Today, we have an appointment with Dr. Sallie Giblin, a 2016 graduate of American University of the Caribbean School of Medicine (AUC) in Sint Maarten. After earning her Doctor of Medicine (MD) degree at AUC, Dr. Giblin did an internal medicine residency at Louisiana State University (LSU) Health in Baton Rouge and then completed a rheumatology fellowship at the University of Mississippi Medical Center. Rheumatology deals with the diagnosis (detection) and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic diseases. Such diseases affect the joints, muscles, and bones, and can cause pain, swelling, stiffness, and joint deformities. Board-certified by the American Board of Internal Medicine, Dr. Giblin has extensive experience in the diagnosis and management of rheumatic and inflammatory diseases. She is on staff at Lexington Rheumatology in West Columbia, South Carolina.
Q: Dr. Giblin, thanks for seeing us today. Tell us a bit about your work at Lexington Rheumatology. What patients do you see; what are your tasks and responsibilities?
A: I currently work at a hospital-employed rheumatology practice, so we have both inpatient and outpatient responsibilities. In the outpatient setting, I see both new patients who don’t have a known diagnosis but who may have various symptoms and/or abnormal labs as well as follow-up patients with a known diagnosis. Because rheumatic diseases are chronic, these patients need long-term care. We care for a lot of follow-up patients.
Q: What are some common conditions and diseases treated by rheumatologists? How are patients referred to you?
A: We see a wide range of conditions, including inflammatory arthritis (such as rheumatoid arthritis or psoriatic arthritis), gout, connective tissue diseases (such as systemic lupus, scleroderma, and myositis), vasculitis, and even osteoporosis. Patients are referred either by their primary care providers for certain symptoms (such as joint pain) or abnormal labs. Such specialists as nephrologists, ophthalmologists, gastroenterologists, pulmonologists, and dermatologists also refer patients to us because there is a lot of overlap in our conditions. We are often asked to manage the medications used for people with an underlying inflammatory eye condition (like uveitis) or interstitial lung disease because we have a lot of experience with immunosuppressants.
Q: Rheumatic conditions and diseases can be complex and difficult to diagnose. What signs and symptoms may alert people to a rheumatic problem?
A: Rheumatology is a gray field of medicine, very rarely is it black or white. Patients with the same disease can have such different presentations. Some important signs to be aware of that could raise suspicion of an underlying rheumatologic disease include joint swelling and stiffness (especially if those symptoms improve with activity), rashes, muscle weakness, and unexplained fevers.
Q: Why do some rheumatic diseases cause severe pain, particularly in the joints?
A: Most rheumatic diseases cause a lot of inflammation, especially in the joints. The inflammation is typically in the synovium of the joint which causes the pain and stiffness and “gelling phenomenon” after periods of prolonged rest. Uncontrolled inflammation of the joint can cause joint damage leading to deformities and possible disability.
Q: How are rheumatic diseases treated? Is surgery ever an option?
A: Most rheumatic diseases need medicines that work on the immune system to decrease the inflammation causing their various symptoms and organ damage. Immunology plays a big role in the pathology and treatment of rheumatic diseases. As more research develops with the certain immunologic mechanisms contributing to the specific diseases, drugs are then developed to work on those specific pathways. There are certain times when surgery could be an option including a kidney transplant for those with severe lupus with kidney involvement. When joint damage is severe, then patients may need joint replacements with orthopedics.
Q: Do you participate in Maintenance of Certification (MOC)? What does that entail and why is it necessary?
A: In order to remain board certified, you have to complete maintenance of certification. These are various educational activities to help physicians stay up to date in their field of medicine. Medicine is always changing so the learning doesn’t stop after you finish your residency or fellowship training. Activities such as conferences and even using UpToDate [a point-of-care medical resource] for research can earn MOC credits. You must earn some MOC points every two years and have a cumulative 100 points for a five-year period. You must also either take the MOC exam in your specialty every 10 years or some specialties have an option where you can do a longitudinal knowledge exam where you answer a certain number of questions each quarter over a five year-period and then it is scored.
Q: You are trained in bone mineral densitometry (BMD). Will you explain what that is and how such BMD tests as dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool (FRAX) work?
