Ask Dr. Bones
A
medical informational site dedicated to answering personal musculoskeletal
health-related questions
|
Dr. Bones died on September 2, 2003. He is now able to fish and play cards all he wants. He enjoyed all things, but the care
of his patients even in retirement was always his joy. Unfortunately, we will no longer be
able to answer questions from this site. |
Case Studies
Case 1~ This condition may cause death
Case 2~ 35 year old man with skin rash and arthritis
Case 3~This treatment is for what common condition?
Case 4~62 year old man who walks with pain
Case 5~Sudden onset of a swollen painful knee
Case 6~What is the diagnosis?
Case 7~A type of chronic arthritis
Case 8~A bad case of sunburn?
Case 9~Can you do this?
Case 10~No, these are not UFO's
Case
11~More than bursitis?
Case
12~Big things come from small packages
Sports Section
Late score on "rub
ons"
Warning...women
athletes beware!
Look who is
pumping iron
Rice for an
ankle sprain?
Hamstrung by your hamstring?
Tips
Of The Week
Arthritis knee pain
bothering you?...Read this before considering arthroscopic
surgery
Look...a new wonder cure for arthritis
This product could ease your arthritis, and is fit for man or beast!
A hearty tip...don't throw out the Vioxx
How to thaw a frozen shoulder
Want to grow a new knee?
Your home may be softening your bones
If you have been ticked off lately...better read this
A prick for pain relief?
A Queen fit for a king
Heal a heel
Magnet
Therapy...fact or fiction
What can you do when
your whine turns sour
A fork in your future...weapon against
arthritis?
Look before you leap
Loose joints...Tight body...Where's the
connection ?
Gouty toe?...give it the boot
Questions
and Answers
Please indicate if you
do not wish your Q & A published
If you have any muscle or
arthritic complaints, and want answers, first call your doctor. Then if you
wish...Bone Up
A picture is worth a thousand
words. For a more detailed reply, please include a digital image of your
problem.
K.H. asks about "The Unhappy Triad of O'Donoghue"
R.T.S. wonders whether arthritis
can predict the weather
M.J.L. has worn out knees
J.S. complains of hot
prickling feet
C.B. worries about a mothers rare dish
J.M. writes about Pagets disease
J.K. inquires about Crest syndrome
J.M. a fitness fanatic , has morning stiffness
C.C.M. has concerns about her father's polymyalgia
J.G.F. sprained his ankle and got a surprise
R.B. must go to bed with one sock on
R.Z. questions Mama's "mexican medicine"
L.L. cries, please help my foot
M.L. asks, to rub or not to rub?
K.H. dreams of growing taller
J.S.S. questions whether her x-rays can predict her future
|
Due to health
reasons, I will not be accepting new questions. Please feel free to explore this site for similar
questions and answers that may be of help. |
Aging seems the only available way to live a long time.
A medical revolution has extended the life of our elder citizens without providing the dignity and security those later years deserve...John F. Kennedy
If you are going to live longer...live better. It is more fun to wear out than rust out. For the "young" out there...try this
Forty is the old age of youth...fifty is the youth of old age.
A man of sixty has spent twenty years in bed and over three years eating...Arnold Bennett
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Q & A
Q: Dear Sir, I am a junior at
Sturgis HS in Sturgis MI. I am doing a report in my human anatomy/athletic
training class, on a total knee blowout. I was told it was called the
"unhappy triad of O'Donoghue". I am not very sure about it and would
appreciate any information you could give me about this injury. I have been
unable to find any information on the internet about this subject.
A: Hello K.H. The condition you describe is indeed a terrible injury. It occurs commonly as a result of a football injury, or other similiar trauma. If the leg is hit with force on the lateral portion of the knee, this results in a tear of the ACL, medial meniscus, and medial collateral ligament. Major knee reconstruction is necessary to repair this damage...Dr. Bones
Q: Dear Dr.Bones, I was wondering...Can aches and pains be blamed on the weather? Can people really say that "I know it's going to rain, because my joints ache."
