If you have read some of my Google reviews, you’ll see that some patients who come to see me leave feeling VERY VERY sad inside.

In this article, you can learn some tips and lessons on making sure your visit with me isn’t full of SAD SAD feelings.

The problem

Did you know that most people who walk into a surgeon’s office are NOT HAPPY? It’s true. They are usually dealing with misery and pain, and they want it to go away. So, I’m in very specialized profession whose customers are ALWAYS mad and upset or frustrated at a baseline.

Think of the opposite type of business – wedding planner – customers are ECSTATIC about life and their new marriage. Of course they have stress, but the whole reason they come to your business is because of a happy event.

The good news

The good news is that every surgeon I know is 100% invested in solving your problem FAST.

Surgeons do not waste time. They want to fix problems.

So in this sense, the patient and the surgeon have goals that line up perfectly. And for 90-95% of patients, this works really well.

Another secret: most surgeons consider you being happy a bonus – if your problem is fixed, but you think your surgeon is arrogant – he’s probably going to sleep just fine at night.

The bad news

When surgeons who have that one focus – solving the problem – start having conversations and interacting with patients, there can be a surprising amount of friction and difficulty.

Surgeons aren’t going to change.

They’re not suddenly going to become cuddly therapists that want to spend hours talking with you.

Some patients – it might be 5% or even less – just can’t have a good professional relationship with a surgeon.

How this article will help

In this article, I’ll outline some information you need to know about seeing a sub-specialized surgeon – this applies to me (because I’m writing this), but will apply to many or most surgeons out there, in most fields of specialized surgery.

I’ll try to explain how surgeons think and act and make decisions.

Google reviews

Our source material for inspiration will be the eternal supply of Google reviews left by my patients.

It’s actually illegal for me to discuss a specific patient’s medical condition or what happened in an office visit with anyone. So any patient of any doctor can leave a lying, hate-filled review of an office visit, and the doctor literally cannot respond to anything specific.

It’s like beating up a three year old.

Legally, the doctor is defenseless.

Don’t misunderstand me – I like reviews. I leave reviews for restaurants or whatever – I think it helps customers and patients. But the vast majority of patients leaving reviews for doctors are telling tales of HORRIBLE experiences. Usually the angriest, saddest patients are leaving the most reviews.

In one day, I see between 30 and 50 patients. This amounts to about 120-130 patients per week. I get about THREE online reviews per week, maybe TWO. Now, sure, half of my patients could be angry and sad and just don’t leave reviews, but I wouldn’t be a surgeon for long if that were true. The fact is that most people are satisfied with surgeon visits, but don’t take the time to leave a review online. I’ve had patients say, literally, “you saved my life – thank you so much”, and don’t leave a review when we hand them a comment card. Who knows why.

So Google reviews show a mixture of good and bad opinions, but the bad ones are REALLY bad! And from these bad experiences, we can learn a lot. Again – I’m not so naive to think that it’s impossible for a patient to hate my guts and think I’m Hitler. But what you see in the reviews is usually only about 10-20% of the full story.

So what we’ll attempt to do here is to use the reviews to inspire topics that will educate you BEFORE you come see me or another surgeon.

The first story

Coming soon…

When the bones are healed, it’s time to take the pins out. This is usually SIX weeks after the surgery, but may be slightly earlier, depending on the exact bone broken.

If the pins are sticking out of the skin, they can usually be taken out in the office without any special anesthetic.

In this video, you’ll see me taking some pins out of a hand. The pins are MUCH longer than you may expect. At the end of the video, I show you what the pins looked like on the xray before I took them out.

Finding a bump on your hand that wasn’t there before can be scary, especially when you don’t know what it is. Thankfully, these bumps, or tumors, are almost never malignant (cancer), although they may not be particularly pleasant. Here’s some information on some of the most common hand tumors.

What are hand tumors?

A hand tumor is an abnormal bump or lump on the hand. The word “tumor” just means “swelling”.

