Dr Max Writings

From time to time Doctor Max writes about his knowledge of the medical industry, orthopedic developments and Vallarta Happenings!

Arthritis of the Shoulder

In 2011, more than 50 million people in the United States reported that they had been diagnosed with some form of arthritis, according to the National Health Interview Survey. Simply defined, arthritis is inflammation of one or more of your joints. In a diseased shoulder, inflammation causes pain and stiffness.


Although there is no cure for arthritis of the shoulder, there are many treatment options available. Using these, most people with arthritis are able to manage pain and stay active.



Arthritis of the Shoulder




Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).


The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff.


There are two joints in the shoulder, and both may be affected by arthritis. One joint is located where the clavicle meets the tip of the shoulder blade (acromion). This is called the acromioclavicular (AC) joint.


Where the head of the humerus fits into the scapula is called the glenohumeral joint.


To provide you with effective treatment, your physician will need to determine which joint is affected and what type of arthritis you have.





Five major types of arthritis typically affect the shoulder.


  • Osteoarthritis
  • Rheumatoid Arthritis
  • Posttraumatic Arthritis
  • Rotator Cuff Tear Arthropathy
  • Avascular Necrosis




Pain. The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.

If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the weather. Patients complain of an ache deep in the joint.

The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder. This pain can sometimes radiate or travel to the side of the neck.
Someone with rheumatoid arthritis may have pain throughout the shoulder if both the glenohumeral and AC joints are affected.

Limited range of motion. Limited motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding, clicking, or snapping sound (crepitus) as you move your shoulder.



Doctor Examination

Medical History and Physical Examination

After discussing your symptoms and medical history, your doctor will examine your shoulder.

During the physical examination, your doctor will look for:


  • Weakness (atrophy) in the muscles
  • Tenderness to touch
  • Extent of passive (assisted) and active (self-directed) range of motion
  • Any signs of injury to the muscles, tendons, and ligaments surrounding the joint
  • Signs of previous injuries
  • Involvement of other joints (an indication of rheumatoid arthritis)
  • Crepitus (a grating sensation inside the joint) with movement
  • Pain when pressure is placed on the joint



X-rays are imaging tests that create detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis.

X-rays of an arthritic shoulder will show a narrowing of the joint space, changes in the bone, and the formation of bone spurs (osteophytes).
As the disease progresses, any movement of the shoulder causes pain. Night pain is common and sleeping may be difficult.

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Anterior Cruciate Ligament (ACL) Injuries




One of the most common knee injuries is an anterior cruciate ligament sprain or tear.
Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.



Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.


Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.


Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.




About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Injured ligaments are considered "sprains" and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.


The anterior cruciate ligament can be injured in several ways:

Changing direction rapidly
Stopping suddenly
Slowing down while running
Landing from a jump incorrectly
Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.


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Rhythyms of the Night in Puerto Vallarta

rhythyms of the night

Only in Puerto Vallarta.

As the sun sets, enter into the magical and ancient land of Rhythms of the Night where mermaids greet you by starlight and trees come to life. This mesmerizing performance will captivate your heart and leave you spellbound.

Walk along the torch-lit paths while haunting flutes and the rhythmic drumbeat summon you to a pyramid nestled among the towering palms. In a mystical amphitheater under the star-studded sky, witness Mexico’s mythological past come to life through contemporary dance and music in this spectacular, 50-minute performance that received raving reviews from the New York Times as "An unforgettable evening under the stars."

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Exercises for strong bones

bone excercise

The best exercises for building and maintaining strong bones are weight-bearing and muscle-strengthening activities.

Weight-bearing exercises are any activity performed standing up, such as walking, running and dancing. When your feet and legs support your weight, your bones have to work harder, making them stronger.
Muscle-strengthening exercises are any activity that requires your muscles to work harder than normal, like lifting weights. This type of resistance exercise works the tendons that attach muscle to bone, which in turn boosts bone strength.

It must be stressed that all forms of physical activity will help to keep your bones fit for purpose and reduce the risk of falling. Good balance, co-ordination and stamina, as well as the confidence that comes from being regularly active, will all reduce your chance of a fall.
Check out the government’s physical activity recommendations for early childhood, young people, adults and older adults.

Physical activity is only one of the building blocks for healthy bones – the others being a healthy balanced diet and avoiding certain risk factors.

