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| Q&A: Dr David Hartman on Head Injuries (824 Posts)
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The Grey Zone
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On 5/12/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Haim,
It's not YOUR job to diagnose you! If one doc is not sure, go to another university hospital and bring your previous records. Pin them down, do not go undiagnosed or untreated, whatever it is. In the meantime, stay cool (literally) and skate easy if you feel up to it.
drdh
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Good news..and thanks
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On 5/12/2004
Haim
wrote in from
(62.219.nnn.nnn)
First off - thanks for that great reply. Gives me alot of hope, and useful information. Second thing is I just got back from my spinal tap (this disease goes to 11..). There was alot of disagreement between the head of the dept. and the neurologist who originally told me it was 80% sure MS, according to the MRI. Basically, he thinks the clinical signs don't support MS and the MRI may be too sensitive to go so far with. I'll get the results of the ST in a few days and the visual brainstem response next week, so I'll have more info then. I'm mostly concerned now with being caught in the grey area - some symptoms, but no treatment...and does that mean I can skate and exercise aggressively, or not? In the meantime, I'll try to just listen to my body and not overdue it.
Oh - I live near Haifa,so it is not SOOO hot, like in the Negev. I never skate until evening, anyway. Even when I'm feeling tip-top.
Thanks again,
H
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Haim another thing
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On 5/12/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Also, if you live in the Hot Zone, do outdoor exercise early morning or later evening when things cool off. There's almost no way to stay cool in the middle of the Negev at noon unless you're going wateraerobics in a tub of crushed ice. . . .drdh
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Herbn and The Pill
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On 5/12/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Herbn,
Check the list archives. Glucosamine with Chondroitin is good stuff, supported by good science. People seem to like Cosamin DS as the best over-the-counter brand.
DrDH
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No Sweatin with the oldies for Haim. . .
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On 5/12/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Haim,
Complicated question. First, if you've got Lyme disease, you need to see a specialist and see if you need to get on antibiotics, etc. That's first priority. DOn't wait and don't mess with it. Get a differential diagnosis between MS and Lyme. This is not something to wait on, if you've got a positive MRI.
If you've got MS, there's some good news about exercise Here's the poop from the MS Information Sourcebook, produced by the National MS Society.
"In addition to being essential to general health and well-being, exercise is helpful in managing many MS symptoms. A study published by researchers at the University of Utah in 1996 clearly demonstrated the benefits of exercise for people with MS. Those patients who participated in an aerobic exercise program had better cardiovascular fitness, improved strength, better bladder and bowel function, less fatigue and depression, a more positive attitude, and increased their participation in social activities.
Inactivity in people with or without MS can result in numerous risk factors associated with coronary heart disease. In addition, it can lead to weakness of muscles, decreased bone density with an increased risk of fracture, and shallow, inefficient breathing.
An exercise program needs to be appropriate to the capabilities and limitations of the individual, and may need to be adjusted as changes occur in MS symptoms. A physical therapist experienced with the unique and varied symptoms of MS can be helpful in designing, supervising, and revising a well-balanced exercise program. Any person with MS who is initiating a new exercise program should also consult with his or her physician before starting.
Periods of exercise should be carefully timed to avoid the hotter times of the day and prevent excessive fatigue. With some guidelines, a good exercise program can help to develop the maximum potential of muscle, bone, and respiration, thereby avoiding secondary complications and gaining the benefits of good health and well-being."
Keep some ice water around. Don't over-exert. Maybe get one of those frozen headband thingies to wear, and keep seeing your doctor and/or MS specialist. As long as you don't have neurological symptoms related to weakeness, balance, incoordination or other motor problems, you can skate - carefully! Symptoms change in MS so if you start developing any of the above, see your neurologist immediately and don't do any extreme sports, including skating. Lesions in MS appear to come and go, so get retested every now and then do see what happens. Needless to say, where the helmet.
Best of luck. There are good treatments for both Lyme and MS. Be aggressive about getting whichever is appropriate. Let us know, we're with you.
DrDH
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don't shoot, Herbn
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On 5/12/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Hey Herbn,
By "access" to cortisone, I'm assuming you've got a source that isn't your doc. I wouldn't use it unless you get the guy in the white coat's approval. The reasons being (1) the research says it's not all that effective and (2) injecting anti-inflammatory steroids can weaken tendons. You need to check out why you be wobbly in the first place. Orthopods and/or sports med docs are your best bet. If you've got numbness, shooting pain, etc., a neurologist might help.
