It’s been 49 days since California’s Governor Newsome announced details of his bold executive order N-39-20 giving the Director of the Department of Consumer Affairs (DCA) the authority to waive professional licensing requirements for the healing arts boards under DCA during the COVID-19 State of Emergency, hoping to produce a flow of recruits to the newly created California Health Corps, a new army charged to staff an additional 66,000 hospital beds, now closed, but expected to be needed as the COVID-19 pandemic spreads. I wrote about this on my blog April 5 https://theviewfromharbal.com/2020/04/05/come-back-west-old-man/. With 37,000 medical professionals in the state who had let their license lapse within the previous 5 years, the pool seemed deep. Already licensed professionals could also apply to the Corps. The whole thing was to be funded, with no budget stated, out of the state’s Disaster Relief fund, which has provision for substantial reimbursement from the feds. The response was phenomenal, with 25,000 applying in the first 24 hours, to 34,000 in first 48 hours, up to 82,000 a week later, and totaling 93,000 after a month. But problems ensued. 2/3ds – 60,000 – didn’t have a valid license. 20,000 haven’t filled out a license renewal application despite being sent a reminder. Part of this might have arisen from some confusion in the application process. There are two websites at which one can apply to the Corps. The one accessed from the California government’s Coronavirus (COVID-19) Response https://covid19.ca.gov/healthcorps/ has only the Corps application with no mention of the license renewal program. For that, you need to go to the California Medical Board https://www.mbc.ca.gov/Licensees/License_Renewal/Physicians_and_Surgeons.aspx#COVID19_Temporary_CME_Waiver, where the license renewal program is explained as something to be done first before applying to the Corps, the button to the application placed just after.
As of April 30, 10,500 applicants were in final review and 4,900, about 5% of the volunteers have been cleared to participate, 2/3ds of which are nurses with 417 doctors. Pay is not bad, but pretty lowball by California standards.
Section V applies to employees appointed by EMSA. Employees entitled to the HAM authorizations identified below include all new hires as of 04/17/20 in the following classifications listed.
Class Code
Class
CBID
Department Location(s)
Range
Hiring-Above- Minimum Total Salary Rate
7551
Physician and Surgeon
R16
EMSA
Rg A Rg B Rg C Rg D
$10,161 $12,310 $12,904 $13,278
8165
Registered Nurse
R17
EMSA
Rg A
$6,572
8212
Nurse Practitioner
R17
EMSA
Rg A
$8,394
No beach house will be bought with these state checks, which don’t start till you’re deployed. 233 soldiers in this army – doctors, nurses, respiratory specialists and support personnel – landed in Sacramento April 20 where they staff the 363 bed emergency hospital set up at Sleep Train Arena, let by the state for $500K a month expecting to get 75% of that back from the feds. So far there are no patients. 600 more nurses will soon be deployed, formed into regional “strike teams” to help control the infectious disease in skilled nursing facilities. So that still leaves over 4,000 soldiers sitting on the bench. But at least they have an inspiring flag:
Does that doc have a beard? Doesn’t that render your N-95 mask essentially worthless? And masks they’ll need. When you figure this army is composed of quite a few retirees, you’ve got the elderly facing up to patients with active COVID infections: a recipe for disaster if there ever was one. The youngsters will be sitting on the sidelines making book on which side will have more fatalities.
But the war smoulders on. When I first wrote about this on 4/5, there had been 5,304 confirmed cases in LA county. As of this morning, according to the Johns Hopkins site, there had been 37,360 confirmed cases in LA county, a little over 745/day since my last post. There’ve been 1,793 deaths at a rate 369.7 per 100K population. 1,044 new cases since previous day, all in an area with a total population of 10,098,052 (1,299,277 age 65 or over). Some of the increase could stem from improved testing.
Down south in San Diego county, where Kathy and I want to go, there have been 5,662 confirmed cases, 209 deaths at a rate of 169.35/100K and 27 new cases since the previous day. Total population 3,302,833 (439,595 age 65 or over). But on May 13 County Supervisor Jim Desmond, a conservative, pointed out that only 6 deaths of the 194 ascribed to COVID-19 to date in the county could be considered “pure” COVID deaths, in that the victims had no other underlying medical condition. https://www.sandiegouniontribune.com/news/politics/story/2020-05-13/supervisor-jim-desmond-says-san-diego-has-only-had-six-pure-coronavirus-deaths
The entire Golden State holds 39,510,000 and has had 78,725 confirmed cases (0.2% of the population), 3,208 deaths (about 1/3d are nursing home patients), with 1,179,126 tested so far.
Back home, my Michigan has had it worse. Of 9,987,000 Michiganders, 50,538 had confirmed COVID-19 (0.5% of the population) with 4,881 deaths (1.5 times as many as California, which is nearly 4 times as populous as Michigan) with 357,921 tested so far. Wayne County, population 1,761,382 (258,954 age 65 and over), home of Detroit, has seen the worst of it, with 19,016 confirmed cases (0.43% of the population) with 2,212 deaths and 134 new cases since previous day.
But the docs and nurses of this state have handled it with aplomb. At U Hospital, the number of new cases and deaths have been going steadily down and occupancy is creeping up. We never had to use the 500 bed field hospital they set up in the Track and Tennis building. And the only “army” I’ve seen are the rednecks with their AR-15s marching on Lansing with a message for Governor Whittmer.
When I first wrote about this, I said I’d pass on taking Governor Newsome’s offer of a freebie renewal of my lapsed California license. There would be opportunities to serve in the war on COVID just a short walk away. Fortunately, I never had to put the white coat back on. And it looks like I won’t be needed in California, either. I still filled out the renewal form this morning, just to see what will happen. It’s a two part process to get in the Corps, so I think I’m safe, which is how everyone these days wishes me to stay.
Nathan Wei, late of Frederick, Maryland, died of gastric cancer two years ago March at age 68. His wife held his memorial service at his packed house in Laytonsville just about two years ago. She asked the men to wear bowties, which Nathan so liked to sport when he had to wear a tie (he preferred scrubs), so I bought a nice maize-and-blue one at van Boven’s out of double respect for the guy, who’d did a year in Radiology and two in Internal Medicine training at U-Hospital.
Nathan and I had become scopy buddies in the very early days, maybe ’86. He saw what Bill Arnold was doing and was determined to do it himself, and did, and then some.
He got some help from the legendary late Bob Jackson of Toronto who took advantage of being Canadian team physician for the ‘64 Tokyo Olympics to spend time with modern arthroscopy’s father Makei Watanabe then come home to Toronto and figure out how to do surgery with the scope of his he just bought. Jackson had no worries about rheumatologists picking up the procedure and welcomed Nathan’s interest. Later on, Nathan collaborated with another American arthroscopy legend – Lanny Johnson of East Lansing – so he’s been touched by the two biggest names in North American arthroscopy. Pretty good bloodlines. Whereas I got Bill’s attention to teach me and Bill Kelley’s department of medicine to pave the way, that same institution would throw up a lot of road blocks that Nathan didn’t have to see. Granted, he had his share of challenges. He took on most anything that looked good to him. Arthroscopic surgery for arthritis of all types, even use of a laser, epidurals, nerve blocks, DEXA, bone biopsy, muscle biopsy, salivary gland biopsy (I taught him that one), skin biopsy, fat pad biopsy, stem cell treatments and platelet-rich plasma (PRP) injections, in-office MRI, ultrasound, even US-directed wire transection of the volar carpal ligament for carpal tunnel syndrome. Now and then he took on an associate, but mostly it was just him and his many nurses, who always got authorship credit on his publications. Pharma sought him out and vice versa, not just for the mundane crank-em-through phase III studies, but interesting early studies of novel agents, especially if they wanted tissue. They knew Nathan could get the patients, handle them and the paperwork efficiently, and get ‘em tissue. He did over 200 studies before he wrapped it up December ’17. Over the past several years, he’d gotten into social media to promote his practice, featuring regular web broadcasts on various medical topics. When I visited him last, he interviewed me for one of them. Whenever I visited, which was much less than I wish I’d done, I’d be in awe of his operation.
