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| Q&A: Dr David Hartman on Head Injuries (824 Posts)
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Which doctor?
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On 5/14/2003 psYch0Lloyd
wrote in from
(198.160.nnn.nnn)
Chris skated with an injured foot and is wondering why it hurt so much when he stepped off the board onto tranny (they call it pool feet dood). He was instructed to make a small sacrifice to the unwholy ones but all he could do was kick the cat. Now he'll be needing those nine lives to live with all this karmic response. If boiled seeweed soaked in lye is not the solution, maybe a little rest should be the prescrition. Sit back on your Harley 'cause St. Louis is calling - 100 cones burning into yer board!
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my foot
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On 5/14/2003
cfavero
wrote in from
(205.188.nnn.nnn)
doc,my foot was injured amonth ago,to be quite frank,i am glad to be walking.the injury occured stepping off my board and getting turned away from me,the injury is in the part of the foot between the ankle and the toes.it involves my arch and the top of the foot.its seemed to have hit a wall healing,especially in regards top lateral support,i am considering seeing a sports related doctor,does this make sense or should i give it more time to heal first.cf
p.s.i did have medical care when it occured and they called it a bad sprain
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Apologies to Bar et al.
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On 5/11/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Hey Bar,
I really am sorry if I've offended you and I completely understand that the state of health insurance in the U.S. is a horrorshow. Be that as it may, Rich's description of his problem suggested that it WAS NOT going away on its own, and in fact, might leave him with problems later on if he didn't get it looked into. There are teaching hospitals and county hospitals in some places, but as you suggest, there are times when free advice (even mine!) isn't enough. Rich's case sounded like that.
So, please accept my apologies. I was trying to jog Rich into getting his arm looked at, not tweak people with bad insurance DrD
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""Don't you guys ever go to doctors? Sheesh. . .""
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On 5/10/2003 Bar
wrote in from
(68.97.nnn.nnn)
Dr. Dave says "Don't you guys ever go to doctors? Sheesh. . .""
SHEESH!!!!???????
Where do you live? CANADA?
I am one of many self employed americans that scrapes by feeding my 7 children, my wife and myself.
Lowest cost to insure my family on a crappy plan was $8000 a decent plan was well over $10000.
My children go when they need to, my wife goes when she needs to, I go when there is no other choice.
My Dr. is a nice guy and takes into account we are a private pay with not much money and even still most visits cost at least $70. If extra treatment or diagnostics are needed of course it goes way higher.
I have found that most injuries and illnesses get better on their own if you know how to treat them and don't aggravate things by ignoring it.
I am not stupid about my health but when I can get some free medical advice, I will take it.
I may be over sensitive, but SHEESH! from a Dr. doesn't cut it. I thought you had this forum to offer advice
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Alex's Flatspots
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On 5/3/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Alex, I could tell you about getting rid of flat spots on your head after your hit the ground without a helmet, but if you are talking wheels, check out Wheels forum.
drDH
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RIch's Built-In Elbow Pads
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On 5/3/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Don't you guys ever go to doctors? Sheesh. . .
O.K. Rick, you have not healed up from this. Pads and Leathers stop your skin from peeling but don't eliminate the shock. Go see your doc unless you want to wind up with your arm looking like Wiley Coyote after failed use of Acme anti-roadrunner rocket skates. See the following, but get a Sports Medicine Ortho Doc on your case NOW.
