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BarbaraBergin.posterous
The Doctor Writes, the Writer writes, the Rider writes.
More of My Favorite Things
If you can, for a moment and for the benefit of your foot, give up on style and high heels, then come over to the Dansko side. As in Dansko clogs. If you fit this shoe correctly, I think they’re actually one of the best buys around. They’re not cheap (around a hundsky) but they last forever. Because of the wide toe box, it doesn’t put pressure on your toes. For the purpose of foot comfort and health I recommend only buying the style with the back, as shown in this picture. The back is not made to cup your heel like a traditional shoe. I know it looks like a stiff piece of leather and that’s because it simply serves as a bolster to keep the shoe from sliding off in mid-stance. Fit the shoe with a small fingerbreadth of space between your heel and the back of the shoe and another fingerbreadth of space between your arch and the top of the shoe. That way your foot just floats within the shoe; putting no pressure on your toes or the top of your foot and allowing air to circulate…so they never stink! Try a pair. I personally prefer the red patent leather which I begin wearing after Labor Day. After Easter I start wearing the pink patent.
A large number of the people I see in my office have fallen down! It’s an inglorious way to end up with a broken bone and sometimes the results can be quite devastating. Hip fractures are one of the fastest ways to disability as the result of a fall. But just falling on your knee cap can result in a lifetime of pain. You know I wouldn’t be telling you this if it wasn’t true. Many people resist the need to use a cane, but it would be prudent to use a cane when you are older and have poor balance. But canes are just…well, they’re just…canes. Awkward, ugly, aluminum canes are the ubiquitous sign of getting old. So let’s put a little kick in that concept. Get a walking stick. And better yet…a collapsible walking stick. They’re sporty. They are based on ski pole technology so they just look cool. They’re actually easier to use than a cane. You hold them a little more in front of you than at the side so they give you a better third point contact with the ground. If you’re a hiker, a walking stick is a must-have. I would love for everyone to get a cane or walking stick before they fall. Alas, that is not usually the case, but when you decide you need one, consider the walking stick. Get two. They’re cheap.
Don’t reach for high things in the closet…over and over again. First of all, bring things you use on a frequent basis to a lower shelf. But if you must leave things up high then get a step stool and keep it handy. Frankly I keep one in every closet because I’m too lazy to go to the garage to get one when I want to get something up high or to change a light bulb. But always be safe on a step stool. If you have poor balance then make sure you use one you can hold on to. This particular one is very handy. It’s lightweight (but strong), and collapsible, so I carry one with me to horse shows and use it to get up on my horses. Saves my bad left knee.
People often associate carpal tunnel syndrome with work related, repetitive use, but frankly I see carpal tunnel syndrome in the general population just as much as I see it in computer programmers and secretaries. Let’s face it. We use our hands…a lot. And we use them repetitively. And we live a long time so they take a beating. Anything you can do to lessen the work your hands have to do on a daily basis might make a difference. It might slow down the progression of the arthritis in your hands, especially if you’re genetically scheduled to get it. It might lessen the potential for you to develop carpal tunnel syndrome. Here’s something you might consider.
If you read a lot, then you have to hold books open. This can put a strain on your hands. Consider using a Kindle or a Nook. They’re light. You don’t have to hold them open for hours at a time. They’re also easy on the eyes.
If you read in bed, consider plopping that Kindle on a reading pillow and keeping your arms free to rest. Even the pressure of the bed against your bent elbow can also irritate nerves in the arm.
Book RestI started using this little combination of bookrest pillow and Kindle and within a week my carpal tunnel syndrome had improved. I am no longer waking up in the middle of the night with numb hands. I’m not saying this is a “cure” for carpal tunnel syndrome. It just helps if you’re reading a lot in bed. And as I’ve said before, anything you can do to lessen some of the unnecessary stresses on your joints is all good in my book.
It’s always good to have ice packs and heating pads around. Just for the record, I think ice is best for acute injuries and acute onset of pain. Heat works well for more chronic conditions, like arthritis. But also for the record; you can’t argue with using whatever temperature feels best. You can always pack a bunch of ice in a baggy and you can always heat up a moistened towel in the microwave. It’s easy to slap those things on an ankle or a knee. But it’s a bugger bear to try to keep anything sitting on top of your shoulder. A patient recommended this one; it’s got options for heat and cold.
