A Hand Surgeon’s Perspective

From the desk of Dr. Balourdas

You will find some insights into my approach and philosophy regarding the practice of medicine as it affects my patients.

First, I 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 an independent (solo) hand and upper extremity sub-specialist my practice depends solely on referrals.  The privilege of providing care is typically based on a personal referral from physicians, therapists and our patients. It is with great pleasure that I continue to practice limited to the hand and arm. Your interest in our practice is sincerely appreciated.

As a patient you will be treated with the utmost respect and you will be an active participant in your care to achieve the best outcome.  All possible courses of treatment will be discussed and explained to your satisfaction before embarking on treatment.  Review our office site to get more information. Schedule your appointment.

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, and is changing the way we work and play.  Medicine and healthcare is leading the way on the internet.  Please however, 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

Most patients are unaware of the arrangements that various managed care companies have with their doctors to limit (or manage) the healthcare that is provided. This is a very sensitive subject, and many doctors don’t want to discuss it with their patients.  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 participate in one of many such plans and you have concerns, they should be addressed and you should be allowed to seek a second opinoi

If you already have a hand problem, it may be too late to change healthplans. Please check with your broker or employer. 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 managed 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.

Regarding Herbals

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.