November 2011

Arthrits and Golf in Cincinnati

Playing golf well is not easy. Neither is living with arthritis. I know firsthand about the challenges of golf— I want to shoot under 80, but I don't...yet.

I know a little bit about arthritis from a personal perspective (I have some osteoarthritis in my back), but mostly I know how difficult it is to live with arthritis from the experiences my patients share with me. Each day people who live with rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and gout must determine to get up, exercise, work, play, have relationships, and enjoy life. And just as the game of golf has its ups and downs, its moments of success and times of disappointment, life with arthritis can certainly be unpredictable.

But we push on, we keep trying new approaches and working hard. Because it's worth it. Golf is only a game, whereas living with arthritis is serious business. But both can be fun, full, and rewarding, if we keep trying. Or, we can give in, settle for bogeys rather than pars, focus on our disease rather than our health, and miss the joy of the journey.

I Took my Diabetes on a Bicycle Ride

Yesterday I rode my bicycle, and I planned my ride so it included a visit to the polls (it was election day). I didn't want to ride my bicycle, and I didn't want to vote. For some reason, yesterday I just didn't care, and I didn't want to do two things I know are good for me. I could have put the bike ride off, but I couldn't comfortably live with myself if I didn't vote, so I decided to kill two birds I didn't want with one stone: a bicycle ride to the polls. 

As usual, I felt much better after a couple of pedal strokes, and I felt awesome voting in my bicycle helmet and gloves. I turned heads. I like to turn heads. And, let me tell you, I voted as you might expect a person who rides a bicycle in this community to vote...I voted differently than my neighbors. But that's not my point.

I took a different route home, and I spotted one of my neighbors out raking his leaves. Most of our neighbors have lawn services, so he goes a little against the grain, too. Lately he's been alluding to the fact that his health isn't so good, so I stopped to learn from him what's going on. He lives alone and has no family in town, and if his health is failing, he'll need some support.

I learned that the kidney disease my neighbor has lived with for many years is rapidly shifting; he'll probably soon begin dialysis and go on a transplant waiting list. (I asked him what he needed. He said, "A donor." Uh oh. I'll save the conversation that occured between my higher and lower natures upon hearing that response for another post.)

Here's my point today: I have Type 1 Diabetes. My neighbor has kidney disease. Neither of us knew of the others' disease even though we've lived with these companions for a long time. I was riding my bicycle. He was raking his leaves. We were not sitting inside watching TV and complaining. We talked a little bit about being healthy people who happen to have diseases. Then we got all worked up talking about politics (we lean the same way). 

Yes, disease may take us. It may change what we do and how we do it. So there you go. Disease does not get to make us unhealthy or unhappy. 

Cincinnati Rheumatologist Blogs from 2011 ACR: What Is Education?

Evelyn V. Hess, MDEvelyn V. Hess, MDWhen I completed my rheumatology fellowship at the University of Cincinnati, I told my mentor, Dr. Evelyn Hess, that I was elated and relieved to have finally completed my medical education; now I could rest.

Dr. Hess quickly shot back (with an expression similar to the expression she wears in the image I've posted of her here) that I had only just begun my educational process and that I would be studying and learning for the rest of my life. I looked at her strangely, though I somehow knew she was right. The next day, I began my vacation in Hawaii. 

After one month of rest, I hung out my shingle...I opened my private practice...and yes, my true education really began then. Not only did I have to start independently putting into practice the knowledge I had acquired over the years, as I was now seeing patients completely without supervision for the first time (an intimidating realization for any new doctor), but I was also learning the nuances of running a business and earning a living.

Twenty four years later, I continue to see patients and manage a private practice. The field of rheumatology has grown exponentially since I completed my formal education. But by staying connected to research and excellent rheumatologists at UC (where I have worked in the outpatient clinic since my fellowship), by reading journals, and by attending annual ACR meetings, I have expanded my knowledge base in synchrony with the growth in my field. All this education is actually delightful—it's as if each new thought and new discovery adds granules of sand atop an ever-expanding base...I picture it in my mind's eye as a giant sand pyramid. At this point in my career and in my education, because I've constructed a solid, wide base of knowledge in which to anchor new information, I can sit back at meetings and absorb the gestalt of a lecture rather than fervishly writing notes and facts as many of us do when we're learning something new. 

The greater challenge to me these days is keeping abreast of the swiftly changing administrative aspect of running a medical practice—electronic health records, revised coding and documentation requirements, etc, are radically changing how physicians practice medicine and earn a living. Once again, a part of my education is only beginning. It keeps me sharp. I didn't realize, back then, how right Dr. Hess really was.