Episode 55 | Dr. Nandini Moorthy – KIDDOS & RHEUMATIC DISEASE

Dr. L. Nandini Moorthy, MD, MBBS, MS is a Professor of Pediatrics at the Rutgers Robert Wood Johnson Medical School. As Chief of the Division of Pediatric Rheumatology, she has established a clinical practice renowned for caring for complex patients, collaborating closely with colleagues to provide comprehensive care for children with rheumatic diseases.  
 
In addition to her clinical expertise, Dr. Moorthy has extensive experience in conducting research and overseeing projects aimed at improving diagnosis, treatment, and quality of life for patients with childhood lupus and other pediatric rheumatic diseases. Dr. Moorthy's publication record reflects her significant contributions to various studies examining clinical outcomes in rheumatic diseases. 

See Dr. Moorthy’s links below. 

Arthritis Foundation
https://www.arthritis.org/juvenile-arthritis

Lupus Foundation
https://www.lupus.org/our-work/childhood-lupus

American College of Rheumatology - patient resources
https://rheumatology.org/patients/juvenile-arthritis

American Academy for Pediatrics

https://www.aap.org

A Psalm of Life by Henry Wadsworth Longfellow.

Trust no Future, howe'er pleasant!
Let the dead past bury its dead!
Act,—act in the living Present!
Heart within, and God o'erhead!

Transcript

SPEAKER_04 0:00

Children with rheumatic diseases and conditions and their parents face unique challenges. Illnesses like lupus, juvenile rheumatoid arthritis, and fibromyalgia disrupt family and school life, often in profound ways. In a recent review of 19 studies assessing over 1,400 participants, the impact on our youngest rheumatic patients was considered, and four themes emerged. First, symptom burden. Pain, fatigue, physical changes often disrupt life and alter self-image, both having serious implications for mental health. The second theme centered on the treatment itself. Medication side effects and ambivalence around taking the medications are very common. The third theme illustrated how life just becomes more complicated and burdensome living with rheumatic disease. Extra planning is needed to do anything, and then disease or symptom flares blow everything up. And lastly, the need for adequate coping resources, such as support of family and friends, maintaining resilience and optimism when things get tough, and the value of strong relationships with caring healthcare providers. Today we are joined by one of the most caring health care providers I know. She also happens to be a pediatric rheumatologist. Dr. L. Nandani Morthy is a professor of pediatrics at the Rutgers Robert Wood Johnson Medical School. As chief of the Division of Pediatric Rheumatology, she has established a clinical practice renowned for caring for the complex pediatric patients in close and collaboration with colleagues to provide comprehensive care for children with rheumatic diseases. In addition to her clinical expertise, Dr. Morthy has extensive experience in clinical research and overseeing projects aimed at improving diagnosis, treatment, and quality of life for pediatric patients with rheumatic diseases and conditions. Hi Nandani, we are so excited to have you here today. I can't believe that we reconnected after some time, and it just seems like the perfect timing to have somebody with your background on the show.

SPEAKER_03 2:00

I'm so excited, Dr. Hassett. I'm so happy we reconnected. Thank you so much for having me. It's really a pleasure to be here. And I have to say, when we reconnected and I learned you had a podcast, I was so surprised in the best possible way. Yes. And it's been wonderful to see how our professional journeys have unfolded over time. And I'm so happy and grateful that our paths have crossed again. And um, we get to have this conversation today.

SPEAKER_04 2:32

Oh, you make my heart so happy. Thank you, Nandane. You call me Afton. You're being fancy for the podcast, but our listeners all know me is Afton. All right, Afton. I should thank you. So I wanted to have you on because you're a pediatric rheumatologist, and you'll be the first one that's ever been on this podcast. We've had a couple folks that have talked about children with chronic pain and these types of illnesses, but really nobody with really your rich and unique perspective. So, really, there's only a handful of pediatric rheumatologists in any given state, and some places have maybe one or even two. So it's an incredibly rare profession.

SPEAKER_03 3:15

So unfortunately, access is a huge issue.

SPEAKER_04 3:20

Yeah.

