Wrist Tendonitis Problem, Grad Student, Levaquin may be involved

by Tina


I'm 24 and at the end of July noticed pain in my right wrist/arm as I was packing to move from CA to GA.

I wore a wrist brace and took Advil but the problem escalated so have been to an orthopedic and physical therapist here in GA and so far my condition is not improving and has become worse with typing.

I had an EMG test which revealed no nerve damage but "some hypersensitivity over superficial radial nerve."

The orthopedic ordered the test thinking it would show carpal tunnel.

He hasn't discussed the results with me yet, but I'm assuming it's Tendonitis.

Some contributing factors may be that I was on Levaquin 750mg for 10 days in January 2009 for a horrible strep sinus infection during which time I did feel joint pain.

In March a blood test revealed I had a Vit D deficiency. I also lost weight when sick, but now my general health seems much better and my weight is 110 and I'm 5'5".

Currently my right wrist feels like it's constantly flexed and feels very clenched when I type, drive, cook, etc. For the past few weeks, I've had someone helping me so I don't drive, cook, clean, etc in hopes that rest will help my hand.

I've been deep icing for the past week and it has helped my left wrist which was also hurting but not nearly to the extent as my right wrist. My right wrist isn't responding to the deep icing so now I'm wondering what I should do next. Do I continue the deep icing for another week or is 7 days some kind of limit?

I ordered the DVD for carpal tunnel which I have not received yet, but should I do some of the exercises that it will mention? I really need to type papers for my grad classes and am wondering if I am doing permanent damage to my wrist(s)?

Any words of advice would be greatly appreciated since I feel like I cannot function on a daily basis without someone here helping me constantly.

Sincerely,
Tina



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Joshua Answers:


Hi Tina. Thanks for all the details.

I certainly do have some thoughts and advice, and I need some more information, I still don't have a clear enough picture.

1. What was your activity level with your hands before packing? Lots of typing, sports, etc? I imagine that your wrists were ready to hurt and packing sent them over the edge.

2. Did you have any numbness or tingling, is that why the doctor did an EMG? Or were they just testing due to pain?

3. Do you know your Vitamin D level from the test? How low were you? Are your levels now up in the normal range? (If not, we need to get you up, pronto)

4. Please describe, in more detail, your pain and symptoms. How when where why how long how often etc. How bad is it that you have someone helping you so much?

5. When you had joint pain from Levaquin, did your wrists hurt? Describe those pain symptoms more, how long it lasted, etc.

6. No you're not doing permanent damage. Well, let me say that another way. If you don't do the right things to reverse the problem, it will technicaly be permanent, but unless it's Levaquin tendon damage, it can be reversed. If it is Levaquin related, that may or may not be a different story.

7. By deep icing I assume you mean ice dipping.
What do you mean it's not responding? Say more about that. And, how exactly and how much are you icing? That's important for me to know.


Let me know, and lets start getting your pain levels down.



Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Oct 07, 2009
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starstarstarstarstar 		PART 2 - the follow-up information you requested - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I'll try to keep this short even though there are 7 questions to address. Thank you for being so thorough.

1. From 2004 to 2008 as an undergrad, I did lots of typing and took lots of hand written class notes with no wrist problems. In June 2008 after typing my last 20 page paper, I did notice my wrists being tired and tense but it went away the next day. I also played trombone during those years and prior. After graduating, I took a year off where I did little typing and did not play trombone. I did however join a gym where I started lifting small arm weights (5lbs).

2 & 4. My symptoms are not pain but rather tingling especially when the thumb side of my arm is touched (I think that would be my radial tendon). If I squeeze to make a fist or grasp something, it feels like the muscles right at my wrist are clenched very tightly & even after I relax my hand they still feel clenched. It's hard for me to push down on a squirt bottle not because of weakness, but because there's so much tension & tightness in my right wrist. The same thing happens when I type. I can touch my thumb to each of my fingers but it feels like it takes gargantuan effort, and I can feel my muscles in my wrist staying tight even after the motion has ceased. When one doctor hit just below the base of my right thumb where the thumb joins the wrist, there was an explosion of tingling pain. Writing or holding a pencil tires out the muscles of my wrist quickly & it feels tight & tense & sometimes tingly.

3. I don't know the numbers of the Vitamin D test since the results are in CA, but I've been taking 800 IU of Vit D along with 1,000 mg Calcium with 500 mg Magnesium, and 15 mg Zinc. I have not been retested but am feeling better regarding my overall health. Since my wrist began hurting, I've been taking 100 mg of B6 also. In addition I take a B stress complex, colostrum, juice plus, and egg protein powder. I eat a healthy diet in general.

5. The joint pain after taking Levaquin was in my knees and legs. My feet were very cold every night for months, so cold that this prevented me from sleeping.

7. I did ice dipping with 10 lbs of ice in water. I dipped my whole hand to my elbow for 10 seconds every 10 minutes for 2 hours for 7 days. It helped my left wrist, but my right wrist doesn't feel any different and I'm still experiencing all the symptoms of Q4.

(I have a couple more things so I'll send another post)

Thanks,
Tina
Oct 07, 2009
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starstarstarstarstar 		PART 3 - continued follow-up - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Other info: My doctor now wants me to take Neurontin but he has not given my a diagnosis on my condition. What is your opinion about that?

Initially he had me take Diclofenac 750mg twice a day, but I had a reaction so I stopped after day 2. I sleep with a wrist brace at night.

Should I continue physical therapy where he gives me an ultrasound & anti-inflammatory medicine delivered through the skin? I have not done any exercises for the wrist. I have not tried the ice massage yet. How often per day and for how long should I do the ice massage? Should I continue the ice dipping?

In general, I need to know how much I can use my hands in daily activities such as driving, grocery shopping, cooking, and especially typing.

I'm still waiting for the carpal tunnel DVD to arrive and am looking forward to more information to heal my wrist. Thank you so much for your advice and help.

Tina


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Joshua Comments:

Thanks for all that Tina.

DVD should be there today or tomorrow. Having said that, I really think we're looking at something nutritional with you. I think we need to hit the nutrion hard, and then bring the DVD more into play. Do watch it though.

Potentially, if you saw me in the office, I could work on the tissue and make some change. But if it's a nutritional thing, that wouldn't last.

So.

1. Either call your Doctor and get your Vit D test results, or go get retested. I doubt your levels are up AT ALL if you're taking 800 IU/day. 800 IU/day is an infant's dose. Point being 800 IU/day ain't much.

Some people have to take 50,000 IU's/week for MONTHS before their levels come up at all.

I would up your intake. A LOT. I take 150,000 IU's/month. Sometimes less, sometimes double that. My levels are middle of the good range, 46 last time I checked.


(continued in PART 4)
Oct 08, 2009
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starstarstarstarstar 		PART 4 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

(continued from PART 3)

2. For a week I would experiment with significantly upping your levels and experiment.

Up to 900mg/day of Magnesium if your bowels can handle it. As described on my Kerri's Magnesium Dosage page. Make sure you're using the better magnesium.

Up to a gram of B6. Might as well up the B12 to up to 10 milligrams/10,000 micrograms too.

Specifically methylcobalamin B12. Again info on Kerri's site. Methylcobalimin B12.

Up to two weeks on high dosage b12, if that doesn't help, then that's not the problem. It's a cheap way to find out.

Can't hurt yourself with B6 and B12. Never been a case of somebody hurt by high doses.

If you want, I can make the case for how these deficiencies have nerve pain symptoms. Or you can trust me and save me the typing. :)

I also have a couple more questions.

1. When you touch thumb to fingers, is it tight muscles that stop you, or does it just -feel- like tight muscles stop you.

I mean, if I pressed into your muscles, would they be super tight ans short and such?

Sometimes muscles can feel tight, but it's more of a lack of muscle energy.

Along those lines...

2. If you go up stairs, or lifting weights, etc, how are your energy/strength levels?

(Continued in PART 5)


Oct 08, 2009
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starstarstarstarstar 		PART 5 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

(Continued from Part 4)

Your questions:

Neruontin. I would stay miles away from it, because it has side effects, and because it is not a cure to the problem. I prefer to go after the source of the problem, not just covering up the symptoms.

Plus, if s/he doesn't know what the problem is, what the $*%# is s/he prescribing you potentiall dangerous pharmaceutical drugs for??!?


Physical Therapy. I'm not going to tell you not to. It probably can't really hurt. Doesn't sound like it's helping, though.

