Plaquenil... The Wonder Drug...

I love Plaquenil.

Also known as hydrochloroquine. It's a medicine that works wonders for a lot of my patients with lupus and rheumatoid arthritis. It can also help with Sjogren's syndrome, and even sarcoidosis. When it comes to treating autoimmune disease, there is no equal. It's a generic, it's time-tested, and effective.

It's an old anti-malarial medicine. The US Army gave it's precursor, Atabrine, to a few million GI's in the South Pacific to prevent malaria during World War II. A few of the Army doctors noticed that some of the men with autoimmune disorders got better... There wasn't much else to offer these patients, so they brought the medicine back to the states, and we've been using it ever since.

There are no drug interactions with plaquenil. It's very well tolerated, but does sometimes cause nausea, but that almost always gets better after you take it for a while. Most of my patients notice improvement in their fatigue within a couple of weeks. Then, over the next few months, many of my patients begin to feel their joints loosen up, their mouth sores clear, and their dryness improves... It's pretty unusual that it's the whole answer, but it's part of the treatment plan for a lot of my patients.

It's good stuff!!!

Which is why I can't, for the life of me, figure out why some clinicians don't at least try it!!!

I saw a new patient today, a nice girl who's been diagnosed with scleroderma at a young age. She developed some arthritis later, as well as Hashimoto's thyroiditis and interstitial cystitis. Throw in some mouth sores, rash, fatigue... She's a walking textbook of autoimmune illness. When she has a positive ANA last year her internist offered plaquenil. The patient called her rheumatologist, and he said 'no way, won't work...'

Huh?

How did he know? Why not try it? I've been shaking my head all evening over it.

I had another patient last month, with lupus, whose previous rheumatologist refused to write her for plaquenil even though she asked for it by name. He said he 'didn't have good luck with it'. Whatever. I started her on plaquenil and she's much better.

Sure, these are just a few patients. But my point is, if there's something out there that's low risk, effective, and can possibly help your patients, why not give it a try? Sure, there is the extremely small chance of eye problems with the medicine, but that's rare and with proper monitoring doesn't pose a long term risk.

 So, give it a try... You'll be glad you did...
 

A Birthday Blog, or What Gilgamesh Can Teach Us About the Meaning of Life

Today is my birthday. Please hold your applause.

Today is a great day to reflect on my life. As a husband, father, and member of the healthcare community, I am so fortunate to have a job where I am able to provide care, help people, and alleviate suffering.

I am reminded of the Epic of Gilgamesh. This was a story from ancient Mesopotamia, and the earliest tablets date back to the 18th century BC. There are 12 tablets and a lot of things going on, but the part I want to share is about the hero, Gilgamesh. He was quite the hero; part-god and part-man, and apparently was quite the specimen. He had it all, but went on a quest to find the meaning of life.

He went on an epic journey, crossing the ancient world seeking true meaning. He tried a solitary life, communing with nature, but that left him lonely. He thought that maybe killing the ogre Humbaba would give him renown, and elevating his status among his people would bring him meaning. Didn't really satisfy him. Gilgamesh tried wine, women, and song... I'm sure that was fun at first, but it soon left him empty... Longing.

He spends the night in the desert pondering his dilemma, with the enormous weight of the meaning of life on his mind. He finally collapses in exhaustion under a tree on a hill overlooking a city. He awakens as the sun rises.

Gilgamesh gazes upon the town as the morning sun begins to shine on the houses, and sees the townspeople begin their day. Men, women, children milling about, starting their morning chores, interacting, eating breakfast... Living their idyllic ancient Mesopotamian lives...

Then it hits him.

It's people. People are the answer. People are the answer to the question of meaning in life. Interaction with people, working with people, making people's lives better. Laughing, healing, growing...

Almost 4000 years ago the Mesopotamians figured it out. It's still true.

We were not meant to live in a vacuum. Our being, our DNA, our souls are all  programmed to be interacting with others. And by making other lives better our souls are fed, and meaning will fill our lives until it overflows.

I'm so lucky. I get paid to help people. Lots of them. Some of them desperate, with problems that very few clinicians want to deal with. And a lot of them get better. It's an amazing thing to see...

Some people dread birthdays. I say, bring 'em on!