is there a doctor in the house?

Uechij · Post by **Uechij** » Sat Mar 23, 2002 2:05 am

Ian,
The irritant solution I believe is made up of glucose, cod liver oil extract, and a little phenol. I dont know the proportions and I have heard some other doctors will vary the receipe, but this seems to be the most popular. Troll Under The Bridge, did you have prolo or trigger point treatments? Just curious.

Troll Under the Bridge · Sun Mar 24, 2002 12:20 am

I guess I am not sure. We discussed trigger point injection so that is what I believe he did. After reading Ian's post I have more questions. If all the injection has done is reduce the inflammation, It seems that I am going to have to find some specific excersizes to strengthen and stabilize the shoulder to avoid re-injury? I have a follow up scheduled and perhaps that is the purpose. Again, will let you know.

Guest · Post by **Guest** » Sun Mar 24, 2002 12:59 am

It seems that I am going to have to find some specific excersizes to strengthen and stabilize the shoulder to avoid re-injury?

I'm just a layman going thru similar problems but I'd suggest it couldn't hurt.

Besides,if you can not keep the old shoulder blade locked down were it's supposted to be all your power flows out your back. Much better if it transfers thru your hands and into the target.

Laird

Ian · Post by **Ian** » Sun Mar 24, 2002 1:08 am

Some women as a complication of breast cancer surgery lsoe the nerve that holds the scapula to the back, so it wings out. Wuld be interesting to see what happens to their punches. Could also happen to a man with thoracic surgery, or injury. However the latissimus is what really holds the shoulder girdle locked down for stability and energy transfer, so I would *guess* they'd be ok.

The local irritant injection, btw, sounds like its basically homeopathy. This is where you treat a problem (pain, inflammation) by giving something that causes the same (homeo). Uusually incredible dilution to the point the original substance is gone is part of most homeopathy however. This stands in contrast to traditional western medicine which is "against," where we try to reverse the underlying cause for management although symptom/ pain control is also important and treated as a second benefit for primary treatments (sometimes) or a second target of therapy.

Guest · Post by **Guest** » Sun Mar 24, 2002 1:09 am

Then again there's a few benifits to the instability in the shoulder.

My shoulders tend to be more forward and down than most. So I've always got a great place to tuck the old chin.

Laird

Guest · Post by **Guest** » Mon Mar 25, 2002 6:14 am

I've been told I have some muscle atrophy in the lower and middle traps. The muscles that anchor the lower corner of the blade.

Been working on the exercises assigned. Trying to stabilize the shoulder, wake up some nerve connections.

This morning around 4.30 I work up with big time muscle spasms in the back. (This is kind of normal, has been for too damn long.)

Biggest pain and muscle knots between the blades.

The discomfort did not allow me to sleep. I eventually gave up and passed my problem on to my significant other about two hours later. I got a massage, some painkillers and a heating pad slapped on my back.

I discovered that I have zero feeling in parts of my back. The heating pad was too hot. Yet part of my back could not feel the heat. I suspect you could put out a cigar there, if I didn't smell it I would not know.

Funny my doctors and physio therapists didn't notice. Then again there kind of busy saying next please, so I guess it just slipped on by.Then again it is part of my body and I didn't know either.

I'm a wee bit pissed at my medical folks. No tests,no time , just do these exercises and pay our bills, come back again in three days , ten minutes with yet another one and here's another $45 bill. My shoulder is getting worse. It pops, it clicks, and it punishes me if I think about raising it above my head. I have increasing pain.

Yes I I'm not a car. I just can't roll into
the shop for a tune up. Hey it took a long time to create this damage. I'm sure it will take just as long to reverse the problem.

BUT:

I was kind of wondering if you doctors in the house would give me some more advice.

1. What exercises would you recommend to stabilize this shoulder?

2. What causes this muscle atrophy? Why do nerves just stop sending messages?

3. Should my medical personnel be doing some sort of imaging of the shoulder?

Laird
????????????????????

[This message has been edited by uglyelk (edited March 25, 2002).]

