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SteveW
Trad climber
The state of confusion
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You don't need to, Lynnie--Tarbuster is it. No 17% solution. . .
But he's already taken. . . . :-)
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Tarbuster
climber
right here, right now
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Thanks to Piton Ron,
I spent an hour on the telephone last night with a rheumatology doc.
He spoke with me at length concerning symptoms and reviewed my blood work, history, & EMG/nerve conduction studies.
He understood and underscored the distinction between fatigue/weakness/pain
(my bilateral muscle problem is primarily experienced as persistent and provokable fatigue, while the corresponding lateral and radial tendon problem is expressed as transient and provokable pain)
The skinny:
 MCV is fine
ANA screen indicates no need for individual antibody workup
CPK is fine
vascular/muscular/neurological/anatomical components are un revealing
compartment syndrome: he's not buying it without collateral nerve issues
Nevertheless, when I mentioned inter compartmental pressure testing for chronic exertional compartment syndrome in the forearm may be difficult to test, he then concurred that I need to isolate the physicians who have intervened in the handful of cases extant.
(Dr. Schoeffl, from Germany, who has studied inter compartmental pressure in healthy climber's forearms, returned my e-mail query on the matter and said anybody who has the device for measuring ICP in the calf muscle should be able to do it in the forearm)
The rheumatologist I spoke to last night added that if I want constructive input at this point that I need to seek a specialist in muscle or neuromuscular disease; never mind what they call themselves.
If it's a rheumatologist who I might directly query, muscle disease has to be their focus, but he indicated that at this level of engagement, those practitioners best suited with the problem would rise above any independent definition of practice such as neurology, rheumatology and etc...
He narrowed it down to programs at three facilities:
National Institute of health in Bethesda Maryland
Washington University in St. Louis
UCLA
It turns out we both knew the first rheumatologist who I saw back in 1991/92 and that Dr., coincidentally, has been struggling with a very strange neuromuscular problem of his own which presents only during eccentric contractions and when he engages muscles likewise, his CPK (I think that was it) shoots through the roof.
I also got a note back from the office of one of the better hand surgeons around and they'd never done any inter compartmental pressure testing in the forearm.
Have a good weekend everybody!
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healyje
Trad climber
Portland, Oregon
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Roy,
Man, that sounds really helpful in starting to really hone down both the problem definition and the resources needed to address it. Will be in touch later this weekend...
Joseph
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Toker Villain
Big Wall climber
Toquerville, Utah
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Mike is a no BS, very well informed doc.
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Crimpergirl
Social climber
Boulder, Colorado!
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Sure want to see you well, but to go to St. Louis for it...desperation man! Desperation! Heh heh.
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Tarbuster
climber
right here, right now
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Good point.
I'll be sure to get compartmental pressure variants looked at BEFORE I go to St. Louis.
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Toker Villain
Big Wall climber
Toquerville, Utah
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Hi Roy, was talking to Mike an hour ago while he and his son Alex were driving to San Diego.
Before we got cut off he sounded pleased to have given you some leads.
Then all I heard him say was, "There isn't a restroom for a hundred miles. Do you want me to,... "
Sounds like another epic in the making.
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Tarbuster
climber
right here, right now
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Dr. Mike is a helpful, inquisitive, and patient man.
I mean, he stayed with me even as I strayed briefly into details concerning my wife's blood work and her mountain running career...
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Lynne Leichtfuss
Social climber
valley center, ca
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That is indeed a rare physician for this daily day...of endless hours, govt. regulations, paperwork, and so many cut backs in insurance reimbursement. Cheers to yo Sir. I salute you. LRL
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Todd Gordon
Trad climber
Joshua Tree, Cal
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I can't see...I can't see.....I can't see.....( I can't see missing this party....)...
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Mighty Hiker
Social climber
Vancouver, B.C.
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Does this mean if I miss the party, the yolk will be on me? Or that I'm a yolkel?
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Lynne Leichtfuss
Social climber
valley center, ca
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Well, I sho hope I don't.....miss the partee, that is. Got my casa lined up and hoping to bring a friend or two.
Hey, Gordo we may be out at the Tree Sunday. Taking the kiddos around Ryan Campground area...possibly Headstone Rock, south face...if yo and your son want to join us. :D
EDIT: Hi Mighty Hiker ! Come see us in So Cal in April !!!!!!
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Todd Gordon
Trad climber
Joshua Tree, Cal
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It will be hopping.....
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Pennsylenvy
Big Wall climber
Fry Canyon, UT
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Making my plans around this. What a win -win . Let's all have a gud time and raise some $$$. Still trying to brainstorm $$$$raising ideas....
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healyje
Trad climber
Portland, Oregon
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Me too, never been, should be quite the time. Will jaybro be there do upsidedown things?
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Lynne Leichtfuss
Social climber
valley center, ca
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So what's happening with the band, Cactus Dudes, are yo showing up ? Heard you at Stephanies party. You are pretty darn great !
Peace on a super cool Sunday. lrl
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Tan Slacks
Social climber
Joshua Tree
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Hi Lynne,
The date has been carved in stone. See you there.
Cactus Pricks
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Ezra
Social climber
WA, NC, Idaho Falls
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Tar,
The Rheum doc you spoke to sounds very reasonable and competent.
He's definitely correct you don't need additional antibody testing if you have a negative ANA (sorry if i missed that).
I wouldn't worry about your elevated MCV that much either.
However, I would still take B12/folate supplementation, and know that you ARE at increased risk for clotting and atherosclerosis due to elevated homocystine levels. I have seen clots in fairly young people (40s-50s) due to elevated homocystine levels. Granted yours is barely elevated.
Did he say if you'd benefit by seeing another rheumatologist at the end of march?
Best,
-e
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healyje
Trad climber
Portland, Oregon
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Tar,
Got overwhelmed with work over the weekend - will have time tonight to look at it.
If the whole anitbodies / autoimmune thing is ruled out then it would seem you're honing in one pretty tight on the TOS / CECS sorts of things, even if possibly complicated by the whole frostbite thing.
It would still be interesting to know if the whold viagra/calais thing would have any impact, or even some niacin just prior to climbing.
I've used niacin for outdoor work where my fingers are exposed in fingerless gloves by loosely taping heater packs to the undersides of my wrists and eating well to keep my core temp fueled. It works surprisingly well at getting blood to the extremities and keeping fingers warm.
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Tarbuster
climber
right here, right now
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Ezra,
The rheumatology doctor I spoke with on the phone was of the opinion that if I should see another rheumatologist, they should specialize in muscle desease.
When I countered the muscle disease tact with the idea that this is local he said:
"How do you know it isn't on its way to your legs or elsewhere, albeit slowly?"
I still have my rheumatology appointment for the end of the month (been deliberating on canceling that).
I'm thinking I need to fly to see one of the doctors that has performed a fasciotomy for CECS.
Niacin:
'had plenty, doesn't really help, even if I work up to over 1000 mg doses. As far as the heat packs are concerned; I never go outside in the winter without them.
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