Uncommon Chat with a Rheumatoid Arthritis Specialist, part 2
This is the second half of an interview with RA specialist Dr. Shashank Akerkar of India.
In Part 1, read the doctor’s enlightening remarks about Rheumatoid Arthritis, using the internet for healthcare, and an amusing theory from a patient. Thank you, Dr. Akerkar, for visiting RA Warrior.
Doctor, in America, there are not enough rheumatologists and they are not as well paid as some other specialties. Do you have the same problem in India? The same problem does exist in India, as well. There is gross shortage of rheumatologists. India being a populous country, all of us have a big patient load. Believe it or not, I must see about 60-80 patients every day! Maintaining quality in the face of such a patient-load is another challenge all of us face especially in this part of the world. India has a two tier system in place, with government-run hospitals, teaching hospitals, and private hospitals with private clinical practice in place. All Consultants are paid equally in the government system.
How long have you been a rheumatologist? Six years to be precise. I was a faculty in Rheumatology at the Seth GS Medical College & KEM Hospital, Mumbai. I have been a practicing consultant for four years.
Rheumatology is a field with fast-changing science. How do you keep up-to-date the flood of information? The internet has been the biggest messiah. I also use scientific journals & EULAR (European League of Rheumatism) courses. Conferences do help keep abreast of the latest developments.
Can I ask, what do you think of the Marshall Protocol or antibiotic therapy for Rheumatoid Arthritis? No scientific basis for any of these.
Well, what about dairy and gluten? Can diet be used to treat Rheumatoid Arthritis? No scientific basis for any dietary cures for RA. All claims regarding these are unsubstantiated.
You say you want RA patients to conquest over RA. What is the biggest challenge that you face with helping your patients to fight RA? The depression that is associated with a chronic disease like RA. Many patients have seen multiple health care professionals with varying levels of relief. Many or in fact most of them inform them that this is a chronic disease with no treatment and it’s something that they will have to live with. Getting them out of this mindset is one of the biggest challenges. However, nothing succeeds like relief of symptoms and this is what works in most of them once they are on DMARDs.
What other challenges do you see to fighting RA? One of the biggest challenges for any RA patient is getting the family members believe in the pain they are going through. “You don’t look so sick” is a common phenomenon. Counseling the family members is an important task and getting them to understand what the patient is going through and making them a part of the team is essential in overall success of therapy. One’s family is the first and nearest support system for the RA patient.
What can be done to help patients’ family members to understand RA? Do you think doctors should counsel with families? It is true that given the patient numbers, it is difficult to spare time to educate the family members. However, some basic counseling is a must and we cannot do away with this. Apart from this basic counseling, one can always give a list websites to the family members to understand what RA is and its treatment options. In fact, this is precisely how my own site came up… to educate the patient and the family members.
Do you like the idea I have been suggesting of a class for new RA’ers and families? We do have patient & family members’ seminars for the education purpose. However, efforts are needed at the society level to increase the arthritis awareness. The internet is another medium for the same use. I’ve numerous patients who started with the search query of “joint pain” which lead them to the term “rheumatism,” then to rheumatology & then to rheumatologist & then to me. RA public awareness definitely requires a dedicated work from rheumatologists as well as patients who have gone through the hardships finding the right consultant. WHO’s ‘let’s work together’ is a unique concept in this direction.
Doctor, it has been enjoyable and enlightening to hear how hopeful you are about the fight against RA. You emphasize that patients and doctors should be a team; I agree. But that made me wonder…
Can you tell us the strangest treatment for RA that a patient has ever suggested? Cow urine is considered holy by some and has mythological value in Hindu culture. I still remember one patient who used to bathe with cow urine as she was told that this would cure her RA.
Recommended reading:
- Is it safe to wait? Can I Delay Treatment for Rheumatoid Arthritis? Part 2
- The real RA versus the mythical RA: To Tell the Truth: Will the Real Rheumatoid Arthritis Please Stand Up?
- Laughing it up about RA: Some Answers for Rheumatoid Arthritis Just Bring More Questions
- Did you miss Part I of Dr. Akerkar’s interview? Uncommon Chat with a Rheumatoid Arthritis Specialist
Cow urine is a new one! LOL… What a great interview with an enlightened RA doc. It’s astounding that his patient load is 60+ patients a day though. He sounds like a very caring doc but with that kind of load, it makes one wonder how soon he’ll experience “burn-out”. I’m blessed with a great rheumy, and I’ll share this with him as I think he’ll find it very interesting. Thanks again Kelly for your great work.
Hi Kelly,
Thanks for the interview. I enjoyed reading. I did chuckle to myself over the cow urine. In my area, bee stings are a big thing – everyone with RA, MS or anything else auto-immune related are doing it! (not me! I will stick with my shots!). Some are getting 30 – 40 bee stings at a time. They are saying it’s working…. They did just start an RA/fibro support group in my dinky little town. Meets at the end of Feb for the first time. Can’t wait to see if I’m the only relatively young person there…
I enjoyed this second half of the interview as well. Thank you Kelly. Very interesting to hear the views of a caring rheumatologist.
