Many years ago my then wife and I invited a mutual friend of the
feminine gender, an actor of minor talent but
great egocentricity to an evening
of dinner, (roast beef and its accoutrements), requiring some precision cooking timing. We then planned to attend
a special showing of a highly
acclaimed movie. Dinner was scheduled for 6 PM; off to the cinema @ 8. Six o’clock passed, then 6:30. At
7:00 the lovely and talented
pain in the ass was still unaccounted for. The two of us sat down to a dried out well-done roast and as we did,
the buzzer sounded signaling the
arrival of our guest. What the hey, 6 o’clock, 7 o’clock, what difference?
Extremely pissed, I managed to stifle, accepting the
lady’s pitifully inadequate
excuse with clenched teeth.
Off we went arriving just in time for the feature. As we
sat down, I noted an
uncomfortable feeling in my right buttock. My then-wife (with whom my relationship at that time could be described
as tenuous at best) and our
guest began what turned out to be a running commentary throughout the film, ignoring my suggestions that they cease and
desist. The uncomfortable feeling in my
butt upgraded to true pain, increasing in severity logarithmically by the minute, causing me to twist and shift
in my seat. Forget the film! I had no idea of
what was going on. Finally, the
movie ended and I tried to get up.
#&%@! Drat! Agony! I could barely
walk. With the help of some kind friends
I was assisted to a taxicab. The woman who came to dinner (or almost) left us and my wife and I proceeded to our
4th floor walkup apartment on
the upper West Side.
Getting up the steps was arduous and agonizing. Upon
arrival at our front door I was
screaming. Tears of anger and pain. Suddenly, uncontrollably, words erupted from my mouth: "I should have kicked both
of your @#$%#$& butts!" I fell to my
knees. And just as suddenly, when I tried to get up, I realized that the pain was gone!
So what? Quite simply an illustration of the power of the
mind over the body or lack of
it. And not an extraordinary one. Was my pain a manifestation of hysteria? Did it accomplish the secondary gain of saving me from incarceration for felonious assault?
Take the long-time patient who consulted me some months
ago about severe pain in both
knees. It began following overuse of the leg extension machine at her gym 2 days previously. I examined her
and determined that she had
acute inflammation of both patellar tendons. No big deal. She had simply over-exercised and had a common, usually
benign problem, particularly
when caught this early. Rest, ice, anti-inflammatory meds should handle it in a few days. But no. Her pain got
progressively worse, to the
point at which she was literally unable to walk. Climbing or descending steps was agony. She was unable to
drive her car. We (our physical
therapists, myself) repeatedly assured her of the benignity of her condition, but she continued to deteriorate. She
was re-examined. No change in
diagnosis or prognosis. Now she was talking about getting manual controls for her car and applying for disability.
After daily (and sometimes several times a day)
communications over the telephone
and via e-mail, totally exasperated, I made a serious tactical error. I knew that ten years prior; this same
patient had suffered a similar
ailment. At that time she remanded herself to complete bed rest for several weeks. Her terminally ill mother, with
whom she lived, was pressed into
service as her primary caregiver, expiring soon after. Could it be that this present situation pushed a
button that reminded her of the
earlier event? And that the guilt attached might in some way be the source of the severity and prolongation of
her present disability?
Duh! Of course, you may say, one needn’t be Sigmund
Freud to see that. Right. But
then my error: should I have communicated my brilliant analysis to my psychotherapist patient? Certainly
not! Hell hath no fury like what
was unleashed by my inappropriate and poorly timed attempt to remedy the situation with one brilliant stroke.
There have been no civil words
from her since that time, and I don’t blame her. Being right is not all there is. I hope she has recovered. I have
not.
It’s been over a year since I started taking a form of
glucosamine/ chondroitin called
"Cosamin DS".
It’s done wonders for most of my osteoarthritic
pains, but I still had to have
my hip surgery. That was simply too far gone to be saved by conservative measures. My lower back feels fine, and
that was a major problem area.
Certainly fixing my hip made a big difference by allowing a return to a somewhat normal gait, but I am sure
glucosamine/chondroitin has helped. Based on
my own experiences and available
information, I have not hesitated to recommend the same to my patients and friends.
Now that we have some more information, and some
endorsements from more authoritative
sources, it’s time to take another look at these supplements.
We need to be aware that these nutritional substances are
not now and will probably never
be curative of arthritis or any other disease. That, however does not negate the benefits
available with long-term use.
Glucosamine is a low molecular weight substance whose
primary role in the body (where
it occurs naturally) is as a substrate for glycosaminoglycans and hyaluronic acid and to stimulate the secretion of
glycosaminoglycans in joint cartilage.
Which means what? Simplified, glucosamine
supplies the building materials
for joint cartilage in a form that is absorbable and usable by the body. This is necessary because joint cartilage
as a cushioning structure is
subjected to incredible mechanical stresses during weight bearing and movement. Although the body depends in
all areas on its reaction to
stress as a growth stimulant, it does not have a sufficient supply of the raw materials for these building
blocks necessary to repair the
wear-and-tear damage imposed by injury, aging and athletic activities.