Key bone-building years

The key bone-building years are those up to our mid-20s, when the skeleton is growing. This is a critical period during which we have the opportunity to build as much bone as possible to last us for a lifetime.
The gains achieved during youth put the skeleton in a better position to withstand the bone loss that occurs with age. After about 35, bone loss gradually increases as part of the natural ageing process.
However, regular physical activity, including bone-friendly exercises, will help keep bones strong and slow the rate of bone loss, even in people with osteoporosis. Leading an active lifestyle can halve your risk of breaking a bone, particularly in your hip, according to Age UK.

High impact exercises

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For bone strength, long exercise sessions are not always necessary and brief bouts of high impact exercise are sufficient. High impact exercises, which are anything involving running or jumping, provide a jolt to the skeleton, including the hips and spine.

“A few jolts are enough to stimulate the bone-strengthening process in the body,” says Sarah Leyland of the National Osteoporisis Society. For example, running up 10 steps provides 10 jolts on the way up and 10 jolts on the way down. Do this five times a day and you have clocked up 100 jolts, which is likely to produce a positive effect on bone strength.

You can also target specific bones. Research found the bones in the serving arm of tennis pros were stronger than in their non-serving arm. So make sure you get the balance right!
“Beyond our 30s, physical activity is unlikely to strengthen bones but it will help reduce the rate of natural bone loss,” says Leyland.
High impact and bending exercises while lifting heavy loads place a lot of stress on the bones in the spine and are not recommended for people at risk of a fracture.

However, low impact activities, such as walking and step machines may help slow the rate of bone loss and improve your balance and muscle strength, which will help reduce your risk of falling.
Find out what activities and exercises are good for your bones depending on your age, level of fitness and bone strength.

Bone-building years

Childhood, adolescence and early adulthood up to mid-20s, when the skeleton is growing, are the time for building strong bones.
Young people aged five to 18 are advised to do vigorous intensity activities that strengthen muscle and bones, on at least three days a week.
Examples of muscle and bone-strengthening activities:

  • Under 5s not walking:
  • tummy time
  • active play
  • crawling
  • Under 5s walking unaided:
  • climbing
  • walking
  • jumping
  • running games


Children and young adults:

  • running
  • ball games, such as football, basketball, hockey and netball
  • trampolining
  • racket sports, such as badminton, squash and tennis
  • gymnastics
  • martial arts, such as karate and taekwondo
  • skipping and jumping
  • body weight exercises such as press-ups and squats/lunges
  • exercise to music such as aerobics and boxercise
  • rock climbing
  • dance-related activities 


Bone loss years

To reduce the rate of natural bone loss that occurs from age 35 onwards, aim to do muscle-strengthening activities at least two days a week.
See the ‘children and young adults’ section above for examples of relevant activities.
Examples of other suitable activities for adults include:
brisk walking, including Nordic walking
moderate-resistance weightlifting
stair climbing
carrying or moving heavy loads such as groceries
exercising with resistance bands
heavy gardening, such as digging and shovelling
cross-training machines
Try Strength and Flex, a five-week exercise plan for beginners to improve your strength and flexibility.
People with osteoporosis
If you have osteoporosis or fragile bones, regular physical activity can help to keep bones strong and reduce the risk of a fracture in the future.
Depending on your risk of fracture, you may need to avoid some types of high impact exercises. However, if you are otherwise fit and healthy and already enjoy regular exercise then you should be able to continue.
Check out the exercise resources on the National Osteoporosis Society website. Speak to your GP and ask if there is an exercise referral scheme in your area that caters for people with osteroporosis.

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Dr. Max Greig, Orthopedic Surgery

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Dislocated Shoulder

shoulder pain

The shoulder joint is the body's most mobile joint. It can turn in many directions. But, this advantage also makes the shoulder an easy joint to dislocate.

A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it is all the way out of the socket. Both partial and complete dislocation cause pain and unsteadiness in the shoulder.



Symptoms to look for include:

  • Swelling
  • Numbness
  • Weakness
  • Bruising

Sometimes dislocation may tear ligaments or tendons in the shoulder or damage nerves.

The shoulder joint can dislocate forward, backward, or downward. A common type of shoulder dislocation is when the shoulder slips forward (anterior instability). This means the upper arm bone moved forward and down out of its joint. It may happen when the arm is put in a throwing position.



