Medical Bankruptcy

When I first started writing this column, it was all about sports injuries. It actually started out as a question and answer thing, answering questions about athletic injuries.  Dr. Bob Haralson and I took turns answering the questions in this space. It was called “The Jock Doc.” We did it that way for about a year.


It became a column not long after and I’ve been writing it every week since then. For 34+ years.  In all these years, I have covered a wide variety of topics, often having little to do with sports. But it’s always been about helping this community be a better place because…well…I’m all about making this community a better place.


When I arrived in Maryville in 1977 (December 12^th, to be exact), there were three physical therapists in all of Blount County. Blount Memorial now has about 90 Physical Therapists and Physical Therapist Assistants and a whole host of other rehab clinicians that are Occupational Therapists, Athletic Trainers, and Speech Therapists. There are other rehab clinics and clinicians around our community providing good care.


Obviously, health care has changed. The medical community here has grown to meet the needs of our county, also reaching into surrounding communities. Our population is now over 130,000. Here’s the problem:  Every single day, I encounter someone without health insurance or someone that is terribly under-insured.


All too often, I will get a boy or girl having had surgery to repair a torn ACL, a devastating injury to a young athlete. And maybe they have no health insurance or are under-insured. The rehab following ACL reconstruction is extensive. But even if they have insurance, maybe their insurance has a hard max of 10 visits for physical therapy (that means that insurance will only pay for the first 10 visits). They need more than that to get back to their sport.


Health care costs, including the costs of providing physical therapy, are expensive. Insurance and other forms of third party-payment are important in helping us get the care we need while protecting our financial viability. Unfortunately, over 500,000 people go bankrupt because of medical bills every year. That constitutes a national crisis.


Let’s look at this from a different perspective. One of my best friends in the world just got back from M.D. Anderson Hospital in Houston. He has a rare and aggressive form of cancer. So he traveled to the best cancer treatment center in the world. The cost doesn’t matter. His life is in the balance.

In the United States, we have the best medical professionals, the best technology, the best hospitals, the best medical care in the world. Twenty years ago, my friend would not have had a chance. Now, he does. And he will pay whatever it takes to beat this thing.


I’m not going to get political on you and offer my opinion about what we should do as a country. I don’t think there is a single best solution. But I can tell you my opinion about what you and I can do.


We can get healthier. We can take better care of ourselves. We can eat better. We can control our weight. We can exercise daily.


We can get an annual physical, not because we’re sick but because we’re making sure that we stay healthy by controlling our blood pressure, managing our diabetes, and by discovering medical problems early, before they turn into catastrophic events and diseases.


We can stay away alternative forms of “health” care that claim to treat everything from glaucoma to asthma to bedwetting. We have research that tells us what the best course of action to treat injury and disease is. Insist on evidence that what any provider is suggesting will really work.


We can prioritize our health and take ownership of our personal wellbeing at a level that will drastically decrease what we spend on health care. And be healthier and happier because of it.

More on Simply Moving

I want to talk about movement again today. I listened to a podcast this week about movement and it had some really great points. We just really don’t move much anymore. Modern conveniences have created a sedentary culture.


I see tons of patients with shoulder problems. A lot of those are related to their posture and a lot of that is from spending too much time in front of computers and digital devices. Neck, shoulders, upper back…all pay the price for sitting too long.


Lots and lots of jobs consist of sitting in front of a computer all day long. Even my job requires me to sit at a computer for long periods of time (hello, medical documentation). We even advise people who work at computers to set an alarm to tell them to get up and move around every so often.


Modern conveniences have been built around not moving. Drive up for fast food. Eat in your car. Drive up to the pharmacy to pick up your medicine. Drive up to the bank to handle transactions. We don’t even get out of the car.


We can call in our grocery order, pull into a designated spot and someone will bring everything we ordered and put it in our vehicle. I realize that can be a great blessing for those with limited mobility but I still advocate for getting out and going inside to do your shopping, even if it is in one of those motorized wheelchair-type things.


Even when we get the stuff home from the grocery store, we don’t have to do anything to it. We don’t have to wash it. We don’t have to chop it, peel it, or dice it. It’s already in a bag ready to eat. Instead of planning, assembling, and preparing dinner, you can get a complete meal at the grocery store that requires only that you heat it up.


And ordering things online. First, you sit in front of a computer, making your choices. You wait a couple of days and then it is delivered to your door. It couldn’t be easier. And it couldn’t require less movement unless somebody carried from the porch into your house.


You can order take-out from lots of restaurants and don’t even have to go pick it up. Someone will pick it up and bring it to you. You could conceivably exist in today’s world without ever leaving the house.


Even the rear facing cameras on our cars can be seen as a deterrent to movement. You don’t even have to turn around to look behind you. (But don’t take mine away—it’s a blessing for senior citizens like me.)


When I was a child, we had three TV channels. And those channels signed off about midnight. Heavens forbid that the President was talking—it would occupy all three channels. And the remote was my Dad telling me to get up and change the channels. You actually had to touch the TV!


Today we have an almost infinite number of shows to watch, 24 hours a day. That means that you have the potential to sit for hours on a time, completely captivated by what is on the TV screen. For goodness sake, we had to suffer through the Lawrence Welk Show when I was growing up!


We need to move, not just when we exercise. We need to move throughout the day. Don’t drive around looking for the closest parking spot. Don’t take the elevator up one floor. Never surf channels just trying to find something you might like to watch. Walk. Meander. Shop. Move!


You might find this hard to believe, coming from me, but exercise is not the solution. Exercise without a life of movement is like taking vitamins and supplements to provide you with what you’re not getting from what you eat. If you are sedentary much of the day but spend an hour in the gym exercising, you just aren’t getting the movement that your body needs. You’ve got to move all day.

