Year 4! Block 1: Rheumatology/Neurology

To start off my 4th year, I had my medicine sub-specialty block, so I chose to do two two-week rotations in Rheumatology and Neurology. Both I felt to be very important aspects of family medicine and sports medicine.

My preceptor for Rheumatology was Dr. Gary Silverman, DO. He ran a pretty chill, low-key office in Scottsdale that made for a pretty good learning environment. I became very familiar w/ arthiritis, many auto-immune diseases such as lupus, and fibromyalgia. Most of the patients were long-term established patients who had diagnoses in place, so I was able to see how treatments were tweaked over time, and used this as an opportunity to learn more about musculoskeletal pharmacology. I had learned about a newer drug class called TNF-alpha inhibitors, and had become very popular over the last decade. It was interesting that Dr. Silverman remained very skeptical about them. He related that traditional DMARDS (disease modifying anti-rheumatic drugs are like a watering hose on the disease, and TNF-a are like fire hydrants; very effective, but very broad, leaving risk of serious side effects. And even though I will rarely use those drugs in my own practice, there were tons of other musculoskeletal joint meds that I learned a lot about. He was also very active in the medical community, and introduced me to an online medical community known as Sermo, who was recently in the news as they opposed Howard Dean and the proposed new health care legislation. Overall, this was a good rotation, and I am glad that I did it. But in 2 weeks I saw about everything I was going to, and wouldn't have gotten too much more out of an addition 2 weeks.

I moved on to Neurology next with Dr. Mark Winograd, who ran an office next to Banner Thunderbird. It was nice that it was so much closer to my house. This was a very different environment. Dr. Winograd was a lot more intense, as he reminded me a lot of Regis Philbin, as he would raise his voice at unexpected times, and often wouldn't make complete sense. He would also tell me the same thing over and over. He was a very good neurologist, though, and good to his patients. I learned a great deal about EMG's, and I appreciated that I had a lot of one on one face time with the patients. He had me see all new patients first,to evaluate them and present my assessment to him before he would come in. I saw some good things, like fibro, seizures, lots of dizziness, movement disorders, and a lot of chronic pain. I learned that neurology is the specialty that gets the patients that no one else knows what's wrong with them. As such, I became very familiar with the diagnosis of myofascial pain syndrome! This again was very good for hitting upon different areas of pharmacology, and found applications to primary care and sports medicine. And Dr. Winograd was good at trying to make connections to sports med, and related first line management at a primary care setting. It was a good rotation, but again, 2 weeks was perfect.

Meanwhile, on the homefront, Meghan was at the end of her 2nd trimester and feeling all the discomfort of pregnancy. She had a really bad bout of sciatic pain from the uterine growth causing secondary impingement on the nerve. I was able to provide temporary and partial relief with osteopathic treatments, but it was not long lasting at first. Finally, either treatments helped or her pain tolerance improved greatly, and she was able to do better with her normal activities. Braylei and Tayscen were both still in swimming classes, and I made it as often as I could, but I was at the will of my preceptors and the work schedules!

For updated pictures of the family and our adventures, check out my facebook page For all our photo albums!