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Jene Bramel

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Everything posted by Jene Bramel

  1. CDB is finished and waiting for a little cleanup and approval. Should be on the site -- with commentary and tiers -- by tomorrow morning. Hopefully sooner. Attached an XLS file of the CDB for y'all here. I think it'll be downloadable... 2020 CDB.xlsx
  2. No. It's coming. Work responsibilities and lack of attention to IDP detail over the past two seasons have made this a difficult undertaking. Shooting for Monday but could be out sooner. No guarantees on future years, however. This is becoming less and less my flavored analysis and more and more a different way to present the work of others I trust... Appreciate everyone's interest in the feature and understanding.
  3. I'm frustrated, too. But I'm certain that this approach does not work. Whatever you think of the most vocal anti-vax nuts you read on Facebook and Twitter and the other platforms du jour over the past 25 years, the vast majority of the families we have these discussions with every hour of every day are well-meaning folks with reasonable questions. With the occasional rare exception, they ask questions in the best interests of their kids. They are not the enemy. **Frightening them into vaccination does not work. **Reporting them to Child Protective Services is reactionary. This attitude is more likely to foster distrust in medicine. It guarantees a family who truly isn't sure but open to learning doesn't get any vaccinations the next week or month. They're unlikely to ask good questions about whether an antibiotic is truly needed, whether an x-ray is absolutely necessary, or how to handle a sensitive behavioral health problem if you show no willingness to recognize the difference between a family that doesn't truly know what they don't know and a family who believes their "kid is more special than others." And I'm strongly against delayed vaccination and make a concerted effort to show families why it's not best practice. But refusing to recognize that getting a two-month old vaccinated for pertussis and pneumococcus and haemophilus at the expense of delaying the second Hep B vaccination a bit (i.e. agreeing to two vaccines rather than three or four) is better than sending that infant out completely unvaccinated isn't an ever-so-slightly better option isn't smart either.
  4. I still struggle with this. Unfortunately, I believe two things to be true. 1. Dismissing families who refuse or delay vaccinations will not improve vaccination rates. 2. Including unvaccinated and under-vaccinated families in a practice puts all families in the practice at risk. As frustrated as I am with the second concern, I'm still swayed by the first. I may not always be successful at improving vaccination rates in my own practice -- but I know I'm trying rather than risking funneling these families to practices where other providers may not make the same effort. And I feel like I'm seeing the tide turn a bit. I think our practice is successful in getting folks on the fence to choose vaccination. Like you, I'm now getting nearly as many questions from families who vaccinate about what we (and they) can do about families who do not vaccinate. I may have had that discussion once a year previously. I'm seeing more and more folks supportive of vaccination on Facebook and Twitter actively combat misinformation with helpful links and data than ever before. Families now seem to know -- and are sharing with others -- the truth about Wakefield and the facts about mercury/adjuvants/preservatives. Some even have a working understanding of how the number of antigens has greatly decreased (to combat the "there's too many shots" argument). Unfortunately, it's taken yet another measles outbreak for this to happen. But it's happening.
  5. This will depend on how much range of motion he has by midweek. If his throwing motion will be altered or he's not able to protect himself in the pocket, they won't risk him. They'll need to know relatively early to adjust their game plan. Plenty of comps for quarterbacks who have played through low-grade AC sprains without missing time but it's too early to say which side of questionable he's on.
  6. 1-4 weeks. Players return when they have enough strength and range of motion to protect their head/neck. Two caveats here. 1. Bengals do not accurately report their own injuries. This could be muscle strain, ligament strain around the spine or stinger. Variable return estimates with each, some closer to four weeks, some much less. 2. Burfict left last week's game to be evaluated, too. If yesterday's injury was aggravation of that neck condition -- and it feels like it probably was -- I'd err on 2-4 weeks over 1-2 weeks. Probably won't know more -- unless Marvin Lewis feels especially generous today -- until the Thursday/Friday practice reports.
  7. My daughter got all of her shots by age 2. You think her chances of getting any of those were significantly higher because we took a few months longer? A lot of FUD being spread IMO. Define significantly higher. In my community, the number of lab confirmed cases of pertussis is well over 100 in the past few months. That's ten times what it was last year. There was a similar outbreak a few years ago. I've seen three cases myself this season. One of those was a grade school aged child who was dropping to the ground pale and choking with coughing spells. The parents had stopped vaccinating their children because they'd been getting "sick" after those doctor visits. The mom was in tears after the diagnosis. She didn't think the risk was high either. I'm very happy your children are fully vaccinated. I appreciate the concern I hear from families who feel that multiple vaccines stress their immune system too much. As Gian has posted, it's well known that the antigenic load from a set of vaccinations is lower than many other situations children are commonly exposed. In fact, parents who bring their children into a doctor's office for additional shot visits because they've spread out shots are exposing their kids to more potential illnesses than they would have by sticking to the schedule anyway. I don't have a website. I'm not selling books. I'm not selling chelators or diet aids. I'm not getting rich providing vaccinations. I'm in this game to advocate for child health. Vaccinate your kids. On time. And make sure they know how to wash their hands well anyway.
