By Jennifer May, M.D.
As a rheumatologist, I often get the question, “What do you do?” According to my kids, their mom does “something with joints.” At the conclusion of patient visits, when I propose a diagnosis such as polymyalgia rheumatica or PMR, I often hear, “What is that?” The fact is most people do not think about rheumatology until they need a rheumatologist. And then, learning the lingo about disease, medications, and lab monitoring can be a challenge.
Rheumatology is a relatively new specialty in the world of medicine. Focus on the disease in America began in the early 1920s with initial definition and discovery, followed by the famous breakthrough of cortisone at Mayo Clinic in 1950, and grew to a deeper scientific understanding of arthritis diseases today. Treatments have progressed from cortisone and aspirin to immune system modification with biologic medications. Future therapies will involve genetics, engineering new cartilage, and creating cells that rheumatologists will command to do our bidding upon the immune system.
Today we work to manage autoimmune diseases such as rheumatoid arthritis or lupus with medications that adjust the immune system response. Symptoms that can occur in association with some of these diseases are rashes, joint swelling, fevers, lung problems, and kidney issues. By adjusting the immune system, we can change the symptoms, hopefully lessening their impact on the patient.
In our fast-paced world, we often want answers and quick solutions to our problems. However, rheumatology cases require persistence. There are no blood tests that specifically diagnose the problem. Rheumatologists must take time to talk with and examine the patient. We gather additional information from labs tests, studies, and x-rays. Once all the data is available, sometimes the condition is clear. But other times, the case is more challenging and requires several visits before making a firm diagnosis.
Like most health providers, I enjoy solving patient problems and making a diagnosis. We get satisfaction from figuring things out and our reward comes when a treatment improves a patient’s function or quality of life. Our goal in rheumatology is to help patients achieve remission, or better yet, to predict who is likely to get rheumatoid arthritis in hopes of preventing it from starting in the first place.
So, when patients look at me with that expression that asks “rheuma-what?”, they don’t necessarily want to hear about the science of what I do. Instead, I assure them that we will keep working together with the same goal: To get the immune system to quiet down, and help the patient feel better so they can get back to life.
Jennifer May, M.D. is a contributing Prairie Doc® columnist. She practices rheumatology in Rapid City, South Dakota and serves on the Healing Words Foundation Board of Directors, a 501c3 which provides funding for Prairie Doc® programs. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
Gratitude for Grandparents
by Joanie Holm, R.N., C.N.P.
A three-pound baby entered the world in recent days. This precious child was born after his Mom spent seven weeks in the hospital on bedrest. At home, Dad and two siblings were working, going to school, and worrying. Surrounding the family were two sets of grandparents who ensured that the pieces all fell into place. From meals and lawn care, to virtual school, from evening shifts and overnights to early mornings, these grandparents were there every step of the way. They will continue to offer support while the baby remains hospitalized and growing, and after he comes home, because that is what grandparents do, if they are able.
Grandparenting can be an awesome stage in life, benefitting the grandchildren, the parents, and of course the grandparents in significant ways. Grandparents are known to influence values and behaviors and provide valuable life experiences. A child who has a connection with grandparents may have increased self-esteem, with better emotional and social skills. A relationship with a grandparent can give a child strength and comfort into adulthood.
In an article titled “Why Grandparents are VIPs,” social researcher, educator and author, Susan V. Bosak writes, “The special kind of love you get from a grandparent is a love you can't get anywhere else. It is an important kind of love – in fact, a very important kind of love. Parents have to worry about who children will become in the future; their role is to be providers and disciplinarians. Grandparents can just enjoy children for who they are in the moment. The love of a grandparent is often freer, more unconditional, and far less psychologically complex than a parent's love. The love of a parent and the love of a grandparent are different, second in emotional importance only to the parent/child relationship.”
In a world of many dual-career families, the benefits of active grandparents can be lifesaving for parents. Often grandparents fill in the gap between school and the time parents get off work, driving kids to different events or helping them with homework.
Lastly, active grandparents report less depression and a higher degree of life satisfaction and a hopeful feeling for the future.
Margaret Mead, a well-known American cultural anthropologist, said the connection between generations was “essential for the mental health and stability of a nation.”
This Thanksgiving, may we celebrate the grandparent-grandchild relationship with gratitude.
Joanie S. Holm, R.N., C.N.P. is co-founder and president of Healing Words Foundation, a 501c3 which funds Prairie Doc® programs. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
Dementia Affects the Family
By Debra Johnston, M.D.
I was very young when my grandfather suffered his first stroke and began his battle with vascular dementia. I grew up understanding that he was not like the other adults in my life. He would take me on long walks around the neighborhood, but it was never entirely clear who was supervising who. He rarely had much to say, and when he did, it did not make sense. He communicated mostly through gestures, and sometimes unnerved my cousins and I with his uncertain temper.
With the benefit of age and experience, I appreciate now how frustrated he was, and what a herculean task my grandmother took on.
Medicine has made progress in the nearly 40 years since my grandfather’s death. We are better at preventing strokes and mitigating the aftereffects. We are better at distinguishing between the diseases that cause dementia. We have treatments for some of those causes, however disappointing those treatments are. We are better at addressing related challenges, such as sleep disruption and depression. We are better at guiding families as they struggle with difficult decisions, like when to stop driving.
