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Mighty Hiker
Social climber
Vancouver, B.C.
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Feb 24, 2009 - 03:24pm PT
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"Shoals" seems more poetic than "shallows", so I changed it.
How is tarbuster himself going to get to Joshua Tree on the 25th?
Bump.
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Prod
Trad climber
A place w/o Avitars apparently
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Feb 24, 2009 - 03:34pm PT
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Yo Tar,
Just because Cialis is for your arms is no excuse to waste a boner! Getty up Lisa!
Prod.
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graniteclimber
Trad climber
Nowhere
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Feb 24, 2009 - 06:35pm PT
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"I think Healy is right on on his last post. It is unlikely that an amino acid disorder would present as a localized forearm issue."
The problems are isolated to your arms (mostly your forearms), correct? And although you had severe tendonitis before, it got much worse after you really pumped out your forearms in the theater job?
Bad enough compartment syndrome could potentially cause long-lasting damage to the nerves and muscles. Have they ruled this out?
http://www.nlm.nih.gov/medlineplus/ency/article/001224.htm
http://emedicine.medscape.com/article/1269081-overview
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Tarbuster
climber
right here, right now
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Feb 24, 2009 - 07:52pm PT
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Granite Climber,
Yes this is what we have been discussing and thanks for those links.
However, per the first link you provided, during rapid onset of this muscle failure (not muscle failure in a clinical sense, this is just what I call it) which was almost 12 years ago (June/July 1997), I never experienced any of the following:
"Typically, severe pain will occur when a muscle running through a compartment is passively moved. For example, when the doctor moves the toes up and down, a patient with compartment syndrome in the foot or lower leg will experience severe pain. The skin overlying the compartment will be tensely swollen and shiny. There will also be pain when the compartment is squeezed."
When a neurosurgeon looked at my C-spine MRIs, around 2001, he conjectured at best I may have had a minor bout of compartment syndrome. But I never had a tensely swollen, as in outsized, shiny skinned situation with my arms. It wasn’t particularly painful, as in adding pain, to engage in flexion or extension at the time. Hypertonicity of the muscle maybe... largely a feeling of stiffness and fatigue.
I've heard secondhand reports of a young climber with compartment syndrome in the forearms. The reports definitively involve the swelling of his forearms; I would never describe this, then or now.
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Toker Villain
Big Wall climber
Toquerville, Utah
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Feb 24, 2009 - 08:12pm PT
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OK, just back and only skimmed a few pages, but Roy, my man! You made friends with a rheumatologist who has climbed Cerro Torre at Snow Canyon.
I'll talk to him again shortly. Do you want me to have him give you a call?
email me.
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Tarbuster
climber
right here, right now
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Feb 24, 2009 - 08:18pm PT
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Ron,
So I've met the man?
Sure, have him call me 303 258 3455.
Granite Climber,
I can certainly see the similarities.
Again from your second link:
This looks much like CECS proposed by Healyje:
"Chronic CS (CCS) is a recurrent syndrome that occurs with exercise or work. CCS characterized by pain and disability that subside when the precipitating activity is stopped but that return when the activity is resumed. Although more common in the anterior compartment of the lower leg, CCS has been described in the forearm of motocross racers and other athletes.7, 8, 9
Chronic CS (CCS) is clinically distinct from the acute CS; it often occurs bilaterally, and pain may be reproducible at a specific workload or time interval. Most athletes cannot play through the severe pain, but symptoms tend to resolve within an hour of terminating the activity. Bilateral CCS should be suspected in patients who complain of bilateral exercise-induced pain in the anconeus muscle, the forearms, the thenar and hypothenar regions, and the first dorsal interosseous muscle. The symptoms are usually minimal during normal daily activities."
Again, although it's very close, bilateral and exercise-induced (exacerbated would be more correct), it doesn't necessarily go away upon cessation of activity and never did.
Also I've had a handful of physicians performing exams for compartment syndrome: reviewing my history, listening to my descriptions, and they're just not coming up with it; not enough to do a pressure test.
Doesn't mean I don't have some weird form of it...
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graniteclimber
Trad climber
Nowhere
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Feb 24, 2009 - 08:25pm PT
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Yeah, most of the material on compartment syndrome is about accute compartment syndrome (when someone gets compartment syndrome after being in a car wreck for example.) There is not as much material out there on chronic compartment syndrome. Also, as far as I know it is pretty rare for people to get "permanent" damage from chronic compartment syndrome. But from what I've read, it is possible.
