Category Archives: Doc Blog

BAD TO THE BONE: Treating Knee Pain

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The knee is a very complex joint with many components making it vulnerable to a variety of injuries. When damaged, it can seriously impact your quality of life. Knee pain is one of the most common reasons people visit an orthopedic physician. Difficulty standing and walking can greatly diminish your sense of independence. The GOOD news is that most collective knee pain problems are treatable.

The CAUSES OF KNEE PAIN are many, including injury and disease. Injuries of the knee commonly seen tend to be damage to the anterior cruciate ligament, or ACL, and the meniscus. There are an estimated 2.5 million sports-related injuries a year just by adolescent athletes alone. A fracture is most often caused by trauma such as a car accident, a fall, or sports contact; the most common broken bone in the knee is the patella, more generally known as the kneecap.

Fast facts on knee injuries:

  • The highest knee injury rates occur in people between the ages of 15 to 24.
  • Sports participation is a high risk factor for knee injuries.
  • 60% of high school sports-related injuries occur in the knee.
  • Female basketball and soccer athletes are as much as 8 times more likely to suffer an ACL injury than a male.
  • Young athletes suffering an ACL injury will have an increased risk of arthritis as they age.

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Avoiding knee injuries:

  • Warm up properly prior to exercising or participating in sports.
  • Wear proper footwear with a good fit.
  • Don’t increase sports or exercise workouts suddenly.
  • Wear knee guards in sports activities.
  • Maintain strong, flexible leg muscles.
  • Always, always, always … Use a seatbelt when driving.

The MOST WIDESPREAD DISEASE affecting the knee is arthritis, which is caused by the gradual wearing-away of cartilage. Primary symptoms are pain, swelling, and stiffness in the knee. Currently, there is no “cure” for arthritis, however there are options, both surgical and non-invasive. Depending on the amount of arthritic damage, treating knee pain may often be done without surgery. These options may include one or a combination of physical therapy, weight control, injections, medications, bracing, exercise, and strengthening. When considering knee replacement surgery, the physicians and physical therapists at Sarasota Orthopedic Associates have a wide array of experience and expertise.

Whatever the cause of your knee pain, from sports injury to trauma to arthritis, the 13 physicians at Sarasota Orthopedic Associates are here to help alleviate your discomfort. We have four convenient locations. Browse here to view our physicians and their specialties or call us at 941-951-2663 to make an appointment.

Sources: SOA.md website; MediLexicon International; arthritis.org; webMD

MAY IS NATIONAL ARTHRITIS MONTH: Getting the Upper Hand on Arthritis

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According to the Arthritis Foundation, 46 million Americans live with arthritis or chronic joint symptoms. Arthritis symptoms limit everyday activities such as dressing, bathing, and cooking for more than 7 million Americans. Half of those Americans with arthritis aren’t aware of options now available to help alleviate their symptoms.

The most common forms of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis is a degenerative joint condition in which the joint cartilage deteriorates resulting in pain and loss of movement when bone begins rubbing against bone. Your hands are constantly on the go. Everyday activities such as preparing a meal, woodworking, carrying grocery bags, or using your computer may damage your joints over time. Fortunately, joint protection techniques may help reduce pain, stress, and inflammation. These techniques may also help prevent further deformities and increase your independence in daily activities. There are many easy and inexpensive ways to protect your hands.

Here are a few tips to keep your hands healthy:

 Give your Hands a Break

  • If you have pain during an activity, stop the activity. Pain is one of the best ways your body has of letting you know you are causing tissue damage, so listen to and respect your pain.
  • If writing is painful, try using a thick, rubber grip pen with a gel tip or roller ball to decrease the amount of pressure.
  • Remember to stretch and take breaks every 15 minutes during repetitive or prolonged activities such as needlework, painting, sewing, knitting and crocheting, hammering, and filing.
  • Use enlarged grips on every day equipment or tools to reduce strain on your joints; e.g. potato peelers, gardening tools, tooth brushes, hair brushes, or build up the handles with foam.
  • Keep scissors and knives sharp to minimize effort.
  • Always use two hands when lifting heavy objects. A gallon of milk weighs about 8 pounds, and lifting it with only your fingertips places excessive stress on your joints.

