How I Manage Tennis and Golfer's Elbow.

Lateral and medial epicondylitis are common in sports and work activities that require repetitive gripping or exert acute forces on the forearm. Left untreated, epicondylitis may interfere with daily activities. Most patients respond to early conservative treatment consisting of activity modification, ice, anti-inflammatory medications, and rehabilitation exercises. Approximately 5% of patients will fail conservative treatment and require surgery. The outcome for most patients following surgery is excellent.

Home Exercises for Tennis and Golfer's Elbow.

The essential exercises for a home rehabilitation program for tennis or golfer's elbow include stretching and strengthening (figure 1) to improve flexibility and range of motion, and to reduce forces on the affected tendon. Slow, passive stretching exercises and gentle strengthening exercises can be started right away.

Fearsome Fido.

Runners and cyclists are among the occasional victims of playful, curious, and even downright nasty dogs while exercising outdoors. How exercisers react to the animal's advances often determines whether they will make a safe getaway or a trip to the emergency room.

Exercise After Angioplasty: How Much? How Soon?

Less costly and less invasive than bypass graft surgery, percutaneous transluminal coronary angioplasty (PTCA) enables many patients who have mild or moderate coronary artery disease to resume normal activities-including exercise-within a few days of surgery. When formal, supervised exercise rehabilitation programs are not available, it's up to the primary care physician to design a program to help patients reduce their cardiac risk factors.

Exercise and "the pill": putting a rumor to rest.

PIP: Every once in a while, female athletes hear the rumor that oral contraceptives (OCs) keep them from performing their best. Yet, studies that have tried to evaluate the effects of OCs on physically active women have not been conclusive. This rumor probably started with the initial, higher-dose formulations instead of with the current biphasic or triphasic OCs. Side effects of the higher-dose OCs included weight gain, nausea, fatigue, headaches, and increased risks of hypertension, thromboembolism, and changes in glucose and lipid metabolism. Current OCs minimize these side effects and the risk of complications. In fact, the aerobic exercise female athletes undergo most likely neutralizes the negative effects of OCs on coagulation and lipid metabolism. Further, OCs may even improve athletic performance because they can decrease bleeding, the risk of iron deficiency, and frequency of cramps. Moreover, athletes can use OCs to orchestrate their menstrual cycles around competitive meets. Some studies with small sample sizes show that athletes on OCs experience a slight reduction in functional aerobic capacity and endurance capability. A Swedish study of female soccer players reported that OC users suffer fewer traumatic injuries than nonusers. It is difficult to attribute this to OCs, because there is considerable psychological control over sports performance. A sports physician in Hawaii is aware of rumors that OCs induce sluggishness or fatigue during certain days of the month, but he does not know a female athlete who believes this. The head trainer of the US Olympic Committee says that many female Olympic athletes use OCs. Strenuous exercise, considerable weight loss, and possibly other stress factors induce athletic amenorrhea, especially in adolescent females. In many cases, OCs can treat it. They are especially needed to minimize the risk of reduced bone density and musculoskeletal injury.^ieng

Tricyclic antidepressant overdose: conservative management in a community hospital with cost-saving implications.

Reports of late-onset cardiovascular complications following tricyclic antidepressant (TCA) overdose have led to a very conservative approach to these patients. Many patients have been hospitalized for continuous cardiac monitoring, regardless of the clinical presentation. Management algorithms based on clinical predictors of outcome have recently been proposed. We used the algorithm developed by Tokarski and Young to retrospectively evaluate the care of 33 TCA overdose patients admitted to our hospital over a 3-year period. We then identified 11 patients who could have been treated on an outpatient basis had the algorithm been employed. Ten were admitted to a monitored unit and spent a mean of 31.6 +/- 15.64 hours on the unit. None of the 11 patients developed complications during their hospital stay. Use of the algorithm would have resulted in an estimated cost savings of 13 hospital days and $14,000.