SPEAKER_03 3:20

Pediatric rheumatology is one of the smallest pediatric subspecialties in the US, and only about 400. Oh my goodness. Caring for many children with rheumatic diseases. And for that reason, there's a big problem with workforce. So some states have very few rheumatologists, and many families have to travel long distances to see a specialist, and access to care remains a real challenge. Yeah.

SPEAKER_04 3:47

Well, you know, bless you for doing this. And, you know, for um members of our audience that might not know exactly what a rheumatologist or pediatric rheumatologist does, you know, it'd be really interesting to kind of hear about you and how you got to this point. So, you know, maybe, you know, talk a little bit about you know your journey and what brought you to become an expert in your specialty area.

SPEAKER_03 4:13

Oh, I'm so honored to talk about it. So, quickly, what is pediatric rheumatology? It's a field that cares for children whose immune systems they cause inflammation in the body. Some examples are like arthritis, lupus, scleroderma, periodic fevers. These children can get joint pain, swelling, limitation of movement, rashes, fevers, sometimes they limp, and they can get also other symptoms that affect different systems. And basically, we help them while they're still growing and developing. So my journey after I have Shrek in my mind because there's going to be Fiona over the weekend for a play, but in a far, far away land. I grew up in India with parents who were not physicians, and but their instinct was always to heal.

SPEAKER_02 5:04

Yeah.

SPEAKER_03 5:05

My father was an engineer in the FOS, and mom was a biochemist. And after they were constantly finding ways to help anyone around them who had a medical problem. Every single childhood scrape of mine was treated with turmeric antiseptic poultices. My wounds never got infected. And super hot summers in North India, poor sparrows would sometimes come flying into our house through the open windows, trying to escape the unrelenting heat. Yes. Didn't have air conditioners or coolers, only ceiling fans. And sadly, the birds would sometimes get hit by the fan and fall down. And my father actually set up a little rack in the kitchen. We had a tiny, tiny house, and there was an entire healing rack where he would essentially nurse all these birds back to health along with my mom, giving them medications, preparing dexterous water. There was a whole rehydration program going on in my house. And they all recovered and flew away. No, no bird failed my parents' magic treatment. And my father would also help many neighbors who couldn't afford medical care. So growing up in that environment, healing, helping just was so natural. It was the natural way to be. And so right after high school, I went to med school in New Delhi. And during those years, I was fascinated, but also very humbled by the suffering I saw and by how many different diseases people faced. So around that time when I visited my mom and my sister in the United States, we used to watch the TV show Dr. Quinn Medicine Woman. And I was just so impressed by Dr. Quinn, how carefully she listened to people's stories, how she cared with the cared for them with very limited resources. Also, she was such a strong woman practicing medicine at a time when that wasn't easy. Then when I pursued pediatric residency at Cornell in New York, I fell in love with many pediatric specialties, including immunology. And then I realized I wanted a field that combined many areas of medicine and really depended on listening closely to the patient's narrative. And rheumatology fit that beautifully. And often in the two decades or more that I've known you, I have not regretted choosing this field.

unknown 7:34

Yeah.

SPEAKER_04 7:34

And I think when I hear from other rheumatologists and oncologists and immunologists, there has been a revolution in care that has made it very gratifying. New treatments that can reverse or at least stop illnesses that used to kill and disfigure so many people. So it feels like it is a growing exciting and rewarding area. Extremely so, very well put. Yeah. So how do your sweet little patients find you? What's usually happening in a child's health that leads to a referral to someone like you?

SPEAKER_03 8:14

So most of my patients, they are referred by their pediatricians or family physicians. Um, essentially, the child has symptoms that doesn't fit the common diagnosis, like persistent joint pain and swelling, limping, unexplained fevers, rashes, fatigue, fingers turning blue, white and red, abnormal lap testing suggesting inflammation or autoimmunity. Sometimes children are also referred by other specialists like orthopedics, dermatology, or infectious disease doctor when the cause of disease is not clear. One of my mentors actually said that pediatric rheumatology should be called obscurology and no obscure obscurology. But by the time they reach us, the families are often looking for answers to symptoms that have been going on for a while. And our job is to piece together their story and sort of be a detective.

