Last month something occured that has not happened since the inception of this website back in 2004….July’s Corner was totally empty…nothing…nada….zip….zilch….zero.  I didn’t even prepare an apology.  I had expected to have my new ‘Blog Site’ up-and-running by then.   Well, the reality is now hitting me in the face….this is an entirely new technology to which I need to become accustomed.  Not being a teenager any longer, these type of adjusments don’t come easy.  Now it is time for me to ‘pay the piper.’ 

     During the first weekend of July, I completed my third ‘Tour de Montes.’   I, along with my biking buddy Dave ‘Bikeman’ Richardson, biked 265 miles over three days.  The second day featured six mountain climbs nestled comfortably in the framework of a 110 mile ride.  Although I chose to do only five climbs, I am in no way apologizing for my short cut.  This is and continues to be the hardest endurance event that I have ever done. In fact, a professional triathelete, who was participating in the event along with me, said that the ‘Tour’ was harder than an Ironman Triathelon.  I guess that ‘Torture is in the Eye of the Beholder!’  I do feel that God must be a biker, though.  The weather leading up to the Tour was ‘Maryland at her best….hazy, hot and HORRIBLE’!!!  Then suddenly, on the morning of the event and for the subsequent three days, it became cool and dry.  I believe that it was this fact, more than the miles of training I had done leading up to the ride, that was responsible for my successful completion of it.  For a more in-depth review of a previous Tour, go to the Archives of July 2005.

     As discussed in an earlier ‘Corner,’ my daughter Carleigh has been suffering for the past two and a half years with a debilitating tendonitis affecting her left foot.   This problem has led us through a parade of specialists, most recently Dr. Gregory Guyton, from the Foot and Ankle Center of Union Memorial Hospital.  Now, at age 13, she is skeletally mature enough to do a definitive procedure to hopefully put this behind her once and for all.  This will involve the breaking of some bones which will then require bone grafting to reconstruct her foot and ankle into a more structurally correct unit. In addition, her calf muscle will need to be lengthened.   The entire procedure will require about two and half hours to complete.  When asked if this was something she wanted to do at this time, the answer was an unhesitating and resounding ‘yes!’  We have the utmost confidence in Dr. Guyton.  For Carleigh and our family, he is ‘just what the doctor ordered.’  We are indeed very lucky to have found him.  

     I am beginning to appreciate the advantages of ‘blogging.’  It is now Sunday, 48 hours after Carleigh’s surgery.  She is recouperating well.  The entire experience at Union Memorial Hospital was WONDERFUL.  Now remember, I am referring to hospitals and surgery here.  Everyone with whom we came in contact was personable and attentive.  This started with the parking attendant, continued on with the registrars, the nurses and anethesia personel.  EVERYONE with whom we interacted appeared to really care about us and our problem.  They went out of their way to make us feel comfortable and at ease.  In addition, the system flowed like a well-greased machine.  Waiting was rare.  Well, this is not entirely true.  Carleigh took what seemed like an eternity to come out of anesthesia.  Although the surgery was, as predicted, about an hour and a half, it took her twice as long to wake up enough for us to bring her home.  Finally, Dr. Guyton was very comforting both before and after the surgery.  He even showed us some intraoperative Xays revealing the restructuring of Carleigh’s foot which will hopefully put an end to her misery.

     Finally, on this Labor Day, I would like to wish all of you a great end-of-summer.  Have a great fall season.  And now, let’s see if this blog thing really works…

The Happiest Country on Earth 

I happened to tune in to Good Morning America this week before going to work and heard a discussion on
‘The Happiest Country on Earth.’  The hosts spoke of a survey that listed countries in order of the happiness of
the people living within.  Would you like to guess the number one country?  I’ll give you a hint.  Its residents pay an
astonishing 60+% income tax.  The answer is:  Denmark.  Now I don’t know about you, but I whine just thinking
about my seemingly paltry-by-comparison 35% bracket.  What could possibly make a people happy while giving
more than half of their yearly earnings to the government?  I was intrigued. The fact is that the Danish enjoy their
existences so much simply because of the lower expectations they put on themselves. They highly enjoy their
present-moment existences and are always flexible enough to change their moment-to-moment plans if more
satisfying opportunities present themselves.  

