January 30th, 2010 by DrPaulSAuerbach in Better Health Network, True Stories
No Comments »
We found out today that we are going to ship out tomorrow. My feelings are certainly mixed. There is an incredible amount of work to be done here – we have only contributed to the first wave of what is necessary. This may sound strange, but I cannot remember the details of much of what we did the first three days, when we were functioning on hyperdrive in a battlefield setting. My recollections become detailed after the third day, when we were able to see only four or five patients at a time, and we stopped triaging amputees to the operating room.
Now the hospital has been substantially augmented. Teams of foreign (to Haiti) surgeons have left to go home, because the operations to be performed now are largely orthopedic and plastic surgery, as well as specialty cases. Sadly, there are scores of patients with spinal fractures who are paralyzed, and little can be done for them this far out from the initial injury. Children continue to break our hearts. I had a small child who is a triple amputee offer me his cracker with his remaining hand. One can only pray that the memories he carries of this tragedy are erased swiftly, that he is assisted in his rehabilitation, and that his life improves. All of these will, of course, be hard to achieve. Read more »
This post, Leaving Haiti: Small Child - A Triple Amputee - Offers MD A Cracker With His Remaining Hand, was originally published on
Healthine.com by Paul S Auerbach M.D., M.S..
January 15th, 2010 by DrPaulSAuerbach in Better Health Network, Health Tips
No Comments »
We’re in ski season and so a few unfortunate individuals will suffer few knee injuries. A while back, a reader asked me to describe an uncommon injury, which is a torn posterior cruciate ligament (PCL).
This injury usually occurs during a fall. As you can see from the drawing, the PCL keeps the lower leg bone (tibia) from moving too far back in relation to the upper leg bone (femur). If a sudden unnatural force is applied, usually a direct blow to the front of the lower leg near the knee while the knee is bent, the tibia is jammed backwards and the PCL may be torn. In the skiing situation, this usually happens during a fall and a tumble, when someone strikes an immovable object, or when the knee is bent or “twisted” and struck forcefully from the side.
The immediate sensation is pain, and there may be a feeling of instability to the knee, particularly when trying to walk or change levels (e.g., walk over the snowpack or on stairs). When the injury occurs, there usually is not the “pop” sensation noted with an anterior cruciate ligament tear. However, the knee will almost always swell, because there is bleeding into the knee joint and/or soft tissue swelling. Read more »
This post, Ski Season, Knee Injuries, And Posterior Cruciate Ligament Tears, was originally published on
Healthine.com by Paul S Auerbach M.D., M.S..
December 29th, 2009 by Medgadget in Better Health Network, News, Research
No Comments »
Students at Northeastern University are developing electronic gloves to help post stroke patients recover their motor skills. The Angle Tracking and Location at Home System (ATLAS) bimanual rehabilitation glove has sensors and a feedback mechanism that interfaces with a computer to allow hand training at home. Read more »
*This blog post was originally published at Medgadget*
December 17th, 2009 by Medgadget in Better Health Network, News, Research
No Comments »
Touch Bionics, a company out of Livingston, UK and Hilliard, Ohio known for its i-LIMB device, is making available a new finger prosthesis system. ProDigits, a customizable platform that can be adapted to the needs of individual patients, provides electronically powered artificial fingers that can grasp and manipulate objects. The new hand can also be used for more advanced tasks such as typing on a keyboard. Read more »
*This blog post was originally published at Medgadget*
December 9th, 2009 by DrPaulSAuerbach in Better Health Network, Health Tips, Research
No Comments »
The National Highway Traffic Safety Administration reported an analysis of motorcycle helmet use in fatal crashes. What was discovered is not surprising - namely, that in states in which there is not a state helmet law, the odds of a rider in a single-vehicle (e.g., the motorcycle) crash wearing a helmet was 72% less than in states with a helmet law. So, absent a law, people are not particularly inclined to wear a helmet.
One needs to couple this information with the facts about the benefits of wearing motorcycle helmets. First, motorcyle fatalities and fatality rates are increasing at a time when motorcycle riding is becoming more popular. Second, the average age of motorcycle fatalities has moved up to 39 years, from 30 years nearly 20 years ago, probably because the age of motorcycle riders has increased. Third, motorcycles expose the drivers more directly to lethal forces than do enclosed vehicles. Helmets are essential to prevent brain injuries and deaths. Read more »
This post, Motorcycle Helmets: Why Don’t People Wear Them?, was originally published on
Healthine.com by Paul S Auerbach M.D., M.S..
November 3rd, 2009 by DrToniBrayer in Better Health Network
No Comments »
What medical condition costs the U.S. Health system the most in disability and overall costs? If you said heart disease or cancer or pulmonary disease you would be wrong! I would have said one of those myself.