The muscles may have spasms from the disruption, and this can make it hurt more. When the shoulder dislocates time and again, there is shoulder instability.

The doctor will examine the shoulder and may order an X-ray. It is important that the doctor know how the dislocation happened and whether the shoulder had ever been dislocated before.


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Rotator Cuff Injuries


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Your rotator cuff is located in your shoulder area. It is made of muscles and tendons. It helps your shoulder to move and stay stable.

Problems with the rotator cuff are common. They include tendinitis, bursitis, and injuries such as tears.

Rotator cuff tendons can become inflamed from frequent use or aging. Sometimes they are injured from a fall on an outstretched hand.

Sports or jobs with repeated overhead motion can also damage the rotator cuff. Aging causes tendons to wear down, which can lead to a tear.


Some tears are not painful, but others can be very painful. Treatment for a torn rotator cuff depends on age, health, how severe the injury is, and how long you've had the torn rotator cuff.

Treatment for torn rotator cuff includes:

  • Rest
  • Heat or cold to the sore area
  • Medicines that reduce pain and swelling
  • Electrical stimulation of muscles and nerves
  • Ultrasound
  • Cortisone injection
  • Surgery


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Health Benefits of Eating Oats and Oatmeal


Oats are among the healthiest grains on earth.

They're a gluten-free whole grain and a great source of important vitamins, minerals, fiber and antioxidants.

Studies show that oats and oatmeal have many health benefits.

health puerto vallarta

These include weight loss, lower blood sugar levels and a reduced risk of heart disease.

Here are 9 evidence-based health benefits of eating oats and oatmeal.


What Are Oats and Oatmeal?

Oats are a whole-grain food, known scientifically as Avena sativa.

Oat groats, the most intact and whole form of oats, take a long time to cook. For this reason, most people prefer rolled, crushed or steel-cut oats.

Instant (quick) oats are the most highly processed variety. While they take the shortest time to cook, the texture may be mushy.

Oats are commonly eaten for breakfast as oatmeal, which is made by boiling oats in water or milk. Oatmeal is often referred to as porridge.

They're also often included in muffins, granola bars, cookies and other baked goods.

Oats are a whole grain that is commonly eaten for breakfast as oatmeal (porridge).


Oats Are Incredibly Nutritious

The nutrient composition of oats is well-balanced.

They are a good source of carbs and fiber, including the powerful fiber beta-glucan (1, 2, 3).

They also contain more protein and fat than most grains (4).

Oats are loaded with important vitamins, minerals and antioxidant plant compounds. Half a cup (78 grams) of dry oats contains (5):

  • Manganese: 191% of the RDI
  • Phosphorus: 41% of the RDI
  • Magnesium: 34% of the RDI
  • Copper: 24% of the RDI
  • Iron: 20% of the RDI
  • Zinc: 20% of the RDI
  • Folate: 11% of the RDI
  • Vitamin B1 (thiamin): 39% of the RDI
  • Vitamin B5 (pantothenic acid): 10% of the RDI
  • Smaller amounts of calcium, potassium, vitamin B6 (pyridoxine) and vitamin B3 (niacin)
  • This is coming with 51 grams of carbs, 13 grams of protein, 5 grams of fat and 8 grams of fiber, but only 303 calories.

This means that oats are among the most nutrient-dense foods you can eat.


Oats are rich in carbs and fiber, but also higher in protein and fat than most other grains. They are very high in many vitamins and minerals.


Whole Oats Are Rich in Antioxidants, Including Avenanthramides

avena 2Whole oats are high in antioxidants and beneficial plant compounds called polyphenols. Most notable is a unique group of antioxidants called avenanthramides, which are almost solely found in oats (6).

Avenanthramides may help lower blood pressure levels by increasing the production of nitric oxide. This gas molecule helps dilate blood vessels and leads to better blood flow (7, 8, 9).

In addition, avenanthramides have anti-inflammatory and anti-itching effects (9).

Ferulic acid is also found in large amounts in oats. This is another antioxidant (10).

Oats contain many powerful antioxidants, including avenanthramides. These compounds may help reduce blood pressure and provide other benefits.


Oats Contain a Powerful Soluble Fiber Called Beta-Glucan

Oats contain large amounts of beta-glucan, a type of soluble fiber.

Beta-glucan partially dissolves in water and forms a thick, gel-like solution in the gut.

