Surgery on Paul Nystrom

Cancer as a Metabolic Disease

Fri, 27 Mar 2026 00:00:00 +0000

If cancer is only a genetic disease, as we’ve often been told, then patients have no agency. What good does it do to take control of your life? Why fight?

Fighting is what makes us human: enduring hardship, enduring suffering, and having the agency to say, “I will not die today.” It’s a cheesy line from a long-lost Leonardo DiCaprio movie set on a deserted island, where he’s telling a tall tale about facing a shark. (It turns out it was just a baby shark.) But the point remains.

Expecting a Specialist

Sun, 15 Mar 2026 00:00:00 +0000

If you go to the ER expecting to see a specialist, go during the day. Your odds are a little better than at night. Very rarely do specialists come to the ER in the middle of the night. The rest of Big Medicine—besides the ER—does not really operate 24/7. Yes, at large hospitals, there are always many specialists on call. But it takes a real emergency for them to actually come to the ER.

Procedure vs. Surgery

Sun, 15 Mar 2026 00:00:00 +0000

These are not the same thing, although they are often confused. Generally speaking, surgery involves cutting into the body to repair, remove, or readjust tissue or organs. A procedure, on the other hand, can involve looking into the body but usually does not involve making a new incision. Any intervention is most often carried out through a naturally occurring orifice.

Appendectomy, cholecystectomy, craniotomy, and total hip/knee arthroplasty are all examples of surgeries. Surgeries are performed under sterile conditions in the operating room. They usually involve general anesthesia, which includes placing a breathing tube in the trachea.

MRIs in the ER

Sat, 06 Sep 2025 00:00:00 +0000

There are only 2 MRIs that typically need to happen in the ER. Brains and spinal cords. There are virtually no extremity MRIs that have to happen emergently. I see patients regularly that have things that could be diagnosed on an MRI… rotator cuff tears, meniscus injuries, torn ACLs. But none of those things need emergency surgeries so they don’t need emergent MRIs. Patients often come to the ER within minutes of a knee injury and they may very well have a torn ACL. But I don’t have to find it immediately. No Ortho surgeon is rushing to the ER to fix it. You would not want them to in most cases. For things like rotator cuff tears and minor tendon or ligament tears, the first line of treatment is physical therapy and pain medicine. This is referred to as “conservative therapy”. Most of the time, this resolves the problem. Surgery is something to consider when conservative therapy fails. It is not the thing that has to happen immediately upon finding an injury.