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Re: Prelim Validation Prediction Rule for DVT
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Re: Prelim Validation Prediction Rule for DVT - July 17, 2005 9:38:00 AM
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Jon Newman
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From: Amherst, WI
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Hi Alex,
Glad you had a good time and the pictures are great. Did you get the chance to see the Giro de Italia as it rolled through Italy this year?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Prelim Validation Prediction Rule for DVT - July 17, 2005 10:19:00 AM
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jma
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From: NY
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Excellent pictures Alex. Thanks for posting them.
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Re: Prelim Validation Prediction Rule for DVT - July 17, 2005 1:21:00 PM
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Randy Dixon
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Jon,
I don't have a problem viewing Lance as a chronic pain sufferer, the guy has had testicular cancer and he puts his body through grueling workouts. What I questioned is your perspective. It seems obvious that you came to the situation with the idea that fitness can't solve pain, and used very sketchy evidence to reach that conclusion this time.
It wasn't meant as a criticism of you, except in the formal sense of that word. It was meant as a "heads up". I don't think anyone who has any idea of what the TDF is, is going to think racing in it or even training for it is going to, or is meant to, resolve pain. Does that mean that fitness and exercise aren't effective for pain relief or protection? There is no evidence either way in this example.
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Re: Prelim Validation Prediction Rule for DVT - July 17, 2005 3:07:00 PM
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SJBird55
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From: Michigan
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Isn't it the individual's perception of pain that is important to consider? From reading Jon's link... Lance has no fear of pain; Lance expects pain; Lance welcomes pain. He doesn't seem to view it as "harm." Pain is part of what he does and apparently he wants it there. I believe marathon runners are the same way... some of the triathletes are the same way... and it is funny treating them. They have "pain" and then they have PAIN. The normal "pain" bothers them, but doesn't. They don't focus on it in a bad way - it's more of a joke or "bragging" rights.
Welcome back, Alex. Where's that shirtless photo with writing on your chest? ;)
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Re: Prelim Validation Prediction Rule for DVT - July 17, 2005 4:24:00 PM
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Jon Newman
Posts: 1691
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From: Amherst, WI
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Hi Randy,
I can see how it could be interpreted that I suggested that Lance's motivation for exercise was pain relief. For that I'm guilty of bad writing as it was not my intent. My point was that exercise done primarily to increase strength and endurance does not lend much to lasting pain relief. I do think it offers a counter measure to the ravages of a shrinking movement repertoire secondary to pain. I do think something more needs to be added to exercise if it is to produce something lasting.
Here's a passage from "It's not about the bike: My Journey back to life". The passage occurs after Lance seems to be unable to get back to his job. His perception is that he is disabled (for his job description). He is convinced to go to a private training camp. Only good friends are around.
[QUOTE] I continued upward, and the mountain grew steeper. I hammered down on the pedals, working hard, and felt a small bloom of sweat and satisfaction, a heat under my skin almost like a liquor blush. My body reacted instinctively to the climb. Mindlessly, I rose out of my seat and picked up the pace. Suddenly, Chris pulled up behind me in the follow car, rolled down his window, and began driving me on. "Go, go , go! he yelled. I glanced back at him. "Allez Lance, allez, allez!" he yelled. I mashed down on the pedal, heard my breath grow shorter, and I accelerated.
That ascent triggered something in me. As I rode upward, I reflected on my life, back to all points, my childhood, my early races, my illness, and how it changed me. Maybe it was the primitive act of climbing that made me confront the issues I'd been evading for weeks. It was time to quit stalling, I realized. Move, I told myself. If you can still move, you aren't sick. [/QUOTE]I think it is experiences such as these that may happen to occur during exercise that are more likely to lead to lasting relief than the exercise itself.
You are correct. I don't have the type of evidence which you speak of.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Prelim Validation Prediction Rule for DVT - July 17, 2005 4:32:00 PM
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nari
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In a section of today's local paper, Lance was quoted as saying: "I used to ride my bike to make a living, now I just want to live so that I can ride".
Motivation and self-perception are a powerful pain reliever; he becomes fit on order to ride and thus becomes fitter in order to continue to ride. Pain relief is a fringe benefit.
At least that is how I see it.
Nari
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Re: Prelim Validation Prediction Rule for DVT - July 18, 2005 1:57:00 AM
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Sebastian Asselbergs
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Having worked for quite a few years with a couple of world champion skaters, skiers and triathletes makes me agree with the notion that chronic pain is "expected" by a quite a few of these athletes (probably most). Massage therapists, acupuncturists, physiotherapists and chiropractors are all scheduled around their training sessions. As nari states, "pain relief is a fringe benefit".
