Healing time: pay attention to your surgeon—but not too much
Recently I was talking to a friend who’d had shoulder surgery six months ago. When I asked her how she was doing she replied, “Oh, generally okay, I guess,” without a whole lot of her usual enthusiasm.
Turned out she had just been to her doctor for her six-month followup, and he had pronounced her shoulder to be as good as it was ever going to get. Since she still has a fair amount of pain and limitation—although certainly nowhere near as much as she had pre-surgery—this made her rather gloomy. She’d hoped for a better outcome.
I can’t tell you how many times I’ve heard this story. I’ve experienced it myself, with various injuries and orthopedic surgeries. It’s happened to friends. It used to happen to people I knew online some years ago in a support group I joined after I sustained an unusual arm injury.
It goes like this: the doctor, or the literature, says that after a certain surgery the patient will have completed all the healing he/she will ever experience by (fill in the blank) months afterwards. I’ve found, over and over, that very often it’s just not true. People can continue to improve for quite a bit longer, even for years in many instances.
In my own case, I had a complex nerve transposition surgery in my right elbow, after an injury that had given me chronic pain and disability for nine years. I’d engaged what seemed to be the best and most experienced surgeons to perform the operation. Before the surgery they told me upfront that it was a risky procedure and that I might even end up worse off than before. They told me that the normal healing time was six months to a year. They told me I should regain full range of motion a month or two after surgery.
They told me a lot of things. And even though they were kindly men and skilled surgeons as well, much of what they told me was just plain wrong.
Initially post-surgery I was very bad, with severe pain and restriction of movement. I was in constant fairly severe pain and unable to use that arm at all. The elbow was essentially frozen.
This stage lasted much longer than anyone had expected, and stumped a number of physical therapists, who proceeded to give up on me after haranguing me. This demoralizing situation continued for months until I found a more creative physical therapist who changed the program and gave me some different exercises from the ones all the others had been pushing, and within a day or two of beginning the new regime that elbow started moving.
After a year I was told this would probably be as much healing as I would ever experience. Oh, maybe there might be a miniscule bit more for the next six more months, but that would be it. I decided that at least the surgery hadn’t made me worse. It had been a gamble that hadn’t paid off, but the result wasn’t horrific, and I never regretted giving it a try.
But the healing continued. It was significant, and it went on for longer than six months.
After two years I felt I had experienced at least a 25% improvement, maybe even more. I’d take it.
After three years that percentage had increased to 50%. I was very happy about it.
And I’m not so sure my arm didn’t continue to improve for several years afterwards. At that point it was harder to tell, since the surgery had happened enough time earlier that I no longer remembered as many details of what it had felt like beforehand. Mercifully so, I might add; I never never never want to go there again, if I can possibly help it.
My experience may be a bit extreme. But from the evidence I’ve gained from talking to friends online and off, I’d say it’s rather typical of the general trend.
So this post is a sort of pep talk, in case you and/or someone you love have been discouraged by a doctor or physical therapist who’s told you that there’s a time limit to how long a person can improve, and that you’ve reached it. Don’t believe them.
Oh Neo, how funny that I just now finished a posting on my blog about the constant pain in which I have found myself since breaking my leg 18 months ago. My surgeon told me the same thing, that I would be about as good as I would get at the one-year mark.
Well, this week I suddenly found the pain is almost, but not quite, gone. I feel like it is a little miracle, one that I had given up hope on because of the prevailing wisdom. I almost don’t know what to do without the pain!
You’re right, this does seem to be reality, rather than the outcomes that are often predicted by the medical people.
It seemed to me that the surgeon always gave the gloomiest scenario and the PT’s give you the rosy one. Reality is somewhere in the middle.
Damn good article, and exactly right. Nicely done.
neo,
Boy do I have a story for you. But first let me preface my anecdote with some words of wisdom. Doctors, surgeons, and therapists are not all-knowing. These extremely bright people do work very hard and try to keep up with everything that’s happening in their fields. I know, since I am married to an occupational therapist who works in a practice that is fed by a number of surgeons. She specializes in hand, wrist, elbow, and shoulder injuries. Anyway, the surgeons in the practice all range in experience and ability. The worst are not that bad at all, and are learning. The best ones I’ve been blessed to benefit from their expertise. I have a THICK chart at both the surgeons’ office and the rehab facility where my wife works.
