Friday School 10/30–Rheum/Immunology, Disparities & Knee/Shoulder!

Resident Friday School

Transitions of Care within Rheumatology: Dr Chira, from the Rady Children’s Hospital Department of Rheumatology, gave a session on Transitions of Care! Dr Chira emphasized the importance of a transition process for all children transferring care from the pediatric to adult health care system. He highlighted the 6 Core Elements of Transition from GotTransitions.org! The second half of the session was spent in small groups working through cases and building models to help us transition and welcome our young adult patients in our Internal Medicine clinics.

Health Disparities in Asthma: Dr Akuthota, from our Pulmonary & Critical Care Department, highlighted the high proportion of asthma and ER visits related to asthma in Latinx and Black ethnicities. These discrepancies between races are most likely multifactorial- SES, genetics, Vitamin D status, history of violence/stress, access to healthcare, environmental exposures. 

Pregnancy and Autoimmunity: Dr Smith, from our Rheumatology Department, emphasized that a “planned pregnancy is the best pregnancy” with our patient with autoimmune diseases. Low risk medications during pregnancy include HCQ, NSAIDs, AZA, calcineurin inhibitors, sulfasalazine, TNF alpha inhibitors! Do NOT use MTX, MMF, cyclophosphamide in pregnancy! HCQ is also associated with better pregnancy outcome in patients with SLE!

Mystery Case: Today we interviewed a patient about his symptoms. He endorsed worsening back pain and stiffness starting in his early twenties. As time passed, his symptoms became worse and he started to notice decreased range of motion of his back. Pain was worse at night and was associated with considerable morning stiffness. What was the final diagnosis? Ankylosing Spondylitis! Thank you to Mr H for joining us and telling us your amazing story!

Intern Friday School

The interns had a separate session dedicated to the knee and shoulder exam! Dr Quan walked them through the exam with interactive videos with real patients to help illustrate many of the physical exam maneuvers we use in clinic!

Click our Rheumatology and Allergy/Immunology in our Friday School section on the blog to get access to presentations and articles presented during these sessions!

Buprenorphine DEA X-Waiver Training: September 17th!

Who:  Residents can take this course prior to obtaining their own DEA – your completion will be recorded for use later.

What:  AAAP Buprenorphine Half and Half Course (½ online independently and ½ “in person” via Zoom)

Where:  YOUR OWN HOME via Zoom! You MUST RSVP in advance, attendance will be taken

When:  September 17th, 2020; 8 am -12:30 pm (you must attend the entire time for the waiver)

Why:  To be qualified to get a DEA waiver to prescribe buprenorphine products (one common brand name is Suboxone) AND to feel confident managing this growing patient population

This course is designed to equip prescribers with the information necessary to understand and prescribe buprenorphine in a safe and effective manner.  It also meets the 8-hour requirement (½ in person; ½ on line) for MD’s and DO’s to apply for the DEA waiver to prescribe buprenorphine.

Details:
This training is for ½ of the 8-hour requirement.  The remaining 4 hours must be done online, and you must pass a self-study exam to apply for the waiver. Contact Carla  Marienfeld (cmarienfeld@health.ucsd.edu) if you are interested in attending.

Celebrating the Life of Civil Rights Leader John Lewis: “Stand up, speak up and speak out…”

JOHN LEWIS, the civil rights leader and congressman who died on July 17, wrote this essay shortly before his death.

Listen to his friend, Morgan Freeman, reading the essay out loud here:

