I chose to specialize in pediatric rheumatology because...
I ended up being a rheumatologist by complete accident. When I was a resident at the University of Freiburg in Germany, I was chatting with a friend of mine after one of our noon conferences. He had just returned from a trip to France and I was interested to know how his trip had gone.
In my interest in talking to my friend, I overlooked the fact that the Director of the Children's Hospital had mentioned earlier in the conference that, anyone interested in entering the field of Rheumatology should remain behind after the conference.
So, my friend and I were sitting there discussing his trip to France. The room emptied out. Suddenly, the next thing I knew, the Director of the Children’s Hospital in Freiburg was shaking my hand and congratulating me on my excellent decision of a career in pediatric rheumatology. It turned out to be for the best. Once I got involved in the field, I realized that rheumatology is one of the most fascinating areas of medicine.
I chose to work with children because...
I made the decision to work with children very early on in my medical career and entered the pediatrics program at my school. By the time I was a resident, I knew I wanted to study pediatrics.
Of course, you need to have the personality to want to joke and play with your patients. But I have also found that children are much more truthful most of the time than adults. They will tell you how they are really feeling, what their health is really like. Working overtime to help figure out the absolute best medicine and treatment protocol for children became an obvious fit for me.
I joined Children's Hospital Los Angeles because...
When I finished medical school, I was setting out to apply for a fellowship grant to learn more about rheumatology and conduct clinical research. I knew I wanted to come to the United States but the question was “where.” I had spent some time in Hollywood earlier in my life so I made it a top priority to see if I could end up back there.
I came out to visit friends in the area, met up with a rheumatologist at Children's Hospital who was conducting research on the long-term side effects of anti-inflammatory drugs in children – a research topic on which I had just presented a paper back in Germany.
Over the course of a few days, we hammered out the grant proposal. When I got home, I submitted it, and ended up procuring the research grant. So I came to Children's Hospital and have stayed here ever since.
What I love about my field is...
What I have really enjoyed about being in rheumatology is the degree to which I have watched this field change. Because of all of the work in our field to find drugs to treat inflammatory diseases, the types of drugs that our field is developing, referred to as biologics, are really making our field one of the “coolest kids on the block” so to speak.
The other thing that I enjoy is caring for children who have chronic illnesses. We have children with rheumatologic diseases who have “grown up with us” as we have guided them from early childhood through the difficult time as teenagers to young adulthood through providing care in our Division.
My Role at Children's
Having my position means. . .
I impact the care for children in a couple of ways. Even though my administrative role keeps me very busy with managing the needs of the division, I still manage a large clinical caseload and follow over 500 patients annually, ensuring that each child receives the very best care for their condition. I am responsible for teaching the next generation of healthcare professionals. And, I still conduct research, as well as publish articles and present my findings throughout the world to improve care for children with rheumatologic disorders.
A typical day for me is like . . .
My mornings begin with rounding on inpatients. I examine children, discuss care with fellows and rotating physicians as well as residents. In addition I provide care for patients in the infusion clinic.
>Midday, I am engaged in team meetings with the various administrative staff for my division. In the afternoons, I see outpatients in our Rheumatology Clinic. And I am usually here till about 10 p.m. finishing up administrative tasks related to running the division, writing articles on my research activities, or preparing for lectures.
Developing a rheumatology network...
Currently, there are 300,000 children in the country with childhood rheumatic diseases, but there are only 150 practicing, board-certified pediatric rheumatologists in the country.
Families searching for a specialist for their child can become desperate. They are frantic about their child’s health, yet can’t find a local physician who can treat their child. Or they find one, finally get a call back, the waiting list is horrendous. Sometimes, families will travel long distances at great hardship just to see their child's physician. All of these factors lead to delayed or incomplete care. As a consequence, the majority of children with rheumatologic diseases nationwide receive delayed care, incomplete care, or are followed by adult rheumatologists or specialists from other subspecialties. All of these factors lead to less-than-best health outcomes for children with rheumatologic diseases.
I have been working to develop a business model for care that would meet the needs in our field by providing administrative support for our fellow rheumatologists in the field, as well as also build capacity through training. Such a network hub could cover underserved areas in southern California, Nevada and, possibly, beyond.
We have already had interest in our project from hospitals as far away as Colorado and New Mexico, which is gratifying, but we will have to hold off until we can prove sustainability in a region closer to home. I anticipate that the end result of this project will be an improvement in care, combined with an increase in our ability to train fellows in our subspecialty to provide manpower for the nation and even internationally.
Researching better treatments...
One thing that I am really proud of is the degree to which our hospital has been involved in the development of new therapeutics for children. I can say that there is virtually no anti-inflammatory or biologic drug that has been placed on the market in the last 10 years that was not tested in clinical trials here at our hospital.
We are part of the genetic core at the University of Southern California and, together, and we work to find out which genes are involved in various rheumatological diseases. We have been working for ten years and recently published a paper on two genes involved in pediatric lupus. More findings will be coming out in published papers soon.
In addition, we are conducting research to determine if we can take a droplet of blood from a pediatric rheumatoid arthritis patient, analyze it via a computer chip and use the analysis to tell us exactly which drug the patient will respond to immediately. Having this capability would reduce the trial and error process for us and for our patients greatly.
A pre-screening tool for Bone Marrow Transplant therapy...
BMT therapy is an aggressive, arduous therapy that is prescribed in cases where children are diagnosed with systemic scleroderma and their condition is resistant to all forms of biologic therapy. We are working to develop alternatives to BMT for patients with scleroderma.
However, even BMT therapy is not always effective for this disease. But without a validated pre-screening tool, there was no standardized process for determining which child would respond well to therapy and which would not.
Our hospital recently created a standardized pre-screening tool that will allow physicians to ensure that a child that they refer for BMT therapy to treat systemic scleroderma will be benefitted by the treatment.
Ambulatory Infusion Center...
Our division manages the hospital's Ambulatory Infusion Center, which provides infusions and treatments for children receiving treatment in our division, as well as by the divisions of gasterenterology, nephrology, genetics, endocrinology, and ophthalmology, among others.
">The reason that our division is able to provide oversight for this infusion center is because the majority of the medications that are provided were initially developed for rheumatology patients and subsequently were applied successfully to disorders for other specialties.