SPEAKER_04 9:15

Yes. I think that's absolutely how I think about rheumatology. It's like when there is a baffling patient that comes in and the symptoms don't fit. And I've even heard patients, symptoms staff sometimes as a weirdoma, that there's just something that is happening in the body is just so odd that it's not clear. When this type of patient presents, it's always called room, call the rheumatologist in. You guys are indeed the detectives. So despite kind of all of these new biologic therapies that we were kind of alluding to before, um while treatment is often very effective, these illnesses and conditions really can be disruptive and I think an unusually um difficult for children. You know, what are some of the things that children face when they are diagnosed with these diseases and conditions?

SPEAKER_03 10:16

So what they face is risk of damage in case of arthritis. Is there limitation of mobility and damage to joint? And um, in addition to functional limitation, additional impact, such as you know, emotional impact, psychosocial impact, school self-esteem, etc. But again, the good news is the treatment of pediatric rheumatology diseases, especially JIA, it has changed dramatically. Before that, they had significant disability, ongoing pain, but now these targeted therapies do achieve disease control more quickly, does reduce long-term damage, supports normal growth, activity. So I think kids have a better chance overall. The horizon looks good, the landscape has changed, but still I think I think it affects them physically, emotionally, it's very challenging in terms of school issues. Yes. You know, it creates extra pressure essentially to meet the expectations that their peers might take for granted.

SPEAKER_04 11:29

Right. So even granted that we have these kind of game-changing medications, what we refer to as biologics and you know, kind of as a class of medications, um, there's still a lot of fallout from having any chronic illness. And I think when we started working together initially, I think the thing that I loved most about your work. Well, there's much to love, but what I loved is that this was an important part of the story you would tell as we talked about these patients and what they faced and your desire to really get at the impact that these children experienced. And so you developed a measure called Smiley. Can you talk a little bit about that? We developed a measure after we were part of the core team together. Time was on the sideline. Come on. You're amazing. But talk about Smiley.

SPEAKER_03 12:20

So as you and I've spoken about this before and many times in children, lupus brings so many challenges, yeah, both from the disease and its treatment, like you brought up, its chronic, unpredictable nature, its variability between patients, like it's so heterogeneous. Uh, the expectations and needs of children that constantly evolve, all of that made measuring well-being and even understanding quality of life so difficult. On top of that, the cognitive development of children, it's so variable by age and by disease, and the reliance of caregivers to report symptoms, the added psychosocial impact and the things that are different in children compared to adults, self-esteem, school issues, social issues. There were so many layers of difficulty in measuring outcomes of well-being. So, yes, we developed the smiley, the simple measure of impact of lupus arythmatosis in youngsters. It's a brief, easy to understand, valid and reliable pediatric lupus-specific questionnaire, measures quality of life. And um, as you remember, we not only validated it rigorously in the US, but also translated it into multiple languages, helping children with lupus worldwide and parents have their voices heard and experiences better understood. And I'm so thankful that you were part of the core team. So thank you, Act.

SPEAKER_04 13:54

Oh, it was a pleasure, and it was so fun. How many languages is it in? Do you even know?

SPEAKER_03 13:59

Over 30. And just recently, and I still get requests after. I still we we had we did cult cross-cultural sort of translation and cross and and and we did a whole study related to that. And I still get emails from different um from different providers saying in this country, can we go ahead and get it so we can validate it in our population? So I don't have the exact count, but maybe we can do another podcast just about smiling and talk about smiling.

SPEAKER_04 14:28

And it's beautiful, it's perfect for children. It is, you know, it asks a question, and then the child indicates the smiley face that best, you know, you know, indicates how they are doing, you know, the sad little face for if they're doing poorly, and the really happy face if they're doing well in a particular category. And you can kind of add it up and get a sense of the whole picture of the areas in which the child isn't doing well, and other areas that, you know, whether they're accomplishing what they like to accomplish. So it's it's really a cool thing.

