Tiger Woods Spine Surgery

Tiger Woods just had surgery on his back for the second time and will be out for a indefinite amount of time.  Apparently, something was pinching on a nerve and causing him significant pain.

(ESPN Story)

Below is a video of my own spine surgery from several years ago.  Thankfully, I have done very well.
Let's hope his second surgery will allow Tiger to return in 2016 to an elite level of play.


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TotalTendon

Respect Your Future Health (#BodyIRA)

Body Individual Retirement Account (BodyIRA)

When I was in medical school and about 22 years old, an erudite 50-year old professor made a claim that the warranty on the human body wears out at age 45.  As I fidgeted in my uncomfortable back row seat in a packed classroom, I thought to myself---what an old man.  I couldn't even contemplate what it would feel like to be 45 or 50.  I can now attest to the validity of my professor's claim because I have seen friends, family members and patients endure unexpected medical issues in their 40s.  I have a suggestion:  Open a BodyIRA.

What is a BodyIRA?  It's not a financial investment, but an investment in good health practices. Think of a BodyIRA as a bridge to your future health.  Just like a retirement savings account, a BodyIRA is a gift you give to yourself, by taking care of yourself now so you can be healthy far into the future.  And just like retirement savings, the sooner you begin to contribute to your  BodyIRA, the more benefits you will reap later in life.

Request to join the BodyIRA LinkedIn Group 
(Goal:  share ideas about health and fitness)

Four Starter Recommendations for your BodyIRA

1.  Maintain or work toward your ideal body weight (Keep a daily record of your weight)

2.  Stretch your hamstrings and develop strong legs  (See the PowerKnee Program)

3.  Focus on your posture (Sit up and Stand up straight)

4.  Get 7-8 hours of sleep per night or more

Consistent exercise, a healthy diet coupled with stable sleep patterns are like buying index funds for your future health.  In our twenties, we are told to begin contributing to a retirement savings plan like a 401k or an individual retirement account (IRA).  Put away a little money each month and you will see it grow into millions of dollars over the course of the next 40 years.  We need to emulate that sage advice and translate it to our health.

BodyIRA leads to dramatic dividends later.  One profound example is bone density in women.  Women in their teens and early twenties are building their bony framework.  In their thirties and beyond, they will make withdrawals from this bone bank.  If they do not deposit enough early on, they pay a heavy price later in the form of osteoporosis.

We have all heard this type of advice before but let's make it actionable.  Don't just take it from a friend or a medical professional.  Take it directly from your future self.  What would your ten-years-older self have to say to your current self?  If that older you limped in the door and looked at what you were doing, he or she might just scream at you to get your butt off the couch, stop bingeing on Netflix and get some exercise.  Begin by committing to writing down your weight daily and doing some simple leg exercises.  (See PowerKnee Program)  If you can initiate the habit of contributing to your BodyIRA for two weeks, you will experience some immediate benefits and also be contributing to your future health.

Importantly,  it's never too late to open a BodyIRA.  Don't worry if you are in your 30s, 40s, 50s or even beyond 60, you can still work toward a better physical and mental situation.  Much like a "catch up" contribution to your 401k or IRA, if you start later, you will need to pay more.  Also, as we age, the body requires more maintenance.  Don't get mad about it and neglect your aging engine and wheels.   Respect your future health and start your own BodyIRA today.  You will reap the priceless reward of future well-being.  


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TotalTendon

Will Biologics Revolutionize Musculoskeletal Care?

The economic costs of musculoskeletal care in the United States is approaching $800 billion or about 5.7% of annual GDP.  (Ref)  These costs are expected to increase significantly as our population ages.  This is clearly not a sustainable path.  A recent article published by the American Academy of Orthopedic Surgeons (AAOS) suggests the "early evidence is promising" for biologics to revolutionize musculoskeletal care.  (AAOS Article in full)

Biologic therapies represent a rapidly evolving frontier similar to arthroscopy in the 1970s and 1980s.  There will always be a need for continued research and development but the data supporting treatments such as platelet rich plasma (PRP) and stem cell treatments for tendinopathy and arthritis is increasing significantly.  PRP is now a recognized treatment for chronic tennis elbow that has been shown to be better than surgery.  (See Ref)  The number of PRP articles on PubMed now is over 8000 and the Google Trends for PRP is rising rapidly. (See Graph)

Biologic orthopedic procedures are in the process of revolutionizing the options available for patients for difficult problems such as arthritis.  It is an exciting time to execute on these point-of-care biologic treatments.   Continued progress will demand hard work and innovation by elite motivated teams in order to produce transformative outcomes for patients.