Don’t Use your Hand as a Tool

  • Don’t tear your mail open – use a letter opener to open mail.
  • Use utility scissors in the kitchen – do not rip open bags.
  • Always use the right tool for the job – use pliers for tight pinching and a small hammer for pounding.
  • Use a staple remover instead of your fingers and thumb.

Use Adaptive Equipment to Decrease Stress on your Joints

  • Use foam to enlarge small diameter objects such as paring knives, cutlery, toothbrushes, paint brushes, pens, and pencils.
  • Purchase lightweight kitchen, gardening, and workshop tools with built-up handles.
  • Perform a search on the Internet for “adaptive equipment” to see what products are available.

When Symptoms Become Severe

If you have already tried these techniques but are still experiencing symptoms, it might be time to consider a consult with an orthopedic specialist.  Gregory Farino, MD, a Board Certified/Fellowship Trained hand and wrist specialist at Sarasota Orthopedic Associates, can help you with providing an accurate diagnosis as well as treatment options.

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In the initial stages of arthritis, conservative management provided by a hand therapist may be all you need. Hand therapists can fabricate splints to support and protect the joints, recommend home exercises to improve strength in the small muscles of the hand, and educate you on pain management techniques.

If the arthritic process or your pain and stiffness is more severe, treatments like oral and topical medications or a cortisone shot may help relieve pain and improve mobility and strength. If conservative measures are not successful, surgery may be recommended. Joint replacement or joint fusion surgery has been consistently successful for both osteoarthritis and rheumatoid arthritis.

The hand and wrist team at Sarasota Orthopedic Associates is here to help you manage hand arthritis and stay as active as possible. We have four locations (Sarasota, Lakewood Ranch, Venice, and Bradenton) and offer same day appointments when necessary. Call us at 941-951-2663 for an appointment or visit our website at www.SOA.md for more information.

Note: Article written by Gregory Farino, MD, a Fellowship Trained and Board Certified Orthopedic Surgeon with a specialty in hand and wrist and Sangeetha Bulusu, OT, CHT, CLT (Occupational Therapist, Certified Hand Therapist, Certified Lymphedema Therapist). Both are available to see patients at Sarasota Orthopedic Associates.

Time Out with Johnny Gibbs, MD

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Our weekly blogs have given us fascinating insight to the more personal side of our SOA physicians. This week we sat down with Johnny Gibbs, MD, a Fellowship Trained, Board Certified Sports Medicine Physician, and learned a bit more about what makes him tick.

What inspired you to become a physician?

I originally started my career as a physical therapist, and learning more about disease processes, I developed a strong interest in medicine.  During my first year as a physical therapist, a young patient of mine, Claire, passed away from what seemed to be medical complications of her disease.  She was a young woman, in her thirties, a single mother, and wonderful person.  I will never forget how helpless I felt over her passing and as a result, was compelled to pursue medicine to help improve patient outcomes.

Why orthopedics?

My original interest in sports medicine and rehabilitation was sparked when I was a patient myself during high school.  That, along with a background in physical therapy, made it an obvious decision for me.

What do you love most about your job?

I love that I’m able to give people their active life back and alleviate their pain.   And, of course, I love the detail and intricacy of operating!

Gibbs with girl in cast   Gibbs surgery

What is your biggest challenge?

Trying to meet patient expectations while dealing with the constantly evolving challenges of the healthcare environment is an enormous task. At times our hands may appear to be temporarily tied as a result of changes in healthcare and insurance. I want patients to know I am their advocate.

If I weren’t an orthopedic physician I’d be a __________________.

That’s easy … If I weren’t an orthopedic physician I’d be a football coach.

Your proudest moment?

Even easier answer … Becoming a father to my children.

Where is the most interesting place you’ve travelled? Why?

Bamberg, Germany, a small picturesque town famous for its smoked beer. Why? It’s delicious!

Any hobbies? Activities?

I love sports, watching ESPN, exercising, golfing, and spending time outdoors with my children.

What’s your next adventure?

My wife and I are going on a European river cruise to celebrate her graduation from dermatolopathology training.

Your guilty pleasure food?

Chocolate chip cookies and preferably Otis Spunkmeyer.

