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Vikings Lineman Suffers Gruesome Ankle Injury

Vikings offensive lineman Josh Samuda will miss the entire 2014-15 season after suffering a gruesome leg injury during non-contact drills on Tuesday.

Samuda underwent surgery Wednesday to repair a broken fibula, a dislocated ankle and deltoid ligament damage he suffered while participating in a non-contract team workout. A source close to the situation said more will be known about the extent of the injury in the coming days, but officials don’t believe the injury is career threatening.

“We’ll wait, like, six weeks and see how he starts to heal,” the source said. “He’s in good spirits. It’s a freak accident; it’s unfortunate and severe, but he’s focused on rehabbing his body.”

Doctors believe the injury will keep him away from football activities for 9-10 months, which means he won’t be able to suit up for the Vikings this season. You can see a picture of the injury below. Skip ahead if you’re squeamish.

Samuda joined the Vikings in 2014 after signing a reserve/future contract with the team in January. The 25-year-old guard signed with the Dolphins as an undrafted free agent in 2012. He then spent the 2013 season as a free agent before signing a deal with the Vikings this year.

Dr. Silverman comments

Ankles are not supposed to bend this way.

These things happen, especially when you factor in Samuda’s size and speed. He simply overloaded the leg with too much force/torque.

He’s got a long road of recovery ahead of him, but it sounds like he’s in good hands. Doctors will want to closely monitor the leg in the coming days to make sure there aren’t any complications or other issues that weren’t initially diagnosed. The best thing going for him is his current condition. Samuda is young and physically fit, which bodes well for recovery and rehabilitation.

Hopefully this isn’t the last time we see this young man in a football uniform.

Related source: Ben Garvin, Pioneer Press, ESPN

The Sad State of the Medical Landscape in 2014

Depressed doctorThe Daily Beast recently published an article titled, “Why Your Doctor Hates His Job – How Being a Doctor Became the Most Miserable Profession.” The article takes a close look at the harsh reality of the medical landscape and the role physicians play in this equation. Today, I’m going to give my perspective on the piece, and on the medical community as a whole.

The article begins bluntly by noting that 9 out of 10 doctors will discourage others from entering the profession, and that on average, one doctor commits suicide every day. Citing another study, the article claims that physicians have the second highest rate of suicide among all professions, trailing only marine engineers.

Those numbers are chilling, but they are only surface-level statistics. By digging a little deeper, we can find out why doctors are so depressed.

The article goes on to cite three main factors that make a doctor’s life miserable, and not surprisingly, I mentioned all three in my Q&A session with MedPage Today. They are:

  • Bureaucratic red tape.
  • More patients than ever before.
  • Unappreciative patients.

Off the first point, the article notes that processing insurance forms costs doctors $58 for every patient they encounter. The time and money spent on insurance regulations alone has led many health professionals to jump to management or supervisory positions, which in turn leads to the second point.

An increasing number of people are entering the healthcare system without an equal number of doctors entering the equation. This leads to doctors taking on more patients than ever before, which means they’ll spend less time with each individual. The article notes that the average face-to-face clinic visit last about 12 minutes.

Again, this leads to the third problem – the unappreciative patient. Sometimes the best advice is rest, but patients want a miracle cure for their ailments. When an operation is available, it can be costly, and that can leave patients feeling dejected. But we try to work with patients. We provide care at essentially a sliding scale based on ability to pay, not on complexity of care delivered. We discount our bills routinely to help out others unable to make payments and set up payment plans that would make an accountant cry.

Every month, I am presented with a list of patients by my office management and the same line, “We have attempted to contact these patients multiple times and they haven’t responded to our calls or letters. They are 6-, 9-, 12-months past due on their bills. Can we send them to collections?”

These people that I know, that I have spent time building relationships with in order to be able to deliver the best care, now think that little of me and my office that they won’t answer a letter or return a phone call? How would that make people in other businesses feel?

All of this care and work is completely unseen and unacknowledged by the public. The media gives us stories about the doctors that made the most money last year through Medicare, not the doctors that donate the most time and energy.

Is it disheartening? Yes.

Am I surprised about the number of doctors jumping into Administration or into Finance? Nope. Money attracts a lot of smart people.

Am I surprised by the number of doctors committing suicide? Yes, because as bad as it gets, I still get a boost every time I hear, “Thank you Dr. Silverman,” or “I tell all my friends and anyone I meet that they must come and see you.” I hope other doctors hear that too.

Is the medical landscape getting worse? Sadly, yes. But I ask doctors, medical students and patients to remember this sentiment:

Doctors do more good every day then most people do in a year.

We listen to people. We to get to know them. We listen patiently to their stories and the way they communicate in order to build relationships and to understand how to best provide our health care recommendations. We literally put people, both physically and mentally, back together. Remember the rewards this job offers the next time you feel down. Know in your heart you are making a difference.