A: Bone mineral densitometry measures the bone strength and quality in an individual. It is important to know the bone mineral density in a person to try to help prevent fractures from occurring, especially as we age. The most common way to measure bone mineral density is through DXA. This is a way to diagnose low bone mass, predict fracture risk, and monitor response to therapy. DXA is a form of X-ray that allows quantification of bone mineral density. It is best to use measurements of the lumbar spine, femoral neck, or total proximal femur. The distal 33% radius can also be used for diagnosis, especially if the patient has had previous surgeries to the back and/or hip. FRAX is a computer-based program that uses clinical risk factors along with the femoral neck bone mineral density to calculate a 10-year risk estimate of a hip fracture or major osteoporotic fracture. We use these in a patient with osteopenia to see if they would benefit from treatment for osteoporosis if their FRAX is high. Treatment is advised if a patient’s 10-year risk of hip fracture is better than 3% or the chance of a major osteoporotic fracture is greater than 20%.
Q: What do BMD test results tell you about a patient? Who should get such a test?
A: The BMD test results can determine if the patient falls in the normal range, osteopenia range, or osteoporotic range to determine who would benefit from treatment. It also helps monitor response to therapy for those already being treated. Anyone may be tested, but we BMD recommend testing for:
- Women age 65+ and men age 70+
- Post-menopausal women or those in menopause transition
- Anyone with potential low bone mass because of low body weight, a prior fracture, high-risk medication use (especially steroids), disease, or any condition associated with bone loss
- People with a history of fragility fractures [broken bones from low-energy trauma]
- People on osteoporosis medication (in order to monitor response to therapy)
Q: What other imaging studies can help assess a patient’s rheumatic condition?
A: We use X-rays a lot to assess a patient’s joints. There are some findings that can be more suggestive of inflammatory arthritis vs osteoarthritis. Ultrasound has become a valuable tool to assess for synovitis (inflammation of the lining of the joints) and other features to help identify inflammatory arthritis. We utilize magnetic resonance imaging (MRI), especially when we are evaluating for sacroiliitis in a young person with back pain and stiffness. Computed tomography (CT) scans of the lungs are important in diseases that can cause lung pathology.
Q: You have trained in rheumatology infusion therapy. Will you tell us about that, maybe explain how it works?
A: Many immunosuppressant medications are offered through infusion. This allows the patient to come to the clinic and have the medication administered intravenously. We must be on the lookout for negative infusion reactions and monitor patients closely throughout the infusion. Infusion therapy is a great option for patients that don’t want to give themselves shots; a lot of our medications are subcutaneous.
Q: You completed a residency in internal medicine after graduating from AUC. Was your original plan to stop there and practice as an internist — or did you always intend to move on to rheumatology?
A: I went into residency with an open mind. I wasn’t sure if I wanted to be a hospitalist or go into a specialty. I did a rheumatology rotation my intern year and had the most amazing mentor, so that piqued my interest. I found myself most interested in the rheumatology cases that I came across during my intern year. I also wanted to find a specialty that had a good work-life balance. I did another elective in rheumatology my second year and decided that it was the specialty for me. I also had a personal connection with rheumatology even before medical school because my brother was diagnosed with an autoimmune disease during college.
Q: Aside from medical school in Sint Maarten, your undergraduate study, residency, fellowship, and work have all been in the southern United States. Is that by design?
A: Yes! I was born and raised in South Carolina, and knew I always wanted to come back here to practice. It was great to get away for medical school, and I traveled to Miami and New York for some of my third-year rotations, but the southern United States has always felt like home. My husband is from Louisiana, but fortunately he was on board to move to South Carolina when I finished my fellowship because I always wanted to be close to my family.
Q: Do you remember the moment you decided to become a doctor? What brought you to that decision?
A: I remember writing an autobiography in fourth grade, and I wrote about wanting to be a doctor when I grew up. I wanted to be a pediatrician back then. My dad gave my uncle a kidney around that same time, and that’s when I realized how special medicine is. The passion grew throughout high school and college, especially with all of my science courses.
Q: How did you end up going to AUC? What was the application and interview process like? What was the feeling upon acceptance into the MD program?
A: I initially only applied to in-state MD programs within South Carolina and was waitlisted. I didn’t love the idea of waiting around another year to go through that process again. I was taking the year off and babysitting in Charleston during that time. One of the families I was babysitting for told me about their best friend going to AUC, and she got me in touch with him to hear about his experience. After talking to him, I decided to apply. It was a huge relief when I got accepted, because I realized my hard work had paid off and I was finally getting the opportunity to pursue my dream.
Q: What was your first impression upon arriving in Sint Maarten and then at the AUC campus?