In the 90s, he decided to convene a small course to teach others what he did. These were initially held at his office then later at the Anatomy labs of the University of Maryland in Baltimore. He procured several fresh cadavers from the city morgue and had the 6 or so in attendance (plus 3 instructors, of which I was one) go through multiple joint injections, other injections, and various biopsies. Tuition was not cheap, but students liked what they got. Besides the procedural training, they got a little taste of the Nathan philosophy. Brought up to disdain mammon in medicine, I was sometimes taken aback when he talked about things like the precarious position of rheumatology practice and the need for “marketing”. Probably too late I realized that what that really involved was being able to explain what you were doing, including why it was special and important, in a clear terse understandable manner. For rhematologists who seldom deal with anything that’s clear cut, bringing clarity to a pronouncement can be a big challenge.
I sort of lost track of Nathan until the Spring of ’16, when I saw on one of those academic tracking sites that someone out of Frederick Maryland had accessed one of my old arthroscopy papers from the early 90s. I called Nathan to ask why he needed to look at such ancient stuff. He denied doing such a thing, but we got to talking about what he was doing and of course it was interesting. A company called MyEye had made a 1.4 mm arthroscope you could just poke in under local anesthesia in the office, plus they’d used state of the art image enhancement to make what you see look like something from the standard 4.0 mm glass lens scope you’d use in the OR. The “needle scopes” of the 90s that got a lot of rheumatologists hyped up suffered from poor image quality. Not the MyEye. I went to visit in August and was impressed. I could see this bringing arthroscopy back to rheumatology. Nathan arranged a dinner with Mark Foster, president of MyEye, and we made all sorts of plans. My upcoming sabbatical at UCSD with scopy buddy Ken Kalunian would be a chance to do this in earnest. Nathan was pleased he’d have some company and we were off to the races. Too bad we crashed and burned. Too bad I never made it back to Frederick till it was too late.
I don’t do arthrocopy anymore, haven’t since May ’01 (unless you count that cadaver knee at the Marriott in La Jolla January ’17), but I can still write about it; I’ve done 2 slightly different versions of “Arthroscopy in rheumatology”, one already into the The Journal of Surgery and Surgical Technology, and one about to be submitted to Rheumatology (Oxford). My coauthors on each are my mentor Bill Arnold and my best scopy buddy Ken Kalunian. Each manuscript is dedicated to Nathan, as follows:
“We dedicate this to our dear departed friend and ever inspiring colleague, Nathan Wei, for whom the light was always burning bright.”
Now let me take words from others to tell you about Nathan. The first is from The Rheumatologist, a monthly tabloid put out by the American College of Rheumatology. Danny Malone from Wisconsin shared Nathan’s cowboy ways, perfecting with him a technique using a wire under ultrasound guidance to treat carpal tunnel syndrome. And you know Bill Arnold by now.
The second item is by Nathan himself, written for Medcape in October ’17, not long after he received his cancer diagnosis.
The last item is his obituary from the Frederick News-Post, followed by comments.
From The Rheumatologist
In Memoriam: Nathan Wei
May 18, 2018 • By Daniel G. Malone, MD, RMSK, FACR, & William J. Arnold, MD, FACP, MACR
We are sad to report that Nathan Wei, MD, FACR, passed away March 27 from aggressive cancer.
Dr. Wei was a passionate, compassionate, fiercely independent innovator, student and teacher, who carved out his own way of doing things, always in the pursuit of excellent patient care. He was unafraid to embrace cutting-edge medical services for his patients, and to seek training from the best and most authoritative people in the world to provide those services.
Dr. Wei was one of a kind that we may not see again in this era of guidelines, rigid training requirements and limitations because of medical malpractice concerns. These days, there are few who match his innovation, ingenuity and passion, all of which we should strive to teach our trainees.
Nathan preferred the road less traveled, and what he valued above all else were the benefits to his patients and the professional rewards of providing them with the best care available. He would let nothing stand in the way of accomplishing those goals.
Dr. Wei did his rheumatology fellowship in the Arthritis and Rheumatism Branch at the National Institute of Arthritis and Musculoskeletal Diseases under John Decker, MD, and Paul Plotz, MD, MACR, 1978–1981. He then established a solo rheumatology practice, which—even in those days—was difficult. Difficult was Nathan’s cue to get something done. He read countless books on business. He studied arthroscopy under the orthopedic surgeons who helped bring it to the U.S., and he became an adept arthroscopist. He was the only rheumatologist member of the North American Arthroscopy Association. He was one of the two rheumatologists in the world who perform the thread carpal tunnel release procedure, a new, innovative, minimally invasive, ultrasound-guided method for complete carpal tunnel release with no incision, sutures or post-op rehab necessary.1,2 His practice became extremely successful in general rheumatology, and it also offered patients a variety of skillfully done procedures.
His passion for learning was matched by his passion for teaching. He created and directed a variety of procedure courses for physicians in his office and in the cadaver lab at the Maryland Anatomy Board. He also organized a semiannual patient education day, to which he brought nationally known speakers to provide education completely for the enlightenment of his patients. These were always well attended and highly lauded by the patients.
Dr. Wei is survived by his wife and four children, who will greatly miss him, as will we, his colleagues, who admire his abilities and his dedication to education, teaching and excellence in patient care.
Daniel G. Malone, MD, RMSK, FACR, is president of the Wisconsin Rheumatology Association, a clinical associate professor of medicine-rheumatology at the Medical College of Wisconsin in Milwaukee and a rheumatologist in the Prairie Ridge Clinic of the Columbus Community Hospital.
William J. Arnold, MD, FACP, FACR, is a co-founder of Orthopaedics & Rheumatology of the North Shore in Skokie, Ill. He is the recipient of the Arthritis Foundation’s (Illinois Chapter) Freedom of Movement Award and was named a Master of the ACR in 2011. He has served on the Board of Directors of the ACR Research and Education Foundation and was a member of the task force on ultrasound, as well as a board member of the International Society for Musculoskeletal Imaging in Rheumatology.
Five months before he died, Nathan published in Medscape how he was doing with his new diagnosis. I hope he put a lot of miles on that Porsche
Perspective > Wei on Arthritis
from Medscape
When a Physician Finds Himself the Patient
How One Doctor Is Dealing With His Diagnosis
Nathan Wei, MD
October 05, 2017
A Doctor’s Diagnosis, His Daughter’s Prescription
It began with 3 days of right upper quadrant pain. I called a surgeon friend of mine, who examined me in his office and ordered a gallbladder sonogram. It showed acute cholecystitis as well as a possible hemangioma in the liver.
Nathan Wei, MD
A laparoscopic cholecystectomy ensued, but afterwards the surgeon said that he saw something peculiar on my liver. He contacted a hepatic surgeon colleague at Johns Hopkins, who recommended an MRI scan (the second of innumerable imaging procedures to come.) A recommendation for other tests, including a liver biopsy, came next.
And so my odyssey began.
The liver biopsy at Johns Hopkins was uncomplicated, and I thought, “It’ll be a hemangioma.
I still remember the call from the Hopkins surgeon. It was noon on the following Thursday, and I was ready to eat lunch. I picked up the phone, and the surgeon told me, “They found poorly differentiated squamous cell carcinoma,” adding, “I need to schedule you for more tests.” The only word I could murmur at the end of the conversation was a weak, “Okay.”
After I hung up, I asked my staff to cancel my afternoon schedule. I was in no shape to see patients. The next thing I did was to call my wife with the news. When you receive the diagnosis of cancer, it hits you like a tsunami. All the neurons in your body shut down. You become a zombie.
