Recruiting Forum Football Talk II

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#165,809
#165,809
VolsDoc81TX said:
It’s an excellent type job. I would definitely find out what your oncall status will be. How often do you have to round on weekends, etc. Call is the unfun part...

Ask if they do PRP and Stem cell injections.
Ask for Ultrasound training (invaluable for musculoskeletal practices). It’s absolutely great for Baker’s cysts. Also for Suprapatellar recess injections (great for Synvisc One injections...otherwise they hurt). Many insurers require Synvisc for gel injections or I wouldn’t use it. >30% of people have a painful synovitis flare after Synvisc, whether it is the 3 series or One. Once I learned that, I just inject with 40 mg Kenalog whenever I have to use Synvisc. (Treatment for the reactive synovitis is a steroid shot). Have had zero synovitis flares since I started doing that. Ultrasound is also excellent for hip injections...office procedure and easier than fluoroscopy guidance. You can make plenty of diagnoses with Iltrasound as well. Invaluable for Piriformis injections (common problem after THA)

Use the smallest needle that you can for shots. I typically use a 25 gauge. Don’t ever use an 18 gauge, except to draw up the meds or to aspirate a potential Infected joint. (Or Baker’s Cyst). If you don’t draw up your injection meds, make sure that they don’t use the same needle to draw meds that you then use for the injection...dulls the needle and it hurts more. If you need to use bigger than a 25 gauge, then use the cold spray or put a lidocaine skin wheal. Always pull the skin taut before sticking the needle in, allows the sharp needle to slide through the skin rather than tearing a hole through loose skin...
I use a 22 or 20 gauge to inject the viscosupplementation gel. Easier to inject.

Once through the skin, advance the needle slowly. That way you don’t hit anything that you shouldn’t. Over time, you will be able to feel when you pass through the joint capsule... If the patient feels more than pressure, stop and redirect the needle slightly. Inject slowly and it shouldn’t hurt. If it hurts (not pressure) you are in something that you shouldn’t be (ligament, cartilage, etc). If it’s difficult to inject, you definitely are. That’s why I don’t use 18 gauge, you can inject into cartilage, ligament, and even bone with an 18 gauge...

That’s how I teach injections.
I hope that helps. Best advice that I ever got was to use the smallest possible needle...
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Wow, you put 40mg Triamcinolone in a single joint combined with HA??? Do you not think that’s excessive? I often inject 4-8 joints at a time with my horses, and don’t exceed 30 mg total dose in all the joints combined. Usually only use about 18-20mg total dose. I am so glad to see a human orthopedist that combines HA with steroid. I almost always do it, and it’s very common practice in equine Sports medicine. I use triamcinolone or betamethasone in almost all of my Joints except lower tarsal joints (tarsometatarsal and distal intertarsal) in which I use 40mg Depomedrol with 10mg HA. Are you using any polyacrylamide gel in end-stage joints?
 
#165,812
#165,812
OGbabyaviVol said:
Wow, you put 40mg Triamcinolone in a single joint combined with HA??? Do you not think that’s excessive? I often inject 4-8 joints at a time with my horses, and don’t exceed 30 mg total dose in all the joints combined. Usually only use about 18-20mg total dose. I am so glad to see a human orthopedist that combines HA with steroid. I almost always do it, and it’s very common practice in equine Sports medicine. I use triamcinolone or betamethasone in almost all of my Joints except lower tarsal joints (tarsometatarsal and distal intertarsal) in which I use 40mg Depomedrol with 10mg HA. Are you using any polyacrylamide gel in end-stage joints?
Click to expand...

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#165,818
#165,818
OGbabyaviVol said:
Wow, you put 40mg Triamcinolone in a single joint combined with HA??? Do you not think that’s excessive? I often inject 4-8 joints at a time with my horses, and don’t exceed 30 mg total dose in all the joints combined. Usually only use about 18-20mg total dose. I am so glad to see a human orthopedist that combines HA with steroid. I almost always do it, and it’s very common practice in equine Sports medicine. I use triamcinolone or betamethasone in almost all of my Joints except lower tarsal joints (tarsometatarsal and distal intertarsal) in which I use 40mg Depomedrol with 10mg HA. Are you using any polyacrylamide gel in end-stage joints?
Click to expand...

