by Sudeep Mehta, MD

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The chemical structure of hydrocodone.

The recent opioid epidemic has left physicians in a state of anxiety. The introduction of the STOP Act has led physicians to be cautious when prescribing opiates due to the fear of inducing long-term opiate addiction and dependence. It is imperative as physiatrists for us to still address pain management with a holistic and evidence-based approach, with a confident approach to ultimately achieve optimal return of function to their pre-morbid state.

An article in the JAMA Network journal in April, 2019 entitled “Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy,” discusses the correlation of opioid dose variability with the risk of overdose. A nested case-control study using a Colorado integrated health plan in the duration of 2006 to 2018, studied dose variability in >14,000 patients who were prescribed long-term opioid therapy. A dose-response association between variability in opioid dose and overdose risk was noted, and sustained opioid therapy discontinuation was associated with an approximate 50% reduction in risk of over-dose. …


by Chiamaka Ukoha, MS IV

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Photo by Cliff Booth from Pexels

Before reading this, I want you to take 3 of the deepest breaths you have taken all day in through your nose and out through your mouth then reflect on how you feel. Believe it or not, you just engaged in one of the most essential techniques of the practice of yoga, breathing. Breathing is something we do involuntarily every day, but by bringing it to our consciousness, it gives a person a sense of control and awareness over their body. …


By Roshani Patel, OMS-IV

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Photo by Vlada Karpovich from Pexels

It’s my final year of medical school. Ordinarily around this time, students embrace the nomadic nature of the fourth year, traveling to new cities and hospitals of residency programs across the nation. Except it’s 2020. Things have changed, to put it lightly, and it’s become the metaphorical wild, wild west. There are no rules, no precedents of what the world of medical education must do during these times.

After most of our carefully planned rotations cancelled, a myriad of virtual rotations emerge in response. The hunt begins, but also the inequities widen. Students who have shunned the addictive nature of social media to focus on studying start to miss out. The ones who have children at home are now having to balance being a teacher and a zoom student. The ones who are still studying for boards because that was the only reschedule date available but must balance it all. Those who don’t have a home institution. …


Quality Improvement

by Jason Mascoe, MS-4

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Photo by alexandre saraiva carniato from Pexels

During one of my earliest encounters in medical school, we participated in a poverty simulation. This seemed like an odd endeavor. Why? I am the son of Jamaican immigrants, a former missionary in domestically underserved urban and impoverished countries and had post-baccalaureate internships medically serving marginalized groups: refugees, unsheltered homeless and immigrants without insurance. I did not understand what there was to simulate. Poverty is closer than we admit to seeing. I vocalized my apprehension to my academic leadership. It was deemed educationally valuable. Skeptically, I participated.

There was an elaborate setup with all the establishments and resources the picturesque, marginalized, urban community would have. I received my packet of the character I was to embody. He was a 27-year-old African American male with a felony, living below the poverty line, supporting his girlfriend and her infant son from a different father, and lived check -to-check. Inside the packet were supplemental wages and ancillary obligations. For the next few hours students were engrossed in this alternate universe, personifying what it should feel like to live either on or below the poverty line. …


A Breath of Air

by Michael Chiou MD

Due to the overwhelming surge of COVID-19 cases, resident physicians in physical medicine and rehabilitation at Mount Sinai Hospital in New York were redeployed to COVID-19 units.

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I hold the N95 mask cupped to my face with my left hand while my right dexterously slips the rubber straps behind my head. I check the seal. No leak.

I am ready.

