The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / The Rheumatologist as Detective

The Rheumatologist as Detective

February 1, 2015 • By Charles Radis, DO

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Looking up at the clock over the exam room door, I brought myself back to the problem at hand. Start over. When all else fails, the saying goes, examine the patient. If there was an answer to Leon’s illness in the referral notes and labs, he wouldn’t be here. Start over.

You Might Also Like
  • Rheumatologist-Nobel Laureate Dr. Baruch (Barry) Blumberg Deserves Recognition
  • Hepatitis-C Virus–Associated Arthritis
  • Osteonecrosis of the Jaw
Explore This Issue
February 2015
Also By This Author
  • RA Diagnosis Uses Lab Tests, Clinical Insight to Rule Out Lyme

Start at the Beginning

The first thing I noticed when I shook Leon’s hand was that, at the corner of his elbow, folded neatly at the crease, was a completed New York Times crossword puzzle, in ink. Put that into the mix, I thought. He cautiously extended his hand. The fingers were cracked and calloused. Subtle swelling was present in the second knuckle. The right forearm was bruised. “Leon Woodle. Everyone calls me Leon. Thanks for not gripping too hard, Doc.” He noticed the internal medicine resident hovering at the door. Some patients are reluctant to have another stranger sit in on their consultation, but Leon was comfortable with the attention. “Come on in. Two heads are better than one.”

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

If at first the diagnosis eludes me, a careful review of the history & a good physical exam with a dash of focused lab usually makes the obscure apparent.

With a look of relief, the resident entered and leaned against the sink. For the past week, this particular third-year resident, “Dr. Litmus,” had shown that she was a cut above most of her classmates who rotated through my office. She was comfortable with patients, bright, logical and empathetic, and I was hoping to interest her in applying for a fellowship in rheumatology rather than her stated interest in cardiology.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

I asked Leon how long he’d lived in Maine. “Five years. Came back to live with my mother. Help out with the farm. My opportunities for making a living in New Jersey were, what I would call, limited.” He hesitated for a moment and added, “Prison will do that.”

“What’s it like working with pigs?” I asked.

“Yeah … You know, pigs are pigs. They eat most anything, and as long as you shovel their sh*t and keep their shed clean, they’re pretty content. Seasonally, I tar driveways. Money’s actually pretty good. Keeps me busy.”

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

“So what was the first thing you noticed when your health changed?” I asked.

“Fatigue. That was maybe six months ago. The heat and I don’t agree, so when I began to get the sweats at night, and it was summer, I didn’t think much of it at first. But I got so bone tired, it was all I could do to drag myself out of bed.” He stopped for a moment and scratched at his elbow. “I think the swelling in my right hand came next. This one was first,” he pointed to the second knuckle, “then this one.” The fourth finger’s middle joint was reddened and boggy.

Pages: 1 2 3 4 5 6 7 8 9 10 11 12 13 | Single Page

Filed Under: Conditions Tagged With: pigs, Radis, rheumatologist, Whipple's diseaseIssue: February 2015

You Might Also Like:
  • Rheumatologist-Nobel Laureate Dr. Baruch (Barry) Blumberg Deserves Recognition
  • Hepatitis-C Virus–Associated Arthritis
  • Osteonecrosis of the Jaw
  • Why I Still Like Being a Rheumatologist

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.