A: Hello R.T.S. Yes, this is absolutely correct. Weather does affect bones and joints. Some years ago one of the leading rheumatologists in the country, Dr. Joseph Hollander, built a climate chamber at the University of Pennsylvania. What he found was that as the humidity rises, and the barometric pressure drops, joints begin to ache. That is exactly what happens before a rain storm...Dr. Bones
Q: I am 32 and have undergone a total of 13 arthroscopies involving both knees. No one really knows what's going on except the fact that after about a year to year and a half...my knees start all over again. I fell on a side walk,15 years ago, and landed on both knees. I have been having pain, swelling, "hot" spots of pain, usually on the outside and inside of both knees. I am again going for another MRI to rule out pattelarfemoral disease. I do know, however, that the synovial fluid gets inflammed resulting from a roughness under my knee caps which in turn effects the joint and cartilage. I do have a fissure on the surface of either the tibular or femur bone. I have to try to find some kind of resolution to this...for I am very tired of being in pain. Somedays I can go without pain and some I cannot. The barometric pressure changes and weather, cold, excessive heat, strain, standing, sitting, climbing, all play a part of the knee disorder. I have been told, however, that I am a good candidate for knee resurfacing/replacement, but that (1) I am too young and (2) I live in Maine and there really isn't anyone around, I think, that will do the procedure with the utmost of current tools, practices, and knowledge. Can you advise me or help me with anything? Do you have or know of any information I can have to take to my Orthopedic or something I can research on to help myself? Thank you for your patience and time in reading this message and cry for help(for information & advice)
A: Hello M.J.L. I have given some thought to your medical problem. The description of your knee complaints suggests the diagnosis of chondromalacia. This is a condition that is characterized by roughening and softening of the articular cartilage overlying the knee causes for this degenerative condition. Your clinical description of your symptoms are typical. I am concerned, however, about another diagnosis which could also produce similiar symptoms, called "osteonecrosis". Another name for this condition is "avascular necrosis". Although I do not have enough medical information to make that diagnosis in your case, an MRI would show this abnormality. You seem to have been given good advice and insight into your treatment options. With chondromalacia resurfacing is a temporary treatment aid. Depending on the severity of cartilage destruction, and subsequent development of degenerative arthritis, joint replacement is a future consideration. Thats the bad news. There is also good news! There are now available newer techniques for cartilage "repair". This involves a new type of surgery to replace worn out cartilage. In fact the new technique is being taught to orthopedic surgeons by the Genzyme lab in Boston Mass. For the latest information on cartilage transplantation please check http://www.medseek.com/askdrz/articles.html. I hope this information will be of help to you...Dr. Bones
Q: Dear doctor, Why are the bottom of my feet getting very hot with a prickling feeling?
A: Hello J.S. What you are describing commonly is due to a condition called "peripheral neuropathy". Simply explained, this develops when the nerves and nerve endings in your feet are not well. This may occur for a number of reasons including Diabetes Mellitus, certain vitamin deficiencies, and sometimes circulation problems. Also this may just be associated with the aging process, and thus is a common complaint among senior patients. This diagnosis can be confirmed by an electrodiagnostic test called nerve conduction study. This test is safe, simple, and does not take much time to run. Before the diagnosis of peripheral neuropathy is considered, you must have a thorough examination of your foot and lower leg by your physician to rule out all other potential causes of foot discomfort, such as local bacterial and fungal infections, exposure to certain chemicals, and mechanical foot pain from arthritic conditions. Although I have mentioned the most likely causes for your foot complaint, other less likely conditions are possible. For any persistent foot discomfort, always, consult your physician...Dr. Bones
Q: My friend's mother was recently told by her MD that she has "DISH", a rare disease that causes her bones to be very dense in some places, and very sparse in others. We know that "DISH" is an acronym for something, but don't know what. It was thought at first that she had cancer, but that has since been ruled out. She has been referred to a Rheumatologist. Can you tell us what "DISH" is, and where can we get more info on it?