You need to MOVE!

I’ve got a patient right now that came to me about three weeks ago with back pain. At her first visit, she was in a world of hurt. I had no idea how she was still going to work every day. But this isn’t a story about the patient. Or even about back pain.


This is a story about movement. This patient had been having back pain for about three years. She had tried a lot of different things before she found her way to my door. Previously fit and always active, her back pain had limited her activity level and added 70 pounds to her frame.


When I first saw her, it was clear that she was terribly deconditioned. For three years, she had simply failed to move. Any initial injury was likely long since resolved but now she had to get over the recovery from whatever it was that started her back pain.


Our bodies need to move. No…our bodies have to move. We are made to move. I don’t mean we have to run or jump or play sports. But we do have to move.


A lot of the health problems that we as Americans are suffering from today are due in no small part to the lack of movement. Obesity. Diabetes. Heart disease. Vascular disease. All those things and more can be effectively treated with movement.


Let me break it down in a little different context. Years ago, rehab, my world, was focused on joint protection. In other words, after knee surgery or shoulder surgery, we might brace or splint and protect the joint from movement. Then we got smarter. Now we know that early movement is a huge advantage in rehab. Total knee replacement? Needs to move early and often. Rotator cuff repair? We will even go into the recovery room to start early movement.


Our joints, ligaments, tendons, and muscles need to move. Put a healthy joint in a cast and take it off in a month. That joint, which didn’t hurt before, will now hurt.  I guarantee it. Our heart, GI tract, lungs, and blood supply need us to move. Our bodies are amazing and how they work is simply incredible but without movement that body starts to deteriorate.


You don’t have to run a marathon but you might need to walk around the block. If you can’t walk, then maybe you ride a bicycle. If you can’t ride a bicycle maybe you can swim. If you can’t swim maybe you can just get into the water and move around. It works. It really does.


Our bodies are not made to sit in the same place for long periods of time. People who spend too much time at a computer have all sorts of issues. People that drive for a living will eventually pay the price.

Something will fail them. Their back. Their neck. Most likely, their shoulders.


I don’t watch much television. I do have a favorite show:  Madam Secretary. I can’t tell you when it is on but I know that my wife keeps it on DVR so I can watch it whenever I want to, without commercials. The only other time that you will catch me sitting in front of the television is when
Clemson’s football team is on. But sitting even that long leaves me feeling…well..yucky. And stiff. My body is telling me that it needs to move!


So here’s the rest of the story about my patient--the first time I took her to our rehab gym, she cried pretty much the whole session. I picked her exercises carefully (and wisely, I hope) but I was convinced she just needed to move.


The second session she cried but cried less. The third session she noted that she was better. By the fifth session, she declared that she felt “marvelous.” For the first time in three years. I didn’t provide her with any great physical therapy interventions, I simply asked her to move. And gave her parameters to do so safely.


What about you? Do you need to move more? Do you stay in the same position doing the same thing for long periods of time? I’ve got one really important piece of advice for you, simple as it may be. JUST MOVE!

Be A Generalist!

I just finished a book called Range, by Daniel Epstein. The subtitle on the book is “Why generalists triumph in a specialized world.” The book starts out by comparing the development of the careers of Tiger Woods and Roger Federer, the greatest golfer and tennis player of their generation.


Tiger was destined for golf from an early age. At age 4, he was beating 10 year-olds. Everything from birth to his professional career was focused on making him the greatest golfer ever.


Roger, in contrast, played everything.  His mom was a tennis instructor but she did everything she could to discourage him from a tennis career. He played squash, wrestling, and basketball and went skiing, swimming, and skateboarding.


When other kids were attending tennis academies, working with personal trainers and nutritionists, and competing around the globe, he was agonizing over having to give up soccer. And at an age when most tennis professionals retire, he was still the number one ranked player in the world.


The book is full of statistics and research and reaches some pretty startling conclusions. In a nutshell, the most successful of athletes in pretty much every sport played lots of different sports growing up.

The exceptions were gymnastics and…well…gymnastics. That’s it. Really. Everything from golf (well, except for Tiger) to football to equestrian events, the most successful athletes were generalists.


The easy answer to why is athleticism. The more complicated answer is in emotional development.

It seems like there is a ton of pressure on young athletes to be stars, to be on the winning team, to be successful in sports at an early age. Pitching coaches for 8 year olds. Sports performance training for adolescents before their body is ready for that kind of activity.


According to the American Academy of Orthopedic Surgeons, more than 3.5 million children age 14 and under are treated for sports-related injuries each year.


Dr. Jim Andrews is probably the leading sports medicine physician in the world. An orthopedic surgeon in Birmingham, Dr. Andrews’ patient list includes Michael Jordan and Tiger Woods. His surgery allowed Drew Brees to return to the NFL after a devastating shoulder injury.


Dr. Andrews on youth sports injuries: “I have seen my patient population and surgical cases get increasingly younger. Children, parents and coaches need to realize that kids need to take a break from playing one sport year round. Sports should be fun for children. Overuse injuries in children is a concerning trend.”


His core advice is simple—Take time off, don’t specialize. OK, but when is it OK to concentrate on only one sport? Maybe in high school. Maybe later. Certainly not before they reach puberty.


The bottom line is that there is no way in the world that anyone knows that a 10 year old is destined for sports stardom. Oh, we can have a good idea that they’re going to be really good at something, but we can really never know exactly what. Everybody thought Roger Federer was going to be a soccer star.


Winning a weekend baseball or softball tournament is meaningless if your child doesn’t get better. Winning a flag football league is a waste of time if your child doesn’t have fun. Let your kid play. Let your kid have fun. And let them play everything.