ATC vs Coaches: How Did We Get Here?

Written by admin on March 31, 2014 – 10:26 am -

Preview the original article here

The author addresses a recent, growing and troubling trend in modern medicine. Medical decisions are increasingly influenced, if not driven, by the profit center concept rather than the best interest or the medical well-being of the patient. This represents further erosion in the doctor-patient relationship and an involuntary separation between the doctor and his Hippocratic Oath. This wedge of separation assumes a variety of names: hospital CEO, Board of Directors, Insurance Company, (Insert Name of Government Agency/Politician here), or as highlighted in the referenced article, collegiate athletic directors and head coaches. Many are unaware that Licensure of athletic trainers is dependent upon and subordinate to the medical oversight of their supervising medical doctor. Sports medicine professionals have allowed the athletic directors and universities to suborn this relationship. This has not been a conscious decision or a voluntary submission, rather a gradual erosion by the weight of financial expectations borne of the pressure to “win” above all else. The importune actions of others, including decisions by Universities to place athletic training providers under the purview of head coaches, does not abrogate medical-legal responsibility and does not supersede the doctor-patient relationship. Unfortunately, the team doctor and the athletic trainer can be replaced by the athletic director or head coach at whim, so as a result, the Athletic Director or Head Coach becomes the de facto supervising medical provider. The ATC and Team Physician are thus pressured to make decisions that put athletes on the field when they otherwise should not be allowed to play. How is this done? Providers that make decisions that anger the head coach/AD are not renewed for the next season or are dismissed, and the message is sent. Conversely, those providers that are malleable become the “coach’s guy.” When the coach gets a new job, he brings with him his own hand-picked personnel replacing the previous staff. Last season, during the NFL playoffs, we were all afforded a rare glimpse into these operations when the Redskins’ team physician publicly disagreed with team officials regarding the availability of an injured RGIII. We all know how that story ended. This is the exception—a team MD with the stature to defend the rights of his athlete, but highlights the inner-workings of the industry. Co-opt the MD and the ATC into making decisions in the best interest of the Club rather than in the best interests of the patient (the athlete).
The team physician must be afforded the autonomy for adjudicating the medical care of a patient, and the Athletic Trainer, as an extension of the Team Physician, must be accorded the same freedom. Athletic trainers and medical doctors cede this right only at their great and grave peril and at the expense of the athletes entrusted to their care. It is incumbent upon all health care providers, athletic trainers, and team physicians alike, to protect the health, well being, and rights of their patients whether or not they are athletes or weekend warriors. The excuse “I was just following orders (of the athletic director, the head coach, etc.)” is and ever has been unacceptable. It will stand neither the test of time in the court of law nor the court of public opinion. It not only fails the ethical responsibilities and obligations of the health care provider to the patient, but also shouldn’t we expect more from ourselves and other health care providers? It is ridiculous to suggest or operate under a different set of rules simply because the patient is a scholarship athlete and or under contract. Indeed, it can be argued that these patients, as they are subjected to higher levels of stress and danger of injury, should be even more closely protected than the average patient – not less so. Given the recent legal decisions regarding players’ safety in the NFL, the ever-increasing awareness of athletic-related injuries, and diminished longevity of playing careers at all levels, we should remain steadfast to our Hippocratic Oath and to our desire to always protect our patients above all else. Unfortunately, if we relinquish these rights, there are many who will be only too happy and quick to assume our responsibilities, as currently evident at the highest levels of athletics and sports medicine. If we are truly serious about protecting the rights and health of our athletes – our sons and daughters – then we must reclaim our position and our responsibilities as the preeminent decision makers in healthcare matters at all levels of athletics and sports medicine.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, and is the Supervising Physician for over 20 ATCs in NC


Posted in Sports Medicine | No Comments »

