Sad News

Last week I received an email and a phone calll from Tom Shives, my former professor at Mayo who is still a friend and mentor.  "Danny," whose real name is Jared W., had a recurrence of his osteosarcoma a few months ago.  He had to have the leg amputated above the knee.  He underwent more chemotherapy but this time, the cancer did not respond.

Jared  died on July 31, 2007, two weeks after his seventeenth birthday.  He had developed uncontrollable metastatic disease.  This news saddens me more than I can express.

I have spoken with Jared's family and they have indicated that any correspondence or donations to the family can be sent to the attention of Ms. Adeline Smoker, P.O. Box 322, Frazer MT 59225. 

The New York City Marathon took place on Sunday, November 5, 2006.  More than 35,000 runners from all corners of the Earth participated.  Thousands of spectators cheered them on.  Even Lance Armstrong ran the race this year.

What this means for me as a cyclist is that, after having retired my running shoes after last year's race, I joined some of my cycling mates to marshal the race for wheelchair and handicapped athletes.  Marathon Day is possibly the best day of the year in New York City.  The positive energy is overwhelming

What this means for me as an orthopedist is that many runners in the marathon come to the office for myraid aches, sprains, pains, twists, cracks and clicks.   Most of these issues are benign;  they can be treated with rest, cross-training and over the counter medicines.

Some of them are not.

Our bones are made to withstand the forces of our activity.  They are remarkable in this quality. They do this through their material properties of strength and elasticity.  That is, they either resist the forces or bend to accommodate them.  Until they don't.

Fractures occur when the force on a structure exceeds its material properties.  Sometimes this happens because the force is too great; a car accident or a fall from a height.  In other cases, the material properties of the bone are changed;  there is a metabolic disease or age-related change to the bones so that they aren't able to stand up to everyday stresses.  Something so simple as stepping from a curb might cause a break. 

Finally, there are "overuse injuries."  The stresses themselves aren't enough to overwhelm the properties of the bone.  But, cumulatively, relentless sub-threshold stresses can cause failure of the bone structure.  When we place great, but not failure-level forces across our bones repeatedly, a "stress fracture" can occur. 

A person with a stress fracture may have normal xrays.  She may only have pain when she does high-impact activity.  She may have enough pain to cause her to go to see a doctor.  Sometimes the fracture is never detected and the person self-limits because of pain, the fracture heals and life goes on.  If symptoms cause concern, an MRI test or a bone scan can detect the injury and treatment can be rendered. However, if the offending activites continue, the bone could snap and require surgery or some other "drastic" measure.

Now our bones are governed by our physiology.  Unless there is something wrong with our healing process, bones will mend when treated appropriately.

But what happens when we overwhelm other systems?  How do we deal with the relentless sub-threshold stresses on our emotional skeleton?  There's nothing so definitive as an MRI test to tell us when we've reached the limits of our patience.  The pains related to stress fractures of this nature are vague and difficult to localize.

I've treated four patients in the past 6 weeks with real stress fractures of their bones.  One woman had fractures in both hips.  Another, in her foot.  A young boy had a break in his tibia.  Another young lady was unlucky enough to have had a stress fracture which cracked completely and required surgery.  All of these folks were under 33 years old.

In contrast, I cannot count the number of patients, mostly young women with small children, who come in for treatment of low back pain, neck pain, hand pain, knee pain, shoulder pain... the list goes on.  These women seldom have a concrete medical problem.  I believe the issues here are with the taxing of other systems.  Many of my such patients sleep only three or four hours per night because of work, house and child care duties.  Some have not had a day to themselves for years.  They are exhausted, stressed and overwhelmed and this shows up in the form of physical pains.

But how do I treat this?  My tool kit includes medicines, therapy and surgery.  Is there a way to fortify people so that they are more resilient?  Or do we just wait for them to break?

Namaste. 

Today, after many months of looking, negotiation, heartache and headache, my sister and her family are going to close on their new house.

My niece is very excited to have her own room.  In fact, she's invented a game called "this is my room," using curtains or chairs or whatever is available to make her own space.  Only the select few are invited into her realm.  It's very important to close the door/curtain/sofa cushion behind you.

I've become accustomed to my own space.  Have not had a roommate since college.  My residency call rooms were palaces compared to some;  we had our own room and shared a bathroom with the adjacent room.  Not that we had much time to sleep, but at least we could close the door and be alone if desired.

Makes sense, then, that the purchase of one's own property is called a "closing."  One buys the opportunity to shut others out. One can change the locks and decide who gets a key. 

Obviously, the term comes from the thought of finalizing, or "closing" the deal.  It's natural to be excited for the finish.  We celebrate endings, especially when they mark another beginning. 

