Why treating shoulder pain in baseball pitchers and other throwing athletes is so difficult

“The results of treatment are not as predictable as the patient, family, trainer, coach and doctor would like to think,” according to an article in the journal Physical Medicine and Rehabilitation Clinics of North America.

Nickolas Garbis, MD, an orthopedic surgeon who specializes in shoulder and elbow injuries at Loyola University Medical Center, is the primary author.

Shoulder pain occurs in athletes who play sports that require rapid acceleration and deceleration of the throwing arm. They include baseball pitchers, tennis players, softball pitchers and javelin throwers, as well as athletes who play handball and water polo.

Overhead throwing generates a large amount of stress on the shoulder, which is one of the most mobile joints in the body. This makes it vulnerable to injury.

It is difficult to diagnose the cause of shoulder pain. The shoulder is comprised of four joints, and a problem with any of them can cause pain and affect performance. Moreover, many of these structures are deep in the shoulder and therefore difficult to examine by touch. Also, the same kind of pain can be due to multiple causes. For example, pain in the front of the shoulder can be due to rotator cuff tendinitis, rotator cuff tears, biceps tendinitis, shoulder instability, shoulder stiffness and several other causes.

“A systemic approach, and some experience, can help the clinician become more familiar with which constellation of findings in these athletes is not normal,” Dr. Garbis and co-author Edward McFarland, MD, write.

Shoulder problems can begin during adolescence. Little League shoulder, an injury to the growth plate in the shoulder, is one of the most common. Adolescent pitchers most at risk for injuries are those who compete on traveling teams. Overuse injuries can lead to more serious mechanical injuries. Adhering to pitch counts should reduce injuries and decrease fatigue.

Treatment should be primarily nonsurgical. Nonsurgical options include icing the shoulder and judicial use of nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen. Rehabilitation can restore a normal muscular balance. Rest can help, but it should not be prolonged, because the shoulder could become deconditioned.

If nonsurgical options fail, arthroscopic surgery can be considered. For example, surgical repair or trimming of partial rotator cuff tears can be highly successful, returning as many as 89 percent of college and professional pitchers back to play. However, the type of surgery needed depends upon the patient’s shoulder problem.

5 best places to experience fall in New York State

Autumn in America, otherwise known as fall lasts until 20 December and transforms landscapes across the country into a spectacular array of vivid colours and New York State is no different. From the Great Appalachian Valley which dominates eastern New York to the peaks of the Adirondacks in the north, New York State has some of the best places to experience fall in America.

1The Adirondacks

Adirondacks

The tree littered Adirondack Mountains in upstate New York transform into a vibrant display of autumnal colours and there are a couple of brilliant ways to witness it. One option is climbing Whiteface Mountain, which has a 4,872-foot summit that can also be reached by car or gondola and has incredible views for miles around. Alternatively, visitors can ride the Adirondack Scenic Railroad which winds its way through remote forests, sparkling rivers and into the magnificent beauty of Adirondack Park.

Stay at The Point, a five star private estate consisting of log cabins and guestrooms set next to a mountain lake. Rooms start from £1,310 a night for two people sharing.

2The Catskills Mountains

Heading up mountain in Catskill Park on Rt 23

Located only 100 miles from New York City and part of the Great Appalachian Valley, the Catskills Mountains have been a favoured destination of urban holidaymakers since the mid-20th century. Located within the mountains is the Catskills Forest Preserve, which is protected from many forms of development under New York State law and as such has retained its natural beauty and ‘wild forests’ making it one of the best places to enjoy fall. Hike along one of the many trails that include a number of lookout points over the Hudson Valley and as an added bonus the park has bountiful wildlife to glimpse including bobcats, black bears, minks and coyotes.

Stay at The Arnold House. This country retreat is set on seven acres in the forests of the western Catskills. Rooms start from £151 a night for two people sharing.

3Central Park, Manhattan

Fall in Central Park, New York City (c) Kelly Kopp

It’s not only rural areas that experience the best of fall, as Central Park in Manhattan blooms with striking autumnal hues creating a scenic collision between man-made structures and nature. Stroll through the park enjoying the colours from within or witness the scene on a grander scale by climbing the Empire State Building for a top-down look on the park. Another option is the 360-degree view from Top of the Rock Observation on the 70th floor of the Rockefeller Centre right in the heart of the city.