Athletic Training: Expanding Horizons in Modern Healthcare

Written by admin on March 3, 2014 – 11:48 am -

Where does an athletic trainer work? You think you know the answer? Easy, right? In a college, high school, or with a professional sports team. As true now as it has ever been, but times are changing, and the reach of Athletic Training is at the forefront of that change. Although the origins of the profession are deeply rooted in athletics and in sporting events, their work environments now stretch far beyond those typical settings.
Though athletic trainers are now indispensable components in a variety of different organizations, it has only been in the past 10 years that they first began to appear in non-traditional settings: the military, motorsports, fire and police departments, and the performing arts. Perhaps most surprisingly, the U. S. military has fully embraced the athletic trainer as an integral member of their medical teams. Navy and marine bases now have Sports Medicine and Rehabilitation Therapy (SMART) clinics and the Army has the Musculoskeletal Action Team (MAT) to serve their soldiers. These clinics/teams, staffed by athletic trainers and physical therapists, are being implemented at military bases around the world. Their presence has proven to decrease the number of emergency room and orthopaedic physician visits (which are often costly, unnecessary and delayed from time of injury) and provide their personnel the immediate, specialty musculoskeletal care that they need. Initiating care earlier (often immediately after injury) and lowering the cost of the care provided. The Army and Marine Corps also utilize athletic trainers during basic training to keep their trainees “in the game.” The addition of athletic trainers to basic training camps has resulted in a noticeable increase in the number of trainees graduating. Not traditionally considered the seat of innovative thought, the U. S. military has proven agile in this instance and our soldiers, sailors and marines are the beneficiaries. Athletic trainers have been the very soul of that innovation.
From humble origins but always true to their core mission: health and welfare of athletes, athletic training has become an indispensable partner for various and disparate organizations. An athletic trainer is an invaluable healthcare asset to any organization. Athletic Training—thinking outside the box: it’s not just for sports teams any longer!

Alyssa Rabert is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com


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Posted in Injury Prevention, Sports Medicine | No Comments »

Kobe Bryant: Not Your Typical Knee Injury

Written by admin on January 28, 2014 – 1:11 pm -

As a result of his most recent bite from the injury bug, NBA superstar Kobe Bryant is expected to miss six weeks after sustaining a lateral tibial plateau fracture on December 19th. If you’ve never heard of this type of injury, you are not alone. Tibial plateau fractures are not among the most common injuries in sport.

The tibia is the shinbone that runs the length of the lower leg and is part of both the ankle joint and the knee joint. The tibial plateau is the top of the bone that flares out and widens to create a weight-bearing “seat.” There are two portions, one on the inner (medial) portion of the knee and one on the outside (lateral) aspect. There are many different types of tibial plateau fractures, but the main differentiating factor that determines treatment is the alignment of the fragments. In a displaced fracture, the bone is broken in two or more places and the edges are not lined up properly.

The most common mechanisms of injury are hyperextension of the knee and direct contact (say from a helmet in football, or in a car accident involving a pedestrian which has given this injury the nickname of “bumper fracture”). Replays of Kobe’s incident confirm his to be a non-contact injury. He plants and hyperextends on the soon-to-be-injured leg, which then buckles.
The injury results when the femur and tibia come into forceful contact with one, sometimes resulting in a bone bruise or, as in this case, a fracture. Tibial plateau fractures often result in acute swelling, stiffness, deformity, and inability to bear weight on the extremity. X-rays, CT scans, or MRI are used to diagnose this injury.

Often, the treatment for this type of injury is a surgical procedure which brings the edges of the fracture into close approximation and uses surgical screws and plates to hold them in place; a procedure known as open reduction and internal fixation. Smaller fractures that are not displaced often respond to conservative treatment of immobilization and non-weight-bearing on the affected leg. Kobe’s fracture is believed to be relatively minor and so his recovery spectrum is 6 weeks. More severe or complex injuries (such as those with vascular or nerve damage) or larger fractures require much longer recovery. In addition, tibial plateau fractures are often associated with injuries to the meniscus or ligaments in the knee. These associated injuries require additional treatments and rehabilitation. Fortunately for Kobe and the Lakers, this injury is (by all reports) relatively mild and with a majority of the regular season still ahead, Kobe has a chance to return and contribute meaningfully to the Lakers’ season.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com



