Thomas Bottiglieri, D.O.

Chief Sports Physician & WellnessDirector-ColumbiaOrtho-NYP, NYC. opinions my own. interests…Exercise Medicine, HRV, Concussion, Ultrasound.

[Thomas Bottiglieri, D.O. @DocBottsNY]

Excited to share our team's work on ProScope - a new AI-powered diagnostic tool that could transform how we detect concussions. By measuring unconscious head and neck stability patterns, we're able to identify concussions with 80-90% sensitivity in just 3 minutes. This technology addresses a critical gap in sports medicine, where up to half of the estimated 3.8 million annual concussions go unreported. Grateful to collaborate with Dr. Linus Sun, Christopher Driscoll, and the team at NewYork-Presbyterian and Columbia.
Read more at https://t.co/KAAAH39Ngv

#Concussion #SportsMedicine #MedicalInnovation

[Thomas Bottiglieri, D.O. @DocBottsNY]

@DrDiGiorgio @DrFerdowsi 100%. This has been and remains a power grab

[Thomas Bottiglieri, D.O. @DocBottsNY]

@MMAFighting @M2MMAofficial @contrariansmind

[Thomas Bottiglieri, D.O. @DocBottsNY]

@noahkaufmanmd @ethan45738438 Always check number of following and followers of these bots 🤖
This “person” is almost certainly a bot or fake account for the machine

Many fake accounts, paid to post accounts, bots, and others are designed to maintain existing structures.

[Thomas Bottiglieri, D.O. @DocBottsNY]

Exercise is medicine. 💊

[Louisa Nicola @louisanicola_]

Most people think exercise benefits the brain because it increases blood flow.

That is only part of the story.

Every workout triggers a cascade of biological signals from muscle, heart, liver, adipose tissue, and immune organs. These molecules travel throughout the body, influencing inflammation, energy metabolism, neuroplasticity, and cellular repair.

The result is not simply a healthier body.

It is a brain that processes information more efficiently, adapts more effectively, and resists degeneration for longer.

Your cognitive performance is not determined by the brain alone.

It is the product of constant communication between every major organ system in the body.

Exercise strengthens the entire network.

[Dutch Rojas @DutchRojas]

You’re worried about the debt.

Fine.
Name the line item.

It’s healthcare.
It has always been healthcare.

The federal government does not buy healthcare like a market.

It buys healthcare like a Soviet planning committee with lobbyists.

CMS sets prices.
Congress creates carveouts.

HHS writes rules nobody understands.

Then every trade association in Washington shows up to turn one sentence into a billion-dollar reimbursement advantage.

Friends on Ways and Means?
Congratulations. You found margin.

Protected category?
Congratulations.
You found a moat.

Special payment model?
Congratulations. You found a taxpayer-funded annuity.

Everyone wants to argue about Medicaid fraud in California or Minneapolis because it makes for a clean villain.

The real villain is bigger.

It is the entire healthcare bureaucracy pretending central planning becomes moral because the acronym is federal.

Medicare and Medicaid keep growing faster than the economy.

Healthcare already consumes roughly a third of federal spending.

Zero out foreign aid.
Zero out culture-war nonsense.
Zero out half the things cable news screams about.

The debt still wins because the machine keeps writing healthcare checks nobody priced in a real market.

This is why every serious debt conversation eventually ends in healthcare.

Not tanks.
Not Iran.

Not some DEI grant your uncle found on Facebook.

Healthcare.

The deficit is a hospital bill with a flag on it.

[Thomas Bottiglieri, D.O. @DocBottsNY]

So very well stated.

[Daniel Priestley @DanielPriestley]

Under capitalism, socialists are free to build socialism.

Under socialism, capitalists aren’t free to build anything.

Nothing stops a group of socialists pooling their money, forming a company, and splitting every wage and every pound of profit perfectly equally.... Or to donate all profit to the government.

It’s legal. It’s easy. Owning the means of production is as simple as setting up a company.

Marx wrote his manifesto before the invention of limited liability companies. Back then “seize the factory” meant seizing it from the handful of families who could afford one.

That argument expired the day anyone could start a company with limited liability, raise investment and hire who they want.

Socialists are free to lead by example and demonstrate their system works. They can out-recruit, out-motivate, out-build and out innovate based on their ideas if they like. It would prove the philosophy works. Capitalism will happily host their experiment.

The fact that nobody does this tells you a lot.

[Thomas Bottiglieri, D.O. @DocBottsNY]

Did you know that many ACL injuries happen without any contact at all?

A sudden pivot, awkward landing, or quick change in direction can place tremendous force on the knee, causing the ACL to tear. Dr. Thomas Bottiglieri breaks down the mechanics behind ACL injuries and explains why they are so common in sports.