Uechij · Post by **Uechij** » Mon Mar 25, 2002 9:48 am

Uglyelk,

I don't really know the details of your case but it sounds like from the syptoms you describe you're suffering from lax ligiments due to injury, or wear-n-tear of age. The muscles, tendons, and ligiments, can be thought as of levers. When one tension of these levers or shock absorbers loosens, others become tight. Then the muscle skeletal system becomes misaligned. When the ligiments loosen the muscles try to take up the slack by, tensing, to stabilize the joint. These muscles wern't designed to stabilize all the time and hence, become very tired(i.e. muscle spasm). Others, due to lack of tension, can quit working (i.e. Muscle atrophy). This is just my opinion but rehab will proably be useless. I base this on my own experience and observations made at the fitness center I work at, which has a physical rehab office involved in treating problems such as ours. When you attempt to strengthen the muscle that is already tired from stabilizing, which it wasn't meant to do, you just burn it out more, sometimes worsening the situation. I think that rehab therepy is not much more than band-aid therepy. After talking to hundreds of these patients, most of them regain strentgh in the jont, so that it is functional, but still suffer pain and other syptoms. I spent a year and a half doing rehab exercises of all kinds (even invented a few)for my joints and while they did get stronger I would at times be worse off pain and syptom wise. I never got better. I finally came to the conclusion that burning out an already tired muscle would never work. The reason they probably aren't recommending MRI, CAT scan, etc. is that most of the time they don't show soft tissue damage. So you would go through the process of spending your money and time for what they already know. Basically you will have two choices, surgery or some kind of tissue hardening therepy, such as prolo or sclero therepy. Ohterwise, you will proably always need pain killers, massage, chiropractic alignment, manipulation, etc., and at best they will only be temporary fixes. It can be a very viscious cyle. Again, I am making an assumption based on what very little I know about your case. I don't mean to sound so drab but once you damage a ligiment, or even a tendon, it can be very hard, if not impossible, to get them to heal back to a properly fuctioning stage. I know your frustration about feeling like another number at the doc's office, I felt exactly the same way. I even felt that they thought I was trying to get out of work or get some drugs to get high with, when what I really wanted to do was just the opposite. I wish you the best of luck in whatever decision you make and hope you can find some resolve soon, as I know how much this problem can consume your life.

[This message has been edited by Uechij (edited March 25, 2002).]

Bill Glasheen · Post by **Bill Glasheen** » Mon Mar 25, 2002 3:02 pm

Laird

First of all, neural deficits are a big red flag. Time to go see the doctor. Enough said.

I'm not as pessimistic about your prognosis as the last fellow, although none of us really know what's wrong without a proper medical exam by a qualified orthopedist. But I will make a few comments and offer a few points of advice.

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR>I have some muscle atrophy in the lower and middle traps...

Been working on the exercises assigned...

This morning around 4.30 I {woke} up with big time muscle spasms in the back...Biggest pain and muscle knots between the blades.<HR></BLOCKQUOTE> Well as the kids would say, Duhh!!

You worked on the lower and middle traps. And now your lower and middle traps hurt. You overdid it; lighten up a bit. Enough said. <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote

I got a massage, some painkillers and a heating pad slapped on my back.

Wooaa there, fellow. When you mess something up, always, always START with ice. The cold kills pain, stops internal bleeding, stops swelling, and arrests the process of inflammation. Heat can exacerbate the situation. Heat is for when you want to either stimulate circulation to enhance the healing process or physcially warm the muscle up to prepare it for exercise. But heat will make inflammation worse and heat will make bleeding/swelling worse. I know it (initually) hurts like &%$# when you slap a big ice pack on an injured area, but that's what you want to do.

Providing the ice isn't so cold that it'll frostbite your skin, the best thing to do is take a very large ziplock bag, fill it with ice, and slap it on the freshly abused area for 20 minutes (or even longer). Often when you're easing your way into an exercise routine where you have a degenerating inflammation situation like yours, it's not a bad idea to put moist heat on, exercise, and then finish with ice. The first two are designed to stimulate healing. The last treatment arrests the inflammation and swelling that can come on because of the irritation caused by your underlying degenerative condition. <BLOCKQUOTE><font size="1" face="Verdana, Arial">quote

What causes this muscle atrophy? Why do nerves just stop sending messages?

This depends... But somewhere, somehow a nerve is getting pinched, and thus cannot properly send its signal. Irritated or narrowed spaces inbetween vertebrae will pinch nerves. Inflamed areas that nerves run through will pinch nerves. A buildup of scar tissue around a nerve will pinch a nerve. Sometimes arresting the process of inflammation will make things better. Sometimes surgery is needed to relieve the pressure on the nerve. The good news is that modern arthroscopic techniques in shoulder surgery mean the probablility of success is much higher than it was in the past, and you will be back in the gym much faster than in the past.

The shoulder is THE most complicated joint in the body. Sometimes imaging helps, but most of the time one really doesn't know what the problem(s) is/are until a surgeon gets a scope in there and takes a look. And once you have done that, you're all set up to repair it if possible.

But don't assume surgery is needed. Get medical advice. Get a second opinion from a good "jock doc" if you don't like the first opinion. Try PROPER rehab first (if they say it is an option), and don't be afraid of surgery if it's the right thing to do for YOUR condition.

Keep your chin up, and don't give up! Shoulder problems can take a while to fix, and they take patient, dedicated rehab with or without the surgery (sometimes years of work). But there CAN be light at the end of the tunnel.

- Bill

[This message has been edited by Bill Glasheen (edited March 25, 2002).]

Ian · Post by **Ian** » Mon Mar 25, 2002 7:10 pm

Laird, I know what you're going through with the health care complaints. I experience the same problem from the other side, and these are some of the constraints I face (and more importantly, see the attendings face):

Time and money: Turns out that internal medicine is generally not an easy way for hospitals to make money. There are all these restraints on the way we practice care and provide services. There is increasing pressure to say as many people as possible in as short a time as possible. I met a family doc who had his practice bought by the local HMO; they fired his partner and asked him to see 4 patients an hour plus up to two walkins--that's ten minutes a person, and if you factor in greetings, history, exam, planning, explanation, drawing any needed labs, etc, it's just not feasible. The day always went at least an hour late, maybe two or three. They had to have a professional biller with the time and experience to code for the diagnoses, full time. After the long day, the doc had to dictate all his notes, and under medicare, reimbursement is tied directly to the detail in the notes, even if it doesn't help the patient and just takes a long time to do.

