Articles Posted in Orthopedics & Sports Medicine

cdcheadsup-300x111Common sense and moderation can matter a ton in maintaining good health, as recent news reports show, particularly with kids and concussions, middle-aged adults and heart disease, and collegiate alcohol abuse.

With youngsters returning to school and so many of them participating in sports and recreation programs, it’s good that the federal Centers for Disease Control and Prevention has issued evidence-based guidance on protecting kids who suffer mild traumatic brain injury or what most of us would call concussions.

These injuries have become a growing concern for parents and young athletes. Sports leagues and sporting groups are coming to a time of reckoning with just how harmful head trauma can be.

Bundle-300x151Federal regulators may be forced to reconsider their plans to curtail a cost-containing experiment that affects some of the most commonly performed surgeries — knee and hip replacement procedures that hundreds of thousands of seniors undergo annually through their Medicare coverage at a cost to taxpayers of billions of dollars.

Under the Affordable Care Act, doctors and hospitals were pushed to adopt a new and different way to think about and to bill for these surgeries, which, by the way, aren’t risk free. Instead of patients getting flooded with bills from each provider involved — the lab, radiologist, anesthesiologist, surgeon, hospital, and so forth — Obamacare got all the parties together and told them they would get a single, “bundled payment.” Hospitals, typically, then acted as the chief point of contact, getting the providers to figure their fair share, billing patients (once), and collecting reimbursements and distributing them appropriately.

The system seemed to work: costs declined, the quality of care went up, and patients expressed relief that their mailboxes weren’t jammed with a blizzard of the usual incomprehensible medical bills. But doctors, hospitals, and insurers kept grumbling. The Trump Administration and Republicans in Congress, as part of their relentless and counter-factual assault on the ACA (more on that in a second), took aim at bundled payments and talked about changing and eliminating this approach.

ncaalogo-300x200College football has kicked off its fall season with a flourish, but the signs are increasing that concerns about players’ health and safety may slash at the game’s size, spectacle, and importance.

Just as the pro leagues were forced to answer in court for the harms that athletes suffer due to repeated blows to their heads, the National Collegiate Athletic Association (NCAA) has been hit with claims in the civil justice system, asserting wrongful deaths of players from the recent past.

Lawsuits, believed to be part of what will be a wave, were filed against the college sports conference on behalf of the survivors and estates of a onetime University of Southern California fullback and a University of California at Los Angeles running back.

mcnair-240x300In College Park, Md., new cooling tents have sprouted on the University of Maryland’s football practice field, where the training staff also is taking pains now to provide adequate cold drinks and breaks to players. Observers say the pre-season regimens, however, are not only marked by greater attentiveness to the young athletes’ needs, they’re also eerily quiet and somber.

That’s because top Terps leaders have apologized and conceded the school shares blame for the tragic and preventable heat stroke death of Jordan McNair, 19, a Maryland offensive lineman. Coaches forced the young man to run and over-exert himself during a May 29 practice. More importantly, they failed to diagnose the severity of his condition, neglecting to so much as take his pulse and blood pressure, and, in a disputed account, not noticing that he was suffering seizures, or acting fast to drop his body temperature with ice and cooling baths.

Published reports suggest he showed heatstroke signs before 5 that afternoon, though trainers did not call for emergency help and an ambulance until nearly 6, when his body temperature may have hit 106 degrees. He was admitted to a hospital, where nurses and doctors immersed him in a cooling bath and reduced his temperature to 102 degrees — 90 minutes or so after he apparently got into distress.

alslat-254x300The National Football League, which long has resisted the growing reality that game-related head blows can cause major harms to its players, may be providing yet new and unintended warnings about the sustained damages of concussions.

The Los Angeles Times reported that pro football’s pay-outs, as part of its billion-dollar head-injuries settlement with NFL players and their union, have been surprisingly high in cases where retirees have claimed damages due to Parkinson’s and ALS.

Parkinson’s, the newspaper noted, is a “progressive movement disorder that produces tremors, impaired movement, and slurred speech.” It is “marked by the buildup of proteins called Lewy bodies in brain cells.” ALS, also known as amyotrophic lateral sclerosis or Lou Gehrig’s disease, is a condition affecting “nerve cells in the brain and spinal cord and ultimately results in a fatal inability to initiate and control muscle movement.”

cdc-opi-aug-300x227When Big Pharma pursues rapacious profits and regulators snooze, patients suffer terrible consequences, as new revelations about the opioid crisis show.

Kaiser Health News Service , via the Washington Post, and The New York Times both have done excellent investigative digging into drug makers’ role in fueling the prescription painkiller mess that authorities estimate claims 116 lives a day due to overdoses.