Watch now and learn how these injuries occur and what athletes can do to reduce their risk.

#ACLInjury #SportsMedicine #KneeHealth #AthleteLife #SportsInjury #ACLRecovery https://t.co/1TCNV2neKc

[Thomas Bottiglieri, D.O. @DocBottsNY]

Stress kills.
Exercise, like other medicines, has a therapeutic dose.

[Alan Couzens @Alan_Couzens]

A question I get all the time:

"I have a busy life, and I only have a few hours to train each week. Shouldn't I make them count by going harder?"

No.

See, your body doesn't separate training stress from life stress.

If you're carrying a full-time job, poor sleep, family responsibilities, and financial stress, your "stress bank account" is already running too low for high-intensity training....

You're broke!

Your adaptation reserves are already being spent!

My latest...

Why Too Much Intensity Breaks Athletes:
Understanding Adaptation Energy

[Thomas Bottiglieri, D.O. @DocBottsNY]

🏃‍♂️ How soon can you return to sports after patella stabilization surgery?

Recovery is about more than just waiting a certain number of months. Dr. Thomas Bottiglieri explains why athletes typically return to sport around 7–9 months after surgery, and why strength testing, muscle balance, and sport-specific rehabilitation are critical before stepping back onto the field.

✅ Restore quadriceps strength
✅ Correct muscle imbalances
✅ Consider BFR therapy when appropriate
✅ Complete functional testing before return

Remember: Don't return based on time alone—return when your body is truly ready.

#SportsMedicine #PatellaStabilization #PatellaDislocation #KneeRehab #AthleteRecovery #Orthopedics #PhysicalTherapy #ReturnToPlay #SportsInjuryRecovery #DrThomasBottiglieri https://t.co/VbXSxqtPX9

[Thomas Bottiglieri, D.O. @DocBottsNY]

@tferriss nugget that reveals a lot about human nature and has undertones of the Dunning-Krueger effect..."'Gell-Mann amnesia effect.' This was coined by the incredible author, Michael Crichton, who created Jurassic Park, the original Westworld, the ER TV series, and countless others. From his Wikipedia page:
​
​[Crichton] explained that he had chosen the name ironically, because he had once discussed the effect with physicist Murray Gell-Mann, "and by dropping a famous name I imply greater importance to myself, and to the effect, than it would otherwise have."​
​
​Briefly stated, the Gell-Mann Amnesia effect works as follows. You open the newspaper to an article on some subject you know well. In Murray's case, physics. In mine, show business. You read the article and see the journalist has absolutely no understanding of either the facts or the issues. Often, the article is so wrong it actually presents the story backward-reversing cause and effect. I call these the "wet streets cause rain" stories. Paper's full of them. In any case, you read with exasperation or amusement the multiple errors in a story-and then turn the page to national or international affairs, and read with renewed interest as if the rest of the newspaper was somehow more accurate about far-off Palestine than it was about the story you just read. You turn the page, and forget what you know."

[Thomas Bottiglieri, D.O. @DocBottsNY]

I love the pseudo intellects crapping on osteopathic medical schools. Not very progressive and inclusive in their thinking. The inclusion only counts if it’s allowing virtue signaling that fits the fashionable positions.

[Brent A. Williams, MD @BrentAWilliams2]

Who is a better physician?

A DO from Kirksville with years of experience taking care of patients, or an MD from Yale who decides to create a “digital start up” after taking care of patients for 2 years?

[Thomas Bottiglieri, D.O. @DocBottsNY]

@MistersHomeRoom @DutchRojas Yes to this. Amen. How does local governance win again?
I don’t want to make America great again from the top down, I would prefer we do so by engaging our communities and governing ourselves as intended.
But how?

[Thomas Bottiglieri, D.O. @DocBottsNY]

@DutchRojas It was designed this way. Accurate.

[Thomas Bottiglieri, D.O. @DocBottsNY]

I still prefer the term post concussion syndrome for the complex, chronic symptoms that can occur after a sports related concussion. 🤕
It’s often the sequela of more than the most recent head injury, complicated by other factors.
It’s different than persistent concussion symptoms.

[Thomas Bottiglieri, D.O. @DocBottsNY]

When you get people to work for free, it seems like it’s efficient….ot is not: 👇🏼⬇️

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

This is one of the most persistent myths about Medicare: it has low overhead.

Medicare offloads all the billing, coding, compliance, quality metrics, EHR costs… all of it on private doctors and hospitals.

Of course their numbers look pretty.

Meanwhile, doctors spend 2h on the computer for every 1h of patient care time. That’s not captured in the Medicare overhead metrics. The median hospital employs 7 people full time just for quality metric compliance. That’s also not captured.

Those are just a few examples.

