Dysautonomia/Orthostatic intolerance assessments

 

To start the process of booking an assessment, we first need a referral from your GP or specialist doctor. This referral should be addressed to Dr Edmund Song.

As an adult physician Dr Song is only able to see patients that are >16 years of age.

If you are in regional Western Victoria (West of Melton) or in Geelong, the referral can be sent by you or your GP to reception@ballartcardiology.com.au. Otherwise, the referral can be sent to Dr Song’s main rooms in Box Hill at admin@articulatedhealth.com.au to begin the process.

There is a limited scenario where Dr Song can perform an initial assessment via telehealth. Patients would need to either have had a NASA lean test or have had a tilt table test completed prior to your initial appointment. Your GP would also need to screen you for underlying hypermobility especially if you have a history of being flexible or consider yourself “double jointed”. Your GP would need to complete the hEDS (hypermobile Ehlers Danlos Syndrome) diagnostic checklist. Your GP can follow the guide on the Ehlers Danlos society website on how to perform a Beighton score for assessing hypermobility. If you have numbness or pins and needles of your limbs you would also need to have a documented complete neurological examination by your GP or specialist(s) of your upper and/or lower limbs prior to the initial review.

Interstate patients:

For patients from interstate, Dr Song is happy to provide assessments with some caveats. The first assessment ideally is performed in person with subsequent follow-up reviews being able to be performed via telehealth. You should check that your GP is happy to work together with Dr Song to prescribe and monitor any medications that may be suggested by Dr Song. Dr Song will provide a comprehensive report to your local doctor. If medications are suggested, associated guidelines of dosing and side effects to monitor for will also be provided.  Dr Song is not able to prescribe medications for patients who are interstate due to the complexity of patients with orthostatic intolerance and the difficulty with monitoring and managing side effects of treatment if they occur.

Process:

Once we have received your referral, Dr Song’s team will be in contact with you to with the next steps to book an appointment. With an initial assessment you will receive a Medicare rebate of $250.65 and if you have reached your Medicare safety-net your rebate will be $750.65.

We will require your assistance by forwarding copies of your previous specialist assessments/letters and relevant tests to us. This especially includes cardiac testing that you may have had performed previously including reports of previous 24h holter monitor, 24h BP monitor, echocardiogram and tilt table test. Our team will also send you requests for pathology testing as well as cardiac testing to be completed prior to your initial appointment. If you have had some of the cardiac testing as above you will only need to complete the ones that you have not performed previously. A list of high-quality cardiology practices in Melbourne that do the above testing will also be provided for you. If you are being seen at Ballarat Cardiology, for ease, testing will be organised there. You will also be booked in for a 30 min appointment for a stand test prior to your initial review with one of Dr Song’s nurses if you have not had a tilt table test in the last few years.

You will also be sent a pre-assessment questionnaire that should be completed and returned at least 1 week prior to your appointment.

You will have an initial appointment booked for at least 60 minutes. A considerable amount of work and time is spent before and after your appointment. This includes reviewing any previous specialist letters as well as relevant testing to ensure that we make the most of your initial review, as well as the time taken to complete your comprehensive report. Dr Song will be able to diagnose if you have a dysautonomia and what possible subtype it is at your initial appointment once we have all the above information. Common subtypes include initial orthostatic intolerance/hypotension, POTS (postural orthostatic tachycardic syndrome), undifferentiated orthostatic intolerance, neurogenic orthostatic hypotension, vasovagal syncope.

The Defy Dysautonomia approach:

A comprehensive history of your symptoms as well as commonly associated issues in patients with dysautonomia will be taken. Testing that is performed is used to help define if you have a dysautonomia and what potential subtype it is, rule out conditions that may mimic a dysautonomia, rule out important other diagnoses and/or assess for issues that contribute to your symptoms.

In your initial appointment Dr Song will also assess you for commonly associated issues in patients with dysautonomia. This includes hypermobility, other organ autonomic dysfunction including gastrointestinal issues, possible mast cell related dysfunction, headaches/migraines, sleep disturbances, fatigue including ME/CFS. Dr Song is able to diagnose hypermobile Ehlers Danlos Syndrome (hEDS) if you meet the diagnostic criteria.

Dr Song will then discuss with you our Defy Dysautonomia program, a comprehensive management program that is tailored specifically to you. This program takes a global view, taking into account how your conditions may interact with each other as well as how treatment is affected by your conditions and vice versa. A copy of your detailed letter/report will be sent to your GP/referring doctor, other relevant specialists and yourself after your initial appointment.

Patient Fees

 

Dr Edmund Song’s rooms are a private medical practice. Almost all our services attract a medicare rebate. Most outpatient consultations attract an out of pocket cost. Please contact the rooms for specific fees.