Vitals Magazine asked two alumni how they are challenging conventional wisdom and embracing the unexpected in their work to transform medicine and healthcare.
Pushing Musculoskeletal Medicine Beyond a Binary
Keith DellaGrotta, MD, MED ’15, Sports Medicine Physician, Point Performance
Six years into practicing emergency medicine, I noticed a pattern I had not anticipated becoming my life’s work: patients cycling through the ER for musculoskeletal pain that did not require emergency care. Without timely outpatient management, the ER was a stopgap—expensive, impersonal, and unable to address root causes. That observation, along with a personal passion for fitness, redirected my career into sports medicine.
What I have found on the other side is a field being quietly rewritten. Patients today want to stay active well into their 60s, 70s, and beyond—not just survive aging, but move through it well. That demand is pushing musculoskeletal medicine past its old binary of physical therapy or surgery.
Holistic physiologic and biomechanical assessments can guide patients to reach their sport and activity goals. Tools like shockwave therapy and carefully titrated and targeted orthobiologic injections (e.g., platelet-rich plasma, mesenchymal stem cells) now offer real solutions for tendinopathy, arthritis, and various injuries, particularly in patients who have not seen results from conventional PT. In my practice, a large majority of these difficult cases achieve meaningful, lasting functional improvement—often in people who assumed their options were exhausted.
These therapies are not universal fixes. They require the right patient, the right pathology, and honest conversations about what intervention, including surgery, genuinely is necessary. But for many, they are changing what is possible—proof that healthcare’s unexpected turns often lead somewhere better.
What Snake Bites Taught Us About Food Allergies
Stephen J. Galli, MD, MED ’70, Professor Emeritus; Pathology, Microbiology and Immunology Stanford University School of Medicine
Bites of poisonous snakes cause an estimated 81,000 to 138,000 deaths annually, primarily within under-resourced populations in Sub-Saharan Africa, India, and other parts of Asia. People who are bitten but don’t die of the bite often suffer from life-altering disabilities, including amputations.
In better-resourced parts of the world, including North America and Europe, there has been a decades-long increase in the percent of the population who are at high, potentially fatal, risk for developing anaphylaxis due to ingestion of common food items, such as peanuts, tree nuts, milk, eggs, fish, and shellfish.
Poisonous snake bites and ingestion of foods to which one is highly allergic cause similar reactions in the body: Mast cells, normally distributed throughout the tissues, very rapidly degranulate and release large amounts of stored mediators, including histamine, proteases (such as tryptase and chymase), and other biologically active substances. This can be a catastrophic reaction with potentially fatal consequences.
But that mast cell activation isn’t supposed to be maladaptive. My research group showed that this massive release of mast cell proteases can actually increase survival in a mouse model after injection of the venom of four different poisonous snakes, the Gila monster, two deadly species of scorpions, or the honeybee.
Our work has demonstrated the benefits of extensive mast cell activation in response to certain venoms, and it has devised ways (including immunotherapy) to limit the ability of mast cells to be activated by otherwise benign food components.
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The Accident
AdvantageSome of medicine’s biggest leaps forward started with a surprise. At Dartmouth, serendipity is part of the plan.
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How to Change
MedicineMedical discoveries can take years to reach patients. Dartmouth’s Center for Implementation Science is transforming that process.
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From Farm to Bedside
These Dartmouth Health initiatives are turning the proverb “an apple a day keeps the doctor away” into medical care.