SPEAKER_03 14:57

And and just to um close the loop on that, I thank you for mentioning that. There was one child who aged out of the study. So she was older, and we said, and and when she came into clinic, we said, Yeah, you'd hi. And she's like, I'm not gonna fill out those faces this time. I said, No, you don't have to, because happy birthday, you're now older. She's like, Oh, I'm so sad I can't write how I feel. I'm like, you still can. I just thought about it. I'm like, she's just writing how I feel. I don't need to use that for research. She can just, you know, express herself. She's like, Oh, I still can feel fill it out. So she was excited to share.

SPEAKER_04 15:38

You bring up such an important point that I think it really matters to patients that the physician knows how they're doing in the world, especially if they need some help or if they're doing particularly well. And then you brought up something that um, you know, I it probably is a whole podcast in itself, too. But you know, when young children or adolescents kind of age out and that transition from a pediatric rheumatologist into adult care, that can be tricky.

SPEAKER_03 16:05

So tricky. And unfortunately, due to insurance issues, growing independence, and you know, sort of they're going off to college and all of those issues. Unfortunately, many of them just are lost to the medical field during that time. They just don't make it to see an adult rheumatologist many of the times. It's very sad. So I think transition is very important. And as a family, uh, we pediatric rheumatologists, um, the medical family essentially, we need to we need to all work together with the patient's family, the school, the um pediatrician, and the adult rheumatologist to try and get them over very safely. In fact, we just worked hard with an adult rheumatologist in our um medical system, came up with four videos with a bunch of students, and now we have a nice little website with a QR code to give our patients. So we are like, This may see me talking to adult rheumatology, and then the students ask a bunch of questions so they can see the younger, sort of young adults, right? The questions and they can kind of relate to it. So I'm like, and they'll still see me, who they recognize as the pediatric provider, endorsing the care of adult rheumatology.

SPEAKER_04 17:27

I love that, and so it's just an opportunity to have other peers say, You're gonna be okay. This is a great transition. I, you know, I hear this over and over again how hard it is sometimes for um for a young patient to leave their pediatric rheumatologist or pediatric provider of any of any uh practice behind because those relationships are very rich. You literally have watched some of these children grow up.

SPEAKER_03 17:52

Absolutely. We feel like they're part of our family at this point. It's just, you know, the prom, the graduations. We spend so before even we talk about medical care, we first catch up. Yeah, because we've all known them forever. That's catch up first. Yeah.

SPEAKER_04 18:08

And it must be really um rewarding to you to watch sometimes very, very sick young children then go on to be medically stabilized, get the care that they need, and lead rich, interesting lives and go to prom and graduate and have the first boyfriend and you know, have these incredible experiences.

SPEAKER_03 18:29

And that's what's really special, and um, it actually humbles me deeply that we are trusted and we get to know how these people feel and um how they hold us close. And I hold that very, very special and important.

SPEAKER_04 18:50

I uh and it sounds just to type, that's who you are. And when you told me that you've had a growing interest in narrative medicine, I said, Well, of course she does. This is this is who Nandani is, and um, you know, I'm just curious about you know, what is this um practice? So talk about narrative medicine, and then what led you to it?

SPEAKER_03 19:15

That's actually a very interesting story. What led me to it? I think I understood it by the name of narrative medicine after I came to the United States. So when I was 16, going on 17, I started med school in India. My mother had gone to the United States with my sister, and she would send me beautiful letters, almost packages of letters and all-inspiring stuff. She would say, I got this from this book, and or she would send a photocopy of a poem or a photocopy of a story of a doctor or a surgeon before he goes on to do surgery, how he prepares with mindfulness that everything should go well. And she'd be like, Read about all this, be mindful, and listen to the story. And she would send me all these stories. So I would have all our mail, it's it's like put out in our dorm in a common area. So the girls would see the postmark and like, you've got mail, Nandani. I'm like, yeah, and they're like, read it out, it's so big. Like, I would have the thickest, fattest envelope and a brown with the America postmark. Yes. I would open it during dinner time in my girls' dinner, dinner area, and they'd be like, Can you not share it? What's going on in the US? So I'd skip all the personal parts and I would read everything, all those inspiring things, and all the other girls would be like, Oh my god, that's so exciting! Your mom sent all this. So every single time I would get a letter, I would share it. It would be like a dinner time affair, you know. So I realized that's what narrative medicine is. It's listening to stories, it's telling stories, it's appreciating what is needed, it's it's it's having empathy, it's exploring empathy, and this helps us navigate uncertainty and ambiguity in medicine, opens up the vault of empathy. We can understand patients and their families as whole people and truly provide care and resonate with their experiences. So I think I think that's what narrative medicine is. And I didn't know this was narrative medicine until I came to the US, and now I'm part of a narrative medicine group. And um I actually got all my mom's letters and I bound it into little booklets.

