Sunday, February 07, 2016

Signing of the Stars and Coach Jim Harbaugh

What I learned from the University of Michigan Signing of the Stars and Coach Jim Harbaugh

by Allan Mishra

Seek a unique perspective.
Harbaugh and his expert production team took a rather mundane event (signing of high school football players) and turned it into an Oscar-like event.  The day inspired not only the Michigan football program but the entire university.

Embrace diversity.
The crowd supporting the newly signed Michigan players included Tom Brady, Derek Jeter, Denard Robinson, Jordon Kovacs, Charles Woodson, wrestler Rick Flair, world champion poker player Phil Hellmuth, rap group Migos, Owen Wilson, Vince Vaughn, Coach Mike Ditka, and many others.  The collective value of the group to the signees and audience was staggering.

Sometimes you just have to ask.
Former Notre Dame Coach Lou Holtz helped carry the event with excellent one liners.  Why did a coach from another school come to a Michigan football event?  Simply because Jim Harbaugh asked him.  To the new Michigan players Holtz said:  "You didn't just make a four year decision, you made a 40 year decision"  He understands and articulated how the new players would be part of Michigan for the rest of their lives---a powerful message.

"Some people think less is more, I believe more is more."---Jim Harbaugh
Jim Harbaugh doesn't like meetings and discusses strategy on the field with this players and coaches during marathon four hour practices.  We all should have less meetings and execute instead of engaging in perpetual discussion.

"Those who stay will be champions"-----Coach Bo Schembechler
Harbaugh added a corollary to that famous Michigan axiom.  "Try hard and you will stay".  He has written this above the exit sign from the Michigan locker room.  The implication is clear.  Work as hard as you can and you will stay.  Stay and you will be a champion.  Embracing this mindset could help all of us in our chosen professions.

"Attack each day with an enthusiasm unknown to mankind."---Jim Harbaugh 
Harbaugh and his team gave a swag bag full of gear emblazoned with his motto to all the presenters.  After the star-studded event was over around 1 pm, Harbaugh, true to form, was quoted by the Michigan daily as saying:  “We’ll be back to work at 2.30.”  Translation---have some fun but then return to the relentless pursuit of being one of the leaders and best.

Video montage of the event produced by VisionVideo360


Tuesday, January 26, 2016

Platelet Rich Plasma beats Surgery for Tennis Elbow

Treatment of tennis elbow using platelet rich plasma (PRP) resulted in an average of 83% improvement in pain scores at one year compared to baseline in a recently published study of 110 patients by Karaduman et al.  The surgery group had 46% improvement in pain scores.   Mayo elbow scores were also higher in the PRP group.  (See graphs below)  

The study used the Biomet GPS PRP device and the Nirschl surgical technique

This is an interesting study comparing the value of PRP versus a commonly recommended surgical procedure.  The data suggest PRP is a safe and effective alternative to the much more invasive and expensive surgical procedure.

See abstract and reference below:

Karaduman et el 2016



To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique.


A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements.


VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength.


The PRP seems to be better for pain relief and functionality in the short and mid-term periods.


  • Nirschl surgical technique
  • Platelet rich plasma (PRP)
  • Chronic elbow tendinosis

Sunday, January 03, 2016

Biologic Orthopedic Society passes 5000 Member Mark

The Biologic Orthopedic Society (BOS) recently passed the 5000 member mark.  (Link to join)

The society was started in 2012 with the simple goal of connecting what I thought would be 200-300 people interested in biologic orthopedics.  The group has dramatically exceeded those expectations. We now have members from six continents spanning many different orthopedic, musculoskeletal and business disciplines.  As 2016 unfolds, the BOS will hopefully continue to grow and help advance this rapidly expanding field.


Saturday, December 19, 2015

Brave Thinking

Seek the distance and difficult shore. 

Earth "Rising" from NASA
The data suggests almost no chance of reaching the distant destination.  Think bravely and embark in spite of the data.  As you progress on your faithful journey, you will become more efficient with your efforts.  Productive currents could also land you ashore beyond your previously imagined target.  By setting insanely lofty goals, you distinguish yourself from the fearful masses pursuing objectives they know they can accomplish.  Yes, you may not achieve your stated objective.  You may be disappointed, discouraged or even collapse.  Only by failing, however, will you know the limits of what you can accomplish.  

Landing of SpaceX Falcon 9 Rocket

Thoreau stated it well: 

“In the long run men (and women) hit only what they aim at.  Therefore, though they should fail immediately, they had better aim at something high”.   