NOTE:  Dr Gibbs is a board certified, fellowship trained orthopedic surgeon at Sarasota Orthopedic Associates with a specialty in sports medicine.  You may read his professional bio by visiting our website or clicking here. SOA has 13 physicians in four locations (Sarasota, Lakewood Ranch, Venice, and Bradenton) and offers same day appointments when needed.

Powerful TLC for Your Feet and Ankles

Eric James, MD is a Fellowship Trained orthopedic foot and ankle surgeon at Sarasota Orthopedic Associates. He specializes in foot and ankle advanced techniques and reconstruction of complex foot deformities. Dr James shares with us the importance of not neglecting our feet … they need a workout as much as the rest of our body!

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Stretch, Stretch, Stretch

Many common conditions affecting the foot and ankle can be attributed to, or worsened by, having a tight calf muscle. A large percentage of people have overly tight calf muscles and could benefit from a daily stretching routine. I prefer the runner’s stretch where the leg being stretched is straight behind you with the heel on the ground. This is done for varying periods of time, but I generally encourage a long, deep stretch.

calf stretch

Use the Little Muscles

The small muscles in our feet are often neglected and as they weaken, so does our foot’s ability to maintain correct alignment. Keep your feet strong by using them frequently. I recommend using the toes to pick up and grab objects off the floor. Spare sock on the ground? Grab it with your toes and avoid having to bend over while providing a work out for your feet.

Wear the Right Shoes

Finding the right pair of shoes can be challenging but makes a big difference in your foot health. Make sure you plan to try on shoes later in the day when your foot has done any swelling so you don’t end up buying shoes that are too small. Wear activity appropriate shoes. Try to limit high heel wear and shoes that are too small or pointy in the toe box. These shoes can lead to numerous problems like foot pain, bunions, hammertoes and neuromas.

Check Your Feet

It is a good idea to do a check on your feet daily when you shower or bathe. Check for any skin irritation, blistering, or other abnormalities. This is particular important if you have diabetes or neuropathy (loss or abnormal sensation) in the feet.

Our feet and ankles are very important and we need to keep them healthy! Let us know if we can help in maintaining your foot and ankle health!

NOTE: Eric James, MD is one of 13 physicians at Sarasota Orthopedic Associates treating conditions of the joints, spine, and muscles. We offer same day appointments when needed. Call 941-951-2663 for an appointment at any of our four locations: Sarasota, Lakewood Ranch, Venice, or Bradenton.

Thumbs Up for Dr Gregory Farino

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This interview marks the halfway point in chatting with our physicians at Sarasota Orthopedic Associates. Dr Gregory Farino, a Fellowship Trained and Board Certified orthopedic surgeon, has a specialty in hand and wrist conditions. Take a look at what inspires Dr Farino and what he does in an occasional spare moment:

What inspired you to become a physician?

I wanted to do something in the sciences where I could be useful and helpful to others. Initially during college, I was going to be a teacher but after spending some time with a few different MDs, decided to pursue medicine.

Why orthopedics?

As a medical student, I thought I would pursue primary care but after rotating through, sensed it wasn’t the right fit for me. I decided to try orthopedics in my 4th year of med school. I did a rotation at Einstein hospital in Philadelphia and worked with a great group of guys. They let me do an entire surgery and I was hooked. I decided to apply for an orthopedic residency.

What do you love most about your job?

Obviously the job is challenging in many ways but I enjoy knowing that the things I do and decisions I make translate into another person feeling better and functioning better. It is satisfying to know all of the time and effort I spent in training allows me to do something useful, not just for myself, but for everyone I see.

What is your biggest challenge?

Dealing with imperfection. I don’t handle failure well at all. I expect 100% success with what I do. Logically, I know it’s not possible but I expect it anyway. That creates unhappiness for me when things turn out less than my expectation.

If I weren’t an orthopedic physician I’d be a ____________.

I’m not sure. Maybe a college professor in history.

Your proudest moment?

I have to say my proudest moment was probably the day I matched in orthopedics at Penn State. It was my first choice and the culmination of 8 years of really hard work.

Where is the most interesting place you’ve travelled? Why?

Sicily. It has everything: food, wine, beautiful vistas (the sea, mountains, an active volcano), fascinating history and great people.

Any hobbies? Activities?

I like to read mostly ancient Greek history and early American history. I am teaching myself to play the guitar and ukulele.