SPEAKER_04 21:40

Beautiful. Oh, that's that's such a beautiful story in itself, a story about stories. Yeah, when one practices narrative medicine, what would that look like talking to a child? What sorts of things do you ask that help open up and learn about their stories?

SPEAKER_03 21:58

So I think it Could be journaling, asking them to write how they feel, giving them some prompts, reflection, draw. In fact, if they are young kids, I always ask the child to draw and talk about their hobbies. And they just start drawing, the child's relaxed, the child shows me what she or he has drawn. We say, Do you like this? And then that's what somehow we've already bonded. And then we talk about other things that are important to them, and then we go on with the clinic visit. But narrative medicine can be done in many different ways.

SPEAKER_01 22:42

Complex networks connect these remarkable cells so we can breathe, move, think, communicate, and feel pleasure and pain. Changes in some of these brain networks are thought to underline chronic pain. But these networks are not underlined. Stress, sadness, fear, and loneliness can athletic brain networks and make your pain worse. But healthy eating, sleep, and exercise can help your brain make new connections. And so can mindfulness, joy, friendship, and love. Because this is true, the power to create a new tomorrow with less pain and a more rewarding life already resides within you.

SPEAKER_00 23:56

Dr. Hassett's book, Chronic Pain Reset, can be found on Amazon and independent bookstores everywhere.

SPEAKER_04 24:04

It is, it opens up the conversation. And in a world of medicine where increasingly the visit to your physician includes the poor practitioner Harried with too little time, staring at a computer, entering notes, it's a different world to have a physician sit down and ask questions about who you are and what's important.

SPEAKER_03 24:30

I think it's fun for the physician too. I think it's important for me because if I know that somebody likes planting sunflowers, like one of my teenagers, he I had no idea he liked gardening. I had zero clue. And his fingers were affected, and he told me how planting sunflowers brought him joy. And I showed him the sunflowers had grown. I grew sunflowers every year, and I love gardening. And we were just so excited. We were laughing and chatting about sunflowers, and you know, his face was brightly lit up. He was so excited. So I think I think that allows bonding and it allows him to feel a bit more comfortable.

SPEAKER_04 25:17

Yeah.

SPEAKER_03 25:18

Saying, I didn't take my medicines, or I want to do something better, or I can't stand this, or I will want something else, or you know, whatever it is that he feels. It allows them not to be closed up.

SPEAKER_04 25:34

That's really brilliant. It's the notion that this rapport is going to allow you to practice better medicine because the patient trusts you, they're comfortable with you, and they don't maybe feel judged, that they can say, hey, I didn't take my medication or I'm not doing the exercises you do. And then you can ask, well, what can we do to change that? But if you don't have information, you'll never know why the medication isn't working. You won't know that the patient isn't taking it. So it's just another reason why we want to build these rich relationships.

SPEAKER_03 26:08

Also, I think they feel that we don't just see them as another patient with lupus or JIA or something. They like to not be different from their friends. Oh, baby. If I had one big theme, that's huge. Yeah. They want to be like everybody else, they don't want to feel different. That's one thing. The other thing is whatever they do about trying to be independent with parents or not, they still need to, they still want to be accepted by their parents. And they they do, they do, and they want to be successful at whatever they are. So I could tell for for example, one child was so unhappy that she couldn't understand schoolwork, it was just so frustrating for her. Nothing to do with the rheumatic disease, it had a different issue, but I understood that was part of her frustration, which is why it affected other parts of her life. So I these, if I had themes, these are the three things. So I think in whatever ways we can help rheumatic disease get better and get them better in terms of physical and social function. Uh, make sure they have their self-esteem and they feel similar to the peers and uh they can be successful in what they want. I think that would be valued by them.