Together, You Can Redeem the Soul Of Our Nation

While my time here has now come to an end, I want you to know that in the last days and hours of my life you inspired me. You filled me with hope about the next chapter of the great American story when you used your power to make a difference in our society. Millions of people motivated simply by human compassion laid down the burdens of division. Around the country and the world you set aside race, class, age, language and nationality to demand respect for human dignity. That is why I had to visit Black Lives Matter Plaza in Washington, though I was admitted to the hospital the following day. I just had to see and feel it for myself that, after many years of silent witness, the truth is still marching on. Emmett Till was my George Floyd. He was my Rayshard Brooks, Sandra Bland and Breonna Taylor. He was 14 when he was killed, and I was only 15 years old at the time. I will never ever forget the moment when it became so clear that he could easily have been me. In those days, fear constrained us like an imaginary prison, and troubling thoughts of potential brutality committed for no understandable reason were the bars. Though I was surrounded by two loving parents, plenty of brothers, sisters and cousins, their love could not protect me from the unholy oppression waiting just outside that family circle. Unchecked, unrestrained violence and government-sanctioned terror had the power to turn a simple stroll to the store for some Skittles or an innocent morning jog down a lonesome country road into a nightmare. If we are to survive as one unified nation, we must discover what so readily takes root in our hearts that could rob Mother Emanuel Church in South Carolina of her brightest and best, shoot unwitting concertgoers in Las Vegas and choke to death the hopes and dreams of a gifted violinist like Elijah McClain. Like so many young people today, I was searching for a way out, or some might say a way in, and then I heard the voice of Dr. Martin Luther King Jr. on an old radio. He was talking about the philosophy and discipline of nonviolence. He said we are all complicit when we tolerate injustice. He said it is not enough to say it will get better by and by. He said each of us has a moral obligation to stand up, speak up and speak out. When you see something that is not right, you must say something. You must do something. Democracy is not a state. It is an act, and each generation must do its part to help build what we called the Beloved Community, a nation and world society at peace with itself. Ordinary people with extraordinary vision can redeem the soul of America by getting in what I call good trouble, necessary trouble. Voting and participating in the democratic process are key. The vote is the most powerful nonviolent change agent you have in a democratic society. You must use it because it is not guaranteed. You can lose it. You must also study and learn the lessons of history because humanity has been involved in this soul-wrenching, existential struggle for a very long time. People on every continent have stood in your shoes, though decades and centuries before you. The truth does not change, and that is why the answers worked out long ago can help you find solutions to the challenges of our time. Continue to build union between movements stretching across the globe because we must put away our willingness to profit from the exploitation of others. Though I may not be here with you, I urge you to answer the highest calling of your heart and stand up for what you truly believe. In my life I have done all I can to demonstrate that the way of peace, the way of love and nonviolence is the more excellent way. Now it is your turn to let freedom ring. When historians pick up their pens to write the story of the 21st century, let them say that it was your generation who laid down the heavy burdens of hate at last and that peace finally triumphed over violence, aggression and war. So I say to you, walk with the wind, brothers and sisters, and let the spirit of peace and the power of everlasting love be your guide.

(Taken from The New York Times, July 30, 2020)

Happy Juneteenth!

This day is traditionally celebrated as the day slaves where emancipated in the United States. As Barack Obama said, this day does not signal victory, but rather progress for those whose basic human rights had been squandered since birth. As we reflect on recent events, we can see that there is still a lot of progress that must be made. In addition to active reflection, we encourage you to look at the resources available at the Justice in June Campaign google doc. There are plenty of short articles and resources to further your understanding and expand your knowledge on the deep seated biases and systemic barriers that affect our marginalized communities! 

Impact of COVID on Communities of Color–Webinar 6/20/20

The San Diego National NMA has created a Taskforce addressing the negative impact the COVID19 pandemic has had on communities of color. This Saturday, June 20, 2020 from 9 – 10:30 AM, they will be hosting a panel of NMA physicians and supporters discussing what is taking place in their communities, specifically addressing concerns regarding health disparities. Please join with the attached link!https://us02web.zoom.us/webinar/register/WN_gCASMHScSbO2dNROdz08eg

#UCSD4antiracism medical student- and resident-led protests across all campuses

Students, residents, faculty and staff staged peaceful demonstrations at all three UCSD campuses. Speakers at the School of Medicine included Med Students Betial Asmerom, Jonathan Cunha, Ian Simpson-Shelton (incoming UCSD IM Intern!), Dr. Sierra Washington (faculty, OB/Gyn), and Dr. Cheryl Anderson (new founding Dean of the UCSD School of Public Health).

#WC4BL #BLM

UCSD SOM/VA
UCSD Hillcrest
UCSD La Jolla

COVID Perspective Piece in NEJM

I read this piece in this week’s NEJM and found it to be very thoughtful. I hope you do too.

n engl j med 382;19 nejm.org May 7, 2020

Fear and the Front Line

Susan L. Murray, M.B., B.A.O.

I have been thinking a lot about fear lately, and how much it behaves like a virus. How it can spread insidiously, person to person, or airborne, through new media and old, faster than we can contain it. How it induces so many of the same symptoms as a virus does: sweating, palpitation, nausea, shivering, and sometimes an almost overwhelming desire to curl up under a blanket in a dark room and stay there. How once fear has infected you, it is hard to get rid of, but extremely easy to pass on to others.

It is 2014, a different virus is splashed across the front pages, but the same sort of unease is in the air. I am a newly minted fellow at a small-town hospital, a long, long way from the epicenter of infection or anywhere that a genuine case of Ebola virus has been confirmed. On the street and on the wards, people are anxious. Having the wrong color skin is enough to earn you the side-eye from your fellow passengers on the bus or train. Cough once, and you will find them shuffling away from you.

The hospital is caught up in uncertain paroxysms of preparation for an epidemic that it hopes will never come. There are meetings and then more meetings. We are taught how to do the personal protective equipment hokey-pokey of gowning and degowning. There is ongoing debate as to whether we have the right gear. A sign appears on the entrance to the pneumatic tube leading from the emergency department to the laboratories: “If patient has Ebola, please do not put blood in chute.” Everyone seems uncertain.

“What will you do if we get a case?” my resident asks me, after yet another querulous staff meeting.

