Recent Posts



Telemedicine: Rheumatology is coming to a rural town near you.

Rheumatologist are few and far between. The supply is low but the demand is high. Patients with rheumatoid arthritis account for about 1 percent of our population and are in constant need to be evaluated by their rheumatologists. Well, what about those living in rural communities who need to drive 2 to 3 hours to see theirs? That’s a 4 to 6 hour round trip. Add an hour for the appointment. Add an hour for food and restroom breaks. Add the cost of gas. Add the time away from work. Now, multiple that by every 3 month visits and imagine the emotional and financial expense. What if you were 75 or 80 years old and have transportation limitations? Telemedicine provides medical care for these patie

Lupus Rash Photosensitivity

Photosensitivity has been associated with lupus and lupus flares. The most important question is what does that mean? Photosensitivity in lupus means that sunlight exposure activates the immune system. The most common reaction is a facial rash but the key is that the rash is not soon after sun exposure. It’s an inflammatory process. Liken it to a skin infection after a scrape, scratch, bite, puncture, or sting. The affected area develops redness, warmth, tenderness, and the skin raises at and around the damage area. It is a gradual process and is not instantaneous. It also lasts for a several days if not treated. The lupus facial rash is similar to that but without the manual injury. The sun

Rheumatology in the World of Telemedicine: My Experience

I have been working with Vigilias, LLC (FreeState Health Care) as a rheumatology consultant on their Telehealth platform for a year now providing outreach in remote towns in rural Kansas. I have been able to help many, which is the sole purpose of my participation. The more I have explored this landscape, the more I have uncovered limitations as a rheumatologist. Rheumatology is not a binary disease. There are shades of grey that muggy the water and make things complex. So What are the Good and the Bad? The premise is simple. Patients access my rheumatology clinic by visiting contracted local satellite hospitals ( The setup is simple. Screen

I have the gout.

When patients ask me about gout, I ask them why do you ask about gout? Patient: I was diagnosed with gout. Me: How were your diagnosed? Patient 1: By blood tests. Patient 2: My foot hurt after working. Patient 3: I ate a lot of crabs and then my toe started to hurt. Me: Did it start all of the sudden, like you woke up with the pain? Patient 1: No. It was over several days and has been getting worse since. Patient 2: I felt it when I put on my work boots and got worse as the day went on because I was standing a lot. Patient 3: Yes. It woke me up in the morning. WHAT IS GOUT? Gout usually is an "all of a sudden severe to extreme" pain in a joint, classically, but not exclusively the big toe. I

Doc, my neck hurts.

Many patients complain to me about neck pain or shoulder pain. The pain is aching, throbbing or even burning. My doctor said "you have arthritis in my neck." The most common reason, in my opinion, for neck/shoulder pain is poor neck posture. The muscles in the neck that extend from the upper back shoulder area into the neck is the trapezius muscle. It almost looks like a triangle on its side, with the wide base along the spine and the apex pointing towards the shoulder. Poor neck posture or slouching occurs from people who do a lot of desk work; computer, reading, writing, etcetera. You're so focused on the material in front of you, which may be small font, that you voluntarily but not reali

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