Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week -- eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93. If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your ...

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As I sit in the exam room waiting for my first patient of the afternoon, the phone rings. It rings four more times before I realize that Amanda Ringwald, our eighty-year-old receptionist, hasn't come back from taking a rare lunch break. I pick up the phone and say, "VA Hospital. Marianna Crane." Oops, I'm not back at the VA anymore. "Senior Clinic," I quickly add. "Hello, my friend." The familiar voice makes my ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation ...

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Having a chronic disease can be frustrating, especially when the patient seems to know more than the doctor. Unfortunately, this situation may be familiar to the millions of Americans suffering from a rare disease. In June, I had the unique experience of attending a convention for patients and health care providers to learn about one such rare disease category, vasculitis. Vasculitides (plural of vasculitis) are a family of autoimmune diseases characterized ...

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I had my first outpatient surgical procedure when I was still in high school and needed a plantar wart removed from the sole of my foot. As the doctor injected the area with a local anesthetic, he explained he did these procedures all the time, and I wouldn't feel a thing. After a short wait, he began to dig out the deeply embedded wart with a hooked scalpel. With the first ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including ...

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It was Albert Einstein’s “biggest blunder.” Using his general theory of relativity, Einstein devised a formula that predicted the universe was expanding. This was an unfathomable idea, though. How could the universe expand with all the gravitational forces pulling the heavenly bodies together. In Einstein’s time, the universe was thought to be stationary. A universe that was anything but stagnant was an inconceivable idea since celestial matter would spin out of control, ...

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On my last day of internal medicine residency, as I finished my senior grand rounds presentation, I “came out” to my colleagues and confessed the deep dark secret I had been hiding since medical school: I have fibromyalgia. A few jaws literally dropped, and there was an awkward silence, then polite applause. Afterwards several of my colleagues came up to talk with me privately and were offended and/or curious as to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing ...

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Back in my first year of blogging, I wrote a post, titled "A Day Without a Diagnosis," about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school. That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring. My first patient of the day was ...

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