     Feeling I was on to something, I did a brief internet search and found another survey on the same topic.  The
University of Michigan World Values Surveys has been doing this for the past twenty years.  They list countries
based on ‘Subjective Well Being (SWB).’  People are asked ‘how happy’ and ‘how satisfied’ they are with their
lives, and the answers are combined to form the SWB.  On this list the top five are:  Puerto Rico, Mexico,
Denmark, Colombia and Ireland.  The United States came in at number 15.  Isn’t it interesting?  With the possible
exception of Ireland, wealth is certainly not a characteristic associated with any of these countries. For the average
American, this is an incredible juxtaposition.  Happiness without money?  How can this be?  It seems as if there
are central common threads in the philosophies of all of these countries.  

1.  People enjoy their ‘present-moment’ lives.   I have had the opportunities to travel to several Latino nations.
There is definitely a ‘this-is-all-you-get’ mentality in the people there.  I do not mean this in a negative way, either.
There is flexibility in the daily schedule, with planned breaks.  Show me an American who takes a siesta on the job and I’ll show you someone looking for a new job.  People earn a living to pay for the enjoyment of being alive.
Many Americans, on the other hand, enjoy making money for the sake of making money, and all the trappings that come with it.
There is a feeling that money is the solution to all the problems both now and in the future. For me,
from the viewpoint of a primary care physician, the pursuit of the ‘golden ring’ often comes to the exclusion of ALL
other aspects of life.  Waistlines grow, hearts soften, cholesterols rise and money earned is spent on early funerals,
medicines or health care provider visits.  As John Lennon aptly stated, ‘Life is what happens to you while you are
making other plans’.  

2.  Families are number one.  I know what you are thinking. Americans are very family-oriented.  Just
go to any playing field on any given weekend and see at least three generations of relatives watching Johnny play
his sport.  Sure, it is great to see everyone together for a common cause.  But I feel this may also reflect the Baby
Boomer’s continued belief that we cannot be denied, and that all that happens in our world should pass by us for
our approval. Do we REALLY help our kids by standing on the side-lines and being irate with the ref?  Is this
‘being family-oriented,’ or is is just another expression of our never-dying competitiveness?  Maybe we would do
our families more good by finding our own interests, enjoying them, and putting competition on the back burner.
My wife was telling me about how today’s parents are increasingly involved in every aspect of their children’s
college application processes and even job applications.  Again, are we helping raise independent thinkers who are
problem solvers, or are we just propagating another generation of our ‘alter-egos’?  Happiness often comes, not with
acquisition of something, but with the process by which it is acquired.  I remember my parents letting me make my
own decisions growing up.  Some were beauties, too.   But I learned from each one of them.  Having my own
children now, I only wish my folks were around so I could thank them for the wonderful job that they did. 

     I do not have the answers to what is amiss in our country.  I still feel it is the ‘greatest country in the
world.’  Just travel abroad and see how truly wonderful we have it here.  But I do think that many Americans have
lost their way.  The search for happiness has sent us down the wrong road.  The pursuit of ‘things’ has left us
with many possessions, but with feelings of emptiness inside.  The more empty we feel, the more we DO to try and
fix it.  We make even more money, buy even bigger cars and homes, take even more expensive trips and, in the
end, the emptiness grows.  It is really, REALLY, REALLY difficulty for most American to ‘just be.’  That is where 
these other happier countries have it all over us.  Aren’t we HUMAN BEINGS?   When did we make the change
to become HUMAN DOINGS?  What is really so wrong with not working on the house or the garden over the
weekend and just hanging with each other.  What is wrong with reading a book after dinner?  Is it really so wrong
to just enjoy our lives.  All this stuff we are accumulating won’t go with us when all is said and done.  Our bodies,
on the other hand, which are failing at alarming rates, will accompany us to the very end.  It could make for a very
painful journey.
 

