With the buzz surrounding the verdict on the Isiah Thomas' sexual harrassment case, I suppose it is just about time for our friend Al Sharpton to plant his face on our television screens. What does he want now? An apology for Thomas' apparent permission for use of the word "bitch" between members of the same race.

First of all, there are far worse words that one can use if one has bad feelings about someone. The word itself is rather benign. The Oxford English Dictionary gives the following:
1) a. The female of the dog;
b. The female of the fox, wolf, and occasionally other beasts.
2) a. applied opprobriously to a woman; strictly, a lewd or sensual woman. Not now in decent use but common in literature. In modern use especially a malicious or treacherous woman; of things: something outstandingly difficult or unpleasant ("son of a bitch.");
b. Applied to a man (not common);
c. A primitive form of lamp used in Alaska and Canada.
3) Combinations and attributes, as (sense 1) bitch-puppy, -whelp; (sense 2) bitch-baby, -clout, -daughter, -hunter, -son; bitch-daughter (obs.), the nightmare; bitch-fou a. (Sc.), as drunk and sick as a bitch, `beastly' drunk; bitch-goddess, in William James's phr. (see quot. 1906); cf. success sb. 3.
4) A mining instrument used for unscrewing rods or recovery of broken rods.
verb
1) a. To frequent the company of lewd women;
b. To call anyone "bitch;"
c. To behave bitchily towards.
2) a. To hang back (rare);
b. To spoil, to bungle. Also as "botch;"
c. To grumble, to complain.

Of course, the "lewd or sensual woman" definition is the source of the sexual harassment suit against Isiah. However, my bet is that his use of the word about Ms. Sanders in reality was as a "malicious or treacherous woman."

What does Al Sharpton have to do with any of this? Besides to ride on the coattails of a public spectacle and create more public anger than already exists?

In the late 1980's and 1990's Sharpton's presence was important in bringing justice to Brooklyn gang members who took part in racially-motivated beatings. Sharpton played a critical role in the way hate crimes are viewed and managed in this country. His experience as manager for James Brown gives Sharpton a public marketing angle in trying to raise public awareness. He was instrumental in the 1986 Howard Beach protests when three African-American men were assaulted by a white mob. Sharpton also raised awareness and staged protest in the 1989 Bensonhurst attacks on four African-American teenagers and the subsequent shooting of one of them.

His methods, however, sometimes create more public unrest, anger and violence. It is common for him to accuse his target first in the public eye without having investigated to see if there is validity to his accusation. This type of "trial by press" incites rage and sometimes violence.

Perhaps the most famous of these is the 1987 case of Tawana Brawley, the then 15 year old woman from Wappinger's Falls who fabricated an elaborate racially-motivated abduction and sexual assault. There was glaring evidence that she had not been kidnapped or harmed. In fact, witnesses saw Brawley at parties during the time that she was ostensibly "missing." Under the leadership of Rev. Sharpton, the investigation became a witch hunt against members of the police and local government. Given the nature of the evidence, it is likely Sharpton and his team suspected the abduction was a fake. Yet, they pressed on, harming many innocent people in the process.

The incident did catapult Sharpton's public image and made him the celebrity he is today.

So why does this man now choose largely benign name calling as his rally point for action? Is the use of words like "bitch" and "ho" cause for public demonstration and outrage? Are there so few issues deserving of our attention that we must get riled up over this?

Or is Sharpton merely coasting? He thrives on media attention and seeks it wherever he can find it. But, perhaps our dear Reverend is no longer courageous enough to tackle the larger issues which gave him that celebrity in the first place.

Disillusionment has been a common feeling for me of late.  Having recently become involved in the sport of cycling and racing, I look up to those with enough talent and strength to compete in contests like the Tour de France.  This year, two incredible athletes were removed from competition based on suspicion of their use of "banned substances." 

It's unclear to me whether I am supposed to feel outrage at this.  Are the truly awesome performances of these two men attributible only to their alleged  pharmacologic enhancement? Would I be just as inspired to have seen them perform without having used these illicit substances?  Nobody knows. 

The bigger question is whether viewership would be the same if these athletes could not pull off stunning performances and blowout comebacks.  Would anyone watch?  Are we as a World audience so accustomed to superhuman exploits that we no longer care to be reminded of our mortality?

Another recent discovery of mine is the "reality" show Man vs. Wild,  featuring Bear Gryllis, survival expert.  He is dropped off in remote areas and must battle the wilderness, the elements and sometimes wild animals in order to reach safety.  The show touts the fact that Bear does not receive assistance from the camera crew or from others.  He is provisioned only with a canteen, a knife and a flint.  He eats bugs.  He wrestles fish from the ocean and eats them raw.  He wards off bears.  He fends off exhaustion, extremes of temperature and hunger.  Or does he? 

Turns out he stays in motels sometimes during his adventures.  He has assistance with the building of shelters and rafts.  He has more to eat than the flora and fauna of the region.   The media are up in arms about this.

Do I care?  Not really.  Am I still entertained by his adventures? Yes.  Will I continue to view the show?  Of course.  It's a TV show for goodness' sake!  I have little interest in seeing someone freeze to death or pass out from exhaustion in the name of television. 

But where do we draw the line between entertainment and sport?  Is there any such thing as pure sport anymore or has our commercial interest superceded our interest in testing the  limits of unenhanced human power?

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.