Rheumatology care

Rheumatologists and their patients writing on KevinMD about autoimmune and inflammatory disease: lupus, arthritis, fibromyalgia and its myths, the diagnosis that took twenty years, medical gaslighting, and chronic illness lived by the physicians who have it. Board-review cases make up part of this archive. Two maintained records draw on this archive: Medical errors: what physicians say, in their own words, and Opioids: what physicians and pain patients say, in their own words.

February 18, 2023Feb 18, 2023

In this episode, we have a special guest, Laura Fernando, a patient advocate, who shares her heart-wrenching story of her daughter Lily's medical journey with COVID-19 and other health conditions. Joining her and Lily is Linda Bluestein, an integrative medicine…

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In this episode, we have a special guest, Laura Fernando, a patient advocate, who shares her heart-wrenching story of her daughter Lily’s medical journey with COVID-19 and other health conditions. Joining her and Lily is Linda Bluestein, an integrative medicine physician.

Lily was a healthy 12-year-old when she contracted COVID-19 in June …

Conditions and Diseases

From diagnosis to digital health advocate: Navigating lupus in the era of technology

Alyshia Merchant

February 17, 2023Feb 17, 2023

It's been over ten years since my life changed forever. In 2012, I was out to dinner with a friend when I developed a rash across my face. Little did I know, this was an early sign of what would…

It’s been over ten years since my life changed forever. In 2012, I was out to dinner with a friend when I developed a rash across my face. Little did I know, this was an early sign of what would soon be a life-altering discovery; I have lupus. Receiving this diagnosis was both challenging and overwhelming and showed me the importance of being your own advocate. It took a fainting …

Physician

Gaslighting and dismissal: the consequences of invalidating patients’ concerns

Lisa Baron, MD

February 12, 2023Feb 12, 2023

Social media has really exposed the trauma caused by gaslighting, dismissal, and misogyny by medical professionals. Chronic illness groups are rife with posts recounting the poor treatment they suffered at the hands of doctors. Imagine presenting with extreme fatigue, intermittent balance problems, and tingling in your hands and, after a cursory exam, being told your symptoms are due to stress and to lose weight. Two years later, you are diagnosed …

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Health Technology

How technology is transforming medicine and making distance healing a reality

Francisco M. Torres, MD

January 8, 2023Jan 8, 2023

My first job as a "real" doctor was in 1991. During one of those early days in my career, one of my coworkers — a woman who worked in reception — approached me for help. Even then, I could recognize…

My first job as a “real” doctor was in 1991.

During one of those early days in my career, one of my coworkers — a woman who worked in reception — approached me for help. Even then, I could recognize a look of desperation. It reminded me of the look I saw in my sister when all she could do to lessen the pain she had suffered for so long was …

Podcast

Treating rare, multi-system illnesses [PODCAST]

The Podcast by KevinMD

January 4, 2023Jan 4, 2023

"If patients had an accurate diagnosis and their physicians knew the root of their illness and could treat it effectively, then the medical care costs would go down. The effect on patients of being diagnosed years earlier and having a…

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“If patients had an accurate diagnosis and their physicians knew the root of their illness and could treat it effectively, then the medical care costs would go down. The effect on patients of being diagnosed years earlier and having a shorter diagnostic odyssey is impossible to quantify. We need more elephantologists. …

Conditions and Diseases

My daughter and COVID: a tale of 3 doctors

Laura Fernando and Linda Bluestein, MD

November 4, 2022Nov 4, 2022

It was the best of medical encounters; it was the worst of medical encounters. But it is indeed a story of how two physicians viewed the same situation very differently, and how one brought trauma to a young patient, and…

My daughter was a healthy and vibrant 12-year-old when she first had COVID in June 2020. She …

Conditions and Diseases

Why adopt a lifestyle pyramid for rheumatoid arthritis?

