Clinical Medicine

I’ve joined the prolotherapy volunteer clinic every year since 2023. This year (2026-10-03), Dr. David Wang (David C. Wang, DO, founder of Virtuosity Physical Medicine in Reston, Virginia, USA) taught a method for out-of-plane needling. The whole system comes down to three angles and three numbers, and as soon as I heard it I wanted something I could pull out and check at any time. So when I got back, I turned my recording into notes (using lecture-to-notes, a tool I open-sourced earlier), then built a web page around it. It’s bilingual (English and Chinese) and made for phones first: ...

Let me start with the one thing you need to remember most: osteoporosis has almost no symptoms before a fracture. It doesn’t ache, it doesn’t hurt, and it isn’t uncomfortable. The bones hollow out bit by bit. By the time you have symptoms, you’ve usually already crushed a vertebra just bending over to lift something, or fractured your hip slipping in the bathroom. So the phrase “I’m perfectly healthy, I don’t feel anything wrong” is completely useless when it comes to osteoporosis. ...

Let me say the most important thing first: when older folks walk slower, complain of being tired, and lose their strength, it’s not “just getting older." It has a name—frailty—it has clear diagnostic criteria, and the earlier you deal with it, the better you can stop it. I’m writing this for anyone with older relatives at home. What is frailty, exactly? Frailty isn’t a disease; it’s more like your body’s savings account running low. ...

Let me say the most important thing first: when some elders “take things lightly, have fewer friends, and like to be quiet by themselves,” it doesn’t necessarily mean something is wrong; it might be a healthy shift in mindset. Gerontology calls this “gerotranscendence”: the body slowly declines, but the mind actually becomes calmer and knows more clearly what it wants. This post is an extension of Does an 80-year-old still need to exercise?, written for those of you worrying about why your older family members are getting “more and more indifferent.” ...

Let’s start with the most important point: When older adults with dementia say “I’m fine, no problem,” it’s often not stubbornness, nor a refusal to face reality. It’s that their brain literally cannot detect its own decline. In medicine, this is called impaired insight, and it’s a part of dementia itself. This is an extension of the post Do 80-Year-Olds Still Need to Exercise?, written for those of you who are caring for a family member with dementia and feeling frustrated that “they won’t admit it and won’t listen.” ...

Let’s start with the most important thing: depression in older adults often doesn’t look like “depression." They might not cry or say they’re sad. Instead, it turns into aches and pains all over, poor appetite, bad sleep, and a lack of energy for everything. And so it’s very easy for the whole family (sometimes even physicians) to write it off as “that’s just what happens when you get old,” and quietly miss it. ...

First, the most important sentence: the harder you push someone to change, the more they will defend “not changing”; letting them state their own reasons for wanting to change is how change actually happens. This conversational method is called “motivational interviewing.” Healthcare professionals use it to talk to patients about quitting smoking, exercising, and controlling blood sugar, but it works just as well for persuading your parents to exercise or your partner to see a doctor. ...

Let’s start with the most important point: telling people to exercise rarely works, not because you haven’t said enough, but because you’re talking to the wrong “stage." Psychology research shows that when someone changes a habit (starting to exercise, quitting smoking, or controlling their diet), they go through five stages, and what works at each stage is completely different. Throwing an exercise routine at someone who hasn’t even considered moving is like pitching a loan to someone who isn’t looking to buy a car. It’s bound to fail. ...

One of my original intentions in becoming a physiatrist was hoping to help patients recover and improve their quality of life with more than just medications. I was fortunate earlier this year to attend a lecture by Dr. Tso-Liang Wang, president of the Somategrity Academy. He shared insights from his many years of practicing manual therapy and how he uses it to help patients improve. In Dr. Wang, I saw my ideal image of a physiatrist, and I also heard him highly recommend a brand new course in Taiwan—DAI Osteopathy (D’Ambrogio Institute). ...