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Dr. Mark Galland Discusses “New” Knee Ligament

Written by admin on January 7, 2014 – 1:54 pm -

There has been much consternation, if not outright titillation, recently regarding the “discovery” of a new knee ligament. Multiple news outlets breathlessly report that doctors in Belgium have “discovered” a new ligament. Reader’s comments in these online articles range from excitement to incredulity and borderline outrage “that doctors could miss such an obvious thing.”

Is this possible? Is it likely that there is an anatomical structure that has gone undiscovered despite centuries of patient, methodical, laborious anatomical research by thousands of surgeons, anatomists and students?

Certainly, anything is possible (that’s the premise behind lottery tickets, right)? Is it possible that this ligament can go unnoticed by the literally millions of MRI that have been performed over the past 30 years? Maybe a little less possible than the previous example, but for the sake of argument, let’s say “Yes, it’s possible.” Except that it’s not. You see, this ligament was first described in 1879–the same year the light bulb was invented! The ligament has never had one single name that we could all agree upon (previous monikers include: mid-third lateral capsular ligament, capsulo-osseous layer of the iliotibial band (What a mouthful!) and even the current ‘anterolateral ligament’ have been used in the past). Though, until recently, no clear anatomical description had been provided, surgeons have long been aware of it. Most Orthopaedic surgeons (particularly those specializing in sports injuries) have been aware of its significance, abeit indirectly,for decades. The Segond fracture caused when this ligament sometimes avulses a fragment of bone from the tibia when an ACL is torn, bears the name, not coincidentally, of the first physician to “discover” the ligament (he called it simply a “pearly fibrous band”). To emphasize this point, the authors of the paper that initiated this furor, do not claim “discovery” they merely proffer a standardized name for this ligament and
postulate its significance in knee stability.

Why the delay? If it was first noted in 1879, why are we only now: 1. giving it a name and 2. postulating its function? To answer, one must first understand the structure of a joint. Every joint is surrounded by a capsule. The capsule is like a balloon that surrounds and attaches to the bones that comprise a joint. Certain parts of the capsule are thin and others are thick and well defined. those parts that are well-defined and thick usually merit a name and are considered “ligaments” examples are the MCL (medial collateral ligament) and LCL (lateral collateral ligament). Some areas are slightly thicker than the rest of the capsule but not nearly as much as the named ligaments. Sometimes these get a name, sometimes not, and sometimes doctors argue over what name, if any, should be assigned to this “thickened area.” as you can imagine, doctor-scientist cocktail parties can get pretty rowdy! These in-between ligaments typically have arcane names like posterior oblique ligament and popliteo- fibular ligament–names like these can only result as the brain-chlild of the aforementioned post-party delirium–scientists! still it’s better than listening to them argue these points at a medical conference.

Additionally, with the advent and popularity of minimally invasive and arthroscopic surgery, these ligaments are no longer exposed in surgical procedures, unless the procedure is intended to specifically address an injury to one of these ligaments.

Arthroscopic surgery occurs within the joint, these “capsule ligaments” are by definition outside the confines of the joint and are not seen during routine arthroscopic surgery. anyone want to trade the 2 tiny incisions typical of any “scope” surgery for a 10’‘incision (and all the extra rehab and lost work-time attendant to such incisions) so that we can have the satisfaction of looking at all the knee ligaments? No? I didn’t think so.

What about MRI? “Why has no one mentioned this ligament before now, if we can, in fact evaluate it with MRI?” good question. the answer is simple. radiologists may see the ligament/capsular area on every scan, but until we name it and tell them that it is important, they view it not unlike like the skin and fat and gristle also well-visualized on every mri but are not worthy of mention.