Spring Has Sprung 

What a pleasant surprise this year to be ’springing forward’ one month earlier than last year.   I just love having
sunlight later in the day.  For those of us who go into a state of relative hibernation during the winter months, how
wonderful it is to emerge from our burrows earlier than planned.  With increased outdoor activities comes the
possibility of shedding that ‘winter coat’ that so many of us put on during the previous season.
     I would like to review for you some of the outdoor options for exercise and the plusses and minuses for each.
Don’t forget that eliminating 500 calories a day will result in one pound of body weight per week. The best way to
do this is by burning more and consuming less on a daily basis. The exercise will allow you to burn more fat per
pound of body weight lost, thus preserving that precious muscle mass which does so many wonderful things for
you.  Calorie consumption is based on body weight, which makes sense.  The more you weigh, the harder it is
for your muscles to move you.  A 200-pound person will burn more calories performing the exact same exercise as
someone who weighs 100 pound less.  For the sake of my sanity, I will base all calorie estimates on a middle-of-the-
road weight of 170 pounds.  For more precise numbers, click on the energy calculator at the end of this page.

1.  Walking and Hiking.   This is perhaps the best all around activity for the people of all ages.  Minimal supplies
are needed:  just some comfortable shoes, weather-appropriate clothes and a safe place to walk.  Calories burned
walking are dependent on effort.  Casual walkers will burn about 4 to 6 calories per minute, while power walkers
will expend around 8 to10 calories per minute.  An added benefit here:  walking is a weight-bearing activity, great
news for anyone trying to help maintain bone density.  Another way to use walking for fitness:  buy a pedometer
and shoot for 10,000 steps per day, instead of a more average 3500.  It will become a healthy game.  How many
steps do I have so far?  Where can I walk now?  Every step you take burns more calories.

2.  Running.  The next most common activity is running.  Unlike walking where one foot is always on the ground,
running is a series of leaps through the air.  The faster you run, the longer your float phase (e.g. the time in the air).
For this reason, it is more stressful to the lower extremities.  It is very important if you are new to this activity to
’start low and go slow,’ so as to acclimate your body to the new stresses.  The same supplies that are needed to
walk are needed here.  Generally, calorie expenditure is more, around 9 for joggers and 10 to 12 for faster runners. 
Just like walking, running is excellent for maintaining bone density. 

3. In-line skating.  Let me start this by saying, this is NOT an activity for everyone.  It takes coordination and
there is a high risk of falling.  Falling on asphalt is a ‘cruel and unusual punishment.’  If you have any balance issues
or weak bones, this is NOT for you.  With all that aside, people who are skilled at this love it, and enjoy
tremendous aerobic benefits and experience muscle strengthening, especially of the core and lower
extremities.  Calorie expenditure per minute is roughly  nine.  The downside is that the skates and all the protective
pads and helmet will probably set you back two or three hundred dollars. 

4.  Cycling.  Ah, a favorite of mine.  I will tell you that Maryland is one of the most beautiful states for cycling
outdoors.  There are many quiet county roads on which you can bike without encountering cars, a big fear of many
would-be cyclists.  If the thought of road cycling is just too fear-inducing,  there are alternatives to dodging traffic. 
The North Central Trail beginning in Phoenix extends Northward offering MILES of aerobic fun.  If you are daring
and yearn for a more rustic experience, there are an unlimited number of off-road trails for mountain bikers who
want to be ‘one with nature.’  Cycling climbs up the investment scale, however.  In order to cycle, you need a bike. 
I am a firm believer that the more you spend, the better bike you get.  I have many seen folks spend $100 at a
discount sports store for a bike that never is used.  Heavy bikes, clunky components and big soft seats do not make
for pleasant long-term relationships.  The good news is that with today’s technologies, you can get a VERY GOOD
MACHINE for 500 to 1000 dollars.  If solo-cycling is not your bag, there are many cycling groups, like the
Baltimore Bicycling Club which offer group rides for people of all ability levels.  Finally, to get the most aerobic
conditioning from biking, follow one simple adage:  NEVER STOP PEDALING!!!  If you pedal up
the hill and then coast down the other side, your heart rate drops and your aerobic benefit decreases. Here calorie
expenditure is around 10 per minute.  See ya on the road. 

