Principles of sports medicine

[old goat]

A couple drinks per day is not insignificant. 3 or more drinks per day is considered the upper limit beyond which you probably shouldn't use any acetaminophen at all.

https://health.clevelandclinic.org/i...oure-drinking/


Regarding anti-inflammatories, IIRC it's pretty well established at this point that chronic use of NSAIDs impairs bone and soft tissue healing.

my kid (surgery resident, it's the family business) keeps closer track of this one than I do but he tells me that the evidence is thin--mostly lab studies. But when the neurosurgeon says don't take nsaids I don't take nsaids.
From a theoretical standpoint it certainly makes sense--the inflammatory reaction is what starts the healing process. From a practical standpoint--is there something that actually has to heal and is it important? A lot of nsaids are used for pain and inflammation where there isn't anything broken that needs to heal, just stuff that's irritated.

[PB]

That heart attack n-said was Viox (Rofecoxib), and it was the bees knees for chronic inflammation relief. Who needs a heart any way? Somebody's just going to break it.

[summit]

Vioxx was supposed to let you take your NSAID chronically for your chronic problem because it would not give you peptic ulcers, GI bleeds, GI upset that you would get if you took your aspirin or ibuprofen or naproxen chronically (because they inhibit COX1 as well as COX2).

Turns out selective COX2 inhibition causes vasoconstriction and platelet aggregation = heart attack.

So... no more Vioxx. Celebrex (same class) is still on the market but with an FDA Black Box Warning.

[old goat]

Thanks for remembering for me guys. Scary moment yesterday when I was on the phone to Social Security and couldn't remember my number. Came back to me eventually.

PB--the pain will pass and new doors (ie legs) will open. Trust me.

[PB]

Good God man - you're talking to SS while on serious pain meds??? Far braver the I, Sir.

It was a throw away glibness; my heart's fine cuz my best friend can red my semi-functional mind. No longer thinking about opening legs; that urgency is in the rear view mirror.

[old goat]

Good God man - you're talking to SS while on serious pain meds??? Far braver the I, Sir.

It was a throw away glibness; my heart's fine cuz my best friend can red my semi-functional mind. No longer thinking about opening legs; that urgency is in the rear view mirror.

Rear view? Got it.
You have a point about the pain meds; maybe I can blame the meds instead of age.

[PB]

Ha! Not quite what I had in mind, but good one!

[bodywhomper]

not exactly a "principle" of sports med, but is there a good repository of information/ratings of sports/fitness related PTs? My general physician recommended PT to help my knee, after he concluded that there seemed to be no ligament or meniscus damage. He did some manipulations (he's an DO). Where i live, there seem to be a lot of fairly fit people, obese people, and elderly. i'd prefer a PT that is more geared and oriented toward athletes. i had a bad experience with the one available podiatrist after breaking my foot last year (on the same leg as the now hurting knee). thanks

[old goat]

Where are you? I have no personal knowledge but I doubt you're going to find any national list. I know your frustration--when I was diagnosed with lumbar stenosis I was given exercises. They were absurdly easy, so I went to the internet and found some harder ones, same story. A lot of PT is geared to keeping people out of nursing homes, not back on the slopes.

[bodywhomper]

Where are you? I have no personal knowledge but I doubt you're going to find any national list. I know your frustration--when I was diagnosed with lumbar stenosis I was given exercises. They were absurdly easy, so I went to the internet and found some harder ones, same story. A lot of PT is geared to keeping people out of nursing homes, not back on the slopes.

Western Nevada County. Really don’t want to drive beyond grass valley.

I’ve also seen a physiatrist. Former elite-level athlete. He’s great, but crazy busy. When my knee wasn’t better after a week, I called to make an appt with him. Earliest time was late May.

[MakersTeleMark]

Do you have insurance? Because I could put you in touch with the best people in the world in Central Colorado. We treat rehab for pros like getting a cup of coffee or a big mac.

[bodywhomper]

I have insurance. High deductible, though. With my life, it needs to be a local PT or I am not gonna get there. Btw, i have a good friend in with some famr in sports medicine. Denver-based. Pulmonary stuff. you may know him.

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[old goat]

Western Nevada County. Really don’t want to drive beyond grass valley.

I’ve also seen a physiatrist. Former elite-level athlete. He’s great, but crazy busy. When my knee wasn’t better after a week, I called to make an appt with him. Earliest time was late May.

