Victor Rodrigue: “In India I wish the doctors would share more information about the illness and treatment with the patients. Many times ignorance about the illness leads patients to quacks. Especially in case of RA which is incurable in allopathy, many Indians try alternative forms of medicine which only worsens their health. Allopathic doctors tend to withhold crucial info from the patients, leading patients to fall prey to false promises of the quacks.”

 Mr. Victor Rodrigue, on my facebook page, has echoed immensely correct feelings about the incurability of Rheumatoid arthritis. But about doctors not sharing more information with patients thus leading patients to try alternative medicine beyond allopathy, I have mixed feelings. My comments are as follows. 

1. Whenever I diagnose a disease condition like rheumatoid arthritis or any other rheumatological condition, I always make a point to hammer in the mind of the patient but politely, that disease is going to stay in most of the patients. But to allay the anxiety coming with the new knowledge of incurable disease I compare RA with other diseases like Diabetes and hypertension, and tell them that although it is incurable, but inflammation caused by it which is the cause of all symptoms and pain, and also the damage can be easily controlled and they can lead a comfortable life but there is a need of regular follow up you’re your Rheumatologist who a medical professional trained especially to treat this type of disease. I also emphasize that they are not alone in their struggle but millions of people around the world go through the same symptoms and pain. In many ways, it is like diabetes where you have to control the glucose level with the help of anti diabetic medicines and insulin and by regular monitoring by their doctor to avoid complications. 
2.  I state facts in front of my patients and let them decide. My responsibility is to tell them the truth so that they do not fall prey tonquacks. I emphasize on the play of time, time is the greatest denominator in the development of deformity. If inflammation of the joints is not controlled adequately by ‘scientifically proved medicines’ at an early stage of the disease, it will lead to the irreversible joint damage. 
3.  No therapy has been proved to be 100% curative so far, and it is better to remain under the umbrella of scientific rheumatological medicine prescribed and monitored by a rheumatologist than consume xyz chemicals that will only harm your system and increase damage.
4.   But I understand that it is also not that simple. People and their relatives have faith in different types of medical systems, cost of therapy is also a concern, so patients go to various systems of medicine to try to find an invisible cure, go from one system to another driven by hope generated by various agencies, sadly losing out on precious time. I’ll say this again. You have just one body, one life. Please take care of it and don’t experiment with life. 
5. The proven fact is, patients remaining under the care of a Rheumatologist do far better. Those not, go from one system to another losing precious time, continuously damaging their joints, and return to a Rheumatologist in a crippling state.
6. Hence I say that my comments are mixed as even if doctors tell the patients nothing but the truth, patients go and try various systems in search of finding a cure, that give them false promises and hope. Generally, it is not a personal decision, it is a family decision. They also believe that if a doctor cannot cure your ailment permanently, the doctor is no good, let’s try another. I find this scenario  quite sad. It’s more like a moral dilemma for a lot of doctors I know. 
7. However I’d say that if a knowledgeable doctor, finds time to explain the disease and its dangers of not following modern medicines, the story may be different one. 
8. It is also my request to patients who have experienced the disease and understands various aspects of it to be social ambassadors and share their knowledge and understanding with others who are struggling to find the right path. 
9. I am always available to anybody who seeks my opinion to lessen their sufferings. I will always do my best within my limitations. 

Thanks for taking out the time to read my blog. I always look forward to your suggestions and comments on the posts. You can follow me @DrOPGarg or drop me a line on facebook.

Being a Rheumatologist, I try and make all the efforts to make the consulting experience as pleasant as possible for my patients because the truth of the matter is that no one ever looks forward to an appointment with the doctor J I make sure that my patients leave in a better frame of mind than they came in and always take great care that I do not increase their sufferings with my actions, words or behaviour.

During my career, I’ve experienced that people who come to me are simple suffering souls. They come to me to find a solution to their problem because they are troubled by it. A lot of us, in the medical profession tend to send them back saying that their suffering is all in their minds, if we are unable to find a problem or diagnose a disease. This, in my mind is a wrong approach. Most times than not, the patient is really suffering and it’s just that we are not able to see it at that time because of our personal inefficiencies or scientific inadequacies. It is an absolute disrespect to the individual if we tell them that they are fine and imagining the symptoms! We, as a community of medical practitioners, have to realize that the patient knows his/her body the best, better than us. What might be normal in most cases, might be an exception in the present one. The earlier you accept that 2+2 is not always 4, the better it will be for you. The need of the hour is to see beyond the obvious and realize that the scientific knowledge we have is not complete. Science keeps evolving and reinventing itself every day. It’s very important to place yourself in your patient’s shoes when trying to find solution to the patient’s problem. Sit with them and take time to get to the root of the problem rather than just eliminating all possibilities. A lot of us have made these mistakes, it’s time for the younger generation to learn from them.

