Bringing home a patient…

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By Dr Irwin Lim, Rheumatologist

pony

We visited my niece last weekend. My girls are jealous.

Their cousin, L, got a pony for Xmas! A little girl’s dream and the whining started.

Can we have a pony?

Can we have a pet, etc, etc,

I tried to explain that L lives on a property with space. Even more importantly, her father is a horse vet, and he very likely had this pony or this pony’s relative as a patient, so it was easy for him to bring the patient home.

I then offered to bring home a patient with arthritis for them to meet and talk to.

The girls were not enthused.

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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What not to wear for foot arthritis

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HeelsBy Dr Irwin Lim, Rheumatologist

I couldn’t resist this picture.

You all know the problem. Yes, we all love the heels. Me including – at least, the whole look that goes with it.

I dedicate this post to Chloe McLeod, Katherine Gordon & Sarah Thamin. That’s their feet at our Xmas party.  These already tall women decided to make those of us vertically-challenged all feel even shorter.

This Xray gives you an idea what the bones are experiencing in high heels.

Courtesy of http://imgur.com/zP5lgNS

Courtesy of http://imgur.com/zP5lgNS

 

Poor, poor bones!

If you wear heels repeatedly over a few decades, what do you think you’re doing to bones and joints?

I’m sure this won’t stop the trio and the odd occasion should be OK. There’s always a place for suffering in the quest to look good.

Thanks to Dr Suleman Bhana (@simba37) for highlighting this great pic.

 
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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Plaquenil Pigmentation

2

By Dr Irwin Lim, Rheumatologist

Hydroxychloroquine (Plaquenil) is not a new therapy. It has been used in rheumatology for decades and it’s proven a very useful medication. In my clinic, I mainly use it for these 3 indications:

  • in combination with Methotrexate for Rheumatoid Arthritis (the combination is thought to be more efficacious than either drug alone) when Methotrexate monotherapy is insufficient
  • in Systemic Lupus Erythematosus (SLE)
  • in a variety of Connective Tissue Diseases (a broad group of autoimmune disease)

I thought these photos were worth posting. The patient has rheumatoid arthritis and is actually on Hydroxychloroquine as monotherapy due to a number of other diseases restricting our use of other disease-modifying agents.

She’s been using the medication for months and is finding it effective. Today, she showed me her arms:

HCQ_Pigment

The right forearm has darker patches and the back of both hands seem affected.

I think it’s due to Hydroxycholoroquine-induced hyperpigmentation (an example of drug-induced skin pigmentation).

I thought it worth showing those of you on the medication.

Why is it so much worse on the right forearm?

Well she’s only just started to drive again. She holds the steering wheel generally with the right hand only and when driving in Australia, this is the side next to the driver’s window. It’s also summer and it’s been hot. So, I postulate that it’s the increased sun exposure.

How do we avoid it? It’s thought that protection from the sun helps.

She’s not fussed by it and was happy for me to share the photos to help teach. Other cases I’ve seen have been reversed by stopping the medication.

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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The Dreaded 1st day back to rheumatology clinic post-hols

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Guess which city?

Guess which city?

By Dr Irwin Lim, Rheumatologist

3 weeks overseas with my family. 3 junior school children. Almost every minute of every day together.

Time to return to work!

It’s the longest break I’ve had since commencing private practice a decade ago. Holidays are crucial to refresh and to refill the rheumatologist’s compassion quota so I definitely plan to take more this year!

However, I’m usually very wary of what I’ll return to. I think my colleagues are the same. The work builds up, problems fester, people get sicker during this time away.

The 1st day back in clinic can be very painful!

I thought you might be interested in strategies I use to cope with this:

  • Work closely with other rheumatologists. My mates can help field calls and see my patients urgently while I’m away.
  • Have reception staff with good common sense. Reception staff need to triage messages from patients and help redirect the urgent ones rather than having patients wait till I return.
  • I accept and answer emails from staff and patients on holiday. My wife does not like this. But I find that I can relatively quickly and easily sort out little problems, and redirect more urgent ones.
  • I used to check patient results while away by remotely logging into our servers. Yes, I’m type A. I’ve learned to stop this habit and have relied on staff flagging urgent results which in turn have been flagged by pathology providers, etc.
  • The afternoon/night before returning to the 1st clinic is however spent, sitting with my laptop at home, going through all these results. 3 weeks away meant a few hundred pathology test results to review. Rheumatologists tend to have lots of these given the medications we use and the requirement for regular monitoring blood tests.
  • I arrive at least an hour before clinic begins. The usual mound of mail needs reading, sorting and attending to.
  • The 1st day tends to be longer with any break spent returning phone messages and attending to lists of various tasks.

The above steps help me nip problems in the bud and help make the 1st day back after holidays more pleasant.

I’d be interested to know what my rheumatology colleagues do but I assume they have developed similar coping mechanisms.

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:
 
Enter your email address:
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BJC Health’s Vision & The Sushi Train

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By Dr Irwin Lim, Rheumatologist

The family’s spending New Year in Tokyo. One night, cold and hungry in Shibuya, we stumbled into this Sushi Train joint.

photo 1It was very cool. A departure from the usual procession of sushi plates going round and round the track.

We all took great delight in ordering the nigiri and norimaki we wanted on the touchpads provided. The order was sent electronically and soon after, a “carriage” rolls out and stops just in front of you. You lift your food off the carriage and then hit a button to send the carriage back into the kitchen.

photo 2A reinterpretation. Unexpected and delightful. We all enjoyed the delivery as much as the actual food.

That serves as an introduction for the main reason for this post. Our Vision Statement.

It’s 2014. I started my life as a consultant rheumatologist in 2004. If you’re a regular to this blog, you already know that I work as part of a team. A team of rheumatologists, physiotherapists, exercise physiologists, dietitians and more. Our path has meandered a little but we’ve always believed that this sort of group practice enhanced care for our patients with rheumatological problems.

We’ve been working on refining our vision over many years and actually committing it to words has proven very difficult. Our leadership team has toyed with a variety of versions and we’ve finally agreed. The wording may change in the future but I think the central theme will endure:

Our Vision

BJC Health has a vision that people suffering with arthritis deserve the best possible care.

This will be achieved through a multidisciplinary approach. We call this Connected Care.

One step to achieving this vision is creating a purpose built Arthritis Centre in Parramatta by 2016. This will set a new standard in arthritis care in Australia.

It’s a big step to commit this vision statement to print. An important reminder of what drives our leadership team, and a reminder of the shared purpose for all our staff.

What does a vision statement have to do with a sushi train?

Not much really.

Except to say that while getting from point A to point B is clearly important, we should also spend effort in making sure that how we do this, the journey, is as pleasant, as effective and as convenient as we can make it.

Patient care in rheumatology can be reinterpreted. Creating something unexpected and hopefully, delightful. A lovely vision for me to start my year.

I wish you all a Happy New Year!

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