Gott second in line to comics

August 2, 2013 By

Q: I’d like to start off by saying that I thoroughly enjoy reading your column after I’m done reading the comics. That may see a bit odd, seeing as I am only 16, but you have had good advice for many different health issues that people have had and I thought I would see what you have to say about my knee.

I’m a very active female and have had no serious injuries before. I play multiple sports, including field hockey. I’ve had no injuries before, except for a recurring right quadricep strain and have always had full mobility in both knees. However, I’ve suddenly been unable to bend my right knee into any position resembling “Indian style” without terrible pain. I’m still able to run and move my legs in other ways without pain.

I’ve spent the last few weeks at the beach and have been running a few times on it (about a mile or so) and spent a lot of time surfing. Both of these things are not out of the ordinary for me.

Field hockey begins very soon and I’m afraid that I could have done something to a tendon or ligament somewhere that could get progressively worse. What should I do?

A: Knee pain can occur for a number of reasons to include a torn meniscus, or often as a result of participating in sports or recreational activities and various work projects. The femur (the upper leg bone) and the tibia and fibula (lower leg bones) are connected by ligaments, tendons and muscles. The surface of the bones within the knee joint is covered by cartilage that acts as a shock absorber, which provides a smooth surface for movement of the joint. Were you older, I would lean toward arthritis or even osteoporosis, however in someone your age, the most likely answer is injury – injury from bending or twisting the knee (as in crossing your legs), from a fall or blow to the knee, or from simple overuse. In the case of an injury, pain, swelling and bruising may develop within minutes, alerting you to the damage incurred. In other conditions, damage may not be readily apparent or visible to the naked eye right away. Sprains, strains, tears and more importantly overuse, can cause damage to ligaments and tendons that support the knee cap. Also, tendons have a poor blood supply and do not heal as quickly, making the pain last longer.

Sprains are stretches and tears of ligaments (the strong bands of tissue that connect bones) that support the knee. Sprains can result from stretching in one direction while the ligaments involved are attempting to hold the knee in place. Strains on the other hand are injuries that involve tendons and muscles. Tendons are tissue that connect muscle to bone. A strain may be the result of over-stretching a tendon or muscle. A simple strain can take up to three weeks to heal. Overuse can cause problems with participation in repetitive or prolonged activity. Inflammation, pain and internal damage can result.

A condition known as Osgood-Schlatter disease can present in young people who participate in sports such as soccer, basketball, running and jumping. Symptoms include a bony protrusion just below the kneecap, with pain and swelling in the front of the lower portion of the knee. The condition is common enough to appear in as many as one in five young athletes. You don’t mention anything other than pain so my guess is this condition can be ruled out. Further, it generally presents in girls up to the age of 12 and in boys up to age 14. Osgood-Schlatter resolves on its own once an adolescent stops growing.

Treatment, whether from a strain, sprain, tear, overuse, or another cause or condition will depend on the primary reason for the problem that should be determined by an orthopedic or sports specialist. Resting your knee, elevation, wearing a temporary brace, physical therapy, the application of ice and other options are available. An over-the-counter non-steroidal anti-inflammatory (NSAID) might be appropriate to lessen your symptom of pain. Following that, an MRI might be considered to help rule out or diagnose the torn meniscus.

Above all else, keep reading the comics. They’re why many people buy their local newspaper every day!

Filed Under: Daily Column, Leading Letter Tagged With:

Sleep an impossibility because of pain

March 22, 2013 By

Q: I am a 76-year-old female and have been treated for arthritis in my knee. I am fine in the daytime when my weight is on my legs (standing, walking) but within a few minutes of retiring, my hip OR knee OR both begin to ache, sometimes unbearably. When the pain does not subside after a few minutes, I get up and walk around; it is gone…like turning off a switch. I hesitate to take anything at night because of a bladder lift that could result in bed wetting if I ignore the urge to urinate.

I take an abundance of calcium, chondroitin/glucosamine with MSN and get lots of exercise and frankly, I am in excellent health. Help!

