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Mighty Hiker
Social climber
Vancouver, B.C.
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Feb 28, 2009 - 07:07pm PT
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It's real and it's a sculpture on a boulder in the forest below the Grand Wall at Squamish. It was created in the late 1960s, and is about a metre high.
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Chiloe
Trad climber
Lee, NH
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Feb 28, 2009 - 08:00pm PT
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So I'm gone for a while then come back to find that this thread, well-inspired to
begin with, has evolved into the Taco's finest hour. Never seen more thoughtfulness
and sincerity, everybody chipping in what they can (and for some that's quite a lot).
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Tarbuster
climber
right here, right now
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Feb 28, 2009 - 09:19pm PT
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MH2,
Per your suggestion, I’ve recast the question.
As you said you hadn’t read the thread, I’ve embedded my primary symptom and the question (both in bold) within a concise history.
Thank you,
Roy
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Male patient, 48 years of age, physically fit and active.
Presents with intransigent forearm fatigue, bilateral, medial compartments, 12 years.
(complicated with persistent bi-lateral, lateral epicondylitis/tendonosis)
Additionally presents extreme cold sensitivity to all extremities, yet capillary refill is robust.
 Vasodilators at the arteriole level, two week course, give no relief to cold symptoms
(nifedipine, time release)
No history of major surgeries or protracted medication.
Severe concussion, age 12.
Initial physical exams negative for compartment syndrome and thoracic outlet compression.
3 mm bulge at C5/6 confirmed with MRI at C-spine; deemed irrelevant by neck/neurosurgeon.
Three consecutive nerve conduction studies over eight years, negative.
Although presenting symptoms for diagnoses are incomplete, the following are suspected:
Chronic Compartment Syndrome:
inter compartmental pressure has not been tested; doppler yields a negative
http://www.jbjs.org.uk/cgi/reprint/78-B/5/780
Exercise-Induced Thoracic Outlet Compression:
CT angiogram during a variety of positions has not been performed; thoracic pulse is good
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1764965
Following exclusion of these two diagnoses listed above, could a congenital microvascular insufficiency be further complicated with the following aggregate, so as to precipitate permanent bilateral forearm fatigue?
Cardiovascular risk factors collateral to gum disease
Peripheral trauma to the hands from severe second-degree frostbite injury
10 years of sustained rockclimbing at five days per week
7 additional years of sustained fine motor skill work at a sewing machine at six days per week
Adrenal fatigue
High level of homocysteine
At year 17 of consecutive repetitive stressors: rapid onset of bilateral forearm fatigue occurs
Note that following the combined 17 years of repetitive stress noted above, the 12 ensuing years have encompassed a 70-90% reduction in said stressors, with little to no recovery.
(I’m leaving any detail or a link to Reflex Sympathetic Dystrophy Syndrome out; I mentioned that I would include it because I had heard that it can be caused by damage to blood vessels; frostbite in my case.
So many of the presenting symptoms are so severe and I just don’t show them, that I didn’t run it down any further, but I thought someone familiar with that syndrome might be able to cross-link that particular causal factor and it’s propagation routine.)
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MH2
climber
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Tarbuster,
I've gone back and had a look from the beginning of the thread. From what I see there is a Hell of a lot more that is right and good about you and your past than this medical trouble amounts to, whatever it is. You are a great guy and have an amazing history.
On the specific question of a possible congenital defect I will quiz my wife. When I mentioned the forearm weakness last night she just said, "repetitive-use injury." I know it isn't that simple but that could still be a fair part of it.
What radical said seemed about right to me:
Could be just a plain old overuse injury and severe tendonitis after years and years of climbing.You are off the grid for just about all docs and medical books
Especially the part about being outside the norm for most docs. Your forearms are unlikely to be middle-of-the-road forearms. If I remember rightly there are a lot of adaptations when you use particular muscles heavily, such as increased capillarity, that could perhaps make the usual diagnostic tests for particular conditions unreliable in your case.
Strange that you can have weakness with no (detected) nerve involvement or altered sensation. Also in one of the earliest posts on symptoms there was the phrase "searing pain." I understand it only happens with use but it sounds unusually intense.
Please overcome any inclination you may have to respond to this post. I have a suspicion that your excellent and well-directed motivation may in a sense be doing you in, here. Slack off a little, man.
Very best wishes,
Andy Cairns
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Ezra
Social climber
WA, NC, Idaho Falls
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Tar,
That summary you just wrote is a great cover letter,
I would only add 2nd degree frost bite in '84 (as part of the main history)
best, -e
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spectreman
Trad climber
CO
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The people I have treated with RSD (Reflex Sympathetic Dystrophy) have severe and constant pain in the involved extremity with hypersensitivity to the point where they cannot tolerate clothing touching the skin or any type of manual contact. They also exhibit sympathetic nervous system changes as they relate to vasodialation and constriction and they can start to have skin changes due to poor circulation in the extremity.