Families struggle when they know Dad is not safe behind the wheel or at home, but Dad thinks everything is fine. One of the many things that dementia robs from people is the ability to grasp their condition. Some patients are skilled at hiding the extent of their impairment. Sometimes spouses fill in the gaps, so problems are less noticeable to the rest of the family. Patients can hide troubles from their doctors, too, so it is critically important that families and care teams maintain communication.
Just like many fully capable adults, dementia patients may fiercely resist the involvement of others in their business and many suffer for it. One of my patients hid her impairment until she was conned out of her entire savings. Another minimized his symptoms, until the family got a call from a stranger saying their father had gotten lost behind the wheel. Overruling the wishes of your adult parent can be difficult. But, when we recognize their vanishing judgement, intervening is the loving, and sometimes the lifesaving, thing to do.
Through much of my lifetime, I’ve watched my father worry about his own memory. This is a common concern for people who have seen a loved one struggle with dementia. I hope that someday, we will have more to offer, but there is no magic pill. For now, the best we can do is to give the same advice you hear from us on virtually every other topic: Eat a healthy diet. Get exercise. Keep your brain active. And welcome support from those who love you.
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
Let’s Put Ourselves in Their Shoes
By Debra Johnston, M.D.
When I met her, she was younger than I am now. I was responsible for admissions to our hospital that day, and the ER doctor called me about a woman with intractable bleeding. It had been going on for several months, but she was embarrassed and unsure. She hid the severity of her bleeding from her husband, until the day she passed out in the kitchen.
Ultimately, we diagnosed her with cancer, and she started down a difficult road of surgery, chemo, radiation, and more surgery. But they faced many hurdles beyond her disease.
She and her husband each had finished high school with the help of special education classes. They struggled to understand the complicated reality of her cancer, and the choices they had to make. He was on disability, but she had never worked, and she certainly was not able to now. They got by on his social security check, which was not enough to cover her medications.
Her family lived several hours away, and their relationship with his family was often combative. The steps into their home were rickety, and she couldn’t navigate them with her walker. They couldn’t rely on their old car to get them to medical appointments, or even to the grocery store.
Fighting cancer or any life altering illness or injury is hard even for those who are financially secure and have the support of extended family. For a moment, let’s put ourselves in the shoes of those who face an uphill battle just to get to neutral.
Perhaps we grew up with a parent who had an untreated mental illness or addiction, or who was abusive. Perhaps we face discrimination because of our race or religion or gender or sexuality or some other fundamental characteristic. Perhaps we struggle with poverty, and the attendant evils of housing and food insecurity. Perhaps we live in an unsafe neighborhood, or we cannot easily get to a grocery store.
How, then, do we eat right and exercise safely? How do we find and keep a good job if we have limited education or we don’t have reliable transportation? How do we communicate with a doctor if we don’t have a phone and can’t read very well?
All these things are part of the social determinants of health. Our health and wellbeing depend on so much more than the factors we can control. Living with chronic stress, particularly chronic stress we experience as a child, impacts our physical health throughout our lives and that stress can continue down through generations. If we genuinely want to promote wellness, for ourselves and for our society, we must put ourselves in other people’s shoes and pay close attention to these underlying issues.
Debra Johnston, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streamed most Thursdays at 7 p.m. central.
Choose Respect Not Fear
By Andrew Ellsworth, M.D.
My son is a cub scout, and I am den leader. Recently our den met outside and practiced putting up tents and learned how to build a fire. With efforts to stay distanced, every scout made his own s’more, and we had such a fun time.
One highlight of the evening was letting each scout try to light the fire. We went through a series of mistakes with the matches and thankfully no one got hurt. They were so proud to learn how to light a match and start a fire. However, it was also daunting for them. One scout specifically commented on how excited he was and how scared he was. I tried to teach safe techniques and explained how you do not need to fear fire, but you do need to respect it.
Approaching something with respect rather than fear is helpful in so many things in life. Whether it be a wild animal, fire, or a weapon, cautious respect is usually more helpful than fear. Education and experience, without losing that caution and respect, may be lifesaving.
Those principles could be helpful as we cope with COVID-19. Depending on your situation, you may not be afraid, or you could be overcome with fear. On the one hand, fear could paralyze us and cripple our response. On the other hand, a complete disregard for measures to help decrease the spread of the virus is like being careless with fire. We all want to return to a normalcy and way of life that is healthy physically, mentally, socially, and economically. However, cases are on the rise and denial of reality and a disregard for others is fuel for the fire.
The efforts of so many people to decrease the spread such as social distancing, wearing masks, washing hands, and being careful is helping to give scientists more time to research treatments and vaccinations. Progress is being made, and so many people are united in the same goal of getting through this pandemic, safely, together.
Recently I was visiting with a 98-year-old man. I asked him about this pandemic and what he experienced in the Great Depression and World War II. He was confident we would get through this. We will succeed if we do not let ourselves become divided, but work together, treating the virus with caution, and supporting those around us.
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.