As many of you probably know....I am a physician type. Family medicine more specifically. Military to be even more specific.

Well, I am involved in a constant effort to keep my clinical knowledge up to date, and less rusty. I read/listen to many sources, developing/maintaining my skills to stay at the level of a "competent generalist". In the military its a bit tough though because my patient base is just too healthy until they get blown up, then its mostly meat and bone carpentry and then shuttle quickly to the surgeon.

So, I help my friends (thats all of you) alot (probably more than most other physicians). A) it helps my skills, B) it hopefully helps out my friends, C) because of my situation (doc starving for the challenge in the face of healthy patients) it helps me feel better about myself. D) I am an attention whore.

Thus, I thought it might be good to open up a thread where you, my BOTLs/SOTLs, can throw out some concerns and I can see what I can do.

Disclaimers:
1) I can't promise you specialist knowledge. Depending on the question I may throw down what I already know and leave it at that. Or, maybe I will research it to a level I am happy with and then throw down what I have learned. Or, maybe I won't have much to put down about it and that is what you will have to settling with.

2) Anything I throw down here is to be taken for what it is....someone you don't really know (for all many of you know I am a 12 year old pretending to be a doc), fielding questions I may not be qualified to answer. NEVER take what you read here as gospel. If its serious, if its important, you should still see your doctor.

3) I am not always available. I get shipped around alot, spend long times without internet access. I am also orchestrating a big career change in the next 7-8 months (releasing from military, developing a civi practice, renovating a house, parenting children, being a good spouse, selling/buying a house, moving, prepping for the new practice). If I am not responding, maybe I never will.

4) This thread is an experiment. If life gets out of hand or things get too crazy in this thread I may abandon it. I will probably make that known though before it happens.

5) Once again...this thread should not count as your only medical consultation. I cannot refer you to specialists, I cannot determine the "all important" aspects of the situtation without actually being present with you. You probably don't realize how much of medicine is about the intuitive aspects of this situation. Body language, physical traits, they way things get said in a face-to-face encounter have HUGE importance in the evaluation of the situation. I could easily miss major important elements simply by not being in the same room with you, watching you as you describe your issue. Certainly physical exam is impossible, as would diagnostic testing. Finally, I can't start treatments, or even guarantee I will discribe the treatments best suited; once again, intuitive reasoning goes a long way here.

6) This is an advice column. Most advice columns are full of BS. Don't expect more. While I try to stay current and "evidence based", medicine is too big for everything to be based on well-worked out science. As a generalist I try to keep up, but its all too much, so my evidence based knowledge is going to be pathetic in orthopedics compared to an orthopedic surgeon. Its always possible that I may spout out "establish wisdom" in a sub-field of medicine that has already been proven wrong 10 years ago.

Scared you away yet?

And, with that, shoot out your questions and I will see what I can do. Ultimately this is probably going to take the form of a banter thread (in certain ways).

Cheers

Cy

PS: three out or every two people don't know how to handle statistics. Even worse, five out of four people misquote their statistics. I am no different. But, I take stats with a grain of salt. Telling you that condoms are 97-99% effective means that I don't really have the number memorized and that I don't really see the need to more accurate than that anyway....it means condoms are good (unless you are trying to stop herpes, which case they are only 30% effective)
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Why does it hurt when I press *here*?


Sorry, had to do it.
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I think it might be the pointy tips of the asterisks. That's probably why it hurts. :-)
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Well, we know you;re not a 12 yo. If you were, you'd tYpE lIkE tHiS and talk about boobies and comic books...:-)
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If that's a qualifier I think a lot of us are in trouble. :-)
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I'll give ya a whirl Cyanide.

My right knee has no ACL or medial meniscus. I don't have any trouble with the stability of my knee. It has never "popped" again, and it doesn't limit my ability to be active when I want to. I can play squash, hike, climb, etc. I didn't get ACL replacement as I felt it unnecessary.

