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The Myth of Growing Pains

Discussion in 'Pediatrics' started by Kevin Kirby, Apr 9, 2015.


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    Drs. Matthew Sciaroni and Douglas Hight just had an article published in the April 2015 issue of Podiatry Management magazine titled The Myth of Growing Pains .

    I liked the article and think the article introduces some new ideas that will hopefully stimulate further research on this important subject. Good job Drs. Sciaroni and Hight!
     
  2. drhunt1

    drhunt1 Well-Known Member

    Notice that in this article, we "hedged" our bets, by appearing vague about ALL restless leg syndrome having the root cause as referred pain from the STJ. That was because all of the patients in that subset I saw distinctly remember having growing pains as children. Since the time of this study, (data stopped being collected 3 years ago), I have had a LOT of patients with RLS that did not have GP's as children. Same result...clinical cure, and no longer needing any medication.

    One more noteworthy point...the one failure I had in this study was a female patient that was applying for total disability, although she never informed me of that...ie., she was not going to get better no matter what I did, and/or how the orthotics "worked". The results would've been 100% success rate in both groups if not for her application for disability, IMO.
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. drhunt1

    drhunt1 Well-Known Member

    Can someone in Australia please forward the above link to Dr. M. Angela Evans. The last email link I had for her no longer works. TIA.
     
  5. Bug

    Bug Well-Known Member

    I've forwarded the link to Angela.

    I'll admit I have many reservations about the surety of this statement:

    I categorically disagree. How has this been diagnosed? It's like me saying that the majority of kids I see that are presenting with what has been described as growing pains in my clinic, are as a result of Vit D deficiency. To be honest a lot actually are, however some have biomechanical issues, some have bizarre dietary habits, some have mild undiagnosed neuro conditions. If I treated them all the same, there'd be huge issues.

    That said, if there is foot/leg biomechanical issue, nutritional or systemic then it's NOT growing pains. It's muscle overuse or whatever your preferred term about osseus malignlinment is, deficiency or systemic issue actually is.

    I think we need to stop confusing each other, our less experienced colleagues and the general public with saying a conditions is actually something the result of something with such limited proof.
     
  6. drhunt1

    drhunt1 Well-Known Member

    Cylie-thanks for forwarding the link to Dr. Evans...much appreciated.

    Let me address the concerns you raised. First, in Dr. Evans' epic paper published in 2003 in JAPMA, she concluded that growing pains were caused by pes planus based on the findings from 8 patients. Her paper basically launched her Podiatric research career and is still being referenced by many others which I witnessed when I performed my due diligence on the matter. My pilot program, single case studies has over twice as many subjects, (and MANY more since I closed the study window). In her follow-up study in 2008, (I'm assuming funded by the NIH in Australia), she moved away from the conclusions she reached in 2003.

    Second, I stand by the statement you referenced. Knowing the differential diagnosis of a child that complains of pain in the feet/legs, especially at night helped me with that conclusion. The penetration of growing pains in children is remarkably high, depending on what study you believe. The range has been estimated from 15-49, with a mean of less then 40%:

    http://europepmc.org/abstract/MED/15289780

    Still's Disease, thankfully, is not nearly that high:

    http://www.jrheum.org/content/29/7/1520.short

    Neither is Osgood-Schlatters Ds. So it was no "leap of faith" on my part when I wrote that sentence and made that claim.

    Third, the diagnosis is not only one of exclusion, as many authors have suggested, but there are physical signs that can be attributed to this malady which are the same for RLS. By pressing on the sinus tarsi, thereby increasing intra-capsular pressure, or by direct pressure on the posterior facet of the STJ from either medially or laterally, the observer will elicit a painful, often times guarded response. Have the Pediatric patient scheduled late in the afternoon, therefore allowing for a days activities to exacerbate the problem, and then check this patient yourself by the method I describe, (after you've ruled out more serious problems first). These symptoms disappear once the orthotic therapy is instituted, but will return if these devices are taken away.

    Fourth, while many Podiatrists realize that orthotic therapy can successfully treat GP's in children, prior to my pilot study they didn't know why. Many of our colleagues described GP's as an "overuse syndrome", which it clearly is not. [I have a problem with the term overuse syndrome in many discussions for a variety of reasons] This study and study group, (and the many patients I've seen afterwards), identifies the problem after 192 years of inquiry and will make it vastly easier for the practitioner to successfully treat. Every Podiatrist that reads this study, should send a copy to the pediatricians in their area. The word needs to get out.