Thanks for taking the time to read my blog. I always look forward to your suggestions and comments on the posts. You can follow me @DrOPGarg or drop me a line on facebook.

(If treated at this stage by modern drugs, further damage can be halted/ or delayed. If not treated at this stage effectively, damage will continue leading to the severe deformity as below.)

Deformed hand joints due to Rheumatoid Arthritis (RA)

Only a few years back, whenever somebody developed persistent joint pains and swelling, it was thought that there is no remedy except few pain killers  to relieve the pain and inflammation, patient was doomed to suffer. There was no concept of halting the ongoing march of arthritis, which usually resulted in progressive damage to the joints ultimately resulting a crippling bed ridden/ chair bound state. With the frame of mind of helplessness on part of patients as well as clinicians, these disorders were being managed by multiple agencies by unproven medications and therapies.

In the last decade or so, to deal with medical disorders of  the joints not requiring surgery, a new superspeciality called Rheumatology has emerged on the horizon of internal medicine. Modern drugs used in rheumatology have proved their effectiveness in halting the damaging effect of various arthritides especially Autoimmune diseases which include Rheumatoid arthritis (commonly known as Gathiya affecting mainly young females in child bearing age), Systemic lupus erythematosus (Multisystem inflammatory disease with skin rashes, fever and arthritis which can prove life threatening if not treated with urgency), Dermatomyositis ( Skin & muscle inflammation), Polymyositis (Muscle inflammation with severe proximal muscle weakness) and Sjogren’s syndrome (dryness of mouth & eyes and may be associated with joint pains) and of course Osteoarthritis ( Arthritis associated with age, obesity or weak musculoskeleton) to name a few. Rheumatology has developed considerably in recent years with the advent of better understanding of these diseases with modern diagnostic methods and better management with novel therapeutic modalities. A physician who deal with the whole spectrum of causes of Rheumatic deseases is called Rheumatologist. He is specially trained physican who has received specialized advanced training after obtaining MBBS & MD (Medicine) qualification   to find out & treat  the exact cause of arthritides by proven, scientific, modern rheumatic interventional techniques with the aim to halt the course of the disease and to save the joint from being deformed.

We’ve come a long way in the world of rheumatism and one of the most important things we’ve learned in recent years is that early and aggressive treatment is key to getting arthritides under control and preventing disability. But what is happening in the real world, all joint diseases are being dumped in one basket called arthritis and being treated by all and sundry by all sorts of ingredients and practices. What happens in the mean time, precious time is lost and arthritis continue to march  to damage the joint structures to limits of no return. A layman does not understand where to go, whom to seek the scientific, effective treatment. Patients go wherever their friends, relatives and medical practitioner of multiple discipline advices them to go.

Lack of awareness about the meaning of the rheumatologic terms is so acute that, what to talk about lay people, even few doctors, well educated doctors in their field are not aware about the meaning of Rheumatology & Rheumatologist. Very often patient reach to the rheumatologist after having developed multiple disabilities and deformities. With this in mind we are giving below the self explainatory table so that  everyone can decide for themselves where to go after developing the musculoskeletal pain in back or limb joints.

About rheumatism, it is a nonspecific term used by lay persons for various conditions with pain or other symptoms arising from joints (including those in spine ) or related to other elements of musculoskeletal system ( i.e. muscles , tendons, ligaments, cartilage and bone). Rheumatology includes over 120 diseases wherein arthritis and joint-symptoms are commonly present.

With the advent of Rheumatology, battlelines between patients in a partnership with their rheumatologist on one side and disorders we fight on the other have been drawn, and the scientific gauntlet has been thrown. In response to this, the clinical and tectonic plates of rheumatology have shifted in a profound manner, all for the good of our patients. Though a combination of explosions in our knowledge about basic mechanisms of disease, advances in our appreciation of the clinical “personalities” of autoimmune and musculoskeletal disorders, and the rapidity with which basic scientific wisdom is catapulted into therapeutic advances at the bedside, our patients are living better and longer lives. Today,s rheumatologist uses the multiple effective weapons in his armamentarium to detect and  intervene the disease process in its budding stage before it causes irreparable damage. He uses advanced immunological tests, imaging techniques (Musculoskeletal ultrasound, C-arm, video capillaroscopy) for this purpose. In other words, we can say that scene has changed in rheumatology for the great advantage to the patients. The need is to spread the awareness about this fact so that everyone can reap the benefit of  knowledge of rheumatology and save their joints, the basic transport of human and keep the wheels (joints) of nation moving.

One of the queries on my facebook page asked me for my opinion about AP therapy by Dr. McPherson Brown. Explaining everything in detail is quite a task on the post so I thought, I’d include this in my blog for the benefit of other patients.

First, let me give you a background of AP therapy. It is an antibiotic protocol therapy propagated on the premise that rheumatic diseases including Rheumatoid Arthritis (RA) results from mycoplasma infections and prolonged antibiotics can resolve the arthritis¹.

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