More medical mafia tendonitis

[LarryHoward]

Looking for imformed second opinion. Got back from a business trip last Friday that included more than my usual walking in unstructured deck shoes. Right Achilles increasingly sore over the weekend and painfully sore Monday at the office. Managed to see my ortho late Monday and received a diagnosis of acute achilles tendinitis and a "ice it, rest it and gentle stretching. See you in a month."

Through Wednesday, it got worse to the point that I'm using a cane and/or crutches to get around. Very tender to the touch and enough to wake me in the middle of the night.

For you medicos. Anything I can do to accelerate healing/relief. I don't "do" inactivity well and this is the best boating time of the year plus a busy time at work. Doc was non committal on anti inflammatory meds (naproxen) and didn't suggest or offer pain meds (and it was't that bad when I saw him). I have some tramodol around and took some this morning. Can't say it helped.

Any chance it's something worse? How long before I can expect some relief? I'm thing about calling him and reporting increased pain/no improvement. I've had plantar fasciatis before and "tennis elbow" so know it's not a fast heal but I feel a bit like the Chester gimping around any my normally jovial disposition is suffering.

[Ish]

My cure for anything these days is Tylenol Arthritis. Helps my knee, helps my plantar fasciitis. A morphine drip would be better, but would be much more hassle to carry around. 2 every 8 hours.

[Olaf Hart]

First question, are you on flucloxacillin?
If so, can cause Achilles tendonitis, don't really understand why but it's a trap for players.

Second comment, if you have Achilles tendonitis, be very careful about loading the tendon, may be caused by a partial tear and you don't want the tendon to let go.

Given your story, you might have Achilles Bursitis, responds well to topical AI gels, like voltaren gel.

If the pain is still coming from the tendon, try a bit of a heel raise, sometimes a quarter inch pad inside the shoe under the heel helps take the load off the tendon when you weight bear.

If it turns out to be bursitis, your shoes are probably the cause, direct pressure over the bursa.

Of course, all advice is worth what you paid for it, if the pain is migrating up under the calf muscle you might want an ultrasound.

[LarryHoward]

First question, are you on flucloxacillin?
If so, can cause Achilles tendonitis, don't really understand why but it's a trap for players.

Second comment, if you have Achilles tendonitis, be very careful about loading the tendon, may be caused by a partial tear and you don't want the tendon to let go.

Given your story, you might have Achilles Bursitis, responds well to topical AI gels, like voltaren gel.

If the pain is still coming from the tendon, try a bit of a heel raise, sometimes a quarter inch pad inside the shoe under the heel helps take the load off the tendon when you weight bear.

If it turns out to be bursitis, your shoes are probably the cause, direct pressure over the bursa.

Of course, all advice is worth what you paid for it, if the pain is migrating up under the calf muscle you might want an ultrasound.

No to the flucloxacillin.

Aware of the risks of rupture and taking precautions. Previous (21 years ago and I can still remember the "pop") 50% tear on the same side but at the calf muscle, not the heel. Probably why I'm concerned. I've "been there. Done that" on the 9 month recovery.

Yes to heel pads. Have them. Wearing running shoes exclusively. No to calf migration.

Appreciate it. Don't like it but can live with the cane/crutches during recovery. The limited mobility interferes with both work and recreation and the persistent pain bothers me most as it is distracting at work. This ortho is the same one who has done my knees and he seems to have 2 meds. Tramodol and Vicodin. The tramodol isn't quite enough and I'm not big on being zoned out with Vicodin.

[Orestes Munn]

I would add, knowing this syndrome well from the former distance athlete's perspective, that you need to really unload that tendon until the acute inflammation goes away. The running shoe may not be protecting enough from stretch and you might need a different shoe with a heel. I have also put layers of linoleum tile under the insole in the heel of running shoes to reduce compression. Once it begins to recover, you should start a program of gentle stretching, progressing to eccentric resistance training. This latter requires a PT or a good trainer. Many people have had good results with a night brace to impose continuous stretch.

I remember you mentioned plantar fasciitis a while back, too. This is a sign that you have tightness all up the posterior chain to the back. You can start gentle hamstring and back stretches now, which may even give you some immediate relief and will help prevent recurrence.