Let us know and good luck. DrDH
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Lyme's disease
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On 5/12/2004
Haim
wrote in from
(62.219.nnn.nnn)
That is an interesting thought about "chilling". The unfortunate part is that I live in Israel, and it is kind of hot here....
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slightly silly thoughts that may work
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On 5/12/2004
Tom M.
wrote in from
(164.227.nnn.nnn)
I started using glucosaminm (sp?) several months ago. My prior symtoms: A LOT of clicking in my knees when I went into/outof a downhill sliding position (i.e., deep knee bends) which would -- if done enough -- result in a bit of pain in the knees for the next few days. I also had a terrible "POP" when going from "standing" on my knees to sitting on my feet (i.e., the typical slide-out position for the bowls, etc.).
IIRC, I take about 500mg morning and night. The same pill has some MSM? in it (don't remember how much). Get them from WalMart (Nature Valley??).
At any rate, I don't have the symptoms any more. No side effects AFA I can tell.
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slightly silly thoughts that may work
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On 5/11/2004 herbn
wrote in from
(152.163.nnn.nnn)
Man ,lyme disease can do that,now i really hate those little buggers,would cold climates help,getting used to hypothermia, or at least starting a session cold? Is there an actual increase in body heat, can you skate with sort of a body temp monitor(like a heart rate monitor). Off the subject , how do people feel about glucosaminm,i know a few lifers who swear by it, the three month start up time has got me a bit skypticalm,seems like they got 70 bucks of your cash before you can even judge it's effectiveness.
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Sk8 and nervous disorder
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On 5/11/2004
Haim
wrote in from
(212.179.nnn.nnn)
Hi Dr. Dave,
I got the disturbing news that my MRI came back with foci looking like MS (or Lyme's). I'm not disabled at all - just some hearing loss in one ear. The Neurologist said she thought with the new MS drugs (ie. Rebif) I should lead a normal life EXCEPT not to overheat during exercise. Do you think it is possible to continue a mellow-kind of skating regimen? I tried it last week, expending about 25% of my normal session energy, drinking huge amounts, standing in the shade, and taking off the helmet between runs. The session was not so satisfying, but I felt normal the next days...Do you think I can keep this up as long as I can, or should I just forget the skating (which I love)?
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wobbles and my new floppier right ankle
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On 5/6/2004 herbn
wrote in from
(205.188.nnn.nnn)
got some shimmying today at a considerable speedm, at least upper thirties. It might have been equipment but it brought out the weakness in my right ankle (effected by my cyatic nerve trama)it's all in the shin splints,so now it's back to rehabing it. I found if i sit on a set of steps and put my heels on a step and raise and lower the foot ,it works those muscles most directly. Any other suggestions? I do have access to safe(?)cortizone injections, what's the deal with that?
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G Thanks
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On 4/30/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Thanks G. Hey, tell your doc that she has a good patient :)
You've got the recovery thing down. I couldn't tell you any better than what you're doing. The exercise-to-non-impact-to-slowly resuming the other stuff is the way to go.
If you tend to get injured in that area. . .see the advice for Ty. . .check out a sports podiatrist, who can give you advice on shoes, etc.
Keep your readers posted on your progress. . . drdh
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The Arch of Tyler
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On 4/30/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Hey Ty,
So what ARE you doing when you get the pain? Is it that you are spending the day sk8ing and then it hits you at night? Does it happen when you change shoes? Stomp your feet at a concert? Go running in a set of cowboy boots? Inquiring minds want to know. . .
The more common specific causes of arch pain can be:
* plantar fasciitis (strain of the plantar fascia - a band-like ligament that supports the arch)
* tarsal tunnel syndrome (a pinched nerve at the ankle that sends pain into the arch)
* foot strain from a pronated foot or flat foot
* osteoarthritis of the joints in the midfoot that can cause arch pain.
The solution in the short term is to get out the ice to lower the inflammation, but that's not the real solution. You gotta see a sports podiatrist and let him or her x-ray your foot, look at how your shoes are wearing, and point you to some long-term solutions like different shoes, orthotics, etc. In the meantime, make sure that the shoes you *are wearing have good arch support for the midfoot and good cush in the heal and mid foot.