The health benefits of beta-glucan fiber include:

  • Reduced LDL and total cholesterol levels (1)
  • Reduced blood sugar and insulin response (11)
  • Increased feeling of fullness (12)
  • Increased growth of good bacteria in the digestive tract (13)

Oats are high in the soluble fiber beta-glucan, which has numerous benefits. It helps reduce cholesterol and blood sugar levels, promotes healthy gut bacteria and increases feelings of fullness.




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Effects of Aging

It's no secret that our bodies change as we age. Some changes are obvious, while others are more subtle.

Many people age comfortably and remain active, alert, and vibrant throughout their lives. Their physiologic age may be quite younger than their chronological age.


agin in bones


Others may experience the effects of osteoporosis and osteoarthritis, which can gradually diminish their abilities to participate fully in activities.

Knowing what to expect and taking steps to counterbalance the effects of aging can help you maintain a young spirit and an independent life. A healthy diet, regular exercise program, and positive attitude can help delay the onset and slow the progression of many age-related changes.

The Effects of Aging

Aging Muscles:

  • As muscles age, they begin to shrink and lose mass. This is a natural process, but a sedentary lifestyle can accelerate it.
  • The number and size of muscle fibers also decrease. Thus, it takes muscles longer to respond in our 50s than they did in our 20s.
  • The water content of tendons, the cord-like tissues that attach muscles to bones, decreases as we age. This makes the tissues stiffer and less able to tolerate stress.
  • Handgrip strength decreases, making it more difficult to accomplish routine activities such as opening a jar or turning a key.
  • The heart muscle becomes less able to propel large quantities of blood quickly to the body. We tire more quickly and take longer to recover.
  • The body's metabolic rate (how quickly the body converts food into energy) slows. This can lead to obesity and an increase in "bad" cholesterol levels.

Aging Bones

Throughout life, bones constantly change through a process of absorption and formation called "remodeling." As we age, the balance between bone absorption and bone formation changes, resulting in a loss of bone tissue.

  • The mineral content of bones decreases, so that bones become less dense and more fragile.
  • As bones lose mass, osteoporosis develops, affecting both women and men. In the spine, osteoporosis can lead to crush fractures of the vertebrae, resulting in a "dowager's hump." Osteoporosis is also responsible for almost all hip fractures in older men and women.
  • The chemistry of cartilage, which provides cushioning between bones, changes. With less water content, the cartilage becomes more susceptible to stress. As cartilage degenerates, arthritis can develop.
  • Ligaments, connective tissues between bones, become less elastic, reducing flexibility.


Aging Joints

  • Joint motion becomes more restricted and flexibility decreases with age because of changes in tendons and ligaments.
  • As the cushioning cartilage begins to break down from a lifetime of use, joints become inflamed and arthritic.


Counteracting the Effects of Aging

Many of the changes in our musculoskeletal system result more from disuse than from simple aging. Less than 10 percent of Americans participate in regular exercise, and the most sedentary group is older than 50 years of age.

fitnessStretching is an excellent way to help maintain joint flexibility. Weight training can increase muscle mass and strength, enabling people to continue their daily routine activities without maximal exertion. Even moderate amounts of physical activity can reduce your risk of developing high blood pressure, heart disease, and some forms of cancer.

Long-term regular exercises may slow the loss of muscle mass and prevent age-associated increases in body fat. Exercise also helps maintain the body's response time, as well as its ability to deliver and use oxygen efficiently. Just 30 minutes of moderate activity, incorporated into your daily routine, can provide health benefits.

An exercise program doesn't have to be strenuous to be effective. Walking, square dancing, swimming, and bicycling are all recommended activities for maintaining fitness as we age.

The 30 minutes of moderate activity can be broken up into shorter periods. For example, you might spend 15 minutes working in the garden in the morning and 15 minutes walking in the afternoon. It all adds up.

But if you have never attempted an exercise program before, be sure to see your doctor before starting one now.

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Calcium is an essential mineral needed for bone health and just as important as any other product in your age-defying beauty regimen. Even though our bodies need calcium, we don’t produce the mineral. We get it from the foods we eat every day. Unfortunately, most people don’t get enough calcium.

The amount of calcium you require depends on your age and sex. Here is a breakdown of what you need on a daily basis.

