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When she was in elementary school, Sandra Pagnussat, MD, began experiencing unrelenting pain and stiffness, first in her pinky and then in her other fingers. Her pediatrician diagnosed her with polyarticular juvenile idiopathic arthritis (JIA).
In high school, Sandra decided to pursue a career in medicine and began taking advanced placement classes in biology and chemistry. She went on to graduate from the University of Miami Leonard M. Miller School of Medicine in 2005 and then completed a residency at Jackson Health System in Florida.
“I’m open about my own experiences with arthritis, and parents often inquire about my condition when they notice the minor deformity in my pinky finger,” Dr. Pagnussat says. “I think my pediatric patients realize I’m able to understand the frustrations many of them have when it comes to coping with arthritis and wanting to continue participating in sports. I try to encourage them to stay active, but to choose non-impact workouts, like swimming, whenever possible.”
Dr. Pagnussat remembers how she found solace on her school’s swim team after her own diagnosis of JIA. “The water supported my body, limited the stress on my joints, and helped keep me flexible and strong,” she says. “Through swimming, I was able to remain active and enjoy activities with my friends.”
Take Time to Listen
Dr. Pagnussat
Over the years, Dr. Pagnussat has learned that one of the most important things she can do for her patients is to practice active listening. This allows her to catch problems sooner, prevent medical crises and better support her patients.
“Many patients are frustrated and in pain by the time they are referred to a rheumatologist,” she says, “so taking the time to just listen and let them tell their story can offer great comfort. Every patient is different, and pain levels can be confusing—what someone may consider a 2 can be a 7 out of 10 for another patient.”
Because doctors have only a limited amount of time to spend with their patients, Dr. Pagnussat also strives to empower her rheumatology patients to become actively involved in their own care and treatment.
“I encourage my patients to join local support groups through the Arthritis Foundation, [such as] Silver Sneakers, which is a fitness group for seniors, and to also look at local exercise groups that offer arthritis-friendly yoga or aquatic exercise,” she says. “I try to view each patient as a whole and take into account their stress, work, family circumstances, sleep hygiene and depression. If needed, I refer [patients] to other specialties, including psychologists, physical therapists and nutritionists, to help with their care.”
Knowing that patients with rheumatic diseases often have comorbidities, including hypertension, diabetes and osteoporosis, Dr. Pagnussat strives to look beyond each patient’s initial diagnosis to determine how to optimize the management of these diseases while also improving patient outcomes.
“Patients with any chronic condition get depressed because of their condition and how it affects their life on a daily basis,” she says. “Many can’t pursue hobbies and sports they used to enjoy, because they’re now in pain,” Dr. Pagnussat says. “It’s a vicious cycle because pain also leads to fatigue and depression, and I’ve found that if all these factors aren’t addressed, they can negatively impact a patient’s overall health.”
Empower Patients
Rather than relying solely on pain-relieving medications, Dr. Pagnassat encourages her patients to be proactive about self-managing their chronic conditions and improving their quality of life. “I stress the importance of exercise therapy, managing stress and getting adequate sleep,” Dr. Pagnassat says. “I encourage my patients to follow a diet containing anti-inflammatory food, lots of fish and vegetables, and cut out processed, high-fat foods. Some patients don’t realize that even a modest weight loss of 5–10 lbs. can help with weight-dependent joints like hips, knees and ankles.”
Dr. Pagnussat manages her own RA though a combination of medical treatments, diet and exercise.
“I don’t like to talk about my specific treatment regimen because RA affects each individual differently, and treatment needs to be tailored to each patient’s individual case,” she says. “I do try to educate my patients about such topics as diet because some believe diet alone can cure arthritis. [Although] I don’t believe diet alone is effective in treating RA, I do avoid fatty, processed foods and sodas that have been linked to an increase in inflammation.”
Working with each patient to develop a treatment plan ensures that both parties are on the same page when it comes to managing their rheumatic disease, says Dr. Pagnussat, and identifying measurable targets to determine their disease is well controlled.
“Often, this means letting patients know that being pain free may not be the goal—but rather pain tolerable,” she says. “I also inform them how the first therapy we try may not be always be the right fit for them and that sometimes it’s a trial-and-error experience. Although it may seem like a roller-coaster ride, I reassure my patients that I’m there to support them.”
Following Her Own Path
Twelve years after graduating from medical school, Dr. Pagnussat continues to enjoy her choice of specialty and the rewards that come with making a difference in the lives of patients who often feel their diagnosis equates disability.
“I like the field of rheumatology, because it allows me to follow patients over the years and through the course of their disease, while also building lasting relationships,” Dr. Pagnussat says.
When she’s not working, she enjoys spending time with her husband, Christian, and their two young daughters, Kaitlin and Abigail.
“I try not to pile too much on my plate,” Dr. Pagnussat says. “A typical evening after work involves spending time with my husband and daughters playing board games or watching television.”
To keep her RA symptoms in check and to keep joints and muscles in motion and to build muscle strength, Dr. Pagnassat also enjoys swimming and spinning classes.
“I know my body, and I don’t push myself beyond what I’m capable of doing, and I encourage my patients to do the same,” she says. “I also don’t beat myself up if I only manage to exercise three times a week.”
And as she knows from first-hand experience, staying on top of her RA symptoms to prevent flares is critical, yet Dr. Pagnussat admits there have been times when she hasn’t always been the perfect patient.
“I don’t routinely share this with patients, but there were times in my younger years when I would stop taking my medications to see what would happen,” she says. “I definitely don’t encourage my patients to do this!”
Linda Childers is a health writer located in the San Francisco Bay Area.