But let me move on… In early 1998 I was diagnosed with osteoarthritis of my left hip. Turns out I had a slight deformation in that joint when I was born. Over the years of playing ice hockey and other physical demands like working construction when I was in college. I was told I might have five years before needing surgery. Well, the deterioration in the joint proceeded more quickly. By 2000 I was in considerable pain that medication would not alleviate very much. I was using a cane. My first option was to see if I could get into an FDA study program out at UCLA Medical under the surgeon Dr. Amstutz. Instead of severing the head of the femur and then inserting an artificial device, his procedure involved not severing any bone. Surgically, the joint would be dislocated and the bone cleaned and smoothed. Then a steel stem cap would be inserted over the head of the femur and then inserted into a steel acetabulum. The advantages are considerable and this procedure is now becoming more and more used as surgeons are trained in how to do it. But the FDA closed down the program before my turn was to be realized, and I had to go to a Plan B. The problem is that I am young, and at the time I was 45 years old. I needed materials that would not wear out after 10-12 years. My Plan B was a Dr. Harris at MGH in Boston. He came up with a new cross-linked polyethene liner. A plastic that had the free radicals taken out of it by a laser beam. Naturally, the femoral head had to be cut out, the artificial femur inserted, but the plastic liner in the acetabular end would last perhaps 30 or more years.
The surgery went well, but afterwards the young fellow who did the surgery with Dr. Harris noticed that my left foot was not flexing or had any sensation. For whatever reason, I had suffered a c,omplication from the surgery called peroneal nerve palsy. So, a couple of days later the young Fellow was on his rounds and checked in on me. He asked me to really put my mind to it and see if I could move my foot or big toe. He put his fingers there in order to sense if anything was happening. Well, he sensed movement in my tendons and said this was a good sign. Not a guarantee that I would get it all back, but a hopeful sign.
The literature on peroneal nerve palsy from hip arthroplasty is out there and I’ve read everything there is to obtain. The prognostication: what you get back after 18 months is all you are going to get.
I’m a walking contradiction to the prognosis. It has been very slow and painful. I have to take medication to alter the dysfunctional signals between the brain and the peripheral nerves (a medication that epileptics take). However, here I am, nine years later and I almost have it all back. I can flex my foot and my sensation is getting better and better. I am still on the medication, however. Low pressure systems and storms seem to make the neuropathic pain worse, and it is at its worst at night time when I am trying to relax and sleep. Every now and then I will have a night when it just won’t calm down. It’s the main reason why my wife and I now sleep in separate bedrooms.
Back in 2006 I had the other hip done, this time by a local surgeon at a local hospital in Rochester. The surgeon was a Dr. Harrington, who works in the practice that feeds patients into the clinic where my wife works. I was very nervous before this surgery, because I feared the same thing happening to the other side. So, after I was moved to post-op and had started to come out of the anesthetic (and epidural block plus something to relax me – I slept through that surgery) I was constantly trying to flex my right foot to see if everything worked. I was overjoyed that I could flex that foot.
Crazy shit happens in surgery that is beyond the control of the surgeon. And outcomes can be surprising. My left side peroneal nerve network has been healing far beyond what the medical professionals think possible. And in view of how painful that process is, perhaps it is a good thing that it did not heal a lot faster. The pain would be a lot worse. So, I guess nature and God are wise. Now, when my wife tries to see how I can hold my flex of that foot under her attempts to pull it down, she can’t pull the foot down. The neurologist I see is just amazed every year I see him for tests.
I am not surprised by the stories you related, neo. My wife is always telling me about amazing stuff she sees with her patients.
About ten years ago I had an impingement in my left shoulder repaired. Post surgery and therapy I had regained most of my range of motion but still had a fair amount of soreness in the shoulder. The surgeon explained that it might improve, but I might always experience some pain.
To make a long story short, I bought a new home about two years later that had only primer on the inside walls and I had to paint the whole thing. Using a roller with a long handle was painful at first, but I kept going. By the time I finished painting the pain was gone and has never returned. The shoulder feels like nothing ever happened.
