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ICYMI: Steroid Poker

It began as many cases do: an ill patient, in the ICU, with signs and symptoms across several body systems, yet no clear unifying diagnosis on admission. With things stabilizing, the internal medicine hospital team on which I was serving as hospitalist that week assumed care of the patient. As the case unfolded – pulmonary infiltrates that could be hemorrhagic, renal dysfunction with proteinuria – rheumatic diseases rose in the differential. When serologic studies and other data suggested GPA rather than glomerular basement membrane (GBM) disease or other possibilities such as infection, it seemed the right time to act. And that is when a game of what I call “steroid poker” began.

ICYMI: Drug Safety Risk Communication- The 800 lb Gorilla Approach

Discussions on drug safety can be as treacherous as quicksand for the patient and physician. What the physician knows and what the patient perceives may not be in sync.

My Personal Delta COVID-19 Breakthrough Infection

As many of you are aware, I have written and spoken on COVID-19 extensively over these past 20 months, and just last month wrote about the dangers of the delta variant. In July, things took an unexpected turn when I developed a breakthrough infection with the delta variant.

Interview Season

We are at that time of year when rheumatology fellowship programs across the nation are exploring potential candidates to train. Program directors work hard to attract the finest candidate, hoping to shape a future leader; applicants want to impress programs with their experience and desire a place where opportunities are available to explore their potential. So how does a program choose from a large pool of qualified applicants to fill just a few seats? What should applicants look for in a program to ensure a good fit? 

Three Healthcare Hashtags You Should Follow 

I've sent more than 2,000 tweets since joining Twitter in July 2010. Even better, I've read (and sometimes shared) thousands of other educational, informative and sometimes humorous tweets from fellow rheumatologists, physicians, healthcare providers and others around the world. While following individuals and organizations relevant to you is important, so is following hashtags. Here are three I recommend.


Since the COVID vaccine rollout, more people have been eligible to receive the vaccine. However, not everyone chooses to get one. I have heard many reasons (aka excuses) from my patients who are vaccine hesitant. 

Consults in Cars

In this episode of Dialing for Doctors (aka, Tales of Telehell), we consider a growing subset of telehealth seekers connecting from their cars. This has happened several times and it always catches me surprise. While I've had "live" televideo visits with patients walking the dog, waking up in bed, and from the waiting room of another doctor's office, consults in cars is about the nuttiest. What is the patient's role in telehealth?

Zoomatology – Present in Absentia

Are you a zoomatologist or a doomsatologist? Zoom has replaced the meeting, the teleconference or the board meeting. If your old meetings were bad, then your replacement zoom meetings will also be bad, if not worse. Largely because you have failed to master the medium. Here are the new rules of Zoom.

20,21 Whatever it Takes

Amazingly, we made it through 2020, a most forgettable year.

Life was great in the first 3 months of 2020, and then COVID hit the fan and a pandemic steamroller derailed life as we knew it.

Best of 2020: My Experience as a COVID19 Vaccine Trial Participant

I have been an investigator for many clinical rheumatology studies over the past two decades but have never been a study subject until now. On October 31, 2020, I enrolled in the phase 3 trial of the Pfizer/BioNTech mRNA vaccine against SARS-CoV2 (protocol C4591001). Here's my experience.

Best of 2020: Some Good Things, During the Time of COVID-19

It is not hyperbole to acknowledge that the COVID-19 pandemic has changed the world, inflicting pain and suffering to many, and inconvenience to all. As everyone struggles to make it through these difficult times, it might be worth pointing out some small silver linings that have emerged despite this pernicious dark cloud.

Best of 2020: Wisdom for New Rheumatology Fellows

Congratulations on choosing the greatest profession, one equally dedicated to both science and patient care. You are now part of a guild that will support you and anticipate your success. Rheumatology needs you to be a big thinking, futuristic problem-solving practitioner who will lead and learn, research and teach. Here are my words of wisdom for aspiring MSK phenoms.