I recently had a doctor say to me: "look, you really need to get focused on how you felt when everything was working right, instead of focusing on your pain. That's what it takes to recover after a surgery." Yeah, I know - should have just slapped his face. Would have been less wear and tear on my vocal cords. But, you know me - why punch when you can just harangue, right? I mean, what is it about, "I have severely atrophied musculature in my lower legs from a congenital condition" that these guys just can't get? "Work harder and you'll be able to re-build them." Oh, criminy sakes, would you guys just listen to yourselves? Where exactly did you do your medical educations?
But that's really just a part of the over-all slide into opinion as the primary operating procedure for expertise we are seeing in this country (yes, yes, its my opinion. Sheesh - it's also my blog, and I don't do this very often, so be patient, OK? The meds ought to kick in soon.) From pretty much every profession, yes, even those supposedly held firmly in the grip of the scientific process, the tendency is toward cookie-cutter thinking, framed through the lenses of ideologies.
So, to review the (actual) science. re: muscle atrophy:
This is an abstract from:
Journal of Bone and Joint Surgery - British Volume, Vol 59-B, Issue 4, 465-472
Copyright © 1977 by British Editorial Society of Bone and Joint Surgery
H Isaacs,
JE Handelsman,
M Badenhorst,
and
A Pickering
In talipes equino-varus the diminished bulk of the calf muscle suggests a neuromuscular defect. Accordingly, biopsies were taken from the postero-medial and peroneal muscle groups, and occasionally from abductor hallucis, in sixty patients mostly under the age of five years; 111 were studied histochemically and histologically, and a further fifty-three by electron-microscopy. Histochemical anomalies were revealed in ninety-two specimens; the muscle fibres in the other nineteen varied in size but were abnormal at the ultramicroscopic level, as were all specimens examined with the electron microscope. Evidence of neurogenic disease was seen in most instances and was more obvious in the older patients. The pattern of abnormality was similar in both muscle groups. It is thought that shortening of the postero-medial muscles may result from a small increase of fibrosis due to minor innervation changes occurring in intra-uterine life. There is evidence that immobilisation, stretching or relaxation of muscles does not account for the anomalies observed. This study of the extrinsic muscles in talipes equino-varus indicates a dominant neurogenic factor in its causation.
And this one:
Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired?
J Child Orthop. 2009 Jun;3(3):171-8
Authors: Ippolito E, De Maio F, Mancini F, Bellini D, Orefice A
PURPOSE: To investigate whether atrophy of the leg muscles present in congenital clubfoot (CCF) is primitive or secondary to treatment of the deformity. METHODS: Magnetic resonance imaging (MRI) of both legs was taken in three cohorts of patients with unilateral congenital clubfoot (UCCF): eight untreated newborns (age range 10 days to 2 weeks); eight children who had been treated with the Ponseti method (age range 2-4 years); eight adults whose deformity had been corrected by manipulation and casting according to Ponseti, followed by a limited posterior release performed at age 2-3 months (age range 19-23 years). All of the treated patients wore a brace until 3 years of age. Muscles were measured on transverse MRI scans of both legs taken midway between the articular surface of the knee and the articular surface of the ankle, using a computer program (AutoCAD 2002 LT). The same program was used to measure leg muscles in the histologic cross sections of the legs of two fetuses with UCCF, spontaneously aborted at 13 and 19 weeks of gestation, respectively. Measurements of the whole cross section of the leg (total leg volume: TLV), of the muscular tissue (muscular tissue volume: MTV), and of the adipose tissue (adipose tissue volume: ATV) of the tibia, fibula, and of the other soft tissues (tendons, nerves, and vessels) were taken by using an interactive image analyzer (IAS 2000, Delta System, Milan, Italy). RESULTS: Marked atrophy of the leg muscles on the clubfoot side was found in both fetuses and untreated newborns, with a percentage ratio of MTV between the normal and the affected leg of 1.3 and 1.5, respectively. Leg muscle atrophy increased with growth, and the percentage ratio of MTV between the normal and the affected leg was, respectively, 1.8 and 2 in treated children and adults. On the other hand, fatty tissue tended to increase relatively from birth to adulthood, but it could not compensate for the progressive muscular atrophy. As a result, the difference in TLV tended to increase from childhood to adulthood. CONCLUSIONS: Our study shows that leg muscular atrophy is a primitive pathological component of CCF which is already present in the early stages of fetal CCF development and in newborns before starting treatment. Muscular atrophy increases with the patient's age, suggesting a mechanism of muscle growth impairment as a possible pathogenic factor of CCF.
(bold highlite added for emphasis)
So, the next time a doctor, PT, orthotist, etc., makes some remark that you just aren't working hard enough, or that if only you'd get focused on healing (like that would be the last thing you really would want, right?) send them these two abstracts.
Then, tell them to shut up and refer you to someone who's already done their homework.
Oh, just to do full disclosure? The second abstract above? I found it at http://www.checkorphan.org/
This is from their "About" page:
CheckOrphan is a non-profit organization located in Basel, Switzerland and Santa Cruz, California that is dedicated to rare, orphan and neglected diseases. CheckOrphan offers users an interactive and dynamic platform for all these diseases. This strategy allows visitors to be updated daily on all the latest news and interact with people internationally. This is essential, because due to the nature of these diseases, there is not a large concentration of individuals within any given proximity.
