Exercise Resolution

With a 5-lb potato bag in each hand, extend arms straight out from sides & hold.  Soon you’ll find you can hold this for a bit longer.  Try to reach a full minute.  Then move up to 10-lb bags, then 50-lb bags & eventually get to where you can lift a 100-lb potato bag in each hand & hold your arms straight for more than a minute.  (I’m at this level)  Once you feel confident at that level, put a potato in each bag.

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It’s that time of year when people make New Years resolutions, and variations on exercise/get in shape/be healthier are common.  Despite my wish to be in good shape, wishing won’t make it happen.  I need concrete goals (I’ve previously written about goals here):

My resolution/goals are:

1. Develop and follow an exercise routine
2. Write weekly menus for my family and prepare those well-balanced, nutritious meals
3. Carefully keep track of everything I eat

I’ve already been working on the first one.  My family joined the YMCA, and part of the membership fee included an appointment with a personal trainer to customize an exercise program.  This was a huge waste of time.  Fortunately, I also saw a new physical therapist.  The contrast was remarkable.  My physical therapist has been working with me to find stretches and exercises that start with where I am now and will protect my joints while getting me into good physical condition.  I’m already seeing progress.

I also bought a home gym.  Do not pay full price if you decide to do this.  Craigslist is a great place to find exercise equipment.  Things tend to be more expensive when everyone is making New Years resolutions, but many people give up on their resolutions after eating tons of Valentines chocolate, and prices go back down.  Here’s what I got:

The reason I chose this model is that it includes a rowing machine, which is fantastic low-impact cardio.  I still have my elliptical, so now I have two cardio options.

One entire PT session was spent going through the exercise book that came with my home gym, with the physical therapist marking which exercises I should do and which ones should be avoided.  It was pretty interesting to see the therapist’s eyes grow big as saucers as she exclaimed, time and again, “Oh, my!  Don’t do this!  It would be terrible for your ____.”

I love having my exercise routine designed by someone who knows what she’s talking about.  Now I just have to put it into practice.

Any resolutions you wish to share?

Rotator Cuff Tears

Found an interesting bit at MedPage Today.

There are several effective approaches for treating a rotator cuff tear, but none stands above the rest, a systematic review showed.  A literature review revealed that both operative and nonoperative approaches work for improving function and relieving pain, Jennifer Seida, MPH, of the Alberta Research Center for Health Evidence at the University of Alberta in Edmonton, and colleagues reported online July 5 in the Annals of Internal Medicine.

But evidence comparing different techniques was limited and weak, “which precludes firm conclusions for a single approach or the optimal overall management of this condition,” the researchers wrote.

Complication rates across studies were low.

“Because of the low event rates, the benefit of receiving treatment for rotator cuff tears seems to outweigh the risk for associated harms,” Seida and her colleagues concluded from their review, which was prepared for the Agency for Healthcare Research and Quality.

Really?  Getting treatment for a tear is a good idea?  They spent money to figure this out?

Without treatment:  can’t get things out of the cupboard, can’t use a computer’s mouse, can’t wash own hair, can’t dress without assistance, can’t reach overhead, difficult to lift things, can’t play guitar (or violin or piano), can’t help put up hay…

With treatment:  function restored (at least enough to do most routine activities)

It’s really not as obvious as some of the studies Dr. Grumpy reads.  There are risks associated with treatment (even though the article doesn’t say what those risks are).  It’s like taking medicine:  you only want to do it if the potential benefits outweigh the risks.  What they wanted to know is which treatment is best (comparative effectiveness at work?).  The answer is that we just don’t know.  It’s worth reading the entire article:  No Clear Favorite for Rotator Cuff Repair 

With any luck, some poor student in need of a study topic will follow-up and figure out which treatment is most effective.  Not just PT versus surgery, either.  If the answer is PT, I want to know which PT exercises would be best.

