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Author Topic: Unsolicited Medical Advice  (Read 1769 times) Average Rating: 0
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« on: December 08, 2008, 06:32:28 PM »

Disclaimer: the views in the following thread do not represent official policy, directives, or suggestions for medical care from the OrthodoxChristianity.net site, Administrators, or Staff in an official capacity.  All views expressed herein are of the individual members, and their reliability and safety cannot be verified.  Viewer discretion is advised.
« Last Edit: December 14, 2008, 08:00:32 PM by cleveland » Logged

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« Reply #1 on: December 14, 2008, 03:56:12 AM »

This topic was split from this thread in the Prayer Forum.

My husband is in training currently for his deployment to Afghanistan late next month. They have been practicing reflexive firing techniques in full battle rattle. (There is 40lbs of body armor plus whatever other stuff he has to carry like ammo ect.). The technique is done in a sort of a hunched over stance. This time last year he was just starting to recover from a herniated lumbar disc. (He was injured 10-07) After a couple days of riding in cattle cars over pot hole filled gravel roads and firing hunched over in the cold he started having some back/leg pain Thursday morning. Then Thursday night he couldn't sleep because he was in so much pain. He went to sick call Friday and was sent to the Army hospital at Madigan for tests. They have done the x-rays and next week he has an MRI on Wed, then the "diagnosis" on Friday. He is in a great deal of pain and really upset/depressed. They have him on "profile" but it isn't good enough in my estimation. He still has to bend over and scrub toilets and clean the barracks. And being the hard worker his is, my husband is doing what they tell him to do. The last time he herniated his disc he rehabbed himself pretty quickly, but it was really painful.(he was back to army standards and passing his PT tests within 5 months) He hasn't even been recovered from his disc injury for 10 months yet! And this time we don't know if this was just muscle strain, re-herniation of the disc or the effects of the nerve damage from the last herniation. He is on a pretty high dosage of painkillers that are just taking the edge off at the moment. If he is re-injured they will have to rehab him again. Then there is a good possibility that he will be in the rear detachment and commute from home to work. It would be wonderful to have him home, but I don't want him in pain either. My husband is concerned about being able to provide for us financially if he has to go on disability. And I can't go back into the workforce until November of next year because of the pregnancy. (We are due in July, and I need a couple months to establish feeding routines).

The army is not always known for making the proper diagnosis. They often send sick people off as "well people." I would appreciate it if you could pray that the doctors will make the proper diagnosis. This is a lose/lose and win/win situation. If is he OK he will be deployed as scheduled, good-he is OK, bad-we will miss him. If he is re-injured he will have to go thru months of rehab at home, good-we see him, bad-he is in a great deal of pain. I don't even know what to think of all this.

Have him shoot up 40 mg of Kenacort IM (glutes are ideal), he'll know if it's a muscle strain within a half hour. Unfortunately if it is nerves or a disk nothing but popping some OC's and resting it will help, unless it's bad enough for surgery.
« Last Edit: December 14, 2008, 06:51:07 PM by ozgeorge » Logged

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« Reply #2 on: December 14, 2008, 05:16:59 PM »

Have him shoot up 40 mg of Kenacort IM (glutes are ideal), he'll know if it's a muscle strain within a half hour. Unfortunately if it is nerves or a disk nothing but popping some OC's and resting it will help, unless it's bad enough for surgery

My husband is limited to what they give him. Which at the moment is 1000 mg of naproxen. And that medication is making him pretty loopy. He was born with something similar to club feet so the nerve passages and muscles are a bit different for him than most people.

Today the half life of the naproxen is starting to kick in and make the meds take some of the pain away. But he is still in pain days later even on meds, so I am betting it is more than a muscle strain or his nerves.
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« Reply #3 on: December 14, 2008, 06:48:06 PM »

Have him shoot up 40 mg of Kenacort IM (glutes are ideal), he'll know if it's a muscle strain within a half hour.
Triamcinolone Acetonide needs to be injected directly into the affected muscle if it's being used to treat muscle pain. Injecting it into the gluteus maximus will not provide a differential diagnosis if that is not the affected muscle.