I knoweth that of which thou doest speak. About three years ago I sustained a severe injury to my right wrist which resulted in limited use and almost constant severe pain. At first I was sent to physical therapy, but I told the therapist I could not do what she wanted me to do because of the pain I experienced “here” and “here,” pointing to spots on my wrist. She informed me that I could not be having pain “there” and “there” because such pain was inconsistent with what the x-rays had shown. After enough squawking to my doctor, and an ongoing refusual to do any physical therapy on my part, the doctor ordered an MRI, which disclosed that there was much more damage than what was shown in the x-rays and that I was correct in describing the pain I had, which was consistent with the MRI. I was then referred to a surgeon who recommended surgery. The purpose of the surgery was, he said, to eliminate or reduce the pain. He was clear that it would not be restorative in that with my type of injury, full restoration of the wrist to its pre-injury condition was not possible. When I asked if the surgery would really eliminate or reduce the pain, his response was “We certainly hope so,” but admitted that it might also have no effect. In addition, after the surgery my wrist would be essentially “frozen” even if the pain was eliminated, which was a “chancey” proposition. I turned down the surgery. Over time the pain has considerably lessened and I still have the use of my wrist. It hurts mosty “when the weather changes” and I will never be able to play tennis. (Of course, I never did anyway, so no great loss) My point in this long trip through my medical history is that patients need information before any medical procedure, and, if it is not given seek it. Be a pain in the ass if you have to. And, patients need to remember that doctors, contrary to the belief of many in the profession, are not God. Get the information you need and then use your own good judgment before submitting to any medical procedure. Hope your arm keeps getting better and better, neo-neocon.
My daughter is a case manager nurse (not the correct title I know, but descriptive) for a high profile oncology surgeon. She loves him but he drives her to distraction and she threatened to quit many times. The reason; his case load and teaching load and this load and that load leaves no time for communication. She is supposed to communicate with the patients but has to fight like hell to get a few minutes of his time each week to get information for them. She is frustrated, the patients are frustrated, but it is hard to achieve change. He is trying. Part of it is the ridiculous case load that many surgeons carry. Another part is the personality of many surgeons. Their focus is intense, but if they don’t have a knife in their hand they can be fairly dysfunctional.
I had a terrible time with back pain in my early 40’s. I for one am glad i didn’t listen to quite a few doctors who said i should have surgery.
Its been 5 years since i’ve had any problems at all (knock on wood). I attribute it all to a little dog i acquired about that time that demands she and I take a 2 mile walk every day.
“How a New Office Chair Led to Six Cortisone Shots, Two Surgeries and One Enduring Medical Misadventure”
She cites 10 lessons, one of which is schedule surgery early in the day, when staff is fresh and delays are not an issue:
http://www.washingtonpost.com/wp-dyn/content/article/2005/10/07/AR2005100702281.html
Neo,
As you know, I’m a physician. Before specializing in psychiatry, I worked as a family physician. I’ve worked in every conceivable medical setting, from the Navajo Indian reservation, to mountains of western Mexico, to county hospitals, to private practice, to multi-specialty group practice, to academia. My practice for many years has been consulting to internists, surgeons (including orthopedists), neurologists, and other specialists.
I have a deep and abiding respect for my colleagues. Nonetheless, I would heartily endorse what you have said.
No physician, no matter how skilled or experienced, can make a reliable and accurate prediction of how his or her individual patient is going to do in the long run.
When I was a medical student, the dogma was that the mature human central nervous system (spinal cord and brain) could not “make” new neurons. Some years later, we discovered this was not true for birds. Now we know it is not true for primates, like H. sapiens, us.
Jamie Irons
Golly, this thread sounds like a homeowners association meeting here at the”active adult” community where I live. Lots of tales of surgeries, rehabs, which doctors to uvoid, newest medications, and which supplements will cure what ailments.
At 76, I’ve got a few tales to tell, but will heed my wife’s advice, which is, “Nobody cares about how much pain you endured when you cured your torn rotator cuff.”
One thing I will say is that Drs. are just like the rest of us, doing the best they can with what they have to work with. It’s a tough business and not really a science. I guess that’s why they call it practicing medicine. God bless ’em for all the good they do in the world. And thank goodness the human body often defies the conventional wisdom about healing.