Far from the discovery of a new ligament, these distinguished Belgian surgeons have provided us valuable insight into the importance of a known but previously disregarded structure, and have suggested its importance merits a standardized name upon which we can all agree. While not as earth shattering as a truly unique discovery, it is exciting to learn that we may have new insight into the inner-workings of the human knee. Now it is time for those of us who care for those with such injuries to begin developing and utilizing techniques to repair it when injured. Truly exciting news, indeed!

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon and adjunct Clinical Professor, specializing in sports medicine, practicing in Wake Forest and Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on twitter @drmarkgalland.


Posted in Knee, News Releases | No Comments »

“New” Ligament Discovered in the Knee

Written by admin on January 6, 2014 – 2:18 pm -

In October, a group of physicians in Belgium released a study that gives support to the idea that there may be an additional ligament present in the knee. Ligaments, as we know, connect bone to bone and lend stability to a joint. Previously, we had only really concerned ourselves with the four largest ligaments in the knee, the lateral collateral ligament (LCL), the medial collateral ligament (MCL), the posterior cruciate ligament (PCL), and the one you’ve probably heard the most about, the anterior cruciate ligament (ACL).

Building off of the work of a French surgeon, Paul Segond, that dates back to 1879, these surgeons worked with 41 cadavers and microscopic dissection techniques to visualize a small band of connective tissue that runs from the front, outside portion of the femur to tibia and so appropriately named it the anterolateral ligament, or ALL. They were able to identify what they believe to be the ALL in 40 of the 41 human specimens. Researchers believe that this ligament could help support movements that involve pivoting and change of direction, and thus, could also be torn under these same stresses. Because the ACL is also commonly torn as a result of excessive rotational stresses, it is hypothesized that these two ligaments could be sprained concurrently. The surgeons also speculate that because no effort previously has been made to restore function in this ligament during surgery to replace the ACL, that the ALL could be to blame in cases that have less-than-optimal outcomes where patients have continued complaints of instability and lack of full function in the knee. Orthopedic experts around the world have had mixed reactions to this news, but all agree the work is intriguing and they are interested to see the direction further research will take the field.

While its location and potential role in lower extremity biomechanics are becoming increasingly elucidated, there are still many questions that remain. For instance, what is the healing potential of the ALL? Does it even have the potential to heal on its own, similar to the MCL (small tears usually heal with rest, larger or complete tears often warrant reconstruction)? If it is possible to reconstruct, what kind of graft would be amenable to this and what surgical techniques would be used? And then, a few obvious questions: Why haven’t we seen this ligament before? What about the tens of thousands of ACL tears that are surgically reconstructed every year with excellent outcomes where individuals are able to return to their daily and athletic activities? And ultimately, would it even respond to reconstruction in that it could help to restore function and thus result in better outcomes?
This “discovery” must be accorded its proper place in our current compendium of knowledge. It is important not because a “new” ligament has been discovered but rather suggests a more important role for a ligament long-ago discovered but not accorded any particular significance. More investigation into the role and healing capacity of this ligament is certainly warranted.

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com


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Running: Does it Really Matter What’s Under Your Feet?

Written by admin on November 3, 2013 – 2:33 pm -

Where’s your favorite place to run? Ask ten people and their results probably vary as much as the different types of shoes they sport while doing so. As a recreational runner myself, I stick to my trail running like I stick to my Asics—invariably. Being an athletic trainer, though, has made me concerned about my joints and longevity of this activity. And so I began wondering, what surface is best? I searched high and low, looking through published research articles and running magazines alike, and here are the most well-founded and useful tidbits I came across:

• Overall, grass is king. It is soft, has a good amount of give, and thus provides the lowest impact forces of all the typical running surfaces. Unfortunately by its nature, grass has a tendency to hide obstacles like rocks or holes and is slippery when wet so consider the quality of the ground before lacing up.