I haven't been involved with that type of patient for a few years now, but I can guess it hasn't changed much. They expect it, and a few feel it is a sign of their mental toughness and depth of training - if they don't hurt, it wasn't "enough". This is why I have a bit of a jaded view of top athletes - there is something dysfunctional about this self-abusive behaviour - with such little chance of any other benefit than: "I did it". It takes a singularity of purpose at the cost of so much else, that one has to wonder....
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Mundi vult decipi
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Re: Prelim Validation Prediction Rule for DVT - July 19, 2005 11:34:00 AM
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karmzack
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From: Hawaii
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This thread can't die I'm still waiting for a response from Dr. Wagner. Maybe I should just let it go.
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Zack Solomon MPT, OCS, CSCS
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Re: Prelim Validation Prediction Rule for DVT - July 19, 2005 7:04:00 PM
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Yogi
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From: San Antonio, Tx., USA
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Someone please look up the definition of opinion, and see if there is any requirement that there be evidence, or factual basis necessary, for one. We often desire to know the source or reasons for a given opinion, but that does not make anyone less entitled to have one. Or obligate them to provide us with any rationale, that's my opinion, and that is all that is necessary to be said for me to have it.
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Re: Prelim Validation Prediction Rule for DVT - July 23, 2005 12:23:00 PM
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srcase
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From: Michigan
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Didn't Lance and Sheryl Crow split?
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Re: Prelim Validation Prediction Rule for DVT - July 23, 2005 1:11:00 PM
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jma
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From: NY
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Looking at todays photos from the latest time trial, it sure doesn't look that way.
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Re: Prelim Validation Prediction Rule for DVT - July 24, 2005 12:59:00 PM
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dosrinc
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From: Bonita Springs
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Zack,
I think that your prior post pointed out enough inacuracies in Dr. wagner's posts to end all the bickering.
As long as we are giving opinions on Lance that we can't back up with evidence, how about this one:
Is it possible that chronic chiropractic manipulations combined with spending untold hours in a forward bent position has desensitized the mechanoreceptors in the lumbar facet joint capsules, ligaments and muscle bellies of Lance's lower lumbar spine to the point that he now suffers from a condition of clinical lumbar segmental instability and therefore chronic pain? Any thoughts?
Rick
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Re: Prelim Validation Prediction Rule for DVT - July 26, 2005 5:46:00 AM
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Dr.Wagner
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There were no inacuracies. The military training of medical residents is well past its prime and no longer meets the basic standards set forth by civilian training (both in pathology and number of patients), therefore a greater reliance on civilian hospitals. What many of you fail to realize is that there are very few PURELY military residencies, they are combined military-civilian residencies. So, as a result the military residents rotate at both military and civilian hospitals. The primary issue is that military hospitals are becoming so sparce with enough pathology, greater reliance on civilian sights are needed (see Wright Patt AFB, no longer a trauma center, no longer acute neurosurgery...therefore a greater reliance on non military hospitals).
Harborview is facing RRC probation and no longer may have the support of the University of Washington.
The president of the American College of Emergency Physicians stated is best when he said "People don’t realize that when they go to Harborview emergency department they may be seen by a resident or a medical student without any supervision,” he said. “Is this the best way for patients to be treated? We don’t think it is.”
ACEP President Robert E. Suter, DO, MHA, wrote letters of concern to the University of Washington's dean and Madigan's commander stating that Harborview's staffing “is in need of significant and immediate change.”
Quite honestly, I think this should have greater press play...its like having OT's performing all rehab services at a major rehab hospital and thinking "that's ok".
I am not sure how any of that is "inacurate". It is simply a format that I am familiar with and is somewhat hard for those not in the system to grasp. From the outside it looks "OK", from the inside it is a wreck.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Prelim Validation Prediction Rule for DVT - July 26, 2005 8:31:00 AM
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karmzack
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From: Hawaii
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Dr. Wagner, Do you really not get it? Was I not clear enough? The criticism you have is against a civilian (Harborview) emergency department not the military. Madigan (military) has a board certified ER doc on staff. Who is better off, you going to Harborview ED seeing a resident or myself going to Madigan seeing a board certified ER doc? The Harborview residency is a civilian and military problem don’t single out the military, it just makes you look bad. BTW, it’s the civilian’s fault for not providing a board certified ER doc;)
The military patient population is a small (and arguably fitter) subset of the overall US population. Of course it’s not going to see the depth of pathology the civilian side sees. This is precisely why the military has part of it’s residency at civilian hospitals. It makes for a better physician, how can this be criticized?