Ice Dipping. I would continue it. It can't hurt you, it's helping one side, and more circulation is nothing but good. I don't think it's a key to what you have going on right now, but it is a good good thing.

Ice Massage. Save that. I would focus on nutrition for the next week or two.


So. Heavy upping of the aforementioned nutrients.

If you are severely Vit D deficient, that would be good to know.

How's your Omega 3 fatty acid intake? Fish oils, flax seed oils, etc. Fat in general? Coconut Oil is your friend. Not Omega 3, but incredibly good for you. Not enough good fat could be playing a role.(?)

Keep Ice dipping.

If using your wrists doesn't hurt you, or doesn't hurt you more than ice dipping counters, there's little to no benefit in stopping your activity.

Levaquin may or may not be playing a role. Only time and effort will tell.


This is a lot, and I wish there was a simple answer. Nutrient deficiency is a simple answer, but there's a lot of work/education on the front end.

Ok, enough typing for today!

Keep the questions and updates coming.




Oct 12, 2009
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starstarstarstarstar 		PART 6 - Update on icing and supplements - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I wanted to give you an update since today is the first day that I'm starting to feel a difference (for the better) in my right wrist/hand and my left hand feels almost totally normal. I'm still ice dipping and this is my second day of taking the supplements you advised but I haven't quite reached the highest levels. You didn't suggest any targeted levels for the Omega Fish Oil pills so am taking 2 pills with each meal (each pill 1,000mg).

I've typed 2 papers the past week and am no worse for the wear which is nice. I find writing by hand to be the bigger problem now. To answer your question about strength, I think my overall strength is fine climbing stairs (which I do daily at both my apartment and on campus) and am jogging when weather allows. I took both yoga & pilates as an undergrad and will here too when my wrists heal. As far as when I touch my finger to my thumb, it doesn't feel effortless like it does when I do that with my left hand. At the base of my forearm which joins my wrist I can feel tightness and then the feeling persists after the action is stopped and goes a bit numb for a minute or two. Today when I touch my thumb to my fingers it feels better than a few days ago when I did the same thing in that the sensation is less intense.

I agree with you on your view of taking drugs so I will not be taking the neurontin. I'm also not going to physical therapy since the ice dipping seems to be helping a lot more.

I saw an MSM & Glucosamine spray for tendonitis that says, "A topical formula that contains natural menthol and will not only relieve pain, but dilate the blood vessels. This allows for relief of the tendonitis without causing any stiffening of the tissue." It's an all natural pain reliever plus 14,000 mg of MSM & Glucosamine. Would that be a good thing to use before taking class notes which I write by hand or before typing a long paper?

I seem to have turned a corner and am beginning to notice a difference in my right hand after months of no progress so thank you so much for all of your information!

Tina

--

Joshua Comments:

That's great Tina.

KEEP ICING!

Somebody else on here just reported that they started taking Omega3's and their pain dropped significantly.

Omegas are anti-inflammatory, and, your body needs them to operate properly. For some people, that's the main cause of their pain.

As far as the topical stuff...try it if you like. Who knows.

I wouldn't put much money down on a bet that it will be effective. I could see the menthol distracting the pain some and even bringing blood to the area.

Theoretically, the skin shouldn't absorb that stuff deep enough to matter. Stranger things have happened...

I say, it's all an experiment. If the price is right, try it out. Then you'll know.

Personally, I'd do Bone Broth as the best Tendon Supplement. But like I said, what the hell, give it a try.
Oct 14, 2009
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starstarstarstarstar 		PART 6 - watched the DVD - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I liked your DVD and am wondering if I can do the exercises you suggested in between the ice dippings (I'm still ice dipping daily for 2 hours).

Posture is definitely an issue with me so the second exercise looks like it could be beneficial in many ways. I fractured my left elbow in Sept (hence all the needed ongoing help for so long) but it is healing nicely and I can now straighten it. What effect would Activity 2 exercise have on my elbow?

I am still taking the heavy doses of supplements you suggested. I can handle 800 mg of magnesium, but doses of 8,000 micrograms of B12 & 800mg of B6 seem to make it hard for me to fall asleep at night even though I spread taking them throughout the day. I'm curious after 10 days what dosage you want me to cut back to. I am also cooking bone broth so will give that a try in a day or so.

I would appreciate your thoughts on a couple more things. I had a consultation with the orthopedic since I wanted to know his diagnosis after the EMG test showed everything to be normal. He still thinks that I have carpal tunnel and said that 40% of the time the test doesn't reveal CTS even though it's there.

He also stated that the fact that it is hard for me to describe the sensations I feel points to carpal tunnel instead of tendonitis which has definite pain. He said that carpal tunnel can feel "weird for lack of a better word." He was happy to hear the ice dipping was helping so agreed I should continue, and he didn't push me taking drugs.

He offered a cortisone shot which I declined, and now wants me to see a different physical therapist whom he describes as a "hand specialist." Are there any exercises to be leery of that could cause my wrist(s) a setback? I don't want them stretched the wrong way to compound the problem.

Thank you for your advice. It's been very helpful so far.

Tina
Oct 15, 2009
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starstarstarstarstar 		PART 7 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

Joshua Comments:

Hi Tina.


1. Yes, you can do the activities whenever. The Protocol on there is a beginning recipe. Once you figure it out, you can apply ingredients as necessary/desired.


2. The DH activity shouldn't hurt the elbow. Feel into it as you do it, and make sure. A little stretch/strain isn't bad, but at a certain point....

Ultimately it shouldn't adversely affect it.



3. (My Kerri just said to say that) If you take the high dose of B12 for several days and don't notice a difference in energy levels/benefit, then drop down to 1-2k. If it doesn't help by then, that points to not being significantly deficient, and continued high doses won't help anything.

Did you take the b12 for a day or two, and -then- get stimulated/couldn't sleep? That would point to filling the deficiency up.

It's probably the B12 that is keeping you up. You can take it all in the am, no need to spread it out during the day.

I spread magnesium out, that's more of a spread out one. Try taking that at night, it helps one sleep.


4. Gotta love the docs. So what he is saying is that %40 of the time, the test does not show evidence of Carpal Tunnel even when you do in fact have Carpal Tunnel Syndrome?

So doctors routinely use a test that is %40 inaccurate?? Then how do they even know it's accurate or not. What good is a test that is wrong almost 50% of the time?? How do they know?

If the test is so inaccurate, why is it used? What good is it? What's the point? If the -test- is so often wrong, what is the basis for accuracy?

And if that doc still thinks you have CTS, -why- does he think it's from the hand as opposed to anywhere else?

It's true, the 'weird' feeling points to nerve compression, but that can come from anywhere from the hand to the neck.

You also fractured your bone, and that can transmit 'weird' feelings.


Load bearing and/or forced stretches are all you need to worry about with exercise. Movement is fine, and good even. Too Much movement will send info to the nervous system that there is a problem, and you want to avoid those signals being created.


You're welcome.

Ask more stuff!
Oct 18, 2009
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starstarstarstarstar 		PART 8 - supplements & exercises update - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I was on high doses of all supplements you mentioned and then hit my saturation point, so I cut back for 4 days to what I had been taking prior to trying your suggestions and now need to figure out dosages since I think the supplements you suggested were helping.

My reactions were not being able to fall asleep, 3 days of magnesium loose bowel, and one night where my feet were so cold that I stood in a tub of warm water and had to wear socks before being able to fall asleep (that was a symptom when I was taking Levaquin and it went on for months but hadn't been a problem until that one night. After cutting way back on the supplements, it hasn't been a problem since.)

That said, I think the supplements did help since my energy level, mood, and wrist were better. My wrist was at a point where I didn't feel tightness when I wasn't using it, and only felt the discomfort when I used it.

Now it's not feeling as good and I feel the tightness again when not doing anything. For the first time in 4 days since my system seems to have calmed down, I have taken higher doses of supplements again including 3,000 mcg of B12. At the highest levels, I had been taking 1,000 mg Calcium, 800 mg magnesium, 3200 D, 8000 omega 3 fish oil, 600 mg B6, 8000 mcg B12.

What levels would you suggest now? I've read that high doses of B6 can actually cause nerve damage when taken for too many months so I'm a bit leery of that supplement since I have been taking 100 mg/day since Aug.

I'm still ice dipping and have made a soup from the bone broth which I eat once a day.