At my hospital the slogan is "where the patient comes first" and for years, the dollar has come second, and we've been losing millions--tens and hundreds of millions--yearly. As a result we have to--all doctors have to, to stay profitable--learn about how to bill as much as possible for services, to have an attending nearby for a procedure so the same thing is billable, take patients off their usual medications for cheaper substitutes while they're in house, and take account of all sorts of ridiculous rules, like, if we make service convenient for a patient by getting all their scans while they're in the hospital, we don't make a cent, but if we make them get in line and come back in 2 weeks for them, they can be billed in full. Pressure increases about every day to get patients out as fast as humanly possible, even out as early in the morning as possible, with new meetings and committees created to speed discharge.

This isn't to pay for our sports cars, its to keep the hospital from closing. Most of the people there are underpaid by national averages, and they're salaried, so all the additonal work dumped on them by cost restraints is unpaid.

One of the basic problems is that technology and the ability to do things and as a result cost sky rockets. There's a medicine now that is the first specific treatment for sepsis, Xigris. It reduces the death rate about 6%, and it costs about $6,000. If these and other medications continue to be used whenever there's an opportunity, health care costs will continue to skyrocket consuming more and more of our GNP, and eventually striking limits will be set on what people deserve to get. At some point someone's going to have to say, ok, that may reduce their risk of death 6%, but they don't get it. In clinic, people love it when we prescribe over the phone, or triage over the phone, but it costs a lot of money to do it, and we CAN'T bill for it. From now on the answer usually has to be, "come in," whether that's needed or not.

At the same time there's so much pressure on doctors not to make decisions for patients and so much pressure to avoid lawsuits that we can often do little to stop things. If you come to an emergency room with chest pain, Jesus himself generally has to show up to keep you from getting admitted for "rule out MI (heart attack)." This is done by drawing three blood tests 6 hrs apart--total 12 hrs--BUT if you come to a hospital with 16 hours of chest pain and the initial tests are negative they will STILL admit you for two more even though MI has already been ruled out because they're afraid of being sued. We also have people in the intensive care unit critically ill with metastatic cancer ventilated with ten infections and no (NO) hope of recovery and the family still pushing us to "do everything possible" when such things are not just fruitless, they're sometimes cruel and hugely expensive. Such a patient can cost $4,000 a day before you factor in the indirect costs of the resistant bacteria they spread to other patients. And sometimes that's less than a lawsuit will cost, even when you win.

In europe the doctors would gently tell the family that admission to that ICU isn't going to help, and the family accepts it. Here, we have patients with widespread cancer and potentially lethal calcium as a result getting IV fluid poured into them and complicated bone marrow transplantations to keep them alive a few weeks, and in UK, high calcium from cancer isn't on the list of treatable conditions.

Neither is dialysis if you're over 65, but wouldn't you want it?

For the shoulder in question, before you ask the doctor for a $2,000 scan, try asking these questions: would a scan change what you're going to recommend? There's a limited number of treatment options. If the person doesn't want surgery, or sugery doesn't really help, then there's pills and exercises/therapies. While a lot of people want scans because they can FEEL the HMO's pressuring the docs not to get them and that makes them worry they're not getting something they need. And there's limititations to the things we can do. I have people come back to me with colds and flu and sore knees for which they don't want pills or surgery, and they leave unsatisfied because they're unfixed.

Meanwhile, I've taken care of people after being up 35 hours, and I know it's not ideal. The flip side: I have to take care of sick people I don't kow that well because the doc that does know them is off. It's either tired doc or a string of new docs, and if I were a patient neither would satisfy me.

We keep working on it.

Bill Glasheen · Post by **Bill Glasheen** » Mon Mar 25, 2002 9:24 pm

Sadly much of what Ian says is true. Fortunately there are people like me researching ways to make situations like this better. I hope we succeed. I hope the rest of the world - particularly those that will need health care the most one day - will jump on board.

In the mean time, make sure you get some sleep, Ian. The world needs you.

- Bill

Ian · Post by **Ian** » Tue Mar 26, 2002 2:32 pm

2 European studies of 414 DJD patients (77% postmenopausal women) recently showed that glucosamine 1.5g/d for three years had no joint space narrowing (measure of cartilage loss) at 3 yr whereas placebo had .24mm loss. More importantly to real people, symptom scores improved by 5.5% in the treated group and worsened by 15.4% in the placebo group. Citation I have does not mention statistical significance, except that one of the reasearchers is quoted saying symptoms got better in 2 weeks and this treatment was statistically significant at 3 mo.

Troll Under the Bridge · Wed Mar 27, 2002 5:00 am

Wow, miss a day and you miss a lot!

The first time that I hurt my shoulder, I found that a slow heaven six excersize with sticks felt good. I am going to try again soon. It was an easy way to work the shoulder again as as I felt better, I could increase the speed.