Somehow, I drove home. My wife was at the back door to greet me. She was on the phone with our oldest child, and said, “Becky has a great idea and would like to talk with you.”
I put the phone to my ear: “Dad, you should go out and get that Porsche you’ve always wanted.” I thanked Becky for her suggestion and handed the phone back to my wife.
My legs felt really heavy all of a sudden, and I went in and sat on the couch. My wife said, “You should do what Becky said,” adding, “Don’t be cheap about it.”
While still in my zombie-like state, I stood up and said, “Okay, I’ll do it.”
The two of us drove to the Porsche dealer. My wife stayed with me a bit but had some other errands and left me with the parting words, “Do it!”
Usually, my wife and I purchase preowned vehicles after doing a lot of research and entering into brutal negotiations. So it was completely out of character for me to walk in to this dealer with no negotiating weapons in my quiver. After minimal haggling and signing a bunch of papers, I got the keys to a Porsche 911 Carrera 4, my ultimate dream car.
I drove away in this cushy cocoon, this Teutonic work of art. Extravagant? Outrageous? Yes. Affordable? Probably not. But emotionally, I felt on top of the world.
Treatment Begins
The subsequent days were a combination of more imaging studies, lab tests, and two hospital admissions. The first was for a bleed into the liver. My hemoglobin dropped to 6 g/dL, and I spent the day in the ICU getting transfusions. After discharge, I was readmitted with fever and dyspnea. This hospitalization was longer because, frankly, the doctors were stumped. Finally, empiric antibiotics designed to hit intestinal pathogens seemed to do the trick. I was able to go home.
(Oh yeah, my diagnosis is carcinoma of the stomach with metastases to adjacent lymph nodes and liver.)
I stayed healthy enough to get a port placed the next day and started chemotherapy the day after that. One of the drugs, 5-fluorouracil, requires a 24-hour infusion through a portable pump you have to carry around. The next day, a home care nurse came out to show me how to remove the needle from the port.
Having some of our children travel home to be with us was a great help.
For the first 2 days after chemo, I felt fine. Then, the bottom dropped out. Ten to 15 bouts of watery diarrhea a day for the next 5 days, and oral hydration wasn’t cutting it.
When my systolic blood pressure hit 78 and I could barely walk, I bit the bullet and went to the local emergency department to get my tank refilled. Talk about night and day! I felt terrific after the fluids were in.
Going back to work after missing almost 4 weeks was tough. Even a half-day schedule was fatiguing. It still is. I can barely go a half-day still.
Reflections
It’s funny how some things become important. I never used to be bothered by being referred to as “Mr.” in the hospital when I’ve been a patient in the past. However, I requested that I be referred to as “Dr.” It was one of the few pieces of dignity I felt I had left.
Being poked a lot was not pleasant, and my ordinarily big-veined pipes turned into little pipes, along with ugly ecchymoses around them. My arms would be an entree into the Blue Man Group, for sure.
I’ve let my hair and beard grow because I’m expecting they will fall out soon, so what’s the point of getting them cut?
While I’m not particularly religious, I’ve always believed in a force, a Supreme Being that is larger than us. So I have always prayed on a daily basis, every time beginning with a thank you for what I have: my health (I’m still on the green side of the grass!), my family, friends, work, and the many blessings I have had in my life. I am also grateful for the gift of another day. As my wife says, “One step at a time, one foot in front of the other.”
As you can see, I don’t pray for a cure.
The mantra of the Stoic philosophers is this: “Control what you can; cope with what you can’t; concentrate on what counts.” I have no control over what the cancer will do. What I do have control over is to meet the enemy with courage, a strong will, and conditioning; to give it my best shot.
I listen to my kind of motivational music to pump me up: “Gonna Fly Now” (Bill Conti from Rocky), “Hit Me with Your Best Shot” (Pat Benatar), “We Will Rock You” (Queen), “Eye of the Tiger” (Survivor), etc—things to keep my spirits up.
Prior to all of this, I was a fitness fanatic and earned my certification as a personal trainer through the American College of Sports Medicine. So it’s been killing me not being able to work out like I did. I’ve started riding a recumbent bike slowly, and even that’s an arduous undertaking.
Being on the other side is not where you want to be, but we’ll all be there someday. Fortunately, my patients have been very understanding, and it’s been gratifying to know I’ve made such a positive difference in their lives.
You would think that as a rheumatologist, I would be studying all of the effects of the chemotherapy drugs on my T cells, cytokines, and so forth. I couldn’t care less. All I’m interested in is learning about side effects and how I can minimize them.
When it comes down to it, it’s a primal struggle.
Some other things occur to me. I started unsubscribing to many of the emails I get. Many are no longer relevant. Reading the book The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living has helped me gain more insight into myself. Finally, I have Nietzsche’s quote hanging up in front of me at home: “What doesn’t kill us makes us stronger.”
I hope I get stronger.
Nathan Wei
finally, from the Frederick News-Post
1949 – 2018
Nathan Wei, MD, 68, of Laytonsville, Maryland, passed away on March 27, 2018, at Georgetown University Hospital after a brave battle with gastric cancer. He was born on August 10, 1949 in New York City to Peter and Pearl Wei, recent immigrants from China.
Dr. Wei was a 1971 graduate of Swarthmore College and a 1975 graduate of Jefferson Medical College. After an internship in Medicine at Blodgett Memorial Hospital in Grand Rapids, Michigan, he pursued a residency in Diagnostic Radiology at the University of Michigan Medical Center in Ann Arbor, where he also completed his Internal Medicine residency. He then took up a fellowship as a clinical associate at the National Institute of Arthritis, Metabolism, and Digestive Diseases at the National Institutes of Health in Bethesda. After completing his Rheumatology training in 1981, he opened a private practice in Frederick, Maryland, where he worked for 37 years until his retirement in December 2017.
Dr. Wei served as a clinical assistant professor at the University of Maryland School of Medicine. He participated in more than 200 clinical trials for arthritis treatments and medications. Dr. Wei is known for his many contributions to the development of interventional rheumatology, including arthroscopy, stem cells, and platelet-rich plasma (PRP) for the treatment of osteoarthritis. He published extensively in medical and arthritis publications and lectured internationally. Dr. Wei was a teacher and a mentor, opening his practice to a countless number of medical students and colleagues. A strong believer in the importance of patient education, he self-produced innumerable online videos, cultivating a sizable following. When he received his diagnosis and found himself in the role of patient, he took it as a learning opportunity.
Dr. Wei shared 34 years of marriage with his wife, Judy Hearst. Together they raised four children, Becky Piper (Jack), Jeffrey, Benji (Megan) and Emily . He is also survived by siblings Wesley, Esther, and Deborah; a labradoodle named Mei Mei and numerous additional family members.
Some of his happiest times were spent on family vacations, in particular a recent trip to the Turks and Caicos Islands in January 2018, just two months prior to his death. He loved to share his favorite activities, including fishing, sailing, snorkeling, and snowboarding, as well as fine food and wine. His cooking skills were beyond compare, especially his exceptional barbecue chicken. An avid fitness enthusiast, he recently completed his personal training certification with the American College of Sports Medicine.
In lieu of flowers, donations in Nathan Wei’s memory may be made to the Pearl Wei Memorial Scholarship Fund at Jefferson. Mail to: Office of Institutional Advancement, Attn: Colleen Gross,125 South 9th Street, Suite 600, Philadelphia, PA 19107, or donate online by visiting giving.Jefferson.edu. Donations may also be made to the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University:
To Plant Memorial Trees in memory, please visit our Sympathy Store.
Published in The Frederick News-Post from Mar. 30 to Apr. 1, 2018.