http://www.mdadvice.com/library/sport/sport256.html
ELBOW SPRAIN
GENERAL INFORMATIONDEFINITION--Violent overstretching of one or more ligaments in the elbow joint. Elbow sprains are relatively uncommon. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a SPRAIN-FRACTURE. There are 3 types of sprains:· Mild (Grade I)--Tearing of some ligament fibers. There is no loss of function. · Moderate (Grade II)--Rupture of a portion of the ligament, resulting in some loss of function. · Severe (Grade III)--Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair. BODY PARTS INVOLVED--------------------· Ligaments of the elbow joint. · Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles. {128} SIGNS & SYMPTOMS--------------------· Severe pain at the time of injury. · A feeling of popping or tearing inside the elbow. · Tenderness at the injury site. · Swelling around the elbow. · Bruising that appears soon after injury. CAUSESSharp force that bends the elbow sideways or backward, causing stress on a ligament and temporarily forcing or prying the elbow joint out of its normal location.RISK INCREASES WITH--------------------· Contact sports such as football, basketball, hockey and soccer. · Previous elbow injury. · Obesity. · Poor muscle conditioning. HOW TO PREVENT--------------------· Long-term strengthening and conditioning appropriate for sport. · Warm up before practice or competition. · Tape vulnerable joints before practice or competition. WHAT TO EXPECT========================================APPROPRIATE HEALTH CARE· Doctor's diagnosis. · Application of a cast, tape, elastic bandage or sling. · Self-care during rehabilitation. · Physical therapy (moderate or severe sprain). · Surgery (severe sprain). DIAGNOSTIC MEASURES--------------------· Your own observation of symptoms. · Medical history and exam by a doctor. · X-rays of the the elbow, wrist and shoulder to rule out fractures. POSSIBLE COMPLICATIONS--------------------· Prolonged healing time if usual activities are resumed too soon. · Proneness to repeated injury. · Inflammation at the ligament attachment to bone (periostitis). · Prolonged disability (sometimes). · Unstable or arthritic elbow following repeated injury. PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures. Average healing times are:· Mild sprains--2 to 6 weeks. · Moderate sprains--6 to 8 weeks. · Severe sprains--8 to 10 weeks. HOW TO TREAT========================================NOTE -- Follow your doctor's instructions. These instructions are supplemental.FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.CONTINUING CAREIf the doctor does not apply a cast, tape or elastic bandage:· Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time. · Wrap the elbow with an elasticized bandage between ice treatments. · After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments. · Take whirlpool treatments, if available. · Massage gently and often to provide comfort and decrease swelling. MEDICATION--------------------· For minor discomfort, you may use: Aspirin, acetaminophen or ibuprofen. Topical liniments and ointments. · Your doctor may prescribe: Stronger pain relievers. Injection of a long-acting local anesthetic to reduce pain. Injection of a corticosteroid, such as triamcinolone, to reduce inflammation. Other oral non-steroidal anti-inflammatory medications. ACTIVITYResume your normal activities gradually after clearance from your doctor.DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.REHABILITATION--------------------· Begin daily rehabilitation exercises when the cast or supportive wrapping is no longer necessary. · Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. · See section on rehabilitation exercises. CALL YOUR DOCTOR IF========================================· You have symptoms of a moderate or severe elbow sprain, or a mild sprain persists longer than 2 weeks. · Pain, swelling or bruising worsens despite treatment. · Any of the following occur after casting or splinting: Pain, numbness or coldness below the elbow. Blue, gray or dusky fingernails. · Any of the following occur after surgery: Increased pain, swelling, redness, drainage or bleeding in the surgical area. Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever). · New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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Flat spots
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On 5/3/2003 Alex Richard
wrote in from
(142.177.nnn.nnn)
How do you get rid of flatspots
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broken elbows...tricky blighters
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On 5/3/2003 Rich
wrote in from
(196.2.nnn.nnn)
Hi DocD
I broke my elbow about 2 and a half months ago, i snapped off the top part of the radius(radial whatever). I have regained all mobility in it except for a bit of pain when turned to the "extreme." But thats not my problem...even while wearing full leathers during races and elbow guards on cruise around sessions. A descent knock to the elbow causes the ligament or tendon to swell up to about 5 times its normal size, resulting in loss of mobility and a bit of pain. Are there any exercises i could do to help strengthen the joint?
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The Doc
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On 4/29/2003 ICE
wrote in from
(165.121.nnn.nnn)
Thanks!!
Your quicker than my heath care provider.
U DA MAN !!!!!