I've done one session of the DH and will start the other exercise on Tues with the physical therapist.

I'll be coming to CA in December, so would it be possible to make an appt to see you in person on Dec 14th or 15th for you to take a look at my wrists and posture (I assume you don't work weekends)?

Thank you again for all of your advice for only your suggestions are helping my wrists heal.

Tina
Oct 18, 2009
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starstarstarstarstar 		PART 9 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

Hey Tina.

That's interesting....the cold feet thing came -back- when you upped you doses. Interesting....I wonder which supplement that was. Might be valuable to isolate that.


1. I do work weekends, I prefer them actually.
Yes, I'd be happy to make an appointment with you in December.


2. No, no nerve damage from B6. Here's a study that followed a bunch of 6 year old kids taking 600mg of B6 daily for 10 weeks.
Children with Autism Helped by Vitamin B6 and Magnesium

If 6 year old kids can safely take that much, you're fine. Maybe at a HIGH amount consistently over time, but you are a LONG way from that.

Here is another link about research finding that the Process of Inflammation causes location specific Vitamin B6 deficiency.
Inflammation Causes B6 deficiency research findings

Which makes sense why some people suffering from Carpal Tunnel get results from taking B6.


3. Just for the record, as I am not a nutritionist, I AM NOT TELLING YOU HOW MUCH TO TAKE!

Just so everyone reading this is clear:)

Having said that, I wouldn't take that much Omega 3's for too long. Too much of a good thing....research points to cholesterol issues from too much for too long.

3k iu's Vitamin D, good. I take 75k-150k iu's per month.

I would keep the Magnesium just under/at tolerance level until we get this resolved, whatever number that is.

Probably could drop you Calcium some. We generally get enough in our diets, and with the Magnesium you are taking your body can actually do something with it.


4. If you just had regular old Tendonitis, I wouldn't suggest this next thing.

I suggest that you get and take the test talked about on the Levaquin Tendonitis Treatment page.

Ultimately, we are guessing with these supplements. The Organix Profile will tell you exactly where you Vitamin B levels, whether your body is detoxing or not, how well it is creating muscle energy, and if not, why. It is going to provide A LOT of specific information about where your body is actually at.

And ultimately, I assert that you will save money and time, because you can supplement to your results, instead of to our guesses and experimentations.

Check it out.
Oct 26, 2009
Rating
starstarstarstarstar 		PART 10 - more info - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I received the test kit so hopefully that will reveal some answers. My Vit D results from Mar 2009 showed 24.1, and last week I went to be retested so I'll have that number in a week. The doctor also said he'd check my calcium level too.

Other past health info which may or may not be useful:

Healthy with no allergies (except to amoxycillian) thru high school. Needed very few antibiotics during those years. During undergrad years in college took minocycline, yasmine, spironolactone for acne in early 2007. April 2007 diagnosed with mono, but was fairly recovered by July 2007. Oct 07 to Mar 08 took Acutane for acne which cleared my complexion substantially. Jan 09 Levaquin for 10 days followed by 2 rounds of Clarithromycin 500/mg twice a day for 10 days and then 14 days (finished antibiotics mid Feb 2009).

Also while on Levaquin and the following month used 2 prescription nasal sprays Nasacort & Astepro. On March 1, 2009, was given a steroid shot since I went to the doctor complaining of not feeling well overall with sore throat, sinus congestion, extremely tired, cold feet, weakness, headache, dizziness and then switched doctors to the one who found my vit D deficiency.

My complexion had been perfect until college, and recently has been getting worse again so am seeing a dermatologist and using topical treatments since I don't want to take any more drugs.

In July 2009 I packed and lifted lots of boxes of books and that is when I noticed the problem with my wrist(s).

Currently I am still ice dipping and am under the care of a hand specialist PT who seems pretty good. My strength seems weak overall since lifting and driving are a problem so I still need help with those. She gave me exercises (like your lengthening exercises) to do which I've been doing for about 4 days but am not sure if they are making a difference, but I don't think they are hurting. I also put my palm on a table and lift each finger, one at a time. Another is crossing my thumb over towards my pinkie.

Another is starting with my hands straight, and progressively curling my fingers until I've made a fist (this one is harder to describe). Would ice dipping longer that 2 hours help more? I spend my days holding books, writing notes, and typing so my hands are under constant use which might explain why they aren't progressing faster?

Looking forward to continued progress.

Tina





Oct 26, 2009
Rating
starstarstarstarstar 		PART 11 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

Joshua Comments:

Yes, you can ice dip all day long. The more the merrier.

The lengthening can only help.


And also....WOW, THAT'S A LOT OF ANTI-BIOTICS!

That's really hard on the body. That can/could have set up a dynamic in your digestive system where the good stuff gets killed off, bad stuff fourishes, parasites can more easily take hold, and you're not able to get all the nurtrion you're taking in.

Your symptoms could be from candida overgrowth....wow, lots of options.

Acne is a symptom of Vit D deficiency, btw.


Good news/bad news, it suddenly becomes a much larger investigation than just simple Tendonitis.

You're on a good start. Getting on good supplements at the right doses is a good start.

If they help, that's good information. If they help a little, that's good information. If they don't help, that's good information too.

You're on a path now, to investigate and figure out the source of the problem.

I still suggest the test on the Levaquin Tendonitis Treatment page. It'll take A LOT of guesswork out of the process and save you a lot of time.

Let me know your Vit D and Calcium levels when you get them.


Oct 30, 2009
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starstarstarstarstar 		PART 12 - Vit D & Calcium results - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

My Vit D level is now 28 (up from 24.1 Mar '09) and my calcium is 9.6. I probably also should have mentioned that during the past years I've had many blood tests taken which the various doctors have said my blood results are always normal (except when I had mono). Thyroid tests have come back normal too. This last time I went to the doctor for the Vit D results, she suggested I see an endocrinologist since she thought my Vit D level should have risen higher than it has. Would that be a good idea or does the urine test which I'll send off this Monday provide enough information? Also I rarely get colds or the flu.

Can I see you in your SF office on Dec 12th in the afternoon? How do I make an appointment?

I'm still ice dipping and seeing a PT here twice a week. The exercises are getting easier, but progress overall seems slow (but at least I feel progress!) The PT suggested I buy a book stand so I'm not holding a book hours each day. I would many times take notes while reading in between ice dips whereas she thought I should rest my hands between dips for those 2 hours. What are your thoughts on that?

Tina


----


Joshua Comments:

1. December 12th, you bet. What time's good for you?


2. re: Thyroid. What are your numbers from the test? Send everything you have, I'll have Kerri take a look at them. (Just post them here, I won't approve the comment, or I'll delete that part of your response, so no one will see them.)


3. re: Vit D. You are on a maintenance dose, not a dose that's really going to up your levels. There's no reason to think that you are having problems absorbing it, much less that an endocrinologist would have anything to do with it.

You just aren't taking enough to get your levels up.

You may want to take 5k-7k. 10k/day for a month or two is safe. (I take 150k-225k/month, even double that in winter. I also take it all at once, as opposed to daily.)

Check out my Kerri's page on Vitamin D Requirements.


3. Book stand, you bet. Resting your hands between ice dipping? The only problem I see with taking notes between dipping is that you'll get your paper wet.

Do take care to take notes with -RELAXED- hands/fingers/muscles. That's a lifelong skill you should practice anyway.

Hold a pen in your fingers. Relax 50%. Then relax 50%. Then again. At a certain point you can't relax anymore or you'll drop the pen. But it's amazing, when you pay attention, how much less work you can do and still hold the pen/perform any activity.
Nov 02, 2009
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starstarstarstarstar 		PART 13 - PT questions - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I definitely grip a pencil/pen tightly so will work on relaxing that grip.

I went to physical therapy last Friday and for the first time had a set back. The PT performed an "active release" and stretched my right wrist backward to the point of straining it and since then my wrist hasn't felt as good as it did prior to that. I returned to her today and told her that the stretching seemed to cause a setback so she did not do that particular stretch.

Hopefully it'll rebound soon since I don't want to deal with regressions since progress seems so slow. She has also been using ultrasounds and iontophoresis which today especially seems to have helped in making my wrist feel better. I go to her twice a week. Just curious about your opinion on iontophoresis.

Also have you heard of a CTRAC device that is supposed to lengthen ligaments and open the carpal tunnel and provide more space for the median nerve? In your opinion, would that be a good thing to buy and try?