Wei Pages
ME MO R IE S & C O ND O L E NC E S
31 entries
December 4, 2018
I was a patient of Dr. Wei’s since 2013. He was a most kind and thoughtful person. I enjoyed our conversations during my appointments and had full confidence in his treatment and care of me. I am so sorry to read of his passing.
Sally Rivenburgh
July 17, 2018
I am so sorry to hear of Dr. Wei’s passing. I worked for him from 2002- 2003 as a marketing recruiter and I really admired him as a physician, as my employer, and most of all I admired the family man that he was. His work ethic and strive for excellence still influences me today. My prayers are with Judy and his wonderful children.
Julie Tharpe
June 21, 2018
Dear family of Dr. Wei,
I found out this afternoon that he had passed back in March. This truly saddens my heart. He was an exceptional man and doctor and I will be forever grateful for not only my treatments but especially Niki’s, my wife. Dr. Wei diagnosed her at age 29 with RA and treated her for over 30 years. Thanks to him she is in remission.
May God comfort you and yours and God bless Nathan Wei.
David Corkran
June 21, 2018
My heartfelt condolences to all who are grieving the loss of Dr. Wei. He was my physician since 1985 when he diagnosed my RA. It was so sad to see him so ill….. Rest In Peace dear Dr. Wei…..
Niki Corkran
June 14, 2018
Even though he was unwell, he helped my wife have a better life. We honor his memory.
Andy Sullivan
June 7, 2018
Dear family of Dr. Wei, I was so, so saddened to learn of Dr. Wei’s passing just a few minutes ago. It breaks my heart. He was beyond extraordinary as a physician. None will ever compare. He had lost his hair, was wearing a mask, and didn’t feel very well during my last doctor’s visit with him and STILL, he was as in tune as ever with how I was getting along and what was needed for my medical situation. It pretty much sums up his dedication. I’m glad to read that he was able to enjoy a wonderful vacation with the family one last time. I know his family and friends are struggling with this loss. I pray for peace for each of you, and mourning to change to memories and smiles. Sincerely,
Renee Lease
May 4, 2018
I want to send my heartfelt condolences for your loss. Nate and I were great friends at Swarthmore College and we stayed in touch through our Medical school and NIH years.
Nate always had a great spirit and a great heart and he will be sorely missed by all of us who knew him.
Sincerely,
Bob Clark
University of Connecticut Medical School
Farmington, CT
April 29, 2018
Dr. Wei was my husband’s doctor a few years ago. I am so saddened by this news. He was always so full of life and laughter. Our deepest condolences to his family and friends. Godspeed, Dr. Wei.
Antonia Litsinger
April 25, 2018
Very sorry to hear of Dr. Wei’s passing.He was intelligent, thoughtful and caring physician and one of my most respected colleagues. I send condolences and prayers to his family.
Anish Patel
April 19, 2018
Sending prayers to the Wei family. I worked for Dr. Wei from 1986-1988 and babysat his two oldest kids occasionally. He was incredibly intelligent and a perfectionist in his work. I have fond memories of those years. Judy, my heart goes out to you and your family and I will continue to keep you in my prayers. With love – Megan
Hassett Krucenski
April 10, 2018
Frank add I are so sorry to learn of Nathan’s passing. We send our heartfelt sympathy to all the family.
Sue and Frank NIsenfeld
April 6, 2018
Dr. Wei was one of the most extraordinary people & Physicians this world will ever know. He made this world a better place in every way. We will never forget him. His intelligence, humor, & generosity can only be described in terms of superlatives. We will cherish our memories of him. Our deepest sympathy goes out to his family & friends.
Allen & GLoria Barwick
April 5, 2018
Dr. Wei was an amazing physician. I was impressed with him from the very first appointment. He talked with me, questioned and really listened. Then diagnosed. Tested to prove he was right. Then treated. He helped me understand my issues and how to live with the diagnosis. My condolences to his family, which we got to know through his newsletters. He was a very special man. He will be missed by the medical community for his innovative outlook, by his staff that became like a family, and his patients that needed his talents.
Carolyn Derr
April 5, 2018
I was saddened to learn of Nathan’s passing. He was among the most health conscious of my neighborhood circle of friends so it was logical to believe we had many more years of adventures. Yoga or biking were two activities we shared. There could have been more. For example, we talked about healthy nutrition on a countryside bike ride, and to illustrate he got excited about buying fresh vegetables at a roadside stand. He practiced what he preached and he loved sharing!
Nathan talked about his wife, children, and Mei Mei in a way that made it obvious he loved them.
Though shocked at this news, I will always remember and appreciate Nathan for his friendship.
Francis Priznar
Neighbor
April 4, 2018
Condolences to Dr. Wei family, friends, patients and staff. My wife was a patient for many, many years and myself the past few years. He will be greatly missed in the medical practice profession. May God grant him peace and be with his family at this most difficult time.
Martin Munday Family
April 4, 2018
Learning of Dr Wei’s death this morning hurt my heart. This morning, my second visit with my new doctor, Dr Epstein, I simply ask if he new Nathan Wei. A strange expression crossed his face and he told me Dr Wei’s dire condition. He took the time and found Dr Wei’s obituary. I know so much about him and you, his lovely family, through his monthly, Wei’s World. He diagnosed my condition in 2002 and I moved to the Philadelphia area 2005. A hard move, leaving my doctor. I’m so sorry for your great loss. I will always remember him as an exceptional doctor and a wonderful person.
Hazel Monk-Montgomery
Philadelphia, Pa
April 4, 2018
I am very sorry to hear of the passing of Dr. Wei. He was truly a wonderful person and he was super to work for. He will be missed. My thoughts and prayers for the family.
Diane Shew
Diane Shew
April 3, 2018
MY HEART GOES OUT TO DR. WEI’S FAMILY AND CO-WORKERS.YOU WILL BE SORELY MISSED BY ALL WHO KNEW YOU OVER THE YEARS.HE WAS SUCH A WONDERFUL DOCTOR TO ME, HE REALLY TOOK THE TIME WITH HIS PATIENTS ESPECIALLY ME AND WANTED TO KNOW HOW I WAS DOING HE WOULD ALWAYS ASKED HOW MY FAMILY WAS. THANK YOU FOR ALL YOU DID AND DONE FOR ME. R.I.P. DR.WEI
LORI PAYNE
April 3, 2018
So very sorry to hear about the death of Doctor Wei. He was a remarkable physician and human being. He never settled for average and was always looking for ways through publishing and clinical trials in an effort to help the patients who depended on him. He just never gave up trying to ease people’s pain.
No one will be able to fill his shoes. He was one of a kind. He was respected and loved by both patients and colleagues. I could always count on discussing a clinical paper that I may have read between my appointments and hear his perspective. Dr. Wei you will truly be missed
Debra Woodard
April 3, 2018
Our family will always remember Dr. Wei for the Good Deeds contest he sponsored around 2003. We will always be grateful and inspired by this act of generosity. We send our sympathy and prayers to his family.
Pridemore Family
April 2, 2018
I AM SORRY FOR Your LOSS My prayers go out to his and his family. Dr Wei
HAS BEEN MY DR FOR 25 YEARS AND a good one.HE WILL BE MISS.God
Bless
Thanks Ms Baugher
Elizabeth Baugher
April 2, 2018
Condolences to Dr. Wei’s family, friends, patients, and colleagues. I I worked at his Frederick Practice mid 1999 into early 2000 – his patients loved him and he did a lot for them and he will be missed. Michelle L. Currey
Michelle Currey
April 1, 2018
Sincere sympathy to Dr. Wei’s family. He was a true pioneer in the practice of Rheumatology for the Frederick community. A gentle and caring human being.
Truby LaGarde OT
Truby LaGarde
April 1, 2018
Not only a great physician , but a great friend for 28 years, Will be missed by my Husband and
Raymond & Vivian Poole
March 31, 2018
A great friend and a great physician, he will mbe missed by all of his colleagues. Leland
Leland Loose
March 31, 2018
A great friend of more than forty years. An inspiration to us all with his efforts at theaching, research, and patient care.