5. Swimming.  Finally, a perennial summer favorite.  Once again, swimming presents a hardware problem: you
need a pool, which for many might involve membership to a club.  In Harford County, two lower cost alternatives
do exist to some of the very pricey private fitness clubs.  First, Harford Community College offers some pool
opportunities at lower costs.  Second, in summer of this year, a new YMCA will be opening in the Abingdon
area.  Check it out.  Swimming offers the ultimate aerobic experience:  you stop swimming, you drown.  In addition,
it conditions your entire body without the pounding wear-and tear produced by some of the other activities in this
group.  One caveat:  if you are looking for an activity that also stimulates maintainence of bone density, this in NOT
the one on which to rely.  Being supported in water eliminates gravity, the key player in stimulating bone growth.
So if this is your main activity, you will want to add walking, running or weight training to your fitness recipe.
 
     Summer offers many opportunities for increased physical activities.  I have highlighted the above five because
of their excellent aerobic conditioning benefit.  Remember, it is the elevation AND THE MAINTENANCE of your
heart rate into a training zone for an extended period which conditions your ticker, the most important muscle in
your body. If you condition your heart, the other muscles of your body will follow.  All the other activities that
summer offers, like tennis, softball, walking the golf course, even gardening and home improvements, are just icing
on your cake. 

     For a more scientific approach to calculating energy expenditure, click on the this energy calculator.  Thanks
to Sydney College for allowing me to highlight their excellent website.

I was returning today from ‘Earth Treks,’ an indoor wall-climbing facility in Timonium with my 12-year,-old
daughter, Carleigh, when she mentioned to me that she had hyperlinked her website at Cockeysville Middle School to
mine.  (For you non-tech geeks out there, it is possible, via computer magic, to type a little here, cut-and-paste a
little there and end up with a link in a website that , when clicked upon, directly routes you to another site.  In this
case, it is to my website).  She suggested that I do this month’s corner on the troubles of her left foot.  You see,
today is a very special day for her. For the past two and a half years, the most exercise she has gotten has been by
pushing a computer mouse.  The reason for her infirmary is today’s topic.  Her problem began with pain on the
inside of her left foot, primarily when she ran.  Being the concerned father and physician that I am, after a cursory
exam, I concluded that  it was probably more related to school stressors with some possible secondary gain rewards
to avoid some unwanted activities.  (Two quotes come to mind.  First, ‘A physician who cares for a family member
has a fool for a patient, and an ass for a physician.’  Second, ‘Families of physicians often get the worst care’). 

Sometime later, my wife Lynn the school teacher now moonlighting as a physician asked me to re-look at Carleigh’s
foot since my previous medical advice was worthless.  The damage had been done. What followed has been
two years of pain, missed gym and sports opportunities, two surgeries, many weeks of casts and umpteen visits to
physical therapy, not to mention the assault on a young girl’s self esteem from being chronically impaired.  She still
loves me, thought sometimes I wonder why.  Today she easily climbed a 65 foot wall TWICE without any
problems.  She really is quite an athlete.

So what has been the source of her misery?

The posterior tibialis tendon is located on the inside of the ankle, just behind the prominent ankle bone.  Besides
supplying stability to the inside of the ankle, it helps support the arch of the foot.  In fact, in cases of rupture of
this tendon, the foot becomes acutely flat, the so-called ‘acquired flat foot.’  It allows you to invert your ankles as if
you are trying to put the bottoms of your feet together. Perhaps its most important function, it allows you to stand
on your tiptoes.  If your posterior tibial tendon is inflamed, it can be virtually impossible for you to stand on the
tiptoes of the affected foot.  When it is functioning properly, it is painless.  The pain has been Carleigh’s biggest
cross to bear.
     After reading this, if you think you have the problem, what can you do?   You will find that the treatment for
many musculoskeletal problems is very similar, at least in the early stages. 
Here are some suggestions.