I tore my rotator cuff last July.  That’s right – a full year ago.  First I did exercises at home that had previously been prescribed for tendonitis.  They didn’t work.  Eventually I spent hours travelling for treatment only to pay a physical therapist to tell me to do the exact same thing I was already doing.

Since all that work/time/money didn’t help, I wasn’t too optimistic when I was sent back for yet another round of PT.  This time, though, I’ve been given different exercises.  This time it’s working.  I don’t have full use, but enough to do most things.  So why didn’t we start with these exercises instead of spending two months (and blowing my insurance company’s PT allotment) on something that was useless.  It would have been really nice to start with the exercises that work.

I guess that’s the point of the study.  Treatment helps, but it would be nice to know which treatments would be best for a specific tear.

Another Doctor

Resting – two weeks of doing nothing - was great for the pain level in my shoulder.  I even considered cancelling my appointment with the surgeon.  Alas, it didn’t take much time at home to realize that although I was feeling better, keeping that appointment might be the better part of discretion.

I’d thought that scheduling on the second day of the week would avoid all the Monday madness of everything that goes wrong over the weekend.  Maybe so, but this particular orthopedic practice has ten surgeons on staff and for some weird reason, none of them do surgery on Tuesday; all ten see clinical patients on Tuesday, which leads to a huge number of patients running (sometimes hobbling) through the office.  It was crazy!

When I checked in I handed the receptionist a small pile (photo id, insurance card, check for co-pay, disk with x-rays and MRI).  She said, “I love patients who are organized.”  I loved her right back when she told me that they communicate with patients via email!

The doctor was very nice.  Like me, he has a fifteen-year-old daughter learning to drive.  And I’ve been reflecting on the fact that I learned this little piece of trivia.  This is no surprise to my regular readers, but I tend to be a very task-oriented person.  Not that relationships aren’t important – they are – but a visit to a doctor is for a specific medical purpose and I’ve tended to view small-talk as being off task.  It wasn’t until I started reading medblogs that I discovered that there are doctors who enjoy visiting with patients, and that there’s a little bit of social time built into office visits.  Pre-medblog reading, I answered questions directly and to the point, cutting off any side issues.  I didn’t realize that sometimes the doctor was just trying to put me at ease and get a little social history.  As a cool bonus, I’ve discovered is that it’s easier to trust a doctor if I know something about the person; not that it should matter over their credentials, but it does make me more comfortable (which is kinda weird).

We chatted, and he noticed my notebook and the form on which I take my notes.  Never before has a doctor observed aloud that I appear to be type-A.  Who?  Me?

About the shoulder:  at the appointment, my range of motion was better, and I had much less pain than a couple months ago.  A look at the films and an exam yielded a cortisone shot and a referral for more PT.  That might provide some relief for now and put off the need for surgery – but that I’ll probably need to have the shoulder fixed within a year.  My job, he told me, is to do the PT exercises and cheat him out of an operation.  When I asked which kind of cortisone, he smiled and gestured at my form while answering my question, knowing that I’d write it down.

Note: my range of motion was better, and I had less pain at the appointment.  Last night when I sat down to check my email and catch up on my reading, I tried to lift my arm to reach the computer mouse.  It didn’t work.  I could use my left hand to maneuver my right arm, but it was both cumbersome and painful; I quickly gave up.  Getting ready for bed was a challenge, but I finally collapsed onto the bed – and found that laying down hurt even worse.

After trying every possible sleeping position, I grabbed a couple polar fleece blankets (light-weight, easily portable) and headed back downstairs where I spent the night in a recliner.  Around 1:00 even managed to fall asleep for a couple hours.  This does not bode well.  As much as this hurts now, I am not looking forward to seeing the physical terrorist for repeated torture sessions.  I’m wondering if all this pain is just from the doctor manipulating my shoulder to see what it would do, or if this is one of those rare complications of a cortisone injection.  Things were fine until I tried to extend my arm, and now… oh!my!word! it hurts.

I’m headed out of town for the weekend, and will be back next week.  Have a great weekend!