Friday, October 24, 2008

Start my day with observing Dr Joshua Rheumato clinic today. I've to be an observer, no license to practice since I'll only will be here for only few weeks. One thing about working here is I feel comfortable and feel accepted. I think I'm more comfortable interact with the superior here rather than in Malaysia. It's easier to discuss things and they are more acceptable to critic or opinion. In fact it is something like sharing experience on how we practice in Malaysia compared to Australia experience. Discuss case of recurrent optic neuritis with no other feature of MS and later on developed peripheral neuropathy. Later diagnosed as Lupus in view of positive ANA marker. There are such condition I've seen but usually with other systemic involvement rather than solely optic neuritis. Such an interesting observation. That lady improve with steroid and methotrexate. He also discussed about a patient diagnosed as Sjogren's and presented with cerebellar lesion which was diagnosed by Prof Alan Sturges(an expert on Sjogren's and the one who found anti-SSA/ SSB). What a rare presentation.

Have an experience to attend their Rheumatology meeting again this week. Today it's in Kogarah. Met some of eminence Rheumatologists here; Prof John Edmond, Prof Alan Sturges, Jim Bertouch (Head of department in POWH) and other rheumatologists; Dr Paul Bird (expert in MRI and I've followed him for Biologic clinic yesterday in POWH),Dr Guilaine, Dr Ron, Dr Harry etc. I can't remember the whole lot. Oh ya, I've met Satgunan as well. He is doing his Rheumato attachment in St George Hospital. At last I met somebody I know.

It is quite relaxing, enjoyable and educational meeting. What's different from our meeting is, it is not too serious but of course I've definitely learnt something, and on top of it even those who're senior seem don't mind presenting. Totally different from Malaysian...usually we will try to push the junior most or trainee to do all the presentation. Amazing culture and they seem to enjoy doing so!! Trainees only listen.

What I've learnt today...
The first case is a case of elderly onset lupus who presented with feature of Steven Johnson's syndrome after taking PPI for H.Pylori. Diagnosis was then made following positive serology marker and presence of vasculitis. Later at some point developed palpitation with tachycardia with heart rate rose to 150bpm during one of the visit. Investigation then showed elevated Free T3(few occasions- baseline was normal)...Is it related or not, some argue may be lab result error. I remember seeing a case while in Selayang, also an elderly lady who presented with pancytopenia and feature of hypothyroidism and subsequently fit clinical feature of lupus...May be there's really a correlation between lupus and thyroid disease. Anyway both are autoimmune related disease.
The second case is suspicious SAPHO, but most of the audience not really convince with SAPHO feature may be more of Osteoarthritis with underlying infection. I notice they use a lot of bone scan imaging here to indicate the hot spot.
The third case is a asymptomatic mother diagnosed as lupus after baby born with neonatal lupus. Baby presented with rash occured 5 months after delivery. Prof Alan Sturge explain rash usually occurs late after precipitated by sunlight in a baby.
The fourth case is a haemochromatosis case with interesting hand Xray finding.
Interesting.

Ok enough for today...I'll have another u/s session with Dr Joshua on Sunday.

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