I open the door to the COVID-19 unit and take a deep breath as I step from the green zone into the yellow zone. I smell mint and I am reminded of the Colgate Total Advanced Whitening toothpaste that I used just hours before. …


by George Raum, OMS-V

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Against the advice of many in the field of sports medicine, youth sport specialization continues a commonly observed choice of many parents and young athletes. With estimates of up to 41% of athletes focusing a single sport, many of these families join club teams, seek out positional-specific private coaching as well as strength and conditioning in an attempt to improve their ability at their chosen sport.(1) In response to the demand, the fitness industry has responded. Gyms across the country have opened their doors to the youth athlete. Some facilities were created with the sole focus of working with athletes from the little league to high school level. …


by Armando Alvarez MD MPH, Rosa Rodriguez MD, Laura Huang MD

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Photo by Karolina Grabowska from Pexels

It’s a pain, both working from home and sometimes, the way we work from home. Poor posture may lead to back and neck stiffness, pain, and strains, also sometimes referred to generally as myofascial pain syndrome. Symptoms can range from a limited mild discomfort to a long lasting, persistent, searing and burning pain that limits your ability to move and focus on your work. A lot is changing and without a doubt social distancing and stay at home orders have led to significant shifts in how we work and attend school. Faculty, staff and students have been forced to reinvent and transition from the physical classroom and meeting spaces into virtual ones. Merriam-Webster defines ergonomics as ‘an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely.’ Working and learning from home, your efficient and safe ergonomic office or library set up may now be a couch or kitchen table. In the home office setting, the U community is also facing reduced physical activity and prolonged sitting, which are known to further exacerbate muscular imbalances and pain. As Physiatrists aka Physical Medicine and Rehabilitation (PM&R) specialists, we deal with functional disorders of muscles, nerves and bones and can be thought of as the MacGyver’s of adaptation. …


by Marcos R. Henríquez, MD

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Photo by Edward Jenner from Pexels

Telemedicine has been playing a significant role during the COVID-19 pandemic, being a safe road for health care providers and patients during these difficult times. The pandemic has forced locked downs all over the globe, limiting health access, shutting down physician offices, including physiatrists departments. Nevertheless, telemedicine, despite lock downs and fear of physical contact, has been able to knock on patients’ doors and provide medical insight. A potential increase has been tracked towards telemedicine by people in the United States, so have been the number of articles published every year on Pubmed. Physiatrists have been taking over the potential utilities of telemedicine throughout the last few years. …


by Evan R. Zeldin, MD

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Photo by Andrey Popov, link here.

For the last few months, we’ve watched the world transform into a place that would have been unimaginable just a few short months ago. First there was China, then Italy, and then New York. Here in North Carolina, we started to prepare once it became clear that what was happening worldwide could happen even in our rural neck of the woods. As society was beginning to close down all around us, we too made changes. We closed our clinics, we limited and then eliminated visitors to our hospitals, we masked personnel, and we moved to a modified schedule to prevent unnecessary resident and attending exposure. It seemed that the needs of a physiatrist would not be important in the acute crisis- we started to prepare for our new future to be “redeployed” into the COVID units- perhaps functioning as a modified ICU physician. We waited and waited for the worst to come. …


by Micheal T. Murphy, MD

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Photo by Karolina Grabowska, link here.

A 54-year-old male with a history of alcohol abuse, A.Fib on AC, CKD III, and hypertrophic nonobstructive cardiomyopathy s/p orthotopic heart transplant on chronic immunosuppression presents with centralized low back pain of one year duration. Pain is constant, deep, and achy with intermittent sharp, stabbing, burning sensation down the left leg. Back pain is worse than leg pain. Pain is worse with prolonged sitting/standing and improved with rest. Patient has failed conservative measures. Exam is significant for 4/5 weakness at left S1 myotome, + lumbar facet loading, and + left Slump. Plain films demonstrated moderate L4-L5 and L5-S1 facet osteoarthritis. An MRI of the lumbar spine ruled out osteomyelitis/discitis and demonstrated left lateral recess stenosis at L5-S1 in addition to multilevel central spinal stenosis, most pronounced at L4-L5. Patient was subsequently scheduled for and received bilateral L4-L5 and L5-S1 facet injections. …

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Resident Fellow Council, AAP

Resident and Fellow Council of the Association of Academic Physiatry (@AssocAcademicPhysiatry)

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