  8. From my Twitter timeline on this...more in the Monday Injury Rounds tomorrow...read from bottom up... Jene Bramel ‏@JeneBramel1m That's all my speculation of course. Hope you all don't mind my quick fire peppering of your Twitter timeline. Jene Bramel ‏@JeneBramel2m I'll bet he does anything to talk himself out of surgery if recommended. And I'd bet his year gets uglier if he does. Expand Jene Bramel ‏@JeneBramel2m You've seen Amendola react to major SC injury last year. And his claims he'd return in 2 weeks from dislocated elbow. Expand Jene Bramel ‏@JeneBramel3m With sports hernia as poss dx, you'd think surgery was best option. But Pats just used IR/return on Vereen. Expand Jene Bramel ‏@JeneBramel4m No way to know whether Amendola's injury is aggravation or part of cascade. Either way, it isn't good. Expand Jene Bramel ‏@JeneBramel5m @SigmundBloom addressing on my timeline past few minutes View conversation Jene Bramel ‏@JeneBramel6m For reference, Greg Jennings said he'd be back in 3-4 weeks last yr. Took two months. Different type inj poss, but bet on the over if surg. Expand Jene Bramel ‏@JeneBramel9m While I'm tweeting, Glazer confirming that it's adductors. That's a better combination and possibly not an "additional" injury at all. Expand Jay Glazer ‏@JayGlazer11m I reported Danny Amendola torn adductors but he's gotten conflicting reports from docs on whether he has ... http://m.tmi.me/18Tivc Retweeted by Jene Bramel Expand Jene Bramel ‏@JeneBramel10m More difficult if additional hip muscles involved. And especially difficult if it is ABductors -- pulling hip out and opposing sports hernia Expand Jene Bramel ‏@JeneBramel11m Going to be harder for Amendola, a quick twitch wide receiver running option routes, to hit a 3-4 week return if surgery necessary. Expand Jene Bramel ‏@JeneBramel12m There's no single sports hernia surgery. Depends on muscle torn and severity. 3-8+ weeks is starting point. Expand Jene Bramel ‏@JeneBramel12m As usual, the projected 3-4 week timetable given for recovery after surgery for sports hernia is best case scenario. Expand Jene Bramel ‏@JeneBramel13m Wonder if Glazer meant ADductor and not ABductor... Either way, that w/ or w/o sports hernia is not good news for Amendola. Expand Ben Volin ‏@BenVolin19m Jay Glazer says on Fox pre-game show that Amendola tore his abductors, which connects the hips to the legs, and possibly has a sports hernia
  9. I finished The Panther somehow but I found Corey borderline ridiculous in this one. Probably won't read the next one.
  10. How much are two disectomies by age 24 indicative of degenerative disc disease? That's a good question. Let me see if I can get an answer on that.
  11. RE: minor back surgery... True, "minor" and "surgery" seem like an oxymoron. However, this isn't a cervical halo or a procedure on the spinal cord that would end his career. It's (probably) not an open laminectomy or fusion that could end his career or necessitate 4+ months of rehab. It's also (probably) not a microlaminectomy that would suggest there's something to the rumors of spinal stenosis. If it's in fact a microdiscectomy, it's "relatively" minor. Smaller incision, less invasive, not involving a serious amount of bone work, etc. It's a semantic distinction, but still worth considering.
  12. TL;DR: "It might be serious. It might not be. But it might be. The Patriots should be worried. I would be." Where is Dr. Bramel when we need him?! Lots of stuff on my Twitter timeline. Update on Gronk (and Foster) should be published very shortly and I'll post a link when it's live. In brief... I'm not sure I like the recent report from Karen Guregian that Gronk could be out until late September and Will Carroll's tweet that the surgery may not be minor after all. It's certainly possible that it's a microdiscectomy and he'll be ready in 4-8 weeks, but those reports make you wonder whether there's something more going on than was suggested two weeks ago. Cross your fingers we'll get enough information after the surgery to do more than wildly speculate.