I wish I could be as optimistic. I had surgery to remove a benign tumor from my pituitary gland that has been problematic for many years. Acromegaly, numerous other conditions caused by this. The neurosurgeon told me to expect incredible changes and a recovery that would remove years from my physical condition. For two weeks I felt 25 again. Then it returned with a vengeance. It was only after that he told me there is a 30% failure rate in the surgery. And of course, guess who falls in that 30 percentile. I have plenty I could whine about. Anybody got any cheese?
How’s this for an unexpected recovery?…
My sister has been battling liver cancer for a year and a half. A month ago, they told her it has metastasized to her bones and peritoneum. Three weeks ago, they started her on a new type of chemo. Two days later, Saturday morning, she started hemorrhaging violently. She crawled to the phone and called her ex, who raced over, saw the place looked like a slaughterhouse, and called 911. It was so bad that the EMTs thought it was a crime scene.
She went to the best hospital in town, where they just barely managed to save her from bleeding to death; but the GI tract was perforated, and her liver collapsed. She went into a profound hepatic coma on Day 2. Her life was despaired of (I had raced down there from New York, being told it was my last chance to see her alive).
The doctors said she was in an irreversible coma, that the ammonia levels in her blood were so high that her higher brain functions were destroyed, and that it was a matter of hours before she died. So we transferred her to a hospice. She had been completely nonresponsive for over 48 hours, and was just a body in the bed. Pupils blown. On oxygen. Breathing, but that’s all.
In the hospice, a day passed; no change. But on the third day, she opened her eyes (which still looked mighty strange). And on the fourth day, SHE WOKE UP. And STARTED TALKING. LUCIDLY. We had all our churches (and hers) praying for her, plus a friend’s synagogue. We’d stood over her bed and laid hands on her and asked Jesus to heal her. Now she’s talking and emailing and eating chicken and making all kinds of sense, and the doctors are so freaked out they don’t want to come and see her.
She said to us, “I just want to report back to you that I heard all of you while I was in the coma. I had conversations with you, and with people who weren’t physically present.” [she and our mother communicated over a distance of 175 miles: our mom has pancreatic cancer and is in the hospital too, if you can believe it]. She continued: “I want to tell you all that whenever we leave this planet, it’s ok because we’re not really going anywhere. And we’re all one. And everything they tell you about God and Jesus is true.”
Wow.
So, BLUE CROSS gets wind of this amazing resurrection (after Ash Wednesday, no less), and one of their goons called my sister IN THE HOSPICE to BADGER her, telling her that they weren’t going to pay for any of her hospice stay – on the grounds that she hadn’t needed it in the first place!!!!
…Now, those docs at the MICU were positive that this was It, that she wouldn’t even last another day, and that her frontal cortex was destroyed. We don’t know what happens from here, but part of the moral of the story is that humans can be amazingly resilient, and that love and prayers do help.
The other part of the moral is that insurance companies are hell-fiends.
PS: If I were one of her docs, I would want to see this patient just so I could figure out what happened. It’s been truly extraordinary. You’d think they’d at least be curious.
br549: You may already be aware of the information here, but take a look anyway, especially the later parts about what to do if your pituitary surgery doesn’t work.
I’m not saying this is the case with your surgeon—but sometimes surgeons are mostly concerned with their role, which is to perform the surgery. If they do that and it doesn’t work out well, they sometimes don’t even think to refer you to other options. According to the site I linked there may be a number of medical options still available for your treatment.
As I said, perhaps you already know all this. But I just thought I’d put up the link just in case.
Jimmy J. wrote:
One thing I will say is that [doctors] are just like the rest of us, doing the best they can with what they have to work with. It’s a tough business and not really a science…
I thank Jimmy for his generous praise of doctors, and I think he is exactly right that medicine “is not really a science.”
It’s not. Scientific knowledge informs medicine.
But it informs medicine somewhat in the way that the science of mechanics (that branch of physics that deals with Newton’s laws) informs baseball.
