Got a medical question? Let me stretch my brain.

[pnoon]

Originally Posted by icehog3

You're such a douchebag.

Originally Posted by kayaker

I'll give ya a whirl Cyanide.

My right knee has no ACL or medial meniscus. I don't have any trouble with the stability of my knee. It has never "popped" again, and it doesn't limit my ability to be active when I want to. I can play squash, hike, climb, etc. I didn't get ACL replacement as I felt it unnecessary.

However, I have noticed over the last year or so that it takes greater effort to get up from a crouching position and my knee aches a little more than usual. It's not a big deal, but I'm not getting any younger.

Would the ACL replacement surgery help with this?

Hey Ian;

The knee is kind of funny, in that there are a number of conditions that can look identical in symptomology. And further, they respond equally well to conservative therapies. But, once they start not conforming to said therapies, then you have to get specific in order to approach the surgical options. That's where MRIs come in.

But, it was reasonable to not repair the ACL, and it may be reasonable to now re-examine the issue to see if things should be approached differently now.

All that said, in the military I find many a soldier with your exact story. Heck, my knee is almost identical in story as well. What it probably boils down to in this case is something called Patellofemoral Pain Syndrome, also known as Chondromalacia Patellae. This is where the knee-cap doesn't track through the groove at the end of the femur (upper leg bone), and as a result gets torn up pretty bad. It leads to stiffness and pain after long periods of sitting (this is called the "moviegoers sign"). What is causing this mis-tracking is a mis-alignment of the tibia (lower leg bone) in relation to the knee. This in turn is commonly cause by fallen arches (either obvious; or "dynamic" where you only see the collapsing inwards when you shift from non-weight baring to weight baring). As the foot collapses inwards, the tibia is slightly angled inwards, meeting the femur at the knee at a slight angle. Now the kneecap tries to jump-rail when the leg is straightened.

I commonly see this in knees where some of the other structures are damaged. This decreases your "physiologic reserve" to compensate for the fallen arches (by simply pulling everything into place through brute strength) and the mal-alignments are allowed to unveil themselves.

So, what do you do?

1) Increase that physiologic reserve by a) strengthening all the muscles groups or b) repairing that ACL (but you can't repair the meniscus)

2) grab some good sturdy orthotics (I find generic, off the shelf ones are best because they are relatively cheap which makes it easy to replace when they wear out, roughly at the same rate as a pair of running shoes), and have a look at how old the soles of your shoes are. People find their knees start to hurt more as their shoes age.

When you get back to Edmonton here I will have a look.

Cheers

John

I will tackle Fumes' next. But in the meantime, do a search on my posts and you will see that I put in some fairly lengthy posts into a back-pain thread about a month or two ago. It would be good background reading. I will re-read it myself and may just post a link to it if I think it covers the info well enough.

But for now....

Back to painting (baseboards are done)

Thanks for the info John.

I appreciate the help.

Originally Posted by Fumes

... I'm wondering if it gives us any new ideas as far as diagnosing the cause of her back spasms. Maybe it was just a reaction to the pain?

Thanks for any suggestions, Doc! Great idea for a thread!

What studies are showing us is that we really don't have a strong grip on the cause of many cases of chronic (or in this case, recurrent) back pain. Reasonable clinicians are starting to dismiss the discs as the cause of all back-pain (and really limitting it to the rare occassions where the discs are actually pressing on nerves).

But, that doesn't leave us with many convincing stories to tell. And, it leaves it up to us to create a compelling fiction to fill the gaps. I just so happen to have one of those "compelling fictions", good enough that I have even convinced myself that it may have validity.

Many back injuries will result in some muscle damage, either from the actual trauma or from the huge muscle contraction you exherted to try to avoid the trauma, pulling the muscle. When the muscle heals, well it heals with scar tissue instead of regenerated muscle fibres (muscle-building is a different process)

Scar tissue has a number of characteristics:

1) its never stronger than 70% the tissue architecture it replaced
2) It has no contractive function, its not a muscle
3) It shrinks over time. Look at any scar on your skin, if its large enough it will have a puckered edge, it shrank (you could easily find exceptions to this)
4) It is heavily innervated with pain nerve fibres.

So, what this leads to is a case where, the moment a scarred muscle starts to fatigue too much through heavy strain (twisting while carrying something) or through prolonged use (like sleeping in a bad position), it lengthens under load, surpassing the length of the scar, the weak scar starts to tear, sends off massive numbers of pain signals to the central nervous system. In a reflex loop, signals short circuit back to the muscles to tell them to go into a massive contraction to protect themselves under load and then this loop just keeps cycling on itself.....resulting in muscle spasm.