    But the "cherry on top" of this study is the anatomic/neurologic/pathologic link to RLS in adults. No one has done this before either. The symptoms are similar, the exam is the same as is the treatment. Now you can successfully treat GP's in children and RLS patients in your own practice. If you don't believe the findings, results and conclusions of this study now, take the time to explore it on your own with your own patients. I'm very comfortable with what you will determine.

    Cheers,
     
  7. Bug

    Bug Well-Known Member

    Thank you for your response Matthew, I appreciate it but I'm still not sold. I'm don't think it is right to go into the scientific manner of how you have addressed your hypothesis as I feel your article is more of an observational piece written for peers, which is often a great place to start the conversation. But at the same time we need to remember the hierarchy of evidence and where opinions and case reports sit. They are great to start a conversation however should not be used to change practice.

    I only work with kids and rarely see what I would class as true growing pains/RLS etc. You have described a diagnosis that shouldn't be called growing pains. I agree there are children who present with foot and referred leg pain but then why not call it what it is. You are treating kids who have pain with a diagnosis. Kids with GP's don't have sore spots no matter where you push, they are the ones that wake and a good stretch often helps or sometimes they need pain relief etc. They are essentially well children but somehow have diffuse and intermittent pain with no cause.

    It's like the amount of times you see a child who's parent says they have the diagnosis of Idiopathic Toe Walking and Autism. Then it's not ITW! It's toe walking associated with autism because we know the two are linked. You have clearly identified that leg pain in children is associated with a biomechanical abnormality and that is great to encourage other practitioners to examine and explore other treatment options for this abnormality however then, why call it growing pains? Will they still have it when they are adults? Probably...then again it isn't GP's.

    It's probably semantics but I really believe the clarity of what we say to our parents, kids and colleagues is important. Call it is what it is and don't add to the myth of what it isn't.
     
  8. drhunt1

    drhunt1 Well-Known Member

    Cylie-good for you! I don't expect anyone to take my research as gospel, just as I question much of the research I read now. One of this nation's Founding Fathers, Thomas Jefferson, extolled us to "question with boldness"...and I believe we should. I don't expect you to accept anything/everything I wrote as the absolute truth, but I've provided you a "roadmap" to follow which should provide you the answers your patients seek. While Vitamin D deficiency is not seen in this country, (at least not where I practice), it might be part of the differential diagnosis where you practice. I also think the symptoms and presentation of GPs in children is well documented in the historical record, thus I sidestepped that part in the article, much like Dr. Evans did in hers. At least test my approach. Hashkes was wrong when he repeatedly claimed that GPs was non-articular...it is. Brenning was right when he believed that GPs in children and RLS in adults were connected...they are. Walters and others are wrong when they describe GPs as the adolescent form of RLS...they have it exactly backwards. The Sciaroni Postulate, (if I am to be that bold), is that these two maladies are a continuum of the same problem. Now, as far as your statement that my article is purely an opinion piece, I will respond that much of what we do in Podiatry is just that...opinions based on numbers. There are no double-blind studies amenable to biomechanics. The best we can do is what I mentioned in the article: the patient's symptoms returned when the orthotic control was "removed", and responded favorably again when reintroduced. Good luck with your quest for the truth...may your road be easier than mine.
     
  9. angelaevans

    angelaevans Welcome New Poster

    Dear Dr Sciaroni,

    I have received the link to your recent article in Podiatry Management, and am about to send a letter to the editor.
    The letter is actually addessed and directed to both the authors and editor, so I am also happy to post it here if you agree.
    Unfortunately, I just don't have the time to also get to podiatry arena discussions, but thank you for ensuring that I received you paper.

    Kind regards,

    Angela Evans
     
  10. drhunt1

    drhunt1 Well-Known Member

    Angela-absolutely...you have my permission. Thank you for the prior correspondence many years ago when you sent me the links to yours, and many other references. Rest assured, I read them all, if I hadn't already. Also, be advised that this was a revised article, reduced from a broader manuscript of 10K words to 3K words in order to fit the parameters of PMM. The original article was designed to be read by PCP's, so it was instructional for those not familiar with biomechanics as well as educational for Podiatrists. Your original article in 2003 was groundbreaking and is still being used by practitioners here in the States, although I didn't read it until several years later.