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Ice Ice Baby
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On 4/29/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Popped your shoulder, Ice? That's gotta hurt. The following is from the University of Michigan Sports Medicine Advisor http://www.med.umich.edu/1libr/sma/sma_shlddis_crs.htm
DrD
Your health care provider will place your shoulder and arm in a type of sling called a shoulder immobilizer. It will aid healing by keeping your arm next to your body and stopping you from moving your shoulder. You may begin shoulder rehabilitation exercises during this time or after you are no longer wearing the immobilizer.
Your provider may prescribe an anti-inflammatory medication or other pain medicine. You should continue to place ice packs on your shoulder for 20 to 30 minutes every 3 to 4 hours until the pain and swelling are gone.
In some cases, surgery may be needed to get the shoulder repositioned correctly or if it continues to dislocate. If your shoulder joint becomes weak because of repeated dislocations, your health care provider may recommend an operation to tighten the ligaments that hold the joint together.
How long will the effects of shoulder dislocation last?
The healing process may take 4 to 12 weeks, depending on the extent of your injury. With proper healing, you should regain full movement of your shoulder.
How can I take care of myself?
Follow your health care provider's instructions when you begin to use your arm and shoulder again, or you may reinjure it. Do the rehabilitation exercises that are given to you by your provider or therapist. Avoid participation in sports until the shoulder has had time to heal.
When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport will be determined by how soon your shoulder recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when:
Your injured shoulder has full range of motion without pain.
Your injured shoulder has regained normal strength compared to the uninjured shoulder.
In throwing sports, you must gradually build your tolerance to throwing. This should be done under the guidance and supervision of a trainer or therapist.
If you feel your arm popping out of the shoulder joint, contact your health care provider.
What can be done to help prevent a dislocated shoulder?
Avoid situations in which you could suffer another dislocation.
Wear layers of clothing or padding to help cushion any fall that may be likely.
Do not return to sports until you have full recovery of motion and strength in the arm.
Ask your provider which shoulder positions are most likely to cause another dislocation.
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dislocated shoulder
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On 4/29/2003
ICE
wrote in from
(165.121.nnn.nnn)
Not a head injury. For the crash check the other board. So yea...
I dislocated my shoulder for the first, time poped out of the back side and was able to get it back in within 10 minuts of coming out. It happened two days ago I've been iceing it and streaching. Any sugestions? It's been sore and stiff thats about it.
Thanks for any advice.
ICE
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Helmets
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On 4/21/2003 R.ene
wrote in from
(156.40.nnn.nnn)
Fatt Matt--
DOT and SNELL refer to motorcycle helmets, although some cycle helmets do meet them. The minimum standard for skateboard helmets is... none. You can sell helmets that are non-certified. The base certification is CPSC for skate and bicycle, but it's not mandatory. I think there is one more certification that is less than CPSC, but I don't remember what the acronym is.
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Low Platelet Count
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On 4/20/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Scott,
If his platelets are normal, your son shouldn't have an elevated risk for bleeding, but the real question is why his platelet count dropped in the first place. There are some fairly serious reasons for that kind of problem, which I'm assuming his doc is addressing. You might want to make sure that there's nothing chronic or progressive going on and that his platelets remain stable and high for a while before he enters any head-bumping contests. Best of luck and let us know how it goes.
Best, drD
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brain trauma
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On 4/20/2003
Scott Yano
wrote in from
(202.95.nnn.nnn)
Hi,
Recently my son suffered a drastic decrease in his platelet count (down to 8000--supposed to be be between 150,000 and 300,000(not sure what units per what units)), was hospitalized, given five days worth of gamaglobulin and after ten days had risen to 230,000.
My question has to do with the risk of head injury. During the time his platelets were down, he was under obvious risk of internal bleeding in his head if his head were to receive any sort of impact. He was confined to bed to prevent this (he's only four and really active). He is out of the hospital now, and I bought him a new helmet for when he does anything outside remotely wheel oriented. I know the helmet will protect against impact, but is he under greater risk from the twisting sort of brain trauma you experience inside your skull from head impact?