If you have a hard time working at a bench or in your kitchen because the surface is too high (maybe you’re short or maybe you have a problem with your rotator cuff), by simply elevating your walking surface, you can diminish the stresses on your shoulders. This concept is the opposite of lowering your computer keypad. Lift yourself instead. But it’s probably not best to use a simple step stool. It’s not a large surface and you’ll find yourself stepping on and off it too much. Try one of these bench step aerobics platforms. You can adjust them for the best height and it gives you a little more room to move about. I picked this one because I used to own a set (remember…no more bench step aerobics for me). I know it to be of good quality and it has a nice rubber surface. There are other cheaper brands and they would all serve the same purpose. Start with the shortest step and work your way up to the most comfortable height, depending on how short or sore you are.
More of My Favorite Things
More of my favorite things. I’m looking forward to getting this whole blog up because I tell patients to get these things every day and now I’ll be able to direct them here to get them. Just yesterday a patient reminded me of another thing I recommended to her, so I added it to the list. Start shopping and feel better and save your bones and joints in the process.
I send patients to the store to buy Tuli’s heel cups all the time. It’s nice to cushion your little heels. They take a beating. These are useful for plantar fasciitis, heel pain in kids (Sever’s disease) and Achilles tendonitis (they lift the heel a little bit, so they take a little tension off the tendon). But once you use them, you might not want to give them up.
Tuli's Heel Cups Tuli's Heel Cups
I know a lot of people who either can’t or find it difficult to put on their own socks. Why bother? Get a sock donner. And this one is without comparison. It looks bulky, but you can tuck it in the corner of a suitcase and stuff stuff around it and that way you can even travel with it. This is a must have for anyone who has had a total joint replacement or for anyone who either grimaces or gets short of breath when they reach down to put on their socks. It also saves your hands from that hard task as well. This is a great gift for anyone over 60.
Save your hands. Use jar openers, even if you don’t need to. These are cheap, easy and they work. Get a half dozen of these and use them for stocking gifts. And don’t forget to knock the sides of the jar against the countertop first.
Make any bed into a sleep haven by adding a 2” memory foam mattress topper. You spend more time in your bed than any other single place. I always recommend buying the most expensive mattress you can afford, but this is the next best thing and at a fraction of the cost. Don’t forget to buy deeper sheets to accommodate it.
A Few of My Favorite Things
A Few of My Favorite Things
Raindrops on roses and whiskers on kittens
Bright copper kettles and warm woolen mittens
Brown paper packages tied up with strings
These are a few of my favorite things…
Over the years I have collected a list of items I often recommend that my patients purchase. I’m going to go through a few of those items as we go into the holiday season, because they would make great gifts and stocking stuffers. And there’s nothing that says you can’t get one of these things for yourself! I own every one of them.
Bucky eye shades. I’ve already mentioned these in my blog on Sleep Deprivation. Blocking out extraneous light is a prerequisite to getting good sleep. I have found that I sometimes go through phases of sleep deprivation and that if I can just get back into the habit of sleeping I then go through long phases of…sleeping well! Covering the eyes and blocking out all the little lights (outside lights, car lights, phones and clocks and fire alarms) which invade the bedroom is a start in the right direction and these little eye masks are just what the doctor ordered. They have a fabric bolster around the bottom edge that puts your eyes in a little cocoon of dark without putting pressure on your eyes.
http://www.amazon.com/Bucky-Eye-Shades/dp/B0001M7PAK/ref=sr_1_2?ie=UTF8&qid=1320965141&sr=8-2
And speaking of cocoon; my second favorite thing, besides whiskers on kittens… a sound machine. Block out extraneous noises by using a fan, but if your fan is too quiet, then try this sound machine. I have a home version and of even greater importance, a travelling version. Hotels come with a lot of noise. The AC unit is always going off and on and the wedding party is up until all hours of the night.
http://www.amazon.com/Marpac-SleepMate-980A-Electro-Mechanical-Conditioner/dp/B000KUHFGM/ref=sr_1_2?s=hpc&ie=UTF8&qid=1320965399&sr=1-2
It’s hard to get to your back to rub it. Buy a box of cheap tennis balls, put one in a long sock (which you most likely have laying around in a drawer, trying to see if its partner ever reappears) and voila…you have a handy little back massager. You bought a can of three balls and you don’t play tennis since you tore your rotator cuff? Make 3 massagers; keep one at home, one at the office and one in the car!