    Although this article doesn't follow strict guidelines on presentation of scientific data, I think you would agree that Podiatric Medicine is not as amenable to Evidence Based Medicine as other medical disciplines.

    Included in the original manuscript, I hired animators and a videographer to produce patient interviews and basic biomechanical animations to better explain some of the more common precepts in foot function and offer personal testimony to treatment course and history. This is one such video.

    https://www.youtube.com/watch?v=7BSetRI_UH4&feature=youtu.be

    Please post your letter here for all to read...good or bad...this is what this forum should be all about.

    Best regards,
     
  11. Bug

    Bug Well-Known Member

    Really? You don't really think that do you, really????

    Podiatry is every little bit amenable to any other health profession, all we need to do is use what we have and continue to push to have the gaps filled where they are identified. Not everything needs a double blinded placebo trial. Randomised comparative effecasy trials are becoming more common place, cheaper and more acceptable where there is established effect. Just being able to read a study and understand how to critique the evidence should be the basic skill that every podiatrist has yet it appears not?

    Where we are continually accepting lower level anecdotal evidence in the face of better quality, we will continue to be seen as a dumb hick of the health world. I'm pretty sure there are other health professions out there that have this title, let's not aim to be one of them.

    I'm bowing out from here on in as I'm pretty sure there will be no middle ground found.
     
  12. drhunt1

    drhunt1 Well-Known Member

    Cylie-note that I wrote: "as amenable" in my statement about Podiatric Medicine and EBM. Let me explain. In Podiatry, we use biomechanics to explain a lot of 'what we do and why'. Yet many of the pathologies we treat take 40 years or longer to become evident. How long does any one Podiatrist practice? On another thread on PA I wrote that as a profession we still haven't generated serial X-rays of any one individual foot as it develops from ~1 year of age through adulthood. My point being that while there's still a lot to be done to forward our cause, Podiatrist attrition and patient geographical relocation works against us in solving many of the mysteries we see and attempt to treat. I noticed, however, in your post I'm responding to that you didn't mention the fact that in 2003, Dr. Evans' article was based on less then half the number of patients I included in our study. Anecdotal evidence is important in our field because it "sets the stage" and allows other practitioners an opportunity to engage those findings as they deem necessary. For the reasons I discussed above, as well as others, it's a beginning I'm comfortable with for now. Regards...
     
  13. drhunt1

    drhunt1 Well-Known Member

    Angela-if you would prefer, you can email me directly: drhunt1@comcast.net. TIA.
     
  14. Jeff Root

    Jeff Root Well-Known Member

    Dr. Sciaroni is a private practitioner who spent a great deal of time on this project and used his own financial resources to purchase references and produce animations in order to put together his pilot study and article. I believe he should be commended for this, especially since he isn't paid to teach or lecture and has no commercial affiliations related to his endeavor. Hopefully his effort will result in his hypothesis being tested in a larger, independent study by an institution with the financial resources to better study this common condition whose etiology has yet to have been adequately explained.

    Jeff
     
  15. drhunt1

    drhunt1 Well-Known Member

    In the words of Rod Stewart, "Every Picture Tells a Story". Here's a pic and a story that every practitioner that views/reads this thread should seriously think about.

    The lady pictured here came to my office 6 months ago with a chief complaint of unilateral heel pain. But when I saw her feet dangling off the end of the examination table, and the significant varus, (inverted), attitude they maintained, alarms went off in my head. I took plain film radiographs which just confirmed what I witnessed clinically. I placed the x-rays in the viewbox in the treatment room and I began asking her questions about her childhood as I examined her feet, taking note of neutral position, ROM of the ST and MTJ's, presence or absence of equinus, etc. She confirmed that she had serious growing pains as a child. As the questioning turned to the present, she confirmed that she now has RLS and was on medication for it, (Neurontin). She also confirmed that she has always been laterally unstable and "falls down a lot". This was in front of her husband, whom was also in the room. I left the room, retrieved my Android tablet which I've downloaded the videos shown at this site as well as patient interview videos, which I have not shared here at PA. I left the room so they could watch the videos while I attended to other patients.