They can vary in size from nigh unnoticeable to much bigger, and can be discolored or painful. A tumor on the skin may appear as a mole or a wart. A tumor on the bone may not appear at all. However, it can still be extremely painful. Luckily, only 1-2% of hand tumors are malignant, so while the bump on your hand may be painful, it probably isn’t cancerous.

The three most common hand tumors are ganglion cysts, epidermal inclusion cysts, and giant cell tumors of the tendon sheath.

Ganglion Cysts

A ganglion cyst is the most common type of hand tumor. These cysts most often occur at the top of the wrist, the palm side of the wrist, the base of the finger, and on top of the end joint of the finger, near the finger nail. From the outside, they look like bubbles underneath the skin.

It is unknown what causes ganglion cysts. They appear in patients of all ages equally. There is some speculation that they form due to tendon irritation. Ganglion cysts may grow or shrink in size, or even disappear completely. They may also hurt, but that is not always the case. They may be soft or hard, and may allow light to pass through them, which aids in diagnosis.

Epidermal Inclusion Cysts

An epidermal inclusion cyst (EIC) is a type of hand tumor that resides on or just beneath the skin. They are generally caused by some kind of trauma to the skin, and usually appear on the palm. This trauma can include cuts and puncture wounds, as well as some kinds of piercing. Men are more commonly affected, and while anyone can get an EIC, they are more often seen during middle age. An important thing to note is that while EICs can be caused by trauma to the skin, they may also develop without this factor.

An EIC is formed when the epidermis is pushed into the dermis, creating a cyst (a sac full of fluid). These can range in size from 5 millimeters to a centimeter. They may be raised above the skin and red. Thankfully, EICs are generally not painful or itchy. They are firm to the touch and usually easy to see.

Giant Cell Tumors of the Tendon Sheath

A giant cell tumor of the tendon sheath (GCTTS) is a type of tumor that can be found on the hand or in other joints, especially in the feet. It is generally painless, and is seen more often in women than in men, usually between the ages of 30-50. It is unsure why exactly a GCTTS develops, although it has been theorized that this is due to trauma or infection, to name a couple of ideas. They are, however, most likely linked to degenerative joint disease, also known as arthritis. The GCTTS is firm to the touch and grows slowly in size. Unlike ganglion cysts, you cannot shine a light through the tumor.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is one of the most common forms of arthritis in the hand, along with osteoarthritis. While osteoarthritis occurs through wear and tear, rheumatoid arthritis is an autoimmune disease. This type of disease occurs when the body falsely identifies a naturally occurring protein within the body as being foreign, and attempts to get rid of it. In the case of rheumatoid arthritis, the body targets a protein within the synovial lining of a joint. This lining secretes fluid that is essential to lubricate and cushion the joint. When the synovial lining is injured, it can allow inflammatory cells into the joint and bone. These wear away at the cartilage and bone. Rheumatoid arthritis can affect any joint, and can occur in any age group.

Rheumatoid arthritis is thought to be caused in part by genetics. Researchers haven’t yet determined what genes are influential in the passing on of this disease. Another probable factor is the existence of certain outside conditions that trigger an immune response that “turns on” the arthritis. Hormones may also play a role, as 70% of those affected are women.

How is Rheumatoid Arthritis Diagnosed?

Your physician will first go over your medical history, and possibly the medical history of your immediate family. This should be followed by questions about your symptoms (when they started, how they have progressed, etc), what sort of treatment you’ve had, and other relevant information. You will then be given a physical exam. Stressing the affected joints should cause slight discomfort, which will confirm the location of the problem. The physician will also look for other signs, such as swelling and limited motion in the joints, as well as lumps or nodules under the skin.

After the examination, you may be sent to get diagnostic tests done, such as x-rays and blood tests. X-rays can check for bone damage and cartilage loss, while blood tests are done to look for levels of antibodies and inflammation known to be present with rheumatoid arthritis, along with proteins called rheumatoid factor. These are present in 80% of people with rheumatoid arthritis. They target and attack healthy tissue in the body. The physician may also take a fluid sample to rule out other conditions such as gout or lupus that can cause some of the same symptoms.

