[at-l] calling all docs..

[shane@theplacewithnoname.com (Shane Steinkamp)]

OFF LIST

> question for orange bug and bear bag, and anyone
> else with an MD...

Will a field surgeon and massage therapist do?

> I had osgood-schlaters(sp) in both knees as a
> teenager - that would be three decades ago.  I am
> taking glucosamine...

Osgood-Schlatter disease isn't really a disease.  It's a
condition caused by the way some people grow.  It shouldn't
be possible for you to suffer from that anymore, and you
shouldn't have had any lasting effect from it - unless you
actually tore the muscles or ligaments.  Did you?

> my right knee has some sort of -it's going on.
> it seems equally swollen all around, and feels
> like a band of pressure.  it only hurts when kept
> in one position, as when I sleep.  when I walk,
> the swelling reduces, I forget about the knee,
> and all seems fine.  when I stop walking, I may
> feel a bit of pressure, but it really is a
> non-issue.

Having no pain is good, but the pressure is still an
indicator that something is wrong.

> there is a moderately tight
> compression brace on the knee from first hiking
> step in the morning to last hiking step in the
> afternoon.

Why?  Is the brace necessary?  Does it fit properly?  If you
sleep in the brace does it make the knee better or worse?
What about sleeping with it wrapped lightly in an ace
bandage?

This can actually be bad.  I don't know your definition of
'moderately tight', but even though you may not be cutting
off circulation of the blood, you could be cutting off
circulation of the lymph system.

> the knee responds well to my pain
> killing cocktail of Excedrin and ibuprofen, two
> tabs each.  my pain killing cocktail was not
> meant for knee discomfort, but rather for my ever
> possible migraine headaches, and I take the pain
> killers always as a last resort...

As you should.  Pain killers, any pain killers, have a bad
reputation in my book.  People have pain, take them, and
keep doing what it was that caused them the pain.  Of
course, as we grow older, sometimes there is nothing else to
do...  So long as you're not popping 20 a day, they should
be fine so long as you alter the Excedrin/ibuprofen every
two hours, and aren't taking them at the same time.

> please give me advice.  if that advice is to lay
> low for a bit, or to go see a doc, or even to get
> off of the trail, I can deal.  if you need more
> info, please ask...

Ah, advice, now that's dangerous...  Without actually
examining you, I'll offer you these:

If you stop moving, and everything locks up, are you sure
you'll ever be able to start moving again?  Now, that's
extreme, but it illustrates the point:  Keep moving!

See an orthopedist.  See a good one.  If you don't like him
or her, get another.  (Where do you live, I may be able to
find somebody...?) Never have surgery unless you cannot
avoid it.

The problem might not be in your knee at all, but rather in
your shoe.  This is an often overlooked area.  If you wear
different shoes, do your knees improve, or not?  What about
barefoot?

Before you start every day, massage the knee for ten
minutes.  When you stop for breaks, and at the end of the
day, remove the brace and massage the knee.  Massage the
knee vigorously.  Try to move the fluid UP the leg.  You can
use something like a rolling pin and literally 'roll' the
fluid up your leg.  (Of course, only roll up.  You don't
want to drive fluid down to the foot.)  When resting and not
massaging, lay on the ground and elevate your legs on a
rock, tree, or your pack.  Flex the knee deeply while there
is no pressure on it.  (Does it POP, creak or groan? Does it
hurt more to straighten it, or to bend it deeply?)
Circulation is the key.

Use of certain things, like aspercream, bengay, and my
personal favorite Zeng Gu Shu (available at Chinese stores),
may help.

See a massage therapist, and explain your problem.

Don't put ice on it.  Never put ice on it.  This is against
the 'western' wisdom, but cold will only make it worse.  If
you do want to use cold, utilize vascular pumping.  That is,
put a cold compress (NOT ICE) on the knee, or wrap a towel
that has been soaked in cold water and put in the freezer
for 20 minutes then around the knee for ten.  Put the towel
back in the freezer and wrap a heating pad or towel soaked
in VERY HOT water around the knee for ten minutes.  (Hot as
you can stand, but don't burn yourself.)  Alternate this
every five or ten minutes for as long as you like or until
you feel substantial relief.  Always end with the hot towel.
(No good having cold joints.)

A nice soak in a hot tub always helps.  Of course, there
isn't much hot water on the trail...

Shane