Keep us posted and good luck. drdh
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Update on Ankle Sprain
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On 4/28/2004
G
wrote in from
(135.214.nnn.nnn)
Hey Dr Dave, just a quick update. I'm at 3 1/2 weeks, the brace has come off and it's going well. The exercises really helped and I'm gonna keep with them. I'm putting off skating for another week. I'll try a little bicycling this weekend and go from there. Thanks for the advice!
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Foot issue
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On 4/27/2004
Tyler
wrote in from
(170.148.nnn.nnn)
What's up Doc, Here's the deal: For a few years now I've been getting some pain and swealing every now and again on the verticle inside of my right foot right above the apex of my arch (i believe it is right by the Navicular or First Cuneiform Bone) Like I said, this hase been happening for years and it comes and goes with no real pattern. I'll skate or ski or run a ton and have no problem, but then out of nowhere it will swell up a bit and hurt for a week or so. Any idea as to what causes this and any possible solutions? Thanks a ton, Tyler
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Ankle sprain
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On 4/13/2004
G
wrote in from
(135.214.nnn.nnn)
Thanks Doc,
I have been doing minimal walking with the air brace on. (Doc said it's okay). Yeah, she's pretty cool, she's a snowboarder, so she has the stoke. :) My stats, blood pressure and pulse are great, so she's encouraged me to keep with skating.
I'll keep being good about not overdoing it and am glad you said not to work thru the pain, I wasn't sure about that when doing my exercises.
I had to laugh when you said to build a new board, I have been stripping the paint off a new deck and cutomizing the paint job already. :)
Thanks again!
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Standing instructions for G
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On 4/12/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
G.
Thanks for the props on helmets. I'm all about good advice, as best I can. Let me give you some thoughts on your sprain. (1) You've got a real good doc. In the land of boxed docs whose idea of treatment is to tell you to give up skating, you've got a keeper. (2) Sprains heal slowly - 4 weeks is a good time to see where you're at but don't go right back to skating yet. You didn't say whether you're walking with or without the brace but take it easy. If anything you do hurts DON'T PUSH THROUGH THE PAIN. Look at pain as your first warning about possible reinjury. And if you re-sprain, your body will make you pay attention the second time by making the reinjury more serious and longer lasting. (3) "Hardly any swelling" means you still have swelling. Take it easy. You'll skate a lot longer and more pain free by waiting until your doc gives the O.K. Keep using your doc's Sprain Surprise pak until she says so. I'll bet most of the skaters here wish they had your doc.
Let us know how you're healing. Use your time to build a new board and rent a few skate videos. When you do get back on the board, remember the pads, and ask your doc about whether more supportive shoes or other protection might help.
drdh
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Ankle Sprain
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On 4/12/2004
G in Seattle
wrote in from
(63.187.nnn.nnn)
Hey Doc,
I sprained my ankle 9 days ago. I did ice, elevation and ibuprofen right away. It's a mild to moderate sprain. I saw my doc and she gave me this fabulous box o' ankle sprain tricks. I have theraband, exercises, cold pack and an air brace. For the last week I have been able to walk using the air brace, am still icing after doing my stretching and prescribed exercise. Now, how long before I can skate? I'm a mellow carving skater, no air, tricks. Doc says 4 weeks healing time total. I have good range of motion, hardly any swelling and can walk and climb stairs like a champ. The clouds have parted here in Rain City and I'm dying to get back on my board.
PS: kick a** last post on helmet use.
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Brady's @%#
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On 4/7/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Brady,
Your comments pretty much sum up the opinion of anyone who knows anything about riding, helmets and head injury. The problem, as I see it, is that there are lots of people who are unable to see the difference between "freedom" and "rights." IMHO, riding either MC's or skateboards is not a "right." Otherwise, why prevent drunks or 3 year olds from doing it?
To those who say it's their "right" not to wear a helmet and if they die, that's their problem, I'd say, 'what about your wife/partner/kids etc?' Is it their 'right' that they live on without you? And what if you have to live your next 30 years as a quad in the back ward of a nursing home? You smell pretty bad strapped into a bed with tubes stuck in every orifice. And my taxes pay for it because you can be sure that your insurance company is not going to comp you for deciding to be a vegetable for the rest of your life.
