FEATURE by Mavis Manus

Dr. Rodanthi Kitridou strides confidently through the halls as she tours the Rheumatology Department of USC Hospital; tall, full of vitality and vigor, the strength of her native Thessaly mountains in her bones.

The small town of Almyros was her birthplace. "Nobody goes there, there are no ancient ruins," she says, "but there is a beloved monastery in the mountains, Panayia Xenia, reportedly painted by St. Luke, and the monks there literally saved the life of my family."

Her father, in the company of his parents and older brother, fled Trabizon in Asia Minor when he was 14, and while the brother studied and would eventually become a lawyer, Rodanthi's father had to work to support the family. He also followed a tradition in the family which always had a chanter in church. "He had the most beautiful baritone voice which he kept until old age. He passed away five years ago and he sang until the end."

"My mother was no princess," said Rodanthi ruefully. "My grandmother was a widow at age 40 and in an age when it was rare for women to work outside the home, she had to support her four children by working in a tobacco plantation during the day and at night made beautiful lace for trousseaux."

Rodanthi's parents fell in love and got married a couple of years before WW II broke out in Greece. "We simply had no food. My father was up in the Albanian frontier and came back full of lice and starving." Then, in these all too common acts of brutal vengeance, because the resistance was prevalent in the area, the Germans burned their village to the ground. It was then the monks at Panayia Xenia sheltered them in the monastery for three months, where they lived in one room with other families. "I still remember Fr. Kyriakos, a kindly, hunchbacked little monk, who brought us some food, and with the horta my grandmother collected from the hills, that's how we kept alive."

After the war the family went to Lamia where her father sang in the Cathedral on Sunday and during the week was a controller for the local branch of the Ministry of Transportation. Her mother, forced because of hard times to become a seamstress, was determined that Rodanthi and her sister would have an opportunity to study. Fortunately both girls enjoyed learning, and when Rodanthi took the exam for med school in Athens, she came out in the top five out of over a thousand applicants. This earned her a scholarship, but it did not provide full support. "My parents deprived themselves of essentials so that I could study. I will never ever forget those sacrifices," she said.

When the scholarship at the Department of Internal Medicine at the University of Athens came to an end six years later (in 1962), she decided to come to the U.S., specialize, and then return to Greece. Out of 15 applications to hospitals, the first acceptance that came was from St. Lukes in Philadelphia, and before a week had passed she had borrowed the $400 for a one-way ticket and was on the plane. "My luggage was lost and I was paid a barely subsistence level salary as a resident but oh, was it good to earn money for the first time! I was able to pay back the loan within three months. I have the old world ethic - You have the money, you buy it; you owe the money, you pay it back!"

After a residency in Medicine and a fellowship in Rheumatology, she was appointed to the faculty where she stayed for over five years. Somewhere in that time frame she married and divorced and by the time all that was over there wasn't enough money in the bank to get her back to Greece. "Also the junta was in power," she said. "I was not at all comfortable with living in Greece with that kind of government. And it must be admitted I was spoiled - used to high quality medicine and academic centers."

Instead, in 1975, she travelled in the opposite direction, taking up a position as Director of Clinical Rheumatology at LAC/ USC Medical Center in Los Angeles. She has stayed there ever since, garnering many awards including Woman of the Year in Medicine in 1966.

The center operates two large outpatient clinics, mainly populated by patients with systemic rheumatic diseases -lupus and rheumatoid arthritis being the most prevalent. "Our aim is to keep them working, or at home with the family," she explained. She sees anywhere from five to 25 patients at a time, teaches medical students, and at times oversees another clinic in a comprehensive health center run by the county. The clinic has eight physicians seeing 50-60 patients at a time which makes more than 600 patient visits per month, and an overwhelming 7,200 a year.