Stay at La Quinta Inn & Suites, a four minute walk from the Empire State Building and a 10 minute drive from Central Park. Rooms start from £103 a night for two people sharing.

4Greater Niagara

Greater Niagara – Niagara Falls State park

Niagara Falls is the one of the top attractions in the world and undoubtedly worth a visit, but there is also some fantastic fall foliage in the wider region such as Devil’s Hole State Park and Whirlpool State Park that shouldn’t be ignored on a visit to Greater Niagara. Both parks offer several miles of panoramic views of the scenic Lower Niagara River gorge, while nearby Genesee Gorge at Letchworth State Park has been nicknamed “the Grand Canyon of the East.”

Stay at The Giacomo, a luxury boutique hotel in the Niagara Falls area. Rooms start from £108 a night for two people sharing.

5Finger Lakes

Barnstormer Winery – Finger Lakes

The Finger Lakes is a group of 11 long, narrow lakes in upstate New York near the huge Lake Ontario and part of the Appalachian swathe. Many of the lakes are surrounded by dense foliage that morphs into a fascinating mirage of reds, yellows, oranges and browns in fall that reflect off the lake’s surface. The Finger Lakes region has been active in reform and utopian movements over the years and it was at Seneca Falls village that the first women’s rights convention was held marking the birth of the women’s suffrage movement.

Additionally, the Finger Lakes region is New York’s largest wine producing region with over 100 wineries and vineyards meaning travellers can enjoy a fine tipple along with the views.

Stay at Hampton Inn Brockport, minutes from Lake Ontario and the Finger Lakes. Rooms start from £110 a night for two people sharing.


Central Park photo by Kelly Kopp

Norway: Exploring Oslo’s art scene

Oslo, Norway (c) Tim Adams

Norway’s Oslo is one of Europe’s most beautiful capital cities: its natural surroundings of rolling hills and mountains, verdant islands and the sea, give this 1000 year-old city an abundance of natural beauty. Lining two scenic bays, it has 40 islands within the city limits (and scores more around the fjord), the city happily straddles both land and water.

Life here is idyllic. No one is in a rush, and the stresses are kept to a minimum. Yet this sleepy city has spent the past few years positioning itself as one of the foremost centres for contemporary art in Europe.

Tjuvholmen – an art district

The waterside district of Tjuvholmen (pronounced Shoohomen) has been regenerated, at great expense but with equally great success, and is now home to some stunning contemporary galleries, and an extraordinary art hotel. Street art and sculptures are popping up all over the place, and vast murals have been commissioned.

Astrup Fearnley Museum of Modern Art

Astrup Fearnley Museum of Modern Art (c) Benson Kua

A must-see is the Astrup Fearnley Museum of Modern Art, which began life in the 1960s as a private collection, and opened to the public as a museum in 1993. The museum’s two dramatic glass and timber structures were designed by the architect Renzo Piano, and have set the architectural style for the other new buildings in the area.

The collection includes thousands of contemporary artworks by Norwegian and international artists from the 1960s to the present. American contemporary artists are particularly well represented, though in recent years the curators have also sought out iconic photographs, sculptures, paintings, and multi-media works by emerging and established Brazilian, Japanese, Chinese, and Indian contemporary artists.

The big name artists include Francis Bacon, Andy Warhol, Damien Hirst, and Jeff Koons.

Here too you can see the work of American Tom Sachs, for whom branding is itself an art form. He takes the mass-produced images we are all familiar with — the McDonald’s golden arches, the seal of the President of the United States, household white goods — and recreates them by hand, using cheap materials such as cardboard, construction materials, wood, and adhesives. Sachs is interested in showing the way things work, the nuts and bolts inside, and so his life-sized sculptures are not only spectacularly detailed, but also often allow us to look inside, as though they were 3D exploded diagrams.