A: Hello C.B. You are correct, DISH is an acronym for Disseminated Idiopathic Skeletal Hyperostosis. This condition is a form of severe degenerative spinal arthritis. By definition it should involve five contiguous vertebra, and may occur in the cervical, thoracic and lumbar spine. Exuberant spurring characterizes this form of arthritis, and there is no bone softening at all. You could look up more detailed information under the category of primary osteoarthritis...Dr. Bones
Q: I have recently been diagnosed as having Pagets disease. In Australia it is considered incurable and that pain relief is the only treatment. Is this the case in the U.S.of A.?
A: Hello J.M. I am sorry to hear that you have recently been diagnosed with Paget's disease.Take hope however in that in most cases, the disease is mild, and very likely will progress very slowly if at all. Unfortunately the disease is the same here in the US as it is in Australia.This means that the medications we use here as well in your country slow the disease but do not provide a cure. Recovery is possible but permanent damage can not be reversed. Medications are available, including diphosphonates, calcitonin, and plicamycin.These slow the breakdown and formation of bone, stabilizing Pagets patients. There are specific markers which can be measured to determine whether or not a patient's specific treatment is effective ie."bone specific alkaline phosphatase" and "urinary hydroxyproline". You might want to ask your doctor about these. In summary, for most patients, lifestyle is not drastically altered. Follow a healthy diet and keep your weight down. Excercise often to maintain strength and flexibility. Discuss any problems or fears with your doctor. I hope this information will be of some comfort to you. For any persistent bone discomfort, always, consult your physician...Dr. Bones
Q: A friend has been diagnosed with something called Crest syndrome. What is it?
A: Hello J.K. The condition that you are refering to is a milder form of of a much more serious disease called Scleroderma. The letters CREST stand for Calcinosis, Raynauds, Esophageal abnormality, Sclerodactyly, and Telangiectasia. In simple terms a patient with this disease has a combination of features resulting in small areas of calcium deposited below the skin, color and temperature changes in the hands and feet, heart burn and sometimes difficulty swallowing solid food, tightness of the skin of the fingers resulting in tapering and shortening of the digits, and dilation of small blood vessles on the skin of hands, face and chest. More information is available at http://www.scleroderma.com/. I hope this brief summary is of help to you...Dr. Bones
Q: Dear Dr. I am a 46 year old male fitness fanatic. Been told I have arthritis. Up until the last month or two its been manageable. Lately the pain and stiffnes in the joints, particularly the knees, has become almost unbearable. Once I manage to get up and get moving the pain subsides. I'm taking Ibuprofen but don't wish to become a slave to it. Also, the pain usually starts returning when I start getting ready to go to sleep. Any suggestions?
A: Hello J.M. Much as I would like to be of help to you, your brief note does not have enough information to allow me to make a correct diagnosis for your arthritic condition. At your age you are a candidate for both degenerative" and "inflammatory" arthritis. Knowing the difference is important to your physician, since treatment for each condition varies. Your concerns about taking ibuprofen on a chronic basis are well founded. This NSAID can be dangerous to your upper GI tract, liver, and kidneys if taken in large quantities. However over the counter ibuprofen which is sold at a lower dose, is felt to be safer if used with discretion on an "as needed" basis. If you have Diabetes, kidney disease or certain other medical conditions which your physician could alert you to, ibuprofen and its related over the counter NSAIDS may be contraindicated. I note that you are an excerciser. Most forms of arthritis are helped by the right type of excercise. The "no pain, no gain", theory has been discarded. That is why it is most important to determine the type of arthritis prior to treatment and excercise recommendations. Pain management may not be necessary once the arthritic condition is properly treated. If an analgesic is required, start with "Tylenol", and avoid narcotics. I hope this information answers some of your concerns...Dr. Bones
Q: My father has polymylagia rheuma-something. The doctor says he may loose sight in his left eye. Could you tell me what this is and what causes it? Can anybody get this or is it something only older people get? They are going to treat it with steroids and they say the treatment will take about a year. What can he expect after treatment is over?
