Day in the Life of a Doctor: Pediatric Rheumatology

Be a part of medical resident Siobhan Deshauer, MD, as she meets Mona, a pediatric rheumatology affected person.
(Following is a partial transcript. Observe that errors are potential.)
Deshauer: Hey, guys! I am Siobhan, a fifth 12 months medical resident. Now, I am coaching to turn out to be an grownup rheumatologist, and a part of that course of is doing one month in pediatric rheumatology. For the final couple of weeks, I’ve been seeing youngsters in clinic, and it’s so a lot enjoyable. This morning we’re going to be in a pediatric rheumatology clinic, and I am actually hoping to introduce you to a 6-year-old lady named Mona. After which the afternoon we’re going to see any consults that come up on the ward within the hospital.
In case you are not certain of what a rheumatologist is, we specialise in treating systemic autoimmune illnesses like rheumatoid arthritis or lupus, illnesses the place the affected person’s immune system will get confused and begins attacking the affected person’s physique. This results in an entire vary of signs, from painful arthritis to kidney injury, and even irritation within the mind. Good morning, guys!
Batthish: Good morning.
Debbie: Good morning.
Maddie: Good morning.
Deshauer: That is such a talented and caring medical group and so they have been so welcoming to me. There’s Dr. Batthish, a pediatric rheumatologist; Debbie registered nurse; Maddie, a resident bodily therapist; and Amy a toddler life specialist. As you may see, they every play an vital function within the remedy of those youngsters.
Batthish: Hello Siobhan, so our subsequent affected person is Mona. She’s a 6-year-old lady with a current prognosis of juvenile dermatomyositis. Mona was identified in April of this 12 months, and he or she has performed tremendously properly since beginning remedy with methotrexate.
Deshauer: Oh, good.
Batthish: Mona is in as we speak for her methotrexate injection and a physiotherapy evaluation. Hey, Mona.
Mona: Hello!
Batthish: How are you doing sweetie?
Mona: Good.
Batthish: Are you properly as we speak?
Mona: Yeah.
Batthish: How fantastic. What can we do…?
Deshauer: Juvenile dermatomyositis is a uncommon autoimmune illness that impacts kids. Dermato, that means pores and skin, as a result of they develop distinct pores and skin rashes round their eyes and over their knuckles, and myositis, that means muscle irritation, which makes these sufferers very weak. Eight months in the past, Mona received sick. She had a lot muscle irritation that she could not stroll and her mother and father needed to carry her into the hospital, a terrifying expertise for them. Mona was identified with juvenile dermatomyositis, and he or she was handled with medicines to suppress her overactive immune system known as prednisone and methotrexate. As you’ll be able to see, she is doing so properly now. Hey!
Mona: Hello.
Deshauer: What’s your identify?
Mona: My identify is Mona.
Deshauer: What was it like whenever you first received sick Mona?
Mona: It was like boring, as a result of strolling is form of enjoyable.
Deshauer: Yeah. It was boring not to have the ability to stroll.
Mona: As a result of like what if we will not play cover and search and stroll?
Deshauer: What was it like whenever you have been within the hospital?
Mona: I’ll say I used to be only a bit scared, as a result of I did not comprehend it was going to be like that needle.
Deshauer: Simply think about how overwhelming it should be for just a little 5-year-old to get a brand new prognosis and wish an injection remedy, getting bloodwork commonly, and coming to the hospital on a regular basis. We even have a sort of healthcare supplier who assist youngsters navigate this entire course of and so they’re known as little one life specialists.
Youngster life specialists like Amy educate youngsters about their sickness. They assist put together kids earlier than procedures like an injection or bloodwork by working towards every step on a stuffed animal. This fashion they know what to anticipate, and it decreases a few of that worry and anxiousness. For Mona, that features numbing the pores and skin with a patch earlier than getting the injection, I wanted we use this extra for adults, after which selecting out a toy to distract her and a enjoyable band-aid for after. Now it is time for the actual deal.
Debbie is giving Mona an injection known as methotrexate. It is a remedy that is given as soon as per week to suppress the immune system and forestall it from attacking her muscular tissues and pores and skin. At this level, after months of receiving the injection, Mona is a professional.
Maddie: Once I first began working with Mona, she had a extremely exhausting time standing, strolling, in addition to loads of joint contractures — which meant inside shoulders and elbows — she wasn’t in a position to absolutely lengthen or transfer her joints. She additionally had contractures in her hips and her knees and her ankles. Mona has put in loads of exhausting work to stretch all of these joints and get her energy again as much as the place it’s as we speak. Now, she is just not solely strolling and standing, however she can also be climbing the steps and dealing on leaping, and single leg stability. So she has made enormous strides since we began working collectively.
Deshauer: A part of bodily remedy is stretching her muscular tissues. As a result of when Mona first received sick she wasn’t strolling or transferring her joints, so that they tightened up, inflicting contractures. Even after the irritation had resolved, the vary of motion of her joints was restricted. She has performed loads of work to get up to now and take a look at her now. I completely love how enjoyable Maddie makes these workout routines. Hey.
Maddie: Excessive 5. Yay, Mona.
Deshauer: What about now? How do you’re feeling now?
Mona: Good.
