Phorest & Trees late March 2021

 

Phorest & Trees Sharing can go both ways. I’d love to hear what you’re enjoying.

VA News

Somewhat new news: VANJ welcomes Dr. Christine Roque-Dang to the Pain service with Dr. Ben Levy. She is a graduate of our program and the “Stitik” fellowship. Super psyhed by this news. The Mission Act has allowed the VA to pay non-va community providers for services but some of us have had concerns. “According to the report released last month, hundreds of providers removed from VA for providing poor care could still be part of its community care network, thanks to loopholes in the program’s screening.” Proud to say we police our own. Proud to see we don’t just jump in the fire with a new EHR like everyone else. The VA’s work on improving LGB and transgender healthcare. ““Gender alterations is listed as an exclusion in the medical benefits package,” Shipherd explained. “It’ll take some work to remove that exclusion, but if we’re able to do that it means transgender veterans would be able to access surgical care in the future.””

Found on Doximity

2 days of step reduction to <5000 per day impairs fat metabolism more than 1 hour of mod intensity running stimulates it. Wow! A proposal on how to approach corticosteroid injections during COVID. The author uses the evidence but still errs on the side of caution. Another win for dexa. A decent study found that self-paced physical and cognitive activity during the first week after sustaining a concussion alone neither hastened nor prolonged concussion recovery in children and teens. A review of the pharm tx for agitation in TBI. After 15 years not much has changed. “Runner’s high” is actually attributed to endocannabinoids NOT endorphins. The NY Times covered it too.  Machine learning is going to be a big part of the medical literature if you haven’t already noticed it. Here they used it to look at vital signs as a marker of pain in sickle cell. “The researchers found that these vital signs indeed gave clues into the patients' reported pain levels. By taking physiological data into account, their models outperformed baseline models in estimating subjective pain levels, detecting changes in pain, and identifying atypical pain levels. Pain predictions were most accurate when they accounted for changes in patients' vital signs over time.” Practical advice on addressing sexual health in females. At the VA, I’ll admit I have no problem addressing this with the majority of my population because I have 15 years’ experience with males limited by their pain or too embarrassed to address with their primary. The advice in this interview was helpful for specifically the females who would require a different approach. Meta analysis of the various injectates. I read this whole study which was well done but I wonder about the heterogeneity of the literature assessed that makes them arrive at their conclusions. But then this one contradicts. Placebo works in the short term for low back pain Hopefully we are all more humble than this physician.

Resources

New England Journal of Medicine Reviews. I go here when a family member or friend has a medical condition that I quickly want to know more about. Thanks to dr. Jon Kirshner for introducing me to the American Bone and Joint Initiative where they have an archive of videos aimed at patient education.  All free and open access. MDPI - Publisher of Open Access Journals

“Inflammatory” Back Pain

This may interest you if you see patients with back pain (I skipped over the IL-17 inhibitor stuff.). Apparently, 25% of chronic low back pain patients are undiagnosed nonradiographic axial spondyloarthropathies and more likely to be missed in women. The symptom burden can be just as bad with nonradiographic axial spondyloarthropathies as RA. Some of the terminology was new to me including the suggested classification of spondyloarthropathies (since 2009).

Osteopathic vs. Sham manipulation in Chronic LBP

First of all, the DO’s on this list know that I have deep respect for the history and benefits of OMT. But I do not support OMT as the sole treatment in the management of anything just like I would not support only injections or only pills. OMT is a manual modality. This well-designed study published in JAMA showing no clinically meaningful benefit in chronic low back pain did not surprise me. No modality is going to show long term benefit in the chronic setting. (Do you think heat or TENS findings would be any different?). What I love about this is the medical community finally giving this important topic the attention it deserves. If you have different thoughts, let me know.

Motorized Internal Limb lengthening

May not be new to my peds friends but this is exciting new stuff to me. For kids and adults with leg length issues, after osteotomy (separating the bone into two segments), instead of external fixators, they insert an intramedullary nail through the length of the shaft. The nail is a motorized telescoping metal rod which the patient activates daily by placing a magnetic external remote controller to cause lengthening. Bone forms in the space and the device is removed. Here’s a marketing version and the process. A whole journal issue was dedicated to it if you’re a real geek.

EMG Stuff

Optimal placement for Radial motor NCS Variability in the digital sensory distributions So proud of my colleague and friend Dr. Sandra Hearn who received the AANEM Young Lectureship award and she’s chosen to tackle the elephant in the room.

Trees

Gut Microbiome knowledge reviewed for 2020 These reproductive guidelines serve as the biggest intersection between rheum and OBGYN. Our Neurology friends are catching up to us in appreciating the role of physical activity. See attached.