Hope this gets better soon!

[LarryHoward]

Thanks OM. The PF was from overworking (distance running) and high arch feet wearing the lightweight Nike Air shoes. Etween that and the torn tendon at age 40, I do a fair amount of stretching. While the crutches are more hassle than the cane, they keep the tension down and help garner sympathy from young women.

I plan to contact the dock again on Monday if improvement by then and will take a look at more heel height. Interestingly, the doc was pretty neutral if not a bit negative on the naproxen so I am not taking those.

Jus plain annoying. I keep looking for the magic pill or treatment as I'm not a patient patient.

[Orestes Munn]

Thanks OM. The PF was from overworking (distance running) and high arch feet wearing the lightweight Nike Air shoes. Etween that and the torn tendon at age 40, I do a fair amount of stretching. While the crutches are more hassle than the cane, they keep the tension down and help garner sympathy from young women.

I plan to contact the dock again on Monday if improvement by then and will take a look at more heel height. Interestingly, the doc was pretty neutral if not a bit negative on the naproxen so I am not taking those.

Jus plain annoying. I keep looking for the magic pill or treatment as I'm not a patient patient.

We don't like NSAIs anymore. They seem to be bad for the arteries.

I assume you're using ice and heat.

Once things have cooled off, definitely consider eccentric resistance training for the calves. No one knows how it works, but it does.

[LarryHoward]

Thanks OM. The PF was from overworking (distance running) and high arch feet wearing the lightweight Nike Air shoes. Etween that and the torn tendon at age 40, I do a fair amount of stretching. While the crutches are more hassle than the cane, they keep the tension down and help garner sympathy from young women.

I plan to contact the dock again on Monday if improvement by then and will take a look at more heel height. Interestingly, the doc was pretty neutral if not a bit negative on the naproxen so I am not taking those.

Jus plain annoying. I keep looking for the magic pill or treatment as I'm not a patient patient.

We don't like NSAIs anymore. They seem to be bad for the arteries.

I assume you're using ice and heat.

Once things have cooled off, definitely consider eccentric resistance training for the calves. No one knows how it works, but it does.

Thanks.

Taking the tramodol as needed. Doing ice but no heat (but the hot tub is calling me). Took some naproxen this am and with a quiet day and several hours of ice this morning, it's Improving but not at all enjoyable. Plan in the elliptical and lots of stretching as it improves but want to get mobile as quickly as possible.

Lynne and Jess presented the start pic today. I understand you had a hand I that. Thanks,

[BeauV]

Once things have cooled off, definitely consider eccentric resistance training for the calves. No one knows how it works, but it does.

Is the eccentric better than a bike? I like bikes.

[Orestes Munn]

Once things have cooled off, definitely consider eccentric resistance training for the calves. No one knows how it works, but it does.

Is the eccentric better than a bike? I like bikes.

I don't know whether you can do effective eccentric contractions on a bike. I was actually wondering about that today on my ride home from work and I sort of doubt it,

[BeauV]

Once things have cooled off, definitely consider eccentric resistance training for the calves. No one knows how it works, but it does.

Is the eccentric better than a bike? I like bikes.

I don't know whether you can do effective eccentric contractions on a bike. I was actually wondering about that today on my ride home from work and I sort of doubt it,

OK, that means I don't know what an "eccentric contraction" is. Off to Google it now.

Edit: I'm back. I am now fully educated, having used Google to become an expert. As I understand it one has to load up a muscle while also letting it extend. The example used was lowering a bar-bell after a curl which extended the muscle while also keeping it contracted. So, for a bike I think that one doesn't do any "eccentric contractions" that I can think of, unless one stands on tip toe while peddling and then lowers the heel while holding a load; an unnatural act when riding a bike.

[Bull City]

Voltaren gel is great stuff.

[Orestes Munn]

Voltaren gel is great stuff.

Yes, but all that stuff is getting an increasingly negative reputation for increasing vascular risk and now carries warnings to that effect. We used to buy ibuprofen by the 500 tab bottle. No more. Interestingly, there are new data on sleep and inflammation. Sleep is probably good for the joints.