To get the recommended amount of calcium, it is a good idea to make sure foods high in calcium are part of your diet. These include low-fat dairy products such as low-fat milk, yogurt, and cheeses, as well as calcium-fortified orange juice. A list of calcium sources can be found below.



Milk (skim), 8oz. 306mg Milk (low-fat, 1%), 8 oz. 290mg Milk (whole), 8 oz. 276mg Low-fat chocolate milk, 8 oz. 273mg

Nonfat yogurt, 8oz. 452mg Low-fat yogurt, 8 oz. 415mg Frozen yogurt, ½ cup 103mg

Goat cheese (hard) 1 oz. 254mg Part skim mozzarella, 1 oz. 207mg Cheddar cheese, 1 oz. 204mg Low-fat cottage cheese, 1 cup 15mg Feta cheese, 1 oz. 140mg

Sardines with bones, 3 oz. 325mg Canned salmon with bones, 3 oz. 181mg

Collards (frozen, chopped), 1 cup 357mg Turnip greens (cooked, frozen), 1 cup 249mg Okra (cooked), 1 cup 176mg Spinach (cooked, frozen), 1 cup 291mg

Vegetable lasagna, 1 piece 450mg Calcium fortified orange juice, 1 cup 300mg Cheese pizza, 2 slices 222mg Chocolate pudding, ½ cup 159mg Vanilla ice cream, ½ cup 85mg Almonds, ½ cup 162mg Soybeans (edamame), ½ cup 197mg Tofu, ¼ block 163mg Chickpeas, 1 cup 105mg Egg, 1 whole (cooked) 55mg

If it is difficult for you to get enough calcium through diet, it may make sense for you to take a supplement, such as a Citracal product.



In addition to calcium, vitamin D is needed for bone health. Your body also requires it to absorb calcium. Women and men up to 70 years of age need around 600 IU daily. After age 70, this increases to 800 IU per day.‡
There are three ways to get vitamin D: sunlight, food, and supplements. Because of the risk of skin cancer and the use of sunscreen, which limits your body’s ability to make the vitamin, most people rely on food and supplements to get their vitamin D. And since it is difficult getting all your vitamin D from food alone, many people may need to take supplements



Not getting enough calcium can lead to a disease called osteoporosis. This is a condition where your bones become fragile and break easily. The most common bones affected include the hip, backbone (spine), and wrist. Many people don’t realize they have osteoporosis until after they break a bone, which means that their bones had been losing strength for years.


Approximately ten million Americans have osteoporosis. The disease mostly affects White and Asian women, but others are vulnerable as well, including men. Women with the greatest risk include those who:

  • Have a family history of broken bones or osteoporosis
  • Have broken a bone while an adult
  • Had surgery to remove their ovaries before their periods stopped
  • Had early menopause
  • Have not gotten enough calcium throughout their lives
  • Had extended bed rest
  • Used certain medicines for a long time
  • Have a small body frame

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Puerto Vallarta. Live it more than once

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Experience of a Sea Turtle Release In Puerto Vallarta

When visiting Puerto Vallarta, make sure to ask your hotel if they carry out turtle releases. This is an activity for the whole family; it is undoubtedly a very emotional moment when you hold a baby turtle in your hand, and you give it a name and before laying it down on the sand; and you watch it move toward the sea at dusk. It will use its fins to move until the waves pull it into the ocean. Then it will start swimming, with the setting sun as beacon. The adventure of its life has begun.

There are eight species of sea turtles in the world, and six of them live in Mexico. Out of those, four species visit us in Puerto Vallarta: Olive Ridley turtle, Green turtle, Leatherback turtle and Hawksbill turtle. The Olive Ridley is the most numerous and the one that visits Puerto Vallarta beaches the most in this season to lay their eggs.


turtle release in puerto vallarta


The official turtle arrival season goes from August to December, but arrivals have been recorded as early as July. Male turtles spend their whole life in the ocean, only females return to their beach of birth to lay their eggs, about 100 of them each time.

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All sea turtle species are threatened by extinction, to some extent. This is why it is important to make efforts to ensure their permanence in the world. In Puerto Vallarta, official organisms and non-governmental organizations have made efforts for preservation and protection of sea turtles, and created turtle camps along the coast.

Hotels have joined such efforts and many have established nesting corrals on their beaches, where rescued nests are protected to ensure successful hatching of the eggs. The incubation process takes approximately two months.

