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8 secrets to finding a great Rheumatologist in Los Angeles

If you have ever looked for a rheumatologist in the Los Angeles area, you would know this is not a simple task. In fact, there are over 50 rheumatologists in the 15 mile radius encompassing Los Angeles. So how does one go about picking the best rheumatologist in Los Angeles?

I put together a list of strategies I would use if I were looking for one:

 1)     Words from the wise- Referrals

Your primary care physician may recommend a good rheumatologist. If you like your primary doctor, chances are you may like the doctors he/she refers you to as well. If you have a friend or family member who sees a rheumatologist, you can also ask them how their experience has been. They can give you the inside scoop on a doctor you will not read on any website!

 

2)     Printed words

Your medical insurance may provide you with a list of their in-network rheumatologists in Los Angeles. You can also find a list of rheumatologists in your immediate are on the American College of Rheumatology website (click here). You can do a web search, but keep in mind not all rheumatologist may have a website or be advertised on the web.

 

3)      The rubber band test

Keeping in mind that the field of rheumatology is constantly changing, I would want a doctor who is aware of and can adapt to the change. New treatments options are rapidly emerging for conditions we had little options for in the past. Rheumatologists that keep up-to-date with the latest developments in the field will be able to offer you more treatment options. Rheumatologists update their knowledge by reading up on the latest journals and attending informational conferences. Some examples of these conferences include the yearly rheumatology meetings by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), and the Carl Pearson conference in Los Angeles, to name a few.

 

4)      Age is in the eye of the beholder

With age comes experience, which is indeed valuable when treating rare diseases. However a rheumatologist who just completed training may be fresh with the most up-to-date information. So which to pick? Perhaps a compromise- a rheumatologist with a few of years of experience may offer the best of both worlds.

 

5)      The gift of time

Most of us living in Los Angeles are familiar with the concept of time shortage. However, when it comes to your rheumatologist, abundance is your wish. Rheumatologic conditions are often complex and need a patient pair of ears to get the full picture.  Also, it will be helpful to have your rheumatologist call you back sooner than later when you have a concern, or be able to squeeze you in the same day when you have an emergency. You may not be able to get the attention you want if your rheumatologist is very busy.

 

6)      Back to school

The academic centers are home to some brilliant minds in rheumatology. After all, these are where most of the research in the field is done. The Los Angeles area is rich with such centers- UCLA, USC, Harbor-UCLA, and Olive-View, to name a few. However, getting care in an academic center can be a double-edged sword, as there is often a lot of demand on the time of an academician- from patient care, to research, to administrative duties. Personally, I would opt for a knowledgeable community rheumatologist who has more time to spend with me, and reserve the academician for second opinions.

 

7)      “I know that I know nothing.” –Socrates

No one can pretend to know everything in medicine. I think the best quality of your rheumatologist – or any doctor for that matter- is to admit when he does not know the answer but will try his best to find the answer for you, or will send you to someone who will.

 

8)      Peas in a pod

So you have now seen your rheumatologist a few times and have a feel for his style. The question now becomes- do you get along with your rheumatologist? Do you feel your concerns are listened to? Is he willing to adjust his therapy to your beliefs? Do you trust him? If the answer is no, it may be time to look for another rheumatologist.  If the answer is yes, then congratulations! You have found yourself a great rheumatologist!

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Gout in toe, gout diet

The Gout diet — simplified

Gout in toe, painful toe, gout diet

Most people who have ever had a gout attack are interested in learning about the gout diet. After all, gout attacks are so painful we want to avoid them if at all possible. But many recommended gout diets are so confusing, listing so many foods that can cause gout, that you’re soon left with nothing to eat. So I decided to make this a little simpler.

 

Why a diet at all?

Gout is caused by excess levels uric acid in the blood. The extra uric acid can precipitate in the joint in form of crystals, causing a lot of inflammation and pain. Uric acid is produced in the body from the breakdown of purines, which are components of DNA, and present in our bodies as well as the foods we eat. Naturally, we all have some level of uric acid in our blood. In fact, it is thought that uric acid may have antioxidant properties that is useful for our health, at low levels.

 

Balance between purine production and excretion in gout
Balance between purine production and excretion in gout

There is normally a fine balance between production of uric acid and its excretion through the kidneys. When this balance is offset- either from excess production from foods rich in purines, or from  kidney disease leading to decreased excretion- there may be a buildup of uric acid, causing gout. In addition, genetics also pay a role, causing gout to be more common in some families than in others. We may not have much control over our genetics or our kidney function, but we can control what we eat. Hence, the gout diet.

 

The diet at a glance

Now that we know that purine-rich foods are the culprit, let’s divide common foods we consume into purine-rich and purine-poor categories:

    Purine-rich

  • Red meat (beef, pork, lamb)
  • Organ meat (kidney, liver, brain)
  • Beer
  • Poultry
  • Scallops
  • Mussles
  • Tuna
  • Herring
  • Anchovies
  • Mackerel
  • Yeast
  • Sardines
  • High-fructose corn syrup (soda, fruit-juices)
  • High fat dairy

 

Purine-poor

  • Vegetables
  • Refined grains (bread, cereal)
  • Coffee and tea
  • Low fat dairy
  • Nuts
  • Peanut butter

 

 

 

 

 

 

Foods that can help prevent gout:

  • Cherry juice
  • Dark berries
  • Omega-3

 

 

 

 

 

 

 

 

I thought you said this was going to be simple!

I usually advise my patients to be aware of the top 3 offenders: Red meats, Shellfish, and Beer.

I think it is impossible (and quite frankly, cruel) to ask patients to remember all the foods that can potentially cause gout. Eliminating the variety can also really affect one’s lifestyle and pleasure in food. I think the best course of action is to limit the top offenders. Beyond that, we do have medications that can also help.

 

Lose weight!

Obesity has been linked to gout and high levels of blood uric acid. So losing those extra pounds may help control or eliminate your gout.

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