From the desk of Dr. Balourdas
Thank you for selecting my website and spending some time here. I am always reviewing the content and updating the practice related portions. Please feel free to email us with your suggestions and recommendations.
As a hand and upper extremity subspecialist I depend on referrals from physicians, therapists and patients. It is with great pleasure that I am privileged to lauch my 22nd year of practice limited to the hand and arm. Your interest in our practice is appreciated. - Greg Balourdas, MD
Regarding The Internet And Medical Information
I strongly advise you to read with great caution and skepticism the medical information that you may find on the Internet. Although I can speak confidently about the accuracy of the educational content on this site, even the information you find here and at the links provided on this site cannot replace a thorough discussion with a knowledgeable physician and specialist familiar with your medical history. The information explosion has been a great benefit in many areas of our lives, including medicine. Please do not confuse information and self-diagnosis with the expertise and care you deserve.
- Quackwatch, a website devoted to exposing quackery on the web.
Regarding The Managed Care
Many patients are unaware of the arrangements that various managed care insurance companies have with their doctors to limit (or manage) the healthcare that is provided to their patients. This is a very sensitive subject, and many doctors don’t want to discuss it with their patients. These arrangements do not make a physician a bad doctor but it can alter the decision-making process and change the practice of medicine. Medicine is an ‘Art’ and in practice depends on an untainted doctor-patient relationship; circumstances that alter this relationship, weaken it. It is important that you learn if your plan does have such incentives, and if it does, how those arrangements could affect your medical care. You then need to decide whether or not you want to be in such a plan.
If you already have a hand problem, it may be too late to change healthplans. Please check with your broker or employer. A pre-existing illness or injury is usually covered only after a period of time. Nevertheless, you may decide that the health of your hand (so easy to take for granted) and the problem from which you suffer is sufficiently serious and urgent that you would like to seek attention outside of your plan. This could take the form of a consultation or perhaps even ongoing care. As you consider the importance of your hands for work and recreation you may come to the conclusion that the cost may be greater to postpone care. We welcome and can usually accommodate patients who choose this option. There is a bias that medical care is a right in our society but not all have access and fewer had the unlimited access that used to be common. While the system is far from perfect, we respect and value the compliment you pay us by asking for the opinion of a independent and well trained specialist.
Dr. Balourdas does not participate in any health plans which provide incentives to limit healthcare.
Regarding Glucosamine and Chondroitin
There is some suggestion of benefit from these compounds but most objective evidence is far from overwhelming.
- The Medical Letter: Glucosamine for Arthritis
- Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee
No difference between glucosamine and placebo.
- Glucosamine and Chondroitin Sulfate
An article from the Journal of Bone and Joint Surgery, the official journal of the American Association of Orthopedic Surgeons. August, 2001.
Please inform Dr. Balourdas or the clinical staff if you are taking any supplements especially if surgery is planned.
(This material is from the American Academy of Orthopedic Surgery.)
The AAOS Committee on Complementary and Alternative Medicine (CAM) has compiled the following chart of commonly used herbal supplements and the potential hazards they pose. Some references are at the end of this page; however, there is very little well-documented information about these potential interactions. Use this chart as a rough guide only. CAM suggests instructing patients to cease using most of these preparations at least two weeks prior to surgical interventions.
|Herbal Supplement||Common Uses||Potential Problems||Potential Interactions with|
|Dong Quai(Angelica)||To treat menopausalsymptoms, PMS, dysmenorrhea||Enhances bleeding; Hypersensitivity to sunlight||Anticoagulants|
|Echinacea||To treat colds, flu, and mild infections, especially upper respiratory infections||Hepatotoxicity; Intestinal upset||Other hepatotoxic drugs; Anabolicsteroids; Methotrexate|
|Ephedra (Ma Huang, Ephedrine Pseudo-ephedrine)||To treat asthma ,cough, and to induce weightloss||Seizures; Adverse cardiovascular events||Cardiac glycosides; General anesthesia; MAO inhibitors; Decongestants, stimulants|
|Garlic||To decrease cholesterol and blood clot formation||Enhances bleeding||Anticoagulants|
|Ginger||To relieve nausea||Enhances bleeding; CNS depression; Hypotension; CardiacArrhythmia; Hypoglycemia||Anticoagulants; Enhances the effects of barbiturates; Antihypertensives; Cardiac drugs; Hypoglycemic drugs|
|Ginkgo Biloba||To improve circulation, especially to brain; Formemory loss, dizziness, and headache||Enhances bleeding; Cramps, muscle spasms||Anticoagulants|
|Ginseng||To increase energy and reduce stress||Enhances bleeding; Tachycardia and hypertension; Mania||Anticoagulants; Stimulants; Antihypertensives; Antidepressants/Pheneizine; Digoxin; Potentiates the effects of corticosteroids and estrogens|
|Goldenseal||Used as a mild antibiotic to treat sore throats and upper respiratory infections||Increases fluid retention; Hypertension; Nausea; Nervousness||Diuretics; Anti hypertensives|
|Kava Kava||To treat anxiety, nervousness, and insomnia||Upset stomach; Allergic skin reaction, yellow discoloration of skin||Potentiates the effects of antidepressants, barbiturates, and benzodiazepines; Skeletal muscle relaxants; Anesthetics|
|Licorice||To treat hepatitis and peptic ulcers||Hypertension; Hypokalemia; Edema||Anti hypertensives; Potentiates the effects of cortico steroids|
|SAM-e(S-adenosyl-L-methionine)||To treat depression orosteoarthritis||Mimics serotonin; Nausea, upset stomach||Drugs that can increase or mimicserotonin, such as antidepressants|
|St. John’s Wort||To treat mild depression, anxiety, seasonal affective disorder||Enhances bleeding||Anticoagulants; Antidepressants; Decreases the effectiveness of cyclosporine, antiviraldrugs; Digoxin; Dextrometorphan; Prolongs the effects of general anesthetics; MAOinhibitors|
|Valerian||To treat insomnia, anxiety||Sedation; Digestion Problems||Potentiates the effects of barbiturates|
Medical References are available, please contact Dr Balourdas at your next office visit or by email or speak with your treating physician.