Perhaps the two longest-established artists whose work is displayed at the Astrup Fearnley are the duo Gilbert & George, Italian Gilbert Proesch and British George Passmore. Having met at art school in London in the 1960s, they led a rebellion against what they believed to be the elitism of traditional sculpture. To bring this medium back within the reach of ordinary people, they pioneered “living sculptures”, performing for up to eight hours at a time on the streets of London, as well as in galleries.  For Gilbert & George, life and art are inseparable, and they explore a number of complicated issues in their work, including religion, sexuality, identity, urban life, terrorism, superstition, AIDS, old age and death.

Tjuvholmen Sculpture Park

Surrounding the museum on the waterfront is the Tjuvholmen Sculpture Park, created as the result of a collaboration with Poul Erik Tøjner, director of the Louisiana Museum of Modern Art, near to Copenhagen.

Eyes by Louise Bourgeois sculpture in Tjuvholmen, Oslo (c) Michal Klajban

The park was designed at the same time as the Museum, also by Renzo Piano, and it contains seven significant sculptures, one each by Louise Bourgeois, Antony Gormley, Anish Kapoor, Ellsworth Kelly, Ugo Rondinone, Franz West, and the duo Peter Fischli & David Weiss. If you have just half an hour to spare in Oslo, you should come here, to walk amongst the sculptures, and then to sit on a bench, peacefully, staring out across the fjord.

Stay in an art hotel

Opposite the Astrup Fearnley Museum, and with a contemporary art collection to rival any museum, let alone hotel, in the world, is The Thief. As you approach the hotel’s main entrance, eagle-eyed guests will spot straight away the prostrate statue to the left of the door is a sculpture by Antony Gormley, and a very fine example of his work.

Inside, every wall, every space, is packed original artworks by Damien Hirst, Andy Warhol and Jeff Koons, video art installations by Charlotte Thiis-Evensen, and album covers by Roxy Music’s Bryan Ferry, just to mention a few.

Damien Hirst on display at The Thief hotel ©JensBredberg

Not surprisingly, the hotel’s art insurance cover is the highest for any hotel property in the world. You will want to allow plenty of time to explore the corridors and other public spaces, wondering which masterpiece will be around the next corner. Even the artworks displayed in your own room will seem as if you have put down your bed in the midst of a leading contemporary art museum, and to all intents and purposes, you have.

Some of the most famous, and impressive pieces are on show in Fru K, The Thief’s restaurant, where gastrophiles and art lovers alike compete for tables. Challenge yourself to identify the artists who have created the artworks around you. Many of them are instantly recognisable. The chances are that your fellow diners will be as famous as the artworks — The Thief is, after all, the preferred hotel of rock stars, super models, and film stars visiting Oslo — so you will want to sit back, a glass of Champagne or a signature cocktail in hand, and enjoy some quality people watching.



Booking.com

Munch Museum – The Scream

(c) Maurizio Pesce

The Scream is undoubtedly the most famous artwork produced by a Norwegian artist, so you had better take time to visit the Munch Museum, dedicated to the life and work of Edvard Munch. Opened in 1963 to celebrate what would have been Munch’s 100th birthday, you can see both The Scream and Madonna, a naked and somewhat controversial depiction of the Virgin Mary. Both of these paintings were stolen to order from the Munch Museum in 2004, but they were recovered by the police after a international two-year hunt, and put back on public display.

Two more sculpture parks

If you prefer your art out in the open air, Oslo boasts two important sculpture parks, in addition to the one in Tjuvholmen.

The Vigeland Park has been created by a single artist, Gustav Vigeland, and contains some 200 works in bronze, granite and wrought iron. Vigeland was also responsible for the park’s design, which was laid out in the mid-20th century and is a popular spot for Oslo’s residents to walk, picnic, and spend time with their families.

Vigeland Park, Oslo (c) WolfBlur

Newer than the Vigeland Park, and exhibiting the works of multiple sculptors, is the Ekebergparken Sculpture Park opened in a woodland in southeastern Oslo in 2013. Here you can see sculptures by Rodin, Renoir and Dali, but also 21st century works in stainless steel, bronze, and marble by the likes of Dan Graham, Diane Maclean, and Lynn Chadwick. Entrance to the park is free, but there is a small charge if you want to take the guided tour, or enter the Skyspace light installation.