Next best, next cheapest back massager; The BacKnobber.
What they do
They smile in your face
All the time they want to take your place.
The backnobbers.
Well, it’s not quite like that, but every time I say the word “back knobbers.” I want to sing that song. And I’ll bet you’re singing it now, aren’t you? And it got you to quit singing “raindrops on roses…”
So these little handy gadgets can deliver a powerful punch to that burning spot just to the inside of your shoulder blade. It’s impossible to reach without tearing your rotator cuff, so now you don’t have to. The tennis balls can accomplish the same thing, but I like to have a little armamentarium of things to relieve the pain…other than narcotics, that is.
More to come!
Shoulder Bursitis; The End
When all else fails…go see your primary care doc or your local orthopod. You’ve tried resting your shoulder. You made sure you didn’t lose range of motion. You’ve changed things around in your refrigerator and stopped drying your hair. You gave your t-ball aged kids up for adoption, quit your job and dropped your membership at the gym. You’ve rubbed your shoulder raw and now have to have an upper GI because you’ve developed a stomach ulcer. Okay…maybe a little before that. But you’ve still got that gnawing little pain around the front and side of your shoulder that radiates down the deltoid muscle. It continues to wake you up at night. It’s even bothering you to drive. It’s time to come see me.
As I mentioned in the first blog on shoulder bursitis; this is part of a spectrum of disorders related to the rotator cuff. If not addressed, it is likely to progress. We’re going to try physical therapy, cortisone injections and prescription strength medications first. And if you haven’t done any of the things I’ve talked about in this blog…we’re going to do some of that too. Sometimes a relatively minor surgical procedure can be used to treat this condition, if you fail to improve with conservative treatment.
But bursitis often progresses to rotator cuff tendonitis and ultimately to rotator cuff tears. Tears often require surgery, and sometimes if the tears are chronic and massively large, they are not repairable. You might think that you would know if you had a large, chronic tear, but it’s amazing how often we see this devastating condition. And I would have to say that this condition is completely preventable. It just requires a little awareness, some preemptive action on your part, and possible a visit to your doctor. And don’t have that common attitude that it’s just something you’re going to have to live with. Because it’s not.
I've had a request to talk about tennis elbow. I would take requests if you have them. Tennis elbow next.
Shoulder Bursitis; Part 7
Going back to Shoulder Bursitis; Part 5, you can refresh your memory on how to modify some of those more activities you do every day, in order to protect your shoulder. Really, this is a basic tenet of treating the repetitive strain conditions from which we suffer as adults. (And don't forget...the shoulder isn't designed to be a weight bearing joint). If you’ve been reading some of my previous blogs, you will begin to see the patterns of activity modifications. Ideally you might be able to figure this out for yourself next time you feel some pain you haven’t previously experienced. I’m not talking about the kind of pain you suddenly experience when you get hit by a car. And I’m not talking about the pain you experience in the left side of your chest when you over exert yourself. Although frankly, just about any pain you experience should be accompanied by some form of rest. But let’s just say for the purposes of these discussions, we’re talking about musculoskeletal pain.
Now back to finishing up on your shoulder. Most of these repetitive strain disorders are associated with some degree of inflammation. And inflammation will respond in some way, to anything which helps decrease inflammation; namely ice and anti-inflammatories. A little massage never hurts either. Just rub it. Use a little Tiger Balm or Ben-Gay or whatever kind of lotion is available. Don’t be afraid to touch.
Put a little ice on it. Frankly, if heat makes it feel better…use heat. If something makes it feel better, use it.
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually helpful. Now this is where I have to do that little thing they do on the end of commercials. Say it out loud, very quickly, and with a deep voice. You should not take these medications if your doctor has told you not to. And if you haven’t had that discussion with your doctor then you should not take them if you are taking blood thinners, if you have peptic ulcer disease, if you have liver or kidney disease or if you have had allergic reactions to these medications in the past. There, that's done.
Now these medications are readily available over-the-counter (OTC). They include medications such as Aleve, Advil (and their generic forms; naproxyn sodium and ibuprofen), and aspirin. There are many forms available by prescription, but for now we’re limiting this discussion to just those you can buy in the store without a prescription.