I don't know anything about them personally, but Anderson PT in Nevada City bills itself as sports medicine. Have you tried them? good yelp reviews FWIW. In western Nevada County you might have better luck with herbs, aroma therapy, and crystals. Sorry I don't have more specific knowledge to help you.

Oh, and stop whomping your body.

[bodywhomper]

I don't know anything about them personally, but Anderson PT in Nevada City bills itself as sports medicine. Have you tried them? good yelp reviews FWIW. In western Nevada County you might have better luck with herbs, aroma therapy, and crystals. Sorry I don't have more specific knowledge to help you.

Oh, and stop whomping your body.

Thanks!!!

Anderson is not in network for me, unfortunately.

[wooley12]

"If it doesn't bleed it doesn't hurt" " Is that still a thing?

[old goat]

Thanks!!!

Anderson is not in network for me, unfortunately.

Ah, the pesky little network thing. Just hold out until 2021 and medicare all will fix the problem for you. Sorry I couldn't be more helpful.

"If it doesn't bleed it doesn't hurt" " Is that still a thing?

The one's I learned are "all bleeding stops, one way or another" and "bleeding isn't serious unless you can hear it". The last one isn't true though--the two worst places to bleed from are the vena cava behind the liver and the pulmonary artery, and you can't hear either. BTW those sayings are professional secrets so don't tell anyone.

[bodywhomper]

Sorry I couldn't be more helpful.

No sweat. Thanks for the input

[wooley12]

Those were the sports medecne tips I got from my HS football coach.

I had a hernia bulge fixed with Laparoscopic about 5 years ago. Doc had a "Top Gun" kid of confidence threw me. He said that when he fixed the right side bulge that he took care of the right side too. I saw my GP a a month ago and he commented on about a hernia he saw on my left side.(?) Is there a warranty?

[old goat]

Those were the sports medecne tips I got from my HS football coach.

I had a hernia bulge fixed with Laparoscopic about 5 years ago. Doc had a "Top Gun" kid of confidence threw me. He said that when he fixed the right side bulge that he took care of the right side too. I saw my GP a a month ago and he commented on about a hernia he saw on my left side.(?) Is there a warranty?

No warranty, sorry. You have to pay for the recurrence just like for the original.
Re the Top Gun mentality, in my years of teaching residents it was my observation that in general, men had more confidence than ability and women more ability than confidence. Certainly plenty of exceptions of course. The thing about surgery is--with age comes humility, but too late for the patients who caused the humility.

[baron]

1) If doing something hurts, stop doing it. Doing it more won't make it go away.
2)Stop thinking you're still 25 unless you're still 25.
3) The only real way to know if you need to see a doctor is to see a doctor, unfortunately
4) Ignore medical advice from any site that wants to sell you something.
5) If your doctor tells you you have condition X and then walks out the door before you can ask questions Wikipedia is an excellent source of information as is Pubmed (the national library of medicine site).

this is some real great advice...

-a lot people think the superman mentality-

I wrecked myself a few times, and healed myself , when most would go to the ER->though I have had a Femur fracture ,a long time ago; it's easy to compare how serious something is .. after that kind of pain. Opium is for post surgery and Emergency.

I don't take and numbing at the Dentist since that leg break ; pain lvl 1-10 is relevant to your experience lvl

>either way just say No, to pain meds > unless you have freakin' cancer or some major fracture , ligament tear ..suck it up! the meds don't really help after a few days ,unless you slowly dose it up.. it is a train wreck waiting to happen. My buddy w spinal cancer ,eventually started melting his pills and shooting them-its just sad.

[old goat]

About saying no to pain meds--with certain situations, rib fractures being an obvious one--pain management is crucial to keep you from getting pneumonia. With limb problems going without pain medication can prolong rehab and can lead to permanent loss of range of motion. As with most things in life (skiing powder being one of the exceptions) moderation is key.

Re opiates--after my recent injuries I was on 80mg of oxycodone per day--10mg every 3 hours for about 2 weeks--clearly an habituating dose. After 6 weeks I am down to 10 mg/day--5 in the morning and 5 mid day. No withdrawal symptoms. Obviously opiate addiction after using prescribed opiates is a real thing--reportedly the frequency is 10%--which is the same as the frequency of substance abuse in the general population. One could think of the situation as analogous to alcohol--an abuse prone substance that most of us can use without becoming alcoholics. In the case of opiates, I think proper education at the time of prescribing helps a lot as is supervised weaning. It is important that docs use the CURES registry to make sure they are the only one prescribing opiates for a given patient. Still some people will become addicted, and how to prevent this without depriving the 90% of adequate pain relief is a tough problem.