Tina


----


Joshua Comments:

I looked up the CTRAC machine. Sure, if you want to spend $199 on it, why not.

If it works as advertised, it will put stretch on the tissue. If you use it 3x/day as suggested.

Or, you could gently stretch your own tissue like it does for 5 minutes 3x/day for a week and see what that does.


I'm all for iontophoresis if it works for you. Some it does, some it doesn't. Ultimately, at best, it's just delivering anti inflammatory medicine locally. In chronic pain situations, some relief can be a great thing.


Just had Kerri look at your numbers. She said everything there looks fine. Maybe on the high end of a couple, but nothing attracted her attention.

She also said that it's common for people to have fine results like that, but still have issues that doctors can't find deal with, because they aren't testing for the right things.

So the good news, is, those numbers look good.

I'm curious what your Organix Profile results will be.





Nov 09, 2009
Rating
starstarstarstarstar 		PART 14 - a couple of questions - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

Just wanted to confirm that Dec 12th at 2:00 works for you in SF.

In general my hands are surviving typing papers and am gearing up for three 20 page papers due in a month. Seems I'm not going backwards but not making huge strides forward either.

I went to the dermatologist and she wants me to use Avar-e green topical sodium sulfacetamide 10%, sulfur 5%. Since it can be absorbed into the skin, I was wondering if it's ok to use this along with taking all the supplements I'm taking nowadays. I'm looking forward to getting my test results so I'll know exactly what dosages I need to take since I'm still guessing with the magnesium and had to cut the dosage again. Overall I'm feeling better since being on the various supplements. Would it be a good idea to add hyaluronic joint complex with glucosamine, chondroitin and MSM? The product said that it promotes healthy joints and connective tissues.

Tina


----


Joshua Comments:

Yes, the 12th at 2 is perfect. I'll get you directions and such.

Sodium Sulfacetamide you describe is topical aspirin. No reason not to use it, necessarily.

Can't hurt to add in the hyaluronic joint complex. It won't hurt anything. And the only way to tell if it hels is to try it. In general, some people notice real benefit, some don't.

Nov 13, 2009
Rating
starstarstarstarstar 		PART 15 - Test Results - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

Kerri emailed me that my Profile test results were all normal so I take that to be good news.

I called and left a message on her phone today to discuss the results next week since I'd like to know what it all means. I'm hoping that since the tests were normal that Levaquin is not a factor in my slow healing.

I'm looking forward to meeting with you in SF on Dec 12th at 2:00 if that works for you. I really need to get this right hand healed before returning to Atlanta in January so any advice from you will be greatly appreciated. I think some squeezing strength exercises that I'm doing at physical therapy are perhaps setting both my hands back a bit but I'm not sure if that's the cause.

I need to regain strength in my hands so I'm eager to do as much strengthening exercises as I should do. I'll be doing a lot of typing this next month so I hope that won't be a set back too.


Tina


----


Joshua Comments:

My suggestion for strenthening is to start slow and build up and pay a lot of attention.

Along those lines, you probably are but keep some typing going so when you do a lot next month it's not a sudden suprise to your system.

Are you still Ice Dipping?

I'll comment on the test after you and Kerri talk.


Nov 18, 2009
Rating
starstarstarstarstar 		PART 16 - lots of typing ahead - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I spoke with Kerri yesterday who said my profile showed overall excellent health. I'll do as she suggested! She also stated that there is no way of knowing if Leviquin has played a factor in my tendons in my hands. I'm interested in your comments also.

Between now and when I see you in SF I have three 20 page papers to complete. Up until this point I've had smaller papers of 3 to 8 pages over the semester so have been typing continually to some extent but not for the hours I need to now. I'm concerned since my hands aren't as good as they were a few weeks ago when the physical therapist stretched my hand to where I felt the pain. She hasn't done that again, but has been having me do twisting strengthening exercises (holding a rubber rod horizontally in both hands and then twisting it while it has resistance) which I think I've overdone for the past 2 weeks. She also had me squeeze clay and pull it which bothered me with that tight feeling again too. I had a different therapist yesterday who said I should have done 2 reps of 10 whereas before I did 5 reps of 10 and stopped when I felt that tight feeling. Weeks ago there were times when I didn't feel that tight feeling at all in either hand, and now my right hand feels it again constantly. My left has regressed also but not to the extent of my right. Should I stop these strengthening exercises altogether?

I'm still ice dipping but for the past few weeks it's been 4 or 5 times a week instead of daily since I've been busier and sometimes it's hard to find the 2+ hours. During the second hour of dipping, my hands are so stiff that I can't write or type in between dips. On the days when ice dipping isn't feasible, should I do the ice message instead since it takes less time? What is the difference between the two as far as benefits of each?

I have part 2 coming since this is so long.

Tina
Nov 18, 2009
Rating
starstarstarstarstar 		Part 16a - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

It seems that every day my hands are slightly worse. Sometimes I wonder if I should withdraw from school until this condition is cleared up since I don't want to do any permanent damage.

How do I know if I'm causing serious damage or if these are just minor setbacks that will heal when I quit doing the things that are causing the aggravation? I'm still not driving and can't lift grocery bags etc so I'm still needing constant help.

The physical therapist I saw yesterday highly recommended an ergonomic keyboard so I bought one on sale and have been using it the past 2 days.

The wrist angle positions and rests feel good but the keyboard keys and in particular the space bar is harder to push than my laptop keyboard. I'm trying to use only my left thumb instead of my right when I push the space bar but I naturally use my right thumb which then causes the wrist to get tight plus my thumb feels like it's moving slower and having to push thru resistance.

My sensations are definitely more tightness in the wrist than pain but occasionally I get a dull throbbing pain. If I rub the radial bone then it feels tingly. Would it be a good idea to sometimes use my laptop and sometimes use the ergonomic keyboard since it varies the hand positions/easier keys to push?

I also bought the Ctrac and started using it 3x/day (as directed) 5 days ago. It is supposed to gently lengthen the ligaments by putting your hand in a brace that inflates to put 180-190 mmHg of pressure on the palm. Is it better to ice dip before or after I use it, or does it matter which order or should there be hours in between?

I look forward to getting help from you in person and am hoping that during my month off in CA I can get this under control.

Tina


Nov 20, 2009
Rating
starstarstarstarstar 		PART 17 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

Joshua Comments:

1. You can ice anytime for 10 seconds a dip. It just creates circulation.

2. How are you icing such that your hands are so stiff afterwards? We might need to fine tune that.

3. It would be a GREAT idea to alternate between keyboards, switch mouse sides, switch how you do things.

4. It may be worth it to invest in voice typing software. I hear it's getting a lot better, and could save your hands typing. More trouble that it's worth...I don't know.

5. How do you know if you are causing damage? Pain is a good indicator. Your mission is to learn to do the most activity with the least amount of resulting pain.

Mostly the pain is from a chronically damaged structure. YOu can cause worse physical damage if you push it too much, but if you push it just right, you should be able to ride the wave of 'pain without any new damage'.

6. It sure sounds like a fluoroquinolone issue....the good news is that the profile results show your levels are good and healthy. It shows you are absorbing nutrients and detoxing appropriately.

The bad news is it doesn't point to anything defient that making suffient could help your symptoms.

The problem with Levaquin Tendonitis is that it seems to damage the tendon in such a way that it doesn't really heal effectively or correctly, leaving one in a chronic and easily irritable.

There is no known cure at this point. Researchers aren't even sure how the damage happens, though they have theories and clues.

So I think the best path is to keep looking for answers and to learn how to best survie and avoid more pain.

For sure get your Vit D levels up over 40 and keep up with the Magnesium.

Let's see what there is to see when you get a session in December (that's coming right up!)

And I've probably said it before, but while I'm really not into lawsuits, I'm all for the class action lawsuits against pharmaceutical companies that produce these harmful drugs, and the doctors that freely prescribe them (though nobody's going after them).

Here is a link to a law firm I've been talking with about this. As I don't have experience with them, I don't offically vouch for them, but they have so far been helpful and knowledgeable answering my questions. SRS Law Firm

Worth a shot, it can't hurt anything, and potentially it will help others avoid this kind of pain in the future.
Dec 04, 2009
Rating
starstarstarstarstar 		PART 18 - confirming appt - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I just wanted to confirm the appointment for Saturday Dec 12th 2:00 in your SF office. I assume I can find the address & directions from your website.