So if you have no contra-indications to using these medications, they could be a useful adjunct to your activity modifications. Just use them as they are recommended on the bottle. Don’t plan to use them for long periods of time and make sure you’re not already taking a prescription NSAID. I often see patients who have been on prescription NSAIDs for a long time and are also take OTC NSAIDs.
I can often nip a potential repetitive strain disorder in the bud with just a little activity modification and a couple of days of Aleve.
Shoulder Bursitis; Part 6
Prescribing rest almost always affects the quality of a patient's life.
The definition of quality of life for you is different than for me. It’s different for a child than for an adult and it’s different for a skilled athlete than for a weekend warrior. For me, right now, in order to be able to have what I define as a good quality of life, I’ve got to be able to do surgery and ride horses. Both of those activities require physical and mental abilities. If I lost a hand, I couldn’t do either to the extent that I do now. Oh sure, I could see patients and I could ride horses if someone else could saddle my horses and operate on my patients, but I couldn’t do those things like I do now.
But my quality of life also depends on my ability to read, write and spend quality time with my family and friends. I could still do all those things if I lost my hand. But would I want to? Would I feel the same about those things if I lost my hand? If I couldn’t work or couldn’t ride horses, would I feel the same about everything else? That’s a question I can’t answer for myself, never mind answering it for my patients.
Sometimes a patient loses all perspective on the other parts of their life, just because they can’t run a marathon. They might still be able to run a 10K, but if they can’t run a marathon, then nothing else matters. You and I might sit back and say that’s not that important, but to them it is, and it’s the kind of problem I have to deal with every day in my practice.
And it’s what makes dealing with REST so difficult. To each individual person, dealing with rest is the hardest thing to define and to accomplish. Rest…to one person, might mean not being able to work. That’s different than not being able to participate in a weekend sporting activity. Yet these restrictions might seem equal in their individual minds. The ability to read, write and spend quality time with your family gives absolutely no solace to a high school football player who has injured his knee and can’t play in the last 3 games of his senior year. To you and me, with all of our perspective on life, this is just a minor setback. To that senior, it is everything.
But in 90% of the cases I see, rest is a key part, if not THE ONLY PART of getting well. Rest can come in the form of a cast at one extreme, or simply in the form of limiting some routine, mundane activity you do every day.
Shoulder Bursitis; Part 5
Here are some examples of how you can modify those simple, everyday activities I mentioned in the last blog. Make these modifications to keep from hurting, and therefore damaging, your rotator cuff;
1) Lower the items you lift from higher to lower shelves. Use step stools to reach the things you can’t lower. Move things around in your house! Store the things you use most in mid-level cabinets. Remember…don’t put them in the bottom cabinet either. Don’t forget your poor knees. Keep top and bottom cabinets for stuff you use once a month.
2) The sleeping issue is a tough one. But for sure you must stop going to sleep with your arm over or under your head. You can’t much effect what you do after you’ve gone to sleep, but if it wakes you up in pain, then put your arm back down. In time you might get out of the habit of doing that. Adjust your pillows to encourage your shoulder to stay in a painless position.
Also work on your sleep hygiene. Better sleepers are less likely to wake up with pain. See my blogs on sleep deprivation. http://barbarabergin.posterous.com/tag/sleepdeprivation
3) If you’re not an experienced throwing athlete, you should be careful when you start throwing as an adult. This is no different than trying to run a marathon. You’re not going to start out with the 26 miles. Start out with one. Same for throwing. Don’t go throw 40 balls to your 6 year old on day one. Work up to it. Make sure a few throws aren’t causing frank pain. Throw underhand. Don’t be a hero. Really. You’ll end up like bunches of my dads; not being able to do it AT ALL! Same with tennis and weekend warriors. Follow the old rules you learned a long time ago which still hold true. Work up to it. And if you have pain above and beyond the mild soreness you get with a new exercise routine, then back off. Try something different. And if you’re dead set on doing this activity and it’s causing pain every which way you try it, then you probably need to get it checked out.
4) Get a smaller purse or open your passenger seat, put your purse in and walk around to the other side.
Modify any activity which is not necessary to do for the quality of your life. If you can modify…then modify!
These are good rules of thumb for just about any adult repetitive strain disorder. I have followed them myself and have cured myself of shoulder impingement syndrome, greater trochanteric bursitis, ankle tendonitis, tennis elbow, among other things. Yep, like you, I’m falling apart. Getting old. I’m entering those “golden years.” And I continue to try to beat myself up. But I stick to these principles and most of these conditions are dead in the water in about 6 weeks or less. I usually try to get well without medications so I can test my theory of activity modification out. And it works.
