Word: legging
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...What Tim had, at least by his history, was a true classic - a common problem. His physical exam was also classic - tender at a certain spot on the inside of the calf, pain here when he tried to stand on tip toe. It's called "tennis leg" because it often happens on the tennis court; it feels like you just got hit with a ball. In the days before MRI we thought it was caused by rupture of an unimportant little muscle in the leg called the plantaris. Now we know it's actually a small tear of a part...
...which a bite of green pepper would have cured? How many poor kids in our parents' generations suffered years in splints, braces and weird, painful shoes treating "flat foot" that was no problem at all if ignored? So the doc-in-the-box might not have know about tennis leg; they're not specialists, they're usually moonlighting docs in their fellowships - someone going into cardiology might know a lot about heart attacks but very little about muscle tears. Tim's subsequent referrals did make this innocence less likely. But it's hard to point the finger of blame...
...Then there were the MRIs of his lumbar spine: Here the docs-in-the-box might have been simply playing the odds. Patients who complain of leg pains often turn out to have what we call radiculopathy, which affects the spinal nerve roots. Sciatica is a well-known term for one type of this. Although caused by pressure on a nerve in the back, there might be very little or no back pain. Patients sometimes just cannot believe there is nothing wrong in their leg. Tim could have been vague about his story, or he might have been so wound...
...Absolutely not. This is a primrose path; no good orthopedist would actually buy any of this. I would blast any resident out of the water if they did this kind of work-up on a tennis leg - the same as my teachers would have blasted me. We train hard in medicine is to develop good clinical judgment: a feel for things. It's a lot like what tells a good cook the roast is ready, or a good teacher that the kid nodding in back doesn't really understand. Clinical judgment often makes a doctor do things the "objective tests...
...been warned - by no less a Liverpool soccer legend than Alan Hansen - about Anfield. "You are in for a night," he told me before Liverpool's home leg European Champions League semi-final clash with Chelsea on Tuesday, hinting at the intimidating cauldron created by the vocal passion of the home crowd. Perhaps someone should have told Arjen Robben: As Chelsea's wide man stepped up to take the first penalty kick of the shootout - after two games and extra time left the score at 1-1 - Anfield stadium was nearly lifted off its moorings by the roar pouring from...