You should also read: From Oslo to Bergen, and the spectacular scenery in between

Exploring the kingdom of Bhutan

Bhutan is a small kingdom wedged between two mighty countries, India and China, in the shadows of the Himalayas. It is a country steeped in Mahayana Buddhism, myths and legends under the sovereign rule of the Wangchuck Dynasty. The magnificent landscape is picture perfect with majestic mountains sweeping down to lush valleys carved by cascading rivers.

Locals still wear their national costumes as their daily attire with pride and success is measured via the Gross National Happiness index because here the welfare of the people is paramount.

Locals still wear their national costumes as their daily attire

Bhutan has never been big on tourism and slow to progress. The internet only arrived here in 1999 and it’s infrastructure is still a work in progress.

Thimphu – the capital of Bhutan

Thimphu the capital city has no skyscrapers or traffic to blot its cityscape. The mini roundabout is a pavilion with statues of goddesses while policemen physically conduct the traffic instead of traffic lights.

The mini roundabout of ornate pavilion with goddesses in Thimphu

There are hints of modernity creeping in slowly with new buildings but this is tightly controlled by the government who insist that they be inkeeping with Bhutanese tradition.

The colossal Dordena Buddha in Thimphu

On a hill overlooking the city, the colossal Dordenma Buddha statue of 51.5m high cast in bronze and gilded in gold is like a spiritual beacon to the people. Dzongs (a type of fortress), which are found everywhere in the country, were built in ancient time as fortresses and monasteries. Today they are used as monasteries as well as government administration offices.

Punakha District – the heart of Bhutan

Travelling into Punakha, the old capital, the heart of Bhutan, is on bone-shaking unfinished road hewn out of the mountainside. The scenery is the jaw-dropping natural beauty of the country which unfolds at every turn of the road. Prayer flags are installed everywhere to send prayers to the universe.

Punakha Dzong, also known as Palace of Great Happiness

Punakha Dzong, also known as Palace of Great Happiness, was built in 1637 by Zhabdrung Ngawang Namgyal. He was a Tibetan Lama, who unified Bhutan as a nation-state and instilled a unique cultural identity. The mighty fortress has glorious allegorical frescos, intricate artwork and carvings and houses the most sacred relic known as Ranjung Karsapani and the resting place of Zhabdrung’s embalmed body.

Phallic Symbols For Fertility at Chimi Lhakhang Village

The most esoteric temple in the Punakha District is the fertility temple of Chimi Lhakhang where the phallus symbol is worshipped notably by women to beget children. We walked through the village amidst rice fields where every house has a phallus image painted on the walls for good luck. The gift shops sell penis talisman for fertility much to the amusement of tourists.

Valley of Phobijkha – flight of the cranes

The stunning Phobjikha Valley of the Black necked cranes

The valley of Phobjikha is a breath-taking vista where the wide sweeping valleys are flanked by lofty mountains. It is a vast wetland that welcomes the annual winter migration of the rare and endangered Black-Necked Crane where hundreds flock in from the Tibetan Plateau in late October till mid February for their winter roost.

Prayer Wheels at Gangtey Monastery in Phobjikha Valley

This natural wonder is celebrated with the Black-Necked Crane Festival in November every year with crane-themed dances, folk songs and drama performances in the Gangtey Monastery. The ancient monastery sits atop a spur overlooking the stunning valley and houses a Buddhist school and prominent religious iconographies. It is said that the cranes circumambulate three times in their flight over the monastery on every arrival before landing on the wetland nearby and do the same on their return flight as if to pay respect to Gangtey Monastery.

Gangtey Monastery

Bound for Bumthang

Religious ceremony at Jambay Lhakhang in Bumthang

The district of Bumthang in Central Bhutan is the nation’s religious heartland and home to some of the oldest temples and Dzongs in the country. Jakar, a small settlement that sprawls over an expansive valley is home to Jambay Lhakhang, one of the oldest temples in the country built in the 7th century dedicated to the Maitreya Buddha.