What’s your next adventure?

I usually have a trip planned but don’t at this time. I would love to go back to Italy.

Your guilty pleasure food?

It’s a tie: pizza and French fries.

 NOTE:  Dr Farino, MD is one of 13 physicians at Sarasota Orthopedic Associates. He is Fellowship Trained and Board Certified with a hand/wrist specialty. You may read his medical biography and CV by clicking here. SOA offers four locations (Sarasota, Lakewood Ranch, Venice, and Bradenton), and provides same day appointments when needed. Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

One-on-One with Trevor Born, MD

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The past few weekly blogs have provided insight to our physicians on a personal level with our one-on-one interviews.  This week, we sit down with Trevor Born, MD, who is Fellowship Trained in Sports Medicine. Dr Born is a Bradenton native with impressive local accolades and we’re so pleased he returned to Florida after completing his medical education.

What inspired you to become a physician?

A couple reasons: Seeing the positive role physicians have in their patients’ lives, including my family members. Also knowing that physicians are constantly challenged and driven to continue the learning process not only for themselves but to further advance their patient care abilities.

Why orthopedics?

Why not? I was mainly drawn to orthopedics from my love for sports. I always thought, “Man, how awesome would it be to be the team doc for the Gators?” Coupled with the fact that building, architecture, and math were always passions of mine, the decision to pursue Orthopedics was a pretty easy one for me to make.

What do you love most about your job?

Establishing relationships with patients as I treat them for their chronic conditions or as they proceed on their journey to recovery from a serious injury. That about sums it up.

What is your biggest challenge?

Following Gator sports too much and their recent struggles? Really though, the most difficult struggle in today’s medical landscape is finding more time to care for and get to know my patients.

If I weren’t an orthopedic physician I’d be an ________

Architect, teacher, or musician.

Your proudest moment?

That would be whenever I receive a letter from a patient or their family members letting me know how thankful they were for the care I provided.  Not many other moments out there make me feel as thankful and proud of my role as a physician.

Where is the most interesting place you’ve travelled?  Why?

Yellowstone National Park. The natural wonders and wildlife, scenery, volatile terrain, and how much of it is still truly unknown makes it pretty interesting in my mind.

Any hobbies?  Activities?

Guitar/music as I have been playing since middle school and there is never a party that could not benefit from a little guitar. When I have the chance I like following Gator sports and continuing to play golf, basketball, and tennis.

What’s your next adventure?

Starting a family.

Your guilty pleasure food?

Dark chocolate.

NOTE: Trevor Born, MD is Fellowship Trained in Sports Medicine with a specialty in upper and lower extremities. You may read his professional medical biography by clicking here.  Dr Born is one of 13 SOA physicians in four locations (Sarasota, Lakewood Ranch, Venice, and Bradenton). Sarasota Orthopedic Associates offers same day appointments when needed.  Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

INSPIRATION JUST AHEAD — Meet Dr Kim Furman

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The fifth in our series of getting to know our SOA physicians on a personal level features Dr Kim Furman, Fellowship Trained and Board Re-Certified Orthopedic physician.  Dr Furman specializes in hip and knee joint replacements, and there’s an inspirational side of him you may not know.  Read about it here:

What inspired you to become a physician?

Great question but difficult to answer.  Since age 9 while growing up in Brooklyn, I wanted to go into medicine. Perhaps I was influenced by my next door neighbor, who was general physician, as well as my childhood pediatrician, who made house calls, when I was sick.  Surprisingly, my parents never directed me to the medical field but fully supported my decision.

Why orthopedics?

Several factors influenced my decision for Orthopedics.

As a kid, I was always working with my Dad in his basement workshop, building and repairing all sorts of stuff.  I was mechanically inclined and loved working with my hands.

For 7 years, while in college and medical school, I was an operating room technician at Columbia Presbyterian Medical Center. I had the opportunity to work with all the surgical specialties.  I was fascinated by reconstructive plastic surgery and this became my initial focus.  During that time I suffered a traumatic knee injury.  A close friend of my family was an orthopedic surgeon.  He took care of my knee injury and had a significant impact on redirecting my focus to orthopedics.

