ankles, knees and money

Monday, December 17, 2012

It’s not often that an athlete forgoes technology and replaces it with common sense. It is a nice teaching moment when Carmello Anthony of the New York Knicks will be resting a sprained ankle and sitting on the bench without the benefit of an x-ray or MRI. In the real world, sprained ankles are common and there is little to do aside from RICE (rest, ice, compression and elevation) and perhaps a little ibuprofen as an anti-inflammatory. X-rays tend to be less than helpful, yet so many patients wanted a picture taken, and so many doctors agreed to order them, that researchers came up with the Ottawa Ankle Rules to decide who really needed an x-ray. An x-ray is NOT needed, if there is no tenderness along the last two inches of the medial and lateral malleolus (the bones that protrude on the inner and outer aspect of the ankle) and the inability to take 4 steps either at the time of injury or in the ER. A foot x-ray is NOT needed if there is also no tenderness over two bone sin the foot, the 5th metatarsal and the navicular. (You’ll need to click here to see where those two bones are located). The Ottawa rules can decrease the number of x-rays taken by more than 40% as long as the doctor can persuade the patient to believe in the physical exam and that a ligament has been torn, the definition of a sprain. It may be easier now that Mr. Anthony has shown the way.

Adrian Peterson is challenging the single season NFL rushing record just a few months after undergoing knee surgery to repair a torn ACL (anterior cruciate ligament). The accomplishments on the field are as impressive as those in the OR. The running back benefits from team, especially the work of the offensive line that blocks for him. Even the most elite running back depends upon those in front to open the way. Similarly, the skills of the surgeon require a commitment for the patient to undergo months of rehabilitation and the patient needs the skills of the physical therapist to lead the way. Mr. Peterson’s nickname is AD (All Day) which likely describes how long he spent in the gym to rebuild the quadriceps and hamstring muscles that protect and move the knee. It’s amazing that a two inch long ligament can take months and a team of experts to heal. But it also takes a ton of football players to rush for just a couple of yards.

When the Powerball jackpot payout climbs to the hundreds of millions of dollars, it is sometimes difficult to appreciate how life changing that amount of money that can be. For some pro athletes, the numbers can be just as astronomical. Whether Matt Holliday is worth $120 million dollars over seven years is difficult to determine. There aren’t many people who have 40,000 fans show up to watch them work along with another few million television viewers, radio listeners and the internet streamers. To get a sense of what $120 million can buy in the medical world, consider that it is the funds needed to immunize all the citizens of 20 poor countries. Closer  to home, those millions could build a state of the art hospital, equipped with labs, operating rooms, elevators and carpeted waiting rooms, to meet the medical needs of a half million people. Doctors and nurses not included.

Life goes on even in the wake of tragedy and yet it is hard to take a deep breath and try to ignore the violence of Newtown, or even hide those thoughts and images. I cannot imagine the strength of the teachers who sheltered the children and the fear all those in the school felt. I am only hopeful, as I am for all my patients who pass away, that they did not suffer. I pray for that.

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