• Next best are trails that are made of ground/natural materials (woodchips, dirt, or that stuff that looks like kitty-litter [think American Tobacco Trail]). Trails can be a great way to mix it up and get closer to nature. In the summer months, they are an especially valuable option because trails that run through wooded areas are often much cooler. However, variables such as roots and snakes are cause to be on the lookout. Also, I would be careful of running on trails the day or two after significant rainfall because it loosens the running surface and can often leave channels in the trails that are dangerous to unprepared runners.

• If you have to, pavement will do but try not to run on banked surfaces and make sure you have a supportive shoe that is in good condition.

• Sand is a unique option that has its benefits if you are fortunate enough to find yourself at the beach. Loose sand easily dissipates the energy of your foot strike and challenges your leg musculature in ways harder surfaces cannot. If you choose to run closer to the water where the sand is more compact, pay attention because that is often where the steepest banking is, which can put uneven pressure on your joints.

• Variety is also beneficial, but ease into new training mediums. The different surfaces stress various muscle groups which can help with overall performance. If afforded different options such as track, trail, and treadmill; take advantage of them.

• If you’re more competitive and/or aiming for a race, it would benefit you to have your training mimic the race. This includes the running surface. If you know ahead of time that you’re going to running on pavement, increase the proportion of your running on similar surfaces as you get closer to race day.

• At the end of the day, as long as it’s even, debris-free, and dry, you’re probably good to go. Your body adjusts to the surface automatically after the first few steps by changing how much you flex your knees while running to absorb the shock. If you are truly a distance runner and really rack up the miles, it’s better to be kind to your joints and go for a softer surface if you have the option to do so.

When it comes down to it, there is considerable research on the forces experienced by the joints when running on various surfaces, which can have an impact (pun kind-of intended) in the long run (nailed it). However, you’d be hard pressed to find a study that directly relates any one kind consistently to injury, and so there is still room for question and a lot we don’t know. Take the above tips with a grain of salt and ultimately rely on your body’s feedback to guide your running choices. If you find yourself in a performance rut or with constant aches in the confines of your running routine, maybe it’s time to branch out and blaze a new trail (sorry, I couldn’t help myself). Happy running!

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com


Posted in Foot & Ankle, Health and Fitness, Sports Medicine | No Comments »

Orthopaedic Specialists Of North Carolina Partners With St. Mary’s School Athletic Program

Written by admin on October 27, 2013 – 12:27 pm -

“Dr. Mark Galland, lead physician at Orthopaedic Specialists of North Carolina (OSNC), has announced that the practice has partnered with St. Mary’s School in Raleigh to provide on-site care and treatment to student-athletes at school sporting events. OSNC personnel will be present for the school’s sporting events and will be responsible for treatment to athletic injuries.”

http://www.ncheadlines.com/releases/orthopaedic-specialists-of-north-carolina-partners-with-st-marys-school-athletic-program

http://www.carolinabusinessconnection.com/cbc/article.html?id=26069

http://www.mmipublicrelations.com/news/entry/orthopaedic-specialists-of-north-carolina-partners-with-st.-marys-school-at/


Posted in News Releases, Sports Medicine | No Comments »

Paleo Coffee!

Written by admin on September 30, 2013 – 8:07 pm -

Bulletproof coffee has taken the paleo world by storm. Not me, though.
Don’t get me wrong. I’m all for people dropping grass-fed butter and coconut/MCT oil into their high-quality coffee, blending it all up into a high-octane mug of frothiness, but I just can’t get into it. If we’re talking coffee additives, I prefer my butter in the form of cream. That’s me. I definitely see the appeal of it, though, and I’m sold on the merits of the drink and its components. It’s just not for me.
However, the idea of adding non-traditional fatty food items to coffee intrigued me, so I decided to explore other options. Eventually, I landed on eggs.

Why eggs?