I'm still ice dipping but couldn't get thru typing all my papers for the end of this semester. I'll probably take next semester off and focus on healing my hands so I'm looking forward to what you have to say.

My PT here in Atlanta thinks that I've had numerous setbacks with too much typing, too many reps with strengthening exercises, etc.

She thinks I'm prone to tendonitis and carpal tunnel since my bones and wrists are small.

She thinks I'll heal with time and continued PT visits and exercises etc. She said she has seen many cases where it's one step forward and two steps back with healing and it takes a long time. Hopefully it's not a Levaquin issue since the aches I felt while on the drug were in my legs and not my arms. Since the Profile test showed all was normal, I'm assuming I can heal when I quit overusing my hands.

I'd like you to check my posture in general plus my left shoulder since it was bothering me last week.

Looking forward to an in person meeting.

Tina


----


Joshua Comments:


Hey Tina.

So for the benefit of anyone reading, Tina and I had an apppointment today.

After some conversation and checking posture and muscle tone and such out, I'm pretty sure that Levaquin isn't playing a role.

I'm also clear that you don't have 'damage'. Meaning, that you don't have any significant wear and tear injury to your structures.

I don't think that, as your PT said, that your 'wrists are too small' and therefore you're predisposed to tendonitis and carpal tunnel.

I do think that the answer to your pain issues is:

1. Increase your protein intake, and your overall calorie intake. Coconut oil and coconut butter are an easy way to up your calorie count and available energy so your body can use the protein you eat do do what the body does with protein...build strong structures and repair damage.

2. Get your Vitamin D level UP! Going from a 26 to a 28 is not an improvement. Get it UP!

3. Magnesium as we spoke of. Vit D supplements need Magnesium to turn to an active form in your blood.

4. The B's can't hurt.


(CONTINUED IN PART 19)
Dec 13, 2009
Rating
starstarstarstarstar 		PART 19 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

(CONTINUED FROM PART 18)



Joshua Comments:

I think that will deal with a large portion of your pain. ALL of 1-3. Not just 2 and 3. Definitely #1 too.

You literally CAN'T get better if your body doesn't have what it needs to get better. I think your PT is smoking crack if s/he thinks you'll get better with time.

It just doesn't work that way.


The GOOD news is that it doesn't look like it's Levaquin Tendonitis. YEAY!


Also, Kerri thinks that you might have adrenal fatigue. If the adrenals are shot (high stress, type A personality, various nutrient deficiencies) long story short, the body won't heal, and if you have pain but no damage or injury, fatigued adrenals can equal ache and pain.

Do 1-3, and let's see what happens.


Dec 20, 2009
Rating
starstarstarstarstar 		PART 20 - after the visit - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

Thank you for seeing Tina a week ago. I'm so glad to hear that you don't think her wrist/hand issues are Levaquin related. As her mom, I always have "one more question" so here are the ones tonight:

She has a lot of trouble doing Activity 2 from the DVD. She stands against a door jam, but can't seem to keep her elbows straight and her rib cage down plus it makes her shoulders tight. Is this particular exercise one she should keep trying to do, or is there another one that would be beneficial and easier for her? Should she do any particular wrist exercises?

She's drinking 2 glasses of Nectar Whey Protein Isolate each day which contains 23g of protein in each serving. (We couldn't find "Now" in Fresno bc we don't have Rainbow Groceries.) She's also trying to increase her protein via food too. Does that seem like enough or does she need to drink 3 glasses per day?

She's taking 10,000 IU of Vit D again. She did that in November for 2 weeks and then dropped down to 5,000 IU. How long can she take 10,000 IU this time?

She's still ice dipping most nights for 2 hours. She's also started rolling her wrist/arm over a frozen water bottle a couple times a day. Should I massage the tissue of her arms too, or does the water bottle rolling accomplish the same thing? If it will speed up healing, I'll do it, but I also don't want to massage her incorrectly.

In general terms, if her problem is nutritionally based, how long will it take until her hands are "normal" again? Will her hands not heal until her Vit D level is around 40 and her protein level increases substantially? She still can't type or write much, and lifting/driving/cooking etc are still problematic for her. She'll be home until the fall of 2010 when she'll head back to grad school. During those 6 to 8 months, I want her to do everything possible to heal so any suggestions are very much appreciated. Should she find a PT here in town so she can get ultrasound and iontophoresis?

Thanks for your advice.
Susan & Tina

Dec 20, 2009
Rating
starstarstarstarstar 		PART 21 - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

Joshua Comments

Hi Tina's Mom. :)


1. There -could- be some Levaquin cytotoxicity at play, but it sure doesn't seem like it when working with her.


2. The difficulties she is having with Activity 2 from the website is EXACTLY the reason she needs to keep doing it. If she keeps at it, pays attention, and goes a little bit at a time, she'll get there. Remind her to rotate her upper arms, not her lower arms.


3. That's probably enough protein, with everything she's adding in. And it's about calories too.

If, for example, she needs 1000 calories a day just to break even, and she east 1000 calories of protein, it will all be burnt for fuel.

I suggested she add in Coconut Oil at 120 calories per tablespoon (in oatmeal, over rice, cook with it, in shakes, etc) because that wil go a long way in having her body have more usable protein to build with.


4. As I recall, her Vit D levels went from 26 to 28. I think she needs to either take a couple hundred thousand all at once, or keep her daily amount at something like 10k for at least a month. Then get another level to see if that's enough to get her levels up into range.

Also, Magnesium is required to convert the Vit D into its active form in the blood, so make sure she's supplementing to tolerance level with that.

I would also be interested to see what happened if she used this Magnesium Oil from Mercola. (Best and cheapest I've found).


5. The Ice Rolling counts as massage. Still, never hurts to have someone rub one's arms. And, you pretty much can't massage 'wrong'.


6. I really think that Tina's primary issue is long term lack of calorie/protein. I don't doubt being so Vit D decient is playing a role, but I don't know how much of one. (Even if it's not playing ANY role in her arm pain, it should be criminal for doctors to allow her or anyone's level to be so low)

It may take some time for her body to bolster itself back up now that she's eating more calories and more protein. It may go fast, just have to eat and watch and see.

I am POSITIVE that just icing and massage won't 'fix' her. There is something else going on at a deeper level. Let's fill up the calorie/protein and Vitamin D holes, and then if there's any other digging we need to do, we'll try whatever's next.

I'll be surprised if the change in food intake and getting her Vit D levels up doesn't 'heal' her.


7. I don't recommend ultrasound or the electro-injected nsaids (iontopheresis), because I've never met a person/client that got any real results from it.




Thanks for being such a good mom. Feel free to ask questions any time.
Dec 27, 2009
Rating
starstarstarstarstar 		PART 22 - update on protein use - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: Tina

Hi Joshua,

I hope you had a nice Christmas and had a break from work. Now that the holiday is over, I thought I'd slip in a few questions before the New Year rolls around.

Tina is working on upping her protein intake on a daily basis which is a challenge for her. She's using coconut oil, drinking 1 or 2 protein shakes a day, and eating more meat and eggs. She's also still taking 10,000 IU of vitamin D a day. She's not ice dipping as much as now rolling her arm over a frozen water bottle. She said that her left hand/wrist feels normal unless she uses it too much (turning, lifting, squeezing, etc) Her right one seems to have hit a status quo in that day to day it feels the same and whenever she uses it, she gets the "tight feeling" fairly quickly. When she does her tendon gliding exercises (basically opening and closing her hands), her left hand feels fine whereas her right hand feels "slow and stiff" and she gets that tight feeling before doing 10 of them so she stops at that point.

She still has a lot of trouble doing the DH exercises. She said she can't do it "the right way" and can only do it with the rib cage coming up or bending her elbows. Should she keep trying to do them, or by doing them incorrectly is she aggrevating something? How many times a day should she do the DH?

She can type a short email (about 5 sentences) before she gets "that feeling" in her right hand so she doesn't type much yet, and I presume she shouldn't continue typing after hitting the threshhold of "the feeling."

She'll be back in the bay area for a few days around Jan 11th. Would it be beneficial for her to see you in person again so you could help her with the DH exercise or other exercises you think would help her? I'd like to think that within a month or two she'll be able to drive, cook, work as a substitute teacher, etc and then ultimately head back to grad school in the fall of 2010. That's our goal and hope it's realistic.

Any words of wisdom are always appreciated!