For the real story, talk to doctors that have dropped Medicare. They report a reduction in compliance costs of 90%.

That’s a massive burden on our healthcare system.

So spare me the low compliance cost tall tale. It’s a myth.

[Thomas Bottiglieri, D.O. @DocBottsNY]

Not every dislocated kneecap requires surgery, but certain anatomical and injury-related factors can increase the likelihood of needing surgical intervention.

In this Sports Medicine Minute, Dr. Thomas S. Bottiglieri explains how specialists evaluate patella instability, MPFL injuries, cartilage damage, and other risk factors to determine the most appropriate treatment plan.

Understanding the cause of recurrent kneecap dislocations is essential for restoring knee function and preventing future injuries.

Watch the full video and learn more about modern treatment options for patella dislocation and recovery.

#SportsMedicine #PatellaDislocation #KneeHealth #Orthopedics #MPFL #PhysicalTherapy #AthleteCare #InjuryRecovery #SportsInjuries #MedicalEducation https://t.co/s1ooXUF2bZ

[Thomas Bottiglieri, D.O. @DocBottsNY]

We have known about the anterolateral ligament for some time now. Those that began anatomical reconstructions have better outcomes. It is Time to update what we look
For on the MRI and practice patters in ACL surgery.

[Orthopedics Today @OrthoToday]

#ICYMI

Patients with ACL instability who underwent isolated ACL reconstruction had a reinjury rate of 10.3% compared with 4.2% in patients who underwent combined ACL and anterolateral ligament reconstruction.

https://t.co/KMLVxHnpUK

[Kevin Pho, M.D. @kevinmd]

A 77-year-old marathon walker developed a headache. Over the next four months, she was seen by a nurse practitioner, a PA twice, a medical assistant, and an emergency room. She was given two Medrol dose packs, NSAIDs, and a prescription for fluoxetine after a PA decided she had anxiety. She had never actually seen her primary care physician. She had giant cell arteritis. A sed rate of 41 confirmed it, the moment her neurologist finally examined her, took her history, palpated her temporal arteries, and asked about jaw claudication.

The patient told her neurologist: "if you think I need fluoxetine I'll be on it, but I don't think I'm anxious and this headache is just crazy."

The structural argument matters more than the cinematic detail. Team-based care is sold as a solution to the physician shortage. The math runs the other way. If a physician is the diagnostic instrument that holds the differential together on a multi-system presentation in a 77-year-old, the marginal cost of putting that physician in the room at visit 1 is zero. The marginal cost of NOT putting that physician in the room across this case was four office visits, an ER visit, two courses of steroids that partially masked the inflammatory signal, a misdiagnosis of anxiety, an SSRI prescription, and a delay in identifying a vision-threatening time-sensitive diagnosis. The team did not save physician time. It spent physician time everywhere except with the patient.

Reeta Achari, MD, a neurologist in solo private practice in Houston for 25 years, makes the operational case in plain terms. There is a physician shortage. The response has been to use physician time for documentation, prior authorizations, peer-to-peer calls, board recertification weeks, and electronic-record data entry. The response should have been the opposite. If there is a shortage of the diagnostic instrument, the workflow has to put the instrument in front of the patient, not behind four other people.

Her own response was structural. She opted out of Medicare. She built a quarterly subscription practice with prices middle-class patients can afford and scholarships for long-relationship patients. New patients get a one to one-and-a-half hour intake. Follow-ups get 30 minutes. The model is not concierge. It is continuity, priced to clear.

The diagnostic line from her conversation: "No physician touched her."

Listen to the full conversation on The Podcast by KevinMD. Link in the replies.

What does the cascade in your practice or your own care look like? Where in the workflow did the physician finally enter the room?

#ThePodcastbyKevinMD

[Thomas Bottiglieri, D.O. @DocBottsNY]

The future is now

[Noah Kaufman, MD @noahkaufmanmd]

We accepted our first Bitcoin payment @kaufcare today!

Saved over 3% on transaction fees alone. Final settlement. Wish all of our payments were in Bitcoin.

THANK YOU 🙂!!!

[Thomas Bottiglieri, D.O. @DocBottsNY]

Did you know a small ligament on the inside of your knee plays a major role in keeping your kneecap stable?

In this Sports Medicine Minute, Dr. Thomas S. Bottiglieri explains the Medial Patellofemoral Ligament (MPFL), how kneecap dislocations happen, and why proper diagnosis and rehabilitation are essential for recovery.

Watch now to learn more about patellar instability, MPFL injuries, and treatment options.

#SportsMedicine #KneeInjury #MPFL #PatellarDislocation #PhysicalTherapy #AthleteHealth #Rehabilitation #SportsInjuries https://t.co/6iBueCSVMY