Many restaurants brag about various things, including their Michelin stars, their wine list, and their reviews, but Botin merely tells you it is the oldest restaurant in the world! That’s a pretty great start and no doubt serves to remind you there is a reason that this place, situated in the medieval Austrias area of Madrid and founded by the Frenchman Jean Botín in 1725, is still there.
Just last week, I went to a doctor’s retirement party. It was festive, with honors and ribbing for the lucky one, but there was an asterisk to his milestone. Retirement was not anticipated or planned for. What is your retirement plan?
A 25 year-old female recently diagnosed with seronegative rheumatoid arthritis was started on a TNF inhibitor. She came in for a follow-up visit and noted that her toenails were brittle and discolored when she removed her nail polish recently.
Patients are labeled as having “difficult RA" when: 1) we are frustrated, 2) it's too late, 3) we've run out of options or 4) the relationship is failing. We see them, but don’t quite know what to do with them.
My original agreement with Jack was to review a serious scientific book. However, half way through one, I was bored, so I went to the library. I'm so glad I did, because I came upon two books, written by Ireland-born physician Patrick Taylor, that continued the tale I'd started years ago about Fingal Flahertie O'Reilly.
“It’s unbelievable how much you don’t know about the game you’ve been playing all your life.” - Mickey Mantle
This is going to be my third visit with this patient and I’m not looking forward to it.
In the first two, I discovered how sick she was and how, despite my handouts, efforts, insights and words, my educated medical expertise was totally wasted.
In the years to come, the availability of numerous new IL-6 inhibitors it will either complicate treatment decisions, alter existing treatment paradigms, or result in an all-out war against TNF inhibitor dominance. Data, differences and time will tell.
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