Egg yolks are excellent emulsifiers. There’s the egg yolk lecithin, a famous emulsifier, plus several different egg yolk proteins with emulsification properties. Good yolks are prized by top chefs around the world primarily for their emulsifying ability. Egg yolks smooth out sauces, salad dressings, and relations between bitter enemies like oil and water. That’s right: egg yolks are the great unifiers of the food world. Throw some olive oil, lemon juice, salt, and pepper into a bowl, whisk it all together, and you’ll have a lovely stratified bowl of fluids of different shades. Oh, they might appear to blend together into a dressing for a second or two, but once you look away, the old immutable divisions will rear their heads and the dressing will disappear. Add an egg yolk or two, though? You’ll get a silky smooth salad dressing that remains so for time immemorial.

If you don’t have a blender but still want a smooth, creamy coffee drink, hand-frothing an egg yolk with a fork or whisk will get you there. Hand-frothing butter and coconut oil requires vigorous labor and may not even achieve full emulsification.

Eggs are incredible sources of micronutrients. While I love grass-fed butter, cream, and coconut oil, they aren’t exactly micronutrient-dense. The best butter contains beneficial nutrients like vitamin A, omega-3s, vitamin K2, and butyric acid, while coconut oil is a unique source of medium chain triglycerides, but for the most part we eat those foods because they are sources of stable, healthful saturated fats. They provide energy. Egg yolks, on the other hand, are baby bird building blocks. They contain everything you need to build an entire working animal from scratch – all the vitamins, minerals, protein, and fatty acids that make life work. And, if you get a pastured egg – which you should if you know what’s good for (and your omelets) – your yolk will be supercharged, with extra choline, vitamin E, vitamin A, vitamin K2, omega-3 fats, vitamin D, and beta-carotene from all the bugs and greens the chickens ate.

I love eggs, particularly the yolks, and enjoy adding them to everything. They’re a solid, dependable, go-to breakfast item, they’re good for you, and they taste great. What more can you want? That’s why they ended up on my list of foods I couldn’t live without, and that’s why they ended up in my coffee. In the end, I just love eggs, and since I already add them to just about everything, I figured “why not coffee?”

Are there any potential problems with adding eggs to coffee?

Oxidation springs to mind. Not only are you subjecting egg yolks to heat, you’re also whipping oxygen into them. It seems like the perfect storm of lipid oxidation, no?

I’m actually not too worried. First of all, the coffee really isn’t very hot. It’s well under boiling.

Second, coffee is a rich source of antioxidants – you know, those things whose primary job is to prevent oxidation. Whereas bathing fragile fats in a boiling bath of water might promote oxidation, coffee is essentially an antioxidant-rich broth. Marinating meats in herbs, wine, and citrus juice seems to prevent oxidation, and I’d bet that coffee can have similarly protective effects. Drinking coffee sure protects LDL particles from oxidation via incorporation of coffee polyphenols into said LDL particles; why wouldn’t coffee polyphenols frothed up with egg yolk offer similar protections to egg phospholipids?

Third, the actual blending/frothing only takes place for a few seconds. It’s relatively short-lived, probably not long enough to be a problem.

Fourth, the vitamin E in egg yolks is there to prevent oxidation. It’s quite good at it. Coincidentally, this is why you should get pastured eggs if possible. The yolks of pastured eggs contain upwards of four times the vitamin E found in standard battery egg yolks.

What about raw egg white’s tendency to bind biotin? Raw egg whites have the well-publicized ability to bind biotin (found in the yolk) and prevent its absorption. Luckily, the binding ability of avidin begins to break down at 158 ºF (70 ºC) and is almost completely degraded at 185 ºF (85 ºC). Since coffee is ideally brewed with water running between 190 and 200 ºF, the finished product should be able to keep avidin from binding your biotin.

But why eggs and coffee?

I stumbled upon something I had never heard of until recently – Vietnamese Egg Coffee – and decided to experiment in the kitchen.

Now, let’s get right to the recipes themselves. As you’ll see, they’re not all that complex. You’re basically just adding eggs or egg yolks to coffee. Still, though, read on to see exactly how I did it.

Primal Egg Yolk Coffee
I did a little playing around with this and tried several different recipes. In the end, I think I came up with a solid recipe.