Is the helmet enough or should I just keep him away from the possibility of wacking his head (with a four year old--yeah, right)?
Thanks,
Scott
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Inexpensive safety
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On 4/15/2003
Fatt Matt
wrote in from
(216.36.nnn.nnn)
Check out this info on helmets.
DOT is the minimum standard. Snell is an added standard. Snell testing is extra security and has to be paid for by the helmet company. Snell is non profit and accepts no funding from manufactures.
Genuine accessories has Snell M2000 (most recent cert) and dot DOT helmets with windshieds. Check out the closeout section and the other brand section.
Regards,
Fatt Matt
helmet info links:
www.genuineaccessories.com
http://www.off-road.com/dirtbike/tech/2002snell/
this link explains ratings a bit.
http://www.smf.org/index.shtml
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Helmet's Doing Their Thing
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On 4/4/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Guys,
The best thing that a helmet can do is take the crash and absorb it. A shattered helmet is great! That means that instead of your skull shattering, a piece of plastic and foam gave up the ghost for you. Best helmets are Snell tested, CPSC tested are good too. If you are doing high speed slalom, look into motorcycle helmets.
Good advice: George G. on sending Dave Hegstrom to the ER. Better safe than very very sorry. Besides the pupil thing, look for impaired balance, slurred speech, poor judgment (more than it takes to slalom 30 mph!) change in emotion, weakness on one side, visual blurring, and so on. The big knot alone is a ticket for an exam. Glad Dave came through OK. I'm glad we are not talking about him in the past tense, which would have been a real possibility without that helmet.
drDH
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Elsinore crash
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On 4/2/2003 george g.
wrote in from
(159.87.nnn.nnn)
i was about 10 feet away and the first person to reach Dave and try and keep him still. he is a big guy and wanted to sit up immediately. he did smack the back of his head, and rebounded and hit again. the first hit broke the flyaway i believe as i heard it smack. he was full extended backwards. his head went up about a foot or more and hit again. it wasn't a gash in the helmet, it was cracked/ shattered (i was told as intended). this event has caused me to look for a new helmet. i do not believe my plastic protec could take that kind of hit. i know enough to tell him to go to the ER and have himself looked at. all i know is to check for odd pupil dialation (real bad!), swelling (he had a golf ball size knot) errant behavior, and he was able to walk it off but that doesn't mean much with a head injury as i understand.
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Best Helmets
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On 4/1/2003
Stevie
wrote in from
(67.120.nnn.nnn)
Dr. Dave - I don't know if you've been following the slalom forum, but last weekend at Elsinore Dave Hegstrom took a nasty fall and apparently cracked his skull. He was wearing a Flyaway helmet. Fortunteley it looks like he's going to be just fine, but I'm left wondering what helmet would have protected his (or any one's) head better? From the sound of it he went down on his back from high-siding a toeside turn, so he slammed the back of his head. That was a fast hill so he was probably going 25 or 30 mph at the time.
Besides my own noggin, I'm thinking about protecting my kids' heads. We all wear pro-tec helmets, mostly because I like the padding better. My kids are the standard issue, very thickly and fairly softly padded. Mine has a denser padding, somewhat harder.
Any thoughts on the best helmets?
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bionic knees
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On 3/30/2003
richard marnhout
wrote in from
(198.81.nnn.nnn)
okay folks,(and the good doc), here goes......
according to my father(an m.d.)
, and my sister (an r.n.),a person should NEVER CONSIDER SURGERY UNTIL ALL OPTIONS ARE EXPLORED!!!!!!so , that being said, i am now seeing a rheumatologist and will try drugs(vioxx and periodic cortisone shots), physical therapy to strengthen my quads, and yoga to increase my flexibility.
granted, my chance at ever being invited to the underground pool duel is uh.. TOAST, but then i never was good at frontside snaps on cope ANYWAY.
what i am trying to say here is that surgeons are 'cutters' and base their system on operating. this is neither good nor bad, but remember, don't cheat yourself out of a less drastic method if you can. if you suffer from osteoarthritis, then the damage is already DONE. what one is dealing with at that point is PAIN. and if, with other forms of therapy you can live and skate, then BY ALL MEANS do so!!!!