Fred Schulte, writing for the independent, nonpartisan Kaiser service, reported that rival makers — seeing how much money Purdue Pharma was making with its powerful and addictive OxyContin drug and that it was encountering law enforcement and regulatory challenges — stepped in with “similarly dangerous painkillers, such as fentanyl, morphine and methadone.”

buckeyes-300x295Soon, many young people  will be back to school and signing up for  sports teams. Many will have to undergo physical exams before they can play.  And it’s a tragic reality that grown-ups may need to think a lot how to protect young people from sexual predators who also are doctors.

That’s because Ohio State University, sadly, has joined the University of Southern California, Michigan State-USA Gymnastics, and Penn State University in the notoriety of dealing with a sexual abuse scandal involving adults and students. In the case of the Buckeyes, it’s Big Ten male wrestlers.

OSU said it had hired an outside law firm to investigate the allegations against Richard Strauss, who had blue-chip credentials and served as the team doctor to university wrestlers roughly from 1979 to 1997. The doctor killed himself in 2005. Lawyers interviewed more than 200 one-time OSU students, with 100 of them accusing Strauss of sexual misconduct, “including former athletes from 14 different sports teams.”

gary-150x150dryden-150x150The 2018 Stanley Cup may rest for a bit as the pride and joy of enthusiasts in the nation’s capital and of its title-winning team. But as fans of the pro and amateur game look to the future, they may have reason to be downcast about hockey’s most important component: its players.

Author Ken Dryden (photo above, left) has important things to say about them, because he was a goaltender for the Montreal Canadiens and has been enshrined in the Hockey Hall of Fame. The onetime Canadian parliamentarian has pointed out that owners and bosses in the National Hockey League, as illustrated by videotapes of their sworn testimony in a long-running court case, are locking arms and taking a counter-factual position on the damages that players may suffer due to blows to the head they receive in games.

In “infuriating” fashion, NHL Commissioner Gary Bettman (photo above, right), Boston Bruins owner and chairman of the league’s Board of Governors Jeremy Jacobs, other team owners, senior league executives and doctors are playing ostriches, Dryden wrote in a recent Op-Ed in the Washington Post. They’re sticking their head in the sand, insisting that hockey has no issue at all with “chronic traumatic encephalopathy, or CTE. That’s a degenerative brain disease that has been found in athletes including professional hockey and football players, as well as soldiers and others who have suffered repeated brain injuries. Symptoms of CTE include cognitive impairment, depression, emotional instability and suicidal thoughts.”

insurersPP-300x296Patients who expect their health insurer will work in their interests to contain costs by medical providers might just as well hope for assistance from leprechauns, unicorns, or the tooth fairy.

Marshall Allen, a reporter for the Pulitzer Prize-winning investigative site ProPublica, has just penned a strong myth-busting piece, cross-posted on the National Public Radio site, about health insurers, writing:

The United States spends more per person on health care than any other country does. A lot more. As a country, by many measures, we are not getting our money’s worth. Tens of millions remain uninsured. And millions are in financial peril: About 1 in 5 is currently being pursued by a collection agency over medical debt. Health care costs repeatedly top the list of consumers’ financial concerns. Experts frequently blame this on the high prices charged by doctors and hospitals. But less scrutinized is the role insurance companies — the middlemen between patients and those providers — play in boosting our health care tab. Widely perceived as fierce guardians of health care dollars, insurers, in many cases, aren’t. In fact, they often agree to pay high prices, then, one way or another, pass those high prices on to patients — all while raking in healthy profits.

nags-300x166If you can get your favorite sports fans peeled away from the latest broadcast pro event  ─ whether it’s the basketball playoffs, hockey championship series, golf tourneys, or the heating up baseball season ─  a conversation of sorts could be sparked by dropping numbers on them. See what kind of rise you can get by telling them their data-driven obsession with improving their own athletic performance may be built on shoddy calculation.

In the “Moneyball,” statistics’ crazy world of contemporary sports and athletic fandom, that statement could be heretical. But the numbers-driven folks at the web site “528” deserve credit for digging into a popular but dubious approach employed by researchers in sports medical science: Magnitude-based inference, aka MBI. Their article’s worth a read, especially for wonks and the numerically inclined. For those who are less so, here’s a taste of what’s at stake, as 528 reported:

At first blush, the studies look reasonable enough. Low-intensity stretching seems to reduce muscle soreness. Beta-alanine supplements may boost performance in water polo players. Isokinetic strength training could improve swing kinematics in golfers. Foam rollers can reduce muscle soreness after exercise. The problem: All of these studies shared a statistical analysis method unique to sports science. And that method is severely flawed.

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