“The Big Sick” Movie Review

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It's Monday morning and my first patient is a newly diagnosed rheumatoid. This is his first visit back after starting methotrexate 6 weeks ago. Despite doing great and in remission with only one active joint, he asks, “Are sure this is RA? Or could this be Still’s disease?” Admittedly, this is a weird second-visit question, but I was impressed.  

Rheumatologist's Vacation Checklist

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Nearly half of all available vacation days go unused and over 40% of Americans failed to use any vacation days in 2015. Common sense says that taking more time off (not less) is likely to lead to increased work productivity. Your next vacation is essential to building a better you. Here are some tips to insure you get the most from your time off.

The Retiring Rheumatologist

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Just last week, I went to a doctor’s retirement party.  It was festive, with honors and ribbing for the lucky one, but there was an asterisk to his milestone. Retirement was not anticipated or planned for. What is your retirement plan?

Lipstick Rheumatology

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A 25 year-old female recently diagnosed with seronegative rheumatoid arthritis was started on a TNF inhibitor. She came in for a follow-up visit and noted that her toenails were brittle and discolored when she removed her nail polish recently.

My Approach to Difficult RA

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Patients are labeled as having “difficult RA" when: 1) we are frustrated, 2) it's too late, 3) we've run out of options or 4) the relationship is failing. We see them, but don’t quite know what to do with them.

The Great Masquerader

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Wine and the Rheumatologist: A Perfect Meal

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I had dinner about a month ago in Phoenix with Peter Lipsky, an icon in rheumatology and who requires no introduction to my readers, where we discussed a rambling number of topics both rheumatologic (hence, the experience does qualify for a blog!) and non-rheumatologic.

What You Don't Know

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“It’s unbelievable how much you don’t know about the game you’ve been playing all your life.” - Mickey Mantle

The Negotiator

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This is going to be my third visit with this patient and I’m not looking forward to it.

In the first two, I discovered how sick she was and how, despite my handouts, efforts, insights and words, my educated medical expertise was totally wasted.

The Pain of Funerals and Suicides

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It's All in the Name

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I got onto flight #610 from Atlanta to Dallas the other day and was greeted by a flight attendant in first class. After introducing himself, he said, “That’s my name and you can imagine how it’s gone for the past 25 years.”

The Rheumatologist’s Rubaiyat: A Mug of Coffee, a Loaf of Bread and Thou Beside Me (Part 2)

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In my last article, I said that coffee, not wine, would be the libation of choice for rheumatologists. Why coffee? you may ask. After all, the language of coffee is not dissimilar to that of wine and writers of coffee (as well as the label descriptions) use the same vocabulary and analogies as does the writing about wine. Often, from the description-with words like spice, cocoa or nuts-it is not clear whether the beverage is a Cotes-de-Rhone or an Americano. Certainly coffee is better hot than cold and appropriate for all meals although some argue that champagne can be quaffed all day long.

The Rheumatologist’s Rubaiyat: A Mug of Coffee, a Loaf of Bread and Thou Beside Me (Part 1)

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In my experience, rheumatologists are very fine people. Since they are cognitive specialists, they are scholarly, thoughtful and prudent. Furthermore, they are sensitive to the vicissitudes of human existence. Rheumatology is probably the first subspecialty to consider the impact of a chronic painful illness on the spirit and soul and emphasize quality of life as an outcome. Seeking wisdom and knowledge from great minds, rheumatologists are also interested in culture, mindful that masters like Renoir and Klee were among their patients.

Early Rheumatology: The Contributions of Max Hirsch, MD

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Many readers of RheumNow know of my interest in the history of our discipline, and some of the writings and discoveries which have resulted from them. In the past three years, I have had the opportunity to explore the contributions of Max Hirsch, MD to our field.

Food and Wine and the Rheumatologist: The Microbiome and Natural Wine

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Is the microbiome influenced by wines "terroir" (“the complete natural environment in which a particular wine is produced, including factors such as the soil, topography, and climate”)? Len Calabrese believes so.