Case was recorded that got 75% improvement in hand OA condition by frequent knitting
Chronic tennis elbow might involve instability in elbow joint. I remember being taught to always inject the radio-humeral joint and I can see why if much of the time pathology exists there. Might explain recurrence rates.
Topical anti-inflammatory drug would be the safest way to go in knee arthritis for example. Yet the number of patients needed to treat to help one case was
Ketoprofen – one in 6.9 cases
Diclofenac (Voltaren) – one in 9.8 cases
Continue reading
Recent study paradoxically found elevated B6 levels – up to 4 times normal in 1/6 of burning mouth cases and stopping B6 seemed to help in a case. Could this be of help in others?
Peroneal neuropathy is a symptom complex of shin weakness, atrophy and foot drop, and knee pain. A common cause is a cyst in the nerve as it wraps around fibula. However, this will be missed in 64% of MRI negative cases but seen later. Another example how MRI God is not infallible.
In the mouse model of Multiple Sclerosis, Pramipexole, a antiparkinson drug, stops the brain neuroinflammation and that form of MS called “Experimental Autoimmune Encephalomyelitis”. This agent is used extensively for restless legs – Got MS and restless legs? – I would get on this drug…
An heriditary version of migraine with aura could be cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Early on, nothing is evident even on MRI; but later, damage can be seen on MRI from this vasculopathy. Clinical features include migraine with and without aura, cognitive decline, ischemic events (mini-stroke events), and mood disorders. Imetrix/Sumatriptan – like vasoconstrictor agents potentially contraindicated
Patients with chronic allergies and chronic sinus conditions can end up with cysts in cheek sinus – the cyst does expand and causes remodeling pressure on bony margins and give pain with it. Sinus issues and pain in cheek? – that could be the cause and the treatment is surgery
80 year old with sharp, intermittent, burning pain worsened on sitting down relieved by simple steroid caudal block when all other measures failed.
Case T7 PHN helped by PRF to dorsal root ganglion
Came across a wonderful list of drugs available for post-dural headaches:
https://www.asra.com/content/documents/aug-14.pdf
p13-14,23
If you can’t reach it, here is the list and more
It has always been vague on the fine points of this techique. A beautiful account for this procedure is available in this newsletter:
http://www.asra.com/content/documents/nov-13_asra_news.pdf
on pages 14-17
I have included a summary for those who can’t reach it.
Some LTC facilities are reluctant to be involved in end stage care as they already have a reputation as the place the old go to die. Those that embrace it, require more staff, as the dying have rights to increased supervision, pain control and not dying alone..
A modified Sgarbossa criteria can be used to suggested and Myocardial infarct in the presence of a LBBB. Additionally, it has been suggested to look for “Wellen’s signs” in V1-6:
Wellens’ Type A – biphasic pattern of T waves in V leads
Wellens’ Type B – deep negative T wave inversion in V leads
Earlier I wrote about Nerve blocks controlling headaches.
Quick Fix For Headaches – Repeated Nerve Supraorbital, Infraorbital, and Occipital Nerve Blocks – and What To Do For The Very Bad
http://painmuse.org/?p=2886
Several protocols had been made up. This present one, was weekly Occipital Nerve Blocks either unilateral or bilateral for one month and then monthly thereafter. After 3 months, headache frequency was cut about in 1/2, and the headaches were some shorter and a bit less severe. This is a good or better than botulinum but if used in combo should give great results.
Had one case where I treated unrelenting headache with repeated IV Dihydroergotamine and metoclopramide just to find, as patient settled, that headache originated from a painful patch on the scalp called nummular headache. This is often due to a crushed nerve in area with nerve damage pain in a circular/oblong area. This triggered the unrelenting migraines which overshadowed it. Nummular patch headaches can respond to botulinum sometimes but other treatments are lackluster. Now it look like palmitoylethanolamide (PEA) combined with topiramate might do the trick.
Taking Alpha-Lipoic acid 800 mg/day for 40 days reduced pain and increased 2 point discrimination. Some nerve operations are fought with problems (nerve transfer in cubital tunnel syndrome); now there is a help.
Pain in midportion achilles tendon medially could be a Plantaris muscle rupture. Eccentric exercises for Achilles tendonitis will not help.
Antibody biologic administered 14 infusions cut sickle cell crises from 2.98/yr to 1.63/year.
Pulsed radiofrequency to dumb down treated nerve is becoming a useful adjunct to treating untenable pain CRPS states. Post hip fracture leg painv pain state left patient with VAS 6-7/10 with breakthru of 9/10. Following dropped to 3/10 – after 8 months went back to 6/10 and was repeated and then down to 2-3/10.
In Dr. Travell and D. Simon’s book they talk about proper cane position:
– on opposite side to leg pain (it become good leg when you lift good leg)-shoulder horizontal with cane held out 15 degrees from body
Now additionally, 15% of your weight should be applied when using it.
Continue reading
Clin Cases Miner Bone Metab. 2016 Sep-Dec;13(3):234-236.
doi:10.11138/ccmbm/2016.13.3.234
Safety and efficacy of vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a prospective multicenter international randomized
controlled study.
Leali PT, Solla F, Maestretti G, Balsano M, Doria C
https://www.ncbi.nlm.nih.gov/pubmed/28228788
Spanish journal which I do not get but results seem clear enough – ketoralac 60 mg ?IM and Nifedipine XL 30 mg by mouth give best results.
Hypothyroid victims on Levothyroxime have a 3 times relative risk to having bacterial overgrowth and the IBS connection that goes with it.
0.05% Methylene Blue oral rinse therapy was cheap and effective treatment for mucositis from chemotherapy or radiotherapy. Amazing result could be big help.