1.  Stop activities until the pain subsides.  Pain, as big of a pain as it is, is your friend.  It tells you when your
system is overloaded and needs some relief.  A great piece of advice that I give to patient’s everyday is  ‘if it hurts,
don’t do it’!  People HATE hearing this.  They are paying money for a professional opinion and I tell something
that their mothers would tell them. 

2.  Massage the area with ice.  Once again, our friend ice has resurfaced.  The same principles apply here.  Take
some Dixie Cups, fill them with water and throw them into your freezer.  Once or twice a day, pull one out, tear off
some of the paper exposing the ice and massage the sore area for 10 minutes AND NO MORE!!!  There are very
important structures that travel with this tendon and you do not want to freeze them.  This is one of those times
where more is not better. 

3.  Take  a non-steroidal anti-inflammatory medication.  Ibuprofen or naproxen work well.  They treat the
real problem — the tendon inflammation.  As the inflammation improves, the pain should improve as well. 
Remember though that not everyone should take these types of medications.  If you are not sure, ask your health
care provider. 

4.  Seek out professional assistance.  This is one of those problems where limping around for a long period of
time in pain could have a potentially serious complication.  The posterior tibialis tendon is prone to stretching and
even rupturing.  If this happens, the arch of your foot suddenly flattens, the so-called ‘acquired flat-foot.’  At this
point, the only hope to fix this is surgery to clean up the mess and reattach the tendon.  So when I see someone
with this problem that isn’t getting better, I will put the them in a walking boot, or even apply a cast if I feel they
might not be compliant with wearing a removable boot.  This would be for around four weeks.  Once the foot had
improved, a temporary lace-up ankle support would be applied and the patient would be sent for physical therapy to
strengthen all the muscles of the foot and ankle.  Permanent orthotics would most liking be in the offing as well. 
 

     I hope this month’s Corner has been of interest to you.  It is not one of your everyday musculoskeletal problem,
and because of it’s potential complication, it is nice to have some knowledge of it.

Shoulder Impingement Syndrome 

This may not sound like something familiar to you. However, it is perhaps one of the most common musculo-skeletal complaints that I see in my office, especially in people middle-aged and older. I am sure that you will recognize this. Let me weave the scenario for you….The victim is commonly a middle-aged person, whose connective tissue is just not what it used to be thanks to the ‘all-to-unpopular-process’ called aging. (This can be found in younger patients for other reasons, but I am not going to deal with this today.) Usually it begins with activity, often activity that involves lifting or overhead-type motions. Good examples of these include putting the holiday ornament boxes back up on the shelf from whence they came. How ’bout painting ceilings? Putting up crown molding fits the bill. Sometimes it starts with something innocuous like reaching over the front car seat to pull something out of the back. Sports which involve any type of overhead activities, like throwing a baseball or a football, serving or spiking a volleyball, or serving in tennis are great risk factors. Many people swim more during the winter because it is often too miserable outside to exercise. Swimming, especially the crawl stroke, is a notorious bad player in this arena. Wintertime activities like shoveling snow can start this off. Sometimes there may be no recalled injury at all. Once the pain starts, however, it has a very typical pattern. The pain is in the front or on the side of the shoulder. It often radiates down the outside of the affected shoulder all the way to the middle part of the upper arm. It is throbbing and aching in character. As the symptoms worsen, it markedly affects the patient’s ability to sleep. Lying on the affected side is very uncomfortable. Putting on a coat or a shirt becomes a chore. Hooking a bra in the back is also very difficult. Probably the worse movement of all involves lifting the affected arm up and above or behind the head. Now I bet this might start sounding familiar to some of you baby boomers, eh? What is it all about?

