Our bodies are a series of highly complex interrelated systems... one system will affect the others.

The older I get, the more obvious this becomes.
Even in Orthopedics, it's clear that adult joint pain is often the downstream result of issues elsewhere.
A Thread... I've mentioned some of these before...
Folks with elevated lipids and/or uric acid experience tendinopathy more often. The crystals replace or damage the collagen in our tendons.

Although unproven, the same might hold true for our menisci.

Knee swelling hours after playing a sport, with no recollection of injury. These are very common scenarios... and almost never require surgery... but the swelling will be with you for months. Nope... it's not due to the meniscus tear seen on your MRI

Muscle mass and strength...
I fed GPT4 my book. I asked it to tweet about muscle mass. I have not edited/changed anything...
How did GPT do??? Sarcopenia, the age-related loss of muscle mass, is a silent factor affecting our longevity. As we age, our muscles naturally diminish, impacting our overall health.

High-tech, low-touch medicine... it's more prevalent than ever-- and it's not getting any safer. And the downstream consequences are getting worse. I've noticed a shift toward high-tech diagnostics for a long while, but let's not forget the healing power of the human touch. The human touch in medicine isn't just comforting; it's a critical tool for diagnosis and connection.

Let's chat about frozen shoulders... A 🧵

There are a few ortho conditions that can make a mess of things due to its natural history, initial presentation, and progression.
Frozen shoulders are one of those diagnoses. I love it when I read review articles that state that frozen shoulders are a benign self-limiting disease.
Clearly, none of those authors have had a frozen shoulder. During the acute phase, it's one of the more painful shoulder conditions. Loss of sleep isn't benign.

You exercise, you do not sustain an "injury" --- and later that day your knee is swollen. There's some discomfort... mostly due to pressure and the swelling. But there's no acute sharp pain.
The all too often sad tale of what happens next. In most of our minds, we are convinced that pain implies harm.
Sure, sometimes that's true. But very often, it's not.
Yes, some types of pain should stop you in your tracks, but that's rare. More often than not, you can carry on. But...

The @WSJ put out an article on how fragile our knees are. These titles attract attention... but we are a terribly sedentary population. Our knees are not fragile. They can handle a lot of force. The risks of inactivity far outweigh the risk to your knee. wsj.com/articles/why-o… I've seen 100s of folks who have shut down their activities due to reading something like this. I have seen 1000s curtail activities bcuz they think it will damage their knees. This is unfortunate. The risks of rest far outweigh the risk of injury. howardluksmd.com/health-consequ…

Everyday we see these quotes wrt what % of employees in various specialties want to leave.

No industry that I found is untouched. Where are all these folks going to go?

What % of lawyers want to leave profession? Over 50%

law.com/international-… What percent of teachers want to leave their profession?
Up to 60%

k12dive.com/news/educators….

Beginning 5 years or so ago, I started wearing a CGM about twice a year.
I know there are many who doubt its efficacy in non-DM populations... but I disagree with that. 1/? Modern medicine is terrible at prevention. We tell folks with an A1c of 6.1 - you're not diabetic yet. We tell folks with an ALT of 40, ApoB of 120 they're fine.
But... we know how this movie ends.

How do you describe this xray to your patient??
Now, assume they’re 48 and very active. RT and running. They’re still running.
They just started to note some mild pain a week ago.
They wanted to be sure nothing was “seriously wrong.” Every word we say in the office to this patient will have a profound influence on their activity level going forward.

Precovid.
Ran 10 min/mi w/ HR~118.
LT1 running was 136 by Bla-

When I left the trailhead HR was 80 and slowly rose to 118 over 10 minutes. I had zero cardiac drift for runs up to 120 min. My recovery HR was 87 after 1 min.
Then came COVID. Btw. No PMH, no Etoh, sleep 7.5 hrs/night. No meds. BMI 23. I’ve run for > 30 yrs.
COVID was annoying for few days.
But my HRV/RHR told a story worse than how I felt.
Became short of breath on stairs. My heart laughed at me w mild efforts .. rapidly approaching > 150.