A: Hello C.C.M. The condition you are referring to is "Polymyalgia Rheumatica". This is a disorder that is associated with stiffness and aching in the neck, shoulder and pelvic girdle muscles. It results from inflammation of the joints as well as arteries. The cause of PMR is unknown. It is not likely that PMR is an inherited condition, and this condition is not contagious. You are correct, PMR rarely occurs below age 50, and is much more common in patients in their 60's and 70's. Women do get this condition more frequently than men. The treatment is low to medium doses of prednisone, not exceeding 15 mg daily. Initial response is "dramatic", but it may take up to 2 years before prednisone can completely be stopped. Your doctor will of course begin to lower the dose as soon as the patient shows a favorable response to treatment and the laboratory test "ESR" returns to normal. Once treated the patient should return to a normal state with complete recovery from the disease. Of course there are many side effects that could develop from the chronic use of steroids, and should be discussed with your doctor. You mention another serious complication, that of sudden and permanent loss of vision. This occurs in a disease called "Temporal Arteritis". In addition to PMR symptoms these patients have scalp tenderness, jaw claudication (cramping), and vision disturbances. This diagnosis is made by taking a biopsy (piece of tissue) from an artery on the forehead. If this condition is not recognized and treated, permanent vision loss may occur. TA requires much higher doses of prednisone, and consequently, potentially more side effects may occur. I hope this information answers your questions about PMR...Dr. Bones
Q: Hi, recently while playing volley ball on a Friday, I came down on my right foot, turning it inward. The pain was immediate, but subsided after walking around. Two days later on Sunday, I went to the German hospital. They said I had a severe sprain, a little piece of bone had broken off in the middle of my foot, and they also noticed two "cysts" in the lower part of my fibula, that should be looked at by a specialist. Then Wednesday at a military hospital they took more x-rays and the radiologist's interpretation says that the cysts are a benign "fibroxanthoma" that I may have been born with. Could you explain this to me a little more? I can't find it in any literature I have. Thanks for your help.
A: Hello J.G.F. It would be inappropriate for me to comment on a radiologic abnormality without having the x-ray films for personal review. I can comment on the diagnosis you were given. Your description of "fibroxanthoma" may represent one of two benign conditions i.e. "fibrous histiocytoma", and "non-ossifying fibroma". The former usually occurs after age 20, and may be painful. The latter usually occurs before age 20, and is painless. There are some who believe these to be the same tumors. It is important to determine the true nature of these lesions because there are descriptions in which the tumor behaves in an aggressive manner. You should be sure to see an orthopedic surgeon to rule out the need for a bone biopsy. I hope this brief discussion eases your fears about your unexpected surprise bony abnormality...Dr Bones
Q: I'm 59 years old and have had two lower back operations, one 40 years ago and the last 20 years ago. Two and one half month ago I had to be taken to the hospital emergency by ambulance as a tearing pain in my lower back near one incision became unbearable and I couldn't move my left leg and foot because of this pain. I was admitted and recieved some physiotherapy and since then I've been asking my doctor to send me to a specialist. He seems to think that all isn't so bad and is taking his time, although he agreed to try and make an appointment for me. My leg from the knee down feels very tender and my foot feels like it is raw. I have to sleep with a sock on it to keep from waking up whenever I move it. My big toe will not come up and the whole leg is very weak and painful. Can you suggest anything to help me? I would be so thankful for help in this matter.
A: Hello R.B. Without actually examining you my reply is meant to be in the form of a discussion, rather than medical advice. I do not wish to alarm you but your symptoms suggest urgent attention. The discomfort which you describe sounds like nerve impingement (pinching) which is associated with pain, and sometimes weakness of the muscles in the leg and foot. Because you appear to have weakness of the great toe extensor, I suspect that you well may have an L5 radiculopathy. My advise is to seek the expertise of a spinal surgeon or neurosurgeon as quickly as possible. I hope this brief discussion is helpful...Dr Bones
Q: Dr. Bones, I need your help. My mom is taking pain killers from Mexico.This medicine is called "artrido". It contains metocarbamol, indomethicina, and betametazona. I wish to know if this medicine is bad for her. She is in her 60's. Please reply as soon as you can.
