Understanding rheumatoid arthritis and a baseball coach, and appreciating egg fu young


My patients come in with RA

From experience,  I know what to say

     On the importance of sleep

     That’s restful and deep

And the new drugs are worth what we pay.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

These two patients gave their permission to me to write this information.

One man has resided in Barrow a few months.  A gifted baseball player, he coached the Mariners for twenty-five years and retired.  He found doing nothing worse than working.  For a complicated series of reasons, he moved to Barrow. Though not Chinese, he cooks Chinese food at a local restaurant.  I told him how much I’d enjoyed his egg fu young.  We talked about how important work is.  I discussed my career change, how I wanted to slow down and I didn’t want to quit.  We reached a complete understanding.

I reached a complete understanding with another patient; we talked about the joys of Enbrel, and what a miraculous difference it has made to our lives.

I do not know why so much rheumatologic disease runs rough-shod over the population of the North Slope.  I’ve been back to Barrow less than a month, and I’ve made the new diagnosis of rheumatoid arthritis (RA) seven times.  On a daily basis I attend more patients with RA than I would see in a total of six months back home in Iowa.  I wish it were a case of mistaken diagnosis, but these patients have textbook history, lab, and physical findings.  The knuckle joints at the base of the fingers enlarge, the x-rays show joint erosion, the sedimentation rate (ESR, or erythrocyte sedimentation rate, or sed rate) goes up and stays up, the rheumatoid factor (RF) and the CCP (a confirmatory test for RA) come back abnormal, and the patient feels terrible.

I care for these patients with empathy; I have a very similar disease, ankylosing spondylitis (AS), which attacks the spine in the same fashion that RA attacks the hands, feet, knees, shoulders, and elbows.  Both maladies wreak havoc throughout the body with chronic inflammation.  If I see a patient with an ESR of 50, I think back to when I had a similar number and I remember how lousy I felt.

Most RA remedies tend to the toxic side, and until the biologics (sophisticated protein molecules) came on the scene, most treatments caused as many problems as they solved.  But the fabulously expensive new drugs work miracles, and when we mention Enbrel, our faces light up.  I talked about how the devil let go of my spine on December 2, 2000, and thirty-three years of pain dropped away in the course of minutes.  The other person talked about leaving the wheelchair behind.

I asked about sleep pattern; from personal experience (confirmed recently with good research) bad sleep causes increasing pain more than increasing pain causes bad sleep.  I shared what I’ve learned.

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