Trek to Tiger’s Nest

Temples at Tiger’s Nest perched precariously on vertiginous cliff

The ascent to Taktsang Lhakhang, the Tiger’s Nest, revered as the country’s most sacred site and iconic landmark is the climax of most visitors to Bhutan. Legend has it that their most revered saint Guru Rinpoche, flew to the mountains on the back of a celestial tigress in the 7th century at a time when the area was abound with demons to harm people.

He meditated in the cave for three years, three months and three days to subdue the evil spirits living in the caves. The temple was first built in 1692 to consecrate the sacred site and ever since it has been a place of pilgrimage for Buddhist saints, monks, devotees and a major tourist attraction.

The final steps to Tiger’s Nest festooned with prayer flags

The mountain is over 3,120 metres high and the temple is 900 metres from the car park. The path varies in steepness along the way, hugging the mountain ledge overlooking a picturesque valley of blue pine and rhododendrons. After the cafeteria half way up, a stretch of steep climb reaches the view point where a long flight of steps leads down to an iron bridge by a waterfall and then another tortuous flight of steps take you up to the temple complex. The path is festooned with colourful prayer flags fluttering in the wind. As in all Dzongs and temples, shoes have to be removed before entering and photography is strictly forbidden. Cameras and phones have to be surrendered at the security checkpoint at the entrance of the temples.

Bhutan is, after-all, about spiritual journeys and trekking in the wild terrain with the mystic of Shangri-La.

Fact File

Bhutan can only be visited with prior arrangement with a tour operator for a minimum package from US$200 per day that includes hotel, guide, land transport and meals.
Check out information and formalities of visiting Bhutan with Tourism Council of Bhutan

Drukair is the sole airline that flies to Bhutan

Oral health problems in elite athletes ‘must be addressed’

The statement came out of the April 2014 Oral Health and Performance in Sport collaboration led by Professor Ian Needleman of the UCL Eastman Dental Institute and Dr Mike Loosemore of the Institute of Sport Exercise and Health (ISEH). This resulted in a conference held at UCL where experts in oral health and sports medicine met with sporting associations and elite athletes to produce a consensus on how to improve oral health in sport.

A UCL survey at the London 2012 Olympic Games found that 18% of athletes said that their oral health had a negative impact on their performance and 46.5% had not been to the dentist in the past year. The latest consensus statement aims to address such issues by embedding oral health into the wider culture of sports healthcare and health promotion.

“Oral health could be an easy win for athletes, as the oral conditions that can affect performance are all easily preventable,” says Professor Needleman. “Professional athletes and their teams spend a lot of time and money on ways to marginally improving performance, as this can make all the difference in elite sports. Simple strategies to prevent oral health problems can offer marginal performance gains that require little to no additional time or money. Things like better tooth brushing techniques and higher fluoride toothpastes could prevent the toothache and associated sleeping and training difficulties that can make the crucial difference between gold and silver.”

The intense dietary and training pressures on athletes could put them at high risk of oral health problems for many reasons. Saliva helps to protect teeth from decay and erosion, so dehydration and drying of the mouth could increase the risk of oral health problems. The amount of energy that athletes need for training often means they have high-carbohydrate diets and regularly use sugary, acidic energy drinks. These may contribute to decay and erosion in athletes’ teeth.

“We do not want to demonize energy drinks and are not saying that athletes shouldn’t be using them,” says Professor Needleman. “However, people should be aware of the risks to oral health and can take simple measures to mitigate these. For example, water or hypotonic drinks are likely to be more suitable for simple hydration, and spit don’t rinse after tooth brushing. For sports where athletes need a lot of energy drinks, high fluoride toothpastes and mouthrinses should be seriously considered.”

The authors also recommend regular dental appointments to identify and address oral health issues before they can affect performance. Olympic athletes are all supposed to have a dental check-up within 12 months of the competition but, as the previous survey found, almost half of the athletes London 2012 had not. The consensus statement calls for national sport funders and policy organisations to take the lead in ensuring that oral health is regularly assessed, especially pre-season, to allow for personalisation of prevention plans and early treatment of any disease.

Dr Mike Loosemoore says: “I think this is an important consensus statement. My experience of instituting a programme of improving oral health in elite sportsman has had a very positive effect.”