Unfortunately if it is nerves or a disk nothing but popping some OC's and resting it will help, unless it's bad enough for surgery.
There are oodles of alternatives if it is a herniated disk or nerve inflammation. Good physiotherapy, ultrasonic therapy, transcutaneous electrical nerve stimulation are needed. The first line medications for neuropathic pain are tricyclic antidepressants, selective serotonin-norepinephrine reuptake inhibitors (SSNRI's), and anti-convulsants like Gabapentin. Opiods may be used as adjunctive therapy, but the rapid tolerance to them, and associated problems rule them out as first line drugs. At any rate, a multidisciplinary team approach is what's needed to provide a combination of physical and pharmocological therapies- which is what a Pain Clinic is for.
« Last Edit: December 14, 2008, 06:52:34 PM by ozgeorge » Logged

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« Reply #4 on: December 14, 2008, 07:36:16 PM »

He had the electrical nerve stimulation last time. It helped him a great deal but he absolutely hated it. It was pretty painful for him. Of all the aspects of physical therapy that he had to undergo, that one is the one he absolutely dreads ever doing again.
« Last Edit: December 14, 2008, 07:50:53 PM by Quinault » Logged
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« Reply #5 on: December 15, 2008, 01:00:29 AM »

Triamcinolone Acetonide needs to be injected directly into the affected muscle if it's being used to treat muscle pain. Injecting it into the gluteus maximus will not provide a differential diagnosis if that is not the affected muscle.

Simply not true, while corticos have some localized effect, if one is uncertain about the location of the inflamation or if one has multiple injuries in different locations it can be more effective to inject it into a large muscle such as glutes or quads that will allow for quick distribution to the entire body...and even if the problem is nerve compression it can still help for that. If the pain is in the lower back your best bet would be the upper glute on the side that the pain seems the worse rather than trying to guess if it's the multifidus or the iliocostalis lumborum or an interspinales muscle and trying to inject directly into it.

However, following your logic...where exactly would you recommend it be injected for the treatment of chronic sarcoidosis?

Quote
There are oodles of alternatives if it is a herniated disk or nerve inflammation. Good physiotherapy, ultrasonic therapy, transcutaneous electrical nerve stimulation are needed. The first line medications for neuropathic pain are tricyclic antidepressants, selective serotonin-norepinephrine reuptake inhibitors (SSNRI's), and anti-convulsants like Gabapentin.

I agree with the physical therapy recommendation, the others are no more going to treat underlying causes than opiates and, on the average, tend to be less effective.

Next are you going to recommend acupuncture? LOL.

Quote
Opiods may be used as adjunctive therapy, but the rapid tolerance to them, and associated problems rule them out as first line drugs.

Wow...sounds like you're quoting an FDA website. However, dispite this paranoia in regard to opiates in some segments of the medical community, most doctors I know would at least prescribe hydrocodone as the first line of drugs.

Quote
At any rate, a multidisciplinary team approach is what's needed to provide a combination of physical and pharmocological therapies- which is what a Pain Clinic is for.

A pain clinic is for those people who are taking 160mg of oxycodone a day and still unable to manage their pain.

Don't get me wrong, I understand where you're comming from, you unfortunately have many allies, especially at the bureaucratic levels of medicine (and fortunately fewer amongst the younger generation of doctors)...but it represents a paranoid fear of chemistry and pharmacology that prevents me and many others from trusting a doctor without experience about his medical practices and philosophy.
« Last Edit: December 15, 2008, 01:00:48 AM by greekischristian » Logged

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« Reply #6 on: December 15, 2008, 01:15:15 AM »

My husband is limited to what they give him. Which at the moment is 1000 mg of naproxen. And that medication is making him pretty loopy. He was born with something similar to club feet so the nerve passages and muscles are a bit different for him than most people.