    Upon my return, there were tears in her eyes. I looked over at the husband and asked if these were tears of joy. She responded that all of her life she had sought medical opinions about her condition and no one, until that day, had been able to answer them. She told me that first visit that she was so laterally unstable, that she's fallen down and cracked her front teeth, and those she presently had were dentures. I was amazed. I casted her for orthotics that first visit. I held her in an inverted position, (she had a rear foot varus deformity with a forefoot varus deformity on top of that, ie., a skewfoot). I had the varus extension applied, which extends to the end of the toes, much like what is pictured in the article.

    On her second visit to pick up the orthotics, she was accompanied by her husband and mother-in-law. She told me at that when she was a child, she had severe growing pains...so much so that she would wake up screaming in pain and crying. Her mother took her to the pediatrician and was told that she would grow out of these pains. But she didn't. After that doctor visit, when my patient woke up screaming in pain, her mother beat her. My jaw hit the floor. I told her that hers was an extremely compelling story that needed to be told, and that I wished I had met her years before, before I finished writing my article and conducting my videotaped patient interviews. I was shocked, dismayed and disappointed. I did, however, tell her that her RLS should be gone by the third night she wore the orthotics, depending on the break-in time and her ability to wear them consistently throughout the day.

    Her third visit confirmed that, indeed, her RLS had vanished, she was no longer taking Neurontin, she was no longer kicking her husband in bed and they were both sleeping much better. [Oh...and her heel pain was gone too]. She indicated to me that she was much more stable then before and not falling down nearly as often, even on uneven terrain. She has given me permission to tell her story for her, and sent me the jpeg seen below.

    So what's the moral of this story? Doctors often don't realize that information they give patients, whether it be in haste, unintentional or for whatever reason, can have long lasting effects and impacts on the patient and their family. It is OK to tell a patient that you don't know the answer. But if you don't/can't offer immediate solutions, what they want to hear is that you're willing to find out the answer, and/or find someone that can be of assistance. Primary Care docs do that all the time, refer patients to specialists...but unfortunately, they also give patients misinformation as well. Many times I have asked parents if when they were told that "Little Johnny or Suzie would grow out of the pain", if that was a satisfying answer. Not one parent has told me it was...not one. "Food" for thought. In the words of Emiril Lagasse, maybe it's time to "kick it up a notch". Perhaps this article will do just that.
     
  16. drhunt1

    drhunt1 Well-Known Member

    Here's Dr. Evans' response on PM:
    http://podiatrym.com/search3.cfm?id=81969
    _____________________________________________________________________________

    I will limit my response for now, but I will write an expanded version to submit to PM.

    First, Angela, I chose the title for a very good reason...because it is a myth. For over 100 years, and still today, doctors are telling patients/parents that the pain is due to the long bones growing faster than the periosteum, (soft tissue) can keep up. Even though many researchers have moved away from that description, many have not. If that were the case, why don't we witness "growing pains" in the arms and UE? It is a myth that needed to be exposed.

    Second, I contacted you 4-5 years ago to be a part of the study via email, because I knew that your database was prodigious. You declined, in spite of the fact that I told you I had discovered the answer. Your choice. But if you remember, you opted out because you were too busy and working on other projects. Really, Angela? In my email to you, I wrote that you were closer to the truth in 2003, then you were in 2008. I stand by that statement.

    Third, my article was reviewed for accuracy, readability and content by Ron Valmassy and a vascular/thoracic surgeon that became CEO/President of the largest hospital complex in my region. They both loved it. Now, if I had to choose between Dr. Valmassy or yourself as a better reviewer of my work, you'll be disappointed which way I ventured every single time.

    Fourth, while you nitpick at the presentation of the material, (I will admit that I didn't perform top level statistical analyses), I get the impression that you're missing the big picture as to the root cause of these pains, (why?). Simply put, you missed an opportunity to discover one of the longest held misconceptions in medicine. Think about that the next time you fly around the world discussing these maladies with Dr. Walters et al. at these high brow meetings. The answer is right in front of you, and has been for years. Quit measuring talar height and navicular drop and go back to the basics, which includes plain film, weight bearing radiographs and biomechanical evaluations. Oh, and try pressing on the sinus tarsi and posterior facet of the STJ, if and when you examine another child with these symptoms. IMO, you're making these problems MUCH more difficult than they really are...as most physicians, especially academics, do.