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TotalTendon

The Apple Watch and Medicine

I just tried on the new Apple Watch and was immediately impressed.

I put the 42 mm space gray Apple Sport version with an aluminum case and black strap on first.  The display was crisp despite the bright sunlight that was streaming into Palo Alto store.  The Apple employee tapped the watch twice and it went into demo mode.  It scrolled through a bunch of its functions including various displays, messaging options and of course the heart rate monitor.  I was fascinated and ready to run out the store with my new toy.  I also tried on the Apple Watch version with the stainless steel case and the Milanese band.  (See video below).  That version was a little heavier than the sport version but the band was simply sublime.  It has a magnetic clasp and can be easily adjusted.  It felt like a high end watch you could wear out to a fancy event.


Both of these watches are expensive ($399 and $699).  Are they worth it?  I am not sure just yet.  I am in the process of trying to figure out if I will order one.  You can't buy in the store and it is now back ordered online until June or perhaps even July.  I do want to replace my chest strap heart rate monitor that is hooked to my iPhone.  Glacing down at my watch would be a much simpler way to figure out if I am at my target zone especially during a bike ride.  I can also see how it would be useful for patients who need to closely monitor their heart rates during exercise because of its simplicity.

Let me know what you think if you have tried it on and if the watch will have any specific medical or exercise applications that will be significantly useful.

AM
TotalTendon

Top 7 Life Lessons from Steve Martin

A few years back I was very lucky and blessed to play poker with Steve Martin in Las Vegas with my friend Phil Hellmuth.  The three of us also had a fantastic dinner discussion that has made an enduring impression on my life. 

Mr. Martin is a superb writer, musician, actor, and producer.  He also recently hosted the Saturday Night Live 40th reunion show and expertly managed the egos of dozens of elite stars from music, TV and the movies. We can all learn from his sublime approach to work and life. 

7 Life Lessons from American icon Steve Martin

1.  “Be so good, they can’t ignore you”

2.  “It’s pain that changes our lives” 

From Shopgirl

3.  “Thankfully, persistence is a great substitute for talent”

From Born Standing Up, A Comic’s Life

4.  “I thought yesterday was the first day of the rest of my life but it turns out today is.”

5.  “I have found that-- just as in real life--imagination sometimes has to stand in for experience.”

From, An Object Of Beauty

 6.  “I just believe that the interesting time in a career is pre-success, what shaped things, how did you get to this point?”

From, Born Standing Up: A Comic's Life

7.  “Were they beautiful? We were all beautiful. We were in our twenties.”

Thank you Mr. Martin for sharing your immense talent with the world.  Please share his wisdom with your network.

AM

Ref:   http://www.goodreads.com/author/show/7103.Steve_Martin

Visit the site for more Steve Martin quotes

PowerKnee Program

DareToBeVital.com  Knee pain is a very common problem.  There are many potential remedies but one that is often ignored is diet and exercise.  This led me to develop the PowerKnee Program.  It is a simple set of exercises that may help improve the pain associated with a variety of knee problems including arthritis.  The exercises help address quadriceps strength, hamstring flexibility and overall lower extremity fitness.    This program can be found at PowerKnee.com.  Pass on the link to your friends and colleagues.

POWERKNEE PROGRAM (See Videos below)
1.  QuadCrunch (TM):  Perform a set of 3 hold for 5 seconds, 3 times per day
2.  Hamstring Stretch:   Perform a set of 3, hold for 5 seconds, 3 times per day
3.  Exercise Bike:          Ride for 30 minutes, 3 times per week, Record calories

Also, maintain or work toward your ideal body weight.  Losing even a small amount of weight may improve your knee pain and function.

Get going today on the #PowerKnee Program.  Pass on the link to your friends and colleagues.

Text "KneePain" to 22828 for a FREE newsletter to help with Knee Pain








DareToBeVital.com

DO NOT BEGIN ANY EXERCISE PROGRAM WITHOUT FIRST CHECKING WITH YOUR DOCTOR.
THIS WEBSITE IS FOR INFORMATION PURPOSES ONLY.  CONSULT WITH HEALTHCARE PROFESSIONALS TO DETERMINE IF IT IS RIGHT FOR YOU.

