An excerpt from Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.
Near my office, there’s a breakfast-and-lunch joint where strangers sit down at shared tables. When Joseph, an attorney …
Beware of worthless procedures and epidural steroids for your back pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 79-year-old man is evaluated for a 3-month history of right hip pain. He points to the center of his right buttock when asked to identify the location of the pain. He has no radicular symptoms. He reports no focal trauma but believes his symptoms began after he stepped off a curb that …
MKSAP: 79-year-old man with right hip pain
As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues.
As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers …
How duty hour restrictions are hurting residency training
As far as follow-up appointments go, this one was routine. My 65-year-old patient had undergone hip replacement surgery two weeks prior, and we discussed her pain level, progress with physical therapy, and eagerness to return to everyday activities. But as she stood up to leave the exam room, I could tell there was something left unsaid. She stepped out the door then stopped, turned around, and leaned in close to …
What surgeons aren’t saying about sex after hip replacement
I have lately been discussing the state of health care with a lot of doctors. I’m a doctor, and I’m also a consumer of health care services.
Imagine my surprise when I visited a local ER on a three day weekend, hoping to get some advice from someone who might be able to use the panoply of diagnostic tools available in the ED to help me mitigate the pain of a …
An emergency physician goes to the ER, and is shocked at the care she receives
No one wants to hear that they have a disease. And yet everyone will develop some degree of degenerative disc disease (DDD) — or degenerative spine disease — over the course of a lifetime. DDD refers to a combination of age-related and wear-and-tear-related changes that occur within the spine over time. It is very common and a natural part of aging.
Most …
A neurosurgeon teaches us about degenerative disc disease
For many women, pregnancy is a wonderful experience. There are, however, many changes and challenges the mom-to-be can expect, and back pain is one of them. The good news for pregnant women is that the development of severe or debilitating low back pain is very rare.
The incidence of symptomatic low back pain that is severe is about 1 to 2 percent. …
Back pain during pregnancy: Advice from a neurosurgeon
As a wife and mother, I have days that are very difficult, especially since my husband is in training. I go several days in a row where I only see him right before bedtime, and some days he is unable to see our son at all. I often feel like I have no control of our schedule, and am lucky to …
Fellowship training, as viewed by a physician’s spouse
I have to admit, I’ve been excited to see radiology slowly infiltrate into the mainstream of sports. Fifteen years ago, it was rare for the public to know when an athlete had an MRI. Now I hear people in the coffee shop saying:
“Man did you see Derrick Rose go down last night?”
“Yeah, we’ll just have to see what the MRI shows.”
In …
What ESPN doesn’t tell you about MRI in professional athletes
“Katie, If you go into surgery, you’re going to miss patients.” It was three in the morning in the ED; the resident was feeling the strain of a 24-hour trauma call, and I was loving it. I had spent the past half hour with a lovely, older woman whose foot had gone through the floor of her vehicle in a crash. We chatted about where she had been traveling, and …
Reflecting on an orthopedic surgery rotation
The phone rang one evening and a pleasant voice was on the other end. “Hi, my name is nurse so-and-so and I’m the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?” she asked. “It’s very helpful to go over things before and after your surgery and to answer any questions you might …
A cardiologist undergoes knee surgery. Read what he learned.
Should joint replacement manufactures provide a warranty for their products? It seems pretty logical since most consumer products come with some sort of warranty these days. Basic warranties are almost universally provided and the market for extended warranties is increasingly popular.
Take for instance my recent upgrade to the new iPhone 5s. At the time of purchase, the AT&T store suggested their extended …
Does your joint replacement have a warranty?
The job of a doctor isn’t to diagnose, prescribe, or examine. It isn’t to be well read, efficient, or punctual. The job of the modern doctor is to convince.
We now have radiological studies whose theoretical discernment limit is subcellular. We can not only map clear and obvious genetic errors of metabolism, but also minor variations of the normal. In a few years, the majority of codes in the procedure manual will probably be laboratory …
The job of the modern doctor is to convince
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 …
Necrotizing fasciitis: A case study and discussion
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 …
Let no broken hip go unfixed: When a surgeon fails to communicate
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, …
Sending your child to the chiropractor: Be very careful
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 …
Toradol in sports: A culture change is needed
Get free updates delivered free to your inbox.