How is Rheumatoid Arthritis Treated?

Current treatments for rheumatoid arthritis aim to treat symptoms such as swelling and pain, and allow the joints to function properly again. There is no known cure for rheumatoid arthritis at the present time.

There are both surgical and non-surgical treatments for rheumatoid arthritis. Non-surgical treatments may be better for when the disease has not yet begun to progress, while surgical treatments can help after the arthritis has taken a toll on the joints.

Non-Surgical Treatments

Cases that are mild and stable can be treated with painkillers and anti-inflammatory drugs, such as ibuprofen. Current research suggests that the disease is best treated immediately after its development, before problems such as erosion can occur. This treatment uses disease modifying drugs, such as methotrexate. Steroid injections into the joint or tendon can also be very helpful. Another alternative is splinting. While this will not stop deformity and erosion, it can help ease pain and increase function.

Surgical Treatments

Surgery can be extremely helpful for people with rheumatoid arthritis. For smaller joints within the hand and wrist, you might consider fusion (joining the bones of the joint together). For larger joints, such as hips and knees, replacement is usually a better option. Inflamed tendons may also require surgical treatment to keep from rupturing. If the tendon has already ruptured, there are several treatments that can replace the tendon or bridge the gap left behind.

What Is Tennis Elbow?

Tennis elbow, also called lateral epicondylitis, is a condition involving the tendons that attach to the outside bone of the elbow. It is very painful, and caused by overuse of the joint. It was given its name because tennis, along with many other sports and activities, can cause this condition. Tennis elbow is an inflammation of the tendon. As it progresses, it weakens the tendon, leading to weakness and pain. This is especially noticeable while doing any activities that require the affected muscle, such as lifting, gripping, or playing tennis.

Your elbow is made of three bones: the humerus in your upper arm, and the radius and ulna in your forearm. The end of the humerus has bony bumps called epicondyles. The bump on the outside is called the lateral epicondyle. Lateral epicondylitis (tennis elbow) involves the tendons called extensors in the forearm that attach to the lateral epicondyle.

What Causes Tennis Elbow?

There are three main factors in the development of tennis elbow: overuse, activities, and age.

Overuse

Tennis elbow is often caused due to overuse and damage of one particular muscle. The extensor carpi radialis brevis (ECRB) helps to stabilize the wrist while the elbow is being held straight. When the ECRB is used too much, it can be damaged. Microscopic tears can form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

Activities

The type of activities you do also has an impact on whether you are at risk of developing tennis elbow. This condition is more common in athletes, but it is not limited to people who play tennis. The activities that lead to tennis elbow can be work related or recreational. Jobs such as painting, plumbing, and carpentry all have higher risk levels for getting tennis elbow, because of the amount of repetitive motion in the forearm.

Age

Most people who develop tennis elbow are between the ages of 30 and 50. However, people both older and younger are also at risk if they have other risk factors, such as playing tennis incorrectly or doing a job that calls for repetitive forearm motion. The condition equally impacts men and women.

How to Avoid Tennis Elbow

One of the most important ways to prevent tennis elbow is to build up the strength in your arms, upper back, and shoulder. Remember to stretch these areas frequently, to keep them flexible and to avoid straining your elbow. Try not to move your arm in the same way repeatedly. Switch arms while playing sports such as tennis or golf, if you can. There may be a trainer who can teach you how to use alternate moves to reduce strain on your elbow.

Make sure the equipment you use in sports and at work is the correct size for you. Using equipment that is made for someone bigger can put a lot of tension on your elbow.

Here are some tennis-specific things you can do to avoid tennis elbow:

• Work with a professional player to develop the correct hitting technique, which will remove stress from your joints
• Consider using a two-handed backhand instead of a one-handed backhand if it’s causing you pain
• Use a racket grip that is soft enough to provide a cushioning effect
• Don’t grip the racket too tightly and relax your grip between points

Make sure to stretch before and after playing a game or doing any other repetitive activity.