Diana M. Girnita, MD, PhD

November 2, 2022Nov 2, 2022

Rheumatoid arthritis is a common autoimmune disease affecting approximately 1.5 million people only in the United States. The most common symptoms that will bring patients to the doctor are: pain swelling and stiffness in multiple joints. most of the time,…

Rheumatoid arthritis is a common autoimmune disease affecting approximately 1.5 million people only in the United States. The most common symptoms that will bring patients to the doctor are:

pain
swelling and stiffness in multiple joints.
most of the time, in a bilateral and symmetric pattern

Unfortunately, rheumatoid arthritis is not only a disease of the joints. Chronic, ongoing inflammation …

Conditions and Diseases

Having more doctors to assess rare, multi-system illnesses

Heather Finlay-Morreale, MD

October 29, 2022Oct 29, 2022

From an Indian parable dated from before 500 BCE: A group of blind men heard that a strange animal, called an elephant, had been brought to the town, but none of them were aware of its shape and form. Out…

From an Indian parable dated from before 500 BCE:

A group of blind men heard that a strange animal, called an elephant, had been brought to the town, but none of them were aware of its shape and form. Out of curiosity, they said: “We must inspect and know it by touch, of which we are capable.” So, they sought it out, and when they found it they groped about it. …

Read more…

Having more doctors to assess rare, multi-system illnesses

Podcast

If you can’t connect the issues, think connective tissues [PODCAST]

The Podcast by KevinMD

September 25, 2022Sep 25, 2022

"When Lauren came to my office as a 16-year-old, she had been diagnosed with postural orthostatic tachycardia syndrome (POTS) and a few other chronic illnesses. By the end of the appointment, she left with a diagnosis of Ehlers-Danlos Syndrome (EDS)."…

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“When Lauren came to my office as a 16-year-old, she had been diagnosed with postural orthostatic tachycardia syndrome (POTS) and a few other chronic illnesses. By the end of the appointment, she left with a diagnosis of Ehlers-Danlos Syndrome (EDS).”

Linda Bluestein is an integrative medicine …

Podcast

Myalgic encephalomyelitis/chronic fatigue syndrome and long COVID [PODCAST]

The Podcast by KevinMD

September 20, 2022Sep 20, 2022

"ME/CFS is a complex multi-system illness that destroys lives (essentially killing the person yet leaving them alive). It leaves patients with unimaginable fatigue, post-exertional malaise (meaning that minor exertion makes them feel worse), cognitive deficits, cardiovascular dysfunction, gastrointestinal malfunctions, unrefreshing…

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“ME/CFS is a complex multi-system illness that destroys lives (essentially killing the person yet leaving them alive). It leaves patients with unimaginable fatigue, post-exertional malaise (meaning that minor exertion makes them feel worse), cognitive deficits, cardiovascular dysfunction, gastrointestinal malfunctions, unrefreshing sleep, pain, and much more.

As a person who has lived with …

Conditions and Diseases

Focus on the rheumatoid arthritis patient, not on their disease

Diana M. Girnita, MD, PhD

September 16, 2022Sep 16, 2022

Medical school, residency, and fellowship taught me pathophysiology, diagnosis, and the most advanced treatments for autoimmune diseases like rheumatoid arthritis. As an attending physician, seeing my own patients, I noticed that targeted therapy is not able to control the disease…

In my previous article, I wrote about one of my patient’s …

Physician

A paradigm of perseverance

Jason Liebowitz, MD

August 31, 2022Aug 31, 2022

At her Supreme Court confirmation hearing in front of the Senate Judiciary Committee, Judge Ketanji Brown Jackson recounted a story from her time as a college undergraduate. She recalled being a freshman at Harvard after having attended public school in Miami, Florida, and her transition to life at the university had been challenging, causing her to question if she belonged at the school and if she could succeed. She was …

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A paradigm of perseverance

Podcast

What a lifetime of gaslighting by other doctors feels like [PODCAST]

The Podcast by KevinMD

August 12, 2022Aug 12, 2022

"Ehlers-Danlos syndrome patients take an average of 10 years to be diagnosed. In that time, the pain from microtrauma and joint instability can become unbearable. “Just exercising more” can backfire, causing injury and disability and creating a cycle of added…

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“Ehlers-Danlos syndrome patients take an average of 10 years to be diagnosed.

In that time, the pain from microtrauma and joint instability can become unbearable. “Just exercising more” can backfire, causing injury and disability and creating a cycle of added stress from chronic illness. But the biggest challenge is when our physicians are our …

Conditions and Diseases

The role of nutrition in rheumatology patients

Diana M. Girnita, MD, PhD

July 31, 2022Jul 31, 2022

Five years ago, I met a patient that changed my view on practicing traditional medicine, especially when it comes to rheumatology. For years, I was proud to be in a booming field that provided patients with a new therapy every few years. As a physician and scientist, I believe that targeted therapy offers tools to treat patients like never before, but I have noticed that results vary over time.

