We should begin with every patient by validating that their pain is real. He discussed the role played by cognitive behavioral therapy (CBT). It is referenced most often because it has the best evidence, but we do not really know how to break that down for patients. He described three basic stages. It is important to recognize that CBT is not the best and only treatment. Exercise is important in a lot of musculoskeletal conditions, but it should be tailored to benefit that window between benefit and symptom aggravation. Next, is the question of what must be done with all the information he has provided in this presentation thus far. There seems to be evidence of some advantage to participating in athletics or being fit. Also, not everyone who is fit is having a good time and not everyone with a chronic condition can jump into fitness in the right way. So, we need to figure out how to meld that. Patients come to us because they are suffering. We need a team approach to close the performance gap they experience. A psychological battle must be dealt with at the same time as physical problems. He described strategies he would use. Find out what exercise they do now and for how many minutes, and their amount of sleep. Determine what they enjoyed doing in the past. It is important to focus on one of their problems and aim to achieve success in treating it. He described some available resources that are useful.   A Question & Answer period followed.

Grand Rounds: Dr. John Vasudevan - Where Sports Medicine Meets Pain Medicine, Why Fitness Helps Everyone Win, Part 2

RUSK Insights on Rehabilitation Medicine is a top podcast featuring interviews with faculty and staff of RUSK Rehabilitation at NYU Langone Medical Center. These podcasts are being offered by RUSK, one of the top rehabilitation centers in the world. Your host for these interviews is Dr. Tom Elwood. He will take you behind the scenes to look at what is transpiring in the exciting world of rehabilitation research and clinical services through the eyes of those involved in making dynamic breakthroughs in health care.

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Dr. Sharon Kolasinski is a professor of clinical medicine at the University of Pennsylvania and chief of the Division of Rheumatology at Penn Presbyterian Medical Center. Part 1 Her objectives in the presentation are to help listeners by learning about evidence-based treatment for patients with osteoarthritis (OA), to understand the process by which guidelines are developed that might help us figure out our evidence-based approach, to review the recommended treatments for OA, and to review some treatments that are not recommended for OA. Her basic evidence-based reference is a University of Pennsylvania guideline that was published in 2020. Numerous other guidelines are available, which she described. She discussed her work with a case involving a 55-year-old male patient. He arrived for routine follow-up care for immunosuppressive medication monitoring. He described pains that he was experiencing and was diagnosed with OA. She indicated the impacts OA has on patients. Clinicians find it a daunting challenge to provide satisfactory treatment. For example, for some clinicians, the guidelines do not appear to be clear and provide a roadmap. Also, they do not always believe in the recommendations contained in the guidelines. In this presentation, she wants to see if she can change some minds about guidelines. She provided an example based on investigations conducted at her institution. The outcome was a series of recommendations that she described. Part 2 Dr. Kolasinski began Part 2 of her presentation by continuing to focus on the importance of having patients with OA engage in physical activity. She stated that “they are worn out and the implication is that a doctor is needed to fix them.” Perhaps a perspective should be taken of a more participatory discourse where we encourage physical therapy and emphasize that physical exercise is safe when you have arthritis and focus on what the patient can do, empowering them to exercise. A starting point is to give patients a physical therapy prescription. She discussed the extent to which physical therapy is useful, along with indicating how much and how frequently exercise is beneficial (e.g., for 20 minutes, three times a week). Losing weight is an effective way of reducing symptoms. Food choices can affect OA symptoms. Diet and exercise used together can produce effective results. References were made to several studies that involve the status of steroid injections on improving patient health status. Acupuncture also was mentioned. She indicated conditional recommendations on the use of pharmacological interventions. She concluded by describing how to treat the 55-year-old patient she mentioned in Part 1 of her presentation.

Dr. Sharon Kolasinski: Grand Round Presentation on Treatment of Patients with Osteoarthritis, Part 2

Dr. Sharon Kolasinski: Grand Round Presentation on Treatment of Patients with Osteoarthritis, Part 1

Dr. Natalie Azar is an Associate Clinical Professor of Medicine & Rheumatology at NYU Langone Health. Certified by the American Board of Internal Medicine, she is a designated long Covid provider in rheumatology. Her practice locations are at the Langone orthopedic center and Washington Square, and she has been in private practice since 2001. A graduate of Wellesley College, Dr. Azar’s medical degree is from Cornell University Medical College. She completed her internship, residency, and fellowship at New York University. Her fellowship in rheumatology was at the Hospital For Joint Diseases. She has been a medical contributor to NBC News since 2014. Part 1 The discussion in Part 1 included the following items: clinical definition of Long-COVID; predictability of developing Long-COVID; whether patients with existing rheumatic disease are more susceptible to developing Long-COVID; whether COVID-19 could trigger rheumatic disease; differences and similarities between Long-COVID and rheumatic disease; whether Long-COVID can occur following mild acute illness; risk factors associated with developing Long-COVID; presence of fatigue as a risk factor for developing Long-COVID; and major symptoms of Long-COVID. Part 2 The discussion in Part 2 included the following items: organ systems and tissues most affected by Long-COVID; variations in symptoms and disease severity among patients; diagnostic and prognostic biomarkers for Long-COVID; protective effects of vaccine; episodic aspects of Long-COVID; use of medications and non-pharmaceutical treatment interventions; and personal and NYU involvement in conducting Long-COVID studies.  

Dr. Natalie Azar: Long-COVID As It Relates To Rheumatology, Part 2

Dr. Natalie Azar: Long-COVID As It Relates To Rheumatology, Part 1

Dr. Jacques Hacquebord is  Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery.  The discussion in Part 2 included the following items: other types of clinicians who provide treatment for patients who need hand surgery; influence of artificial intelligence (AI) on hand surgery; complications that could arise during hand surgery and how to mitigate them; management of post-operative pain; dealing with pre-operative anxiety experienced by patients; quality of patient information on the Internet about hand health problems; advice on how to prevent health problems regarding the hands; personal lessons learned that have implications for improving patient care; and research involvement at NYU Langone Health.  

Grand Rounds: Dr. John Vasudevan - Where Sports Medicine Meets Pain Medicine, Why Fitness Helps Everyone Win, Part 2

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