Finally, imagine all the other nerves that have to traverse from the spine to the periphery. They have to pass around and through all the structures in between point A and point B. Scars love to entangle anything near them as they develop. Its not unreasonable to think that some of these nerves could get caught up in the scar tissue, and thus get tethered down to nearby muscles. As the muscles go into spasm, they wrench on everything attached to them, including the nerves. Nerves don't work well under mechanical tension and thus the numbness would occur. You wouldn't feel the nerve geing stretched. But you would feel odd sensations/pain in the area of the body the nerve served. The brain doesn't know anything about where the nerve travels, only what regions it innervates.

Hope this is helpful..

Cheers

John

Originally Posted by gettysburgfreak

I sprained my ankle pretty bad in PT almost a month ago and it is still a little bit swollen. It doesn't really hurt that much any more but the fact its still swollen has me wondering if it is just because I am constantly on it doing vigorous activities and don't have a chance to rest it, or could it be something more serious?

Its not unreasonable for this thing to continue to swell for a while. I could speculate an anatomic cause, but it would be largely a fable involving healing tissue being leaky and repetative strain making it more pronounced. The key though is that it doesn't continue to hurt without (even gradual) improvement. It may get tight and uncomfortable because of the swelling, but if that "OMG something bad just happened" flash of pain, you are probably OK. All that said, I certainly wouldn't train at 100% until things were 100%...I don't know, keep it down to 75-85% effort

And stretch it out before/after. That story about scar tissue above, that would apply here as well....so the more limber the ankle is while it is healing (within reason of course) then the more likely the scar tissue won't shrink to a performance-hindering "shortness"

[gettysburgfreak]

thanks for the info doc

Originally Posted by gettysburgfreak

thanks for the info doc

What I should add to this would be to wrap the ankle before PT if at all possible. Since you are using the term PT, I assume you have access to a base pharmacy and MIR. Pick up some Coban. Its really great stuff; self-adherent, thin tensor bandages stuff.

The wrap will prevent the swelling.

PRICE works great for most soft tissue injuries. Originally developed for ankles, but pick and choose the rational elements for the injury at hand.

Protection, Painkillers
Rest
Ice
Compress
Elevate

Originally Posted by s15driftking

how do you cure scalp feliculitis, noting that a 10% panoxyl soap bar has gotten you no where?

I haven't seen much scalp folliculitis. It is interesting that it is being treated with a benzyol peroxide solution. If it were a limitted, easy to get to area, I would treat it with something like polysporin or mupirocin (sp?) twice a day for 10 days. If that didn't work or if it were a hard to get to area (like a hair covered scalp) then I would go more for a system (pill) antibiotic like cloxicillin or erythromycin. All that said, I would certainly take a second look at it before concluding its a bacterial infection of the follicles on the scalp. I would be looking for another diagnosis (like pustular seborrheic keratosis) or an underlying cause and treat that.

If it were hard enough to treat I would certainly go ahead and swab it and await lab results to determine if it were anything more problematic than a typical skin-borne bacteria causing it.

Originally Posted by pnoon

Why does Tom's butt itch?

I believe it is because Tom's butt was always meant to itch. Without an itch, one could not define Tom's butt. It's like saying "Why is the sun hot?"

[Cenookie]

First of all thanks, a couple months ago I was helping a friend move furniture when I felt what I can only describe as a warming sensation and pain in my shoulder. I immediately lost strength in my shoulder. In fact I wasn't able to put my truck in gear to drive home. My shoulder only hurts when I move it a certain way. And at night in bed it's not a pain like in the muscle, but more of an ache. I can massage it and fell no sore spots, but move it a certain way and PAIN.

Originally Posted by Cenookie

First of all thanks, a couple months ago I was helping a friend move furniture when I felt what I can only describe as a warming sensation and pain in my shoulder. I immediately lost strength in my shoulder. In fact I wasn't able to put my truck in gear to drive home. My shoulder only hurts when I move it a certain way. And at night in bed it's not a pain like in the muscle, but more of an ache. I can massage it and fell no sore spots, but move it a certain way and PAIN.

Move it which way? How about holding arm straight down at side with palm facing forward. As you rotate the shoulder up to the side (like a properly on a plane, spinning), and then over the top until you touch the opposite shoulder with your thumb (with elbow over head. Does that hurt? Maybe reaching behind your back to scratch your back with your knuckles. Does that hurt? How about holding elbows tight to side and then rotating forearms outwards. Does that hurt?

I am presuming right off the bat that you may be dealing with a rotator cuff injury. However the differential diagnosis (its the concept of "a list that contains every diagnosis that a particular condition could be"...things only get struck off the list when they can no longer possibly explain the situation) would also include a biceps tendon rupture (but I think you would describe the situation differently).

And by the way....Tom might have worms. That might explain the itch.

[Opusfxd]

I'll give this a shot. It feels like I have a NASCAR restrictor plate in my adam's apple area. Sometimes it gets constricted and restricts my breathing. Whether it's going up the stairs, running a few miles, riding the bike it feels like I could be fine if I could only get enough air into my lungs past this constriction. BTW, thanks to sleep apnea I have no uvula, tonsils and my sinuses have been reamed out. I also have incredibly active sinuses. Any guesses?

