Sydenham: Granddaddy of Rheumatology?

Here’s a little quiz for all you medical historians:

  • Which physician when asked to recommend a medical textbook famously advised the enquirer to buy ‘Don Quixote’?
  • Which physician developed (and personally tested) the liquid preparation of opium better known as Laudanum?
  • Which physician was known as ‘the English Hippocrates’?
  • Which physician wrote the greatest description of a gouty attack in English Literature?

The answer to all of these questions is of course Thomas Sydenham, an English Physician who lived in the seventeenth century in an era where only the rich and famous were privileged enough to be afflicted by gout. He is my pick as the granddaddy of Rheumatology, although I suppose his own hero Hippocrates himself is the great-granddaddy (more of that for another blog). In 1683 he published one of the first texts on gout ‘Tractatus de podagra et hydrope (The Management of [Arthritis] and [Dropsy])’ and in it he shared not only the insights he had gleaned from treating patients but also those learned the painful way. For Sydenham himself had been afflicted with gout since the age of 30, and his constant pain led him to personally try (and reject) most of the proposed ‘cures’ of the time. He eventually relied upon taking Laudanum during acute attacks and barley water as prophylactic. He is quoted as saying “Of all the remedies it has pleased almighty God to give man to relieve his suffering, none is so universal and so efficacious as opium”. It is clear that Sydenham was not a great fan of rational medicine and taught others to learn by careful observation and experience.

If Sydenham were around today, I believe he would be a vigorous proponent of ‘narrative medicine’. His classic description of a gouty attack is for me unparalleled in medical literature and speaks directly from the voice of personal experience.

Why can’t IT be used to help us work smarter?

I work in a large organisation, a ‘Trust’ within the larger National Health Service. In fact, we could be the furthest northwestern outpost of the NHS in the UK! In the past we might have been considered a sleepy backwater and our IT department was small and friendly if somewhat dis-organised. There were always a few helpful ‘geeks’ who were prepared to listen to what was needed to get the job done – and who would find ways of sorting it out. We could call round for a chat (without an appointment) and get a straight answer. Now we have a much larger ‘centralized’ IT department which is probably more efficient, but definitely less personal. We can’t call the IT person that we know but have to call a central phone number and get a ‘job number’. We now have total compliance with ‘security’ policies which are probably on a par with the ministry of defence! Internet connections are of course monitored at all times and wireless connections are forbidden.

After we lost the ability to use USB sticks on our computers I started to rely on Dropbox (a great bit of software which synchronizes files smoothly between all your computers). When the IT department discovered my creative ‘work around’ they blocked all access to Dropbox. I should be thankful I wasn’t thrown in jail, I suppose!

This added to the prohibition of accessing any web address with forums, Facebook, Google or Yahoo in the address! So I can’t access google groups at work unless I go direct on my iphone. And of course we can’t synchronise my work email/calendars with my home computer/phone. I had set up a ‘google documents’ group to share ultrasound pictures and teaching materials with trainees but access was denied for ‘security reasons’. But why should I complain? At least they haven’t banned me from taking my phone to work – not yet, anyway! Does anybody else recognize these frustrations or am I being a bit unreasonable?

So – my question is – how on earth (or in cyberspace) am I to keep up with you guys?

P.S. Check out Paul Sufka’s great article on Dropbox and other useful tools!

Evernote and the Rheumatologist

One of my favourite web tools is Evernote. I use it for clipping articles, URLs or pictures from websites and then going back to put them into lectures, teaching materials, blogs or simply for reference later. It works straight from most browsers and the standalone desktop programme allows you to review, tag and generally tidy up the snippets you’ve collected. It also automatically stores the URL of the page so that you can return to the original page and reference your source if you later use it. The fact that I can access this from work, and indeed from any computer I’m using (including Macs and iphones) is the real deal clincher. Sharing via facebook and twitter from within Evernote is possible although I haven’t used those options.

Fifteen years ago when I first created my ‘arthritislink’ website for patients I often used Yahoo and AltaVista search engines to try and find hidden gems on the internet. At that time there was very little reliable information on the web about arthritis – whereas now the depth and quality of information is so mind-boggling that the main problem is information overload. Every patient can now draw up their own online portfolio of useful advice (perhaps using Evernote) – but do they need help in sorting out the good stuff from the bad? And perhaps we as Rheumatologists should be encouraging people with arthritis to help point us to nuggets of information they have discovered.

I understand that Evernote can also be used to scan text or record voice memos  – I’m going to explore the ‘Evernote Trunk’ and see if if I find anything else worth using. So if you have any tips on how to make the most of this software, please share it with the rest of us!


Caffeine and the Rheumatologist

As a passionate fan of coffee, I feel like a real ‘killjoy’ when I advise people with arthritis not to drink too much coffee. So why all the fuss?

The problem is that caffeine has an effect on a chemical in the body called adenosine which is also the target of Methotrexate. In theory taking too much caffeine could stop Methotrexate working, and some studies (in rats, I have to admit) suggest that this  is a real effect. If you want to read about this in more detail, check out a recent article by Bruce Cronstein. Dr Cronstein and his co-workers have done much of the research so he knows what he is writing about. Methotrexate causes release of adenosine which may have an anti-inflammatory effect whereas  caffeine blocks the adenosine receptor (i.e. stops it working). Interestingly, he also says that adenosine helps put us to sleep and this may be why people taking Methotrexate often feel tired. From a practical point of view, if your Methotrexate is working well I wouldn’t worry too much about this, but if it hasn’t had the desired effect then cutting down on caffeine might just work! There are some pretty good decaff coffees so you mightn’t have to give up your favourite drink, after all.

Finally, a poem about coffee and the thinking man…

21st Century Rodin

The upper right-hand
corner of my desk blotter;
a fresh, stark canvas
this morning, now a sepia
montage of concentric
I sip,
I Think.
I sip,
I think.
I sip…
I think.
Colin Harmon, award winning barista, in Dublin brews concoctions here!Sip.
Big sip
sip sip sip
sip sip sippppp.
Final sip, cup down.
A caffeine-laced
still life of a Slinky.
was-I-ever productive

-Mark L. Lucker

My First Message to the mobile world

A wicked and most unflattering cartoon of cyberPhil
Typical patient's comment: You didn't have that beard the last time I saw you!

Here we are with the first page of my medical blog, hopefully optimised for mobile phones. I am going to experiment with some of the tools to integrate Twitter and/or Facebook into the blog. I’m going to have a separate design for the full-size version and another one for the mobile user. Hopefully the system will automatically detect the device you are using to view the site. There will be a lot of design work to be done, so please keep the comments coming in to help me get it right!

Thank you for your patience!