Spe­cial­ists team up to fight au­toim­mune dis­eases to­gether

Mon­treal Gen­eral Hos­pi­tal’s new ser­vice of­fers pa­tient-cen­tred care in one place

Montreal Gazette - - CITY - ISAAC OLSON

Dermatologist. Nephrol­o­gist. Rheuma­tol­o­gist. Cer­tain au­toim­mune dis­ease pa­tients know all too well how long the list of “ol­o­gists” is in the med­i­cal field as they of­ten find them­selves vis­it­ing spe­cial­ist af­ter spe­cial­ist to treat what­ever or­gan, tis­sue or cell their im­mune sys­tems are at­tack­ing.

Nor­mally, the im­mune sys­tem de­fends the body against bac­te­ria and viruses, but for some un­lucky few, it tries in­stead to de­stroy the body piece by piece, spark­ing in­flam­ma­tion in places such as the lungs, kid­neys, skin or joints.

Tra­di­tion­ally, along with the dis­com­fort, pa­tients have had the added has­sle of trav­el­ling to sev­eral dif­fer­ent spe­cial­ists who aren’t nec­es­sar­ily de­cid­ing on treat­ments to­gether.

Dr. Chris­tian Pineau wants to change that by of­fer­ing peo­ple with sys­temic au­toim­mune rheumatic dis­eases (SARDs) a new ser­vice at Mon­treal Gen­eral Hos­pi­tal that of­fers pa­tient-cen­tred care from a full range of spe­cial­ists work­ing as a team un­der one roof.

“It’s re­ally as a team of highly spe­cial­ized peo­ple work­ing all in the same di­rec­tion that you are go­ing to get some­where with this,” said Pineau, di­rec­tor of the Di­vi­sion of Rheuma­tol­ogy at the McGill Univer­sity Health Cen­tre. “If everybody sees the pa­tient in their lit­tle corner, you’re not go­ing to get any­where.”

In de­vel­op­ment for about a year, the Cen­tre of Ex­cel­lence for Sys­temic Au­toim­mune Rheumatic Dis­ease pro­vides pa­tients with a one-stop shop where spe­cial­ists put their heads to­gether in a sin­gle con­sul­ta­tion, jointly de­cid­ing on cus­tomized so­lu­tions for each pa­tient.

Pineau said the spe­cial­ists meet with the pa­tient and dis­cuss con­cerns as a group. Pineau said tak­ing this multi-spe­cialty ap­proach has proven to be a more ef­fec­tive tac­tic for the MGH’s ap­prox­i­mately 4,000 SARD pa­tients who to­gether visit the hos­pi­tal about 12,000 times a year.

“I’m like a stu­dent in the clinic as I learn from other spe­cial­ists about the kid­neys or about the skin, and that re­ally makes me, over time, a bet­ter physi­cian,” said Pineau. “The trainees learn a lot as well .… This has been a very good en­vi­ron­ment for learn­ing.”

This model of care isn’t new to the MGH. Since 1979, a Lu­pus and Vas­culi­tis Clinic has been of­fer­ing a sim­i­lar model. Pineau serves as the clinic’s di­rec­tor and, given its ef­fec­tive­ness, the goal is to ex­pand its reach, wel­com­ing all SARD pa­tients who might have con­di­tions such as rheuma­toid or spinal arthri­tis.

Be­yond the im­me­di­ate treat­ment, Pineau said pre­ven­tion will also play a role in stem­ming heart dis­ease and other con­di­tions that can de­velop af­ter years of bat­tling SARDs.

“We want to im­plant sev­eral pre­ven­ta­tive medicine pro­grams to pre­vent com­pli­ca­tions from these dis­eases and from the med­i­ca­tions that we use,” he ex­plained.

Pineau said the next step is to estab­lish an en­tire space with staff, con­sul­ta­tion rooms, nurse prac­ti­tion­ers and spe­cial­ists on duty.

The MUHC is back­ing this project fi­nan­cially, set­ting aside some bud­get for the ini­tia­tive, but funds are lim­ited. Also con­tribut­ing fi­nan­cial sup­port are the MGH Foun­da­tion and the fam­ily of pa­tient Wendy Singer.

By the fall of 1985, Singer’s ac­tive life­style was slow­ing down as de­bil­i­tat­ing symp­toms be­gan to take over. At age 21, she was de­vel­op­ing ex­treme fa­tigue, arthritic joints, fevers and even kid­ney prob­lems.

The west-end res­i­dent was even­tu­ally di­ag­nosed with lu­pus, a con­di­tion that af­flicts about five mil­lion peo­ple world­wide and can be fa­tal if left un­treated.

Singer has been an MGH pa­tient since she was di­ag­nosed and, af­ter years of her re­ceiv­ing ded­i­cated care, her fam­ily de­cided to give back.

Singer’s fa­ther be­gan rais­ing money for lu­pus re­search two decades ago, es­tab­lish­ing the Singer

It’s re­ally as a team of highly spe­cial­ized peo­ple work­ing all in the same di­rec­tion that you are go­ing to get some­where with this.

Fam­ily Fund for Lu­pus Re­search. The MGH Foun­da­tion has been match­ing that fund dol­lar for dol­lar.

More than $900,000 has been raised by the Singer fam­ily through events such as the semi-an­nual lu­pus bazaar, spear­headed by Lil­lian and Hy­man Shoub. There’s also the Sco­tia­bank Char­ity Chal­lenge in April.

Oc­to­ber was Lu­pus Aware­ness Month, mark­ing the start of the Singer Fam­ily Fund’s an­nual di­rect-mail cam­paign. Along with supporting re­search, funds go to­ward the new Cen­tre for Ex­cel­lence.

“We’re do­ing what we can,” Singer said. “Lu­pus and the other rheumatic dis­eases are re­ally com­pli­cated. As a lu­pus pa­tient, you can have any com­bi­na­tion of sys­tem in­volve­ment. It’s re­ally un­pre­dictable as to what or­gan sys­tem is go­ing to be af­fected. It’s re­ally im­por­tant to have multi-spe­cialty clin­ics.”

To learn more about the Singer Fam­ily Fund, go to Singerlu­pus­fund.com.

ALLEN McIN­NIS

“I’m like a stu­dent in the clinic as I learn from other spe­cial­ists about the kid­neys or about the skin, and that re­ally makes me, over time, a bet­ter physi­cian,” said Dr. Chris­tian Pineau, di­rec­tor of the Di­vi­sion of Rheuma­tol­ogy at the McGill Univer­sity Health Cen­tre.

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