Saturday, September 19, 2015

Tiger Woods Spine Surgery

Tiger Woods just had surgery on his back for the second time and will be out for a indefinite amount of time.  Apparently, something was pinching on a nerve and causing him significant pain.

(ESPN Story)

Below is a video of my own spine surgery from several years ago.  Thankfully, I have done very well.
Let's hope his second surgery will allow Tiger to return in 2016 to an elite level of play.


Saturday, August 01, 2015

Respect Your Future Health (#BodyIRA)

Body Individual Retirement Account (BodyIRA)

When I was in medical school and about 22 years old, an erudite 50-year old professor made a claim that the warranty on the human body wears out at age 45.  As I fidgeted in my uncomfortable back row seat in a packed classroom, I thought to myself---what an old man.  I couldn't even contemplate what it would feel like to be 45 or 50.  I can now attest to the validity of my professor's claim because I have seen friends, family members and patients endure unexpected medical issues in their 40s.  I have a suggestion:  Open a BodyIRA.

What is a BodyIRA?  It's not a financial investment, but an investment in good health practices. Think of a BodyIRA as a bridge to your future health.  Just like a retirement savings account, a BodyIRA is a gift you give to yourself, by taking care of yourself now so you can be healthy far into the future.  And just like retirement savings, the sooner you begin to contribute to your  BodyIRA, the more benefits you will reap later in life.

Request to join the BodyIRA LinkedIn Group 
(Goal:  share ideas about health and fitness)
Four Starter Recommendations for your BodyIRA

1.  Maintain or work toward your ideal body weight (Keep a daily record of your weight)

2.  Stretch your hamstrings and develop strong legs  (See the PowerKnee Program)

3.  Focus on your posture (Sit up and Stand up straight)

4.  Get 7-8 hours of sleep per night or more

Consistent exercise, a healthy diet coupled with stable sleep patterns are like buying index funds for your future health.  In our twenties, we are told to begin contributing to a retirement savings plan like a 401k or an individual retirement account (IRA).  Put away a little money each month and you will see it grow into millions of dollars over the course of the next 40 years.  We need to emulate that sage advice and translate it to our health.

BodyIRA leads to dramatic dividends later.  One profound example is bone density in women.  Women in their teens and early twenties are building their bony framework.  In their thirties and beyond, they will make withdrawals from this bone bank.  If they do not deposit enough early on, they pay a heavy price later in the form of osteoporosis.

We have all heard this type of advice before but let's make it actionable.  Don't just take it from a friend or a medical professional.  Take it directly from your future self.  What would your ten-years-older self have to say to your current self?  If that older you limped in the door and looked at what you were doing, he or she might just scream at you to get your butt off the couch, stop bingeing on Netflix and get some exercise.  Begin by committing to writing down your weight daily and doing some simple leg exercises.  (See PowerKnee Program)  If you can initiate the habit of contributing to your BodyIRA for two weeks, you will experience some immediate benefits and also be contributing to your future health.

Importantly,  it's never too late to open a BodyIRA.  Don't worry if you are in your 30s, 40s, 50s or even beyond 60, you can still work toward a better physical and mental situation.  Much like a "catch up" contribution to your 401k or IRA, if you start later, you will need to pay more.  Also, as we age, the body requires more maintenance.  Don't get mad about it and neglect your aging engine and wheels.   Respect your future health and start your own BodyIRA today.  You will reap the priceless reward of future well-being.  


Thursday, June 11, 2015

Will Biologics Revolutionize Musculoskeletal Care?

The economic costs of musculoskeletal care in the United States is approaching $800 billion or about 5.7% of annual GDP.  (Ref)  These costs are expected to increase significantly as our population ages.  This is clearly not a sustainable path.  A recent article published by the American Academy of Orthopedic Surgeons (AAOS) suggests the "early evidence is promising" for biologics to revolutionize musculoskeletal care.  (AAOS Article in full)

Biologic therapies represent a rapidly evolving frontier similar to arthroscopy in the 1970s and 1980s.  There will always be a need for continued research and development but the data supporting treatments such as platelet rich plasma (PRP) and stem cell treatments for tendinopathy and arthritis is increasing significantly.  The number of PRP articles on PubMed now is over 7800 and the Google Trends for PRP is rising rapidly. (See Graph)

Biologic orthopedic procedures are in the process of revolutionizing the options available for patients for difficult problems such as arthritis.  It is an exciting time to execute on these point-of-care biologic treatments.   Continued progress will demand hard work and innovation by elite motivated teams in order to produce transformative outcomes for patients.


