatologist and an Orthopedic Surgeon?

Joint disorders that can be treated medically (i.e. without surgery), are treated by a rheumatologist. Orthopedic surgeons specialize in surgical treatments and in the management of fractures.

5. Why is it important to use ultrasound needle guidance?

Doctors at The Hirsh Center use ultrasound guidance for most joint, ligament and tendon injections in order to accurately and safely target the affected area. Ultrasound guidance can facilitate visualization of needle passage in joint, tendon and spine injections, as well as in nerve blocks which are frequently helpful in controlling acute and chronic injuries. Using ultrasound needle guidance increases the efficacy of an injection and reduces pain experienced during the procedure.

6. Are the ultrasound-guided injections painful?

The use of ultrasound guidance reduces any discomfort the patient may have and may make the procedure more effective.

7. I received an injection, should I put heat or ice on the shot area?

Apply ice packs to the injected areas every 2-3 hours while awake, typically three or four times, during the first 24 hours after the injection. Small areas like the wrist should have ice applied for five minutes at a time. Large areas like the back or shoulder should have ice applied for 15-20 minutes at a time. Avoid ice packs to the neck. Do not apply ice packs to the fingers or toes. Do not apply ice packs over broken skin.

8. When can I resume my exercises after an injection?

Unless otherwise instructed, you may resume normal, non-athletic activities the day of the injection. Avoid strenuous activity or exercises for the first 24 hours.

9. How long will it take before I feel better from the injection?

For many injections, you will have significant relief within 24 hours. Some injections, particularly in the neck and back, may take up to 72 hours for optimal relief. Many areas need to be injected a second time in 2 to 3 weeks to achieve the desired result. This is normal, and the likelihood of needing additional injections is proportional to the severity of the pain and inflammation being treated.

10. What are some common side effects can I expect after an injection?

You may experience soreness or bruising at the injection site. Flushing, which typically consists of warmth and redness around the chest, upper arms, and face, is a common occurrence related to the use of cortisone and does not represent an allergic reaction. It is generally a nuisance and is not serious. Flushing will typically subside within 48 to 72 hours. Please let our team know if you experience this type of reaction. The doctor can adjust the dose and type of cortisone preparation the next time you receive an injection.

You may also experience insomnia the first night or two after the injection. This is a stimulant-like effect of cortisone.

11. Can I take anything for the discomfort after getting an injection?

Yes. Dr. Hirsh, Dr. Singh, Dr. Kapelow, Javier Chiriboga, and Evan Abramsky PA-C can recommend a non-prescription, over-the-counter medication for discomfort after receiving an injection.

12. I have discomfort at my injection site, is this normal?

If you have an unusual amount of discomfort at the injection site or in the joint that was injected, call us right away. If you develop fever or chills, or have redness or swelling at the site of the injection, call us immediately. These can be signs of infection.

13. Is arthritis seen only in elderly people?

No, this is a myth. Arthritis can affect any age group. Osteoarthritis is the most common type of arthritis, and it does target those 50+ years of age.

14. Is arthritis more common in women?

It depends. Rheumatoid arthritis is three times more common in women. Osteoarthritis affects men and women alike.

15. Do patients with arthritis require a special diet?

No special diet is required for most patients with arthritis. Diet does play an important role in certain types of arthritis, however, such as gout.

16. Why does my doctor want me to do physical therapy?

Physical therapy helps to reduce the discomfort and stiffness in the joints. Exercise also helps increase flexibility and range of motion and strengthens the muscles around the joint.

17. How fast can I expect results from physical therapy?

A typical course of physical therapy lasts 4-6 weeks. Progress will vary as each person’s condition is different.

18. How long can I expect to wait for a return phone call from a clinical staff member?

Our messages are triaged by our clinical team. Calls are returned throughout the day in the order of severity. Our goal is to return each phone call the same day. If a message is left on the voicemail system after-hours, the call will be returned the next business day. If the call is emergent and left after hours with our professional answering service, a doctor will return your call within an hour.

19. How long should I expect to have a refill or medication called into my pharmacy?

It is best to give our office 48 hours notice prior to needing your medication. At times, we are able to fill the prescription more rapidly. Some medications, including narcotics, may not be telephoned, faxed or refilled. A 30-day prescription must be picked up from our office. If you need such a prescription, please call our office the day prior to picking up your prescription.

20. Will I always see the same doctor at The Hirsh Center?

We strive for continuity of care and encourage our patients to choose one physician who will manage their medical care. In the event that you may have an emergency and Dr. Hirsh, Dr. Singh, Dr. Kapelow, Javier Chiriboga, and Evan Abramsky PA-C are unavailable, we will accommodate our patients by scheduling an emergency visit with the available physician. Our clinical team works together to provide consistent treatment.

21. After an emergency visit, will I make a follow-up appointment with my primary rheumatologist?

Yes. If you meet with one of our doctors on an emergency basis, you will generally schedule your follow-up appointment with your primary rheumatologist at The Hirsh Center.

22. Can I still meet with Dr. Hirsh, Dr. Singh, Dr. Kapelow, Evan Abramsky PA-C, and Javier Chiriboga APRN if my insurance is not accepted?

Yes. As the patient need grows, we strive to add new insurance plans. If we are not in network with your insurance plan or you do not have medical insurance, we will see you as a cash paying patient. For your initial visit, a $500 deposit is collected up front. We will collect the remaining cost of the visit, using Medicare allowable rates, at check-out. Remaining fees may include office visit costs, X-rays performed, procedures, and/or medications.

23. What should I do in case I have an emergency after hours?

If you have a medical emergency, please call 9-1-1. If it is outside normal business hours and you need to speak to a physician from our office immediately, you may call our answering service at 1-877-240-3963 and one of our doctors will be notified.

24. What is your cancellation policy?

If you are unable to keep your appointment, please be mindful and call our office within 24 hours to cancel.