Jamie Irons
im in the office chair story now… third year.. constant pain… makes one contemplate things just to get a break from it. but its finally going away…. slowly… once i figured out how it all went south… now i have changed how i behave and such…
but before this, i had zero problems, no colds, seldom a doctor, etc..
now i am aging fast in a family in which everyone averages in the late 90s on both sides…(and now my wife too).
what can i do? nothing i guess… but if it werent for this, i could idyllically grow old…
Greetings:
Over 50? Double healing times.
My poor wife has had several surgeries (two breast cancer, two rotator cuff, two knee replacements, and a spinal fusion).
There seems to be two keys.
Make them let you control the morphine and other strong drugs right from the recovery room, and use as little of it as you possibly can. Ditto other strong drugs. Varies person to person. With my wife any post-op morphine lengthens the hospital stay about three days–she has to wait until they stop forcing it on her to begin recovery. Last several we have succeeded in getting the doctors to insist the nursing staff let her say no.
Physical therapy will help. If physical therapy is not helping, get a new physical therapist.
It won’t be easy and it will get worse before it gets better.
But it will get better.
Jamie Irons,
I want you to know that in no way do I blame the surgeons for the complication from my left hip arthroplasty. I believe they were very, very careful in their positioning of my leg during the surgery. If they had stretched the nerve branch up there in the hip and lower back area, or transected the nerve, I would never have the recovery I have been experiencing. I read reams of articles about how and why one can get peroneal nerve palsy, and I think I found two possible reasons.
One, after the surgery the swelling up around the area of the hip and gluteal area can be worse than normal. The Fellow who worked with Dr. Harris, a really good guy, was very concerned about swelling when I was in the post-op area and was trying to get as much swelling control as possible. It may have been too late at that point. He may have been on to something. I tend to have strong swelling response to injury anyway – I’ve noticed this and I remember it going back to my childhood.
The other possibility, which I read about, is blood pooling in the area around the piriformis. If too much blood pools there, it can also put pressure on the place where the peroneal network is when the sciatic nerve branches out from the spinal network.
A year after the surgery I was having a discussion with the neurologist I see for diagnosis and treatment (he administered an electric test to see where exactly the insult to the nerve occurred). I asked him: “If the peroneal nerve starts just above the knee, and the actual location of the injury was deep inside the hip area, why the discrepancy?” He told me that my question was the most intelligent question any patient and even doctors he’s known has ever asked him. He explained that one has to think of it in terms of a network in a fiber optic cable. The network for the peroneal nerve is right up there as the sciatic nerve branches out of the spine. And that the peroneal nerve network is in a very vulnerable location for this kind of surgery.
So, I was just very, very unlucky. But I never gave up and never lost faith. The very day after surgery, as I was in my room and bed at Mass. General Hospital, while everyone in my family, especially my wife, were just fighting to deal with my outcome, I told everyone that I was going to get it back. I was going to work at it. I was going to battle. I never would lose faith. It has been a very long, painful road. People generally go not know what neuropathic pain is like. I explain it by telling them: ever impinged a nerve such that you lose sensation, and then as sensation returns you get burning and tingling? That’s what it’s like. And more – cramping, cold sensations, strange experiences of pressure at points along the route of the healing. Fortunately, I have two qualities about me that have helped me cope with it. I am a patient person and I know how to stay calm. The other – since I used to play hockey – is that I have a high threshold for pain. And I will say that sometimes I have experienced depression during this journey. I have not been pain free since 1998. That’s a long time. But, you do what you have to do in order to function and be able to enjoy life too.
Having a positive attitude really does go a long way.
FredHjr,
I also have nerve pain — mine is in my legs, mostly in my right leg.
It seems to be due from my spinal issues.
I’ve a couple of dessicated discs, as well as 2 more bulging discs (one of them with a slight tear).
The pins and needles, cramping and the cold sensations pretty much describe me. Sometimes my leg just aches – really bad, usually on the inside of my right calf. I also feel it when a storm’s coming in.
I had a bad reaction when my neurologist had me try an anti-epileptic — I’m glad you’ve found some relief.
Uh-Huh,
I wish you had had a better experience with the anti-epileptic meds. I was on neurontin, which later became the generic gabapentin. For the past year I’ve been trying out Lyrica, and so far I think Neurontin/Gabapentin did a better job. So when I see the neurologist in June I’m going to ask him if we can go back to Gabapentin.