Visit them today, learn about their mission. They are doing the real work, for people like us - people whose issues fall between the cracks.
But that's really just a part of the over-all slide into opinion as the primary operating procedure for expertise we are seeing in this country (yes, yes, its my opinion. Sheesh - it's also my blog, and I don't do this very often, so be patient, OK? The meds ought to kick in soon.) From pretty much every profession, yes, even those supposedly held firmly in the grip of the scientific process, the tendency is toward cookie-cutter thinking, framed through the lenses of ideologies.
So, to review the (actual) science. re: muscle atrophy:
This is an abstract from:
Journal of Bone and Joint Surgery - British Volume, Vol 59-B, Issue 4, 465-472
Copyright © 1977 by British Editorial Society of Bone and Joint Surgery
The muscles in club foot--a histological histochemical and electron microscopic study
In talipes equino-varus the diminished bulk of the calf muscle suggests a neuromuscular defect. Accordingly, biopsies were taken from the postero-medial and peroneal muscle groups, and occasionally from abductor hallucis, in sixty patients mostly under the age of five years; 111 were studied histochemically and histologically, and a further fifty-three by electron-microscopy. Histochemical anomalies were revealed in ninety-two specimens; the muscle fibres in the other nineteen varied in size but were abnormal at the ultramicroscopic level, as were all specimens examined with the electron microscope. Evidence of neurogenic disease was seen in most instances and was more obvious in the older patients. The pattern of abnormality was similar in both muscle groups. It is thought that shortening of the postero-medial muscles may result from a small increase of fibrosis due to minor innervation changes occurring in intra-uterine life. There is evidence that immobilisation, stretching or relaxation of muscles does not account for the anomalies observed. This study of the extrinsic muscles in talipes equino-varus indicates a dominant neurogenic factor in its causation.
And this one:
Talipes equinovarus
Leg muscle atrophy in idiopathic congenital clubfoot: is it primitive or acquired?| Related Articles |
J Child Orthop. 2009 Jun;3(3):171-8
Authors: Ippolito E, De Maio F, Mancini F, Bellini D, Orefice A
PURPOSE: To investigate whether atrophy of the leg muscles present in congenital clubfoot (CCF) is primitive or secondary to treatment of the deformity. METHODS: Magnetic resonance imaging (MRI) of both legs was taken in three cohorts of patients with unilateral congenital clubfoot (UCCF): eight untreated newborns (age range 10 days to 2 weeks); eight children who had been treated with the Ponseti method (age range 2-4 years); eight adults whose deformity had been corrected by manipulation and casting according to Ponseti, followed by a limited posterior release performed at age 2-3 months (age range 19-23 years). All of the treated patients wore a brace until 3 years of age. Muscles were measured on transverse MRI scans of both legs taken midway between the articular surface of the knee and the articular surface of the ankle, using a computer program (AutoCAD 2002 LT). The same program was used to measure leg muscles in the histologic cross sections of the legs of two fetuses with UCCF, spontaneously aborted at 13 and 19 weeks of gestation, respectively. Measurements of the whole cross section of the leg (total leg volume: TLV), of the muscular tissue (muscular tissue volume: MTV), and of the adipose tissue (adipose tissue volume: ATV) of the tibia, fibula, and of the other soft tissues (tendons, nerves, and vessels) were taken by using an interactive image analyzer (IAS 2000, Delta System, Milan, Italy). RESULTS: Marked atrophy of the leg muscles on the clubfoot side was found in both fetuses and untreated newborns, with a percentage ratio of MTV between the normal and the affected leg of 1.3 and 1.5, respectively. Leg muscle atrophy increased with growth, and the percentage ratio of MTV between the normal and the affected leg was, respectively, 1.8 and 2 in treated children and adults. On the other hand, fatty tissue tended to increase relatively from birth to adulthood, but it could not compensate for the progressive muscular atrophy. As a result, the difference in TLV tended to increase from childhood to adulthood. CONCLUSIONS: Our study shows that leg muscular atrophy is a primitive pathological component of CCF which is already present in the early stages of fetal CCF development and in newborns before starting treatment. Muscular atrophy increases with the patient's age, suggesting a mechanism of muscle growth impairment as a possible pathogenic factor of CCF.
(bold highlite added for emphasis)
So, the next time a doctor, PT, orthotist, etc., makes some remark that you just aren't working hard enough, or that if only you'd get focused on healing (like that would be the last thing you really would want, right?) send them these two abstracts.
Then, tell them to shut up and refer you to someone who's already done their homework.
Oh, just to do full disclosure? The second abstract above? I found it at http://www.checkorphan.org/
This is from their "About" page:
CheckOrphan is a non-profit organization located in Basel, Switzerland and Santa Cruz, California that is dedicated to rare, orphan and neglected diseases. CheckOrphan offers users an interactive and dynamic platform for all these diseases. This strategy allows visitors to be updated daily on all the latest news and interact with people internationally. This is essential, because due to the nature of these diseases, there is not a large concentration of individuals within any given proximity.
Visit them today, learn about their mission. They are doing the real work, for people like us - people whose issues fall between the cracks.
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