A: The possible causes of your pain are many, to include the arthritis you already know you have, sciatica, tendinitis and bursitis of the knee or hip, to name a few.

Arthritis refers to inflammation of one or more joints because of a breakdown of cartilage that generally protects a joint and allows it to move smoothly. Without cartilage, bones rub against each other, resulting in pain, stiffness and swelling.

Sciatica is an indication of an underlying medical condition that results from pressure or damage to the sciatic nerve that begins in the lower spine and travels down the back of each leg; however, it most commonly is unilateral. Causes for this condition include fracture, injury, a slipped disk, tumor, or narrowing of the muscle in the buttocks. The intensity may vary greatly but often begins slowly and progresses after standing or sitting, at night, when walking even a very short distance, or when spinal stenosis is present.

Tendinitis can occur because of injury, over-use, or degeneration with aging. It can also occur in individuals with rheumatoid arthritis, diabetes and other systemic diseases. While it can present in any tendon, it is most common in the shoulder, elbow, wrist or the Achilles tendon in the heel. Pain exacerbates at night and with movement.

Bursitis refers to inflammation of the bursa (a fluid-filled sac) found between a tendon and skin or a tendon and bone. This condition is common in the knee, elbow, shoulder and hip and generally presents with pain and warm skin. The knee and elbow can become inflamed simply by walking – either out of doors or on a treadmill – or from a muscle pull. It exacerbates at bedtime when the individual is in a flat position. Referred pain is difficult, since it presents in one location but may originate from another.

Trochanteric bursitis refers to inflammation of the bursa between the bony area of the hip and the iliotibial band. It is commonly the result of overuse with athletes but is also present when a person remains sedentary, such as at a desk or work bench for extended periods of time. This condition is more common in women than in men and often affects those of middle age and older. As such, it commonly exacerbates at night, especially when an individual rolls onto the affected hip.

Diagnosis for trochanteric bursitis might be made by a health care professional through palpation at the point of the greater trochanter of the hip, or through X-ray or perhaps an MRI, with the latter being the better choice in my opinion. While waiting to see your doctor, I recommend you change your footwear to that of good cushioned sneakers (worn even when you walk around the house), using an over-the-counter non-steroidal anti-inflammatory (NSAID) drug with your physician’s approval, placing a rolled pillow under your knees while in bed, and trying to avoid sleeping on your affected side. If stronger prescription medication is in order, you should discuss the matter with your physician.

Your quality of life has been affected. It’s time to see a therapist, orthopedic specialist or osteopath with a dedicated practice to musculoskeletal issues, receive appropriate testing, get a diagnosis, and make changes to move on toward recovery. The sooner you do it, the sooner you’ll get a good night’s rest.

Filed Under: Classic Column, Leading Letter Tagged With: ,

Is antibiotic appropriate for arthritic knee?

September 1, 2011 By

DEAR DR. GOTT: I am being encouraged to try tetracycline therapy for my arthritic knee. Is this a legitimate therapy to avoid surgery?

DEAR READER: Information obtained from the U.S. Library of Medicine, as reported by the Division of Rheumatology in Toronto, Ontario, regarding an October 2003 study, indicated published trials had been hand-searched for further identification of reports and presentations regarding this very subject. Of the 10 randomized trials that included 535 individuals, only three were considered to be of high quality, and elements of bias could not be excluded in the remainder.
[Read more…]

Filed Under: Daily Column, Leading Letter Tagged With: ,

Injection may delay knee surgery

May 20, 2011 By

DEAR DR. GOTT: You receive a lot of requests about knee-pain treatments versus surgery, but I have never seen you mention Synvisc-One. I’m 80 years old and have had two injections over the past two and a half years. They last a year or more and take effect a few weeks following the injection.