African-American men negatively impacted by hormone therapy for treatment of prostate cancer

Konstantin Kovtun, MD, a resident at BWH, Anthony D’Amico, MD, PhD, chief of Genitourinary Radiation Oncology at BWH, and colleagues, analyzed the medical records of over 7000 men from the Chicago Prostate Cancer Center who had low or favorable-intermediate risk prostate cancer, 20 percent of whom were treated with ADT in order to reduce the size of their prostate gland to make them eligible for brachytherapy. They found that African-American men who were treated with ADT had a 77 percent higher risk of death when compared to non-African American men, the causes of which were not due to prostate cancer.

“When African-American men were exposed to an average of only four months of hormone therapy, primarily used to make the prostate small enough for brachytherapy, they suffered from higher mortality rates due to causes other than prostate cancer than non-African American men,” Kovtun explained. “This leads us to believe that there may be something intrinsic to the biology of African-American men that predisposes them to this increased risk of death and that this deserves further study.”

ADT is an antihormone treatment that lowers a man’s testosterone level, and been used to reduce the size of the prostate and in turn make the subsequent brachytherapy treatment possible. This team of BWH researchers is the first to observe the negative effects of ADT in the context of racial differences, specifically comparing African-American men to non-African American men after adjusting for age, comorbidities such as heart disease and established prostate cancer prognostic factors.

“These results show that careful consideration should be taken by physicians when recommending treatment for low or favorable-intermediate prostate cancer, a cancer that very few men die of even without treatment,” D’Amico said. “There is no evidence that ADT followed by brachytherapy increases the chance of cure in comparison to other treatments, such an external beam radiation therapy alone, in these men with favorable risk prostate cancer. The subsequent risks of ADT, specifically linked to African-American men, deserve further study.”

Future research is indicated to explore the basis for the observation of shortened survival in African-American men following ADT use with the hope of developing effect and personalized treatments for all men with prostate cancer.

Investigators report no funding sources for this research.

Most NFL players with injuries to the midfoot return to game action

“While Lisfranc injuries have a reputation for resulting in poor player performance in the NFL, our study is the first to fully assess their career impact, including effect on athletic performance following return to competition,” said lead author Kevin J. McHale, MD, a fifth-year orthopedic resident at the Perelman School of Medicine at the University of Pennsylvania. “Our findings will assist sports physicians in setting realistic goals and expectations when selecting a plan of care. They will also help address such important questions from athletes as ‘Will I ever play again? Will I be back in time for playoffs? How will this injury affect my performance after I return?'”

Lisfranc injuries can occur when a player lands on the heel of another player’s foot, or when a player’s cleats embed in the turf as they maneuver, resulting in a fracture or dislocation of the midfoot. According to the NFL’s Foot and Ankle Committee, the injuries may be a result of shoe companies using lighter weight materials and increasing the flexibility of players’ shoes. Depending on the severity, injuries are treated with prolonged rest and immobilization or surgery, often bringing a players’ season to a premature close. For example, just weeks into the 2014 season, Chicago Bears Tight End Zach Miller suffered a Lisfranc injury and missed the remainder of the season. In the Penn study, which included 11 offensive players and 17 defensive players, 22 players required surgery and six were managed non-operatively.

Top 10 things to do and see in San Diego, California

Sitting cheek by jowell with the Mexican border, in sight of the Laguna mountain range and the Pacific Ocean, this Californian city offers an Hispanic heritage, with a huge dollop of Californian cool and a laid-back vibe of anything goes.

Downtown View of San Diego from Point Loma – Courtesy Joanne DiBona SanDiego.org

First time tourists to San Diego will find this beach city gloriously yielding in terms of attractions. Within its confines are 100 neighbourhoods, 70 miles of coastline, 33 beaches and 120 craft breweries (wine takes a back seat here).

There’s nightlife, heaps of culture and living history to keep you busy.

1Seaport Village

This quaint waterfront shopping and dining area located Downtown on West Harbor Drive is probably a great place to start. There are 54 unique shops including a fun magic shop and plenty of eateries. Supping a coffee while looking at passing yachts and ships on picturesque San Diego Bay is a brilliant way to ease into the day. Also you can pick up The Old Town Trolley Tour, a hop on, hop off bus that passes everything you would want to see in the city including all those listed below.

