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Laurie Niles

Health Care without Healing

June 25, 2011 at 6:28 PM

"It would be best if you stopped gardening," said the hand specialist I was visiting because of some mild but chronic pain I'd been experienced ever since I was knocked off my feet while ice skating last February.

"I don't garden," I said. "I'm really more concerned about being able to exercise and protecting my hands so I can play the violin. I'm a violinist."

Last February while skating with my kids, a woman skated into me from the back, and I never saw her coming. My feet were knocked out from under me, and I went flying into the air. I landed on my tailbone, slamming my arms and hands into the ice. Fortunately I did not land on my head or spine. Still, it rang my bell, and I only noticed later that my hands hurt from the impact. That mostly went away, and I still could play the violin. But after months, I still couldn't lean on my hands without pain, meaning I couldn't do push-ups, certain yoga poses, etc. This wasn't going away. I didn't want it to spread and get worse, and I was also a little concerned I may have broken some tiny bone in there. Not something to ignore, if you use your hands for a living.

The young doctor had taken some X-rays, and the good news was that nothing appeared to be broken.

"You probably activated some arthritis in the base joint of your thumb," he said.

Arthritis? Sorry, that sounds scary to a violinist. I wanted to know more.

"You can take some ibuprofen if you want," he said. "We can wait until it gets worse and then do surgery, but you probably don't need surgery now."

SURGERY?

"Actually, I just want to know how to help things heal," I said. "I don't want it to get worse, but I just need to know what I should do, and what I should not do."

"Well, you should probably avoid gardening," he said.

"I don't really do any gardening," I repeated, gritting my teeth. I didn't mention that I don't actually have a YARD. "I really just need to know how to help it heal."

"You can take some ibuprofen," he said. "But it's true, the more you use your joints, the worse arthritis will get. But if it gets worse, we can do surgery."

"In the mean time," he said. "I would avoid doing any gardening."

Update: Robert thought this sounded like the Xtranormal video with the music teacher and the parent, so he made this:


From David Burgess
Posted on June 25, 2011 at 7:16 PM

"You can take some ibuprofen," he said. "But it's true, the more you use your joints, the worse arthritis will get. But if it gets worse, we can do surgery."

Find a better doctor. I was diagnosed with arthritis nearly thirty years ago. It was controversial at the time, but my first approach was exercise.  I don't think this is controversial any more.

With a combination of researching on my own, and spotty good medical advice, I'm largely symptom free today, and am much more capable of physical activity than most people my age. No related surgeries, and no drugs,  though they were often recommended.

One big thing you have going for you: You are probably more motivated to have an exceptional outcome than many physicians are. Dump the "paint by the numbers" physicians, and explore. The most helpful I found happened to be an internal medicine guy. He and a couple of his buddies "put themselves through med school"  with bluegrass gigging. They still perform occasionally today.

www.annarbor.com/entertainment/rfd-boys-riverside/

The guy straightened out some nerve impingement problems (numbness) for me recently. Or maybe it was coincidence that things improved. There was only one doctor visit, which included some spinal manipulation; some simple instructions on stretching exercises which I would continue on my own, and the usual recommendation to avoid surgery. Surgeons have a tendency to recommend surgery. LOL  Surgical outcomes are mixed, as with drugs, but these passive approaches may not be as good as those obtained by highly motivated people, utilizing other methods.


From Bart Meijer
Posted on June 25, 2011 at 7:48 PM

Laurie,

After a similar accident my left wrist hurt for months. When I went to the doctor she told me it was damage to the cartilage and would take a long time to heal, but in the end it would. And it has.

I have no way of knowing, but I hope it is the same with you.

Good luck,
Bart


From Stephen Brivati
Posted on June 25, 2011 at 7:50 PM

 agree with David.

Your doctor is useless.  Probably tells pregnant women to rest up for the duration while he is at it.

Cheers,

Buri


From David Burgess
Posted on June 25, 2011 at 8:05 PM

Yes, Buri!

I remember a fitness class instructor at the Hollywood YMCA  who worked alongside her class until two days before she delivered her healthy twins.

There can be money in recommendations. It's been offered to me, solicited from me, and it's offered to physicians. Monetary enhancement doesn't happen to be my primary path.