Saturday, April 11, 2015

The Apple Watch and Medicine

I just tried on the new Apple Watch and was immediately impressed.

I put the 42 mm space gray Apple Sport version with an aluminum case and black strap on first.  The display was crisp despite the bright sunlight that was streaming into Palo Alto store.  The Apple employee tapped the watch twice and it went into demo mode.  It scrolled through a bunch of its functions including various displays, messaging options and of course the heart rate monitor.  I was fascinated and ready to run out the store with my new toy.  I also tried on the Apple Watch version with the stainless steel case and the Milanese band.  (See video below).  That version was a little heavier than the sport version but the band was simply sublime.  It has a magnetic clasp and can be easily adjusted.  It felt like a high end watch you could wear out to a fancy event.

Both of these watches are expensive ($399 and $699).  Are they worth it?  I am not sure just yet.  I am in the process of trying to figure out if I will order one.  You can't buy in the store and it is now back ordered online until June or perhaps even July.  I do want to replace my chest strap heart rate monitor that is hooked to my iPhone.  Glacing down at my watch would be a much simpler way to figure out if I am at my target zone especially during a bike ride.  I can also see how it would be useful for patients who need to closely monitor their heart rates during exercise because of its simplicity.

Let me know what you think if you have tried it on and if the watch will have any specific medical or exercise applications that will be significantly useful.


Wednesday, April 01, 2015

Top 7 Life Lessons from Steve Martin

A few years back I was very lucky and blessed to play poker with Steve Martin in Las Vegas with my friend Phil Hellmuth.  The three of us also had a fantastic dinner discussion that has made an enduring impression on my life. 

Mr. Martin is a superb writer, musician, actor, and producer.  He also recently hosted the Saturday Night Live 40th reunion show and expertly managed the egos of dozens of elite stars from music, TV and the movies. We can all learn from his sublime approach to work and life. 

7 Life Lessons from American icon Steve Martin

1.  “Be so good, they can’t ignore you”

2.  “It’s pain that changes our lives” 
From Shopgirl

3.  “Thankfully, persistence is a great substitute for talent”
From Born Standing Up, A Comic’s Life

4.  “I thought yesterday was the first day of the rest of my life but it turns out today is.”

5.  “I have found that-- just as in real life--imagination sometimes has to stand in for experience.”

 6.  “I just believe that the interesting time in a career is pre-success, what shaped things, how did you get to this point?”

7.  “Were they beautiful? We were all beautiful. We were in our twenties.”

Thank you Mr. Martin for sharing your immense talent with the world.  Please share his wisdom with your network.


Visit the site for more Steve Martin quotes

Saturday, March 21, 2015

PowerKnee Program

Knee pain is a very common problem.  There are many potential remedies but one that is often ignored is diet and exercise.  This led me to develop the PowerKnee Program.  It is a simple set of exercises that may help improve the pain associated with a variety of knee problems including arthritis.  The exercises help address quadriceps strength, hamstring flexibility and overall lower extremity fitness.    This program can be found at  Pass on the link to your friends and colleagues.

POWERKNEE PROGRAM (See Videos below)
1.  QuadCrunch (TM):  Perform a set of 3 hold for 5 seconds, 3 times per day
2.  Hamstring Stretch:   Perform a set of 3, hold for 5 seconds, 3 times per day
3.  Exercise Bike:          Ride for 30 minutes, 3 times per week, Record calories

Also, maintain or work toward your ideal body weight.  Losing even a small amount of weight may improve your knee pain and function.

Get going today on the #PowerKnee Program.  Pass on the link to your friends and colleagues.

Text "KneePain" to 22828 for a FREE newsletter to help with Knee Pain



Tuesday, March 10, 2015

PRP enhances healing after Achilles Tendon Rupture

PRP being added to an Achilles Tendon Repair
If you rupture your Achilles tendon, new data suggests platelet rich plasma can enhance the healing.  In an abstract published by the journal Lancet, researchers from England discussed how they treated patients who had ruptured their Achilles with either PRP or a placebo.  Six weeks later, they biopsied the healing tendons under ultrasonic guidance.  In the study, they found improved cell content, better tendon fiber structure and more normal collagen (type 1) in the tendons treated with PRP.  The study included 20 patients (10 PRP, 10 Control) and is the first investigation in humans showing the significant value of using PRP to help treat Achilles tendon ruptures.  Of course, more data will be needed to confirm these important findings.  For years, I have been adding PRP to my achilles tendon repairs and if I ever rupture my own, I will certainly request that PRP is included in the treatment protocol.

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