When baby turtles hatch, they are released at sunset to give them a better chance of survival. At night they won’t be visible to predators.

To be able to witness the arrival of a mother turtle at the beach or to accompany the hatchlings on their way to the ocean is really a privilege to any human being. Once they have been released, sea turtles will spend at least eight years in the ocean before returning to the very beach where they were born. This is why we invite you to participate in the incredible experience of releasing a baby sea turtle.



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A Guide to Safety for Young Athletes

 orthopedic doctor puerto vallarta

For young athletes, sports activities are more than play. Participation in athletics improves physical fitness, coordination, and self-discipline, and gives children valuable opportunities to learn teamwork.
Because young athletes are still growing, they are at a greater risk for injury than adults. The consequences of overdoing a sport can include injuries that impair growth, and may lead to long-term health problems.

Fortunately, many youth sports injuries can be prevented. Some of the more effective ways to prevent these injuries include age-specific coaching, appropriate physical conditioning, and proper use of equipment.

In addition, coaches and parents can prevent injuries by fostering an atmosphere of healthy competition that emphasizes confidence, cooperation, and a positive self-image, rather than just winning. 

Differences Between Child and Adult Athletes  

Children Are Still Growing

The young athlete is not a smaller version of an adult. Children's bones, muscles, tendons, and ligaments are still growing, making them more susceptible to injury. In addition, there are significant differences in coordination, strength, and stamina between children and adults. 

Children Vary in Size and Maturity

Young athletes of the same age can differ greatly in size and physical maturity. Grade school students are less likely to experience severe injuries during athletic activities because they are smaller and slower than older athletes. High school athletes, however, are bigger, faster, stronger, and capable of delivering tremendous forces in contact sports. 

Children Can Injure Growth Plates

Growth plates are the areas of developing cartilage at the ends of long bones where bone growth occurs in children. The growth plates are weaker than the nearby ligaments and tendons. A twisted ankle that might result in a sprain in an adult, could result in a more serious growth plate fracture in a young athlete. Growth plate injuries have the potential to disrupt the normal growth of bone.


Common Youth Sports Injuries

Acute Injuries

Acute sports injuries are caused by a sudden trauma, such as a twist, fall, or collision. Common acute injuries include broken bones, sprains (ligament injuries), strains (muscle and tendon injuries), and cuts or bruises.

Most acute injuries should be evaluated by a doctor. Prompt first aid treatment should be provided by coaches and parents when the injury occurs. This usually consists of the RICE method: rest, applying ice, wrapping with elastic bandages (compression), and elevating the injured arm, hand, leg, or foot. This usually limits discomfort and reduces healing time. Proper first aid will minimize swelling and help the doctor establish an accurate diagnosis. 

Overuse Injuries

Overuse injuries occur gradually over time, when an athletic activity is repeated so often, parts of the body do not have enough time to heal between playing. Examples of overuse injuries include throwing injuries in the elbow, Achilles tendinitis, and shin splints.

Coaches may have more difficulty spotting less severe problems, however, because the pain is low grade and the athlete often ignores it. Repeat injuries may turn into overuse conditions, which can put the athlete on the sidelines for the rest of the season.

To keep athletes in the game long-term, overuse injuries need to be diagnosed and treated by a physician as soon as possible. Parents and coaches should be aware of the more common signs of overuse injury.

These include: 

  • Pain. This pain cannot be tied to an acute injury, such as from a fall. The pain often increases with activity
  • Swelling
  • Changes in form or technique
  • Decreased interest in practice

In the growing athlete's musculoskeletal system, pain from repetitive motion may appear somewhere besides the actual site of the injury. For instance, a knee ache in a child or adolescent may actually be pain caused by an injury to the hip.

Whether an injury is acute or due to overuse, a child who develops a symptom that persists or that affects his or her athletic performance should be examined by a doctor. A child should never be allowed to "work through the pain."


Strategies for Preventing Youth Sports Injuries

There are several strategies that coaches, parents, and athletes can follow to help prevent sports injuries. Most importantly, athletes should: 

  • Be in proper physical condition to play a sport (a pre-participation sports physical examinations can be very useful in screening for potential problems). 
  • Know and abide by the rules of a sport.
  • Wear appropriate protective gear (for example, shin guards for soccer, a hard-shell helmet when facing a baseball pitcher, a helmet and body padding for ice hockey)
  • Know how to correctly use athletic equipment (for example, correctly adjusting the bindings on snow skis)
  • Always warm up before playing
  • Stay hydrated
  • Avoid playing when very tired or in pain 

Proper Training

Young athletes need proper training for sports. They should be encouraged to train for the sport rather than expecting the sport itself to get them in shape.