Her day (including weekends) begins at 8.30 a.m. with daily rounds to various wards. She sees outpatients all day on Tuesdays and private patients on Thursday afternoons. General medicine takes up two months a year and rheumatology service another two. And of course there are conferences, instruction of medical students in the classroom as well as bedside teaching in clinics. A special area of interest is pregnancy in rheumatic diseases and she has been asked by many conferences to speak on the subject. Rodanthi sees big changes in the treatment of rheumatic diseases. "I now have a perspective of 33 years. Up to 1966 we had only aspirin; then indocin and allopurinol (treatment for gout) were new drugs; now we have 14 or more anti-inflammatory drugs and a new class with much fewer side effects. Rheumatoid arthritis is treated primarily with combinations of therapies whereas before we used to start with one non-steroidal drug for three or four weeks and switch to another, then another. If the patient was doing poorly we would start injections of gold or we would use hydroxychloroquine until we realized that these two worked well together. In later years other drugs, including biologics, were used. It's a similar situation in lupus for which we use cortisone- like medicines and cytotoxic drugs. Now we have a whole new shopping list of drugs that are new and exciting."

Rodanthi is distressed by the deterioration of health care due to the inroads of HMO's. With the excuse of cost cutting she feels they have impeded access of patients to specialists as well as restricting and limiting the drug formulary. "I'm not saying that medicine was perfect before," she explained. "There have been abuses. I remember as an intern, I asked the patient, a woman clad in her best finery, what had brought her to the hospital, she replied, 'Oh, Dr. X said that I needed some rest!' Of course that couldn't happen today, but I think we have swung too far to the other side. There are too many restrictions, a tremendous proliferation of administrative personnel trying to tell us how to practice medicine. There are new, absolutely innovative and powerful tools to diagnose and heal, and everybody wants and is entitled to be treated by the best."

Rheumatic diseases or arthritis are on the increase, from about 31 million in 1976 to 41 million now, and close to one million new patients are diagnosed per year. In addition there are 25 million women with post menopausal osteoporosis. Osteoarthritis is by far the most common of the rheumatic diseases, attacking people after the age of 40, or after trauma to the joints. One out of seven Americans, one in three households, has someone with arthritis. 2% of the GNP is spent on arthritis every year.

Gout, another common disease, is no longer the domain of the upper class Englishman of legend. Over a quarter of a million people in America suffer from it. Contrary to all the jokes made about it, it is due to inborn errors of metabolism. Drinking wine will aggrevate it, also working in a battery factory and being exposed to lead. A Philipino man who has eaten rice and little protein, and then migrates to the US and has a richer protein diet, is likely to develop gout. Although men are more prone to it, women may suffer from it after menopause. The good news is that gout is the one totally controllable rheumatic disease.

Asked what she thinks about alternative medicines she replied, "Well, copper bracelets look pretty, and now there is a theory about magnets! I do think that alternative or complementary medicine needs to be studied, and I'm glad that the National Institute of Health is now funding such studies. After all, the autumn crocus was used by ancient Egyptians for gout, aspirin comes from the bark of the willow tree, digoxin from foxglove." But she insisted that the studies must be controlled, double-blind (neither the physician or the patient know which pill is a placebo). As she pointed out, the placebo effect works in many ways: when people are in a drug study environment, they are pampered, really listened to, they improve; even prayer can work with a placebo effect. Also it is possible that when patients think they are taking something that will cure them, it generates endorphins in the brain which have a pain-calming effect.

But alternative medicine can be harmful. She cites the case of a patient, a young woman of 19 who had a very bad case of lupus with high fevers and septicemia. Just in time it was found out that her mother was giving her rattlesnake capsules, which contained an enormous amount of salmonella bacteria.

Her first mentor in rheumatology led a group of students to China where they were told that thundervine worked beautifully in rheumatic diseases. The only trouble was that thundervine extract causes similar side effects as cytoxan, which is an anti-cancer drug. Patients suffered loss of hair, brittle nails, a fall in white cells. "I have an article on the subject called 'The Pernicious Panacea.' While I don't completely put alternative medicines down, I do say 'Caution!'" concludes Rodanthi.