Recently, I underwent surgery for what proved to be an extensive tear of my right rotator cuff. I have never had a major operation before. Here is how it went down. Back in July, I felt a sharp pain in my right shoulder while playing tennis. Of course, I continued to play that day and for two more weeks. When the pain finally prevented me from playing, I saw an orthopedist who ...

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On a hot afternoon in July Harold “Junior” Bray walked around his small farmhouse one last time before it was time to leave for the hospital. Everything was in order -- the coffee maker was unplugged, the windows secure and the message on his brand new answering machine informed callers that he would return their call as soon as his health permitted. Every step was deliberate, slow and painful. Whenever he ...

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There is a lot of talk these days about changing our health care system from “pay for volume” to “pay for value.”  The idea is that we currently reimbursement doctors and hospitals according to the number of services delivered rather than how well they make us.  This perverse system of incentives results in runaway health care spending that doesn’t necessarily result in a more healthy citizenry. There is certainly truth in ...

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Necrotizing fasciitis is a rare but life-threatening soft tissue infection.  Its presentation is characterized by rapidly spreading inflammation and resultant death both of the surrounding soft tissue and fascial planes.  Prompt recognition and aggressive treatment is paramount in order to avoid fatality.  Often times, symptoms may overlap in their presentations so one must maintain a high index of suspicion and a multidisciplinary approach facilitated appropriate imaging studies and resulted in a ...

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On a warm and sunny August Sunday, I was rollerblading with my kids on the Shining Sea Bikeway. On mile nine on the trip, I hit a tree root, went flying, and landed on my shoulder.  I could tell immediately that something was wrong -- I couldn’t move my arm and was in the worst pain of my life. Feeling for my left shoulder, it was obvious that I had ...

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Four months after having a knee replacement, I stumbled into the bathroom at 3am, not fully awake, hoping to urinate. Losing my balance, I fell. The result was a compound fracture of my left leg -- the one with the prosthetic knee. Gazing at my shiny white kneecap, I lost all logic, all control. I simply cried. At eighty, I was unprepared for this unexpected anatomy lesson: my twenty-nine years as a surgeon ...

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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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