Use your laptop while standing

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By Dr Irwin Lim, Rheumatologist

I just installed this in my man-cave.

I sit so so much at work. And while I would like to consult while standing, it might not be seen as that appropriate by my patients (I wonder if this is true?) who may need to sit due to the problem they’re consulting me about.

So, I really needed some option to work standing up at home. I hope this proves useful and comfortable.

It might prove an option for our staff. We’re also considering how we use electronic sit-stand desks.

I thought I’d share this as there must be many of you with the same issue. I’d love to hear your thoughts on how you’ve reduced the over-sitting at work.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
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Welcome Tofacitinib. Now, how should I use you?

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By Dr Irwin Lim, Rheumatologist

I have not previously experienced a marketing campaign of this nature. The message repeated via mail, e-mail, print ads in medical newsletters. Clever design of the media with frequent reminders.

Xeljanz
The product, Pfixer’s Xeljanz. A new class of medication for rheumatoid arthritis is now available for use in Australia.

I’d written about it some years ago in this post: Tofa, would be nice if as cheap as Tofu.

It’s an exciting development and rheumatologists like, want and need options for their patients with rheumatoid who have disease which has not responded adequately to treatment.

Patients in Australia are fortunate that the government heavily subsidises the use of biologic disease-modifying medications (bDMARDs) if their disease has not been controlled by conventional disease-modifying medications (cDMARDs) such as Methotrexate, Sulphasalazine & Hydroxychloroquine.

There is access to Etanercept (Enbrel), Adalimumab (Humira), Infliximab (Remicade), Golimumab (Simponi), Certolizumab (Cimzia), Tocilizumab (Actemra), Rituximab (Mabthera) and Abatacept (Orencia).

Now, we have a 9th medication to consider, after the cDMARDs. This is a good thing.

But, we aren’t yet clever enough to know which of these medications is the best choice front-up for any individual patient. So, rheumatologists try to make educated “guesses” based on available evidence and their personal experience.

I summarise some earlier thoughts on how we choose here: With so many biologics for rheumatoid, how do you choose?

Specialists are usually creatures of habit. I think that’s one reason for the marketing blitz.

A major point of difference for Tofacitinib (Xeljanz) is that it is taken as a pill. So, you can swallow rather than inject or get infused.

Some may see this as a major advantage, others may not. Read the comments on this post: Would you like that IV, subcut or oral?

At the time of writing this post, I do not have a patient on Xeljanz. That’s surely going to change but I am grappling and considering which patient in which circumstance it would be most appropriate for.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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The Not-to-do list for Rheumatoid Arthritis

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Image courtesy of artur84 at FreeDigitalPhotos.net

Image courtesy of artur84 at FreeDigitalPhotos.net

By Dr Irwin Lim, Rheumatologist

If you have inflammation affecting your joints, and it has been confidently diagnosed as rheumatoid arthritis, there are a number of things I think you should not do.

Here’s 6 of these:

  1. Don’t stick your head in the sand.
    • Once the disease is established, it typically does not just go away. I do understand the need to come to terms with a chronic illness. It’s not at all easy but we can’t just wish it away. That’s unlikely to happen.
  2. Don’t procrastinate.
    • It’s clear there’s a ticking watch. The earlier you treat, the better the result for you with a stronger chance of avoiding damage and deformity. We need to treat this nasty disease early.
  3. Don’t just rely on what friends and family tell you.
    • They’re of course trying to help but they may not understand the specifics of the disease affecting you. Please get an expert opinion, and if you are still uncertain or confused, get a 2nd opinion. It’s your body and you need to make educated decisions with doctors you are happy to work with.
  4. Don’t just rely on what you read on blogs and forums.
    • I write a blog, and obviously present one point of view. There are other points of view, written by different people with different motivations. Information on the internet can be extremely useful but you need to be able in some way to filter and process the information, making it relevant to your specific situation.
  5. Don’t just decide to “go natural”.
    • Clear-cut rheumatoid arthritis is not a pleasant disease. It is very well studied, with clear treatment strategies which while not perfect, are on the whole, effective and safe. Trusting the long term health of your body to homeopathic medication, traditional Chinese medicine, Ayurvedic therapies, super doses of celery/fish oil/glucosamine/kumin, the paleo diet, etc, etc seems a poor choice with what we know about rheumatoid.
  6. Don’t smoke, don’t put on weight, don’t eat & drink poorly, don’t be a couch potato.
    • Lifestyle does matter so please do give up the smoking. If overweight, weight loss will help. Good nutrition and regular exercise can only benefit you.

Can you think of other things not-to-do?

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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A New Rheumatology Toy

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By Dr Irwin Lim, Rheumatologist

I’ve been playing with a new iPad app, Adobe Slate, to try and present information in a more engaging way.

Showing off our new toy seemed a good subject. Please check it out and let me know what you think.

Our Rheumatology Toy

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
BJC Health’s vision is to create best care for people with arthritis. Contact us.
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ANA + does not = Lupus

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By Dr Irwin Lim, Rheumatologist

I’m giving a talk to some local GPs tonight. My talk’s title is:

“How to interpret a positive ANA? Is it worth measuring?”

A common presentation to rheumatologists involves a person who has had this test, ANA (anti-nuclear antibody) measured. When the result returns positive, it can be quite hard to interpret.

This is due to the test being non-specific. Many people without disease can have a “falsely” positive result.

This test is really only useful if the pre-test chances of the patient having a related disease is reasonably high. In this case, the positive results increases the probability of disease and helps with making a more certain diagnosis.

When the pre-test chance of having the disease is slim, a positive result becomes confusing. It adds a layer of anxiety for patients especially when they search the net regarding the ANA. What the person will invariably read about will be lupus.

Many patients who see me with a positive ANA don’t have lupus or any other related disease. In these cases, it may be an incidental finding and my job is to reassure them and reduce anxiety.

I usually draw to help them understand. I added these diagrams to my talk tonight but I thought I’d share them.

ANA1

 

There are many people walking around with a positive ANA. The X represents the patient sitting in front of me with the incidental finding of a positive ANA.

ANA2

Some people with a positive ANA will have symptoms related to the ANA. A smaller number of these will actually have enough features to make a diagnosis of a classifiable disease.

ANA3

Yes, some people with a positive ANA may in time develop symptoms related to it, and some may indeed develop an autoimmune disease related to the ANA, but this is the minority. Even if it does develop, it may take many, many years with the important point that people should just lead normal lives and not worry excessively about a positive blood test.

I hope these drawings in some way help me convey the message.

What do you think?

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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