Ingredients:
1 1/2 cup (350 ml) coffee
3 pastured egg yolks
1 tsp sugar
1/4 tsp of salt

First, I brewed the coffee (35 grams of coffee beans – I used a light roast, single-origin bean) in a French press. Dumped the grinds in, added about 350 ml of water, gave it a quick stir, covered it, and let it sit for three minutes. Meanwhile, I separated the yolks from the whites. Once the coffee was ready, I dumped it in a blender, set it to “low,” and dropped in the yolks. After a few seconds, I added a teaspoon of sugar and a pinch of salt (around a quarter teaspoon) and let it blend a bit more. Then, I poured it, admired the head of foam, and got to drinking.

I tried fewer yolks and found the brew too thin. I tried more yolks and found it to be unnecessary. Three yolks was perfect. If you want to switch things up, you can add something a little sweet like I did. I added my usual teaspoon of sugar, plus a quarter teaspoon of Himalayan sea salt. Honey, maple syrup, or stevia should all work well, too. The salt may sound odd, but trust me: it just works as long as you use a little sweetness to counterbalance it.

Primal Whole Egg Coffee
Think of this as a whole foods-based protein shake.

Ingredients:
1 cup (240 ml) coffee
2 pastured eggs
1 tsp sugar
Pinch of salt

I started by beating the eggs together, whole, as if you were making scrambled eggs. You could also blend them. For a 1 cup dose of coffee, I did two whole eggs. Once the eggs are beaten or blended, slowly drizzle in the coffee. You don’t want to cook the eggs. You want them to stay creamy. If you’re really concerned about the avidin in the raw white, dump the coffee in to ensure maximal heat exposure. Otherwise, just drizzle.
I think a higher egg:coffee ratio (using a large shot of espresso, for example) for a stronger coffee flavor would work really well. Also, two eggs in this recipe created a nice and creamy concoction. I suspect three eggs might even be better.

Again, I added a little sweetener plus some salt. It made the coffee taste a bit like a liquified custard. Really, really tasty.

Adding Other Ingredients

I also tried out a few other additions to the brews, to see how they meshed with the eggs. Consider adding these:
Cinnamon – Goes great with coffee, provides insulin sensitizing benefits.
Turmeric – Anti-inflammatory spice, works well with cinnamon.
Vanilla – Tastes good, smells better. May have anti-inflammatory effects. Also works well with cinnamon (but not so much with turmeric).
Butter and coconut oil – If you dig Bulletproof coffee, adding egg yolks makes it even better.

Use Caution!

In the course of research for this post, I ingested five eggs plus five extra yolks along with several cups of moderately strong coffee. I don’t know if it was just an excessive amount of coffee or if the caffeine was potentiated by the phospholipids in the yolks, but I felt like I was under the influence of… something. Although it was a good feeling, a productive feeling, to be sure, I could see it getting out of hand if taken too far. This is potent stuff. A cup or two is probably ideal, at least for me.

“Sugar – really?”

Don’t worry about a little sugar, even the white stuff. The amount I added, a teaspoon, is just four grams of sucrose. And, if you use an actual food like honey or maple syrup, which have different (improved) metabolic effects compared to plain white sugar, the potential downsides of ingesting sugar are lessened even more. Besides, you can always use a non-caloric sweetener like stevia, which has its own set of benefits.

Since writing this article a few weeks back, I’ve begun rotating egg yolk coffee into my morning routine. I don’t have it every day, but do have it several times a week, particularly if I have a busy day ahead of me where optimal productivity is required. Whole egg coffee seems to work well pre-workout, boosting energy, motivation, and providing a nice source of branched-chain amino acids for the training ahead.

