The Empathetic Doctor: Suffering for Empathy

empathy  em·pa·thy (ěm'pə-thē)
n.

1.  Direct identification with, understanding of, and vicarious experience of another person's situation, feelings, and motives.
   
    
   
   
   
   
   I understand that pain is a subjective symptom.  It is difficult to quantify pain.  It is definitely easier to understand someones pain if you have experienced the same or similar pain that a person is suffering from.  
   
   
   I have been athletic for most of my life.  I am fortunate to have been relatively injury free for most of my sporting career.  I have had a few broken bones, a number of sprained ankles, and a hand full of concussions.  I am still involved in athletics and am dealing with a few more aches and pains than I did when I was younger.  I currently suffer from a minor meniscus tear in my knee that may require surgery in the future, I have a small rotator cuff tear in my shoulder (from years of pitching in baseball with poor mechanics), and am currently dealing with a high ankle sprain (from a hockey game I played a few days ago). Dealing with these injuries helps me better understand what someone with knee pain, or shoulder pain, or an ankle sprain would go through, as well as what would be expected for treatment and recovery. 
   Though it is never fortunate when one suffers an injury, I believe I am fortunate to have experienced what these injuries feel like.  I believe that this makes me more empathetic towards patients who have suffered or are currently suffering from these types of "aches and pains."  I deal with athletic (and non-athletic) patients who suffer from similar complaints.  In fact, some of them find it quite surprising that when I explain their symptoms to them while they are describing what their problem is! 
   
   
   I believe that it is important in the health care field to show empathy to patients.  I'm not saying that you should suffer for the benefit of the patient, but it does help understand what a patient must go through when they suffer from pain.

The Crossfit Conundrum: Good or Bad?

Before I start, I should qualify that this is not a hack against Crossfit or a promotion of Crossfit.  It is my opinion based on some of the stuff I've read, some of the stuff I've tried and some of the stuff I've seen.  I have tons of friends who do Crossfit and a number of friends who are actually Crossfit coaches.  I have also been to and experience Crossfit first hand and did enjoy my workouts. 

Crossfit Gym

Regular Gym

So let me start with the good!  I think the Crossfit movement is a great thing!  It is nice to see that people are getting away from your traditional body building mentality and moving to what I would call more "functional" movements.  It is great to see the movement away from big expensive, restrictive machines and towards free weights and movements.  I really think that if fitness is a goal, Crossfit is a great way of improving fitness! 

Here is my thoughts about the downside of Crossfit.  I have concerns about people doing complex movements (sometimes with heavy weights) to and sometimes beyond fatigue.  Its at this point where injuries typically occur.  In some cases, even experience Crossfitters lifting heavy loads to fatigue can suffer injuries.  I also worry about the risk/benefit of some of the exercises.  For instance, do the benefits of doing handstand pushups really outweigh the risks (maybe I do, but no one has explained it to me yet!) 


I also have concerns about the accessibility.  Anyone can go online and look up the Workout of the Day (WOD).  It may call for extremely high volume or max weights.  This should be fine for someone who is experience, but for a novice lifter it could be disastrous.  To Crossfit's credit, they have programs for novices who want to come try Crossfit.  They have coaches who are able to help you with mastery of lifting techniques.

I do like the culture that Crossfit has to offer.  It is appealing to groups of people of similar caliber, and can get quite competitive.  For many people, the challenge of competing against your friends helps to push your workouts. 

The bottom line is that if your training is enjoyable, you will be more likely to continue on with it.  So Crossfit-ON!  But please do so safely!

Dr. Google...I think I have...

So you suffer from a bit of a headache, some nausea, fatigue, feeling chills at times, some neck pain, a bit of tingling in the fingers and some abdominal pain.  Punch your symptoms into the computer and Dr. Google diagnoses you with:

Fibromyalgia
Complex Regional Pain Syndrome
Hypothyroidisim
Diabetes
Chronic Pain Syndrome
Hypertension
Meningitis

and...and...and

With all this information, how can someone accurately self diagnose themselves?  Don't get me wrong, I think that knowledge is helpful, but if fallen into the wrong hands it can be a detriment and not an aid.

Something to think about when talking about symptoms.  The definition of SYMPTOM is an objective change that cannot be observed or measured.  Look at the list of symptoms:  Headache, nausea, fatigue, tingling, pain; none of these can be measured (accurately).  I believe this is why sometimes when you present with pain, some practitioners will tell you that "its all in your head." There is no good way to measure.

When you go to your doctor, they are looking at SIGNS that go along with common symptoms.  SIGNS are objective changes that can be observed by clinician.  For example, neck "pain" may go along with reduce range of motion in the neck indicating some type of joint dysfunction.  A headache may go along with an elevated body temperature or fever indicating a local or systemic infection (that can also be measured by doing blood tests and looking at a blood cell count).

Before you go jumping to conclusions about what you may be suffering from, maybe its time to check in with a health care professional to get a second opinion.

Pulled muscle: What does that mean?

Whether is a hamstring, calf or low back, most people have suffered from a "pulled muscle."  But what exactly does that mean?  The medical term muscle "strain" is more commonly used among practitioners, but it is still vague and highly variable.

It would be so much easier to figure out what happened to a muscle if we could just cut someone open and have a look.  But it is kind of frowned upon.  Though there are some techniques such as diagnostic ultrasound and magnetic resonance imaging (MRI) that can aid in the diagnosis of a muscle strain, they can be costly and wait times are often lengthy.  Without imaging, clinicians and practitioners can go by clinical signs and symptoms as well as relying on clinical experience.

Crudely put, a strained (pulled) muscle is a muscle that has undergone some damage.  There are a hand full of grading systems including a more recent "structural" or "functional" grading system, but here is a simplified grading system (it is actually quite old) that can help visualize what is going:

Grade 1 (Minimal): Tear of a few muscle fibers with no fascial damage

Grade 2 (Mild):  Tear of a moderate number of muscle fibers with no fascial damage

Grade 3 (Moderate): Tear of many muscle fibers with partial tear of fascia

Grade 3 Tear including fascia near musculotendinous junction

Grade 4: (Severe):  Complete tear of muscle and fascia

With that being said, a muscle can be strained (or tear) in a number of different spots.  The most common spot for a muscle to tear is the musculotendinous junction (where the muscle meets the tendon).  It is considered the "weak link" in the chain.  It can also be torn in the muscle belly (middle of the muscle) or even at the attachment of the tendon to the bone (called the enthesis).

As you can imagine, it is difficult to come up with a diagnosis (exactly where the muscle is torn) which makes it difficult to come up with a prognosis (length of time for recovery).  For example, a grade 1 muscle strain at the muscle belly may warrant a prognosis of day to day (about a week for recovery with treatment) whereas a grade 1 muscle strain at the musculotendinous junction may require 1-3 weeks of rest and treatment before returning to activity. 

The important thing with muscle injuries is correctly assessing the problem so you can come up with the correct treatment protocol and provide an accurate prognosis for recovery.

Pulled pork is essentially Grade 4 muscle strain!