A: My dad flew down with me to get me settled on the island. I was nervous about being in a foreign country and not knowing anyone. I realized pretty quickly that I would love island life. The beaches are beautiful in Sint Maarten, it has great restaurants as well as such necessities as grocery stores. I lived in the dorm my first semester at AUC and was impressed with the spacious rooms. The new building wasn’t added until my fourth semester, so I didn’t get to experience the new anatomy lab. I thought the campus was beautiful and had all the essentials. I loved the small library and found myself studying there quite a bit my first semester.
Q: What did you find the most challenging about medical school? Did a particular semester, course, or exam prove the most difficult?
A: Medical school is very fast paced, but I loved the challenge. You have to study every day to keep up with all of the new material being thrown at you. The block weeks were tough, because you had to split up your studying for all of the courses rather than focusing on one at a time. Being away from my family was challenging. I missed a lot of events like weddings and even my sister’s graduation, but the distance allowed me to focus on school without distractions. I seemed to do better each semester. I wasn’t the biggest fan of anatomy; I found it pretty difficult and I didn’t enjoy all the time spent in the lab. That’s probably why I’m not a surgeon!
Q: You were named AUC’s Student of the Semester in 2014. What does that honor entail, and how did you earn it?
A: I was truly honored to receive that recognition. I tried my best to be well-rounded during medical school and spend time with various organizations. I enjoyed serving in the American Medical Student Association (AMSA) as well as being a class representative. I love fundraising and planning, so it was a lot of fun to raise money and plan our fifth-semester party. I like to think I earned the award because other students saw my efforts and felt like I dedicated a lot of my time and energy not just to my studies but outside of the classroom as well.
Q: What was the residency match process like — particularly during Match Week?
A: The residency match was stressful. I applied all over the Southeast and got a good many interviews. I was most interested in staying in Baton Rouge, because that is where I did the majority of my clinical rotations and I loved the two programs there in town. I wasn’t sure I was going to match at LSU, because it is competitive, so I was very excited when I got my results and saw that I had matched there. When you get that initial email at the beginning of the week saying that you matched, it is a huge weight off your shoulders. Then the excitement just builds as you get to Friday and find out the location.
Q: What are the benefits of studying at a Caribbean medical school such as AUC? What unique value or opportunity does it offer?
A: Going to AUC got me out of my comfort zone. I don’t think I would have ever left the Southeast if I hadn’t applied and got accepted. It was great to get away from the distractions of family and friends so that I could just focus on my studies. You build such strong bonds with people who are going through this same grueling process away from their families and friends also. The ability to travel around during your clinical rotations and see different hospital systems is unique. It allows you to be exposed to different cultures as well.
Q: What were your favorite things to do as a student at AUC — both on campus and around Sint Maarten?
A: Someone taught Zumba classes on campus which was a lot of fun. I grew up dancing so it was nice to have a little touch of dance in my life during the stressful process of medical school. I loved exploring Sint Maarten with my friends during my time there. There are so many cool beaches that we loved to visit in our down time. I also liked going to the different restaurants, especially Abu-Ghazi for a late night shawarma during block week. Red Piano, a piano bar, was my favorite place. We spent many nights singing and dancing along to the talented piano players. “Mustang Sally” was a song that got me up dancing every time! I had a lot of fun during my time on the island. I learned quickly how to study hard, but I also found time to have fun.
Q: Do you keep in touch with any AUC classmates or faculty?
A: Yes! My core group of friends I met in the first semester are still some of my closest friends. We would all be at the casino by campus watching college football on Saturdays that first semester, and that’s how we got to know each other. We each had our favorite team and they were all part of the Southeastern Conference. Nowadays, we typically end up getting together about once a year either for weddings, baby showers, or just for a girls trip to Charleston. We were in Greece last September for a wedding and that was a lot of fun.
Q: And finally, many current and future medical students will read this interview. Do you have any advice for them?
A: Enjoy the ride. Don’t be so focused on the end goal that you miss out on all of the opportunities you have throughout the process. You have to take time to have a little fun even amidst all of the studying and stress. Program directors for residency programs like a well- rounded candidate, so get involved on campus during your time on the island.
Thank you, Dr. Giblin, for your wonderful answers and for fitting us into your busy work schedule! To learn more about rheumatology, visit Rheumatic Diseases and Pain at the United States Centers for Disease Control and Prevention (CDC), and Arthritis and Rheumatic Diseases at the U.S. National Institutes of Health (NIH).
If a career in medicine interests you, learn more about AUC and our medical sciences curriculum, as well as the requirements for admission.
The information and material contained in this article and on this website are for informational purposes only and should not be considered, or used in place of, professional medical advice. Please speak with a licensed medical provider for specific questions or concerns. AUC is not responsible for the information maintained or provided on third-party websites or external links.