The answer…slow drumroll….is musculoskeletal disease. Yes, 50% of the adult population reported having a disabling musculoskeletal condition in 2008. The expenditures for these problems include the costs of preventive care, the cost of direct care, the cost of care in hospitals, by physicians, therapists and other caregivers. It also includes the loss of productivity. In 2004 it was estimated that the cost of care for musculoskeletal problems was $840 billion. (Hey, isn’t that about equal to the bank bailout?)
What are musculoskeletal conditions? They include that old nemesis: Low back and neck pain. Spine problems are among the most common problems that bring patients for medical care. That’s why the chiropractic industry is booming. Read more »
*This blog post was originally published at EverythingHealth*
October 20th, 2009 by DrToniBrayer in Better Health Network, Book Reviews
No Comments »
EverythingHealth strongly recommends a wonderful new book called “The Water Giver” and I predict you will not be able to put it down. Author Joan Ryan is a remarkable writer who takes the reader on a journey she lived when her son, Ryan, sustained a near -fatal severe head and brain injury on a skateboard. It is both a medical drama and a meditation on motherhood.
The book begins with Joan’s description of her son’s learning difficulties and years of psychological and developmental testing. Her style as a mother was to intellectualize, do research and try to fix what was “wrong” with her son. The years went by with family stress and teachers conferences and medical consultations but it wasn’t until the day he fell, that Joan realized some things are too big to be studied and fixed.
The nightmare began when he was 16 and went skateboarding without a helmet. The fall on a hill near their home caused a huge brain bleed that obliterated much of his brain tissue. He remained in a coma for weeks and underwent multiple surgeries to relieve pressure. The book chronicles months of near death events in the Intensive Care Unit that nearly drove his parents insane with worry. I will let you read it to find out how it turns out. Read more »
*This blog post was originally published at EverythingHealth*
September 9th, 2009 by DrRob in Better Health Network, Humor
No Comments »
When you were last enraptured by my physical exam series, I was explaining the different directions doctors use to confuse themselves and everyone else. I am happy to leave that land of relativity and now re-embark on the actual human body. I am sure this relativistic view of direction was invented by some liberal anatomist intent on socializing the human body. It is a stop on the road to death panels, in my opinion.
It’s good to get that posterior to me.
My distraction (I get distracted, you know) happened as I was trying to explain how the shoulder works. Since the shoulder moves in so many directions and with such huge angles, I felt it was necessary to totally confuse you and so hide any chance you would pick up my ignorance. It’s always good to keep your readers snowed. So, after spending a whole post making poems about the shoulder (that will no doubt go down in the anals annals of poetry about joints) and another post about the confusing directions we doctors use to confuse other doctors, I will now talk about the actual exam of the shoulder.
As you probably have been taught, the shoulder is the joint that attaches your arms to your body. Some people refer to the top of their torso as their shoulders (as in “shoulder straps”), but this is not what I am talking about. The shoulder is supposed to be the joint between three bones:
- The humerus – which is the long bone in the upper arm, and got its name because of its habit of playing practical jokes on the ulna. The other bones are always inviting the humerus to parties.
- The clavicle – also known as the collarbone. This bone actually looks nothing like a collar, and it resents the implication.
- The scapula – called the shoulder blade. The collarbone is jealous because the scapula has a much cooler nickname. This causes the scapula to snicker often at the clavicle’s wimpy nickname.
Credit
Examining the shoulder Read more »
*This blog post was originally published at Musings of a Distractible Mind*
June 30th, 2009 by DrRob in Better Health Network, Humor
No Comments »
Yes, it’s time for another installment of my series on the physical exam. The goals of this series are:
- To educate my readers on the intricacies of the physical exam.
- To teach the anatomy and physiology as it relates to different parts of the human body.
- To delight my readers with my wit and fine prose.
- World peace.
So you see, through my hard work and persistence (writing almost 30,000 words about the physical exam so far), I have come nowhere near any of these goals. In fact, I have made absolutely no progress toward world peace. I think I’ve been banned in Iran for using the word “Shuttlecraft” too many times.
Maybe I just need some new goals. How about these:
- To irritate my high school English teachers.
- To cause at least 200 people to waste time that they could have spent watching Oprah.
- To make sure Canada stays north of us and does not sneak to Florida.
- To put those pesky French people in their place.
Yes, I think those are much better goals.
Extremely Upper
Our journey over the human body has now led us to the long things that stick out of the top of your torso that have those grabby things on the ends. We doctors call these things arms. There are some hoity-toity doctors who call them the upper extremities. These are the doctors you don’t want to invite to dinner, as they will probably tell you disgusting scientific facts about the food you are eating. Consider yourself warned.
The exam of the arms is usually only referred to vaguely during routine exams. Most docs don’t deal with the arms unless they pick up subtle clues that are discovered only by trained professionals, like when the patient says “I’m having problem with my arms”. We doctors are proud of our mad skills.