The thing about these drugs is that it takes an edge off of my intellectual functioning. I’m not as quick and my memory is just a tad degraded, but you learn strategies to deal with it. One thing that does help to keep one sharp: exercise. I go to the gym several times a week and do weight training and then some time on the elliptical machine (it’s low impact).
But I cannot imagine what you must go through if you can’t take those medicines. We know what it’s like. Wish there was something I could do to help fellow sufferers like you.
As for back problems, I forgot to mention that I have an L-5 spondylolisthesis, which was also diagnosed back in early ’98 when I went to the orthopaedic doctor. And I found out quite by accident that I had it. I had suffered a wicked hit during a hockey game in an adult rec league. I was chasing down a puck and two other players quite accidentally sandwiched me between them. I had a hard time getting back to the bench and felt as if my kidneys had been blasted into space. Many weeks later I woke one morning and my back was so stiff and painful I could not even get out of bed. Saw the doc days later and got a referral to the orthopaedic guys where my wife works. Saw the x-rays and I asked him if a hit I took playing hockey could have done it. He said no he didn’t think so. It was something that had been eroding for some time and that the hit I took didn’t help matters, but that if I managed it long term with a regimen of particular stretches I may never need surgery. It flares up every so often, and I have to take anti-inflams and flexeril (for the muscle spasming – I hate the stuff because it zonks me out for a long time).
I’m hoping you can get some good care for your back.
Beverly, that’s a fantastic story! Thanks for sharing it.
Have you ever read any of Dr. Bernie Siegel’s books? He’s an oncologist who has witnessed several miraculous recoveries from cancer. His book, “LOVE, MEDICINE AND MIRACLES,” is a compilation of such cases and how he sees faith and the human spirit at work to perform these miracles. He might be interested in your sister’s case. His web site is: http://www.berniesiegelmd.com/bernie_siegel.htm
Beverly’s story is instructive to all of us: never underestimate the power of hope, faith, and love.
The stupid insurance company should have listened to and respected the observations of the doctors. My experience of many doctors – and because of my wife’s profession I’ve come to know quite a few – is that a lot of them are actually very respectful now of spiritual things. And are humble enough to say that they don’t know or understand everything. That’s a good sign.
How many lawyers do you guys know who have that kind of humility? LOL! I thought so…
I injured my knees in a karate class when I was 28, had surgery on the right knee, and lived with significant chronic pain, limits, and eventually arthritis ever since. Am now pressing 62, and with a somewhat recent significant increase in simple (recumbant) bicycling exercise, which for years I was told by several specialists to particularly avoid, am finding the chronic pain and problems significantly improved. A brilliant young orthopedic specialist recently gave me the almost opposite advice for my long ongoing therapy regimen, and what a difference it’s made, after all these years…
Thank you for the information neo. It is a good read. Chemo and radiation are my options at this time.
Beverly, your sister is a walking miracle. Most incredible.
I am also dealing with melanoma and lung cancer. So I have recently wondered if I may be leaning a little on the miracle side myself. Especially when taking into consideration that I still possess my rugged good looks, boyish charm, and naturally curly hair.
good advice larry,
my problem is i am a red head and i have a huge natural tolerance to op eee ates [post problems]… (had oral surgery and the doc informed me that after giving me the highest legal dosage, i was still just sitting and shooting the breeze… it took the other meds to put me out).
red heads have a problem with anesthesia as well, they need more of it. (as much as 20 percent more).
i like to romantically think that i comes from my berserker Viking heritage…
Red heads are walking proof that appearances do signify significant genetic benefits/curses…
http://www.nytimes.com/2005/12/11/magazine/11ideas_section3-22.html?_r=1
So, earlier this year, Mogil ran some mice through a battery of pain tests, using mice with the red-hair gene as his test group. (A collaborator in the Netherlands ran the same study with humans, giving them electrical shocks to the leg.) When animals and humans experience pain, their brains release natural op eee ates similar to morphine. In most cases, however, the MC1R gene produces a protein that interferes with the efficacy of those substances as well as of artificial painkillers. What Mogil found is that the variant of MC1R that causes red hair also appears to allow these op eee ates to work unimpeded. As a result, redheads can withstand up to 25 percent more pain than their blond and brunet peers do before saying “stop.”