He will be missed.
Thomas J. A. Lehman MD
March 31, 2018
My sincere sympathy to all his family. He was such a great man, gentle, caring. I missed him when he retired but will always remember how good he was to me.
Shirley Luersen (patient)
March 30, 2018
So sorry to see Nathan’s life cut short like this. Fun person to talk with. Could have great conversation about many topics. Was fortunate to spend a great fishing trip in northern Ontario with Nathan. It was a fantastic trip and one full of great memories for me. I’m sorry we won’t be able to do it again. Rest In Peace my friend.
Scott Mitchell
March 30, 2018
Nathan was one of those doctors who was never satisfied with the “standard of care.” He was continually exploring and pushing the bounds to discover what the standards really should be. His inquisitive nature was a great model for all of us in the personal service industries. He will be missed. Our prayers for comforting
Howie Carr of the Boston herald sorta agrees with me and takes it a little further.
Coronavirus face masks in Massachusetts: Howie Carr says ‘We don’t need no stinkin’ masks’
Better put on your mask, or Gov. Charlie Baker and Lt. Gov. Karyn Polito will be on your case, Howie warns. (Staff photo by Nicolaus Czarnecki/MediaNews Group/Boston Herald)
As for the masks, I did, in fact, once test positive for “incipient” emphysema, when I had a full-body scan. But it doesn’t really matter, because the cops can’t ask you for “your papers” — yet.
Here’s the wording of Herr Baker’s diktat, and it should be read in a German accent, like Gen. Burkhalter’s in Hogan’s Heroes:
Achtung! Achtung! You are verboten to leave der house mit-out der Mask. Zu vill be required to wearen sie Mask “except when a person is unable to wear a mask or face covering due to a medical condition or the person is otherwise exempted.”
Obvious exemption: illegal immigrants. They’re exempted from every other law in Massachusetts, why not this one too? Masks? We don’t need no stinkin’ masks, gringo.
“A person who declines to wear a mask or face covering due to a medical condition shall not be required to produce documentation verifying the condition.”
Not yet.
Gov. Charlie Baker, aka Charlie Parker, aka Tall Deval, is absolutely reveling in this lachrymose daily soap opera, although I suppose it could be worse. I mean, what happens when he hears about the arrival of these “murder hornets”?
Our panic-prone governor will be on TV, his voice cracking, declaring a 10-year shutdown of the state. After all, “If it saves just one life … .”
And then he’ll order every person in the state to immediately begin wearing beekeeper headgear – bee veils, they call them. And this time, he’ll be ordering you to wear the headgear indoors – ja wohl!
But getting back to his latest absurd overreach with the masks, let me ask you this: if this were such a damn emergency, why did he issue his decree Friday, but it didn’t take effect until today?
And if masks are so important, why does the state order us to not use the high-quality N95 masks — “those should be reserved for health care workers.”
So … some people are more equal than others? Shouldn’t everybody be wearing the best mask possible? If it saves just one life … .
And as one of my listeners asked: “If masks are so effective, why can’t we go back to work? If they’re not effective enough to allow us to go back to work, why do we have to wear them?”
He added: “These are rhetorical questions.”
There’s a reason why Charlie Baker is stomping on both civil liberties and the Massachusetts economy. He’s got blood on his hands, from his shocking mismanagement of the Holyoke Soldiers’ Home (70 dead and counting).
Three investigations are underway (four, if you include his own in-house brooming). At least one of the probes, the feds’, is on the level and the findings are going to be beyond damning.
As the Disabled American Veterans Department of Massachusetts wrote Tall Deval directly as the Holyoke death toll spiraled: “This incident represents a catastrophic failure of leadership.”
Which is why you have to wear a mask until further notice. This is Operation: Change the Subject.
Charlie Parker is already on the record as saying his administration knew nothing (kinda like Sgt. Schultz — another Hogan’s Heroes reference). But his hack boss at the Holyoke Soldiers’ Home, who gave $1,950 to him and the lieutenant governor, Pay to Play Polito, contends he alerted Baker’s coat holders days earlier than the governor claims.
Who’s telling the truth here? My money’s on the hack from western Mass.
This is a recurring pattern of deadly incompetence with Tall Deval. In return for cash and political support, he hires old-line Democrat payroll patriots to run obscure parts of the hackerama, and innocent people end up dead.
Happened last year in Quincy with the Registry — seven bikers dead.
Pending Friday’s latest unemployment numbers, 893,000 Massachusetts residents have lost their jobs. Do you seriously believe Charlie Parker knows a single one of them?
I mean, if you asked him, he’d make something up, like he did with the fisherman during the 2014 campaign. But nobody in his cloistered, trust-funded old money Yankee world is feeling the pinch in any way whatsoever.
You can always tell a Harvard man, but you can’t tell him much.
A century ago, H.L. Mencken had Tall Deval’s number:
“Whenever A annoys or injures B on the pretense of saving or improving X, A is a scoundrel.”
Sara McCoy was a rheumatology fellow at UofM, coming from Mayo Clinic and finishing in ’15. She took a job at the University of Wisconsin in Madison as she said her labor-lawyer husband was shut out of the Michigan market by the influence of Jimmy Hoffa, Jr. So sad she had to go. Everyone, including the powers that be, wanted her to stay. Cute as a button, smart as a whip, and a hurricane of energy and enthusiasm, she was someone everyone wanted to be around. When I trashed my shoulder and brachial plexus in a bike accident in December ’14, leaving me with a temporarily useless right arm, she stepped up and did all my procedures for me, under my supervision, learning them very well in the process. One of the procedures, labial salivary gland biopsy, also know as “lip biopsy”, is done mainly to provide tissue confirmation of Sjögren’s syndrome, a not uncommon autoimmune condition that can dry eyes and mouth while also causing mischief in a number of other organ systems. Sara took the lab chops she acquired under Michelle Kahlenberg, young research superstar in our Division, and trained them on Sjögren’s. Doing lip biopsies helped develop her Sjögren’s clinic. Two years ago she floated an idea to the American College of Rheumatology that she and I conduct a workshop on the procedure at the ’19 annual meeting. She acquired and flew in sheep lips on which the participants could practice and it was a huge hit, slated to be repeated this November. I had a manuscript lying round on lip biopsy that needed to be updated and submitted, and we together decided all things relevant to lip biopsy should be on an accessible web site. We’ve been dabbling at both, at a distance, but I was the recipient of the last call to action, and hadn’t followed through. I had an excuse, and wanted to share some details of what COVID-19 was putting our old medical center through. So I sent her this e-mail:
Hello sweetheart!
Hope you’re still hunkering down o.k. on what I hope is the tail end. You know, I used to be a virologist, so I know that all these things eventually come to a close.
I apologize for dropping the ball on the LSGBx review. I got distracted by the prospect of writing some arthroscopy papers and am still wrapped up in that. But I still remain fully committed to SS-LSGBx, paper and website, so don’t lose faith.
I don’t know how it’s been at Wisky, but the MECCA has endured. Now that it looks like we’re not all going to die, or exhaust ourselves caring for those who are, we are facing the consequences. The hospital never did fill with COVID-19 patients and the planned 500 bed field hospital at the Track and Tennis building for overflow patients was never used. The hospital never got much beyond 65% occupancy, which is coming up now as the number of new infections wanes. But Mr. Corona blew a $400M hole in the medical center budget, despite a $3B (yes, B) infusion of government relief funds. So Herr Runge has rolled out the “Economic Recovery Plan”, which mainly seeks to stanch the flow of cash. Those cranes at the site of the new hospital tower will remain idle. 1400 FTEs, mostly staff not faculty, are getting cut. 300 are gone already. Higher ups are expected to take a 15-20% salary cut. Herr Runge is taking 20% off his top. Forget those raises. That nice bennie of having your 401(k) contribution matched? Forget it, at least till June ’21. Main campus is not doing this, but the medical center made for a much bigger suck on the university budget than any other school. No use of discretionary funds for travel, CME or tuition, so pay your own way to the ACR (there goes our audience). And if you’ve got some extry lying around, how about helping out? Endowed professors are being encouraged to tap their endowment to support fellowships.