What I am driving at is that the arm exam is a problem-oriented exam. If you have a boo-boo, the doctor looks at it and sees if a kiss will make it better. If a kiss doesn’t work, usually an anti-inflammatory will (but we’ll get to that later). And boo-boo problems with the arm are usually specific to the longitude and latitude on the body. So today we will discuss the shoulder.
The Shoulder
The shoulder is a joint – meaning, it is a place where your body bends. Without joints, your arms would be unwieldy and you’d whack everyone who came near to you. Not only that; it would also make it impossible to put on deodorant. So between whacking people and offending them with your odor, a jointless existence would truly be a hard one. We all should thank our joints more often.
There is not a more complex joint in your body than your shoulder. Here are some amazing facts about the shoulder:
- There are three bones that are involved in different types of movement: the collarbone (clavicle), shoulder blade (scapula), and humerus (not humorous).
- There are at least 18 muscles that are involved in shoulder movement. Two of them have the word “rhomboid” in them. I like the word “rhomboid.”
- When people say the word “shoulder,” they may be referring to the joint, and they could be referring to the top part of their torso – between their neck and shoulder joints. This is a sad testimony to the English language and just serves to make the jobs of medical professional all the harder.
- The word “shoulder” rhymes with a lot of of words and so is very useful in poetry. For instance:
You shouldn’t have told her that she’s looking older
She wants you to hold her with arm on her shoulder
And go get the folder that llamas once sold her
But there on the boulder the weather is colder.
A fine Jell-O mould or perhaps something bolder
Has rocked her and rolled her but never controlled her
So anger may smolder at cellular slime mold or
Other thingies, sort of.
See? Pretty amazing, isn’t it? Try doing that with “elbow!” Perhaps Dino could write a haiku about it.
So it should not be seen as a coincidence that the shoulder has by far the largest range of motion of any of the joints in the body. This makes things very confusing for medical students when they have to describe the motion, as the joint doesn’t follow any of the rules the other joints have agreed upon. Most joints can be bent (flexed) and straightened (extended). Some joints (like the wrist) can be hyperextended and rotated as well. All the other joints are content with these motions. Is this good enough for the shoulder? Not even close.
Here are the basic movements of the shoulder:
1. Flexion – moving the arm forward toward the chest.
2. Extension – moving the arm toward your back.
3. Abduction – Being picked up by aliens and brought to their mother ship. (This also refers to lifting your arms up from your sides).
4. Adduction – Bringing your arms down back to your sides
5. Rotation – Turning the arm around the axis of the humerus bone.
I have suggested a few more motions that may be added to the roster:
6. Subflaxion – What you have to do to your shoulder to get your elbow in your ear.
7. Soufflétion – When your shoulder is mixed with eggs and baked at 400 degrees.
8. Mallardduction – When your shoulder gets down.
So far the shoulder committee hasn’t answered my mail. I’m not sure why.
But really, the shoulder is very confusing to many medical professionals. The range of motion is so great that it blurs the lines between the typical movements. For instance, adduction is supposed to be when the limb is moved toward the body’s midline. The shoulder makes this difficult. When you put your arm by your side and when you raise it over your head, you move it toward midline. Both could be considered adduction. The same is true with flexion and extension – when is the shoulder joint opened up and when is it closed?
Really, in this modern time we should give up this archaic nomenclature and instead use a GPS device to determine shoulder position.
Wow. 1000 words already and I haven’t gotten to the actual exam. I’ll give it a rest now and let you ruminate on words that rhyme with “elbow.”
I probably should sober up as well.
*This blog post was originally published at Musings of a Distractible Mind*
June 23rd, 2009 by DrJeromeEcker in Better Health Network, Health Tips
No Comments »
Cardiac rehabilitation, or guided exercise under direction of a physical therapist, is a valuable yet underutilized therapy for patients suffering a heart attack. Importantly, in those patients with ongoing risk factors related to obesity and insulin resistance/diabetes, aggressive cardiac rehab was recently shown to be especially effective.
Specifically, two groups of patients were enrolled in high intesity (5-7 days weekly of 45-60 minutes exercise) versus standard (3 days weekly of 25-40 minutes exercise).
High intensity patients lost more than twice as much weight over 5 months as standard patients (18 pounds vs. 8 pounds and had significantly greater reductions in 2 major cardiac risk factors — waist circumference and insulin resistance. At 1 year, both groups had gained a couple of pounds over 5-month weights, but total body-fat percentages in the aggressive group remained significantly lower than initial readings. Other cardiac risk factors changed too - including decreased insulin resistance, increased HDL (good) cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to HDL (good) cholesterol.
Overall then, patients who took advantage of their motivation after heart attack to aggressively address exercise goals reduced potential risk factors and set the tone for a healthier life. If you have been a heart attack sufferer, ask your doctor about cardiac rehab. If you are not a heart attack sufferer but have risks, ask your doctor about trying a program like this on your own.
Questions and comments welcome as always!
*This blog post was originally published at eDocAmerica*