There is a space in the shoulder located under the acromion and above the humeral head.  It is called the subacromial space (sounds pretty logical, doesn’t it).  Actually, the roof of the subacromial space involves two other very important structures.  The coracoacromial ligament, the only ligament in the body to attach a bone to a bone, forms the anterior part of it.  Just inside the acromion is a joint which is not labeled above.  It is called the acromioclavicular joint.  This joint is very prone to arthritic spur formation as we age, which actually helps fuel the entire problem.  The subacromial space contains a bursa and the top of the rotator cuff, the supraspinatus tendon.  (The supraspinatus is one of the four rotator cuff muscles which are the main reason why the shoulder works as well as is does.  The other three muscles are the infraspinatus, teres minor and the subscapularis.  The biceps tendon, though technically NOT a rotator cuff muscle, goes right through the middle of the cuff, so it is intimately related to its misery.  A bursa is like the slippery shell remnant of a grape once the fruit has been squeezed out. It simply allows different structures to slide more easily past each other.  There, I think that covers all the important terms).  This space is VERY small, but normally it is large enough to accommodate all of its inhabitants.  When any of the involved players are injured, they swell and the space becomes much smaller.  The smaller it becomes, the more the structures within it are pinched or impinged which causes more swelling, decreasing the space even further.   Range of motion decreases as pain increases.  Now the vicious cycle has been established.  If you keep pushing through the pain, you could eventually tear or rupture your rotator cuff.  This is when you will go and see your ‘friendly-neighborhood’ orthopedic surgeon.
In order to TREAT this syndrome effectively,  YOU MUST INTERRUPT THE CYCLE!!!!  Here is the treatment regime that I actuate with all my patients suffering from this dilemma.

1.  Avoid all provocative activities.  In other words, if it hurts, don’t do it.  This is not rocket science.  Everysingle time you feel that painful pinch in your shoulder, it is propagating your problem.  Stop activities in what I call the ‘no-fly’ zone.  Stop lifting your arm above shoulder level.  Put your coat or shirt on, bad-arm first.  Do not sleep on the affected arm or shoulder.  Wearing a pair of PJ’s with pockets and sticking the affected arm in a pocket is a nice way to keep your arm at your side.  Avoid overheads and serves in tennis, sticking primarily to ground strokes.  On the links, chip-and-putt only.  No full arc hitting.  Swimming presents a particular challenge.  All of the swimming stokes are problematic with shoulder impingement, with perhaps the exception of a side-stroke with the bad arm up.  Since this is a not a great stroke for aerobic conditioning, might I make some suggestions to all you aquaphiles out there?  Consider water aerobics or vest running.  Remember to keep your arms down. In pilates and yoga, be cognizant of your arm positions.  This may mean eliminating some positions or exercises.  Finally avoid any unnecessary home-related overhead activities.   Do you REALLY need to paint, construct or clean right now?  Will the world stop turning if the boxes stay on the floor?  If the answer is really ‘yes,’ then get someone else to do it.

2.  Keep your shoulder moving!   Here I go again, speaking out of both sides of my mouth!  First I say ‘don’t move it,’  and now I say ‘keep it moving.’  Besides tearing your cuff, the other big problem associated with shoulder impingement syndrome is called adhesive capsulitits, or as I like to call it, ‘frozen shoulder.’  The shoulder capsule is the thin membrane that lies inside the rotator cuff and surrounds the entire joint.  If this contracts and gets tight, the loss of motion and pain are unbelievable.  The main reason that this develops is that a person with a sore shoulder, no matter what the cause, stops moving it to avoid the pain.  Therefore, we must keep it moving within a painless range.  The best way to do this is by Codman exercises, otherwise known as pendulum swings.

To do these, first grab a can of juice or a light weight in your affected hand.  Next, lean over resting your good hand on a table or chair so that the bad arm with the juice can hangs straight down.  Now, gently swing your shoulder back and forth, to and fro, and even in circles.  This should be painless.  Do them several times a day.

3.  ‘Better Living Through Chemistry.’   With this problem, there is usually a component of inflammation.  Taking an anti-inflammatory is often very helpful.  An over-the-counter choice might be naproxen or ibuprofen.  “Taking these medications might not be right for everyone.  If your suffer from hypertension or kidney disease, if you have or have had stomach ulcers,  are taking blood thinners, or have any known allergies to these medicines, please check with your doctor first.”  I never thought I would say this, but the only thing I hate more than the attorneys’ ads on televisions are the pharmaceutical ones.  I just love it when my 12-year-old daughter asks me what a priapism is while watching a ‘Cialis’ commercial.