Susan


----


Joshua Comments:


Hi Susan. Quick answers here.

I think a month or two is very realisitic if Tina keeps up with the caloric/protein intake and self care.

Definitely stick with the Vitamin D intake, as the amounts she was taking won't (and didn't) bring her levels up.

I do think it would be worth it for Tina to see me again in Jan. 'Incorrectly' probably won't hurt her, but if it's not effective, why bother.

Do the DH throughout the day, 5 reps at a time. As long as they don't make her sore, great. Keep doing little bits. It adds up.

Rolling instead of dipping is fine. Remind her to dig in there, get the cold in deep.

And I had a great holiday, thanks:)


Jan 07, 2010
Rating
starstarstarstarstar 		January appt
by: Tina's mom Susan

Hi Joshua,

A few days ago Tina said that her hands felt "a bit better" which was music to my ears after all this time.

Then she started typing quite a bit for an application which is due in less than a week so her hands have been bothering her the past few days. She ice dipped for 2 hours last night and today she feels improvement again so the ice dipping seems to still help (she's basically now ice rolling twice daily instead of ice dipping).

She has a few more days of typing to do and then she can stay away from the keyboard for awhile again.

She types incrediably fast (around 90 words a minute). Is it better for her hands if she slows down? She does take typing breaks now which she used to not do. You pegged her correctly when you described her as a type A, driven, highly motivated, perfectionist person.

She'll be in the bay area again next week so can she see you in your SF office on Saturday January 16th?

I'd really like your advice about her doing the DH since it's painful to watch (like on the sitcom Seinfeld watching Elaine dance!). She has such a difficult time and can't do it without bending her elbows or raising her rib cage. She struggles with it on a daily basis and she says it doesn't seem to get any easier for her as time goes on. I'm sure her posture and shoulders/neck area have an impact on her hands. She said after typing when she tried to do the DH, she was really tense in those areas.

She's still taking all the supplements and protein powder. She's not a big eater so it's hard for her to up her calories a lot but she is eating more protein. Progress is very slow but at least she's not getting worse. She still isn't driving or lifting or cooking etc.

Hopefully in another month or two as her vet D level continues to increase and she continues the protein consumption, she'll progress more quickly.

Thanks for meeting with her again.

Susan


----


Joshua Comments:

Hi Susan.


1. The 16th, is doable, but I won't know exactly when until Monday (the 11th)

2. If she actually takes enough Vit D to get her levels up (she's takimagnesium, as I recall, which is required to convert Vit D supplemnts to the active form in the blood), and -IF- she gets enough calories in her, I would think a month is realistic.

Coconut oil is an easy, healthy way to up her calories. 120 calories a tablespoon, goes into soup's, chili, over rice, cook eggs in it, etc. (Makes soups and chili's REALLY good, actually)

How much coconut oil is she eating every day? Has her calorie count gone up by any significant amount?

-Something- is still keeping her from moving up the Upward Spiral.


3. Tell me again, is she supplementing Vit B6 and B12?


4. I can work on the DH with her, no problem. Interesting/curious she's having such a problem with it.....


I'll get back to you about the 16th.
Jan 22, 2010
Rating
starstarstarstarstar 		thanks for your advice
by: Tina's mom

Hi Joshua,

Thank you for seeing Tina a week ago in your SF office. She said it was a very informative & worthwhile visit. I haven't seen her yet since she's still in the bay area due to the stormy weather but she'll be home tomorrow.

I was so happy to hear that you saw improvement in her wrists/arms and also unlocked the mystery of why she has so much trouble doing the DH.

Hopefully if she continues to do all the things you suggest, she'll continue to improve and one of these weeks or months she'll turn a major corner. Had she followed the orthopedic's advice she would be on neurontin and headed for surgery so I'm so happy we found you online and that she is now able to see you in person!

She'll probably be in the bay area again in Feb or March. Would it be worthwhile to see her again in person so you can determine her progress and adjust treatments/exercises as needed?

Enjoy the sun when it finally appears after all this rain!

Thanks again,
Susan


----


Joshua Comments:


Hi Susan.

You bet, March would be a great idea.

When you see a little improvement on a day to day basis it's easy to lose track and not really notice how much actual improvement there is. I'm happy to help:)

Neurontin. Ick.

And I am SO curious what exactly those surgeons think they would be cutting on...where exactly?? (That's a rhetorical question.)

Thanks again for being a good mom. :)


Feb 18, 2010
Rating
starstarstarstarstar 		Tina's progress February 2010
by: Tina's mom

Hi Joshua,

I hope you enjoyed your time in Washington. It's always nice to get away.

Tina will be in the bay area again between Feb 24 and Mar 2. Can she see you during that time in your SF office?

Here's the update on her. She says her left hand feels quite normal so that's great news.

Her right hand still gives her problems. The icing has helped in the top & bottom of her forearm in that it doesn't hurt her arms when she rolls over the ice with pressure. She still gets the tightness feeling and now the ice doesn't seem to help with that.

Now her main problem is her thumb area -- especially the outside area along side of her hand & arm. She's been icing along that boney area but it doesn't seem to be helping.

During the past month these events have seemed to set her hand back:

1)being in Atlanta packing up her apartment (she did some light packing while others did most of it), meeting with professors which involved shaking hands which bothered her, and opening many school building doors

2)substitute teaching where passing out papers and anything involving the pinching motion of the thumb and index finger is a problem, and 3) having to re-enter cell phone numbers into her phone. Any button pushing using her cell phone is a problem.

She's not gaining weight but not losing any either. She still takes all her vitamins and drinks a protein shake daily.

The shoulder exercises where I pin her shoulder while she stretches her arm while lying on a bed are making a big difference in her being able to rotate her shoulders again. She's using a soup can for the other exercises you've given her.

She can now do the DH even though she says it's hard to do. Should she do that instead of the one where I pin her shoulder? The pinning one still hurts but she's able to stretch straight upward comfortably but it still hurts to stretch sideways.

Her strength is still weak and after lifting the soup can, she feels like she's had a real workout!

She does these exercises every night. Would it help to do them twice a day or is once a day better so as not to overdo? Should she add the DH? We think her shoulders were so locked up due to 10+ years of constant trombone playing (everything from marching band to jazz to orchestra to ensembles -- HUGE part of her life). Her shoulders would be locked and all the motion was in the wrist and elbow.

Any ideas about the thumb area would be great.

Thanks so much! Looking forward to her seeing you again.

Susan


Feb 20, 2010
Rating
starstarstarstarstar 		February Joshua Response - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

Joshua Comments:

Hi Susan. Thanks for the update.

1. If she's weak from the soup can, she needs to do more! Lift weights = get stronger -if- she eats enough.

2. She's got to eat more. Period.

3. Yes keep at the DH -and- the pin and stretch. Keep at it, keep at it, keep at it. What you say about locked shoulders from playing makes a lot of sense. Keep at it to reverse it.

4. For the thumb area, target the ice bottle there. Just like it's helped the forearms, it will help the hand. You'll have to investigate what is causing the pain from shaking hands and such...A. where exactly is the pain? B. Explore that structure and work any and all spots that hurt, are sore, and even parts of the structure that don't hurt. Get it all.

5. I'm in Seattle until the 6th of March, so I'm going to miss Tina this time. :(

And yes, it's great to get away. It's even sunny up here!



Did I miss anything?
Feb 21, 2010
Rating
starstarstarstarstar 		next appt date
by: Tina's mom

Hi Joshua,

I feel Tina really needs to see you again so I'm tempted to make a one day trip on either the 6th or the 13th. Would either of those Saturdays around 1:00 or 2:00 work for you in SF?

Tina will have her Vit D level checked again since she'll have her annual physical tomorrow. I'm sure her doctor here will send her to a "specialist" which I don't mind but she & I are against drugs and/or surgery. I'm curious what her vit D level is now.

The thumb area seems to be worse since she's stopped wearing her brace at night so she's going to wear it again and see if it makes a difference. Maybe she's clenching her fist while she sleeps.

The thumb area that is bothering her is the thumb pad area. She said that it's hard to ice roll on that part -- hard to reach. Should she or I massage that entire area daily?

She'll try doing the DH and the other exercises twice a day and see if that helps.

Eating more is soooo hard for her since she gets full very fast. She eats every 2 hours, but small amounts.

Let me know what Saturday (even if it's after the 13th) works for you.