Daniel was …

Podcast

Fibromyalgia is not a trash can diagnosis [PODCAST]

The Podcast by KevinMD

July 21, 2022Jul 21, 2022

"How would you like to see your career slip away from you as you gradually become less and less able to sleep, to rest, to feel awake, to feel like your memory is failing you, to be taking pills every…

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“How would you like to see your career slip away from you as you gradually become less and less able to sleep, to rest, to feel awake, to feel like your memory is failing you, to be taking pills every night on call because your legs ache so badly, to become …

Conditions and Diseases

What a lifetime of gaslighting by other doctors feels like

Sarah Cohen Solomon, MD and Linda Bluestein, MD

June 30, 2022Jun 30, 2022

"If your shoulder were really injured, that maneuver would make you scream in pain," he told me confidently. My husband and I recently established care with a new family doctor. I was frightened and scarred from a long history of…

“If your shoulder were really injured, that maneuver would make you scream in pain,” he told me confidently.

My husband and I recently established care with a new family doctor. I was frightened and scarred from a long history of medical gaslighting that still tightens my throat whenever I meet a new physician.

Will this doctor believe me? Will he understand?

Years of dismissal made me wary of a new start, but we …

Physician

10 steps to create your direct specialty care clinic

Diana M. Girnita, MD, PhD

June 17, 2022Jun 17, 2022

Three years ago, I was a physician in the "traditional" medical system seeing 25 to 28 patients every day. I spent hours writing notes to provide proper documentation for the correct billing code. Often, my time was spent calling insurance…

Three years ago, I was a physician in the “traditional” medical system seeing 25 to 28 patients every day. I spent hours writing notes to provide proper documentation for the correct billing code. Often, my time was spent calling insurance companies to justify the appropriateness of my medical care. More and more hours were spent on completing tasks for insurance companies rather than patient care. Like many of my colleagues, …

Conditions and Diseases

Fibromyalgia is not a trash can diagnosis

Margaret Macdonald, MD

June 2, 2022Jun 2, 2022

Yet again, while reading an article about fibromyalgia, I was hit with another pejorative term in the first few lines. The authors describe the usual characteristics of fibromyalgia and then say, "and a high level of catastrophizing related to pain."…

Yet again, while reading an article about fibromyalgia, I was hit with another pejorative term in the first few lines. The authors describe the usual characteristics of fibromyalgia and then say, “and a high level of catastrophizing related to pain.”

If you do a Google search for “catastrophizing,” it tells you that it is “a way of thinking that assumes things are worse than they are or will have a far …

Conditions and Diseases

Shortening the diagnostic odyssey for hypermobile Ehlers-Danlos syndrome: a primer for the primary care physician

Linda Bluestein, MD

May 27, 2022May 27, 2022

Joint pain, nausea, dizziness, bloating, palpitations, urticaria, headache, and fatigue. Surely this must be a list of the chief concerns for each of your first eight patients for the day. No, these chief concerns all belong to your very first…

Joint pain, nausea, dizziness, bloating, palpitations, urticaria, headache, and fatigue. Surely this must be a list of the chief concerns for each of your first eight patients for the day.

No, these chief concerns all belong to your very first patient of the day. A new patient is scheduled for a 20-minute slot.

How will you possibly get out of the room in time? How can you ever help this young woman? …

Conditions and Diseases

The journey to diagnosing a mysterious illness

Linda Bluestein, MD and Lauren Vasko

May 19, 2022May 19, 2022

As a clinician, you likely do not have the luxury of playing "Dr. House." Patients enter your exam room, long story in hand, with a litany of mysterious symptoms involving every bodily system, and you were already massively overbooked. Your…

As a clinician, you likely do not have the luxury of playing “Dr. House.” Patients enter your exam room, long story in hand, with a litany of mysterious symptoms involving every bodily system, and you were already massively overbooked. Your patient leaves the encounter no closer to answers despite your best attempts which involved you spending far more time on their assessment than your crazy office schedule allows.

Your staff becomes …

Rheumatology care

Real physician voices, twice a week

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