[BeauV]

Voltaren gel is great stuff.

Yes, but all that stuff is getting an increasingly negative reputation for increasing vascular risk and now carries warnings to that effect. We used to buy ibuprofen by the 500 tab bottle. No more. Interestingly, there are new data on sleep and inflammation. Sleep is probably good for the joints.

I could sure get into sleeping more!!

[Bull City]

Voltaren gel is great stuff.

Yes, but all that stuff is getting an increasingly negative reputation for increasing vascular risk and now carries warnings to that effect. We used to buy ibuprofen by the 500 tab bottle. No more. Interestingly, there are new data on sleep and inflammation. Sleep is probably good for the joints.

Could you elaborate briefly on the ibuprofen risk? Thanks.

[LarryHoward]

Voltaren gel is great stuff.

Yes, but all that stuff is getting an increasingly negative reputation for increasing vascular risk and now carries warnings to that effect. We used to buy ibuprofen by the 500 tab bottle. No more. Interestingly, there are new data on sleep and inflammation. Sleep is probably good for the joints.

I could sure get into sleeping more!!

I could use some uninterrupted sleep. Tired of the constant waking up. Temped to pop a vicodin just for the overnight relief.

[Orestes Munn]

Voltaren gel is great stuff.

Yes, but all that stuff is getting an increasingly negative reputation for increasing vascular risk and now carries warnings to that effect. We used to buy ibuprofen by the 500 tab bottle. No more. Interestingly, there are new data on sleep and inflammation. Sleep is probably good for the joints.

Could you elaborate briefly on the ibuprofen risk? Thanks.

Here's the FDA advisory, based on the findings of an expert panel that met last year.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm454141.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery

There's much more in a Google search, like this one:

https://www.google.com/?gws_rd=ssl#safe=off&q=nsaid+cardiovascular+risk

The scariest part for me is that the risk increases even with short-term use. These are very effective drugs and the benefits can easily outweigh the risks, but it's clear we need something better.

[Bull City]

Orestes,

Thanks for that information. This is from the Harvard Health Publications which came up on your Google search (http://www.health.harvard.edu/blog/fda- ... 1507138138):

Using NSAIDs safely

Taking an NSAID for a headache, or for a few days to ease a sore shoulder isn’t likely to cause a heart attack or stroke. It’s more prolonged use that can get risky.

In view of the new warnings, it is best for people with heart disease to avoid NSAIDs if at all possible, and for everyone who is considering taking an NSAID to proceed with caution. Here are some strategies:

- It’s important to take the lowest effective dose, and limit the length of time you take the drug.
- Never take more than one type of NSAID at a time. There appears to be risk associated with all types of NSAIDs.
- Try alternatives to NSAIDs such as acetaminophen. It relieves pain but does not appear to increase heart attack or stroke risk. However, acetaminophen can cause liver damage if the daily limit of 4,000 milligrams is exceeded, or if you drink more than three alcoholic drinks every day.
- If nothing else works and you need to take an NSAID for arthritis or other chronic pain, try taking week-long “holidays” from them and taking acetaminophen instead.
- If you experience chest pain, shortness of breath, or sudden weakness or difficulty speaking while taking an NSAID, seek medical help immediately.

[BeauV]

Hmmmm, that line about taking 3-drinks per day. .... ..... this is a REAL issue for this lot!

OK, exactly what is a "drink" when the medical community uses the term here? 1 6oz glass of wine? 1 oz of Gin? I really don't know as wine seems to come in 1/2 bottles, bottles and cases.

[Olaf Hart]

Not nearly enough, unfortunately.

The good news is that an alcoholic is someone who drinks more than their doctor.

[BeauV]

It's a VERY slow day here at Ranchito Pasatiempo - not much going on but the snoring of a recovering dog.... so I looked it up. Here is what NIH says on the topic:

In the United States, one "standard" drink contains roughly 14 grams of pure alcohol, which is found in: 12 ounces of regular beer, which is usually about 5% alcohol. 5 ounces of wine, which is typically about 12% alcohol. 1.5 ounces of distilled spirits, which is about 40% alcohol.