Deshauer: Yeah? Do you’re feeling all higher now?
Mona: Significantly better than earlier than.
Deshauer: Yeah. What is the largest distinction now?
Mona: The most important distinction is I stroll usually. All of the nurses are good to me and so they assist me really feel higher, and so they handle me, and so they assist me really feel higher. A particular due to Maddie and Debbie. Peace, guys.
Deshauer: Is not Mona wonderful? You may simply see how comfy and assured and protected she feels, which I believe is a big testomony to this medical group. It is wonderful to see how properly Mona is doing and to listen to the distinction for her high quality of life. However each time I see just a little child with a illness, it’s important to marvel, what does it appear like going ahead for her?
Batthish: Nicely, we’re very lucky that we have now loads of remedy obtainable to us for kids like Mona. With early onset remedy, they typically do very well. Somebody like Mona, who has already proven such enchancment so early, I am actually hopeful that we will preserve her state of remission and finally even wean her off remedy.
Deshauer: Improbable. Hopefully simply be capable to have a standard childhood and…
Batthish: Completely. She ought to be capable to do no matter she desires. Any sport or any exercise sooner or later might be obtainable to her.
Deshauer: That is implausible.
Batthish: Thanks a lot Deshauer for a beautiful morning. I actually admire having you in clinic as we speak. I did hear although, that there could also be a seek the advice of on the ward for a potential MIS-C [multisystem inflammatory syndrome in children] case. Once you’re performed, why do not you meet up with Dr. [inaudible] to assessment it.
Deshauer: Completely. No drawback. I am going to simply end my notes, after which I am going to head upstairs. I really like how the hospital is filled with a lot coloration. It is so cheerful. It is actually, I want we did this in grownup hospitals. Additionally, try these cute buggies to push youngsters round. There’s even just a little parking zone to depart them in.
That is the hospital map and you may see it is divided into 4 colours, which is very nice for youths. It is really actually useful whenever you get misplaced. That is the purple part, as you’ll be able to see. Now, I’ll attempt to discover the ward this affected person is on.
I have not learn this affected person’s chart but. However what I do know up to now is that she is a 10-year-old lady who was beforehand fully wholesome and is available in as we speak with 4 days of fever, feels like belly ache, diarrhea, a rash and has had form of purple eyes. The query to us as we speak is may this be multi-system inflammatory syndrome in kids, which is a severe situation that is linked to COVID-19.
MIS-C can occur to youngsters about 4 weeks after a COVID an infection, and so they normally develop a fever, rash, and swelling. We’re nonetheless studying quite a bit in regards to the situation. However up to now we all know that early prognosis and remedy is vital to stop issues. I stroll into the room and see a younger lady mendacity in mattress along with her mother stroking her hair. Her mother explains that they’ve been so cautious to keep away from any COVID exposures.
She does attend faculty, however there have not been any current circumstances in her class. The lady is not fascinated about speaking, however she does enable me to look at her. Each eyes are purple. Her abdomen is mildly tender, and her fingers do look puffy and purple.
Her lab work exhibits excessive ranges of irritation and particular checks for her coronary heart known as the troponin and pro-BNP present that her coronary heart is beneath further stress. A few of her infectious workup remains to be pending and never again but, however up to now that is trying fairly according to MIS-C.
One factor that is actually totally different in pediatrics is that you just’re not simply treating the affected person, however you are typically speaking with mother and father and counselling them. So it looks like there may be form of a number of sufferers within the room to take care of in a manner. At this level, we have to get just a little bit extra info, get some blood work to search for antibodies to point out if there was a COVID publicity, and an ultrasound of the center. As a result of the blood work confirmed that the center is beneath loads of pressure proper now, and we wish to really see the way it’s pumping, if there may be some other points.
The ultimate step is definitely treating her in order that she may really feel higher once more. We have to deal with the immune system that is so revved up proper now by giving a medicine known as IVIG [intravenous immunoglobulin] and steroids. Each of these ought to work fairly rapidly and get her feeling higher quickly.
I simply really feel badly as a result of it looks like these mother and father are blaming themselves. I imply, they’ve been tremendous cautious. There is no such thing as a identified COVID publicity, however typically that is what occurs. We’re in a worldwide pandemic, so it is unimaginable to keep away from it fully.
I am completely loving this rotation, severely a spotlight in my coaching. This medical group is so passionate. They actually go above and past to advocate for all of their sufferers. It is simply a lot enjoyable to play with youngsters and empathize with mother and father. I imply, there have undoubtedly been some days that I’ve come house, particularly after seeing some actually unhappy circumstances or sick youngsters, that kind of weighs in your coronary heart and that is robust.
However then there are different days that I come house and I ponder why do not I’m going into pediatrics as a result of I am loving this a lot. Then I keep in mind that is the way in which I felt after just about each rotation in medical faculty, as a result of there’s something wonderful to find in each medical specialty. I wish to say an enormous thanks to your entire pediatric rheumatology group and, after all, to Mona for making this video potential. If you wish to see extra movies like this, then make sure to subscribe and that manner, I am going to see you within the subsequent video. Bye for now.
Siobhan Deshauer, MD, is an inner drugs resident in Toronto. Earlier than drugs, she was a violinist, which is why her YouTube channel known as Violin MD.