From Laurie Niles
Posted on June 25, 2011 at 8:12 PM

 He gave me an $85 brace and then charged me for two. I kid you not! Had to dispute the bill!


From Mendy Smith
Posted on June 25, 2011 at 9:12 PM

 Yup, time to find a different doctor.  Preferably, one who doesn't do any gardening.


From Royce Faina
Posted on June 25, 2011 at 9:53 PM

Insurance companies are getting more and more useless since the economy here went south. Ever since then they do not want to let go of their (really ours) money! Rather than pay for needed treatments they are just wanting doctors to prescribe pain killers and leave it at that!


From Scott Cole
Posted on June 25, 2011 at 10:43 PM

 Laurie,

I can very much relate since I'm currently suffering with my own left hand issues of numbness. In some ways, it's scarier than pain.

However, I will say that on one level, your doctor is absolutely correct in saying that you simply need to stop that which is irritating the hand. It's simplistic and not what most people wish to hear (we all expect doctors to do something, but often they can't. And it's possible you don't actually have arthritis at all. But there is something to be said for simply resting.

Scott


From Jim Hastings
Posted on June 25, 2011 at 11:32 PM

David said, "Surgeons have a tendency to recommend surgery" and "There can be money in recommendations."

I am not in the medical profession -- nor in the pharmaceutical field; but what some professionals from both fields have privately told me corroborates these statements.

We often hear observations like this: "Well, we can't really cure the condition, but we can manage it."  Surprising?  Hardly.  If they cure someone, just look at all the repeat business they lose -- not to mention all the big bucks.  Kevin Trudeau makes this very point in his book Natural Cures "They" Don't Want You To Know About.  A lot of surgeries turn out to have been unnecessary.  The "cure" is often worse than the "disease."
- - - - - - - - - - - - - - - - - - - -
Royce said: "Insurance companies are getting more and more useless …."

If health insurance operated more as, let's say, auto and property insurance operate, this would probably do a lot toward reining in runaway healthcare prices.

For instance, auto insurance should keep you from being financially wiped out if your car is totaled.  But it doesn't cover oil changes and tune-ups.  Likewise, if health insurance covered emergencies but made us pay directly for routine, non-emergency visits, we might well have more incentive to know the costs, shop around, and take care of ourselves.  Then, too, maybe some of us would quit running to the doc for every little sniffle or paper cut.

However, the current setup is a cash cow for the health insurance industry -- and, I dare say, the healthcare field itself.  As long as a third-party payer is involved, what incentive does the consumer have to find out actual costs?
- - - - - - - - - - - - - - - - - - - -
I won't say to ditch this specialist; I don't know your overall situation well enough.  But I would definitely keep talking back to him as you have.  And I would keep playing -- provided that the playing isn't delaying the healing or making things worse.

I've worked out with free weights for a number of years; and though I've never gone flying through the air for a hard landing, I've had some of the typical muscle and ligament strains and tears.  They haven't affected my playing -- although they've taught me some valuable lessons in alertness to form, commonsensical prevention, and avoidance of over-training.


From Jen-Chien Jack Chang
Posted on June 26, 2011 at 1:27 AM

X ray can only detect bone fracture. You need to have an MRI scan done to determine whether you got nerve or muscle damages. Best wishes!


From Rohit Harvu
Posted on June 26, 2011 at 2:52 AM

 Hello Laurie, 

I am new here but would like to give you some advice. Arthiritis indeed is a scary term for a violinist, that being said some doctors, such as yours believe that prescribing pain medication helps. That is in itself a wrong step, I think you need to find a new doctor, but you should perhaps explore physical therapy. I had surgery done to my leg for flat foot(Its only  been a week :D), but they are slowly giving me physical therapy and I am starting to learn how to walk on crutches. While that is unrelated to arthiritis, the point I'm trying to convey is physical therapy might just be the answer to your problem. They will try to find out ways to fortify your bones etc.

Hope you get better

Respectfully Yours,

Rohit 


From Anne Horvath
Posted on June 26, 2011 at 1:06 PM

It is dismaying to hear about your physical problems.  I wish you a speedy and total recovery.

And please get a second, third, or fourth, MD's opinion.  Are there hand docs around, or sports medicine docs?