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TotalTendon

PRP enhances healing after Achilles Tendon Rupture

PRP being added to an Achilles Tendon Repair

If you rupture your Achilles tendon, new data suggests platelet rich plasma can enhance the healing.  In an abstract published by the journal Lancet, researchers from England discussed how they treated patients who had ruptured their Achilles with either PRP or a placebo.  Six weeks later, they biopsied the healing tendons under ultrasonic guidance.  In the study, they found improved cell content, better tendon fiber structure and more normal collagen (type 1) in the tendons treated with PRP.  The study included 20 patients (10 PRP, 10 Control) and is the first investigation in humans showing the significant value of using PRP to help treat Achilles tendon ruptures.  Of course, more data will be needed to confirm these important findings.  For years, I have been adding PRP to my achilles tendon repairs and if I ever rupture my own, I will certainly request that PRP is included in the treatment protocol.

AM 

Total Tendon

Top Five Lessons from my Visit to Tesla Motors

Tesla's Headquarters

I recently visited Tesla's headquarters in Palo Alto, California with my daughter and came away truly inspired.  Tesla’s headquarters is located adjacent to the Stanford University campus in rolling green hills just south of the linear accelerator and the venture capital lined Sand Hill Road.  I am lucky to know one of Tesla’s elite engineers who was very gracious and gave my daughter and me a superb insider tour.

Here are my top five lessons from the visit:

Dream Monumental Dreams

Hire Amazing Talent

Stick to your Vision

Innovate and Execute

Create stellar products and have fun

Tesla is America at its best.  It is a visionary company that is trying to change the world with its electric vehicles and products.  Their newest car, the Model S is not a leaf sized lawn mower.  It is a super charged sexy sports car that makes you fell like you are in the Jetsons’ world when you drive it.  (More about that later)

The Model S from Tesla

Tesla is a place of monumental dreams and superior talent that is sticking to its vision of producing electric cars that are better than their gasoline counterparts.  They have already achieved some of that dream by winning Motor Trend’s car of the year in 2013.  (Reference)  The company is also working on a battery that could serve as an axillary power supply for your home and perhaps even support the entire electrical grid.  (Reference)

The people I saw working there have an infectious sense of purpose that is missing in my world of biomedical research and medicine.  They work together without walls or even cubicles.  This promotes a sense of a united mission.  Those of us who work in research and healthcare are too often siloed in our specific specialities.  We almost never cross over and discuss our problems with colleagues outside of our world.  We need to emulate companies such as Tesla.  Their way of executing in the electric car business could lead to breakthroughs in medicine that could be transformative.  I also think Nicola Tesla would be very proud of how his name is being used.

And by the way, I had a chance to test drive a Model S Tesla at the end of my visit.  It was like a magnetic bullet train on wheels.  I punched the accelerator and it felt like we were taking off for Mars.    #Awesome

AM

TotalTendon

$87 Billion Dollars for Total Knee Replacements by 2030?

We have an epidemic of knee arthritis in the United States with over 10 million affected Americans (Ref).  Many treatments are prescribed with variable efficacy for this common problem.  When all else fails, knee replacement is often recommended.  This procedure is overall highly successful but also expensive.

In 2009, the CDC reported the estimated costs of knee replacement in the US to be $28.5 billion dollars (Ref).  Published reports suggest there will be a need for almost 3.5 million knee replacements in the United States by 2030 (See paper).  At a conservative total cost of $25,000 per surgery, that translates into $87 billion dollars. So, the projections suggest the costs will triple over the next 15 years.

That is $87 Billion Dollars just in the United States to treat end-stage knee arthritis.  That is just the cost of knee replacements.  It does not include other surgical or non-operative costs.  It also doesn't include treatment of other potentially arthritic joints such as the hip or shoulder.

We can and should immediately begin an all-in assault against arthritis.

Patients need to act on the first line of treatment.  They can help themselves with a program of diet and exercise.  Simple exercises such as the QuadCrunch and Hamstring Stretching can be quite helpful.  Riding a bike is another way to exercise with arthritic knees.  Losing even a small amount of weight can result in less pain and more function.