Now, I don't know about the rest of y'all, but 1.5 oz of distilled sprits is not a 'drink', that's a starter; and 5 oz of wine is right about half a glass of wine.

[LarryHoward]

It's a VERY slow day here at Ranchito Pasatiempo - not much going on but the snoring of a recovering dog.... so I looked it up. Here is what NIH says on the topic:

In the United States, one "standard" drink contains roughly 14 grams of pure alcohol, which is found in: 12 ounces of regular beer, which is usually about 5% alcohol. 5 ounces of wine, which is typically about 12% alcohol. 1.5 ounces of distilled spirits, which is about 40% alcohol.

Now, I don't know about the rest of y'all, but 1.5 oz of distilled sprits is not a 'drink', that's a starter; and 5 oz of wine is right about half a glass of wine.

I measure "two fingers" as a drink. The thumb and the pinkie held as a "Shaka" .

[Orestes Munn]

It's a VERY slow day here at Ranchito Pasatiempo - not much going on but the snoring of a recovering dog.... so I looked it up. Here is what NIH says on the topic:

In the United States, one "standard" drink contains roughly 14 grams of pure alcohol, which is found in: 12 ounces of regular beer, which is usually about 5% alcohol. 5 ounces of wine, which is typically about 12% alcohol. 1.5 ounces of distilled spirits, which is about 40% alcohol.

Now, I don't know about the rest of y'all, but 1.5 oz of distilled sprits is not a 'drink', that's a starter; and 5 oz of wine is right about half a glass of wine.

I would have to agree with you there. Please do not take this as medical advice.

By way of anecdote, when I was a neurology resident at the old Boston City Hospital, we sliced up a tremendous number of the brains of alcoholics who were no longer using them. It was lore, and I never saw a case to disprove it, that the brain arteries of an alky were always clean. Of course, we had no interest in any other vessels, south of the chin...

[Bull City]

"Work is the curse of the drinking class."
- Anonymous

[Orestes Munn]

"Work is the curse of the drinking class."
- Anonymous

For me, drink wouldn't be half as enjoyable or affordable without work, which I like too.

[cap10ed]

Not nearly enough, unfortunately.

The good news is that an alcoholic is someone who drinks more than their doctor.

At Stingray Point Yacht Club their standard line is. " We are a drinking club with a boat problem ! "

[Bull City]

FWIW, I asked the physical therapist, who is helping me with my knee replacement, about some tendonitis in my elbow. Among other things she said that tendonitis is actually "micro-tears" in the tendon, rather than an inflammation. At least that is what I understood. Anything to this?

[Orestes Munn]

FWIW, I asked the physical therapist, who is helping me with my knee replacement, about some tendonitis in my elbow. Among other things she said that tendonitis is actually "micro-tears" in the tendon, rather than an inflammation. At least that is what I understood. Anything to this?

It's true, micro tears and breakdown of the collagen fibers that the tendon is made of. If you look at affected tendon histologically, there isn't much inflammation. Despite the fact that we call it tendinitis, it's really tendinosis. The difference being that "itis" denotes inflammation specifically and "osis" denotes pathology in general. It's my impression that the processes underlying use-related tendinosis are, to put it in academic terms, poorly understood.

[BeauV]

FWIW, I asked the physical therapist, who is helping me with my knee replacement, about some tendonitis in my elbow. Among other things she said that tendonitis is actually "micro-tears" in the tendon, rather than an inflammation. At least that is what I understood. Anything to this?

It's true, micro tears and breakdown of the collagen fibers that the tendon is made of. If you look at affected tendon histologically, there isn't much inflammation. Despite the fact that we call it tendinitis, it's really tendinosis. The difference being that "itis" denotes inflammation specifically and "osis" denotes pathology in general. It's my impression that the processes underlying use-related tendinosis are, to put it in academic terms, poorly understood.

I LOVE THIS PLACE: I now know the difference between an "itis" and an "osis" !! Cool!!

[Bull City]

Following on this, if Halitosis is bad breath, then Halititis is Dragon Breath?