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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: 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.

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.

Need for Pre-operative Hyperglycemia Testing Prior to Total Joint Replacement

JAMA reports on a large Medicare cohort study showing that amongst patients undergoing total joint replacement (TJR), preoperative HbA1c testing was performed in 26% to 43% of patients with diabetes and in only 5% of those without diabetes. Importantly research has shown that an elevated HbA1c level is associated with postoperative complications.

Staying Abreast of COVID-19

Dealing with unknowns is both difficult and frustrating, as the answer is often not within our reach. The current pandemic has created a tidal wave of unknowns, scaring patients and putting physicians in a difficult spot.

ACR20 Pearls Part 3: Pragmatic Applications for Managing Vasculitis

While the ACR prepares to publish its new guidelines for the diagnosis and management of vasculitis in the Spring of 2020, Dr. John Stone presented his own perspectives on the practical management of vasculitis during the 2019 ACR meeting in Atlanta.  He acknowledged that what may be pearls one day, may be disproven with data in the future. 

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.

Pearls Part 2: Common Sense Rheumatology 

We live in an era where you need evidence in order to believe, but life’s experiences should not be discounted even if we do not have the statistics to support them…yet. In Part 2 of my annual meeting Pearls Trilogy, I present ten tips and observations shared by Dr. Sterling West from his session, "Rheumatology Top Secrets & Pearls".

A Review of the Review Course + How to Make the Information Stick

I have been attending the ACR Review Course for more than a decade, and it seems every year it gets better and better. Contrary to what most people think, this is not a board review course; it is more of a review of the latest research delivered by experts condensing rheumatology in eight hours.

Remembering the Names of Drugs

Knowing the names of the agents in today’s armamentarium should be simple. But, the nomenclature is notoriously confusing. The names of monoclonal antibodies can stretch to five syllables which defy easy pronunciation beyond the “mab” at the end. Who comes up with these names anyway?

When Your Patient Asks Why?

This is probably the most difficult question that a physician is confronted with. A patient is stricken with a new disease or problem and before it even sinks in or is fully comprehended, the patient wants to know “why” or “how” long before they want to know what are we can do about it.
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