In chronic exertional compartment syndrome, the repetitive activity causes tissue in the affected muscle area, or compartment, to swell. That, in turn, increases pressure within the compartment, leading to a decreased blood supply to the muscles. This can cause injury to the muscle and nerves, sometimes resulting in permanent damage.
People with chronic exertional compartment syndrome typically experience pain that begins with activity, progressively worsens and then stops when at rest. As the condition worsens, however, the pain can take longer to subside.
Chronic exertional compartment syndrome is uncommon and sometimes goes undiagnosed. It's not known how many people may be affected, but the number of diagnosed cases has been rising in recent years. The condition seems to affect primarily young athletes in their 20s, although younger and older people also can develop the condition.
Chronic exertional compartment syndrome can be difficult to diagnose, partly because the affected limbs generally look perfectly normal — they may not even appear swollen.
"Introduction" section of http://www.riversideonline.com/health_reference/Disease-Conditions/DS00789.cfm (content from mayoclinic.com)
Chronic exertional compartment syndrome isn't a life-threatening condition and often doesn't cause any lasting or permanent damage. However, if you continue to exercise despite pain, the repeated increases in compartment pressure can lead to muscle, nerve and blood vessel damage. As a result, you may develop permanent numbness or weakness in affected muscles.
"Complications" section of http://www.riversideonline.com/health_reference/Disease-Conditions/DS00789.cfm
(content from mayoclinic.com)
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Tarbuster
climber
right here, right now
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Feb 24, 2009 - 08:33pm PT
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Good work.
Okay so no swelling necessary for a positive on chronic compartment syndrome.
But not getting any nerve damage, not presenting with tingling or numbness, just had a workup from a vascular surgeon and nerve conduction studies with a neurologist, then two prior nerve conduction studies from Physiatrists in 2000 and 2004; no discernible problems there and this has been going for almost 12 years.
Still, pretty close from a layman's perspective, to some chronic form of compartment syndrome.
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Toker Villain
Big Wall climber
Toquerville, Utah
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Feb 24, 2009 - 09:32pm PT
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Hey!
You were supposed to email!
Too late. Spoke to him, gave him your number.
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Tarbuster
climber
right here, right now
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Feb 24, 2009 - 09:38pm PT
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Bitchin'...
(old school for way cool)
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Tarbuster
climber
right here, right now
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Feb 24, 2009 - 10:15pm PT
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Granite Climber,
The second link in your previous post is the best one yet, great job on running these down.
"To make a potential diagnosis of CCS, patients had to fulfil certain clinical criteria in terms of history and examination: (i) the forearm pain must have been of gradual, not acute, onset, deteriorating to a point where repetitive usage of the affected arm in the workplace and at home was becoming restricted and which persisted after work; (ii) there should be distal neurological complaints (paraesthesiae, burning sensation, loss of sensation in the hand, often with a history of shooting pains down the forearm to the wrist after strenuous use, and of interrupted sleep due to forearm pain and paraesthesiae over the back of the wrist); and (iii) other diagnoses must have been excluded. All such complainants had been in jobs requiring prolonged minimal-variation repetitive work involving the painful arm; (keyboard, light assembly/food processing/packing/heavy industrial assembly), so this appears to be a de facto requirement as well.
In addition to the above, clinical examination should elicit tenderness, with or without swelling, on local pressure over the extensor muscle compartment in the upper forearm and often with a positive Tinel's test over the posterior interosseus nerve (PIN) at this point. Repetitive gripping ability over a 2 min test period in the affected hand should be both reduced and progressively painful. Pain and altered sensitivity to touch or pinprick over the dorsum of the wrist and mild median nerve sensitivity are often found but without typical carpal tunnel symptoms. A total of 42 patients fulfilling these criteria have been studied (group 3; 11 males, 31 females).
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I am however not meeting the criteria; I have no neurological complaints, burning, loss of sensation, or shooting pains, as noted in the first paragraph. And as required for a positive diagnosis.
Per the second paragraph, tenderness is not elicited when the arms are palpated.
Even so, this is really good stuff.
If nothing else, the bells are ringing all around the rheumatology department.
