Got a medical question? Let me stretch my brain.

[Whee]

Well, we know you;re not a 12 yo. If you were, you'd tYpE lIkE tHiS and talk about boobies and comic books...

[Rabidsquirrel]

Originally Posted by illinoishoosier

talk about boobies

If that's a qualifier I think a lot of us are in trouble.

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?

[Old Sailor]

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?

Ian.....it's called Old Age!

Originally Posted by Old Sailor

Ian.....it's called Old Age!

Yeah, I know. But I'm not even 40 yet.

I want to still be able to walk a bit when I hit 50.

[markem]

Originally Posted by kayaker

Yeah, I know. But I'm not even 40 yet.

I want to still be able to walk a bit when I hit 50.

I have a similar problem with my left knee. When I'm good about taking my glucosamine, condroitin, msm (all in one tablet), I have almost no problems. Without it, I can tell when there is a low pressure zone within 200 miles.

Might be worth a try.

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

[Fumes]

This is a long shot, but any ideas will be greatly appreciated.

Every once in a while my wife has crippling lower back spasms that are triggered by simple things like bending over or getting out of a chair. They aren't frequent, but when they happen she has pain to the point where she can barely move. It usually takes a full day of rest and heat on her back before she can get out of bed. And ibuprofen. Lots of it. She has taken muscle relaxants for this but they don't seem to work any better than Advil. X-rays show she has narrowing discs, but her doc isn't sure that is the problem. She tried chiropractic for several months but it hasn't been effective in the long term.

That's the background. My question is this: she had a spasm yesterday (just getting off the couch) and afterward she had numbness and tingling in her legs and in her arms from the elbow to the fingers. This was new and it went away after a few hours, so we're not too worried about it, but 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!

[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?

[Sauer Grapes]

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?

I'll let the Dr. give you an official answer, but it could definitely be a sprain and still hurt for months. Some sprains even need surgery, but it doesn't sound like yours is as bad as some I've heard about if you can still run on it or even walk without turning your ankle. Swelling can take months to completely go down as well.

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 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

[Fumes]

Originally Posted by Cyanide

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.

Hmm...very interesting. Mrs. Fumes is a grad student and has been spending an inordinate amount of time sitting on a very worn out couch with her laptop and several large stacks of papers. I suggested that she get up and stretch occasionally, but oh no, there's too much work to do and no time. I would expect that sitting in an ergonomically inappropriate position for extended periods of time might be a trigger for back spasms.

This was quite enlightening! Thanks for taking the time, John.

[kgoings]

I read and hear alot about the hunter gatherer diet, and how with the agricultural revolution we started consuming high amounts of grains and carbs that threw off our bodies.

What is your opinion on this?

Well, I had never formally heard of "the hunter-gatherer diet" AKA "paleolithic diet" until you mentioned it here.

And, I can't say that 15 minutes later I am an expert on the topic.

But, it seems to push a high meat content, followed by wild grains, foraged plant materials etc. The big push regarding this diet is the proposed lack of signs/symptoms of cardiovascular disease, with some bandwagoning in "diabetes, ... cancer, auto-immune diseases, obesity".

From what I see so far there isn't any smoking gun. Unfortunately, some of the websites I have perused do seem to take on a fervor that makes me concerned for what lays beyond.

The claims regarding ridding yourself of these disease really does not have much foundation on which to stand. I would doubt that the studies could really control for enough variables to determine what the causation was. Hunter-gathering leads traditionally to expending lots of energy to obtain the food and probably not gathering an abundance of food. Its the agriculture evolution that probably was one of the first steps to allowing humans to start advancing in population and technology, as food became easy. I think the evidence is really pooling in that a calorie restricted diet may be one of the most effective ways to live as long as possible, at least in animal models. But that leads to emaciation, lethargy and generally a "not fun" life. Your metabolism probably slows down so much that you live longer, wishing you were having fun. Animals don't mind much as they are really just worried about surviving one second to the next. So, lack of food availability probably takes care of obesity, diabetes and by extension cardiovascular disease. I was not able to find any relavent sources, but I do imagine the life expectancy was pretty low in hunter-gatherer eras. Trauma, starvation, infection probably killed most humans then. Only once food was easy to get did we live long enough to die from cancers. Auto-immune diseases? I think that is a red herring. While they are interesting and shocking, they are relatively rare. Including them would only be for the shock value and probably a complete fiction.

I don't think that grains and carbs are the route of dietary evil. I do think that they are cheap and easy to produce and thus are highly utilized in food products. Combine that with overeating and you are almost guaranteed to be eating too many carbs. But that will probably be true for fats as well, not so much protein. For some reason protein doesn't factor high into a poor (which commonly coincides with cheap) diet.

I like to stay active, otherwise I would seriously consider the calorie-restriction thing (isn't the Bernstein diet like this?). But, then, a week in, I would probably hunt down a kid in my neighbourhood and eat them. So, reasonable diet is for me.

If one wanted to be a full thinker in designing a diet, they would first start with what their calorie requirement is. I think mine is about 2400 a day just to live (I am a big guy) then add my exercise expenditures (probably 1200-1500 a day, 10km+ a day). If I wanted to loose weight I would come in under that sum. Otherwise, aim for that sum.

Then decide what the required protein is. I believe the researched requirement per day is approx 0.76 gram/kg body weight for grams of protein a day. Alot of people round that up to 1gram/kg. This is the type of numbers when the dieticians calculate out diets for hospital patients with dietary components to their treatments. It is based on various rigorous studies that I trust (but don't have references to anymore). Then subtract out the calories from that protein (4 cal/gram protein approx). Then calculate the fat. I think its 30% calories from fat, no more than 30% of your fat being saturateds. Fat is 9cal/gram. Then the rest can be carbs. Include at least 30gram fibre into your carbs every day.

Include an exercise program that involves 40 minutes cardio/aerobic (pace that leaves you breathless if you try to converse while doing it) 3 times a week. With that, you are probably sitting on about as healthy a diet as need be.

All the micro-nutrients (vitamins/minerals) will probably be easily satisfied with any balanced food sources you choose (BALANCED, no excluding groups) and you won't have to worry about deficiencies (despite the absolute non-truths spread onto the public) except maybe vitamin D if you don't get enough sun, folate for fertile females, iron for females with heavy cycles.

No nutritional therapies will "boost the immunity" (unless you are actually correcting a true vitamin deficiency). You cannot boost the immunity. The only thing that "boosts the immunity" is inflammation and infection....and that's more a case of stimulating the immune system you already had. You may develop immunity from a particular pathogen that attacked you, but you will not have a "stronger/more potent" immune system. The only diseases that can realistically be treated with dietary therapies are those that involve dietary abnormalities (obesity, diabetes, cholesterol). Cancer will laugh at your dietary changes. If anything, better nutrition will strengthen a cancer, by strengthening you maybe, and thus freeing up more resources the cancer can use up. That being said, don't kill a cancer by killing the host.

I have kind of gone all over the place with this post, and in turn, only touched very briefly on many topics. Hopefully I have hit some of the important ones at a useful level of detail.

Cheers

John

[newcigarz]

Originally Posted by illinoishoosier

Well, we know you;re not a 12 yo. If you were, you'd tYpE lIkE tHiS and talk about boobies and comic books...

hey I like boobies and comic books.

[Whee]

Originally Posted by newcigarz

hey I like boobies and comic books.

You are not alone.