My name is Bharat Kumar and I am a Rheumatology and Allergy/Immunology fellow at the University of Iowa in Iowa City.

I really don’t know where to begin talking about myself.  I’ll start by saying that my version of a perfect weekend is one without work spilling in from Friday (that never, ever happens).  I enjoy learning and exploring the world around me, and creating things, in turn, for others to explore.  Then again, a day at home on the couch watching television and browsing the internets and sharing a bowl of popcorn with the wife is perfectly fine by me.

I should mention that in addition to rheumatology and allergy/immunology, I have a special interest in the “softer” side of medicine – medical ethics, journalism, and education.   I’m always looking for opportunities to explore these.  I’m hopeful this website will allow me to do so.

In terms of my professional background, I have a fairly diverse one.  I went to the University of Pennsylvania in Philadelphia, PA, and then attended medical school at Saba University in the Dutch Caribbean.  I then finished off my residency in Internal Medicine (that is, medicine for adults) over yonder at the University of Kentucky in Lexington.  I hope to have a Curriculum Vitae up fairly soon.

For those who aren’t familiar with the medical lingo, here are some FAQs, and some more personal information.

What is a fellow?

A fellow physician is a doctor who in the process of specializing in a particular field of medicine.  Fellowship range widely in structure and in duration among different programs.  However, they are fairly uniform in that fellows have to have graduated medical school and completed residency.

What is rheumatology?

Rheumatology is the study of diseases that involve the joints, muscles, and ligaments.  Supposedly, these structures are soft tissues” as opposed to visceral organs like the heart, the lungs, or the gut.  Diseases that affected them were once clubbed as rheumatic diseases, which is Greek for river, which is in reference to how they felt that life would flow through these connective tissues.

While modern rheumatology is concerned with arthritis and other joint diseases, it has become almost synonymous with systemic inflammatory disorders and autoimmune diseases, where the immune system redirects its focus on the body itself.  Since many of the autoimmune diseases (like Systemic Lupus Erythematosus and Rheumatoid Arthritis) affect the joints, it simply makes sense for rheumatologists to also be clinical immunologists.

It’s difficult to express why I like rheumatology, but there are three overarching reasons:

• First, rheumatology focuses on the here and now.  I love treating arthritis because my patients get better.  Patients with arthritis can’t do the everyday things that we take for granted – open jars, walk without difficulty, or just get up and go in the morning.  For many types of arthritis, we have ways to help induce “remission” of the disease, and, in the process, dignify people to live their lives how they would like to.  There is no greater satisfaction than witnessing a wholy debilitated person steadily reclaim his or her life.
• Secondly, rheumatologists see some of the most common diseases and some of the rarest.  Arthritis is a highly prevalent disease – especially the “wear-and-tear” arthritis that we call osteoarthritis.  Additionally, 1-2% of the entire world’s population has rheumatoid arthritis and a similar percentage in the Western world have gout.  But we also diagnose and treat rare and poorly understood diseases: the ones that doctors affectionately call ‘zebras.’  Vasculitis – the inflammation of the blood vessels, periodic fever syndromes – where inflammation runs amuck, and scleroderma – the progressive thickening of skin and other organs, come to mind.
• Lastly, the field is ever-changing.  There’s been a tremendous amount of research in the basic science of inflammation, and now, that science is being translated into new medications and other therapies.  Every year, there’s a revolution in the management of autoimmune diseases that directly benefits patients.  And yet, even with these advances, there’s still an entire universe of opportunities for fellows to engage in practice and resesarch.

What is Allergy/Immunology?

Allergy/Immunology is the specialty dedicated to studying immune disorders.  It is a far-reaching specialty that includes allergies of all sorts, asthma, immune deficiencies, and autoimmune diseases, among other conditions.  These allergies include those to the environment (trees, grasses, molds, etc.), foods (like peanuts, eggs, milk), drugs, and stinging insects (bees, wasps, ants) among others.   Related diseases like asthma, eosinophilic esophagitis, eczema,  urticaria, angioedema, and anaphylaxis (though not necessarily related to allergies) are also managed by allergists.

Additionally, allergists and immunologists see children and adults with immune deficiencies, where the immune system is unable to fight back against the various viruses, bacteria, fungi, and parasites that envelop our world.   Some immunologists also deal with transplant patients, HIV infection, and autoimmune diseases.

As you can imagine, it’s a very diverse field, and, like rheumatology, allergy/immunology allows me to see some of the most common diseases and some of the rarest.  And, much like rheumatologists, allergists/immunologists empower patients to do the small things that we would otherwise take for granted.

 What’s up with the “combined” program?

Technically, I am in a dual certification pathway that allows me to fulfill all the requirements of both fellowship programs and permits me to take both board examinations once I graduate.  Most rheumatology fellowships, as well as allergy/immunology fellowships, last two years (with an optional third for in depth research), but because there is substantial overlap among the two fields, I can complete both fellowships in three years, instead of the minimum four.  The University of Iowa is one of the very few nationwide that offer the dual certification pathway – and I’m fortunate to be here.

So far, it has been a challenging career choice.  Since both fields are so expansive, it has been almost like relearning all of medicine.  But it works, because both fields are predominantly concerned with disturbances of the immune system.  While most of us think of the immune system as a dial that can be turned up (autoimmunity, allergies) or down (immune deficiency), the truth is far more complicated.  Patients with autoimmune diseases are more likely to be immunodeficient, and immunodeficient patients very frequently develop autoimmune disease.  We still don’t know exactly why, but I hope to help figure that out.

Secondly, I am privileged to see the most unusual diseases.  Certainly, if “House” were a real physician (barring his extreme unprofessionalism), he would be either a rheumatologist or an immunologist (geneticist and infectious disease specialist are also conceivable).   Because our diseases are rare, and can present in any which way they please, the quality of our diagnostic skills are constantly being challenged.  Rheumatologists and immunologists are the old school physicians, the ones who dig deep into the history, observe closely for clues in the physical examination, and scrutinize laboratory and radiographic findings to get a diagnosis.  At the same time, rheumatologists and immunologists are eager to use the most advanced investigation techniques (biochemical markers, genetic analyses, etc.) to confirm diagnoses.  In fact, rheumatologists and immunologists are often considered as ‘super-internists’ whose skills are prized for helping evaluate the as of yet undiagnosed.

Lastly, by being in both fields, I can be both a specialist and a super-generalist.  Because these specialties are so vast, there is not a single topic in medicine that neither rheumatology nor allergy/immunology doesn’t touch.   When I was choosing specialties, I was concerned that, like many specialists, I would lose touch with bread-and-butter medicine.  But with dual certification, it simply is not possible: I can never get away from primary care.