Related source: The Daily Beast

50 Years of Fighting Big Tobacco Saves 8 Million Lives

16246241_s2014 marks the 50th anniversary of the first surgeon general’s report on the detrimental health effects of smoking. After the initial report was released, government programs, nongovernmental organizations and public entities began to spread awareness about the dangers of smoking, beginning the so-called “tobacco-controlled” age.

While smoking rates didn’t dramatically drop off during the beginning of the tobacco-controlled age, the anti-smoking campaign has led to a gradual but significant decline over the last 50 years. In an effort to quantify the success of the programs of the last 50 years, a group of researchers analyzed cigarette smoking information provided by the National Health Interview Surveys. By comparing smoking-related mortality rates from 1964-2012 to estimated mortality rates with no tobacco control, researchers concluded:

  • An estimated 8 million fewer premature smoking related deaths occurred than what would have occurred without tobacco control.
  • The programs saved an estimated 5.7 million men and 2.3 million women.
  • The 8 million saved lives resulted in an estimated 157 million years of saved life, with a mean of 19.6 years for each beneficiary.

Public knowledge of the negative impact smoking has on a person’s health has undoubtedly helped to save countless lives, but smoking is still a concern in 2014. The Centers for Disease Control and Prevention estimates that nearly 1 in 5 Americans smoke cigarettes, and the authors of the study note “efforts must continue to reduce the effect of smoking on the nation’s death toll.”

Dr. Silverman comments

The campaign against Big Tobacco has been successful, as smoking rates have plummeted from 42% in 1965 to 18.1% in 2014, but as the authors suggest, there is still work to be done.

I believe we are in the middle of a similar campaign against “Big Food.” Obesity rates have skyrocketed over the last few decades, but it does appear that more people are beginning to take a closer look at what they put in their bodies. Researchers are publishing studies condemning carbohydrate-dense and high-fructose corn syrup packed products. Will we see a huge increase in taxes on junk foods or sodas similar to what the tobacco industry went through? It’s certainly possible, but like any intervention program, it will only be successful if people make the conscious decision to improve their health.

Related source: JAMA

9 Ways to Reform Medical Liability in the United States 

9611855_sMedical liability in the United States problematic for both doctors and patients, and fixing it will require a multi-level approach, according to a recent claim by the American College of Physicians.

The current approach “just doesn’t work, it’s unfair to patients…and it spends an enormous amount of money to compensate a small minority of injured patients,” said ACP president Molly Cooke, MD. “Physicians still fear litigation, expect lawsuits, and feel the psychological burden of navigating the complex medico-legal system.”

The ACP criticized the current landscape of medical liability at their annual scientific meeting, but they also provided nine recommendations for fixing the issue. According to the ACP, physicians and lawmakers should focus on these nine areas to improve medical liability in the United States.

  • Continued focus on patient safety and prevention of medical errors;
  • Passage of a comprehensive tort reform package, including caps on noneconomic damages;
  • Minimum standards and qualifications for expert witnesses;
  • Oversight of medical liability insurers;
  • Testing, and if warranted, expansion of communication and disclosure programs;
  • Pilot-testing of a variety of alternative dispute resolution models;
  • Development of effective safe harbor protections that improve quality of care, increase efficiency, and reduce costs;
  • Expanded testing of health courts and administrative compensation systems;
  • Research into the effect of team-based care on medical liability, as well as testing of enterprise liability and other products that protect and encourage team-based care.

Dr. Cooke noted that the nine-point program “should allow for innovation, pilot-testing, and further research on the most effective reforms.”

Dr. Silverman comments

Medical liability can always be improved. It’s certainly tough as a surgeon to do your job to the best of your ability when you know you’re millimeters away from a lawsuit if something goes awry. Negligence should be held accountable, but far too often doctors feel the wrath of a lawsuit for their inability to fix a problem.

In essence, we need to create a well-balanced approach where we reduce the number of medical errors, thus cutting down on the number of lawsuits, and we strengthen the system for compensating patients who are truly harmed through negligence or a poor operation.

Related source: Medscape

Could Blood Tests Solve Concussion Questions? 

6033976_s (1)An analysis of Swedish hockey players discovered that measuring tau protein levels in a person’s bloodstream could help diagnose concussions and accurately predict the persistence of symptoms, according to a study published in JAMA Neurology.

For their study, researchers took blood samples from 288 Swedish hockey players after a friendly hockey game. They also took a similar blood draw when a player suffered a head injury during a professional game. 28 of the 288 players suffered a concussion, and when comparing their blood samples to the baseline average, researchers found:

  • Total tau levels in players with a concussion averaged 10 pg/mL, which was more than double the baseline average of 4.5 pg/mL.
  • By analyzing the area under the receiver operating curve for elevated total tau, researchers were able to predict which individuals had a higher likelihood of experiencing persistent symptoms six days post injury.

According to Dr. Jeffery Bazarian, tau proteins are only released from neurons in the central nervous system, and an elevated presence signals that something is out of order.