SPEAKER_04 27:41

That's such a good thing for parents to understand it. You know, and we certainly see this in children with chronic pain that don't necessarily have chronic pain from a rheumatic disease, but it's the same process, this desire to just be normal, to be like the other kids, to be accepted, not to be thought of as the sick child. Yeah. And then also this underlying desire that, you know, children would love to please. They want their parents to be happy and proud of them. So those are such important themes.

SPEAKER_02 28:11

Big themes for their well-being. I would, I mean, all of that stuff. So very, very big themes. Yeah.

SPEAKER_04 28:18

Does this differ at all from older children or young adults? Or are the themes kind of the same across your young patient populations?

SPEAKER_03 28:27

I think themes in terms of teenagers is also, you know, sort of, I would say, independence. Yeah. Teenagers want to feel independent. So when we talk about well-being and joy and other things and hobbies, it's almost easier for a younger kid who'll quickly take a paper and draw. And, you know, I can I can talk about their hobbies, their friends, their favorite subject, and I can I can get a quicker insight sometimes into their fears, hopes, pressures, and also, you know, during that process, give parents insight of how to sort of support them emotionally and involve them in their care. But with teenagers, I think, I think we need to explore a bit more and more tactfully because they are not going to take a paper and draw for me. They may be like, well, I don't like school or I like a book. So then we talk about what books they read, or maybe a movie or anime. I I remember one child loved Miyazaki anime, and that's how we bonded. We talked about Spirited Away and all those lovely Miyazaki movies, and and and I could I could catch up on that move, those, you know, on that somehow to build back the rapport because exactly, you know, or somebody likes F1 car racing. So it all depends on something they like, so I can have a conversation and hopefully an insight. Because again, you know, time is of the premium, we don't have so much time. And teenagers want to feel independent, even though they are dependent, they don't want to be perceived that way. Right, right. So I think the biggest theme is in all of these aspects of wellness and medical care to have them be part of the medical care.

SPEAKER_04 30:16

Right. And you because there is this push-pull, you know, with teenagers that you know they they are a little bit dependent on their parents and on their medical providers, even though they don't want to be, but the the illness kind of binds them to that. And so I think they feel that very acutely. Yeah. I think so.

unknown 30:36

Yeah.

SPEAKER_04 30:36

So narrative medicine is also about the physician, about the practitioner. What has these richer conversations or you know, this narrative medicine approach? Um, what has it brought to you? What have you learned about yourself as a physician?

SPEAKER_03 30:56

So I think one big thing is I feel lucky, like I I want to share my gratitude, uh, because I feel lucky to listen to the family's most personal stories. And I think that connection not only strengthens strengthens the care I provide, but also reminds me every day why I chose this work. So I feel like if other providers take it for what it's worth in the moment, listening to anybody's story, that personal story of pain, of whatever pain it is in different forms of you know, loss of function, loss of not being able to walk, the the disappointment of not being able to dance at a function or having a rash and not looking the way you want to, whatever pain it is, you are part of that's that narrative as a physician, and you're lucky to be part of the narrative. And to me, that makes me makes me stay in the moment and help the family. And I think other practitioners, if they think that way, I think that might minimize burnout.

unknown 32:05

Yes.

SPEAKER_03 32:06

The other thing, it's also taught me a lot about myself as a physician. Um, this helps me stay mindful and stay present. Because on a busy day, there isn't much more time than just checking with yourself before you walk into a patient's room and then moving on. So I I think I think to me, it is mindfulness and gratitude.