    Fifth, while I did discuss Still's disease as part of the differential diagnosis, since when are Podiatrists allowed to take X-Rays of the lower leg? I'm assuming that you order them on each and every child that presents into your office? In the article you reference in Medicine Today, they discuss night pain in a 3 y.o. child. Really, Angela? You KNOW that the preponderance of studies indicate that GPs in children begin around age 6. Notice that they also bring up seronegative arthropathies, which I discussed...didn't I? Infection? Hemotogenous? Please explain that one. And wouldn't a simple CBC rule that out? Tumors? Again...I would venture to guess that the presentation would be much different in a child with a LE tumor, and wouldn't be referred to Podiatry to begin with.

    Sixth, how disingenuous of you to denigrate our work, and use young Podiatric students to further your cause when the reality is you've seriously misled them in your 2008 article when you wrote: : "iv) Growing pains is not associated with flat feet." You missed it Angela...get over it.

    Seven, I really couldn't care less about all the other research on treatment protocols on RLS. All I'm asking Podiatrists to do is to read the paper we wrote, understand the simplicity of the presentation and examine the patient in a manner that either proves us correct, or wrong. It doesn't take much time or effort on anyone's part to do just that. Perhaps you should be more concerned at discovering the truth which will ultimately translate into better patient outcomes then protecting your own study's findings and/or the manner in which you presented that information...or using Chinese proverbs to bolster your argument.
     
    Last edited by a moderator: Apr 14, 2015
  17. Wow Matt

    very professional

    I would however like to thank you for publishing the letter From A Evans and for Cylie for taking the time in responding

    and I think like this the most from the thread , of course we can expand our knowledge being open and discussing and taking in real evidence

     
  18. blinda

    blinda MVP

  19. drhunt1

    drhunt1 Well-Known Member

    Mike- a "little harsh" for your taste? Let me expand my thoughts. It's no more harsh than Angela's post at PM. Here's why. She didn't want to assist me in my study 4-5 years ago because she was "too busy", yet she admitted that she still is involved in worldwide meetings exploring the associations between GPs and RLS. I basically offered her an opportunity to expand her knowledge on the subject and test my hypothesis. She declined.

    Further, I knew she was still involved in these types of forums because Dr. Walters informed me of that in our first telephone conversation. And guess what? Dr. Walters, himself, is being funded by Big Pharma in his research on RLS at Vanderbilt University. Conflict of interest? You bet. How many hundreds of millions of dollars are spent each year on Requip, Mirapex, Cymbalta, Lyrica, tramadol, neurontin and hydrocodone for this treatment? Yet Angela is concerned about the cost of a pair of orthotics? Seems hypocritical to me.

    Continuing, while I've already admitted that the study had few participants and, thus, is a pilot study, it had over twice a many as Angela's article in 2003, but she took two paragraphs to explain herself, her study and just how scientifically presentable her study was. How does that improve patient outcomes?

    It seems that you've ignored my comment on the two docs that reviewed my work long before I submitted it. Why is that Mike? It certainly "closes the loop" on that topic and makes Angela's concerns about our presentation seem rather sophomoric...doesn't it?

    As I've stated previously, the only treatment failure in the study was a patient that had already applied for total disability yet did not disclose that info to me prior to her inclusion in the study. My mistake. Since that time, however, I've treated dozens more patients with serious success rates that simply should not be ignored nor dismissed. Ditto for the essence of the study.

    Finally, you thanked Cylie for her contribution, ignoring the fact that I initially asked someone here to forward the article to Angela. Did you miss that? And for completeness, Cylie is on the record as treating these patients with zinc therapy. DISMISSED! Hopefully our article puts an end to this type of treatment. It's easy to test our hypothesis...that's all we're asking other practitioners to do.

    Comparing me to Dennis Shavelson? I've had two telephone conversations with him as well, but not since the article was published. He is very passionate about his ideas. I would like to compare myself, however, to Dr. Atkins whom singlehandedly pulled the rug out from under the exogenous cholesterol crowd, of which there were many.