A: Hello R.Z. The first medication you mention is a muscle relaxant. Indomethacin is an old and very effective anti-inflammatory agent and pain killer. Betamethasone is a form of cortisone. Both of the latter medications are effective agents for treating arthritic conditions. Both are potentially harmful to your mother. Indomethacin may cause bleeding from the stomach, and liver and kidney problems. There are a multitude of complications from the long term use of betamethasone, including bone loss, cataracts, infections, ulcers, and diabetes.These are general warnings, and risk is dose dependent, the higher the dose, the greater the risk.
This is a classic example of the reason for exercising caution when using unfamiliar non-traditional medications. This "mexican medicine" could be truthfully advertised as excellent treatment for arthritis, without every mentioning the potential serious side effects...Dr. Bones.
Q: Dear Dr. Bones, I am having a problem with my right foot. Sunday afternoon, with no warning, my right foot suddenly began hurting and I was unable to walk on it. The pain started on the bottom of my foot just in front of my 3rd and 4th toes. My foot has since swollen up and is bruised on both top and bottom and my toes are also swollen. My 3rd and 4th toes have been swollen together since Sunday. I went to my doctor Monday morning. He looked at my foot and sent me for x-rays. The radiologist found no fracture. Now he wants me to have more x-rays and a bone scan Thursday morning. In the mean time he has been extremely adamant about me using crutches (yuk and ouch) because he is afraid that it may be Avascular Necrosis. He said if it is, then my foot will have to be completely immobilized. Is this as serious as he makes it sound? If so, why are they waiting until Thursday morning to do the scan? And, why isn't my foot wrapped or in a brace or cast or whatever? I hope you can help
A: Hello L.L., You have been given good advice. The bone scan will R/O stress fracture,which is more likely than AVN. Many times acute fractures do not show on the initial x-ray, and it may take up to 10 days for the x-ray to show the fracture line. Follow your doctor's recommendations...Dr Bones
Q: Dear Dr. Bones, My girlfriend has been having a lot of problems with the rotator cuff in her shoulder. She is a competitive rower and has to have physical therapy before and after each workout or race. Her doctors are considering surgery and she may not be able to compete again. When her shoulder starts hurting she likes me to massage it, the harder the better. But I am afraid that I may be doing more damage in the long run. Should I obey her and rub it until my shoulders get sore, or just hand her some aspirin and back off?
A: Hello M.L., Massage therapy, if done properly, will ease pain and muscle spasm. This should be physician directed, and ideally, you should be instructed in massage technique, by a Physical Therapist, or Massotherapist. However, if surgery has been recommended, that is what should be done. Stalling, by using massage, may delay appropriate treatment and could result in permanent damage to the the shoulder...Dr Bones
Q: Dear Doctor, I know this question may sound stupid. I really hope to improve on my height. I am only 17 and am 160 cm tall. This is rather short for people at my age. Is there any way that I can improve on my height? Thanks!
A: Hello K.H., If you are shaving, it means that the growth centers of your long bones have or will soon close. That means no more natural growth, and also that grow hormone injections will be contraindicated. There are leg lengthening surgical procedures to give you a few additional inches of height. These are expensive, and only you can decide if the time, effort, and expense are worth it. A man's worth is never measured by his height...Dr Bones
Q: Dr Bones, when someone has bone and cartilage damage from Rheumatoid Arthritis, are there certain precautions one should take? Are bones more susceptible to injury if they are losing their integrity? And is the movement of the joint causing further damage to the bone because of the loss of cartilage? Thanks.
A: The answer to all is yes. Any more specific information would depend on your medical condition. If you send me digital copies of your x-rays, and more information about your disease I can give you a better idea of what you might expect in the future...Dr Bones