All they'll give him is an NSAID? Poor guy...well you know what they say about army doctors, saddly I don't think their reputation is entirely unearned.

Quote
Today the half life of the naproxen is starting to kick in and make the meds take some of the pain away. But he is still in pain days later even on meds, so I am betting it is more than a muscle strain or his nerves.

Unfortunately, you're probably right, unless it's nerve compression...but again, not something generally easily dealt with. It's probably related to his previous injury...hopefully the army doctors are capable of figuring that much out.
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« Reply #7 on: December 15, 2008, 01:17:07 AM »

^ Are you an orthopedic surgeon?  Herniated discs and spinal stenosis (if present) usually require surgery when all other pain management options fail to provide relief.  Depending on where the herniation is located, the vertebra could have collapsed resulting in further pain.
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« Reply #8 on: December 15, 2008, 01:25:30 AM »

GiC

Quote
the others are no more going to treat underlying causes than opiates and, on the average, tend to be less effective.

I have to admit that nothing worked for my situation (2 herniated discs, and spinal stenosis) except rest. The ultrasound and other methods they tried to use to help me didn't do anything for me. Even the pain meds did little other than make me drowsy. But fwiw, apparently I'm a rare case, as the therapists were incredulous that their methods weren't working--apparently they work for almost everyone else.
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« Reply #9 on: December 15, 2008, 01:35:34 AM »

most doctors I know would at least prescribe hydrocodone as the first line of drugs.
I'll send you my shopping list to pass on to them.
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« Reply #10 on: December 15, 2008, 02:05:39 AM »

most doctors I know would at least prescribe hydrocodone as the first line of drugs.
I'll send you my shopping list to pass on to them.

LOL...as I'm sure you know Australian customs are notorious, perhaps one of the most effective and through in the world, even moreso than Canada's, which is still pretty effective, and China's, which probably tries the hardest monitoring incomming, outgoing, and internal mail, but has a hard time keeping up with the shear volume.

Plus, do you honestly expect me to believe that you are so out of touch and disconnected that you can't do your 'shopping' locally? Wink
« Last Edit: December 15, 2008, 02:05:56 AM by greekischristian » Logged

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« Reply #11 on: December 15, 2008, 02:16:34 AM »

Plus, do you honestly expect me to believe that you are so out of touch and disconnected that you can't do your 'shopping' locally? Wink
LOL!  Cheesy
Remind me to tell you about the "hexabong" someday.
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« Reply #12 on: December 15, 2008, 02:42:46 AM »

Any of you with back issues ever try yoga?  I have had scoliosis (all three ways - kyphosis, lordosis and lateral curve) since I was 12.  Consistent yoga (or doing the "poses" if you prefer) seems to be the best therapy.
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« Reply #13 on: December 15, 2008, 02:51:48 AM »

Now that's one option that I hadn't considered before... Smiley
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« Reply #14 on: December 15, 2008, 02:54:05 AM »

^ Mind over matter - use the mind to control the pain, almost like hypnosis.  Studies show that yoga keeps patients out of the OR or away from pain medicines.  Hard to practice yoga while in Afghanistan....
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« Reply #15 on: December 15, 2008, 03:35:56 AM »

If you do forms of intense stretching and supporting, it will lengthen the spine and keep the muscles properly flexible and balanced.  If the spine is being stretched, then the discs won't be compressed.
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« Reply #16 on: December 17, 2008, 08:21:25 AM »

If you do forms of intense stretching and supporting, it will lengthen the spine and keep the muscles properly flexible and balanced.  If the spine is being stretched, then the discs won't be compressed.

I suppose I had never thought of it in that way.  I've had problems with a disc in my back for going on 14 years now.  Are there good places to do research on the 'net, or do I have to find some local studio/guru/whatever to learn more about it?
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