All this came from a Division meeting that just finished. No remarks on the supply side, but Herr Runge has commented we need a 24/7 hospital and 12/7 clinics. Now that we’ve established you can generate RVUs doing televisits on your laptop in your living room – and Runge sees virtual visits continuing, as they “contribute to access” – sky’s the limit.
You may be facing similar things, but I thought you’d like to know what it’s like in your old home, to which I fervently hope you return some day.
I’ve been having a thing with my high school English teacher. She was quite the babe back in the late 60s at Vicksburg High and I was maybe her pet, but nothing ever progressed then like you read about now. I went looking for her to find a discerning reader for my new blog.
Also, I had come across a stack of my high school essays with her red ink all over them, even though there was usually an “A” on the front. Who better to judge whether I’d made any progress in 50 years? My snoop program found but one person with that name, right there in California where her pharmacologist-research scientist husband had whisked her midway through my senior year. Emails bounced back, but one of those real actual letters did the trick. She emailed me back, and we’ve been swapping ever longer messages ever since. This is bragging material to my high school buddies, who all liked (and feared) her too. But having an email relationship with your old English teacher gets you a whole bunch of new essay assignments. She swears she’s given up red ink grading, but you know the expectations are there, if only from a glance at her coffee cup.
She seems not to mind my verbose offerings, unlike some of my email friends. In our last exchange, she mentioned that her high school boyfriend and roommate of 22 years has been talking about having his sore, swollen knee ‘drained.’ She wondered what I thought of this. She learned early on in our correspondence that I’m a rheumatologist, and was smart enough to know what that meant. I’d sent her a picture of me and my mentor Bill from 1987 presenting a poster on some more radical knee interventions (pasted in in about a paragraph), so she was curious about this knee drainage thing and also about my opinions of rice in arthritis, stemming from a bizarre invitation I had forwarded her asking for my contribution to a scientific journal on rice science. I’d offered that the main role of rice in arthritis treatment is to heat it up in the microwave and place it on the aching joints. She asked if she owed me for the consultation.
What happened went from there. She’d touched a nerve.
I let my California license lapse last year when I decided I couldn’t justify the $820/2 yr renewal fee. So this recent consultation is gratis, but mind you is coming from a source no longer certified by your state.
Draining joints was my thing. After appropriate cleansing and local anesthesia, you take a 21-18 gauge needle (3-5 mm), poke it into the swollen joint, drain any fluid there (saving it for analysis if a diagnosis is uncertain), then usually pushing back in some corticosteroid or rooster comb extract. Knees usually have some fluid, smaller joints less likely. I easily did 10,000 over the course of my career, probably more. I was the go-to guy for teaching others how to do this, and the guy they called in when no one else could get it. I conducted courses at national meetings, and was asked to write chapters about it in several textbooks (1-5). But I did more unique things than that. That handsome dude with me in the picture I sent you was my Chief of Medicine Bill Kelley’s first trainee at Duke and had set himself in Chicago after bailing on academic medicine at U of I. Might as well show him right here, he and I standing by our poster at the 1987 American Rheumatism Association regional meeting in Chicago.
We eventually published results of the trial (6). He got orthopedist at Northwestern Dave Stulberg to teach him how to do arthroscopy, then set out to see how it could be used in arthritis patients. Kelley, also a rheumatologist, thought that was a good idea, and picked me to go spend some time with Bill Arnold and learn it. I thought he picked me for my smarts, which everyone was saying were considerable. Years later, I had Kelley’s son Mark as an intern on my service. Mark said his dad had picked me for my height, “because orthopedists respect size”. Kelley later confirmed that to me face to face. So that meant right after buying a house and sticking my fiancée Kathy in it, I had to go live in Lincoln Park for a year and drive home on weekends.
We endured, and got married in October after I came back for good. Once I got going (it took about 6 months for the orthopods to stand down), I became hot shit for a while. Nobody in academics was doing this at the time so I got to show the way. I thought I figured a few things out, published (7-11), taught courses around the country, lectured abroad, and got job offers from Mayo Clinic and University of Alabama (which I turned down, of course). I helped show the way in use of smaller “needle scopes” which could be done in procedure units, avoiding the O.R. Towards the end of the 90s, obstacles began to pile up. Some well done controlled trials showed arthroscopy really wasn’t doing anything in osteoarthritis of the knee (OAK), the drugs for rheumatoid arthritis got so much better that the knee situations an arthroscope might help grew uncommon, and we really couldn’t figure out much from the biopsies of the joint lining (synovium) we were doing under arthroscopic guidance. It didn’t help when I cut through an important nerve in back of a patient’s knee while cleaning it out, an easy lawsuit to win and she did. The department decided not to renovate my equipment when it started breaking down and for the last two years, ending in 2002, I had to rely on the O.R. and just didn’t generate enough business to justify continuing, and I was shut down. Needless to say, I panicked for a while. I’d achieved tenure 10 years earlier, so I wasn’t really worried about my job. But I had lost that great thing that made me unique
Oh, that joint lavage thing was supposed to duplicate what some thought was the main effect of arthroscopy, in which saline is flushed through the joint to clear out debris and provide a clear view. We’d just stick a 14 gauge (8mm) needle into a knee, fill it with saline and then rinse-wash-repeat until a liter had passed though. Prospective trials, done more rigorously than the one Bill and I had communicated, showed the intervention conferred no benefit beyond sham and that was that. Bill still thinks there’s something to it. Some docs overseas still do it for certain situations. I wrote a commentary in Nature (Rheumatology) in 2007 regarding its use in inflammatory arthropathies like rheumatoid arthritis, where it actually may be effective (12). But I sadly tossed out all my special needles when I cleaned out my office last year.
I kept doing some odd invasive procedures no one else did: needle muscle biopsy (13) and minor salivary gland biopsy (lip biopsy), mainly done to support a Sjögren’s Syndrome diagnosis. I taught a lot of fellows how to do the latter, and one of them, Sara McCoy in Wisconsin, had me join her to teach a workshop at our national meeting last year. They asked us to do it again this year.
There’s one more thing: ultrasound. Radiologists have been doing this to sort out joint problems for years, and some of the pioneering work was done by U of M people. All through the 90s, I was itching to get involved, but our radiologists showed me no love. In 2001, our Division hosted Marina Backhaus from Berlin, who was showing rheumatologists all over the world how they could do their own ultrasound and coming up with stuff the radiologists had missed. I befriended her big time, not because I was sucking up to advance my career, but because I genuinely liked her. Kathy too. We took her to the Ohio State football game and had her over for family Thanksgiving. I was unable to find a picture of her at any of those proceedings. We we’re probably having too much fun to take pictures. But here she is in Leeds, UK, mid June 1999 for an arthroscopy course I was helping to teach. That’s my great scopy buddy, friend and hero Staffan Lindblad of Stockholm with a forgotten but nevertheless attractive French rheumatologist in the foreground.
