“Do you seriously want me to stand on my tiptoes?” my gruff 68-year-old patient at the VA Rheumatology Clinic asked, incredulous. “I came with a walker. I think you very well know, doc, that if I get on my tippy-toes, then I’m going to fall flat on my face.” He had a point, one that…
Dr. St.Clair Reflects on Progress in Rheumatology
As a practicing rheumatologist, I have experienced the increasing payer and government involvement shaping our evolving healthcare system. New payment models, changes in health insurance coverage, the federal mandate for the adoption of electronic health records and the implementation of ICD-10 are recent changes that have rocked our world. Our patients are also paying the…
When Sense Disorders Signal Immune System Interactions
I sometimes find myself mired in sticky clinical circumstances. I am facing a distraught patient who is seeking my opinion about a condition that, according to some, may not truly belong in the rheumatologist’s bailiwick. Case example: hearing loss. The Steroid Test Sudden sensorineural hearing loss (SSNHL) and its relative, autoimmune inner ear disease (AIED),…
Health Video Games Spark Interest, Try to Gain Traction
In the late 1990s, Thomas Baranowski, PhD, professor of pediatrics specializing in nutrition at the Baylor College of Medicine, Houston, applied for a grant. For years, he had been interested in finding ways to get children to change their diet and physical activity. He decided to try a video game, and he got the money…
Improve RA Care with Vitamin D
Background Autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematous, occur when the body attacks its own tissue because it cannot differentiate between self and non-self. This is mainly through deregulation of the immune system. Vitamin D has been known to play a critical role in bone mineralization and bone health. Activated vitamin…
Rheumatologist Steven S. Overman Reflects on His Last Day of Practice, Future of Specialty
I am a few weeks post-retirement. Having written thank you notes and completed urgent home projects, I swing in a hammock at our currently fire-threatened cabin north of Winthrop, Wash., and reflect. I feel like a young boy while freely flipping pages of a hand-scribed picture book, The Principles of Uncertainty, by Maira Kalman. She…
Diagnostic Criteria Released for Neuromyelitis Optica Spectrum Disorders
Recent updates to criteria used for diagnosing neuromyelitis optica (NMO) are aimed at helping physicians make the differential diagnosis of this disorder differentiating it from other inflammatory disorders—a diagnosis that can be difficult given the presenting symptoms that can mimic a number of other conditions, such as multiple sclerosis. Published in July 2015, the new…
Patients OK with Secure Web Portals for Test Results
(Reuters Health)—Of all the ways for patients to receive their medical test results, one option—password-protected websites—appears to be preferred much of the time, a study suggests. U.S. researchers surveyed about 400 adults and found they were generally comfortable with web portals regardless of how sensitive the test results might be. This was among the most…
Even Doctors & Nurses Don’t Always Have Healthy Lifestyles
NEW YORK (Reuters Health)—Even doctors and nurses don’t always follow the healthy lifestyle choices they recommend for patients to reduce the risk of medical problems, such as obesity, heart disease and diabetes, a U.S. study suggests. Although rates of these conditions appeared lower among healthcare workers than other people, the diseases were still common. They…
Use of Unspecified Codes in ICD-10: What You Need to Know
The ACR Practice Management and Coding department will periodically update the membership on the new ICD-10 coding guidelines and conventions to assist practices with accurate billing. Our top question during the first week of ICD-10 implementation was on the use of unspecified codes…
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