Nancymd

My husband is a pulmonary critical care doc. He keeps people breathing for a living. I keep people moving for a living. Our dinner table conversations are not for the faint of heart.

But here’s what I actually want to say today. He lets me sing loud even when I absolutely cannot hit the notes. He’s my rock when I chase big dreams. He’s stable and steady when I’m constantly on the move, and somehow he grounds me without ever holding me back.

As a dad, he’s patient. He leads by example. And his dad jokes are the best and the worst at the same time, which I think is the whole point.

Happy Father’s Day to him and to every dad out there being a role model just by showing up.

Once a month I make the drive to the Oregon coast to serve a rural community as a visiting surgeon. It takes me away from my family for a day or two, but it also gives me something I didn’t expect: space to breathe.

Today after surgery, I walked the beach alone. Heart rate monitor on, tracking my aerobic zone, doing the longevity thing.

And then I looked up and it hit me.

14 years ago I was a new mom and a brand new orthopedic surgeon at the same time. I blinked. And here we are, a decade and a half later.
We can chase longevity and we should. But the life we are trying to protect is also happening right now, in between the data and the optimization. The walks, the wonder, the quiet moments after a long day.

Don’t miss them.

For more on joint preservation, women’s health, and living well through midlife, follow along on Instagram at or subscribe on YouTube at .

Mismatched scrubs. Again.

My inner perfectionist is not happy. But at least I have pants on.

Some days that’s the win. And honestly? Practicing that pivot on the small stuff is exactly what trains you for the big stuff. I see it in my patients every day. The ones who come out the other side aren’t the ones with the easiest road. They’re the ones who know how to keep going.

Pants on. Purpose intact. Let’s go.

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A landmark study out of Oxford just gave us the clearest molecular map of osteoarthritis we have ever had. And it confirmed something I have believed for a long time: what is happening inside your joints is not just a structural or mechanical problem. It is a biology problem.

Researchers analyzed synovial fluid (the lubricating fluid in your knee) from over 1,300 patients and measured more than 7,000 proteins per sample. The conclusion? Osteoarthritis is one disease with shared core pathways related to tissue injury and repair. But here is the part that really matters for those of us treating patients: factors like obesity, s*x, and age create variation in how that biology plays out. In patients with obesity, additional inflammatory signals were present in the joint, not the same kind seen in rheumatoid arthritis, but a tissue-injury response linked to systemic inflammation from excess fat tissue.

This is the question I ask in clinic all the time: why does one 250-pound person have no arthritis and another has bone on bone? It is not just the load. It is the environment the body is creating around those joints.

I want to be clear about something. There are excellent cartilage restoration procedures out there, and I perform them. MACI, osteochondral grafting, microfracture. But these work best for contained, traumatic cartilage defects, not necessarily for widespread wear-and-tear arthritis. I think patients sometimes get confused about this distinction and it matters deeply for making the right decision.

What this research reinforces is the case for treating the biological environment of the joint, which is exactly the philosophy behind regenerative medicine and behind the JointSpan approach. Local treatment of the joint environment plus attention to what is happening systemically.

The researchers also specifically noted that perimenopausal women face higher risk for accelerated OA progression. This is not a footnote. This is a reason to take your joint health seriously now, in midlife, not after things have progressed.

This study is a step toward treatments that actually modify the disease, not just manage symptoms. And it validates the conversation I want to keep having with you.

Full study in stories. Take the JointSpan quiz at f2ortho.com/jointspan-md-quiz to understand where your joint health stands today.

We all have our kryptonite.

I’m an Orthopedic surgeon. Seen things. Done things. Totally unbothered by most of it.

…and then I found this video.

I fix bones for a living. I have zero issues in the OR. But phlegm-adjacent modern dance? That’s my limit and I found it today.

We all have that one thing. What’s yours? Tell me in the comments because I need to feel less alone right now.

Follow for more from your favorite surgeon who is also, apparently, a normal person.

When they tell you that you don’t belong, caw and do it anyway.

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Some days are hard. That is the truth of building something meaningful.

There are decisions that keep you up at night. Moments of doubt. Seasons where growth feels invisible. Nobody covers that in medical school or residency.

But years into this work, here is what I know: the hard things do not stop. They just change shape. And slowly, you become someone who can meet them.

Every challenge I have walked through has made me sharper, more grounded, and more committed to the kind of care I set out to deliver. Setbacks are not the opposite of progress. They are part of it.