4.  Ice is Nice.  If something hurts, it is almost a no-brainer to try some ice.  For this, thawing frozen vegetables out on your shoulder that you will later use for a meal is a good trick.  The small vegetables conform very nicely to the contour of the shoulder.  Crushed ice in a zip-lock bag is also a good choice.  A good time to do this is after your Codman exercises. 

5.  Sometimes you need help.  If you have tried  the above suggestions and your misery persists, then it might be time to check with your health care provider.  Getting a professional opinion will help clarify the diagnosis so that more specific therapy can be ordered.  Problems like arthritis of the acromioclavicular or the shoulder joint itself, or biceps tendonitis could be the real problem and the treatment could be different.  Even the best diagnosticians sometimes have problems deciding if the shoulder is the primary problem, or if it could be related to problems in the neck.  MRI scanning is sometimes necessary to help better define the problem.  I will often inject xylocaine and cortisone into the affected area.  This does several things.  Firstly, the numbing medication usually provides IMMEDIATE relief.    Secondly, if relief occurs, then I know we have defined the problem correctly.    I can then feel assured that the cortisone, the real worker here, is in the correct area.  It will usually start to work in several days.  How long it works is very variable.  The longer it works, generally speaking, the less complicated the problem turns out to be.  You might say, why not inject right away, and forget all the other stuff?   To this I reply that the injection is simply a ‘band-aid to a boo-boo,’ one that came about from poor mechanics.  If you don’t correct the mechanics, the problem may come back.  For this reason, I prescribe several home exercises to be done on a regular basis after my evaluation, as well as reiterating all of the above. Sometimes, I may refer you to a physical therapist for more aggressive hands-on therapy.  

I hope this has helped you recognize, and therefore better deal with, a very common problem that you are bound to see at some point in your life.  And remember……… aging isn’t for sissies.

On the New Year 

Ah, the New Year. A time for rebirth and new goals. A time to review last year and make changes so that the next year will be better. Perhaps, even a time to remember our resolutions from a year ago and to determine, perhaps painfully, how successful or not we were with actuating them. It is a time to take chances….to push ourselves to our limits in the name of self-improvement.Which brings me to the topic of this month’s Corner. I received a call on December 30th from my good friend Dave ‘Bikeman’ Richardson. (For more about him, see under ‘Team in Training’ above). He asked me if I was sitting down. I sat. He proceeded to tell me that he had sold his bike store. I was indeed glad that my butt was planted as I did get a bit lightheaded. Dave began many years ago by purchasing the small but popular Lutherville Bike Shop. His business and clientele grew requiring that he move to a larger and frankly more posh location, just a few blocks south on York Road. He began doing in-house bike fits and upgrading his bike selections to more top end brands. All the while, he kept ‘good service’ as his calling card. A friendly knowledgeable staff with quick turn around on repairs as well as guaranteed customer satisfaction. He had reached the pinnacle of his business. And now he has retired.After I had recovered from the shock, I asked him what had fueled such a change. His reply was simply that he had achieved everything he could in the biking business and felt that it was time to do something else. And what might that be,’ I asked. I have no idea came the reply. The great operatic singer, Beverly Sills wears a bracelet. It says…’I.D.T.A.’ She got it after she retired from singing opera at what most feel the top of her form. She got tired of answering the question ‘How could you have stopped singing at the top of your career’? I Did That Already was her reply. And so I applaud you, Bikeman….or should I say ex-Bikeman. Your Chutzpah, which is Jewish for Chutzpah, is admirable. I am glad that I had the opportunity to finance much of your children’s education (yes Lisa and Jeff, you ARE welcome). I am glad that you are moving on to another phase of your life. You and your lovely bride Fran are truly a model for what I think most married people would like to be. And you know I must mean this, as you can’t give me any discounts any more.
And so now, I need to go and meet Ron, the new owner. You know how I hate giving my money to strangers.