[sikk50]

Ok, I'll play.

When I first moved to Chico they had these weird things called "seasons," yea we don't have those in SoCal. So naturaly the trees lose their leaves and polonate rather more dramaticly than down south. Sortly after the move I had the worst sore thoat of my life, so bad that it would wake me up at night, it lasted for a couple weeks with verying degrees of intensity. During that time I also suffered from swollen tonsils, pink eye (first time in my life) and plugged ears. My insurence didn't work up here so I went to the schools med place and she said it was allergies intensified by a nasty cold that had been going around of some sort and just gave me a script for sudifed. Well it helped but I was still displeased and drinking three cups of hot lemon tea and honey a day was rather old at this point so i went to the health clinic. There the doc said that I had a sinus infection at was looking pretty brutal and that he felt that was the cause off all of this, saying as it would max out one area it would move to another. He gave me Leviquin. It helped, but I still wasn't top notch for a week or so after the pills were gone.

Anyway regardless to this day I have wat look like little bumps on the soft tissue above my dangley ball thing in my throat. My family doctor has looked at this and asked promptly if I drink a lot of hot liquids, "why yes, about a whole pot of coffee daily." Do you drink alcohol, "well its safe to say there wont be any breweries closing while I'm around." Do you smoke, "5 cigars a week." then he says that its just an irritant because of all of these things. Now I may just not have paid that much attention to the inner dynamics of my mouth before this ordeal, but I feel fairly confident the little bumps came with that. They don't bug, no irritation, just there hanging out, rather small, about like a pin poke size.

What do you think doc?

[bonjing]

Originally Posted by sikk50

What do you think doc?

Stop hanging around Darrell

[sikk50]

Originally Posted by bonjing

Stop hanging around Darrell

[RGD.]

My grandfather died from a pulmonary embolism. He actually had what they said was a saddle pulmonary embolism and several clots in his left leg. One of the left leg clots actually ripped the artery as it traveled and there was nothing that could be done.
Last spring my mother survived a saddle pulmonary embolism and four clots in her left leg.
A couple of months ago one of my brothers (8 years my junior) wasn't feeling good and drove himself to the hospital. He collapsed in the hospital parking lot. He also had several clots in his left leg and a saddle pulmonary embolism.

So - can this be something hereditary. I'm nervous for my other younger brother and sister. Is there something they should be doing? Check ups or screening of any kind?

Having three family members with the same thing kinda puts you on edge.

Thanks,

Ron

Originally Posted by RGD.

My grandfather died from a pulmonary embolism. He actually had what they said was a saddle pulmonary embolism and several clots in his left leg. One of the left leg clots actually ripped the artery as it traveled and there was nothing that could be done.
Last spring my mother survived a saddle pulmonary embolism and four clots in her left leg.
A couple of months ago one of my brothers (8 years my junior) wasn't feeling good and drove himself to the hospital. He collapsed in the hospital parking lot. He also had several clots in his left leg and a saddle pulmonary embolism.

So - can this be something hereditary. I'm nervous for my other younger brother and sister. Is there something they should be doing? Check ups or screening of any kind?

Having three family members with the same thing kinda puts you on edge.

Thanks,

Ron

I will answer this one next, then later see if I can handle a couple of the others.

MOST CERTAINLY, there are about a dozen genetic/heritable conditions that could lead to this sort of story. With so many people having similar stories in your family I would definitely get them all lined up to do the testing.

Depending on what the genetic distribution of the specific condition is, you may be looking at 50% of your siblings having it. If you do not have it, then your children would not be able to have it. But, different conditions distribute in different ways....thus everyone should still get tested.

Originally Posted by Opusfxd

NASCAR restrictor plate???

I haven't a foggiest regarding what that is. We don't have any real NASCAR in Canada so I don't even recognize the reference.

That being said, it sounds like you have something obstructing the area. Well, that wasn't all that helpful right? This could either be because of anatomical masses (but seeing you have had an ENT-ream-out-job, then I doubt that), or it could be due to secretions (sinus related). Another potential might be due to a cyst of some sort, maybe a thyroid cyst (or enlarged thyroid), or possibly a pharyngeal branchial cyst (remnant of a gill slit...believe it or not).

A simple physical exam (maybe with some simple blood work) might give you some answers.

[mosesbotbol]

Originally Posted by acarr

Thanks for the offer. Maybe a little off the traditional medicine question, but a general practitioner is going to get a number of questions pertaining to non-traditional medicine. So here goes:

Can you tell me whether or not you think turmeric/curcumin is an effective anti-inflammatory spice.

Interesting as I am turmeric crazy in my cooking. I put it in just about everything. I know it is common to mix tumeric in milk when giving to children (in India).