“Concussions result in the release of proteins that go from the brain into the blood,” Bazarian said. “This is going to be how we tell if someone has had a concussion, just like we use proteins to tell us if someone has had a heart attack or a blood clot in the lung.”

Bazarian concluded by saying he believes protein testing may be the next big thing in preventing, diagnosing and treating concussions.

“Keep your eye out for this, this is going to be the wave of the future.”

Dr. Silverman comments

This is a great new development, as CT scans are often negative and expose patients to unneeded radiation. Cognitive testing has been championed, but unfortunately it is unreliable in children as their cognitive levels are constantly changing.

A blood test like this reminds a me of when we started testing for Tropinin levels and were finally able to detect myocardial infractions (heart attacks) even when an EKG was normal.

A test that is predictive of the amount of damage will be great to give parents, coaches, doctors and other people an idea of how to self-regulate.

I am so excited to see the follow up in the medical community.

Related source: Jama MedPage Today

Julie Andrews Missed Oscar-Nominated Performance Due To Ankle Surgery 

Julie_Andrews_Park_Hyatt,_Sydney,_Australia_2013Actress Julie Andrews had to turn down a role in the Oscar-nominated movie “The Wolf of Wall Street” because she was still recovering from an earlier ankle operation.

“I’ve had problems for a long time with my ankle, after I twisted it many years ago. With general wear and tear it got worse, and eventually it just had to be taken care of. I was finding it very hard to walk, I was hanging on to anything I could find. I didn’t like what I saw for the future,” said Andrews.

The discomfort finally became unbearable, so Andrews elected to undergo ankle surgery. She was offered the role as Aunt Emma shortly after going under the knife, but she was forced to refuse the role because her ankle still needed time to recover.

“So I had the operation nearly two years ago. I’m fully recovered now, but I wasn’t over it when I got the Wolf of Wall Street offer,” said Andrews. “I would love to have been part of the film but I couldn’t, alas. It was a really tough choice but I didn’t feel up to it. I was still having a hard time getting about, so very regretfully I had to decline the offer. I’m sure Joanna Lumley was fabulous in the role.”

Dr. Silverman comments

Waiting to fix something isn’t always the best choice. While nonsurgical management can allow us to manage, deal with, make up for, and accommodate for the symptoms of foot and ankle injuries, it rarely corrects the problem.

Explaining the benefits and drawbacks of a surgical operation compared to nonsurgical management is something I do on a daily basis, as it is critical that the patient understands the risks and rewards that accompany each treatment option.

The issues can usually be condensed into a rather straightforward explanation. If the nonsurgical treatment doesn’t treat the problem, but rather manages the symptoms, then the patient has to make a choice about how much of their life they’re willing to give up to accommodate using nonsurgical measures. For example, if it’s a bunion and it isn’t pressing on the second toe and it only requires a small change in shoewear to become more comfortable, than the choice is relatively easy – advise them to choose slightly larger footwear.

If however, the problem is more troublesome and footwear choices are becoming more limited or the bunion is pressing or causing the great toe to press upon other toes, then the decision to opt for surgery makes more sense. Going under the knife will prevent more damage or the need to wear what I affectionately call clown shoes (wide in the front and narrowing the heel).

Related source: News Net 5

Twins Place Bartlett on DL With Ankle Sprain

Jason BartlettThe Minnesota Twins will have to do without Jason Bartlett for the next two weeks as the utilityman has been placed on the disabled list with a sprained ankle.

Bartlett injured his ankle Sunday after trying to score from first base on a double by teammate Chris Colabello in the top of sixth inning. Bartlett beat the throw home, but he injured his left ankle when he collided with catcher Yan Gomes.

Eduardo Escobar replaced Bartlett in the field in the bottom of the sixth inning. The team didn’t think the injury was too severe until later that night.

“With Bart, we didn’t think it was that big of a deal, but he had to come out of the game and it started to stiffen up on him on the plane last night,” said Twins assistant general manager Rob Antony. “He went on the field [Monday] with [head trainer Dave] Pruemer, and he ran around and could feel it. Se we had to figure out what we were going to do, and because he wasn’t ready for a few days, we decided to put Bartlett on the DL.”

The Twins recalled catcher/outfielder Chris Herrmann from Triple-A Rochester on Monday to fill Bartlett’s vacant roster spot.

Dr. Silverman comments

Ankle injuries aren’t as common in baseball as they are in sports like football and basketball, but anytime your have a player sliding into a stationary object, be it catcher or base, you have the opportunity for injury.

On the play in question, Bartlett tried to slide past catcher Yan Gomes during a play at the plate. His left foot just barely grazed Gomes’ leg, but it got caught, if only for a tenth of a second. Bartlett’s left ankle rolled inward, and even though he popped up from the play as if nothing happened, he likely felt the pain set in after the adrenaline from scoring a run faded.

15 days should be more than enough time to recover from the injury, especially since it sounds like it’s not too serious. Keeping weight off the ankle and following a stretching regimen will have him back to full speed in no time.

Related source: ESPN

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