A non-specific Thoracic Outlet Syndrome is a possibility. It is common to exhibit some symptoms of TOS without having any positive Dopplar or EMG/NCV results. You can have mild and transient compression of neural components. Usually compression will occur in the scalene triangle, between the first rib and clavicle, or under pec-minor. Worthwhile to have a skilled manual therapist check these compression sites. Also worthwhile to have a manual therapist perform neural gliding stretches to evaluate movement of the three primary nerves into the arms. I will be glad to perform a one hour manual therapy consultation free of charge if you want to make the trip to Ft. Collins to my clinic. Just let me know. I can also donate several sessions of ASTYM if you think it is a tendinosis problem.
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Tarbuster
climber
right here, right now
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Okay MH2,
One brief question:
Anybody ever heard of localized mitochondrial dysfunction as a result of severe overuse?
And in the same vein, how about cross fiber challenge from competing activities producing permanent muscle damage?
E-mail out to you Specter Man; I'll take you up on you're generous offer.
Thanks Fellas.
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MH2
climber
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Good news, I think.
My wife sees no reason to suspect any congenital type syndrome in your symptoms.
She guesses compartment syndrome could be it and the great thing there is that it can perhaps be substantially relieved by surgery. I read the short paper matisse linked to.
My wife also says that Reflex Sympathetic Dystrophy is usually more intense and constant pain than you seem to have, although she points out that that comes partly from the fact that in order to get the diagnosis that level of pain should be there, a kind of catch-22 perhaps. She says that frostbite could cause sympathetic dystrophy and that there could be milder forms that would not be necessarily diagnosed as such.
I'm not really the person to answer your latest questions. I have read in the lay press or somewhere that mitochondria not only have their own DNA, they also, not individually but as a collective in any one person, have their own natural life span that is somewhat shorter than our own. They don't suddenly check out but they do begin to fade, starting roughly at age 50. One many changes that come with age.
Tarbuster, you have a fine mind and great strength of character. Any employer would be lucky to get you. I re-trained as a nurse at age 50 in an 18 month program. I now work with oldies who have in the head what you have in the forearm. Well, in a manner of speaking. Science has trouble figuring out conditions like yours that come on gradually over years. It is hard to do studies other than epidemiology on that time scale.
If a fasciotomy can fix your arms, though, then we won't have to worry what is going on down at the molecular level.
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Tarbuster
climber
right here, right now
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Thank you MH2
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Robb
Social climber
It's like FoCo in NoCo Daddy-O!
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Bump - Back to the front page for Monday morning.
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Bullwinkle
Boulder climber
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I'm going to print up a few very very special images for this event, one of a kind, one time only, StoneMaster images I made, from my vault. Photo's that I've never printed or shown and will not be in the Book. . .df
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Flanders!
Trad climber
June Lake, CA
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Roy,
It is quite heartwarming to see the topians coming out
in force to seek a solution and offer support. This
really is a good bunch, quite varied talents and skills,
and not slow to offer it up.
Climbing is great, no doubt, BUT life is really about
people and relationships. And it's gooood when it
functions as it was designed.
Doug
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Ezra
Social climber
WA, NC, Idaho Falls
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Tar,
Spoke to my vascular surgeon friend 'bout the CT-Angiogram, said he would NOT have that procedure.
He said the intra-compartmental pressure testing might be worth a try and would probably go that route.
He again reiterated that it is a technically difficult procedure (the ICP testing).
Best,
-e
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Tarbuster
climber
right here, right now
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Great feedback Ezra.
Excellent offering Bullwinkle.
Very nice words Flanders...
LuvU2T*R
Thanks Everybody!
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Todd Gordon
Trad climber
Joshua Tree, Cal
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" I'll try to make it...."'
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ron gomez
Trad climber
fallbrook,ca
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Yeah Todd, I WAS going to show up for Roy The Boy Toy, but since she is coming for the event....I'll be there again!
This needed a bump for maculated.....be there Kristin and bring ALL yer friends, climbers or non climbers.
Peace
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Rick A
climber
Boulder, Colorado
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Topic Author's Reply - Mar 3, 2009 - 08:55pm PT
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Auction stuff is pouring in...It's going to be a great night.
Rick
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Tarbuster
climber
right here, right now
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Thanks to all who have been sending checks!
Spent some today on MAT: a manual physical therapy aimed at revitalizing/balancing chronically spasmed/splinted muscles...
Specter Man has donated a physical therapy evaluation for Friday the 13th. How auspicious!!!
Rheumatology appointment on March 31.
Still looking for the best doctor to test intracompartmental pressure.
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Todd Gordon
Trad climber
Joshua Tree, Cal
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Swingers welcome...
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Todd Gordon
Trad climber
Joshua Tree, Cal
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Bolton has threatened to show up.........but he has a 10 beer limit....or else he gets all wiggly, gushy, and gay......
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