Thanks,
Susan


----


Joshua Comments:


1. Saturday the 13th works perfect. Let me know if I should schedule that in.

2. One way or another, get that ice in there as a grinding tool on the muscles/structures of the thumb pad. Maybe not rolling, but still.

3. I too am very curious about her Vit D level.


Mar 04, 2010
Rating
starstarstarstarstar 		Vit D & blood test results
by: Tina's mom

Hi Joshua,

Good news! Tina's Vit D test showed 73. Her blood tests were normal (as usual) as was her thyroid test. Now that her vitamin D level is way up, how many IUs should she take per day now?

Tina's medical doctor agrees that she needs to gain weight which she still hasn't been able to do. Other than that, her doctor thinks she's in good shape and that her hand should heal even without sending her to a physical therapist here in town. She has referred Tina to one, but has left that decision up to her so for the next month Tina will see how much she continues to improve before seeing the PT.

Her doctor suggested that Tina start using her hands more which she has been doing without causing any setbacks. Her left hand is doing very well, and her right is continuing to improve although she still gets that tight feeling if her right arm is not resting on her lap or the table at the "correct" angle. Tina said the motion of picking up paper where her thumb and forefinger come together still causes problems as does the motion of turning a door knob. Overall though she says that bearing weight is more of a problem than motion.

Tina is still doing your exercises and is getting more movement in her shoulders. She'll be in the bay area again probably somewhere between Mar 18th and 24th. Could you see her then?

Welcome back to CA!

Susan


----


Joshua Comments:

73. Great! I'd say 4k/day as a maintenance dose. Or 3k due to bodyweight, but test again in 6 months if so.


1. Tell me again how much Vitamin D she's actually been taking, that got her up to a 73.

2. Why did she get her thyroid tested, and do you have her numbers? Kerri's looking over my shoulder for that one. 'Normal' doesn't necessarily mean anything. Lots of people get normal results for all sorts of tests but do actually have the problem that that particular test shows they're negative for.


3. 18th-24, no problem, just let me know.
Mar 13, 2010
Rating
starstarstarstarstar 		March appt
by: Tina's mom

Hi Joshua,

We're still not entirely sure what dates Tina will be in the bay area but it'll be somewhere between March 18th and 25th. She'll email you to make the appt as soon as she's certain of dates.

To respond to your questions, she took 10,000 IUs of vit D for months in order for her level to reach 73. Since the weather will be basically sunny here soon, I'm wondering if she should get her vit D from the sun by sitting outside for 10 minutes a day instead of taking supplements. I don't want her level to drop, but I also don't want her numbers to get too high. If she's in the sun plus takes 2,000IU a day, could that be too much?

Her thyroid was tested "just because" -- no particular reason except that both the doctor and Tina thought it might be a good idea. Tina has asked for her results to be sent to her but she hasn't received them yet so she doesn't have results to report to you except that she tested "normal."

Tina has been doing her exercises twice a day and using a pineapple can which is heavier than a soup can. Should she continue to increase the weight and if so, how much? She's also doing the DH and can keep her left arm almost totally straight, but her right elbow still bends slightly (<20%) as she rotates forward to the starting position. She's significantly better than when she started though! She says her shoulders feel very tight when doing the DH and she occasionally feels "that feeling" in her right forearm while doing that exercise. If she goes VERY slowly she can keep her elbow(s) almost 100% straight but she says she feels her abdomen wanting to lift. Should she do the DH correctly and VERY slowly or a bit more fluid and let her elbow bend?

Thank you again for all your help with getting her on the right road to healing.

Susan
Mar 14, 2010
Rating
starstarstarstarstar 		Joshua's response - Wrist Tendonitis Problem, Grad Student, Levaquin may be involved
by: The Tendonitis Expert

Joshua Comments:

Hi Susan.

1. I'd rather her do the DH slow and controlled. This will build her awareness and train her nervous system.


2. Check out the chart at the top of GrassrootsHealth.com.

It basically shows that, for instance, 10k i.u./day will max a blood level out at just below 80, as opposed to continuing to go higher and higher.

8-10k i.u.'s/day may be a good maintenance level for Tina.

YOu could drop it some if she goes out in the sun -if-:

- she sunbathes in something like a bikini, as opposed to being mostly covered up

- she doesn't take a shower with soap, as that washes off the skins oily layer where vitamin D gets produced.

15 minutes of full exposure around noon time, will get her about 5k i.u.'s. Approximately.


3. I'm not too worried about the thyroid thing. Having said that, if YOU are concerned even a little, you shouldn't stop at 'normal' results.

As a general statement, when doctors see 'normal'. they stop looking. HUGE numbers of people have 'subclinical' thyroid issue.

If you're curious, let me know I'll point you to more info.


4. I'll be in town, just have Tina let me know good times and dates.


Mar 29, 2010
Rating
starstarstarstarstar 		weight exercises
by: Tina's mom

Hi Joshua,

Tina's last visit was very helpful again. Interesting about the neck problem -- the fact that she has gotten headaches periodically over that last few years now makes sense. Hopefully icing and massaging will help.

Tina said that when she lies on her bed and does the weight lifting exercises, she can feel a strain in the side of her neck, on the same side as the arm she's moving. She says that the weight doesn't seem too heavy for her arm, but she can't isolate the arm muscles without also firing up her neck muscles. Should she decrease the weight, or what do you recommend?

Thanks again for your help.

Susan


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Joshua Comments:

Hi Susan.

Great, I'm glad it was helpful.


As far as the neck strain and whether to use more/less weight....

It depends on the 'strain'. If she can do the same weight and 'feel' the neck muscle work, and the neck muscle doesn't get bad or painful later, then keep the same weight.

If the neck continues to hurt later, gets irritated for more than a few minutes, etc, then drop the weight some, and build up.

The neck works to support other structures. So she's actually working out her arm -and- her neck. That's a good thing.


Make sense? If it's like a work out strain, keep it. If it's causing a problem, lighten up, and have her self massage that neck muscle that hurts.



Apr 12, 2010
Rating
starstarstarstarstar 		4 month gameplan
by: Tina's mom

Hi Joshua,

Tina spend nearly a week at Harvard and liked the program so will be leaving CA in August. I have some questions & thoughts and once again would value your opinion.

She held up fairly well during the week she was gone and would ice roll when her hands got "that feeling" which helped. She could take 2 pages of hand written notes without a problem, but more than that would trigger "the feeling." No one pushed on her shoulders so they tightened up and we're working on loosening them up again. She won't have a car there and will need to carry books, groceries, etc sizable distances which is difficult now.

A person here thinks that massages on the problem areas on a regular basis would help. Good idea?

My sister who also deals with carpal tunnel & other issues brought over pink foam roller which Tina tried. Tina said when she laid on it & put her arms out, it felt like someone was pushing on her, but with less force (gravity instead of my elbow). Does it accomplish the same goal without me? Would it be good for her to own one away from home in place of someone pushing on her? My sister does an exercise on the roller where she moves her arms like she's making snow angels. Good idea for Tina?

A friend in Redondo Beach uses a personal trainer who has helped him with shoulder & carpal tunnel issues. The trainer uses weights & massage and my friend would like for Tina to see her. The 3 to 5 pound weights that Tina is currently using with your exercises seem like plenty for now. Thoughts?

My uncle swears by heated castor oil packs applied to the wrist & forearm area 45 minutes a day. He healed tendonitis in his foot in 2 months this way. Worth a try? It's supposed to reduce inflamation and stimulate the lymphatic system.

During the next 4 months, what should she focus on in order to gain strength and be able to write & type in an intense environment? I don't want to move her to Boston and then have to move her home again as was the case with Atlanta. How will we know if she's ready to go?

Thanks,
Susan





Apr 13, 2010
Rating
starstarstarstarstar 		one more question
by: Tina's mom

Hi Joshua,

Tina said she might be in SF this weekend -- not certain yet but likely. If she is, would you be free to see her either Sat afternoon or Sunday? I like her to see you whenever she's in SF since every session has been helpful.

Thanks,
Susan


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Joshua Comments:

Hi Susan.

1. Yes, I'm available this weekend.


2. Pink roller, great. Most anything is good if one actually uses it. It's not the same as someone pushing on her, but it certainly isn't bad, as it opens up the front.


3. Hot castor oil packs? It's worth a shot. Potentially the castor oil has some helpful qualities as it soaks in.

Hot and cold, great for ciruculation.