Its one cc of Kenalog. The Synvisc synovitis flare is so painful that I don’t want to take a chance...

Not sure that the polyacrylamide is approved for himans yet. I have seen a clinical trial with it is going on now.
What’s your opinion about Adequan? I want that to get to human trials...
 
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#165,820
#165,820
VolsDoc81TX said:
I don’t want to get in another posting argument with SSVOL...😂 Vitamin D taught me that.

The main thing to remember is universal precautions. Wear a mask FOR OTHERS. Wash your hands frequently. Actually social distance. Love your family and keep them safe. If everyone does this, then this is over.
That’s it.

Oh and slap a person that’s not willing to protect others. Tell them to put others needs before their own. It will help them become a better person.
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😂 I thought you both said vitamin D.
 
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#165,822
#165,822
VolsDoc81TX said:
Its one cc of Kenalog. The Synvisc synovitis flare is so painful that I don’t want to take a chance...

Not sure that the polyacrylamide is approved for himans yet. I have seen a clinical trial with it is going on now.
What’s your opinion about Adequan? I want that to get to human trials...
Click to expand...
I use Hyvisc and do not have any problems with flares, but I always use steroids with it. I think you are only using 10mg Kenalog in the joint. We use Kenalog too, and it’s 50mg in the 5cc vial, so 10mg/mL.

I use a ton of Adequan in horses (And Legend which is IV sodium hyaluronate). It has its place for sure. I use it as an adjunct in my athletes to maintain joint health, and I think it helps increase longevity of my joint injections. Most of my performance horses are getting injected every 6 months to a year in their problem joints. If a horse has a performance issue due to joint soreness, I don’t put the horse on Adequan to alleviate the joint soreness, as I don’t think it fully will work in that capacity. For me, I’m always going to find where that horse is sore and inject it. I’m very aggressive with my treatment plan when my performance horses are having issues. I want to eliminate that inflammatory event in the joint and protect the joint from those nasty inflammatory by-products that destroy the cartilage. Sometimes I’ll have horses starting out a little stiff but not having any performance issues. Those type horses are perfect to put on Adequan without injecting any joints yet. It helps eliminate that stiffness as they start work...similar to People being stiff after waking up and taking a while to work out the aches and pains by moving around some.
 
#165,823
#165,823
VolsDoc81TX said:
I don’t want to get in another posting argument with SSVOL...😂 Vitamin D taught me that.

The main thing to remember is universal precautions. Wear a mask FOR OTHERS. Wash your hands frequently. Actually social distance. Love your family and keep them safe. If everyone does this, then this is over.
That’s it.

Oh and slap a person that’s not willing to protect others. Tell them to put others needs before their own. It will help them become a better person.
Click to expand...

Dude...I'll totally change my position on any of these subjects if I see credible data that contradict it. The problem with this CDC thing is that there is plenty of data that support deaths > 185k, and nothing that suggests otherwise. Changing how things are coded to eliminate any comorbidity doesn't change the facts. Now if new info comes out that states are falsifying death records, then there is room for discussion. So far, the debate isn't how many are dead, it's simply what to attribute the deaths to.
 
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#165,824
#165,824
BaldBiker said:
Ummmm....the hospitals sent the cdc the information that was requested of them. The cdc compiled the numbers. It has been said for months that the information was incorrect...that numbers for covid deaths were being compiled with false information being used. False information being that the individuals did not actually die from covid, but only had covid at time of death. Information being used as a covid death just because the person had covid at some time before they died...etc...etc.

Oh...and the hospitals got paid extra money for any covid related death. Did Trump authorize that? No. No he didn't.
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This is the difference. Died with COVID versus died from COVID. The information was then reported as if everyone will die from it. Which caused people to go to the other extreme when it became obvious that was not true. It is a bad virus that no one wants to get. It is serious for those who already have other health issues. The question then becomes how do we "live" in spite of this.
 
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