SPEAKER_04 32:29

Yeah. No, I I cannot say enough about mindfulness and gratitude. They they keep me grounded as well when so much is happening and you have um a lot of forces pulling at you. And it's not easy to practice medicine in this day and age. I was, you know, lamenting the poor physician who's seeing too many patients in too short a time and having to do so in front of a desktop. Burnout is common. And if there is a practice that can help a clinician return to why they did this in the first place, the honor of providing care, the gratitude that your patients, you have patients before you that trust you to care for them, you know, the um importance of what is done. And I think that's what kind of gets lost sometimes. And it's just the day-to-day grind, and it becomes just a job instead of this kind of beautiful healing profession. I think so. I think that's absolutely right. Yeah. So you um are more than a physician. You I've always been fascinated by your artistic side. You know, you even mentioned it working with children, you get them to draw and to express themselves through through these other processes, but that's the non-deny I know. So you're a dancer. Can you talk a little bit about your dance?

SPEAKER_03 33:55

Oh, I love to dance. I love all kinds of dance, from ballroom to Bollywood, flamenco and Indian classical, so different dance forms. I've learned many, many different dance forms and I enjoy them. I I'm so excited doing that. I mean, um, some of the Indian classical dancing uh that I've learned it's Upirat Natyam and Katak, as well as the Western style. So I I enjoy everything after. And moving essentially connects me to music and a lovely part of myself that's graceful, mindful, and fully alive. And um, in the same vein, I love art, watercolors, acrylic, pencils, mixing colors, watching magic appear on page. I feel like dance and art aren't just hobbies, just like my mom used to say, I see you when you dance and when you paint. That's you, just like you said, that's an Antony, I know. They they allow me to relax, recharge, celebrate creativity, and uh be in touch with that part, you know, of myself. So I enjoy those things tremendously. I think that's great.

SPEAKER_04 35:08

And and you know, I I always remember, you know, you talking about the dance that you do, um, as being just somebody that helps bring you balance, right? That helps it it tickles another part of your brain, it takes you away from kind of the day-to-day street, the day-to-day work, and then it allows you just to have this great creative outlet.

SPEAKER_03 35:30

Yeah, it's so much fun. I think it's a lot of fun, and I recommend it.

SPEAKER_04 35:35

I do too. We have a whole program at the University of Michigan where um physicians have art showings every year, and it's one of my favorite things because they they put it, they put the artwork all throughout the hospital. So the patients get to see this. And there's photography and beautiful sculptures and paint and some kind of terrible things too, but it doesn't matter because it's art. I mean, and some of them, some of these physicians are supremely talented, and there's really, really beautiful works. And I I think that um having a creative outlet is really critical. You know, I I'm an artist too. I I have been honored um to work with um our artists at the Penny Stamps School of Art and Design at the University of Michigan to uh work with them on developing you know interventions and ways that our patients can express their feelings through photojournalism and and other artistic um media and how they've created these books that to me have more clearly shown the experience of living with chronic pain than almost anything else that I've had. And you know, and having this opportunity to to work with the you know creative minds like that is you know is really neat. So I love seeing that it's in one person. There's not a lot of folks that are medicine, science, art, art, art.

SPEAKER_03 36:57

Well, you are you are one person who has so much within you. You're such a fabulous artist and fabulous many things, Afton. So somebody that I look up to tremendously. But yes, when you talk about chronic pain and art and everything, I keep showing, I have this whole lecture for medical students about art to make medical diagnosis. Oh, interesting. I look at yeah, we we all and also art and uncertainty, art and ambiguity, art as being restorative, art describing art and how that allows them to develop diagnostic skills. So we have a whole section where I actually would do this for them, for the students in the medical um, I think it's called the visual literacy elective. Yes. So I would do this lecture for them. And art helps with even diagnosis, describing art and you know, describing other conditions. And I use Frida Kahlo's painting for one on chronic pain. I describe that.

SPEAKER_04 37:56

And that's a dynamite. I believe that hangs in the Detroit Art Museum, and it's just this depiction of Frida Kahlo with almost um punctured skin as she's tortured by this device that is pulling her bones and her body in a natural way. And it's just like, wow, that is chronic pain. That is, I I can't even think of a more compelling depiction to connect to. So yeah, it can help really help us see. Well, well, thank you for taking a little trut and try to down your the the beautiful uh um areas of your of your art and and and dance background. So um there are important resources that we kind of return to this pediatric rheumatology where we started that can help um patients and um and and parents and and other physicians. And do you have favorite resources or websites? If you just I can link them all in show notes if you if you have some favorites.