So wear the helmet. Whether or not it's the 'law.'
drdh
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Liviu's pants
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On 4/7/2004
Dr. Dave
wrote in from
(24.13.nnn.nnn)
Liviu,
You might be interested in a study by Dr. Malvinder Parmar, medical director at the Timmins and District Hospital in Ontario, who found that three of his patients complained about a bewildering sensation in their upper thighs. Physical examinations revealed nothing unusual, but the women shared a proclivity for tight, hip-hugging pants.
Parmar suspected nerve constriction. To confirm his diagnosis, he recommended the women switch to loose-fitting dresses. After four to six weeks, their symptoms disappeared, he says.
Parmar says the lateral femoral cutaneous nerve, which runs beneath both sides of the hipbone, is compressed by the hip band of the pants. This produces "meralgia paresthetica," or burning, tingling thighs, Canada's Globe and Mail newspaper reports.
The nerve damage doesn't seem to be permanent, Parmar says. Still, "people who suffer these symptoms should not wear these tight pants," he says.
You can compress the sciatic nerve by wearing tight pants or even putting a wallet in your back pocket. In many people the pain will go away on its own, but in some adults, permanent pain has been reported. You could try over-the-counter anti-inflammatory medicines if you can stomach them but mainly, wear loose fitting clothing. Hey, baggy is still 'in'
drdh
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Off the Board
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On 4/5/2004
Dr. Dave
wrote in from
(68.74.nnn.nnn)
Hey people,
Sorry about any delay in responding last week. Was snowboarding the last snow this season in Beaver Creek Co. Great ride BTW. 11,000 feet up, your brain just shuts right down in the low oxygen and leaves the fun stuff from the neck down. Will get to the new stuff ASAP.
Thanks, drdh
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helmet injury vs non helmet statistics
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On 4/3/2004
Brady
wrote in from
(68.158.nnn.nnn)
I found this study to be an interesting read...
http://www.sasnet.com/bro/statistics/goldstein/reviews/1.html
What I find insidious is in my state, the helmet law was repealed. But conversely, we have a law that enforces wearing a seat belt. Don`t get me wrong, I always wear one. But the law has been changed from an infraction that could only be cited after another offense has occured (speeding ticket, accident, etc.) to now be that is will be a regular moving violation.
So you can ride around without any sort of protection on a motorcycle, yet get pulled over and cited for not wearing a seat belt. What the F#@& ??
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my pain
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On 3/28/2004
Liviu Ghitescu
wrote in from
(80.97.nnn.nnn)
i used jeans one number under my usual size(in winter i get some more pounds over) wearing leather strong belt.
at the begining (autumn),i felt a pinning sensation after driving or after eating more;puting down pants my pain (inconfort)was dissapearing.
now it is burning sensation in the hip -thigh zone,left foot.
from about one week i wear only large trousers but this pain still persist
it is clear for me that i damagged my sciatic nerve...
now,what doing more ?
thank you a lot for answers....
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Shoulder injury
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On 3/28/2004
Lenny
wrote in from
(205.188.nnn.nnn)
I sprained my right clavical a couple days back and, of course, want to get back to skating ASAP. The doctor at the ER's only advice was, with my size and strength, I should've gone into boxing. The LPN who cleaned up my wounds and gave my the sling said I should work on range of motion. She said it would hurt, but then gave me no specific exercises. Right now: I leave the sling off when I'm at home, can now shave with a little pain, can touch my forehead and both shoulders with some discomfort and last night, could hold a dinner plate almost straight out before calling it quits due to pain.
Especially with The Gathering right at a month away (not to mention summer vacation and the new park in Athens, OH), ANY helpful hints would be grand. Thanks
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MSM/DMSO
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On 3/25/2004
Rob
wrote in from
(216.249.nnn.nnn)
Dr. Dave:
Recently an othropedic surgeon gave me a sample of Pensaid - which contains DMSO - for a recontructed knee that I have been experiencing swelling in. He told me the knee is stable and the swelling is due to arthritis??
In university, almost 15 years ago, I wrote a paper on DMSO (the time when it was only available in animal grade) and there was a lot a concerns about what kind of contaminents it could bring into the blood stream. I found it suprising that it is now available in an perscription.
My personal experience with Pensaid - is that is works very effectively in reducing swelling.
I would be interested in knowing what concerns there are with DMSO and what other anti-inflamatories that you would recommend.
Thanks
Rob
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