In truth analgesics don’t work for me… or rather my own pain tolerance is beyond the level they work at… so if i feel it, they don’t do anything.
Redheads Need More Anesthesia!
http://www.medscape .com/viewarticle/487261
The researchers determined that roughly 20 percent more anesthetic was required, on average, for the redheads compared with the women of other hair color — a finding that was highly statistically significant
The clinical implications of a 20 percent difference in anesthetic requirements may be minimal in terms of the conduct of most anesthetics delivered for typical surgical procedures. However, the broader implication of this finding is that different genotypes and phenotypes can and do manifest different responses to common drugs. We have all heard people who say, “the dentist always has to inject me 3 times before I get numb” or “Tylenol just doesn’t seem to work for me” or similar comments. Perhaps there are indeed genetic explanations for these observations. The concept of “pharmaco genetics” is an emerging field, and many drugs are now known to manifest altered responses in genotypically different subjects. This important topic has many clinical implications that will be revealed as investigators continue these lines of investigation.
[i hate the checker on this system]
When we look at people and we see features, we may also be seeing genetic qualities. this is why the problem with the left is that they hitch their horses to the information being a certain way to force reality rather than just the plain fact that regardless of that particular fact or way, its not the information that causes the end result, but the choice to look at it a certain way over another way and refusing to see it another way that is just as valid.
Such things have big implications to the concept that we are all equal and looks don’t matter. Not to mention the big point it makes not only as to features not being arbitrary, but that in combination they make us individuals. Yes red heads have this, and if you want to look at us as a class, you can judge some genetic qualities in us. But there are African red heads. and Caucasian red heads too…and many silently carrying the genes. So a class doesn’t really fit other than if you want to say we are a genetic class, the class of MC1R.
But does having this ‘benefit’ or sickle cell benefit/curse mean that we or anyone should be treated as members of classes, or groups, or as each individual? For if this is really how it is, how could any of us belong to only one of them?
I hope I made my point that the facts cant be stopped cause reality will not bend to will, and will outlive everything.
[i hate the filter]
A potential god if you will – it may be as simple as that. God is reality, and god is everywhere cause everywhere is god, and the more our culture and ways reflect reality and its rules, the more successful we are, and the more it appears that the heavens bless us. The rest is just clothing this truth in distracting trappings that frame the thing a certain way, and then often push one down alternatives which do not reflect reality. It could be why when we focus on god, we are better caretakers of the earth than when we don’t, for when we don’t, we are saying we are turning our face from reality in abstraction, and so things fail, as if we are cursed. Nothing seems to work right. (And then persecution of the competent happens easily)
So the thing in the brain you need to have religion like we have language, may only be a desire to worship reality and what it tells you and what information it gives you over all other things in an abstract form which can merge this with ethics and other things that reality does not inform on. And then you too will be successful and mana of bounty will appear to magically appear. (our language skills are in born, but what form it actually takes, is not as important as the base that is in all of them that our brains work on. They sound so different, but in truth they all follow a few variations of rules and types in form and structure)
Christianity was the first religion to actually contemplate looking and studying reality to get to know. The many faceted thing (religion) was turned right so that the distractions weren’t blocking a clear line to bounty, and all this technology and understanding was then unlocked…
apologies for the digression…
I’m staying away from surgery for my knees. My ligaments there are stretched and lax which causes my knees to pop and give way but I’ll try ANYTHING ELSE before trusting a doc on that joint. So I turned to prolotherapy with mixed success. I would recommend it for anyone with back pain though. It reduced the pain, if not the curvature, of my spine.
Thanks Hong, your knee symptoms are very similar to mine, no doubt related; Never heard of prolotherapy, googled it just now, interesting, will check it out…
Neo- perhaps slightly off-topic, but be so kind as to explain how your nerve-transposition surgery could cause a frozen elbow. Some anatomical detail will be enlightening. Otherwise, I struggle to see the connection.
That docs, physical therapists, etc. are off the mark with time predictions doesn’t surprise me. Predicting the future seems chancy in general.
Having been banged up and in pain for about 20 years (can it really have been that long?), I think it boils down to two things:
Physical medicine and the human body can perform miracles, and
Never, never, never give up.