Young athletes also should follow a regular conditioning program (in conjunction with their coach) with incorporated exercises designed specifically for their chosen sport. In addition, a well-structured, closely supervised weight-training regimen may modestly help youngsters prepare for athletic activities. 

STOP Sports Injuries

Many sports injuries in young athletes — particularly elbow and knee injuries — are caused by excessive, repetitive stress on immature muscle-bone units. Doctors are seeing an increase in overuse injuries because many young athletes are focusing on just one sport and are training year-round. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries.

Specific tips to prevent overuse injuries include:

  • Limit the number of teams in which your child is playing in one season. Kids who play on more than one team are especially at risk for overuse injuries.
  • Do not allow your child to play one sport year round - taking regular breaks and playing other sports is essential to skill development and injury prevention.

Atmosphere of Healthy Competition

Coaches and parents are also responsible for creating an atmosphere that promotes teamwork and sportsmanship.

Youth sports should always be fun. The "win at all costs" attitude of many parents, coaches, professional athletes and peers can lead to injuries. A young athlete striving to meet the unrealistic expectations of others may ignore warning signs of injury and continue to play with pain.

Young athletes must learn to deal with success and defeat in order to place events in a proper perspective. The promotion of the "win at all costs" ethic can have both short-term and long-term detrimental effects on impressionable young athletes.

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Nutrition and Osteoporosis: What You Should Know


Nutrition and Osteoporosis 1


The most important nutrients for people with osteoporosis are calcium and vitamin D.

Calcium is a key building block for your bones. Vitamin D helps your body to absorb calcium. 

How much should you get? It depends, in part, on your age and gender. 

For calcium: 

  • Children 1-3 years old should get 700 milligrams of calcium a day.
  • Children 4-8 years old should get 1,000 milligrams per day.
  • Teenagers should get 1,300 milligrams of calcium a day.
  • Adults up to age 70 should get 1,000 milligrams per day. Women 51 and over should get 1,200 milligrams/day.
  • Women and men 71 and over should get 1,200 milligrams per day.

For vitamin D: 

  • 600 international units (IU) of vitamin D per day from age 1 through age 70.
  • 800 IU daily after age 70.
  • Some osteoporosis experts recommend 800 to 1,200 IU of vitamin D per day.
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Common Knee Injuries

dr max greig orthopedic surgery puerto vallarta 1


In 2010, there were roughly 10.4 million patient visits to doctors' offices because of common knee injuries such as fractures, dislocations, sprains, and ligament tears. Knee injury is one of the most common reasons people see their doctors.

Your knee is a complex joint with many components, making it vulnerable to a variety of injuries. Many knee injuries can be successfully treated with simple measures, such as bracing and rehabilitation exercises. Other injuries may require surgery to correct.

Common Knee Injuries
Your knee is made up of many important structures, any of which can be injured. The most common knee injuries include fractures around the knee, dislocation, and sprains and tears of soft tissues, like ligaments. In many cases, injuries involve more than one structure in the knee.

Pain and swelling are the most common signs of knee injury. In addition, your knee may catch or lock up. Many knee injuries cause instability — the feeling that your knee is giving way.


The most common bone broken around the knee is the patella. The ends of the femur and tibia where they meet to form the knee joint can also be fractured. Many fractures around the knee are caused by high energy trauma, such as falls from significant heights and motor vehicle collisions.


A dislocation occurs when the bones of the knee are out of place, either completely or partially. For example, the femur and tibia can be forced out of alignment, and the patella can also slip out of place. Dislocations can be caused by an abnormality in the structure of a person's knee. In people who have normal knee structure, dislocations are most often caused by high energy trauma, such as falls, motor vehicle crashes, and sports-related contact.


Anterior Cruciate Ligament (ACL) Injuries

Dr. Max Greig ALC


 The anterior cruciate ligament is often injured during sports activities. Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments. Changing direction rapidly or landing from a jump incorrectly can tear the ACL. About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.