  13. Bone infections are insidious. They can be difficult to diagnose early in the infectious process without a high level of suspicion and specialized imaging. Once the infection has progressed to the point of bone loss, it becomes much easier to suspect clinically and you can see the changes on a plain x-ray. Gronk's situation appears to have been a soft tissue infection likely complicated by the hardware itself getting colonized with bacteria. That's my speculation, of course, but seems likely from the reports we've seen from the New England media. Whether he ever had the beginnings of a bone infection or they were aggressively treating to prevent one while trying to keep the plate in as long as possible is an open question. And I think the point made by Ghost Rider is valid. There will be atrophy of the muscle in his injured arm, possibly made worse due to an infection in the same area. If all goes well over the next month -- no residual infection, no new infection, bone stabilizes around the plate -- he should have 2-3 months before the season to rebuild the strength in his arm. It's unlikely he'll be at full strength by opening weekend, but there's a good argument (acknowledging that defeating jams and gaining separation could be more difficult) that he won't need a 100% recovery to be effective as a receiver.
  14. Great point. The fact that they've treated with multiple courses of antibiotics strongly suggests they were nervous about a bone infection. It's also worth wondering why they felt the need to implant new hardware four months after the last revision if bone healing hadn't been affected by the surrounding infection. I think the answer to that question is that full bone remodeling won't occur for many months and the plate will provide extra stabilization during this coming season, but the question is valid. In the end, I think we have to take the decision to replace the plate (in a high profile, elite athlete) at face value. I don't think the plate would have been replaced if there was any real concern for an ongoing tissue or bone infection. But we'll see. It wouldn't be the first time we were misled on an injury.
  15. I don't think it's an absolute all clear until the cultures are confirmed negative. But I don't believe they'd risk learning that they put a new plate into a dirty location. There's also a chance, though unlikely, that he could have another infection later even if this one has fully cleared now. That's what I've been telling people too. It's not a guarantee that the infection is clear until the cultures come back negative which takes about 72 hours from my experience. By visual examination the tissue likley didn't look infected, but there is really no way to be sure. Don't be at all surprised if the infection comes back in a few weeks.......I'm not completely sold. I have a hard time believing they were able to clear the infection without removing the plate first....since it's tough for antibiotics to work around artificial hardware. That was my first line of thinking earlier today, too. I think it's reasonable to remain skeptical, but I'm being told by my orthopedic contacts late this evening that there are instances where cultures are positive after negative intraoperative testing (bacterial stains, PCR, cell counts, etc.), but that outcome is generally considered unlikely. To be clear, that's in cases similar to Gronkowski's but not this case specifically.
  16. I don't think it's an absolute all clear until the cultures are confirmed negative. But I don't believe they'd risk learning that they put a new plate into a dirty location. There's also a chance, though unlikely, that he could have another infection later even if this one has fully cleared now.
  17. There are antibiotic coated titanium surgical implants in use. Bacteria are still sometimes able to protect themselves with a layer of slime unfortunately. Once that happens, there's no non-invasive way to get antibiotics to the area of infection.
  18. Yes, that would suggest that there's no concern for an active and ongoing infection. His surgeons will not want to risk putting a new plate into an uncertain environment.
  19. I'll update last week's article on Gronkowski after we get more details on his surgery today, but thought those who aren't following on Twitter might be interested in a some thoughts from earlier today... @JeneBramel Working on background for reaction article after Gronkowski's surgery today. Details from print media aren't explicit on today's plan. @JeneBramel Been working under assumption that Gronk would have plate replaced immediately if no signs of infection based on most media reports.‏@JeneBramel I didn't question that assumption, thinking medical team access to advanced pathology tech, direct visualization enough to make decision. @JeneBramel Both Mike Reiss/Karen Guregian noted use of cultures this weekend to assist decision. Positive culture may be known in 24 hours, but...‏@JeneBramel ...negative culture wouldn't be assured until 48 hours and potentially longer. @JeneBramel Been difficult to find a hard number for reliability of advanced/immediate PCR diagnosis of plate infection. @JeneBramel Still waiting to hear from a few orthopedic surgeon contacts as well. But the upshot is this...‏@JeneBramel If Gronk's surgeons choose to rely more heavily on cultures, Gronk's plate won't be replaced today even if no visual evidence of infection.‏@JeneBramel That's my long way of saying we may not get a truly definitive line on Gronk today after all. @JeneBramel Many writers, many sources in usu tight-lipped environment, frequently changing situation make details tough to follow w/ Gronkowski. @JeneBramel RT @bill_weiss Tough call, fixation now vs delay, in convoluted setting. No clear guidelines, many new (overly?) sensitive detection methods...‏@JeneBramel Reasoned/experienced approach here MT @bill_weiss "Game time" decision by surgeon based on all available info, appearance of tissue in OR. @JeneBramel Also worth noting that Gronk's impeding back surgery could make decision to await cultures for more definitive negative answer more likely
  20. He had surgery to treat a herniated disc in his lumbar spine. There were reports that it may have been related to a spinal stenosis, but Gronkowski and Rosenhaus both said that wasn't accurate.
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