Hand & Arm Specialist in San Diego, CA

Thank you for selecting my website and spending some time here. I am in process of reviewing the content and updating the practice related portions. Please feel free to email us with your suggestions and recommendations.

I am the proud father of three wonderful children and am blessed with a wonderful wife and hand therapy colleague in Karen, who I met treating mutual hand patients when I first started out. Karen now runs the administrative aspects of the practice. Becky does the lion’s share of the patient care office work and I’m privileged to have had her to keep the practice running smoothly for so long.

Since 1989 I have practiced in San Diego in my area of sub-specialty; not many solo practitioners can say that these days. Over the years I have made national and local presentations and have written articles on subjects related to the Hand and Arm. I am fellowship trained in Hand and Microvascular Surgery. I belong to Local and National Medical, Orthopedic and Hand Surgery organizations. I have served as a Delegate to the San Diego County Medical Society and California Medical Association representing the Hillcrest/Mission Hills region.

>> View the San Diego County Medical Society Website

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 be in my 32nd 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.

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