Perhaps this is why it's so important to have closure in other things: failed relationships; illness and death; everyday arguments.  We need to close so that we can start again.   With the start comes uncertainty.  Will we be better this time?  Will we succeed in our next goal?  Is this the right house?  Is this the right person to marry?  Should I have given {insert thing here} another chance?  Will I be able to live without {insert person here}?

Some things are easier to close than are others.  For instance, I have been trying to find closure in my last romance for about eight months now.  I wonder if I can't close because I am, impractically, holding out hope that there is a chance for success.  All rational evidence points to "no."  This particular man has failed to follow through on anything he's promised. Yet, the moment I give myself permission to lose hope - to shut the door - he pops up again.  I know my friends are frustrated with me; I frustrate myself!  I want to be able to end this and thus allow myself to start something better, healthier. At the same time I am afraid to do it.

Then I think about my sister's house.  It was not easy.  She was in contract for another house and lost it after a series of random events.  Now she has found a better one.  I hope that same luck finds me.

Namaste. 

Yesterday I met a chef during a ride with the Rotations Cycle Club in Southampton, Long Island. Like me, he's new to the sport.  Like me, he's been riding a lot and has become fitter over the past few months.  In fact, he tells me he's shed about 35 pounds and has just completed his first triathlon.

Then he asks a "medical question."

He asks if I have an explanation for why his libido has diminshed since be began his training.  The devil in his eye, he admits that this change might be for the better.  He admits that his prior libido may have been a little too much sometimes.

During the ride, I cannot think of a medical explanation for this phenomenon.  Hormones?  The effect of the bike seat?  We discuss our training and our goals.  He shares a recipe.

We finish our ride and part ways.  But I can't help but think about his question.  Why, indeed, did his sexual appetite change?  Why has my appetite for food and alcohol changed?   Why do I find myself craving more healthy foods?  Why do I want to retire and rise early, even on the weekends? 

Perhaps our bodies are smarter than we suspect.  As we demand more of them in our athletic pursuits, they demand more of us.  Our appetites change to reflect what we need. And when we are in tune with what we need, we can be a stronger and more efficient machine.  The trick is to listen to this visceral advice.

With food, this makes perfect sense.  Donuts and cheeseburgers do not a triathlete make.  But sex?  One would think that better health would improve or increase libido.  In the case of my new friend, it may be that his prior libido was unhealthy. In the same way his training has caused him to lose excess weight, it has freed him from the weight of unhealthy sexual cravings.  No longer does he feel the need to binge on empty calories. His body has decided to eschew the donuts and cheeseburgers of junk food sex and to instead opt for better, healthier choices.  Now it's up to him to decide whether he wants to listen.

I'm learning a lot from cycling.  Not just technical stuff like when I need to lube my chain and fill my tires.  I'm learning about patience and pacing.  About saving some energy for the end of the ride. About not needing to be first or to win, even though it's fun do perform well.  The gift of cycling (or yoga, for that matter) is in the doing.  The psychic and physical benefits surround that.

Namaste. 

click to enlarge Firemen?

So yesterday I met the Stephens for dinner downtown at Gusto.   After having cycled more than 100 miles up and down mountains on Saturday, I was in the mood for some pasta.

As always, we had wonderful conversation, great food (even though Stephen could likely do better himself!) and a little show and tell.  They had just purchased an antique fire hose nozzle at a shop nearby. What they plan to do with this thing, I do not know. 

What I do know is that it weighs a ton and, aside from it's overt, er, symbolism, it's a fascinating piece of equipment.  Steve filled me in on the various settings used to extinguish a fire or to blow down a door.

Then I began to think about fireman and what drives them.  Sure the very first firefighters didn't have fancy hoses and trucks.  But somehow they felt compelled to lay aside personal safety and rush towards things that were on fire. And I'm sure that early firefighters were: 1) less successful at extinguishing fires, and 2) more likely to be injured or killed.

Firefighters don't make a lot of money.  They aren't in search of the limelight either.  These are truly brave, selfless people.  For sure I would not want to be a firefighter.  I'm scared to death of fire, for one.  But wouldn't it be nice if we all could infuse a little of those firefighter qualities into our own lives?

What if the lawyer decided to work for free for his poorest clients instead of turning them away?  What if the world-famous surgeon, who no longer accepts insurance plans, took on patients despite their financial status and considered only their need?  What if the Deli owner gave out water to elderly or homeless people for free during heat waves?

I'm sure we can all think about something we could do so that little kids would want to be like us.  Why not do it?  Just a little.

Namaste.