While continuing work at Columbia Presbyterian, I rotated through orthopedics.  It was at that point that my decision for orthopedics was solidified.  I loved all the neat tools that were used.  Working on fixing fractures was just like woodworking I did as a kid and continue to do now.

Unfortunately, I suffered numerous complications from my knee injury and seven surgical procedures later resulted in significant knee arthritis.  My personal experience with my injury, multiple surgeries, and arthritis has given me an inside view of the problems of my patients.  I can empathize easily with them.

What do you love most about your job?       SOAStudio-170

The gratification I get from returning a patient to a pain free life style.

What is your biggest challenge?

The ever changing medical environment (insurance, government intrusion) that has taken away the true art of medicine and has made it a business.

If I weren’t an orthopedic physician I’d be an ________________.

Anthropologist/archaeologist

Your proudest moment? 

The birth of my 2 children.

Where is the most interesting place you’ve travelled?  Why?

China, because of the incredible history and culture developments.

Any hobbies?  Activities?

Woodworking, gardening, fishing and traveling.   I was an avid softball, tennis, and paddleball player before my knee arthritis limited those activities.

What’s your next adventure?

A trip to the Antarctic.

Your guilty pleasure food?

Pepperoni pizza

NOTE:  Dr Kim Furman is  a Fellowship Trained and Board Re-Certified Orthopedic Surgeon. He specializes in the treatment of arthritic knees and hips and has been with Sarasota Orthopedic Associates for 30 years. You may read his medical CV by clicking HERE.  SOA treats both adults and children in four locations (Sarasota, Lakewood Ranch, Venice, and Bradenton) and offers same day appointments when needed. For more about SOA, click HERE, or call 941-951-2663 for an appointment.

A CLOSER LOOK AT DR ERIC JAMES – Orthopedic Foot & Ankle Surgeon

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In our ongoing series of SOA physician interviews, we’re getting an up close and personal look at each of our physicians.  This week, we asked Eric James, MD, orthopedic foot & ankle surgeon at Sarasota Orthopedic Associates, to answer some questions and share his thoughts with us.

What inspired you to become a physician?

In middle school I began shadowing a family friend who was an orthopedic surgeon. I found it to be very interesting and it really stuck with me. I studied engineering in college so I would have a broad background, but knew I wanted to work in orthopedics… so, here I am!

Why orthopedics?

I have always been more of a mechanically minded person and there is no better field than orthopedics for the mechanic/engineer/tinkerer. A lot of what we do on a daily basis is correcting biomechanical abnormalities, so it really fit me well.

What do you love most about your job?

Seeing someone complete the process of healing and have an opportunity to get back to doing the things they love.

If I weren’t an orthopedic physician I’d be an __________________.

Engineer, programmer, product designer, something in the technology field.

Where is the most interesting place you’ve travelled?  Why?

Costa Rica for a surfing trip before college started. We spent a good deal of time immersed in the culture and I have a lot of great memories from that trip

Any hobbies?  Activities?

I enjoy being outside and particularly on the water. I grew up surfing, fishing and diving, so I am starting to get back into some of that. I just took up paddle boarding, which is a lot of fun and great exercise too!

What’s your next adventure?

I am in the process of getting recertified for diving and I am looking to get back into spearfishing. Otherwise, I am looking forward to a relaxing vacation as season winds down!

Your guilty pleasure food?

Mint chocolate chip ice cream

Note: Eric James, MD is a fellowship trained orthopedic foot & ankle surgeon at Sarasota Orthopedic Associates.  You may read his professional biography  and watch his video on our website here. SOA has four locations in Sarasota, Lakewood Ranch, Venice, and Bradenton and we offer same day appointments when needed. For an appointment with Dr James or any of our 13 physicians, please call 941-951-2663.  Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

GETTING TO KNOW YOU – Paul Lento, MD

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Last week we featured Dr Michael Gordon. This week, we asked the same questions of Paul Lento, MD, a triple board certified Physical Medicine & Rehabilitation physician here at SOA.

What inspired you to become a physician?

Not so much “what” but “who”.  My father had a pretty strong influence on my decision. He often talked that I should choose a career to help improve people’s lives but was also challenging. I thought medicine would be the best avenue to achieve both of these goals.

Why Physical Medicine and Rehabilitation (PM&R)?