If you are in a hard season right now, whether in medicine, in business, or in life, I see you. Keep going.

Follow along for real conversations about medicine, leadership, and building something that lasts.

My top 5 horror movies – orthopedic joint preservation edition.

1. The Dismissal: The Perimenopausal Edition. You describe months of joint pain, swelling, and lost function. The doctor glances at your X-ray and says: “Looks normal to me. You’re probably just getting older.” You are 48. You are not “just getting older.” Your estrogen is shifting, your joints are paying for it, and no one in that room knew to connect the dots.

2. Minimal Arthritis, Maximum Advice. First opinion for mild arthritis: “You need a total knee replacement.” Record scratch. Slow zoom on an X-ray that looks… basically fine.

3. The Seven-Minute Consult. You waited six weeks for this appointment. You have a complex history, three questions, and real fear about your future. The doctor is out the door in seven minutes. The white coat is already gone. A stethoscope swings in the breeze.

4. “That’s Not Real Medicine.” You ask your doctor about PRP or biologics. They say: “That’s voodoo. There’s no evidence.” Cut to: a stack of peer-reviewed literature slowly rising from the floor. Ominous organ music.

5. Surgery or Nothing. Or Wait Until It’s Bad Enough. You’re 48. You have moderate joint disease. You want options. The surgeon looks you dead in the eye and says: “Your only option is replacement. Come back when it’s bad enough.” The lights flicker. The consent form slides across the desk by itself. A calendar flips forward. It says 2031.

If any of these hit a little too close to home, my door is open. Link in bio to learn more about joint preservation and what’s actually possible. f2ortho.com

15 years in practice and every now and then a case makes you stop and go… whoa.

This is a prepatellar bursa. It sits over your kneecap and cushions the front of your knee. Most of the time you never think about it.
Until it looks like this.

This patient couldn’t kneel, couldn’t move comfortably, couldn’t even roll over in bed. When it gets to that point, we take it out. Full bursectomy. Clean removal.

And yes, that specimen is the size of my fist.

A note on steroid injections: I’m cautious. If there’s any bacteria in that fluid and you inject steroid, you can turn an annoyance into a serious systemic infection fast. I’ve seen it. So I’m selective about when I go that route.

Happy to report this patient is back to projects around the house, sports, and life without an extra passenger on their knee. 🙌

Learn more about the conditions I treat at F2ortho.com

🤦🏻‍♀️ Naomi Osaka recently hosted a dinner for Black players ahead of the French Open. The criticism that followed called it exclusionary.

Before we engage with that criticism, it is worth understanding the history of what Black athletes have actually experienced in tennis.

Althea Gibson became the first Black player to compete at the U.S. National Championships in 1950, only after a fellow player publicly advocated for her inclusion. The sport’s gatekeepers had not done that on their own. Venus and Serena Williams arrived decades later and faced a different but persistent form of scrutiny. Their athleticism was questioned, their appearances commented on, their emotions labeled as aggression rather than competitiveness. Their father Richard, who coached them from a Compton public court to the pinnacle of professional tennis, was a frequent target of ridicule. They became two of the greatest players the sport has ever seen and still spent their careers having to prove they belonged.

That is the context. That is what preceded a dinner.
This dynamic is not unique to tennis. In orthopedic surgery, we see the same pattern.

Black orthopedic surgeons founded the Gladden Society to create a professional space where their experiences, their challenges, and their achievements could be acknowledged without requiring justification. Women represent a minority of orthopedic surgeons in the United States. In response to that reality, the Ruth Jackson Orthopaedic Society was established for female orthopedic surgeons, and FORUM was created specifically for women in orthopedic sports medicine. Both organizations have, at various times, been criticized as exclusionary.

What happens inside those spaces tells a different story.

Clinical education happens. Career development happens. Mentorship happens. But something else happens too. In rooms where people share a common lived experience, conversations become possible that cannot happen elsewhere. I have witnessed female surgeons disclose for the first time that they experienced s*xual assault during their surgical training. They spoke in those rooms because safety existed there in a way it did not in the broader professional environment.

These organizations were not founded to divide. They were founded because division already existed and nobody in the majority had thought to question it.

When a marginalized group creates its own space, the most useful question is not “why are they excluding others?” It is “what was present in the broader environment that made this necessary?”

That question is worth sitting with.