Best of 2020: Steroid Poker

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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.

Best of 2020: Goodwill Wednesday

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Business as usual, Wednesday morning, as I quickly stop at 7-Eleven for my morning coffee and it all begins. A nice stranger holds the door open for me; I reach for a carton of milk for someone unable to; the cashier skips the 2 cents on a $2.02 bill (with a smile). What transpired in a quick five minutes was a series of random, unrelated, unprovoked acts of kindness. Blatant politeness, sincere smiles, compliments between strangers and lots of open doors. This made me think.

My Experience as a COVID19 Vaccine Trial Participant

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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.

Telemedicine: What's Changed and What Needs to be Addressed?

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Along with our patients, we've spent the last several months adapting to telemedicine. Following is an update on legislative changes and uncertainties, a look at the care gap that may still exist, and examining the trajectory of telemedicine after the initial rapid growth spurred by COVID-19.

Rheuma-Yogi-ology

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Since the start of the pandemic, my emotions have swung like the pendulum of the hydroxychloroquine efficacy/inefficacy for COVID-19 debate. Stress has always been a part of my life, but it magnified with the recent events in our world. Dr. Lenny Calabrese had cited the benefits of mindfulness meditation to improve immunologic health and sharpen mental acuity. I had seen benefits in my patients, but never could do it myself. How can people meditate and strike a pose when there is so much to worry about?  Stress-eating seems so much more comforting! 

Wisdom for New Rheumatology Fellows

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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.

ICYMI: Faith

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For Jessica, an ICU nurse, 12-hour shifts were usually fast paced, challenging and productive. But the cadence and demands of work abruptly changed mid-March when COVID-19 came. Amongst her many ICU admissions she took care of Larry, who was instantly interesting and forever memorable. He had contracted the coronavirus less than a week before. He was a 60-ish yr. old man who tried to be humorous, but who was clearly distressed and worried. He was febrile, anxious, breathing hard and on the verge of being unstable. 

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

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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.

ICYMI: Our Privilege

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Another lonely locked-down day. Seems like months. Rent is due, phone and EMR fees next week. Loan is pending. Seems impossible to treat complex diseases without touch and only computer screen rapport. And yet, it is a good day.

ICYMI: Shutdown and the New Normal

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COVID-19 is not going to suddenly end on June 1st. This is a long haul change and you need to be prepared for the aftershocks and fallout. It’s time to be be a Marine and ”Improvise, Adapt, and Overcome”.

ICYMI: Telemedicine Bloopers and Successes

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At my COVID home command center, I feel pretty prepared for everything. From here, I can run my practice, manage and home-school 3 children and keep the family afloat.  I have 2 computers: one for telemedicine/business meetings and one for e-learning lessons/school updates that teachers and school administrators email me throughout the day for my children.  As a no-nonsense, organized mom and doctor, I felt ready to handle any issues that would arise. 

Change from Within

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I attended the #whitecoats4blacklives rally at Dallas City Hall a few weeks ago to support our black colleagues, patients, and friends. It was inspiring, humbling, and emotional. I encouraged other physicians to join me, posting on the Dallas Physician Facebook page that we need to lead by example for our community and our children to fight structural racism. One black physician posed a very important point to my post, “What permanent changes will you make in your personal and professional lives as a result of this? Because not endorsing racism is not the same as not being complicit in it.”