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Bionic Richard
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On 3/14/2003
Dr. Dave
wrote in from
(12.249.nnn.nnn)
Richard,
First, just a reminder that I'm a from-the-neck-up doc, and that you Absolutely Must consult a surgeon who specializes in repairing athletes, rather than senior citizens. He or she will be in the best position to give you advice tailored for your personal case.
That being said, here's some information from http://www.orthoassociates.com/JRC_current.htm. Even though it addresses total knee replacements, the advice is generally similar for partial knee operations: avoid twisting, bouncing and running-pounding.
You've got some specific issues to address with your sports surgeon, including impact injury issues from falls, and effects on the knee from pushing your board. Physiatrists seem to be far more liberal in their sports recommendations than the guy who bangs your titanium knee into place on the operating table. . . . Keep us posted about what you find out and how your recovery goes. The partial op seems to have a faster recovery and feels more natural, according to the information I've seen. Best of luck drD
Here's the quote:
28 surgeons responded to the single page questionnaire canvassed their recommendation about return to 28 common sports after recovery from total hip and knee replacement. Sports in which 75 per cent of surgeons would not allow participation were identified as "not recommended," whereas sports in which 75 per cent of surgeons would allow participation were labeled as "recommended."
Recommended sports included sailing, swimming, scuba diving, cycling, golfing, and bowling after hip and knee replacement and also cross-country skiing after knee arthroplasty. Sports not recommended after hip or knee arthroplasty were running, water-skiing, football, baseball, basketball, hockey, handball, karate, soccer, and racquetball. In general, participation in no-impact or low-impact sports can be encouraged, but participation in high-impact sports should be prohibited.
In an associated study entitled "Sports Participation after Hip and Knee Arthroplasty: Differences in Opinion between Physiatrists and Orthopaedic Surgeons", presented at the Mid-America Orthopaedic Society in 1996, and published in Orthopaedic Transactions, McGrory and co-authors Dr. Michael Stuart and Edward Laskowski address surgeon and non-surgeon opinion as to what type of sports activity is permissible after total joint arthroplasty.
Physiatrists at the Mayo Clinic were significantly less likely than orthopaedic surgeons to disallow return to sports following both hip and knee replacement surgery. After total hip arthroplasty nonsurgeons were significantly less likely to disallow return to running, doubles tennis, football, handball, and ballet after total knee arthroplasty. Physiatrists were significantly less likely to disallow return to running, hiking, backpacking, doubles tennis, football, and handball.
These studies examining return to recreational sports after joint replacement underscore the need for communication between orthopaedic surgeons and both patients and physiatrists regarding the expectations after joint replacement. The effect of impact sports on the longevity of hip and knee replacements has been shown to be deleterious, and this must be conveyed during preparation for modern joint replacement.
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a partial knee replacement or osteotomy?
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On 3/14/2003
richard marnhout
wrote in from
(198.81.nnn.nnn)
dr. dave, PLEASE help me out here. i have osteoarthritis in the medial comprtment of my left knee. it is post traumatic, and meniscal material was removed. additionally, my a.c.l. is long gone.
my orthopedic surgeon is recommending that i have either a minimally invasive partial knee replacement or an osteotomy.
oh yeah, i'm 46 and in good health(other than this).
dr., is it possible to continue skating after this? all of the web sites that i find are oriented towards senior citizens and there is virtually no data geared towards gravity sports.
thanks, richard marnhout
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Snoball and squatting females
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On 3/5/2003
Dr. Dave
wrote in from
(12.249.nnn.nnn)
Be careful before contemplating deep squats, especially with weights. They can tear up your knee. And if you are a pregnant female, consult your doc, since hormones are relaxing your ligaments, making things a little looser and more susceptible to injury.
drD
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female athletes and knee pain
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On 3/5/2003 snoball
wrote in from
(65.32.nnn.nnn)
Can I add a minor addition doc to helping prevent knee strains and such?