She continued her rise into the academic stratosphere, but she’s still good for a hug whenever I bump into her at a meeting. She convinced my Chief that rheumatologists getting into ultrasound is a good idea, and they found $100K to buy a machine. I scored a big 3 year award (my only one like that ever) that carved out some time in which I could seriously teach myself and in about 3-4 years the chief of musculoskeletal radiology said I was good to go. His deal was I could do all the ultrasound I wanted, but could bill for it only when guiding procedures. That was pretty much what I wanted it for anyway, so o.k. by me. And it was neat how ultrasound could turn a difficult tap in to a piece of cake. Easier on the patients, too, as there’s less struggling. In 2007 the American College of Rheumatology convened a Task Force on the use of ultrasound in rheumatology. A lot of rheumatologists had started picking up the procedure as the machines got better, smaller, and cheaper, but a few were using it for some iffy indications. The group elected me chair, a shock to me at the time, and we set out all divide-and-conquer eventually producing a white paper I mainly wrote and finally in 2010 pushed Arthritis Care and Research to publish (14). The ultrasound club is way bigger than the arthroscopy club ever was, and I hardly occupy the same position of prominence. I’ve had the satisfaction of training several fellows in the procedure and managed one cute publication about a maneuver during ultrasound that is now taught as standard practice (15).
Maybe one of the best consequences of ultrasound is that it’s gained me one of my best friends. In 2014, shortly after my accident, the NIH decided it would be a good idea if we could assemble a cadre of people at all the centers studying the synovium who could biopsy that synovium under ultrasound guidance. The folks doing this best were at two institutions in London. The NIH didn’t know when they invited me that my right hand was useless from my December bike accident. My Chief encouraged me to go anyway and even secured NIH approval for business class fare because of my “disability”. Off we all went. My hand was good enough to take a stab at some of the things they were teaching us.
There was a tall, blonde (two of my weaknesses) good looking lady there from St. Louis. Barnes. That’s her just to my right.
She became an intern the year after I left but she’d heard some stories. We knew so many of the same people, and often had the same opinions about them. We had 2 dinner “dates”, one at the famous Ronnie Scott’s Jazz club in Soho we needed to take a rickshaw to find there to see the blind and spectacular Diane Schuur. Deb and I have been fast friends since, her Jeff liking my Kathy and all of us becoming best of friends and compatible traveling companions. We’ll be meeting up in Chicago next weekend (done as of this post: 3/6-8/20), taking separate trains, for a weekend of jazz, eating, and drinking. And, oh, the NIH sponsored group did produce (16).
It’s all been procedures so far. I talked my way into getting one of the major rheumatology texts to have me do a chapter on just procedures, which made it into another edition and is probably my prettiest work (16). They have someone else write it now, but it’s the same pictures. But I’ve spent most of my time over the past 36 years being with patients, not invading them. But every doctor does that, right? My patients have been my sustaining force. It is a great privilege to be in a profession that provides the opportunity for so much giving and for so many distractions from your own innate selfishness. If I ever came home irritated and pissed off, it was because something in the system kept from getting done something I’d wanted for my patients. You’re supposed to remain professional, maintain barriers, and not become friends with your patients. I found that so hard to do, and never really succeeded. Even towards the end, I insisted keeping the computer off to the side so I could sit face-to-face with my patients. I hear that’s no longer possible. If so, I’m really glad I’m out. But I’ll always cherish the time I spent with them. It was a pretty good 40 years (36 at UofM).
References
Arnold WJ, Ike RW. Specialized procedures in the management of patients with rheumatic diseases, in Cecil Textbook of Medicine, JB Wyngaarden, LH Smith and JC Bennett, Editors. Nineteenth edition. 1991, WB Saunders: Philadelphia. p. 1503-1508.
2. Ike RW. Therapeutic injection of joints and soft tissues, in Primer on the Rheumatic Diseases, JH Klippel, Editor. Eleventh edition. 1997, Arthritis Foundation: Atlanta. p. 419-421.
3. Ike RW, Arnold WJ. Specialized procedures in the management of patients with rheumatic diseases, in Cecil Textbook of Medicine, L Goldman and JC Bennett, Editors. Twenty-first edition. 1999, WB Saunders: Philadelphia. p. 1487-1491.
4. Ike RW. Therapeutic injection of joints and soft tissues, in Primer on the Rheumatic Diseases, JH Klippel, Editor. Twelfth edition. 2001, Arthritis Foundation: Atlanta. p. 579-582
.
5. O’Rourke KS and Ike R. Minimally invasive procedures. inPractice Rheumatology 2015. Available at: http://www.inpractice.com
6. Ike RW, Arnold WJ, Rothschild EW, Shaw HL and the Tidal Irrigation Cooperating Group. Tidal irrigation versus conservative medical management in patients with osteoarthritis of the knee: A prospective randomized study. J Rheumatol 1992;19:772‑779.
7. Ike RW, Fox DA. Arthroscopy in rheumatology training programs associated with NIH-multipurpose arthritis centers: Results from a survey of program directors. Arthritis Rheum 1993;35:1329-1331.
8. Ike RW, O’Rourke KS. Detection of intra-articular abnormalities in osteoarthritis of the knee: A pilot study comparing needle arthroscopy with standard arthroscopy. Arthritis Rheum 1993;36:1353-1363.
9 Ike RW. Arthroscopy in rheumatology: a tool in search of a job. J Rheumatol 1994;21:1987-1989. Editorial.
10. Laing TJ, Ike RW, Griffiths CE, Richardson BC, Grober JS, Keroack BK, Toth MB, Railan D, Cooper KD. A pilot study of the effect of oral 8-methoxypsoralen and intraarticular ultraviolet light on rheumatoid synovitis. J Rheumatol 1995;22:29-33
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11. Ike RW, O’Rourke KS. Compartment directed physical exam of the knee can predict articular cartilage abnormalities disclosed by needle arthroscopy. Arthritis Rheum 1995;38:917-925.
12. Ike RW. Arthroscopic lavage of the knee with or without corticosteroids versus joint aspiration—which is best? Nature Clin Pract Rheumatol 2007; 3(6):320-1.
13. O’Rourke KS, Blaivas M, Ike RW. Utility of needle muscle biopsy in a University rheumatology practice. J Rheumatol 1994;21:413-424.
14. Ike R, Arnold E, Arnold W, Craig-Muller J, Kaeley G, McAlindon T, Nazarian L, Reginato A. Ultrasound in American rheumatology practice. Arthritis Care & Research 2010; 63(9):1206-19
15. Ike RW, Somers EC, Arnold EL, Arnold WJ. Ultrasound of the knee during voluntary quadriceps contraction: a technique for detecting otherwise occult voluntary quadriceps contraction: a technique for detecting otherwise occult effusions. Arthritis Care & Research 2010;62(5):725-9.
16. Mandelin A, Homan P, Shaffer A, Cuda C, Dominguez S, Bacalao E, Bridges SL, Bathon J, Atkinson J, Fox D, Matteson E, Buckley C, Pitzalis C, Parks D, Hughes L, Geraldino L, Ike R, Phillips K, Wright K, Filer A, Kelly S, Ruderman E, Morgan V, Abdala-Valencia H, Misharin A, Budinger GRS, Bartom E, Shilatifard A, Peabody T, Pope R, Perlman H, Winter D. Transcriptional Profiling of Synovial Macrophages using Minimally Invasive Ultrasound-Guided Synovial Biopsies in Rheumatoid Arthritis. Arthritis Rheum 2018;70(6):841-54
17. Ike RW. Minimally invasive procedures, in Rheumatology, MC Hochberg, J Silman, JS Smolen, ME Weinblatt, and MH Weisman, Editors. Third edition. 2003, Harcourt Health Sciences: London. p. 245-252.
You know from my 4/16 post “who was that masked man?” how I feel about masks for the general public in a corona-poor environment. So when our Governor Bimbo came out and declared masks for all in public, I had to go out and get one. No report on its filtering capacity
My sweetheart is pretty amazing. Not only is she tall , athletic, and beautiful, but she has one more advanced degree than me, is a “push-hard” doctor (PhD), unlike her “muddle through” (MD) husband. As a senior scientist for NASA, she helped put together the space station and plan missions to Mars. She’s now a beloved teacher of scientific writing who won teacher of the year award from her school last December. She has 30 IQ points on me so I have to watch it all the time. She does not suffer fools gladly, so when one of our church fellowship group suggested we read a little screed out of Apple News on communicating to others whom you think might be misinformed about coronavirus or (gaack) climate change https://apple.news/ArBdW2tW7RkyauRZe12ALmQ, she felt moved to get out of bed early today and write this:
I disagree with the article and here’s my thought process.
