The Dishwasher Dilemma

With our old dishwasher, we never knew whether the dishes in the washer had been cleaned. Before putting the dishes in the washer, we had to scrub them well, otherwise, they’d come out almost as dirty as they had been when we put them in. At the same time, the dishwasher would do such a poor job washing the dishes that, even after a cycle, they were never really clean (just ask a few of our guests who often left their glasses of water—or wine!—untouched). So, with the dishwasher full, we never knew whether we should turn it on to clean the dishes or place the dishes in our cupboard. Continue reading The Dishwasher Dilemma

This is what it’s like to be a physician

Let me tell you about a recent morning working in my outpatient rheumatology clinic. I’ll tell you less about the medicine, but more about my process of practicing medicine. I hope to shed light on what it’s like to be a physician, behind-the-scenes. As you’ll see, practicing medicine is time-consuming; it takes much more than the time spent with the patient in the clinic or at the bedside. Or at least it does if you really want to take care of your patient. Continue reading This is what it’s like to be a physician

(R)evolutionary Rheumatology

I spent most of my senior year in college in the basement of the science building, in a room the size of a closet, watching (and videotaping) fish having sex. I was studying pipefish, a relative of the seahorse in which the males get pregnant. I was interested in learning how this unusual quirk of evolution affected the sex roles of the fish, asking questions such as: which sex is more promiscuous, bigger, and more aggressive? Evolution was at the heart of my biology major, and its existence was palpable in every biology class I took—from Genetics sophomore year to a senior seminar on Ecology. It was clear during my undergraduate education that “nothing in biology makes sense except in the light of evolution.” Continue reading (R)evolutionary Rheumatology

Mastering the Inpatient Consult Service

Every few months I have the pleasure of teaming up with one of my fellows (and often a resident, and sometimes a medical student), to evaluate hospitalized patients with known or suspected rheumatic diseases as part of the inpatient consult service. This is quite a change from my typical day as a rheumatologist, where I see patients in an outpatient clinic.

On occasion, patients with known rheumatic diseases land in the hospital—the patient with lupus and worsening kidney disease, the patient with gout and a severe flare, the patient with vasculitis experiencing a relapse. At the same time, many patients are admitted for workup of unexplained symptoms—joint pain, fevers, rash—or develop these while being treated other conditions. For these patients, we are asked to evaluate for the presence of rheumatic diseases.

Having just finished covering the inpatient rheumatology consult service, I am reflecting on my week and have identified 15 factors that help you achieve a successful week. Continue reading Mastering the Inpatient Consult Service

Predicting Colchicine Response in Patients with Undefined Autoinflammatory Diseases

 

Background/Purpose:

Autoinflammatory diseases (AIDs) are a rare group of illnesses characterized by unprovoked episodes of fever and systemic inflammation.  An understanding of their pathophysiology has led to the development of effective treatment guidelines. Unfortunately, many patients with recurrent fevers have symptoms that do not match any of the known AIDs. There is an unmet need to provide effective treatment to these patients with undefined AIDs (uAIDs). Colchicine, a treatment for patients with familial Mediterranean fever, is sometimes used to treat patients with uAIDs. We examined the efficacy of colchicine in patients with uAIDs and identified clinical factors that predicted a good colchicine response.

Continue reading Predicting Colchicine Response in Patients with Undefined Autoinflammatory Diseases

Uncovering the mysteries of autoinflammatory diseases and other rheumatic illnesses.

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