Us womens generally have wider pelvises, and alot of sports
doctors think that knee problems in athletic females are
due to not bending *enough*. Weird huh? Basically suggesting a deeper squat. So, if you're a female skater try not to straight leg it too much. And do weight training to strengthen your quads and hams. I guess guys could benefit from that too.
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Leo Can You Hear Me. . . .?
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On 2/20/2003 Dr. Dave
wrote in from
(12.249.nnn.nnn)
Leo,
The operative phrase to throw at your SCUBA-aware ENT doc is 'barotrauma' Check it out and let us know. drD
The following is from http://www.aafp.org/afp/20010601/2211.html Dr. Herbert Newton, Neurologic Complications of Scuba Diving, June 1 2001 American Family Physician.
During descent and ascent in the water, the diver is constantly exposed to alterations of ambient pressure. Barotrauma refers to tissue damage that occurs when a gas-filled body space (e.g., lungs, middle ear) fails to equalize its internal pressure to accommodate changes in ambient pressure.2-4 The behavior of gasses at depth is governed by Boyle's law: the volume of a gas varies inversely with pressure.6 During descent, as ambient pressure increases, the volume of gas-filled spaces decreases unless internal pressure is equalized. If the pressure is not equalized by a larger volume of gas, the space will be filled by tissue engorged with fluid and blood. This process underlies the common "squeezes" of descent that affect the middle ear, external auditory canal, mask, sinuses and teeth.
Otic and Sinus Barotrauma
Barotrauma to the middle or inner ear can occur during the descent or ascent phases of the dive and may cause vertigo and other neurologic symptoms.2-5,7 Middle ear barotrauma of descent is the most common type of diving injury and may involve hemorrhage and rupture of the tympanic membrane. Symptoms include the acute onset of pain, vertigo and conductive hearing loss that lateralizes to the affected side during the Weber's test. In severe cases (usually during ascent), increased pressure in the middle ear can cause reversible weakness of the facial nerve and Bell's palsy (facial baroparesis).8
Vertigo can also be induced if barotrauma differentially affects the two vestibular organs (alternobaric vertigo). The vertigo resolves after pressure equalization occurs. Treatment of middle ear barotrauma involves decongestants (e.g., intranasal oxymetazoline, oral pseudoephedrine), antihistamines, analgesics and antibiotics (amoxicillin-clavulanate [Augmentin] in a dosage of 500/125 mg three times per day or clindamycin [Cleocin] in a dosage of 300 mg three times per day for 10 to 14 days) in patients with otorrhea and perforation.2,4,7
Inner ear barotrauma also can develop in patients with middle ear barotrauma. A pressure gradient between the perilymph of the inner ear and the middle ear cavity can occur, causing rupture of the labyrinthine windows (round and oval) and leakage of perilymph into the middle ear (i.e., fistula). Symptoms include the acute onset of vertigo, sensorineural hearing loss, tinnitus, nausea and emesis. The Weber's test will lateralize to the unaffected side in this group of patients. Reducing intracranial and perilymphatic pressures through bed rest, head elevation and with stool softeners can help. Surgical exploration may be necessary for repair of the fistula if conservative treatment is ineffective within five to 10 days (i.e., the symptoms persist or worsen).
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Mongo Dan and his Hurting Heel
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On 2/20/2003
Dr Dave
wrote in from
(12.249.nnn.nnn)
Dan,
Here's what the podiatrists say about heel pain. If your heel pain occured after you really whacked it, you may have a bone bruise. Otherwise, see below. A sports podiatrist is the medic to see for this one. drDH
Heel Pain
Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.
The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.
Heel Spurs
A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome."
Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Plantar Fasciitis
Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.
The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation
Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Disease and Heel Pain
Some general health conditions can also bring about heel pain.
Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur, or may mimic the pain of a heel spur.
Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe, and can be aggravated by the height or stitchng of a heel counter of a particular shoe.
Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendonitis. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
Stress fractures of the heel bone also can occur, but these are less frequent.
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