    Ignore my forum "attitude", (although it certainly pales in comparison to Simon's, which I've never read Mike Weber admonish), and focus on better patient outcomes...you just might be surprised what "falls in your lap", or has been staring you in the face for years.
     
  20. Bug

    Bug Well-Known Member

    Wasn't coming back...wasn't coming back...... BUT in my defense I just have to comment based on this:

    Huh? I did not. I have never in my career told any child to take zinc for any sort of pain? I have referred to endocrine clinics and general practitioner for blood tests for suspected deficiencies, infections or symptoms know to cause intermittent but predominantly night pain without any palpable pain anywhere on the foot, and yes. i pressed. Your article isn't going to put a thing to rest.

    I get that you're defensive as you are obviously passionate about this topic. However most podiatrists here are just as, if not more educated as you are. Most don't work in academia, we work in private clinics and hospitals, just like you. How about a bit of professional courtesy and respect between colleagues because all I've seen so far is mainly an attempt at rational debate and you running around slinging off at anyone who has dared to disagree with you.

    I'd be "busy" if you called me to do research with as well.
     
  21. Indeed
     
  22. drhunt1

    drhunt1 Well-Known Member

    When did I ever mention that you use zinc therapy on children? Remember, that my hypothesis is that these two maladies are a continuum of the same problem. Further, we have forwarded the concept that RLS is the adult version of GPs, something that no other author of any research paper has ever suggested.

    BTW, do you speak/write English as a second language?
     
  23. drhunt1

    drhunt1 Well-Known Member

    Mike-if ad hominems are all you've got, that doesn't really amount to much...does it?
     
  24. Good letter. You should take time to reflect carefully what Dr Evans has to say.

    Regards
     
  25. drhunt1

    drhunt1 Well-Known Member

    Considering I took 5 years to not only research the subjects, but to conduct patient interviews, (videotaped, and in one case with a two year follow up), producing animation and illustrations, I can safely write that this, indeed, is the case. Since the conclusion of the study, I've had dozens more patients successfully treated using the same approach based on that postulate. The last several paragraphs of the reduced article linked above describe where this process needs go....how we, as a profession need to proceed. I stand by those thoughts...I've had a lot of time to think about it and a lot of success in the meantime. After all, isn't better patient outcomes the end point to all of this? Read my lengthy post above describing one of the patients I've seen since I concluded the study. Comment on that post, and the ramifications of what we tell patients...the information we give thinking that its accurate, and even if its not, its what we've been taught and what everyone else is suggesting.

    That being written, I also predicted the "push back" I have already experienced...and even predicted those that are pushing back the most. I discussed this at length on multiple occasions with MANY docs from a variety of specialties. Just follow the money and all pretty much par for the course. And the reality is, it's just begun.
     
  26. Good luck. You're clearly passionate about the subject; time will tell whether your argument holds any water.
     
  27. drhunt1

    drhunt1 Well-Known Member

    “New opinions are always suspected, and usually opposed, without any other reason but because they are not already common.”
    ― John Locke
     
  28. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
  29. drhunt1

    drhunt1 Well-Known Member

    Bingo!

    RE: The Myth of Growing Pains (Angela M. Evans, PhD)
    From: A. James Fisher, DPM

    “Growing pains” is a misnomer, and in my opinion, a myth. Dr. Sciaroni does a pretty good job introducing the subject, giving credit to those who have actually researched it. Dr. Sciaroni even says that more research needs to be done; he even has a suggestion for a biomechanical treatment—a treatment that I personally have used on myself (so I do not have to use oral meds now) and found it very helpful in patients (they do not need meds now either). This so criticized paper is just the beginning of a discussion.

    When I did cancer research, a study as low as five was common; and decisions on vital, life-saving treatments were at stake. I am not saying that we should not criticize, because we should always be skeptical; but at least Dr. Sciaroni addressed a problem, developed a viable hypothesis, and produced a study, however small, that supported his hypothesis. The big sin is he had the temerity to publish it knowing, and even hoping, that he would be criticized.

    A. James Fisher, DPM, Crescent City, CA
     
  30. Griff

    Griff Moderator

    1. Allowing passion to get in the way of objectivity
    2. Attacking those who critique your viewpoint and praising those who agree with your viewpoint

    Yeah....This isn't science...
     
  31. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    ∧∧∧ yep; what Ian said.