The worst activity you can do

The most aggravating activity you can do is palm down lifting (lifting straight up in a pronated position). Think of reaching far out in front of your body to lift up a heavy plastic grocery bag with a gallon of milk inside.

Instead, turn your hand palm up when lifting, and lift heavy weight close to your body, not out away from it.

Ergonomics comes from the Greek words “ergon,” to work, and “nomos,” meaning laws. Now the term is generally defined as the science of removing physical stressors from the body. These stressors, when left unchecked, can result in joint pain and injuries. They can be caused by incorrect posture, too much stress on any particular joint, or even looking at a monitor at the wrong angle.

Here’s some tips for making your desk more comfortable and better for your body.

Fix Your Posture

If your chair isn’t ergonomically designed, it may wear out your spine. This is because the position most chairs force you to sit in doesn’t stack your spine correctly. When this happens, your back can become tense and painful. Ergonomic chairs correct your posture by allowing you to sit up straight, with your tailbone against the back of the chair. This is called your “natural” posture. Once the body has gotten used to the natural posture, it should be very comfortable. It should also relieve the stress on your back immensely.

No matter what kind of chair you have, you can generally adjust it so that you get the most ergonomic and comfortable settings. Make sure the chair is raised or lowered so that your feet sit flat on the floor. If you don’t have an ergonomic chair, buy a back rest that pushes your lower spine forward so that you’re in an upright position. Alternatively, find something soft and round like a paper towel roll to use instead. If you have arm rests, make sure they allow your elbows and forearms to rest at a 90 degree angle to your torso.

Move Your Monitors

If your monitor is too far away, you may inadvertently end up craning your neck in order to see it properly. In order to determine if your monitor needs to be closer or farther away, stretch out your arm towards it. The monitor should be just touching the tip of your middle finger. When you have two monitors, your primary monitor should be directly in front of you, and the secondary monitor should be off-center. You should be able to brush each of them with your fingertip.

Your monitor should also be at eye level. In order to figure out if your monitor is at the correct height, close your eyes and let them open in their natural position. They should open approximately two to three inches from the top of the screen. To adjust the monitor, you can use any built-in features, use a book, or buy/make a monitor stand.

Finally, position your monitor at a 90 degree angle to the brightest source of light in order to reduce glare.

Manage Your Mouse and Keyboard

Your mouse and keyboard generally sit side by side, so they should be considered together. These two items should be kept as close together as possible, and should be placed one to two inches above your thighs. This is to ensure that your elbows and arms remain at or below a 90 degree angle from your body. If you have a keyboard tray, make sure that both the keyboard and the mouse are on the tray.

Your keyboard should be placed directly in front of you, so that your hands rest easily in the center. An easy way to determine the exact placement of the keyboard is to watch the ‘b’ key. This should be positioned directly in front of you and at the center of your desk. The keyboard should not be tilted toward you if at all possible– this can cause strain on your wrists.

The mouse should be placed directly to the side of the keyboard. If possible, they should be about shoulder-distance apart. It’s a good idea to use keyboard shortcuts often to avoid extended mouse use.

Take Breaks

One of the most important ways to avoid putting a lot of physical stress on your body is to get up and move around. Every half an hour to an hour, you should take a short break to walk around, look away from your monitor, and refresh your body. This is one of the only things that can really combat the common health issues that arise from working at a desk.

In order to make sure that you really do get a break when you need one, there are several ways to remind yourself to get up and going for a minute. There are applications for both Windows and Apple that inform you after an hour has passed. If you’re not quite as technologically inclined, you can always just set an alarm to go off every hour.

During your breaks, it’s a good idea to do some simple stretches to get the blood flowing in your limbs again. You should also take the time to refresh your eyes. Look at something a few yards away for about twenty seconds. This allows your eyes to re-focus and removes some of the strain.