Stories such as the ones I read above, and difficult psychological cases, are the practical reason I’m afraid of ObamaCare.
“Healing” unfortunately means different things to different people. I’m not an orthopedist (internist), but I believe they tend to think of bones and ligaments “healing” in about 6-8 weeks as the time that collagen is replaced where they cut or the bone broke. Collagen back in place by the body is their typical idea of “healed.” To the patient, function is what they mean by “healing” and often with shoulders and other joints, and to some extent other parts of bones, that takes longer.
I had a middle-aged man in my office ten days ago that remarked that his shoulder physical therapy had taken 6 months and wasn’t quite over yet, but it had the marvelous effect of improving the rotation of his neck–it was much better, too. So this past week when another patient had great trouble with his neck again, I called patient 1 to get the name and telephone number of his physical therapist.
Like lots of things today, some people get interested in some particular area and become very good at it. In this case neither had surgery and they would hope to have a “healed” neck that WORKED better and caused little if any pain.
Tell me, what does all this have to do with Obama?
I’ve never injured myself severely enough to need surgery (thankfully) but DocJim’s point makes me think of my one major brush with this sort of thing- I snapped the same lateral ligament in my right ankle two years in a row. For years that ankle was weaker and far more prone to “rolling” and reinjuring to whatever degree. It was “healed” in the sense that the collagen did all the replacing it was going to do with no other prompting. Ankle sprains were a perennial problem for me.
Some four or five years later, I took up free weights, with plenty of heavy compound movements. (Screw “isolation” and screw “toning”.) Now the ankle is scarcely noticeable as weaker than the other- the resistance and the stabilization that my joints needed to provide signaled the connective tissue to strengthen, as well as the muscle and bone. I haven’t sprained that ankle again since I started- it’s still a little more prone to let my foot roll, but only far enough to give me a few minutes of profanity, not put me out of commission for a week or more.
So, yes. More than one way to “heal”.
What makes healing prognosis especially difficult is a fact of which few are aware of: we, humans, are very diverse, much more than any wild animal species. This is a specific feature of Homo sapience, and nobody knows why it is so. I mean not genetic diversity, but phenotypic response to it. Humans have not a standard phenotype, unlike all other animal species. Their individual development is quite unstable, so averages actually do not tell us much about individual outcomes.
I guess my comment from yesterday is caught in the spam filter.
One of the biggest cases of academic fraud in medical history
One of the largest known cases of academic fraud and misconduct made the news this week when Anesthesiology News reported that a leading medical researcher was found to have fabricated much, if not all, of the data in his research.
Scott S. Reuben, M.D., of Baystate Medical Center in Springfield, Massachusetts, is said to have made up and falsified data in at least 21, and perhaps many more, studies published at least since 1996, according to the results of a year-long investigation by Baystate Medical Center. Jane Albert, a spokeswoman for Baystate, said that the fraud was spotted after questions were raised about two studies for which Dr. Reuben had not even received approval to conduct human research….
…Dr. Reuben not only worked for a respected academic medical center and was a leading pioneer in his field, his research has provided the support for several clinical practice standards, Anesthesiology News reported. He is well-known among anesthesiology researchers for his studies of multimodal analgesia, the practice of combining several forms of pain relief to better control postoperative discomfort and promote faster recovery from surgery.
Dr. Reuben was one of the most prolific researchers in postoperative pain management and published extensively. A recent PubMed search turned up 72 citations authored by him, according to Anesthesiology News, the most recent was an article in the December issue of the Journal of Cardiothoracic and Vascular Anesthesia on preventing the development of chronic pain after thoracic surgery….
Seemed pertinent to your discussion here.
A hunter friend developed a bone spur in his right shoulder. It got increasingly painful and he was sourly contemplating surgery. But a friend showed up with a new, light .375 H&H Magnum that he just had to try out. He let it off, it kicked like an onager, there was a sharp pain, and his shoulder has had no pain and full range of motion ever since.
Demonstrated by a trained professional. Don’t try this at home.
Hi just wanted to give you a quick heads up and let you know a few of the images aren’t loading properly. I’m not sure why but I think its a linking issue. I’ve tried it in two different browsers and both show the same results.
Today is Sunday and I find such a great blog 🙂