 


From Kenneth Tan
Posted on June 26, 2011 at 1:55 PM

 Well I'm a junior doc and I was thinking on this whole encounter. 

It's partly due to how we practice medicine and partly due to the legal implications.

Legally, we can only recommend treatments that have been proven (by experiments), or by anecdotal evidence (the good old regular treatment). Anything else is experimental and has to be told to the patient as such.

Well guess what happens when we compare two treatments... We have to compare an intervention with doing absolutely nothing.

And so really... when treatments perform as poorly as doing nothing, we'll just advocate doing nothing. 

It's hard to tell patients what to do "to help healing", when such research has never been done before. Of course, stopping whatever activity you've just done would definitely reduce the risk of a similar injury happening again.

Also, like someone else pointed out, X-rays are only good for bones. MRIs are required to evaluate soft tissues (and they cost a bomb), and if it's going to get better anyway, why spend that money?

There's a lot going on in the minds of doctors when they diagnose and treat a problem. And there are also things that patients demand from us, which we simply don't know (or it's not cost effective to find out). And so there you have it!


From Diane Allen
Posted on June 26, 2011 at 2:54 PM

Laurie - See a chiropractor. The impact may have moved some bones around.

Of course we all have our own personal experience. Coming back from a qtet gig we had a car accident. Both of my knees hit the dashboard. Pain for 6 years. Doctors have no explanation - everything looks fine with xrays and mris.

The chiropractor did 1 adjustment - pain gone.

Good chiropractors can fix things in 1 - 3 visits. Stay away from the ones that ask you to come weekly for 6 months!

While I'm on the subject. Violin related or physical exercise related. If I have a sore muscle that doesn't get better and lingers - chiropractor. I've had everything adjusted from back, neck, knees, wrists, pinkies, toes, hips, heals and yes - even my stomach put back in place after pregnancy!

Hope you feel better soon...

Smiles! Diane


From Rebecca Hopkins
Posted on June 26, 2011 at 3:19 PM

For many years I had back pain and would be told the same things by doctors and chiropractors: sit ups, sleep on my side with knees up, etc, plus a list of don'ts (never lay on my stomach or flat on my back, don't bend backwards etc). Finally had a doctor that diagnosed degenerative disc disease and arthritis of the spine and sent me to a physical therapist stating "we want to keep you ambulatory as long as possible" (scary to hear).

The physical therapist immediately had me start doing things exactly the opposite of all the doctors/chiropractors instructions and said that all that other advice had weakened certain muscles. In very little time, the pain diminished, mobility improved, etc. After a few short months of doing the simple exercises, I felt better than I believed I could (and wanted to go slap those other professionals that in essence kept me suffering for 20 years with their advice).

That was 13 years ago, I don't do the exercises that much anymore, but the not babying my back keeps it stronger.

Sorry for the long post, but the point is these different medical disciplines learn completely different things, come at everything from different angles I guess, so a good physical therapist might be just what you need.

 

 


From Jim Tsai
Posted on June 26, 2011 at 5:20 PM

Laurie, sorry about your experience with this young doctor.   I woud seek the advice of another specialist, especially an orthopedist, who hopefully can refer you to the right physical/occupational therapist.    I don't know the extent or nature of your injuries but the implication that exercising makes arthritis worse runs exactly counter to what I was taught.   The point of exercise (in moderation and the right sort) is to strengthen the supporting muscles that help to reduce stress on the joint. 

It may not even be arthritis.  And I'm going to take a guess it's not gardening.   It's time to switch doctors. 


From al ku
Posted on June 26, 2011 at 8:32 PM

 i would like to know if laurie was wearing some sort of garment suggestive of an earthy farmer-like a straw hat, not the fashionable kind, you know-- that made this doogie howser to repeatedly remind her to put down her farming tools for the time being:)

seriously, was there a detailed hand exam before the imaging study?

http://www.mja.com.au/public/issues/182_08_180405/rei10915_fm.html

 MDs are close to useless dealing with soft tissue problems.  and american trained young MDs are close to dangerous.

 if i were you, i would consider this:  http://sitincomfort.com/therhotparwa.html   (there may be more economical models but i just googled)  this modality is quite effective in providing penetrating, soothing heat into tissues which may accelerate healing.

take care~!