What about you, folks? Want to give this a shot? Ever tried this yourself? Got any tips to improve my recipes? If you do try it, let me know in the comment section how it works out!

http://www.marksdailyapple.com/primal-egg-coffee/#axzz2gQF6xb5l



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Dr. Galland featured by ScarySymptoms.com

Written by admin on September 19, 2013 – 1:51 pm -

Dr. Galland was recently quoted in seven  articles on ScarySymptoms.com , a website created to provide answers to symptom questions on the Internet. Dr. Galland discusses a number of topics on the website, including knee arthroscopy, causes of sharp, stabbing pain in the knee when walking, questions to ask a surgeon prior to knee arthroscopy, shoulder blade pain coming from the neck, causes for pain in the collar bone and whether or not deep squats can hurt the knee.

To view the articles, visit:
http://www.scarysymptoms.com/2013/09/anesthesia-local-vs-general-for-knee.html

http://www.scarysymptoms.com/2013/09/causes-of-sharp-stabbing-pain-in-knee.html

http://www.scarysymptoms.com/2013/09/grinding-noise-in-knee-no-pain-should.html

http://www.scarysymptoms.com/2013/09/questions-to-ask-surgeon-prior-to-knee.html

http://www.scarysymptoms.com/2013/09/shoulder-blade-pain-coming-from-neck.html

http://www.scarysymptoms.com/2013/09/collar-bone-shoulder-pain-but-full.html

http://www.scarysymptoms.com/2013/09/can-deep-squats-harm-knee-orthopedic.html


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Retro Running

Written by admin on September 10, 2013 – 11:05 am -

Look out barefoot running and toe shoes, there’s a new stride in town: backwards running. That’s right, we’re talking about running…in reverse. Before you write it off for being unconventional, let’s take a look at some of the reported benefits—many supported by research—and how you may benefit from integrating retro running into your fitness routine.
Many of the advantages of backwards running are related to the altered stride pattern. Instead of the traditional heel strike followed by a roll through the midfoot and push off from the toes, backwards running involves a forefoot strike and the takeoff originating more towards the back of the foot. This biomechanical variance results in less impact stress to be absorbed by the foot and lower leg,which may help speed recovery from certain overuse injuries such as shinsplints while still allowing an individual to stay active. A study from the UK in 2012 and highlighted in this New York Times article found that the stress on the front of the knee is also reduced in backwards running, making it a potential exercise variation for those with anterior knee pain or patellofemoral syndrome.
Furthermore, the muscles involved to produce this reverse movement are challenged in a different way than they are during normal forward motion. They are unable to rely on stored elastic energy that comes from the muscles being pulled taut during landing and recoiling during take off and are thus less efficient in their contractions. Also, additional muscles that are not used during forward running are recruited. This results in a greater expenditure of calories and an increase in overall dynamic musculature of the lower extremity. It also reduces muscle imbalances between the anterior and posterior portions of the lower leg. So while it may seem that running backwards is a tricky endeavor, sensory perception and balance will improve due to the challenges presented by our anatomy.
Thinking about adding some retro running to your life? Running blogs such as this one suggest to start with short, straight distances on a flat and stable surface (i.e. track or quality expanse of grass) that is free of potential obstacles. Begin by walking and then work up to greater speeds; many first-time backwards runners reported being surprised at how quickly the initial feelings of awkwardness subsided and that the movement became much more natural after only a few sessions. You could begin by finishing your 15 minute run on a treadmill with a 1 minute retro running bout or add some backwards strides after your trail run and then workup to alternating running types at various time or distance ratios (just be careful when flipping around!). As far as form goes, experienced runners suggest having a slight bend (but not too much) in the knee and leaning a little forward to help keep your balance. Give it a try: as long as you are careful and give yourself time to find your comfortable style and pace, your body can only benefit from backwards running.

Alex Vitek is a nationally Certified, state Licensed Athletic Trainer and post-graduate Resident in training at The Galland Orthopaedics and Sports Medicine Athletic Training Residency– a 12 month immersional program allowing ATCs to maintain and hone clinical skills while developing those talents necessary to be effective in the clinical setting as an ATC/physician extender. Find out more at www.atcfellowship.com.


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