Justice or wisdom?

The book of Job in the Bible offers an amazing perspective into the life circumstances of a godly person struggling with difficult circumstances.  So often, and understandably so, we ask God “why” events are happening to us.  The why question implies that somehow God is obligated to reconcile our perception of  an injustice against His…

Update on Knee Arthroscopy

While used less frequently now than previously, knee arthroscopy (putting a scope into the knee joint for the purpose of “shaving” roughened or worn menisci) is still considered in certain circumstances. There has been a body of evidence accumulating that suggests this invasive procedure does not afford additional benefit over standard treatment and physical therapies….

Update on Medical Genomics

It has been fun to watch advancements in the basic science of molecular biology reach into the world of clinical medicine.  As an Internist involved in practical clinical practice, at times the articles and information on the basic science of  molecular medicine seemed removed from practice.  But now, new (to me) principles are starting to…

More on the issue of low back pain…

The ACP has put out some additional information on the approach to low back pain.  Because it is so common, this sort of step by step evaluation process is very helpful, see link below… ACP on Low Back Pain

The poor thyroid gland,  he gets blamed for everything.

In a world of fast pacing and quick fixing, wouldn’t It be nice if simply tweaking a slow functioning thyroid fixed all our fatigue and over weight? While confirming a normal functioning thyroid gland is very important, when to treat subtle abnormalities of slow functioning thyroid has become a matter of some debate.  Slow thyroid,…

Non Pharmacologic approaches to Low Back Pain…

Annals of IM has given a nice review on non pharmacological interventions in back pain. Of note physical therapy, accupuncture, graduated exercise and spinal manipulation seem to be the most evidenced based approaches. It is a good reminder that most back pain can and should be treated conservatively, with MRI and surgery reserved for “red…

Rethinking ICD (implantable cardiac defibrillator) therapy

Rethinking ICD therapy.  This article extends important understanding of the role of ICD (implantable cardic defibrillator) therapy.  It has long been conventional wisdom that any form of chf related to reduced left ventricular function (severe enough by criteria) would experience a survival benefit with the implantation of an ICD.  This paper states that ICD’s help…