While I was a General Medical Officer in the Navy taking care of Marines, I realized most of the personnel I saw had non-surgical orthopedic injuries, which often improved with a good rehabilitation program. PM&R focuses on several non-surgical options while treating the entire person, not just one body part.

What do you love most about your job?

Probably learning about the interesting things my patients have done in life. I have seen patients who have played professional tennis to those who taught Vivien Leigh how to talk with a southern drawl. One patient of mine was a bomber pilot in WWII.  Truly amazing people.

(Editorial Note: For the “younger” folks, Vivien Leigh was best known for her two Academy Award winning roles from classic movies as Scarlet O’Hara in “Gone With The Wind” and Blanche DuBois in “Streetcar Named Desire”.)

What is your biggest challenge?

Explaining to patients that I’m not an orthopedic physician. People look at me like I must be from another planet. The specialty of PM&R is very small and not well-known but I chose it as I think it has a lot to offer patients.

If I weren’t an orthopedic physician I’d be a _____________.

Fishing boat captain or a bartender on a beach in St. Barths.  Who knows, maybe combine the two when I retire?

Your proudest moment?

The times when I see my kids being kind to other people.

Where is the most interesting place you’ve travelled?  Why?

While I’ve been to different countries, I would have to say Salt Lake City during the 2002 Winter Olympics. I saw and met people from all over the world. It was like circling the globe in two weeks without having to leave the U.S.

Any hobbies?  Activities?

I love to fish. I would try to fish in any body of water if given the chance. It’s one of the reasons I moved to Florida.

What’s your next adventure?

I may explore Italy in the next year or two if I can get away.

Your guilty pleasure food?

Having lived in both Chicago and Philadelphia, I would have to say deep dish pizza and soft pretzels.

Paul Lento, MD is triple board certified and a Castle Connelly “Top Doc”.  You may read his medical biography by visiting our website here. To make an appointment with Dr Lento, call 941-951-2663. Sarasota Orthopedic Associates has 13 physicians across 4 locations (Sarasota, Lakewood Ranch, Venice, and Bradenton) and we offer same day appointments when needed. Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

GETTING TO KNOW YOU –Michael Gordon, MD

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Over the next several weeks we’ll be asking each of our physicians to reveal a more personal side that extends beyond their medical biography. This week, we spoke with Dr Michael Gordon, who is Fellowship Trained and Board Certified in treating hands, wrists, shoulders, and elbows and sees adults and children of all ages.

What inspired you to become a physician?

I wanted to be able to help people in a tangible and meaningful way. I enjoyed creating and tinkering with and fixing things as a child. You could say I was the neighborhood mechanic. I even built a boat with my father as a summer project.

Why orthopedics?

It’s most similar to architecture, mechanics, and carpentry, and, provides gratification of fixing or restoring function to the anatomy. When I considered applying to medical school, I shadowed an orthopedic surgeon and watched him return the ability of walking to people. It was very inspiring.

What do you love most about your job?

Seeing the faces of joy and gratitude when patients have recovered from their injury or condition.

What is your biggest challenge?

Not having enough time.

If I weren’t an orthopedic physician I’d be a ________.

Rock Star

Editorial Note:  Dr Gordon plays guitar and sings in the band “McDreamy and the Anatomy”, a group consisting solely of physicians! The band competed at the “DR IDOL” fundraising event for Boys & Girls Club a few years ago when they rocked the crowd and won the title.

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Your proudest moment?

Becoming and being a father to two amazing daughters.

Where is the most interesting place you’ve travelled?  Why?

I’m not fond of trying to name the “best”, “favorite”, or “most” because there are so many great places. I would say Thailand, Japan, and Israel were culturally interesting, but Europe is wonderful too. The US has amazing resources that we sometimes forget like the Grand Canyon and Yosemite.

Any hobbies?  Activities?

Music, Music, Music. Exercise has also become a central part of my life.

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What’s your next adventure?

I’d like to make it to the Great Barrier Reef for scuba diving. I haven’t made definite plans, but it’s on my list. Also the Red Sea.

Your guilty pleasure food?

Cheetos.

You can read Dr Gordon’s professional biography by clicking here.  Michael Gordon, MD is one of thirteen physicians at Sarasota Orthopedic Associates.  With three locations and same day appointments, our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.