In talking about opiates (or opioids--I don't know which term is best) it's important to distinguish between habituation and addiction. Habituation is the development of increasing tolerance to a medication, requiring increasing doses to achieve therapeutic effect and producing withdrawal symptoms if the medication is abruptly stopped. Habituation will occur in ALL people given around the clock opiates for 2 weeks or so--some say less.
Addiction is the psychological dependency on a medication, beyond the need to control pain. That's the 10% figure.

I practiced in a closed system where I had access to all of my patient's records from other physicians in the system and all their prescriptions. In my 26 years in that system I prescribed a lot of opiates, often for long periods of time for patients with chronically painful conditions, and I am unaware of any who became addicts. While it is certainly possible that I could have missed an addict, the nature of our system would make that unlikely. (I also drug tested patients on occasion to make sure they had opiates in their system--to make sure they weren't diverting the medications.) So I think it is possible to do better than 10%--but it is important for doctors to follow patients on opiates carefully. One thing that's important is that for people whose pain isn't going away after 2 weeks, space doses out to allow blood levels to fall between doses--that way the drug remains effective and the need for escalating doses is avoided. Use non-narcotic pain meds to supplement.

[baron]

i wish more care givers acted ,like you think

There is a darker side too> there are problems they are not willing to risk treating ,for liability reasons usually. Like skin Ulcers ,are one perfect example. There docs just prescribe pain meds .. anti swelling meds.. and more appointments...I had to live through it ,and it's brutal.

They want to help; but also want you on the patient roster.
Hospitals get direct subsidy for patient #s they report..
..this was part of Obamacare ,and why its harder to get appointments since implementation.

in the end.. listen to your Body, and go to the doctor ,sure..>but if they are NOT helping , your own body can signal where to look next or just deal with it on your own. Doctors want to help ..but their corporation bosses would fire them, if they turned away patients that can add to their bottom line.
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One Bummer that snagged me legally>UTAH has a 2 year limit on malpractice/neglect claims. That is why you see so many doctors and dentists move in and out. This is the perfect training ground for them, and it is 100 times easier to start a career in medicine without that monkey on their back. Something debatable, like skin care, can be argued right past the Legal deadline... and lawyers report any claims to the provider directly ..yea >your lawyer does that! Nice to hamstring the patient from the start...we don't call those lawyers bottom feeders for nothing.
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We need a reduction in red tape,so the Family Doctors return to local neighborhoods .

My family doctor fixed a nasty spider bite from a black widow once. I didn't know what happened ...couldn't stand for more than 20 seconds , legs in a lot of pain+fever. I told him I was skiing in New Mexico , maybe a spider ?After I put 2 +2 together> I was bit on the skull, took an unusual 2 weeks for the poison to hit me. A quick antibiotic and I was fine in 3-4 hours.

Now, with symptoms like that w no obvious wound ..an ER visit woulda cost me thousands of dollars ,as they tested me with every thing that carries a fee. Heck they probably woulda stuck me in a 5k$ cat scan right away

Local family Doc was about 80 dollars ..plus the prescription was like 12 or 15 bucks.

[4matic]

Great knowledge OG. Thanks. I just tossed back a Norco! A frustration I have is quantifying pain level on 1-10 scale. I don’t want to lie but I don’t want to sensationalize either. Maybe a 2nd dysfunction scale would serve me better. With my nerve damage the pain was “5” but my dysfunction was “10”. Speculation in science. I get that medicine is often times an art but for my elbow, shoulder and now back it just came down to I can’t live like this vs pain level. To sell my desire for back surgery I showed the surgeon a picture of me winning a golf tournament 30 months ago and telling him I can no longer walk correctly. I also wrote a three page timeline of my struggle. The pain management doc always worked off the 1-10 pain scale. Thanks again for sharing the insider tips.



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[splat]

In western Nevada County you might have better luck with herbs, aroma therapy, and crystals.

heh.

[XXX-er]

6 years ago my feet were right fucked from a very long ski and not getting better after > a week so when I ran into the sports PT from AUZ at the bar I asked buddy for a quick a consult and he said soak em in ice water so how long i asked

he said " Long as you can stand it, I used to submerge entire rugby players in the ice bath the day after a match " and said something about writing a paper on the use of ice to speed up healing so I did the ice and it worked

So last week I sprained the ankle, it wasn't getting better fast enough so the last 2 days I been sticking my foot in a beer cooler with 6 " of water a couple trays of ice and its defintaly helped ... a good sports med tip