The good news is many new treatments are in development to treat this difficult problem.  The bad news is the effort is fractionated.  It is important to note that knee arthritis is not simply a disease of the cartilage.  There is dysfunction in muscle, tendon, ligament, cartilage and bone when a patient has arthritis.  A better understanding of the genetic and epigenetic causes of arthritis is also needed.  We will need a systematic approach to treating all of the components of the disease in order to be successful.

On the horizon are a plethora of biologic treatments including platelet rich plasma, stem cells and even gene therapy.  We need to embrace these novel treatments do the hard work that is needed to prove their safety and value.

A coalition of patients, providers, payers, researchers and industry need to come together and execute on potential treatments and prevention strategies.  We cannot afford to continue with the status quo and spend almost $90 Billion Dollars on knee replacements in 2030.

Please post your comments or suggestions below.

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TotalTendon

Improve how your DNA works by Riding an Exercise Bike

The Epigenetics of Exercise

Allan Mishra, MD

You can’t change your DNA but you can change how it works. DNA is the coding program for all of the enzymes and proteins that make your body function. 

Epigenetics is a rapidly evolving area of science that studies how modifications on or around your DNA alter the production of specific molecules. Your DNA is fixed but how it works is affected by the proteins and chemical groups that surround the famous double helix.  You can think of epigenetics as variable signposts on the winding tracks of your DNA that either suppress or promote specific genes.  The proteins and chemical groups have fancy names like a “histone” or a “methyl group”.  These "epigenetic" markers don’t change your DNA but rather change how it interprets the underlying genetic code.  They can turn on or off a section of DNA and dramatically affect YOU.  The science is called “Epigenetics” and in 2015 and beyond, it will alter the way we all approach medicine and wellness.  Multiple articles about epigenetics have appeared in Time Magazine, the New York Times and many other elite publications.

Exercise is one way you can change how your DNA expresses itself via epigenetics in a positive fashion.  A recently published study required people to ride an exercise bike with one leg for 45 minutes four times per week for three months.  Before and after the exercise trial, the subjects had a muscle biopsy of both legs.  The researchers found "health enhancing adaptations" were induced by the "physiologic stimulus" of riding an exercise bike via epigenetic mechanisms in the leg that did the pedaling but not in the one that did nothing.  (Ref: Lindholm et al 2014)  The results are meaningful for anyone who wants to stay in shape and be active.  Importantly, the inherited proportion of physical performance has been shown to be about 50%. Therefore, about 50% of overall physical performance is dependent upon training and lifestyle.  (Ref:  Ehlert etal 2013)  This means that we are at least partially in control of how our bodies work and perform.  We can't blame all of our health problems on bad genes.  

Exercise has also been found to have positive effects on the central nervous system, the  cardiovascular system, the aging process, the prevention of type 2 diabetes and the prevention of cancer all via epigenetic mechanisms.  (Ref:  Ntanasis-Stathopoulos et al, 2013)

So, dust off the exercise bike in the garage, make time in your schedule to get to the gym, or join Soul-Cycle in 2015.

Specific immediate action items:  Consider starting your exercise routine with QuadCrunches and Hamstring Stretches.  They are simple exercises that can be done anywhere.  For the bike, try 20-30 minutes 3 times per week with moderate resistance.

Remember, exercise can literally change how your DNA functions and potentially save your life.

AM

TotalTendon

ALWAYS consult your own physicians before beginning any exercise program.

Using a 3D Printer to Make a Knee Meniscus

Meniscus cartilage is the cushioning tissue between the femur and tibia bones of the knee.  Millions of Americans each year tear this cartilage.  Loss of the meniscus tissue can lead to arthritis.

In this novel approach, researchers in New York are using a 3D Printer to create a new meniscus.  They have studied in sheep so far with success.  In the future, it may be possible to use an MRI scan with a meniscus tear to help program a 3D printer to make you a new meniscus.  Treatment in human patients is not yet available but this is quite an intriguing possibility for the future.

Reference
TISSUE ENGINEERING

Protein-releasing polymeric scaffolds induce fibrochondrocytic differentiation of endogenous cells for knee meniscus regeneration in sheep

1. Chang H. Lee1, 
2. Scott A. Rodeo2, 
3. Lisa Ann Fortier3, 
4. Chuanyong Lu1, 
5. Cevat Erisken1 and 
6. Jeremy J. Mao1,*

Read More

Read the scientific abstract

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TotalTendon