Few lay people actually have the knowledge to judge what is “wrong” when it comes to the actual science of COVID-19 or the medical care that is being derived from the science, so any of these discussions are simply speculations by masses of folks who have neither the facts nor the scientific background to understand the nuances that differentiate the “right” from the “wrong”.
Are there issues of a less nuanced scientific nature related to COVID-19? Sure, and these clearly can be and are understood by intelligent people with less of a science background.
Some examples:
We know that chloroquine works as a drug to combat the virus because it has worked, saving many lives, some of which were on the very precipice of death. Wow, that President Trump is a genius!
We know that chloroquine doesn’t work as a drug to combat the virus because it hasn’t worked, and many lives have been lost under its treatment, some of which were rather early in the development of the disease. Wow, that President Trump is an idiot!
The reality? We don’t know if hydroxychloroquine will work or not when we treat a patient with it. We have pretty good information on the mechanism by which it works, but even that knowledge isn’t necessarily going to give us certainty about its veracity as a treatment. Welcome to medicine. Most of us have been exposed to this tiny flaw in the medical field and Bob has been playing the “let’s try this” side of medicine on his patients for years. Those crazy drugs have even been known to change their minds and stop working after having been effective for years.
President Trump was correct when he saw evidence of hydroxychloroquine success and made the statement “this has the potential to be a game changer.” Hydroxychloroquine does have that potential. So do many other drugs. Doesn’t make President Trump the reincarnation of Elijah. Nor does it make him Jezebel.
I am always a fan of discussion and debate, particularly on scientific topics (as opposed to the suggestions we often hear about putting “Climate Deniers” in jail, but more on that later). There is a great deal of merit in listening to others, in trying to understand other views, scientific or otherwise. I am always amazed at how heated and emotional these debates between scientists can get, since science is reputed to be so dry. By the way, I stand guilty as charged in this regard, being arguably the most emotional scientist on the planet. But, as the late senator Patrick Moynihan once said, “Everyone is welcome to his own opinion, but not his own facts.” In a world where anybody can put any nugget of information into the social media and, with repetition and a little marketing, this nugget oddly becomes a fact, the difference between fact and opinion gets blurred. This is made all the more complex when the very people who do understand the science and the medicine disagree about the interpretation of the data (which isn’t quite the same as disagreeing on facts, but from the outside, it sometimes appears that way).
A slightly less scientific right or wrong:
Bob and I were in Busch’s the other day and the woman at the checkout (wearing a cute little mask with red peppers on it) informed us that the governor of Michigan has decreed that everyone must wear a mask of some kind in order to go out in public. When I replied that this was the dumbest thing I had heard in a long time (clearly not having read the article Rhonda sent out), the woman retorted, “the governor just wants us to be safe.” This is usually about the time that the head of the “most emotional scientist on the planet” explodes.
There is nothing safe about any of the masks that any of the folks wandering around Busch’s were wearing. In fact, they may be detrimental. The virus we are wearing masks to protect ourselves from is so tiny, it is beyond imagination. Bob’s description that, if a human hair were as wide as a football field is long, the COVID-19 virus would be the size of a soccer ball provides a pretty good mental image.
Wearing a bandana or a painter’s mask is like replacing the screens in your windows with butterfly netting and making the assumption that you are still protecting yourselves from gnats. Even a surgical mask won’t work. The “N-95” masks are so-named because they are rated to stop 95 % of particles smaller than a tenth of micron. That means that these, the best masks we’ve got, still allow 5% of particles to get through. Have any of you ever seen what folks in these virus labs actually wear? They make space suits look casual.
The governor is doing 2 tried and true political things that are also guaranteed to make my head explode.
1. She’s doing “something”. Doing something is not the same as doing something useful. The governor could line 40 people up outside her mansion and shoot them, thereby guaranteeing that they will not die of COVID-19. It’s doing something, it’s just a really bad something.
2. She’s empowering people to help themselves. Except she’s not, because not only do they not work, but masks constrain your own breathing. Almost anyone who has ever worn a mask for any reason knows the feeling of sneezing inside the mask. The less said about that, the better…
Her bottom line is to “keep us safe” and make people feel better. You know what would make me feel better? Being able to host a fellowship meeting.
I must confess that the author lost her argument with me as soon as she mentioned the non-sense of the 97% of scientists blah, blah climate change, but that is a topic for another day.
Back on March 19, I posted “smokin’ corona” (https://wordpress.com/block-editor/post/theviewfromharbal.com/326). Inspired by meeting some old girlfriends outside the hospital by the bus stop for a “break”, I had to wonder if their habit of periodically bathing their lungs with toxic tobacco smoke might even be protecting them from Mr. corona. Ultimately I concluded alas no. Patients with preexisting lung disease do worse once the virus gets hold of them, which stands to reason. There is also a little molecular hanky panky going on, with the lungs of chronic smokers showing greater expression of a receptor for the MERS coronavirus (1). Presumably the same thing goes on with COVID-19. But the “more smokers are dying” data comes from China where 25% of the population smokes (maybe 50% of the men), so if 9% of those dying smoke compare to 4% of the survivors, does that mean much? (2) In Europe, it doesn’t appear that smoking associates with worse outcome from coronavirus infection (3). Yet aren’t the smokers the ones with the crapped out lungs just waiting their doom?
The French have dared to say it: “pas si vite (not so fast)”. https://news.yahoo.com/france-testing-whether-nicotine-could-prevent-coronavirus-163120850.html. They examined outcomes of COVID-19 infection at one of their top hospitals. Of 343 severely affected patients and 143 patients with milder symptoms, 5% smoked. The French do love their tabaç, with 35% of them smoking regularly. Not as big as the Chinese, where over 50% of the men smoke (women not so much). Data from a March New England Journal study found 12.6% of 1,000 infected were smokers. Do you detect an underrepresented population?
So let the trials begin! One of the first will involve nicotine patches, which I predict will fail miserably as they totally avoid the pulmonary maelstrom where Mr. corona meets Mr. human. There’s so much in the plume arising from your lit cancer stick, who knows who the active soldier might be. Already warnings clang not to let this be an excuse to light up https://news.yahoo.com/coronavirus-people-warned-not-smoke-153142264.html
Nobody’s asked Dr. Fauci about it yet. Even before this, British docs had been lamenting how the social isolation and boredom would get Brits lighting ‘em up all over, reversing decades of social education convincing them this was a bad thing to do.
Kathy and I probably won’t do anything with this. I’ve not smoked (tobacco) since college. Kathy chain smoked her way through college, winning 6 varsity letters and All-American honors in swimming (backstroke). It took commitment to a dedicated stop smoking program once she hit Ann Arbor, and her breath was sweet by the time I met her. But to my girlfriends at the bus stop, I take it all back and quote my title: “smoke ‘em if you’ve got ‘em”
2. Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020 Mar 20;18:20. doi: 10.18332/tid/119324. eCollection 2020.
3. Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med. 2020 Mar 16. pii: S0953-6205(20)30110-2. doi: 10.1016/j.ejim.2020.03.014. [Epub ahead of print]
4. Patwardhan P. COVID-19: Risk of increase in smoking rates among England’s 6 million smokers and relapse among England’s 11 million ex-smokers. BJGP Open. 2020 Apr 7. pii: bjgpopen20X101067. doi: 10.3399/bjgpopen20X101067. [Epub ahead of print]
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