It’s been a while since I did a cycling topic. As I was skimming thorough the Journal of the American Medical Association recently, I came across this review article on spinal injection therapy for low back pain. It was a shocker. Two factors brought my attention to the article. First, almost all the cyclists or runners I know have been beset with either back pain or sciatica (referred pain or weakness down the leg). In ...

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Recently a patient of mine brought in a bottle given to her by her acupuncturist. She had turned to acupuncture with my encouragement after traditional medicine fell short at addressing her chronic pain. Indeed, there is data to support the efficacy of acupuncture in the management of chronic pain. I was encouraged to hear that this treatment, often labeled as "alternative," seemed to be helping her substantially. However, my patient’s ...

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hipscrews Six months ago I posted a story about a demented 94-year-old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall. Her son wanted her to be made comfort care only, and avoid a trip to the operating room since she was likely within six ...

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These days, there is a lot of talk about expanding scopes of practice for the group of folks who used to be called physician extenders and then midlevel providers and more recently non-physician providers, many of whom are now getting degrees with the title “doctor” incorporated. While it seems to vary, these folks may include nurses, physician assistants (one day to be called physician associates perhaps), pharmacists, and more.   Lots ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated for a 5-year history of gradually progressive left knee pain. He has 20 minutes of morning stiffness, which returns after prolonged inactivity. He has minimal to no pain at rest. He reports no clicking or locking of the knee. Over the past several months, the pain has limited his ...

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Years ago I worked as a registered nurse in a busy surgical pre-admission clinic, preparing patients who'd been scheduled for surgery for the upcoming operation and hospital experience. My workdays were packed with back-to-back, hour-long appointments. Whatever surgery the patient was facing--oral, orthopedic or anything else--every interview followed the same format. I would greet the patient, who'd often bring along a family member, and quickly escort them both into my small ...

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She was 94-years old with advanced Alzheimer's. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip. She'd fallen at her assisted living facility. It was the second time in as many months. She'd broken her collarbone on the previous occasion. Over the past year, she'd lost 30 pounds. This is natural in the progression of ...

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There are plenty of things we don’t know about health and illness. Sure, we know a lot more than we did fifty or a hundred years ago—but every day, still, I have questions that aren’t yet answered. I read a dozen or so journals each month. (I know. Nerd.) Each one has at least ten or so good quality studies—good, ...

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051512_papelbon Former Boston Red Sox closing pitcher Jonathan Papelbon may have opened up a can of worms with his remarks about his frequent use of the injectable anti-inflammatory drug Toradol (ketorolac) during his time with the Red Sox. Papelbon, who now plays for the Philadelphia Phillies, told ESPNBoston.com that several Red Sox players were frequently injected with the drug:

"It was kind of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated 24 hours after a new diagnosis of a left calf deep venous thrombosis. One week ago, he underwent orthopedic surgery. Two weeks ago, he returned from vacationing in Italy on an 8-hour flight. Current medications are enoxaparin, 80 mg subcutaneously twice daily, and warfarin, 5 mg/d. On physical examination, temperature ...

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