SPEAKER_03 39:03

Absolutely, and I can even send them to you later. Yeah. The arthritis foundation website is excellent and has so many wonderful resources for families, the Lupus Foundation. Um, and then we've got the American Academy of Pediatrics and the American College of Rheumatology patient resources. So these are some great um resources that I think patients and families can use.

SPEAKER_04 39:30

That's great. And so we will we'll go ahead and we'll um even try to mark the pediatric pages or wherever we can to make this more specific. And we'll put them in the show notes so that people can refer to them. So thank you so much. I I I think um, you know, when people hear this, they'll be hungry for how can we learn more? You know, what what what more can be done? So, well, I I look at the watch and I I can't believe our time went by so fast. Um, Nandini, was there any question that you were hoping I might ask you that you'd like to share with our audience? Um, all right, after.

SPEAKER_03 40:05

So maybe you'll be surprised. But it was to ask me about my baking because I I wish I could get you a slice of my succotort of French vanilla milkcake, Rosie Patchia. Because my because I find it it's my daughter loves all of these things. She gets these creps every time and she needs a snack. So I was gonna I was gonna also mention culinary create creations are fun. And um someday I hope I can host you with those.

SPEAKER_04 40:38

Oh, I would, you are on. That sounds fantastic. I didn't know that you, I know you could, but I didn't know that you made these culinary delights. That sounds right up my alley.

SPEAKER_03 40:49

I I think I think someday if my cousins uh from India, they are like, we should live in a farm and um I should have a cafe, a French cafe, a French vegetarian cafe.

SPEAKER_04 41:01

Oh, I like it. A bed and breakfast. I I'm feeling the vibe here. This is that's very nice. Well, well, thank you, my my sweet friend. Thank you for being here. Thank you for sharing your knowledge. Um, I always ask my my uh my guests one final question. Nandani, what brings you joy?

SPEAKER_03 41:23

So aften I think about that question every day. Do you? I do actually, because there are stretches where I do not get to dance, paint, bake, or even have fulfilling family time. Is every day at work amazing? It's all right, but I focus on the present and my breath because my daddy used to say being happy is your right, and you should try it every minute of your life. So I try to carry that, stay in the moment, and I find joy in very small things, waking up in the morning, seeing the snow or sunshine, a blue sky, a new bloom, sipping my coffee, spending time with family, friends, colleagues, or sometimes with myself if it's a busy day. Because um, when I focus on these moments, joy becomes easy, it's accessible, and it doesn't have to wait for something that I have to do. And one of my mentors, a life mentor, um somebody as special as you, Afton, told me once, trust not future, however pleasant, let the dead past bury its dead. Act, act in the living present, heart within, and God overhead. I have to figure out who exactly wrote it. So what a beautiful He made me learn it as a kid in school. He said you can't wait for anything. You have to just be in the present because that's all you have. So I don't wait for anything, I just try to be happy after.

SPEAKER_04 42:56

That's beautiful. And with that, I say thank you so much for bringing some sunshine to our day and spending some time with us.

SPEAKER_03 43:03

Thank you, Afton. You're very special and um your podcasts are amazing. You're incredible. Thank you. Big smoochies your way. Thank you, Nandani.

SPEAKER_04 43:13

Be well. Be well.

SPEAKER_00 43:17

If the Chronic Pain Reset Podcast series has brought you some inspiration or hope, please consider joining the community of listeners to help fund our production. Your support is important for us to keep creating content for those impacted by chronic pain. Look for the support the show link in our show notes in each episode. Today's episode was produced and edited by William Haskett, made possible by listeners like you, Son of a Books, and the team at Venue by 4M. Our music score, Just Being, was produced by Bohemian Roosters. That's it for today. Join us in two weeks for another episode of Chronic Pain Reset.