2Gaslamp District

Gaslamp Sign, San Diego -Courtesy John Bahu

Don’t worry, the area is not as seedy as the name suggests; it is called so because of the Victorian styled lamposts that light up the streets after sundown. The 16-square blocks in the Downtown district feature Victorian buildings alongside skyscrapers which together, offer an interesting visual. And amid them are boutiques that line the streets, and a mall – the multi-level Westfield Horton Plaza – designed as an outdoor shopping centre.

Of course there’s plenty of restaurants. Cafe 21 on Fifth Avenue is a sure thing, with wholesome food, including gluten free options, served throughout the day. At night there’s live music with some acrobatics thrown in. Some of their cocktails double as meals sometimes served with vegetables and even prawns. Far less wholesome is the raunchy Coyote Ugly Saloon (named after the film) next door where women are invited to strut their stuff on the bar alongside scantily clad dancers.

3Old Town

Old Town Market, San Diego – Courtesy SanDiego.org

The Old Town is pretty much the birthplace of California and was where the first Spanish settlement was created. The 19th century history of San Diego is brought to life in the Old Town’s shops, restaurants and historic sites – in effect it is a tourist trap. But it’s still worth visiting. It’s fun to look at the Indian jewellery, especially in the Covered Wagon – Pala and Kumeyaay Indians were the pre-Spanish native population. Browse the 40 speciality shops and the adobe properties that house them. Just a short walk down San Diego Avenue is the Whaley House, known as the most haunted house in America. They say even the ghost of the family dog has been seen.

If you like Mexican food, there are several Mexican restaurants. Cafe Coyote has a great location and fun atmosphere both indoors and on the heated alfresco terrace where you can watch the tortillas being made. There are others such as Casa Guadalajara where the most joy is in the atmosphere rather than the food.

4Balboa Park

bird’s eye view of Balboa Park, San Diego – Courtesy Joanne DiBona SanDiego.org

Considered the cultural heart of San Diego you will find Balboa Park just north of downtown. It is the world’s largest urban cultural park and inside its 1,200 acres there’s an incredible 17 museums, 8 gardens – including a gorgeous Japanese garden that has a Zen space for meditation – and sensational Spanish Renaissance architecture. And within the Balboa park is the amazing San Diego Zoo.

5San Diego Zoo

The Panda is endangered. The Zoo is home to five giant pandas. Courtesy of San Diego Zoo

It’s not often a zoo enters a top-10 feature, but this one really is a must-see. It sprawls over 100-acres (40-hectares) and looks after 3,500 rare and endangered animals representing more than 650 species and subspecies. There is a prominent botanical collection with more than 700,000 exotic plants.

Their “Inside Look Tour” is two hours of edutainment that offers a behind the scene look at what really happens when no-one is looking. Elephants, reptiles, giraffes, koalas are among the animals you will get to see. And you won’t want to miss the gorgeous pandas. Allow plenty of time, but get there early as it closes at 5pm.

6Coronado Island

Coronado Beach – Courtesy Brett Shoaf Artistic Visuals

Visiting the Coronado island is a relaxing day out and getting there from Downtown is a quick traverse across a bridge. Some people get the jitters crossing the bridge because it is alarmingly high, deliberately so to allow military ships to pass beneath it.

Once on the other side, you’ll find pretty ice cream shops and boutiques, and the lovely vision of a rust red roof and turrets and white walls of the Victorian style Hotel Del Coronado. The iconic hotel has hosted royalty and celebrities and is where Marilyn Monroe and Tony Curtis filmed Some Like It Hot and where Wallis Simpson once lived. Perhaps more compelling for some, is the broad, fine white sand beaches.

7Cabrillo national monument and Old Pont Loma lighthouse

Cabrillo Monument, San Diego Courtesy Joanne DiBona

This is where Juan Rodriguez Cabrillo’s 16th century historic landing took place – a pivotal moment for California. Cabrillo was charged with exploring the West Coast of North America on behalf of the Spanish Empire. And this is where a handsome and towering statue of him stands proud looking over the bay he sailed into in September 28, 1542. The views from here are gorgeous especially as sun sets.