However, I have noticed over the last year or so that it takes greater effort to get up from a crouching position and my knee aches a little more than usual. It's not a big deal, but I'm not getting any younger.

Would the ACL replacement surgery help with this?
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Thanks for offering to help us out!
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Thanks for the offer. Maybe a little off the traditional medicine question, but a general practitioner is going to get a number of questions pertaining to non-traditional medicine. So here goes:

Can you tell me whether or not you think turmeric/curcumin is an effective anti-inflammatory spice.
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hey I like boobies and comic books. :-)
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This is a long shot, but any ideas will be greatly appreciated.

Every once in a while my wife has crippling lower back spasms that are triggered by simple things like bending over or getting out of a chair. They aren't frequent, but when they happen she has pain to the point where she can barely move. It usually takes a full day of rest and heat on her back before she can get out of bed. And ibuprofen. Lots of it. She has taken muscle relaxants for this but they don't seem to work any better than Advil. X-rays show she has narrowing discs, but her doc isn't sure that is the problem. She tried chiropractic for several months but it hasn't been effective in the long term.

That's the background. My question is this: she had a spasm yesterday (just getting off the couch) and afterward she had numbness and tingling in her legs and in her arms from the elbow to the fingers. This was new and it went away after a few hours, so we're not too worried about it, but I'm wondering if it gives us any new ideas as far as diagnosing the cause of her back spasms. Maybe it was just a reaction to the pain?

Thanks for any suggestions, Doc! Great idea for a thread! :-)
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I sprained my ankle pretty bad in PT almost a month ago and it is still a little bit swollen. It doesn't really hurt that much any more but the fact its still swollen has me wondering if it is just because I am constantly on it doing vigorous activities and don't have a chance to rest it, or could it be something more serious?
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You are not alone.:-)
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how do you cure scalp feliculitis, noting that a 10% panoxyl soap bar has gotten you no where?
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I'll let the Dr. give you an official answer, but it could definitely be a sprain and still hurt for months. Some sprains even need surgery, but it doesn't sound like yours is as bad as some I've heard about if you can still run on it or even walk without turning your ankle. Swelling can take months to completely go down as well.
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Ian.....it's called Old Age!:-)
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Yeah, I know. But I'm not even 40 yet.:-)

I want to still be able to walk a bit when I hit 50.
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I have a similar problem with my left knee. When I'm good about taking my glucosamine, condroitin, msm (all in one tablet), I have almost no problems. Without it, I can tell when there is a low pressure zone within 200 miles.

Might be worth a try.
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Why does Tom's butt itch? :-)
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Image
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Wow, this is going to be fun. I am going to tackle this one first, then once I am done baseboards in the bathroom I might tackle some of the orthopedic questions.

OK, checking through pubmed rather quickly I noticed a review of all available data regarding this directly. Curcumin, which is believed to be the "active component" of Turmeric does seem to have some ability to alter gene expression in animal chondroblasts (cartilage progenerator cells) and is seemingly believed to have some anti-inflammatory effect. Some caveats though would be that, as a supplement, having to go up against the GI system and then the liver before it gets into the blood, its unlikely to show any objective anti-inflammatory benefit systemically. The review article does note that further, properly designed studies need to be conducted before it should be advocated for treatment of inflammatory conditions (this usually means that the available data consists of small crappy studies [SCS] that are not statistically powerful enough to prove anything; to see into the truth, bigger studies with rigid controls are needed). As an aside, osteoarthritis is no longer believed to be a true inflammatory condition and so, this is probably why we aren't seeing much benefit from anti-inflammatories in general (it seems to be more of an analgesic effect we are getting from the drugs).

So, bottom line....in cell cultures it might be beneficial, but the delivery method is probably going to get in the way of experiencing any "real" benefit to the person. That being said, if you believe it helps, and it isn't itself causing you any harm....then its reasonable to give it a shot. Just don't take too much of it, as any ill effects in the face of unlikely benefit is a net decrease in quality of life.

Cheers

John
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