    How many times have we seen that exact same approach? Its been an epic fail every time.
     
  32. Rob Kidd

    Rob Kidd Well-Known Member

    Purchase references? Please explain.................
     
  33. drhunt1

    drhunt1 Well-Known Member

    Jeff's at the conference in Vancouver...allow me to answer your question. Ever used Pub Med? Many articles can only be accessed by purchasing them. If one is attempting to fully research any medical topic, these fees add up. The reality is, however, that this cost paled in comparison to the cost of animation to further describe foot function to PCP's, (the original target for this study). Hope this helps.
     
  34. drhunt1

    drhunt1 Well-Known Member

    Compare Angela Evans' 2003 article to the one we wrote, and tell me how they greatly differ. James Fisher is already on the record stating that he has tried the biomechanics alternative and is no longer taking meds for his RLS condition, and has tried our approach on his own patients with equal success. Dr. Fisher is the President of the American Medical Specialty Board in Podiatry's college so I had him review the material some time ago. He has successfully incorporated our thoughts into his own treatment strategies. I suggest you contact him if you have any questions.

    One of the more difficult aspects to this article, was reducing the size of the original article from 10K words down to 3K in order to fulfill space requirements of PM. There was a lot of ground to cover...history, neurology, anatomy, biomechanics, referred pain, etc. Dr. Valmassy read the entire manuscript and loved it. Are you now attacking his credibility as well?
     
  35. drhunt1

    drhunt1 Well-Known Member

    How is my viewpoint not objective? And I eagerly await your vehement rebuttals to Simon Spooner on other threads for "behaving" the same exact way you're accusing me. Are you a hypocrite if you haven't/won't? Hmmmmmmmm.........
     
  36. drhunt1

    drhunt1 Well-Known Member

    To Bug, Griff, Craig Payne, William Fowler and everyone else that "thanks" each other, (as Griff and Ian deplore so much), as they attack our work:

    http://podiatrym.com/search3.cfm?id=82028

    "All we're asking podiatrists to do is to
    read the paper we wrote, understand the
    simplicity of the presentation and examine the
    patient in a manner that either proves us
    correct, or wrong. It doesn't take much time or
    effort on anyone's part to do just that."

    Hope this helps.
     
  37. Griff

    Griff Moderator

    Thanks Matt that does help.

    I've already read the paper and made my mind up. Took barely any time or effort at all.
     
  38. drhunt1

    drhunt1 Well-Known Member

    Drive-by hit jobs...or...

    Head, sand, stuck. Please contact Dr. Valmassy and forward your disrespect directly to him. And I'll give you the name of the vascular/thoracic surgeon, (whom has forgotten more about general medicine than you'll ever know), at some point so you can forward your incendiary comments to him, as well.

    Cheers.
     
  39. J.R. Dobbs

    J.R. Dobbs Active Member

    According to pubmed Valmassy hasn't published anything for 17 years but that isn't a matter because his name wasn't on the paper anyways. I'm sure he's as up to date as you and after all, vascular surgeon's are well known for their expertise on growing pains & podiatric biomechancis anyway. Everyone knows that. Fly-by-wire critics tsssk. Ignore them Dr Hunt. The Church of the Sub-Genius can see your talent. Keep up your sterling work putting these pinks in their place.

    Publishing your ground-breaking research in a magazine, rather than a peer reviewed journal was truly sub-genius. Unfortunately, sub-standard peer review is happening now, from people who actually understand the subject- ignore them all, they're all wrong. You know what's right. Repeat after me: Valmasy said it was good, Valmassy said it was good, Valmasssy said it was good. What does the PhD Angela Evans know about any of this anyway, anybody would think she'd published on the subject in a peer reviewed journal the way she is carrying on. Keep telling everyone that you had to cut it down, that seems to be working and throwing them off the scent. Keep challenging them to try it for themselves, that should keep them out of our hair for a while.

    In the meaning time keep up the egotistical front, keep bombing their silly forum and playing these fools at their own game (you've done this well so far) apply for ordination at the Church- you will make a fantastic minister one day. You have given money willingly to this project, now give to the Church and we will protect your slackness from these pinks. http://www.subgenius.com/
     
  40. What was it? Never mind.

    5th July 1998 is just around the corner, Dobbs.
     
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