DEAR READER: This 2009 FDA-approved medication contains hylan polymers, produced from chicken comb. It is similar to the fluid that surrounds the joints of your body and acts as a lubricant. It is injected directly into the intra-articular space inside the knee and is prescribed for the treatment of osteoarthritis pain in patients who have failed to respond to more conservative therapy. A single dose is reported to reduce pain for up to 26 weeks.
[Read more…]

Filed Under: Daily Column Tagged With: , , , ,

Clicking knees drive patient crazy

March 31, 2011 By

DEAR DR. GOTT: One year after having had both knees replaced, any pain I previously had is gone. Problem solved? No. A few weeks (after surgery) that turned into months, and now one year later, my knees (both) still click with every step I take. There is no pain involved, just annoyance. At times, it feels as if my new knees are rattling around in there. My wife and I enjoy walking in our development, but it is driving me nuts. I asked my doctor about it, and his comment is that all patients’ knees click to some extent. My question to you is, how can I eliminate or at least reduce this annoying problem?

DEAR READER: While I don’t have a ball or X-ray vision, my first guess is that you are likely experiencing normal noises. This is because if your knee replacement were tightened too much, you would likely experience lost range of motion and pain. [Read more…]

Filed Under: Daily Column, Leading Letter Tagged With: , ,

Childhood joint pain and fainting in the elderly

February 8, 2011 By

DEAR DR. GOTT: Regarding your past columns about “growing pains,” I had such severe pain in my knees as a young teen that I could barely walk. I was told it was due to a growth spurt and to just learn to live with it. I had no fevers, redness or swelling, but just a few years later was hit with MCTD, including rheumatoid arthritis. I am happy that you told the child’s granny to look for other symptoms, such as fever, etc., but I think the pediatrician should have looked into doing some blood work to rule out other possibilities.

On another topic: For all those elderly people out there who have “fainting fits,” the “woozies” or the “spins,” drink a couple of glasses of water. My dad used to conk out for no apparent reason, and it usually turned out that he did not consume enough fluids and overused laxatives. [Read more…]

Filed Under: Daily Column, Leading Letter Tagged With: , , , , , ,

Bow legs no laughing matter

August 1, 2010 By

DEAR DR. GOTT: I really enjoy reading your column and hope you can help me deal with a problem. Ten years ago I went to Mayo Clinic with health problems. The rheumatologist was not helpful, nor did she tell me what was wrong with me. She only laughed at me, telling me how bow legged I was. I was so shocked and hurt that I could barely drive myself home.

Last year I went to a different rheumatologist in a different state because of knee pain no one could explain. Again, the doctor did the same thing. I was so shocked I could barely talk. I walked out of his office after he left me feeling angry. [Read more…]

Filed Under: Daily Column, Leading Letter Tagged With: , ,

Octogenarian wants to dance again

July 16, 2010 By

DEAR DR. GOTT: I am an active 80-year-old female in good health. I’m writing about an injury to my left knee that occurred in December 2007 while dancing. In the same month, I fell down while bowling, injuring both my knee and back. The doctors diagnosed me with spinal stenosis and damaged cartilage of the knee.

I’ve since had chiropractic treatments and massage therapy but am unable to continue due to financial difficulties. I saw an orthopedic surgeon but to my dismay, he didn’t refer me for any treatment. Instead, he administered a cortisone shot and asked that I return for a follow-up visit in three months. Follow-up visits were disappointing as he did not even try to refer me for therapy or anything beneficial to my injury.
[Read more…]

Filed Under: Daily Column, Leading Letter Tagged With: , , , , ,

Daily Column

August 7, 2008 By

DEAR DR. GOTT:
I had been bothered with knee pain for two weeks. While I know that’s not a long time for some people, I’d never had the problem before, so two weeks felt like an eternity. I thought I might have arthritis or simply wrenched my knee without remembering it.

Because I really don’t like taking any drugs, a friend gave me cooling Castiva to rub on the knee. I tried it and the pain disappeared a short while later. After only one treatment the pain was gone. I don’t know if all topical salves work in the same manner, but I had to share my experience with you so others might be helped.

DEAR READER:
While all products don’t work for all people, I’m glad you had favorable results with Castiva. Many of my readers have tried it and found it be beneficial. Like you, many of them also did not like taking medication. [Read more…]

Filed Under: Daily Column Tagged With: ,