4. I think she needs to eat more and lift weights and build some muscle. A trainer would be great, if she'll lift enough and eat enough.
One could make the assessment that she doesn't have enough meat on her bones to do the work required to carry backpack around etc without getting fatigued/overworked.

She needs 5-10 pounds of muscle added. And just can't do that without eating more.....(and lifting heavier weights).


5. When will you know she's ready to go? Ahhh, as if there were ever a time someone's ready to go....
You're doing great. One way or another, she'll be fine. (Lest I start waxing philosophical....)


Apr 24, 2010
Rating
starstarstarstarstar 		cross fit trainer
by: Tina's mom

Hi Joshua,

I went to the cross fit facilities and met a cross fit trainer who seems very knowledgeable and has worked with injured Fresno State athletes. He'll be meeting with Tina next week one on one and then decide if she's ready for a class (his classes are 2 to 7 people so she won't get lost in the shuffle).

What do you think he needs to know about Tina? I told him that she has 4 months before leaving for graduate school and needs to gain 10 pounds and get stronger. I said she has been battling tendonitis and carpal tunnel and has problems with her neck, shoulders, arms, and wrists.

Beyond that I don't know what he needs to know. Any suggestions or just let him figure out the best course of treatments? Also, do you think she should see a massage therapist since this place has one that the trainer said is very good?

Thanks again for all your guidance.

Susan



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Joshua Comments:

Hi Susan.

You said "I told him that she has 4 months before leaving for graduate school and needs to gain 10 pounds and get stronger. "

Brilliant!

What does he need to know? I'll say a couple things, but I trust any crossfit guy to take one look at her and know she needs to do some work.

I also know Crossfit, as a rule, doesn't baby anyone.

What I have in my head is like she needs to be in a military bootcamp context (no pity, no sympathy:). Workout hard and get strong.

-I- think she needs to start some heavy duty, hard core workout. Like you said, put on 10 pounds of muscle. And that will take some oomph.

Part of why she is weak, is because she is weak.

Meaning, not enough muscle to do the work required without causing a pain dynamic.

More muscle, better machine operation.

What I would tell the trainer is to push her hard, make her eat, and pay attention that she has a history of low calorie, low nutrition. That has an effect on a body.

She also needs to do it smart and controlled and within her range. Any body can build up, and she has to work with what she's got and where she's at.
Apr 24, 2010
Rating
starstarstarstarstar 		Or...(follow up question)
by: Tina's mom

Hi Joshua,

My neighbor gave me the name of a rehab physical therapist. Is it better to start with him for a month and then see the cross trainer? Everyone has an opinion and so it's hard for me to know where to start for Tina: massage therapist, rehab physical therapist, cross trainer, or a combination of the three?

Thanks again.

Susan


----


Joshua Comments:

Hi Susan.

Yep, we certainly do all have our opinions. Go with what seems best to you.

My opinion is that overall, she should do something like Crossfit over something like rehab therapy.

IMHO, rehab therapy isn't going to push her like her body needs. Too slow, too careful, to much work on isolation of muscles and groups.

I think she just needs to build her body up so she can move through life with more ease/safety.

It's brilliant that you're doing one on one with him. I won't say much about that, but it's a great idea for a variety of reasons.

The thing with Crossfit is, hopefully Tina will like it and throw herself at it. It's a whole new world of learning/knowing, working with her body towards that particular level.

I hope she like it. I think she will.

Massage is always great. Absolutely in conjunction with working out.


Oh yeah. Tell the Crossfit guy not to treat her like she's 'injured', just that she's, really, literally, weak.
May 23, 2010
Rating
starstarstarstarstar 		would like your opinion
by: Tina's mom

Hi Joshua,

It's been a roller coaster since Tina saw you last. I value your opinion so here's the latest.

Tina attended Cross Fit classes for 2 weeks and then went to LA for a week. She initially handled the Cross Fit fine and the instructor modified a few of the exercises due to her hands. She's gained one pound so putting on weight is still an issue. She definitely had more energy.

While in southern CA she saw a rehab physical therapist who is part of the staff of an exercise workout center. My friend recommended her highly and she seemed to know a lot and is experienced. She worked on Tina for an hour on both Thurs and the following Monday. She massaged her neck and spent a little time on her forearms. She said Tina was extremely tight and that her arms felt like "guitar strings." Tina's neck was very sore for days after the massage and she had a dull headache in the back of her head where her head connects to her neck. After the 2nd massage, Tina said that she felt like she had a "bobble head" and it felt very loose and hard to stabalize. When I was driving, acceleration and decceleration bothered her a lot plus she had the dull headache pain in the back of her head which lasted for days. Tina had said that you could prompt a headache too by pushing on certain spots at the base of her head, but it wasn't a problem after she saw you.

When we returned home, she worked out again with no problem but then the following night after the workout and a short jog around the neighborhood, Tina developed an intense painful headache in the front of her head with a lot of pressure behind the bridge of her nose. Later her nose started running which was odd too. She has never had a headache like that in her life and it was quite disconcerting and we were up til 1:00 in the morning trying to get her some relief. She took Aleve which took a bit of the edge off but it was still very painful. She finally went to sleep and in the morning felt much better. She went to her doctor who said that the movement of the headache from the back to the front made sense since the same muscle band is involved, and she thought the headaches were a result of tight musculature in the neck. She said if it happens again, to get an MRI since this is not usual for Tina. Do you think the neck massages last week set this off? Does this show that her neck really needs to be worked on or is this reaction of pain and feeling like her head is unstable stirring up something that should be left alone? The rehab therapist doesn't think Tina should lift anything above her head during Cross Fit since her back and neck muscles are soooo weak. Tina did say that during one workout she felt an odd tingly feeling on her back at the scapula when lifting above her head which didn't feel normal. The rehab therapist doesn't want her to run or jump rope due to the headache episode.

...to be continued
May 23, 2010
Rating
starstarstarstarstar 		would like your opinion pt. 2
by: Tina's mom

...cont:

For days after the neck massage Tina had a hard time moving her head up and down -- side to side seemed ok. Her shoulders and neck seem chronically tight and there hasn't been much improvement in her hands since she last saw you. Could the accident with her neck a few years ago be the root of the problem? It's hard to know how to get her past all of these ailments.

What do you think about all this? Should she get an MRI just to be sure that nothing is wrong inside her head and the the headaches are stemming from tight neck muscles?

Thanks for your thoughts,
Susan


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Joshua Comments:

Hi Susan.

Good, she was liking Crossfit/working out, it sounds like.

1. I wouldn't worry about the headaches, as far as getting an mri or some such. I rather imagine that the therapist just worked Tina's neck too hard/deep.

Specifically, being rough on the joint capsules (the connective tissue wrapping vertebral joints) can cause headaches and pain and such. It's like grinding on a tender, sensitive little ligament that is not designed to be ground on.

Granted, I don't know what the therapist did specifically, but A. Tina doesn't have a lot of 'meat' to protect her joint capsules and B. it's very easy to overwork the joint capsules.

I'm not sure about the bobble head thing, but it doesn't particularly surprise me in this scenario.

Ice, and some time, are the solution here. Basically, the connective tissue has been bruised. Not only can this be painful and cause headaches, but the signal to the nervous system can get wonky. Both can cause intense painful headaches, and could do the bobble head thing.


2. In my humble opinion, Tina's muscles being so weak IS THE REASON SHE ABSOLUTELY SHOULD lift her arms up over hear head.

The body very much works in a 'Use it or lose it' context. It's going to take some getting used to, some strengthening up, some adjustment, as she works out, uses new parts of her body she hasn't (ever) used, and gets stronger.

The tingling in back as she was lifting....she is literally retraining her body to do new things. Adjustments must take place.

It's not a bad thing, and it is something to pay attention to. All athletes must learn to feel their body, and train their body.

She's going from 'weak' to 'strong'. There will be some bumps on the path.

Having said that, as long as the neck is super irritated, I agree, no running or jump rope. As it gets more mild, then start those up.


Does all that make sense? Need more details or clarification?



May 27, 2010
Rating
starstarstarstarstar 		follow up comments
by: Tina's mom

Thanks Josh for your response. Everything you said makes a lot of sense. Tina is feeling better again (no headaches) and has resumed working out. We're hoping by August it'll be 'all systems go' as she returns to an intense grad school program.

You've been very helpful through this difficult recovery. Can't thank you enough!

Susan


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Joshua Comments:

Any time!

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