GI Patients Moving to Adult Healthcare: Employment With a Chronic Illness



Having a Chronic Disease Is ‘a Job,’ but It Pays Dividends

Rheumatologist Susan Goodman says patients who ‘do their part’ after a diagnosis of ankylosing spondylitis can look forward to a life with few limitations.

By Dr. Sanjay Gupta

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Sanjay Gupta, MD, Everyday Health:Young men are typically the most commonly affected [by ankylosing spondylitis]. And they are probably the population of people who are least likely to think that they have arthritis.

Susan Goodman, MD, rheumatologist, Hospital for Special Surgery:Absolutely.

Dr. Gupta:What are those discussions like?

Dr. Goodman:Remember, these are people who probably have had symptoms for five to 10 years, so they know something's wrong. And I think that by labeling it, we're able to do a couple of things: We're able to decide on the best therapy, and we're able to help them prognosticate, figure out what's down the road. And what's so clear with all of the rheumatic diseases: the earlier we initiate therapy, the better we do.

Dr. Gupta:There's a genetic component to this disease. So, for a person who’s diagnosed now, if their father or grandfather had it, how much better are their chances, their prognosis overall, as compared to the generations before them?

Dr. Goodman:Oh, they're much better off now than they would've been a few decades ago. We don't have a cure for ankylosing spondylitis. We have a lot of interventions that can significantly improve function, significantly improve pain and symptoms, and probably decrease the rate of damage.

Dr. Gupta:What are some of the first things you tell your patients in terms of lifestyle changes, things they can be doing on their own?

Dr. Goodman:You know it's a tough question. Most patients, by the time they get to a rheumatologist, they're pretty miserable. And I don't think it's fair to burden them with a lot of extra things to think about immediately. You can't tell a person who’s come in — they're miserable, they have trouble getting out of bed — and you tell them, “And I want you to lose 30 pounds, stop smoking, and go to the gym.” Get them better, and then all these factors are very important to discuss.

Dr. Gupta:It's always amazing — people come in pain, and you tell them, “You should exercise,” and they just can't do it.

Dr. Goodman:Yeah. Give them a few weeks. You know, it's not that hard to get them feeling better pretty quickly. Once you get them feeling better, and they realize that it was a clear response to medication — depending on how old they are, a lot of them will stop it and start it a few times to kind of prove the point — but once they've accepted the fact that there is a medication that makes them feel better, then it's very easy to talk about what the other interventions can be. Exercise is helpful. I prefer when my patients walk rapidly. Jogging — most patients, a lot of patients, if they have any underlying joint disease, will get into trouble eventually if they are doing a lot of vigorous impact sports. But certainly walking, swimming, biking — all of those exercises are very good.

Dr. Gupta:Do you tell people when they walk out of your office that it is possible to live a normal life and do the things you want to do?

Dr. Goodman:Yes.

Dr. Gupta:You’re optimistic for them.

Dr. Goodman:I am. I think people who do their part… Having a chronic disease, unfortunately, it's a job. It takes effort, and it takes commitment. But for the people who understand that and who have a mindset to accomplish that, for the average patient with inflammatory arthritis, there are many, many things that can be done to meaningfully improve their lives.

Dr. Gupta:Perfect.






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Date: 07.12.2018, 13:21 / Views: 94451