Chondroitin sulfate is the major glycosaminoglycan found
in cartilage. Additionally, its
primary function may be to inhibit the degrative enzymes contributing to breakdown of joint
cartilage. This assumes added importance
when we consider that among the side-effects of non-steroid anti-inflammatory medication (NSAIDS), may be the
accelerated destruction of joint
cartilage.
Of more immediate significance and proven by reliable
studies, including six
double-blind investigations, is the fact that glucosamine/chondroitin is an effective pain reliever in osteoarthritis
and in joint pain secondary to high-impact or
mechanical loading activities.
It has been determined to be equally or more effective than therapeutic doses of ibuprofen and further, entirely
without side-effects or
interaction with other medications.
If you have osteoarthritis or a family history of OA, I
strongly advise you consider
taking this stuff.
However, glucosamine/chondroitin or no, the rules of the
game for self management of
osteoarthritis have not changed:
1. Exercise, exercise, exercise, including aerobics.
(Within pain constraints.
Exercise should not cause pain during or after activity).
2. If you’re overweight, get rid of the extra pounds
but eat a well balanced diet.
3. For acute pain episodes, acetaminophen is your first
choice of medication. If
necessary, your next best bets are NSAIDs.
4. Get plenty of rest
5. Cold or heat?
Guy calls his doctor at 5 PM on Friday. "My back is
killing me."
Doc: "Take 2 aspirin every 4 hours, put a heating pad on it and call me
on Monday."
Patient calls back Monday.
Guy: "Doc, my back feels great."
Doc: "Did you use the heating pad as I said?"
Guy: "No, actually I used an ice pack."
Doc: "Ice pack? Who told you to use ice?"
Guy: "My mother."
Doc: "Funny, my mother says use a heating pad!"
If you’re awakened during the night with severe and painful
numbness and tingling in your hands,
fingers and wrists, and you work at a computer or other repetitive strain injury generating job, you probably
assume you have the dreaded carpal tunnel
syndrome (CTS). Further, you think
it is causally related to what you do for a living or to your avocation, e.g. playing a musical instrument,
particularly guitar and piano.
The news is that we may have to do some serious
re-thinking on this subject.
Recently there has been accumulated a substantial body of information to the effect that this is, at least in
a large number of complainants,
not the case. Rather, workers who fit the diagnosis of CTS were much more likely to have a medical disease
(obesity, hypothyroidism,
diabetes mellitus or various arthritic conditions) than control subjects without symptoms of CTS. In
essence, it has been strongly
suggested that symptoms of CTS may be the result of some other non-traumatic medical condition.
The significance of this to us as osteopathic physicians
(D.O.s) should really be nothing
new. After all, as a D.O., it is my mandate to treat the whole patient and not his disease.
In addition to the medical conditions cited, there are
mechanical factors to be
considered.
• Nerve root inflammation related to pressure from a
protruding disc or an arthritic
spur in the cervical spine.
• Myofascial pain syndromes and trigger points (q.v. previous newsletters, website: bonesdoctor.com) involving the
soft tissues of the neck, upper
back and shoulder. These often related to dysfunctional postural mechanics.
• Chronic restricted motion at the
shoulder or elbow leading to abnormal movement patterns at the wrist
At the Center for Sports & Osteopathic Medicine, CTS
and other musculoskeletal
conditions are addressed and managed with all the above in mind.
After making a firm diagnosis based on history, physical
examination and the appropriate
diagnostic tests, which may include electrodiagnostic studies, treatment is initiated including
osteopathic manual therapy, trigger
point injections, medication when indicated.
Physical therapy including splinting, postural retraining,
workplace modifications,
strengthening and stretching exercises, manual therapy including myofascial release is a mainstay of treatment.
For many people, a headache is simply the body’s response to
too much noise, tension or other
stimulation. Most of these headaches are generalized, dull aches. There are times, however, when a headache should be taken more seriously as signifying a more
serious medical problem. Knowing
the symptoms and paying attention to your body’s cues can help you manage your symptoms and derail
potentially more serious problems.
Consider seeking medical attention in case of any of the
following:
• The headache doesn’t seem to be related to
stress or illness
• The headache is present 4 or more days a week in spite of taking medications.
• The headache is brought on by exertion, coughing, sneezing or vigorous
activity
• The headache is accompanied by blurred vision, dizziness, nausea or confusion
• The headache is associated with loss of consciousness or memory lapses.
• The headache is worse than any you’ve ever had and/or is different in
intensity or location, is accompanied by
stiffness of your neck or significantly
interferes with the quality of your life.
Remember, almost, but not all headaches are simply
manifestations of emotional or
physical tension or both. So not to get crazy at the first sign of one. Take a couple of acetaminophens; chill
out; take a walk; get some
sleep; eat something; yell at somebody. If that doesn’t do it, call us.
(Thanks to Dr. Steve Williams of Neuropraxis, a group of
neurological and physiatric
consultants with whom we are working.)
To all of our friends, patients, and colleagues we wish
you healthy and happy holidays
and a wonderful 1999.