Nearby is the Pont Loma lighthouse which is open to visitors. You’ll see how the keeper and his wife lived and be able to climb the spiral staircase. However it only served as a lighthouse for 36 years because the low clouds that descended upon that area made it hard to see.

8La Jolla Cove

Seals at Jo Jolla Cove – Courtesy Lisa Field SanDiego.org

The city has some great beaches, and the one at the foot of the hilly La Jolla area comes with a trendy buzz and some pretty spectacular scenery. And the opportunity to see the native seals. You’ll find it in the beachfront restaurants, the El Pescador Fish Market or in the many art galleries along Prospect Street and even in the Museum of Contemporary Art.

9Little Italy

There are plenty of restaurants in Little Italy for any gastronome but now this burgeoning neighbourhood has become acclaimed for being home to the Top Chef Row on Kettner Street. Five of the city’s celebrity chefs have opened restaurants so check out Herb & Wood for its wood-roasted eats, The Crack Shack for its chicken dishes, Juniper and Ivy which services “refined American food with Left Coast edge”, Bracero for its modern Mexican cuisine and Pacific Standard for its seafood.

10Drink beer

Beer cheers courtesy of Erik Isacson

It’s all about the brew in San Diego and there are around 120 breweries serving hoppy West Coast-style IPAs. So, hop over to Ballast Point and try their Havanero Sculpin – careful though as the Habanero chillies crank up the heat. Or for something salty yet fruity you could head to Point Loma to visit Modern Times to taste their citrus flavoured Fortunate Island and Black House, a coffee roasted stout.

The Stone Brewing World Bistro and Gardens is a fun environment to enjoy a pint. They serve rustic food in their gardens, offers brewery tours, movie nights and of course the beers – its signature beer being Arrogant Bastard Ale.


FACT FILE

Best Time To Go: March to November is peak season but get ther September-October or January-February and hotel rates are at their lowest. Temperatures may get chilly, but not too cold to check out the city.

Getting there: San Diego International airport is just a 10-minute ride to downtown. A cab costs around $18, or hop on the San Diego Metropolitan Transit System’s Airport flyer (Route 992) for $2.25 – kids go free.

If you are based in Los Angeles, catch the train for a lovely 40 minute coastal ride into downtown

Getting around:
San Diego Trolley Light Rail:The San Diego Trolley light rail system stops at points of interest.

Ferry to Coronado: This 15-minute ferry sets sail from Broadway Pier and behind the Convention Center. Fares are $4.25 each way.

Cash free cabs: Uber and Lyft both operate here

The Old Town Trolley Tour: This is a great way to get oriented, hopping on and off at city sights. Adult one-day tickets $39 (£31).

More info: San Diego 

You may also like to read our review of Hotel Sofia, San Diego

Inherited mutations in three genes predict for aggressive prostate cancer

“The study results have an important translational impact because they clearly demonstrate germline mutations in these three well-established genes can be used to predict risk for lethal prostate cancer and time to death,” said Jianfeng Xu, MD, DrPH, Vice President of Translational Research at NorthShore University HealthSystem (NorthShore) and Director of the Program for Personalized Cancer Care. “This confirms major findings from previous studies and provides further direct evidence of the important role of genetic testing in prostate cancer screening and treatment.”

The study was a collaboration of NorthShore, the John Hopkins University School of Medicine (William Isaacs, PhD, et al.), and Fudan Institute of Urology, Fudan University (Qiang Ding, MD, et al.), in Shanghai, China. It is a retrospective case study of 313 patients with lethal prostate cancer and 486 with indolent prostate cancer in men of European American, African American and Chinese ancestry.

“Our aim is to find genetic markers among men who are at high risk of developing an aggressive prostate cancer,” said Dr. Isaacs, the William Thomas Gerrard, Mario Anthony Duhon and Jennifer and John Chalsty Professor of Urology at the Johns Hopkins Brady Urological Institute and member of the Johns Hopkins Kimmel Cancer Center. “Mutations in these genes, particularly BRCA2 and ATM, have been linked to aggressive prostate cancer, and this study provides important estimates of the frequency of mutations in men dying at different age ranges.”