From Laurie Niles
Posted on June 26, 2011 at 9:23 PM

 Wow, thank you for all the great ideas, everyone! Indeed, I'm not even close to thinking about surgery. It's interesting to me that my left hand has actually healed almost completely, and it's my right hand that continues to have pain with pressure. My left hand is constantly writing (I take notes by hand, it's insane) and honestly, I think that this, along with violin playing, has actually helped. I want to get back to yoga, though, it really affects my whole well-being. I will report back if/when I find some alternatives that are working!


From Royce Faina
Posted on June 26, 2011 at 9:08 PM

By no means will this post be exhaustive. I am a firm believer of eliminating the wasting money and time of Health Care professionals with needless trips to docs for something that could be taken care of at home. A dear friend of mine who I work with has had a battle with his back even having to have a stimulator in planted which has been a Godsend. Hard working Electrical Engineer, good work ethics. He needs surgery to fix the core and root of the problem and every time he has something come up it has always been legit and the implementation (surgery, therapy, etc.) warranted. Now he had to go to Denver for a 2nd opinion, a mental health evaluation which costs money plus him having to wait longer for relief and it's not just him but all of us with the current insurance company.

     Honest people with legitimate problems that need immediate attention are getting a needless run around. Let me put it like this. Someone comes into an ER with a slash in their carotid artery. Blood volume is dropping and they can be saved in 15 minuets with immediate surgery. A  Cephalacaudal exam by two ER docs has confirmed this. However the insurance says that this person must go through a psychological battery to determine if the blood loss from the carotid is really from the slash or maybe depression or another psychological issue. Please tell the patient to stop bleeding until the psych. battery results come back and is reviewed.


From bill platt
Posted on June 27, 2011 at 3:03 AM

When you call 911, never tell them how the injury occurred. By no means should you ever say you hurt yourself, as in "I was trying to prize up a muffin with the paring knife and put it through my hand" because if you do, you can forget about ever seeing an ambulance, as the police look for a psych unit. This happens all the time.

You have to game the system to effectively use the system....in all aspects of medical help...


From Bruce Goldstein
Posted on June 27, 2011 at 3:35 PM

 I'm a physician as well as an amateur violinist. I recently experienced similar pain in my right wrist with some swelling at the base of my right thumb. My off the cuff consult with my ortho friend thought it might be a ganglion cyst. My self- diagnosis is tendonitis from repetetive motion (Writing). I obtained two splints from the sporting goods store( a lot less than $85) and it eventually subsided.

   I would recommend that you wear the braces when possible, take frequent breaks from playing, find a new doctor and consider getting an MRI for diagnosis if it doesnt resolve. (Oh yea, and stop that gardening).  Hope this helps.


From Francesca Rizzardi
Posted on June 27, 2011 at 8:21 PM

My son had multiple RSI's from the guitar.   His doctor sent him to a clinic that specializes in hands--I don't think it has an MD but it has acupuncture, massage, and PT.   So far he's been approved for 16 visits, one per week, and they do all kinds of stuff with him.  Very impressive in this age of screwed up medical systems.


From Lisa Van Sickle
Posted on June 28, 2011 at 11:21 PM

Having lived in Hand Hell for about a year, I'd recommend talking to other professional people.  Maybe another doctor, especially if the first one you saw was a general orthopedic surgeon and not a hand specialist, but more importantly a physical or occupational therapist who specializes in hands.  I've found the OT I use to be very well-informed and respectful of what I need to do with my hands, music ally as well as in my occupation.  If you can get a prescription to go to one, they're also a good source of information on which MD you might want to see if the one you have isn't working out.  Four or five moths is a long time for a problem to persist.  You should try to get a better answer, and it shouldn't take a $2000 MRI to sort it out.

If you are left-handed, you probably use your right hand for heavy-duty stuff, like holding the six bags of groceries while you fish for the key and open the house with your dominant hand.  Could be why it's been so slow to heal.  On the other hand, if you would just quit gardening . . .


From Elizabeth Kilpatrick
Posted on July 2, 2011 at 12:52 PM

 I would most definitely agree with those who suggested physical therapy.  I had a volleyball thumb injury that didn't get better for 7 months, no matter how many doctors I went to. Then I went to physical therapy, and now it is better!!! Physical therapist's are amazing....

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