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Zack Solomon MPT, OCS, CSCS
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Re: Prelim Validation Prediction Rule for DVT - July 26, 2005 11:30:00 AM
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JLS_PT_OCS
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Hey Zack, I think you might be a little on the "Derr" side...
:)
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Prelim Validation Prediction Rule for DVT - July 28, 2005 12:09:00 PM
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Dr.Wagner
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Zack,
THe hospital is part of the Madigan Army Medical Center/University of Washington Medical Center Affiliated Residency in Emergency Medicine...if the program can't staff the ED with an EM board certified physicians, IT IS THEIR FAULT. The residency recieves ACGME accreditation and government money and funding. If the government is funding a residency that has no board certified supervision...then how are they properly educating the residents?? Those are military residents...the program director is a LTC(Benjamin P. Harrison, MD, LTC ), the Chair is US Army(David A. Della-Giustina, MD, , LTC US Army), the Assistant Director is a Major (MAJ Kurtis Holt/Kathy Jobe, MD )...now, whose fault is it? Who is running the residency...all military docs. This is NOT a civilian residency. And one must point the finger DIRECTLY at the chair, resdiency director and also at harborview. But if you can't assure board certified supervision of your military residents, regardless of location, it is the PROGRAM'S fault. NOT the university.
Is the university deficient by ACEP, ABEM, and AAEM standards, yes...is the residency deficient, absolutely. It is the RESIDENCY that determines staffing at the ED's in their program...and who is in charge of the residency? The military heads as listed above.
This is a MAJOR deficiency (forgive the pun). And once again, the military simply shows they are no longer in the business of medical education of specialists.
Nuff said, and by the way, Zack, what the hell do you know about residency education? Stop defending a program that is substandard, when you really haven't a clue. THere should be no residency if they can't provide appropriate education...and the RRC agrees.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Prelim Validation Prediction Rule for DVT - July 28, 2005 3:19:00 PM
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Synergy
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From: Forney, TX
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Wow! Okay...Alex, post some more pics. Todd, wherever you are, let's get some more discussion about the USPS. :)
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Chris Adams, PT, MPT
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Re: Prelim Validation Prediction Rule for DVT - July 28, 2005 5:42:00 PM
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karmzack
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From: Hawaii
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Thank you Dr. Wagner, you finally admitted that it is a joint (military and civilian) problem at Harborview. As I’m sure you know they are working on rectifying the problem.
Honestly, I didn’t know that the EM board certified physician was only at the ED for the residents and not the patients and the funding came from the school. So if Harborview did not have a residency program an EM board certified physician would not be needed in the ED?
Correct me if I’m wrong, but I believe other specialties such as Internal Medicine and General Medicine docs are/were attending to the ED patients at Harborview. Is a patient better off going to Harborview or Madigan (where there is an EM board certified physician)? I guess I’ve placed too much importance on the EM board certification for actual patient care, not just training.
Let’s get down to the real issue. You made a joke regarding the competency of military physicians (BTW many military docs are purely civilian trained). How do you come to this conclusion? You talked with people and you worked at a DoD hospital (how long?). The problem is you generalized your experience to the entire DoD health care system. I work with military physicians everyday and my family is cared for at military hospitals. There are many brilliant docs and some not so great. I’m sure you could say the same everywhere. You criticize the DoD health care system, is civilian health care perfect? I don’t want to have a debate on whose system is better, there are pluses and minuses to both. I’m sure even you can partially agree with that if you know anything about the two systems.
Do you live anywhere near a military hospital? Maybe you should pay the hospital a visit, at least it would give you a little more credibility.
USPS ROCKS!
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Zack Solomon MPT, OCS, CSCS
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Re: Prelim Validation Prediction Rule for DVT - July 28, 2005 5:55:00 PM
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karmzack
Posts: 181
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From: Hawaii
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[QUOTE]Those are military residents... [/QUOTE]Too be exact, 8 Military, 4 Civilian
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Zack Solomon MPT, OCS, CSCS
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Re: Prelim Validation Prediction Rule for DVT - July 28, 2005 6:54:00 PM
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Jon Newman
Posts: 1691
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From: Amherst, WI
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About the 'derr'
[URL=http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2005/07/21/do2101.xml&sSheet=/portal/2005/07/21/ixportal.html]link[/URL]
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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