I eyeball the rows of gleaming new anti-Ebola Wellington boots lining the back wall of the ward. “Maybe I’ll just call in sick that day,” I sigh.

And then, one otherwise ordinary day, a young man arrives in the emergency department. He is in pain and shaking, far from home and struggling to overcome a language barrier. His cancer, when I assess him, is one of the most advanced cases I have ever seen. The edge of his liver is craggy with cancerous deposits. His bones are pockmarked with metastases. His skull is swollen with disease and pushing into the substance of his brain. He squirms in pain in the bed. We do what we can for him, but he is almost too sick for treatment. All we can do is try our best to make him comfortable.

Just before midnight on the second day of his hospitalization, he spikes a fever.

The possibility that he is infected with Ebola is remote, hypothetical. The embers of the epidemic in his home country are guttering. In 3 days’ time, the World Health Organization will declare it officially extinguished. But the guidelines for quarantine are clear. I discuss it with my attending, and she agrees that we need to take every precaution.

And just like that, the atmosphere starts to change.

The rumor spreads like ripples from a stone dropped in a still pond. I watch faces turn gray and eyes turn glassy as I try to explain that our suspicions are low, but yes, we are taking every sensible precaution. Work on the ward slows to a crawl. We do not have enough protective gear stocked, and other departments are suddenly guarding theirs jealously. I am told by a senior doctor that he and his entire department are unavailable to consult on the patient until further notice, since their safety cannot be guaranteed.

I am lucky, or maybe I’m just reckless, but the knowledge of the remoteness of the risk, and of the shiny, red patch of phlebitis on the man’s left arm that is almost certainly the source of his fever, inoculates me a little against the fear. In fact, I am almost certain that Ebola virus did not lay quiescent for a month and then travel 600 miles across the country to infect this man before he got on a plane to come here. I am prepared to bet my life, but not to ask others to do the same.

Still, at 5 a.m., wrapped up in a protective gown, trying and failing to get an IV access into his thrombosed vein because no one else will enter the room, I want to scream my frustration. The patient is only semiconscious now. He moans in pain as he sleeps.

At 8 a.m., when the day shift arrives, things only get worse. There are nurses hiding in the ward storeroom and doctors threatening to turn around and go home. The head of nursing arrives to demand that one of the nurses take responsibility for caring for the dying man. Eventually, she takes off her suit jacket, gowns up, and cares for him herself.

Most health care workers I know are brave people who perform demanding jobs in difficult circumstances. But one of the terrifying things about an outbreak of transmissible disease is that it’s not just our own life and health that we are being asked to put at risk in caring for patients. We risk being the vector that brings the illness home to the people we love — to our children and partners and parents — and that can be truly terrifying. It is easier to risk our own safety than to threaten the people we care about. Without support, without proper education, training, and contingency plans in place to help protect health care workers and their families, fear can run riot through a hospital or through a community. If we are not prepared to fight fear and ignorance as actively and as thoughtfully as we fight any other virus, it is possible that fear can do terrible harm to vulnerable people, even in places that never see a single case of infection during an outbreak. And a fear epidemic can have far worse consequences when complicated by issues of race, privilege, and language.

At 5 p.m. that evening, the man’s tests return, giving him the all clear. Around the ward, life begins to relax, heart rates slow, people smile again, the whole thing begins to seem a little like a bad joke, as the effects of the fear virus ebb.

The patient dies at 6 p.m.

Free Clinic Celebration and Fundraiser on May 14th!

Dear Friends, on May 14th 2020, the UCSD Student Free Clinic Project is hosting a virtual Celebration and Fundraiser. This is an annual event with touching stories about the impact that clinic volunteers make in our community. The details for the event are below, and everyone is welcome! See below for details:

Event Page:

https://medschool.ucsd.edu/som/fmph/education/freeclinic/support/Pages/events.aspx

Everyone is welcome! Whether you are new to UCSD Student Run Free Clinic, or have worked with us over the years, we hope you can join us. The event is free because we hope to include as much of our San Diego and national Free Clinic community as we can. Please take the time to register—we will be using the contact information to send a Zoom invitation closer to the event.

The event page also has a survey, “Free Clinic Over the Years.” This is not required for the event, but we are starting to archive stories from throughout the generations of the Free Clinic Family and hope to continue to add for many more to come!

If you are not able to attend the event, we would be grateful for your support by sharing your memories of Free Clinic with the survey or by any donation you are able to make. The funds will help Free Clinic continue to support our patients in a time when they need us the most. To learn more about how Free Clinic is currently doing, please see “Free Clinic in the Time of COVID-19” on our home page.

Opportunity in Addiction Medicine

The California Society of Addiction Medicine’s annual conference will be held in San Diego from August 26-29th, 2020. Scholarships are offered to cover the entire cost of registration. Please contact Stacy Charat (scharat@health.ucsd.edu) if you are interested in attending with local faculty members.  The scholarship application requires very little preparation but the deadline is April 24th so please express interest ASAP!