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A Runner ’s Comeback: From Multiple Fractures to a 50-Mile Race

Treatment TermsOrthopaedicsAnkle pain and ankle injurySports medicine CategoriesFamily health Author MaryAnn Fletcher Overview In April 2017, Harry Mendez Jr. crossed the finish line of a 50-mile race, exhausted but triumphant. The 35-year-old Durham resident had completed triathlons and endurance events before, but none had demanded the strength, commitment, and perseverance this one had. Just nine months earlier, he ’d been in Duke University Hospital, pins and rods holding his lower left leg together, wondering if he’d ever run again. Hero Imageharrymendez_blog.jpg Preview Image Content Blocks ContentIt started with when he set out for a bicycle ride. “I put my foot down to balance myself. My bike cleats--those shoes that clip into your bike pedals--got stuck in the pavement, and I fell over,” Mendez said. “When I went to get up, I couldn’t. I looked down, and my foot was just dangling.” Section Features Text Content Section Header Image/Videogym_1.jpg Section Features Images/Media Text Content Header A Surgical Solution ContentDr. Reilly was one of nine Duke orthopaedic surgeons--includingfoot-and-ankle andsports-medicine experts--who looked at Mendez ’s X-rays and CT scan and consulted on his case. The following week, when the swelling had subsided, Dr. Reilly performed surgery to repair his fractures. This included inserting a rod called an intramedullary nail down the center of his shinbone, then placing...
Source: dukehealth.org: Duke Health News - Category: Consumer Health News Authors: Source Type: news

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CONCLUSIONS: Studies evaluating the effects of PTD on common TBI impairments have yielded mixed results. Evidence suggests PTD precedes the development of executive dysfunction, and a strong link exists between fatigue and PTD, with fatigue preceding PTD. Future prospective studies evaluating PTD relationships to pain and headache are warranted to elucidate causality. PMID: 29355429 [PubMed - as supplied by publisher]
Source: Brain Injury - Category: Neurology Tags: Brain Inj Source Type: research
Conclusion: The ePAT is a suitable tool for the assessment of pain in this vulnerable population.Dement Geriatr Cogn Disord 2017;44:256 –267
Source: Dementia and Geriatric Cognitive Disorders - Category: Geriatrics Source Type: research
Conclusions:The strength of agreement among imaging, endoscopic, and histologic findings was suboptimal. Colonoscopy and imaging are both likely to be necessary in patients with suspected inflammatory bowel disease. Although colonoscopy may be superior in diagnosis of colitis, imaging may provide more information regarding small bowel disease. Background: Computed tomography scans (CTs), more recently magnetic resonance imaging, are often used to assess the gastrointestinal tract in patients complaining of abdominal pain. We aim to determine the strength of agreement among abdominal imaging, endoscopic, and histologic ...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Gastroenterology Source Type: research
Nearly all patients with acute pancreatitis (AP) experience some degree of abdominal pain that is severe enough to prompt medical evaluation and necessitate analgesia. Effective analgesia is a priority in caring for such patients. Despite its importance, strategies for pain management in AP have been poorly studied, particularly in the field of pediatrics. Presently, no published data examine the management of pain because of AP in children at the time of initial presentation. Management approaches are often extrapolated from adult practice and based on anecdotal experience in the absence of objective data. The aim of our ...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Short Communication: Pancreatology Source Type: research
Authors: Alaverdashvili M, Laprairie RB Abstract Allosteric modulation of the type 1 cannabinoid receptor (CB1R) holds great therapeutic potential. This is because allosteric modulators do not possess intrinsic efficacy, but instead augment (positive allosteric modulation) or diminish (negative allosteric modulation) the receptor's response to endogenous ligand. Consequently, CB1R allosteric modulators have an effect ceiling which allows for the tempering of CB1R signaling without the desensitization, tolerance, dependence, and psychoactivity associated with orthosteric compounds. Pain, movement disorders, epilepsy...
Source: Drug Metabolism Reviews - Category: Drugs & Pharmacology Tags: Drug Metab Rev Source Type: research
Authors: Dopart R, Lu D, Lichtman AH, Kendall DA Abstract The cannabinoid receptor 1 (CB1) is a G protein-coupled receptor (GPCR) that is located primarily in the central nervous system. CB1 is a therapeutic target which may impact pathways to mediate pain, neurodegenerative disorders, hunger, and drug-seeking behavior. Despite these benefits, development of orthosteric therapeutic compounds, which target the endogenous ligand-binding site of CB1, has been challenging due to detrimental side effects including psychoactivity, depression, and suicidal thoughts. However, CB1 also has an allosteric binding site(s), whi...
Source: Drug Metabolism Reviews - Category: Drugs & Pharmacology Tags: Drug Metab Rev Source Type: research
The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity...
Source: Regional Anesthesia and Pain Medicine - Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Special Articles Source Type: research
This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twen...
Source: Regional Anesthesia and Pain Medicine - Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Special Articles Source Type: research
Conclusions The incidence of LAST nationally in total joint arthroplasty with adjunct nerve blocks is similar to recent estimates from academic centers, with a small decreasing trend through the study period. Despite an overall low incidence rate, practitioners should continue to maintain vigilance for manifestations of LAST, especially as the use of regional anesthesia continues to increase.
Source: Regional Anesthesia and Pain Medicine - Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Special Articles Source Type: research
The experimental use of lipid emulsion for local anesthetic toxicity was originally identified in 1998. It was then translated to clinical practice in 2006 and expanded to drugs other than local anesthetics in 2008. Our understanding of lipid resuscitation therapy has progressed considerably since the previous update from the American Society of Regional Anesthesia and Pain Medicine, and the scientific evidence has coalesced around specific discrete mechanisms. Intravenous lipid emulsion therapy provides a multimodal resuscitation benefit that includes both scavenging (eg, the lipid shuttle) and nonscavenging components. T...
Source: Regional Anesthesia and Pain Medicine - Category: Anesthesiology Tags: Regional Anesthesia and Acute Pain: Special Articles Source Type: research
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