Rotator Cuff

Harvey · Post by **Harvey** » Fri Feb 14, 2003 5:44 pm

Thank you Mary, for the kind thoughts and the caution. Apropos the caution, I am probably older than your father, and I am very careful about exercise, though I do a lot of it. I intend to be back on a bike next week for a couple of hours every other day. And I hope to add an hour of elliptical trainer the week after that. (If I were doing karate and t'ai chi, I would only do one hour on the bike). I will probably do a little more with the shoulder than is prescribed, but not much and certainly no karate.

I was under general anesthetic both times and my head was really clear when I came to, like a wonderful night's sleep. I think the problem the second time was that I was out longer and probably had a higher dose.

I will add to this thread, as things change, because I think rotator cuff injuries are (un)fairly common in the martial arts game and it is useful for people to be able to discuss the issues of surgery and recovery.

Bill Glasheen · Post by **Bill Glasheen** » Fri Feb 14, 2003 5:45 pm

Harvey

Thanks for staying in touch.

It sounds like you are experiencing considerable pain. This can be expected, given the type of injury and how much we use our shoulder in both activity and rest.

Take it day by day, just the way we all do in any life endeavor. So far it sounds like things are going well.

Meanwhile...I thought you might enjoy reading this article about a UVa basketball player's journey from prospective star to serious injury and then back to playing again. His was a very difficult experience, but personality and spirit brought him through. Perhaps there's something there you can take with you as you struggle each day through recovery.

For Virginia guard Mapp, it's been long road back

- Bill

Harvey · Post by **Harvey** » Fri Feb 14, 2003 7:03 pm

Funny you should send this article. Actually, my jump shot is just about the same. But Glasheen, sensei, your appearance raises a question I forgot: is this oxycodene stuff they gave me, the same as the oxycontine that is being heisted from so many pharmacies that many have stopped carrying it? I know that it is an opium derivative.

Bill Glasheen · Post by **Bill Glasheen** » Fri Feb 14, 2003 8:47 pm

Oxycodone is the active ingredient in both Percocet and Oxycontin. Percocet may typically have 5 mg of oxycodone and a standard dose of acetaminophin. Oxycontin is pure, time-released oxycodone, and comes in sizes anywhere from 10 to 80 mg. It's this pure, high-dose form of oxycodone absent the potentially hepatotoxic acetaminophen (a.k.a. Tylenol) that the druggies abuse.

Oxycodone is a highly addictive opiate in the same family as heroine, opium, and morphine.

- Bill

Harvey · Post by **Harvey** » Fri Feb 14, 2003 10:40 pm

Thanks, Bill. I did manage to get through today without a pill and you have made the alternatives much clearer: either a hit of opium or a glass (or two) of wine. I have to ask myself, "which goes better with lamb?"

I think wine with dinner and a pill if I wake up in the middle of the night. At least I never had to worry about my jump shot getting any worse.

RACastanet · Post by **RACastanet** » Sat Feb 15, 2003 12:28 am

Question for Bill: I thought percocet's active narcotic was codeine, not a morphine derivative. Or is codeine a derivative of the morphine family?

Rich

Harvey · Post by **Harvey** » Sun Feb 16, 2003 12:09 pm

Thanks for the compliment, Mary. But if I remember correctly you are possibly a thirty-something. I am a few weeks shy of 62. I have wine 33 years old, that I bought new. And Bill thanks for the info on the drugs. I will be careful.

I found the other day that I could make it dinner drug free, but a couple of glasses of wine were not enough to stave off the pain, so I am back on a few pills a day. The shoulder hurts more than before the operation, but I am almost back to the range I had then. And now I am getting incrementally better, instead of worse, every day.

Mary S · Post by **Mary S** » Mon Feb 17, 2003 6:59 pm

Harvey thanks for the compliment on the age - not true but I'll take it!!

I have a bottle of French red at home that's 22 years old a gift from a college friend....I'm saving it for a special occasion

(although it's probably like vinnegar now!)

Whatever you do, don't go out there and dig out from the snow - I hear you guys are getting some today and we're expected to get it tonight and tomorrow (we honestly have no more room for the white stuff!!!!) Besides it's much better exercise lifting the glass than the shovel.

Van Canna · Post by **Van Canna** » Mon Feb 17, 2003 9:01 pm

Harvey,

You need a TC substitute..like sex in the city..it'll straighten you right out pal...

Van Canna · Post by **Van Canna** » Mon Feb 17, 2003 9:03 pm

But leave Kim Cattrail for me..okay?

Harvey · Post by **Harvey** » Tue Feb 18, 2003 3:27 am

So, Van, you are also a master punster. . . in two languages! And Mary, better drink that wine: "Gather ye rosebuds while ye may," and all that sort of thing. Thanks for the good thoughts, folks.

Van Canna · Post by **Van Canna** » Tue Feb 18, 2003 5:13 am

this one is for you, Harvey...

Gene DeMambro · Post by **Gene DeMambro** » Tue Feb 18, 2003 6:31 am

Codeine and morphine are very similar, chemically and physiologically. Oxycodone (the active ingredient in Percocet and Oxycontin) is chemically similar to codeine, which is in turn similar to morphine. Ergo, oxycodone is also chemically similar to morphine, but is more similar to codeine.

Gene

Van Canna · Post by **Van Canna** » Tue Feb 18, 2003 2:52 pm

Gene,

How about celebrex? How does it compare with advil?

What's it really good for?

Heard there might be some cardio issues?

Thanks!

Bill Glasheen · Post by **Bill Glasheen** » Tue Feb 18, 2003 10:27 pm

Hey, Van.

Both Ian and I have posted on this.

Celebrex and Vioxx are a special category of NSAIDs (non-steroidal anti-inflammatory drugs) that were designed to be very specific about how they block the cyclooxygenase (COX) enzyme in the body. Aspirin, ibuprofen (Advil, Nuprin, Motrin), and naproxen (Alieve) all block both COX I and COX II enzymes. Problem is, COX I enzymes help in forming the lining of your GI tract. This is why those over the counter drugs can eventually lead to ulcers if taken for very long periods of time.

Celebrex and Vioxx selectively inhibit only the COX II enzyme, which eventually leads to inflammation, pain, etc. They work no better than or no worse than ibuprofen for relieving pain/inflammation according to scientific studies, even though individuals swear that they work better for them. A physician would consider prescribing Celebrex to someone such as a person who has rheumatoid arthritis and needs to take NSAIDs for a lifetime.

And yes, as you alluded to, recent studies have shown that these new wonder drugs put you at higher risk for a cardiac event. Interestingly enough, the studies show that for every hospital admission avoided due to a GI event, you have one new admission due to a cardiac event. Bottom line is that people who are at risk for a heart attack should not be taking these new drugs.

Another interesting study came out concerning NSAIDs. Most folks know that doctors often prescribe aspirin therapy to folks at risk for a heart attack, or for folks after a heart attack. It "thins the blood" (increases clotting time), thus reducing the risk of a clot forming at a narrowed coronary or even cerebral artery (the former leading to a heart attack; the latter leading to an occlusive stroke). A recent study showed that if you take ibuprofen and aspirin at the same time, the ibuprofen blocks aspirin's therapeutic "cardiac effect."

The good news is that you can take ibuprofen, do kotekitae, and not be all black and blue the next day like you would if you were taking aspirin. The bad news is that you can't take ibuprofen for pain if you are on low dose aspirin therapy to prevent a heart attack or stroke.

BOTTOM LINE: There is no free lunch with drug therapy - even the relatively harmless over the counter stuff.

- Bill