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John Moosie
climber
Beautiful California
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Feb 24, 2009 - 11:16pm PT
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Roy,
I feel for you and hope that you find a solution. I have had two times in my life when I had health problems that were difficult to diagnose, so I know what you are going through. The first time was in my twenties. I had intestinal pain and trouble digesting food. 12 specialist later I had a diagnosis of Crohn's disease and one of colitis and one of ulcerative colitis. I was so happy when I got the first diagnosis of colitis, because I thought I was on track to fixing it, then I found out that colitis means pain in the intestines. Doh ! At one point the docs recommended removing a large section of my intestines. I asked for a second opinion and the doc scoped me again and found that the section of my intestines that was inflamed was no longer inflamed, but a completely different section was.
Eventually I got frustrated with docs and stopped going. I went on a very restrictive diet and cut out milk products, red meat, corn, wheat, sugar, caffeine and alcohol and all prescription meds, I was on a long list of meds including prednisone . After about 3 years I got considerably better and added most of those foods back into my diet.
Then in my forties my health went south again. The short list is that I had Multiple Blood clots, lung problems, a minor stroke, plus rhuematoid arthritis. Then it appears that some of the meds I took weakened my tendons and I blew out my achilles.
Eventually I started doing things like meditating and now my health is slowly coming back. My adrenal glands were totally shot and everything hurt and I think the meditating helped with that.
There are other things that I believe have helped me, such as really looking into what I believe about God. I know that many people don't want to hear this, so I wont go on, but I do pray for you and hope that you will find the solutions that you need.
You have been a source of inspiration for me as you calmly negotiate your way through your problems and this has helped me to see that my reactive nature wasn't helping me. So thank you for that. I really admire your courage and fortitude, and your willingness to be enthusiastic. Even more so now that I know more about your conditions and the challenges that you face.
Hoping for the best.
John
P.S. Thanks Erza for your input. I know that I and others have been hard on docs in the past here on the taco, so I appreciate your willingness to jump in.
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Tarbuster
climber
right here, right now
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Feb 24, 2009 - 11:20pm PT
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Your encouragement and prayers are much appreciated and wholeheartedly accepted!
Yes, Ezra has provided steadfast and productive companionship here along this stretch.
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Lynne Leichtfuss
Social climber
valley center, ca
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Feb 24, 2009 - 11:22pm PT
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Nice and Honest post from the heart Moosie. Good to hear from you and Howdy. We met at the FaceLift. Hope to see ya this coming year, God willing and the Creek don't Rise...as my Grandpa used to say. Lynnie
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Tarbuster
climber
right here, right now
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Feb 24, 2009 - 11:37pm PT
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Well, if the creek rises, GROUP HUG and as a unit we'll rise above!
Flotation is groovy...
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Todd Gordon
Trad climber
Joshua Tree, Cal
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Feb 24, 2009 - 11:45pm PT
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See Tucker's feet;...IN PERSON....Stonemaster slides/Tarbuster Benefit;...........
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John Moosie
climber
Beautiful California
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Feb 24, 2009 - 11:46pm PT
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The creek sure did rise here in Wawona after that last rain. I enjoyed meeting you at the facelift Lynne. Maybe next year I will challenge you to a game of bocce ball if I make it down before dark. haha..
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Todd Gordon
Trad climber
Joshua Tree, Cal
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Feb 24, 2009 - 11:53pm PT
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Lynne Leichtfuss already starting to party;....(getting ready for April 25th)....
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Ezra
Social climber
WA, NC, Idaho Falls
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Feb 24, 2009 - 11:58pm PT
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Tar,
I had thought about the chronic compartment syndrome too, the more I think about the more likely it seems. My mentors use to say to me "uncommon presentations of common diseases are more common than uncommon diseases". Another way to interpret that statement is "patient's don't read the text book".
If Rheumatology fails to find an answer an orthopaedic hand surgeon would probably be a good next step (unfortunately they ain't cheep).
The Cialis suggestion would be almost entirely experimental (and off label) , again it would only treat the symptoms and not the underlying problem, although if you responded it would further strengthen a vascular argument.
Chronic compartment syndrome or vascular insuficiency (microvascular narrowing) are my favored diagnoses (and would present essentially the same way). We'll seem what rheumatology turns up. It's good for us all not to get to in love with our ideas (especially full of themselves MD's like myself).
Logically, it would seem your forearm muscles are out stripping their blood supply, either due to temporary reversable occluison (chronic compartment syndrome) or narrowing of the arteries (vascular occlusion). Now lets find a way to prove it and fix it.
Best
-e
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