For patients and families

Preparing for your DISH appointment

Bring the information that helps your team connect the images, your daily needs and a practical care plan.

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Chapter 6 of 6

Choose the main reason for this visit

Begin with the problem you most want help with. It may be understanding an unexpected X-ray finding, improving a difficult activity or deciding what to do about a new symptom. One or two priorities are easier to work through than an unstructured list of every concern.

Write a sentence in your own words: “I can no longer turn comfortably to check traffic,” or “Food has started sticking and I want to know why.” Add when it began and what has changed. Urgent symptoms, including new spinal pain after injury or new neurological problems, need prompt assessment rather than being saved for a scheduled routine appointment.

Bring records that can change the discussion

Recent and previous imaging reports, plus a way for the clinician to view the actual images.
A list of prescription medicines, over-the-counter products and supplements, with doses when known.
Relevant diagnoses, spinal or other operations, falls and fractures.
Details of physical therapy, exercise programs, injections or other treatment and what changed afterward.
Information about medication allergies, adverse effects and any past difficulty with anesthesia or a breathing tube.

Include past retinoid treatment, such as isotretinoin or acitretin, even if it was prescribed by another service. Approximate dates and duration are useful. Long-term use can matter when assessing extra bone formation. Listing a medicine does not mean it caused your condition or that you should stop it.

If obtaining an old image is difficult, bring the report and identify where and when the examination was performed. The clinic can advise whether retrieving the images is important for the present decision. Do not delay urgent assessment while collecting routine records.

Explain what an ordinary day is like

Describe where pain or stiffness occurs, how long it has been present and which movements are limited. Mention sleep, walking, dressing, reaching, work, driving and other important activities. One concrete comparison is useful: “A month ago I walked to the corner without stopping; now I need a break halfway.”

Tell the clinician about falls, altered balance, hand clumsiness, tingling, weakness, changes in bladder function or swallowing difficulty. Include food sticking, coughing during meals, a changing voice, snoring or witnessed pauses in breathing during sleep. These details help determine whether another assessment is needed.

Explain what you have tried, how often you used it and why you stopped. Lack of benefit, side effects, cost, scheduling and uncertainty about instructions lead to different solutions. A plan is easier to improve when the team understands what actually happened at home.

Questions to choose from

Which findings support DISH, and which parts of my symptoms does it explain?
Could another condition be contributing to this particular problem?
Would another test change the plan, and what would it help us decide?
What activity and physical therapy are appropriate for my degree of stiffness?
What is the goal of each treatment, and when should we judge whether it helps?
Do I need a fall-risk or bone-health assessment?
What should I tell a surgeon, dentist or anesthesia team before a procedure?
Which changes need same-day assessment, and which require emergency help?

Select the questions relevant to this appointment. You can ask for unfamiliar terms to be explained or for the main steps to be written down. Bringing a support person may help with remembering the discussion if you would find that useful.

Preparing for an operation or procedure

Contact the procedural team in advance if you have restricted neck movement, a markedly curved or rigid spine, swallowing problems, a previous difficult airway or sleep apnea. State the DISH diagnosis and share relevant imaging or specialist correspondence if requested. Early communication gives the team time to plan assessment, positioning and airway care.

Before hip replacement, mention DISH to the orthopedic surgeon and ask whether it changes planning or rehabilitation. The team will consider your full risk profile. Advice about medicines before an operation should come from the treating team, particularly when a drug has been prescribed for another medical condition.

Leave with a plan you can use

Before leaving, confirm what happens next, who arranges each test or referral, and how results will reach you. Agree on a specific activity goal and a review point. Ask whom to contact for side effects, worsening symptoms or a referral that has not arrived. Say if cost, transport or other responsibilities make the plan difficult.

A short visit note can have five lines: my main concern; the agreed explanation; the next action; who is responsible; and when to review. Keep the note with your medication list and imaging information. Update it when the plan changes.

You can print this page or copy the checklist into your own notes. The Your rheumatology visit collection offers more preparation resources. Try the The Visit Starts at Home patient demo to practice organizing medicines, results and questions; the demo is open without registration.

Keep personal medical details in the channels your clinical team has approved. The educational website is not an emergency service or a place to send private medical records.

Print and bring with you

Visit planner · PDF DISH / stiff spine card · PDF

Evidence reviewed as of October 30, 2026

Sources and further reading