Posterior Cruciate Ligament Injuries

The posterior cruciate ligament is often injured from a blow to the front of the knee while the knee is bent. This often occurs in motor vehicle crashes and sports-related contact. Posterior cruciate ligament tears tend to be partial tears with the potential to heal on their own.

Collateral Ligament Injuries

Injuries to the collateral ligaments are usually caused by a force that pushes the knee sideways. These are often contact injuries. Injuries to the MCL are usually caused by a direct blow to the outside of the knee, and are often sports-related. Blows to the inside of the knee that push the knee outwards may injure the lateral collateral ligament. Lateral collateral ligament tears occur less frequently than other knee injuries.

Meniscal Tears

Sudden meniscal tears often happen during sports. Tears in the meniscus can occur when twisting, cutting, pivoting, or being tackled. Meniscal tears may also occur as a result of arthritis or aging. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Tendon Tears

The quadriceps and patellar tendons can be stretched and torn. Although anyone can injure these tendons, tears are more common among middle-aged people who play running or jumping sports. Falls, direct force to the front of the knee, and landing awkwardly from a jump are common causes of knee tendon injuries.


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Guidelines for Preventing Falls

Guidelines for Preventing Falls

Falls can happen anytime and anywhere to people of any age. However, as people get older, the number of falls and the severity of injury resulting from falls increases. According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of fatal and nonfatal injuries in people age 65 and older. Common injuries due to falls are head injuries, shoulder and forearm fractures, spine fractures, pelvic fractures, and hip fractures.

There is a pattern to falls among the elderly: The fear of falling, then the injury, followed by hospitalization, decreased independence and mobility, and often relocation to a nursing or residential institution.

<p">Falls can be a major life-changing event that robs the elderly of their independence.

 Fortunately, many falls can be prevented with healthy lifestyle choices and safety modifications in the home.


prevent falls for older adults


Facts about Falls and the Elderly

  • Each year, one out of three adults age 65 and older falls, according to the CDC.
  • In 2000, falls among older adults cost the U.S. healthcare system more than $19 billion, according to the CDC. That equals more than $28.2 billion in 2010 dollars.
  • According to the National Hospital Discharge Survey, more than 90% of hip fractures are caused by falling. Three-quarters of all hip fractures occur in women.
  • Approximately 25% of hip fracture patients will make a full recovery; 40% will require nursing home admission; 50% will be dependent upon a cane or a walker; and 20% will die within one year of the fall.
  • Causes  

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    Arthritis of the Foot and Ankle

    Arthritis of the Foot and Ankle

    Arthritis 1

    Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body, and is common in the small joints of the foot and ankle.

    There are more than 100 forms of arthritis, many of which affect the foot and ankle. All types can make it difficult to walk and perform activities you enjoy.

    Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.

    The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There can be other symptoms, as well, including:

    • Pain with motion
    • Pain that flares up with vigorous activity
    • Tenderness when pressure is applied to the joint
    • Joint swelling, warmth, and redness
    • Increased pain and swelling in the morning, or after sitting or resting
    • Difficulty in walking due to any of the above symptoms 


    The major types of arthritis that affect the foot and ankle are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.


    Osteoarthritis, also known as degenerative or "wear-and-tear" arthritis, is a common problem for many people after they reach middle age, but it may occur in younger people, too.

    In osteoarthritis, the cartilage in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful osteophytes (bone spurs).

    In addition to age, other risk factors for osteoarthritis include obesity and family history of the disease.

    Osteoarthritis develops slowly, causing pain and stiffness that worsen over time.


    The major types of arthritis that affect the foot and ankle are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

    Rheumatoid Arthritis


    Osteoarthritis that has progressed to bone rubbing on bone and bone spurs. (Bottom) Swollen, inflamed synovium and joint deformity are signs of rheumatoid arthritis.
    Reproduced from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

    Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body, and often starts in the foot and ankle. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

    Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages the bone and cartilage, as well as ligaments and tendons, and may cause serious joint deformity and disability.

    The exact cause of rheumatoid arthritis is not known. Although it is not an inherited disease, researchers believe that some people have genes that make them more susceptible. There is usually a "trigger," such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system begins to produce substances that attack the joints. 

    Posttraumatic Arthritis

    Posttraumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury.

    An injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated. In fact, following an injury, your body may actually secrete hormones that stimulate the death of your cartilage cells.





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