Next time I’ll talk about what to do when modifying an activity affects the quality of your life. Therein lies the rub.
Shoulder Bursitis; Part 4
The next step is to pay attention to the activities which cause your pain. The earlier you catch this, the more quickly you can get better if you just have bursitis or tendonitis. In general most rotator cuff tears are not going to get well. But I think if you deal with this condition early, maintain your range of motion and quit doing the things that hurt the rotator cuff, you might just be able to heal yourself. This has pretty much been my mantra over the past 10-15 years. Recognize the problem early, maintain mobility and condition, then limit or modify the things that result in pain.
Fortunately for my business but unfortunately for mankind, most of you don’t do this. You wait. You think it will get better on its own because that’s what it did when you were 20 years old. You try to “work through it,” or you just stop using your arm altogether. This doesn’t work. And then you end up in my office somewhere between 6 weeks and a year later. If you don’t read this in time or you can’t figure it out, I’d much rather you get in to see your primary care doc or your orthopedic surgeon early on in the course of your problem. You’re much more likely to have success with conservative treatment if we catch this early on.
So with rotator cuff disease (bursitis, tendonitis and partial tears) you will probably start experiencing pain in the front of your shoulder or down into the deltoid muscle (upper arm) when you;
1) raise your arm to do things like lift items (light and heavy) from upper shelves. Milk cartons from the top shelf of your fridge, plates from your cabinets, books and supplies from across your desk.
2) sleep with your arm over or under your head. This pain might actually wake you up from sleep. Of all the conditions I see, rotator cuff problems are most likely to keep my patients from sleeping. Many are pretty wigged out because of long sleepless nights!
3) throw overhead. 40+ dads who are just starting to throw to their kids in t-ball. Tennis league gals. Weekend warriors playing quarterback with 20 year-olds.
4) put your purse/brief case over on or behind the passenger seat.
These are just some of the common presenting complaints I see in about 5 patients every day. When you recognize you have this pain, I want you to start thinking about how you can modify each of these activities to keep them from hurting your shoulder. More on that next time…
Shoulder Bursitis; Part 3
"Doc, it hurts...right there..."
About a third of you come in having already become stiff. It’s usually women who get contractures and I can’t really tell you why that is. It might be some physiological or hormonal or anatomical factor. But I also think it can be related to many women’s attitude toward pain. I think many are fearful of pain and their first instinct is to protect the arm. Don’t move it. Pain might mean something bad is happening. If I could fix one thing, it would be to tell you to move that arm. Unless a bone is broken and sticking out of the skin…then move that arm. If you just wake up one day with a stiff, sore shoulder…or a stiff sore anything for that matter…move it. Move it gently, BUT MOVE IT!
I had shoulder impingement in both of my shoulders about 6 years ago. I was lifting weights at the time and doing a lot of horseback riding; saddling, washing horses, fixing gear, etc. I don’t recall any injury. Of course on Day One of the pain, I knew exactly what I had. One of the fringe benefits of having gone to medical school! I went ahead and took an X-ray (fringe benefit of having my own machine) and found that indeed I had that inferior projection of my acromion. It hurt to raise my arm to the side, especially with my hand pointed down. Rather than stop moving it there, I just raised my arm with the hand turned upward because that didn’t hurt. I never lost range of motion or developed a contracture. As I discovered new ways in which my shoulder hurt, I soon figured out ways to move it and accomplish the same movement in another way which didn’t hurt.
Try everything possible to keep that shoulder moving and if you can’t, then don’t wait around for 6 weeks before seeing your primary care doc or your orthopod. Once you develop a contracture, it is very hard to rehabilitate your shoulder, no matter what the problem is. Don’t wait to see if this is going to get better on its own.
Here’s an easy exercise to do on your own in order to regain range of motion.
Wall Walking
Flexion: Face a wall and put your finger tips on the wall. Then use your fingers to help you elevate the arm as high as you can to the point of resistance or discomfort. Then bring your hand back down and repeat as you’re able.
Abduction: Turn your side to the wall and use your finger tips to assist you in raising your arm to the side. Raise the arm to the point of resistance or discomfort. Then back down and repeat as you’re able.