Thanks Kelly & everyone for all the appreciation.
You can continue visiting arthritissupportboard (www.arthritissupportboard.com/) & the blog (http://doctorakerkar.wordpress.com/)for all the RA related information & the latest scientific information that would help you manage your RA.
I am looking forward to rheumatology web 3.0 wherein, I would like to help RAers with their problems with online tools. The first endeavor in this is an online tool to help those with persistent complaints despite the DMARDs —‘My Rheumie says my RA is well controlled, but I keep having persistent pain’ This tool would have a set of questions would guide one to a possible cause which can then be discussed with one’s Rheumie. I plan to have numerous such tools down the way.
I’m sure that this is the road ahead to provide online interactive solution to the needy in consultation with their Rheumies. I hope you would help me in this endeavor.
Take charge of your RA; we (as Rheumatologists) would be a good guide & help you with your problems, online & otherwise.
Doctor Akerkar: Thank you so very much for all of your help, dedication and support for all of us. I was wondering if you see patients with AS and if so, does your treatment approach differ any? I suffer from AS and it is very rare that I find people out there who have ever heard of Ankylosing Spondylitis before nor are there blogs for this disease. I would love to learn more from you. Best of wishes!
Yes. AS is definitely a part of Rheumatology.
We call it a ‘poor cousin’ of RA; neglected despite its importance.
Approach wise, sulphasalazive & TNF alpha blockers have a much bigger role to play in AS vis a vis RA.
There are hardly any blogs on AS. I would like to include AS in my blog.
You can get in tocuh on twitter (http://twitter.com/doctorakerkar) for any specific queries. I would be happy to help you.
Wow, I loved this 2 part interview. I always wondered about the shortage of RA docs, now it all makes sense.
I also thanks Dr. Akerkar for acknowledging the importance of mental health being affected by a chronic disease such as RA. Not all Dr.’s understand how depression is a big part of living with RA.
Yes, I thought of your comment as I saw my dr. today. She said her greatest concern w/my condition is that depression can set in when I do not see improvement for so long. I thought that was a good sign.
I added this: I think I’m not depressed because I have some others w/RA to talk to…& that helps me. 😎 😎 😎
Having others that truly understands makes a world of a difference, I wish I had that support in the beginning. Now, I make it a point to help others who are newly diagnosed, I want them to learn from my mistakes.
I like when he says (in part 1) about seeing the smile on a patient’s face when they go into remission…. that is my wish for all of us.
I’ve just come across the interviews with Dr. Akerkar and found both part one and part two informative. I’ve been suffering severe joint pain since Dec. At 48 years old I’ve had a very healthy life. The dr “thinks” it’s RA and has been treating me as such until I go back to him next week for blood test results. I’ve been on Arcoxia and Methatrexate for a month and there’s been no change. In fact, the pain seems to be getting worse. As this is my first time EVER being “sick” (if I can put it that way) I am extremely frustrated at the way I feel – especially when I wake up in the morning. My entire body is painfully locked! The dr I am seeing is an internist….not one who specializes in RA. I’m at my wit’s end!
Hi Shawnette,
I know that feeling – one person wrote me that it’s like Gulliver being tied down by the Lillputians.
While I bless the internist for doing so much to try to help, RA does usually require a specialist – I know good ones can be hard to find, but that is the best way. Methotrexate takes weeks to help and the dose has to be high enough – and it still may not be enough on its own, depending on the RA. I don’t blame you for being frustrated!
Wow! Thanks for your reply, Kelly. This was my first post and you were the first to reply! 🙂 I was on 2.5mg taking 3 tablets once a week.(There were 12 of them) I just took my last three last week and have my first follow up this week Wed. I’m actually hoping the blood tests reveal it’s something else “fixable” 🙁 Regretably, there’s no RA specialist here in Bermuda.
Well, then if he and you are willing to work hard with research, you can make the best of it. Maybe he can even use email or phone to consult with a specialist to make sure he gets it right. I’ll be the American College of Rheumatology could help him find someone. RA diagnosis can be hard especially since symptoms may be inconsistent and medicine can mask them or alter blood tests.
Have you read through some pages here about tests and diagnosis? That might help you to as you try to know for sure what’s going on. You can look at the topical lists using the Tags list. I agree – hopefully not RA – but treatment early is what counts in that case. Good luck!
Yes. I’ve read several comments and they have been helpful in the understanding of RA. Seems mine just “snuck” up on me – if that’s what it is – and the pain from Dec to now (April) is awfully intense 🙁 I’ve also had xrays done last week and will have those results on Wednesday as well. Thanks so much for your kindness and all the information you have provided.
Pleastretment of rehmutiteairthrites