Got news about an hour ago about a young friend. Apparently, she killed herself this past weekend. I've had this happen twice before in my life (I guess if you live long enough, odds are it'll happen in your life, as well.) It always leaves a hollow feeling, especially for those who have known the depths of depression themselves - not the actual urge, mind you, but the internal dialog. Especially when pain just seems never-ending, and pointless. You move beyond that "why me" crap, and end up, well, down, less worried about such a stupid question, and more resigned to, how should I put this? Never being "normal?" Tired? Many clubbies have had those nights, and days, and if not thinking about cutting the damn things off, perhaps only thinking about drowning the pain in a heavy-bottomed glass.
But here's the thing, though you may justifiably perhaps accuse me of "rationalizing," or "philosophizing," but there really isn't anyone on this small blue orb that has it exactly easy-peazey. Sure, the rich have fewer worries, but they are just as prone to pain, self-doubt, and the myriad of human ills and ill-perceptions as the rest of humanity. They just get to eat at fancier restaurants than we do. In thinking about what it may have been that caused this young woman to cut the final cord, I thought about my grandmother, and my mother-in-law, both born early last century, both went through the Depression, at least two wars, well, more than that, now, had to work both in and out of the home, struggled to raise their kids, and sure, they got depressed from time to time, but they stuck it out, they understood that life isn't a Hollywood movie, its got suffering, and pain, and lost dreams, and the whole shebang, as my grandma would say it.
So what is different, now? Yes, suicide isn't anything new, but what is new is the shear numbers of folks just fed up, unwilling to stick around any longer. And then I had to look at what it was that's kept me from even thinking about such a choice, and it occurred to me its the same thing that has kept me in this relationship with my sweety for so long. Before I met her, I was a real serial monogamist, but every time things got tough, I'd say, "hey, who needs this," and be on my merry way. But when I met my honey, and we had that first, inevitable fight, and that same little petty thought raised its sorry-assed head inside mine, it suddenly occurred to me that, if I cut out at that point, I'd never know what was on the other side of that particular hill. And strangely enough, that same thought has come up every time we have gone through some rough patch, and well, I guess I've learned to make the same assessment about my own continuance. No way to know how the movie's gonna turn out if you leave before the closing credits.
But still, we don't all have the wherewithal to stomach all the crap that flies our way, I understand that. Its just now, she, and her family, and her friends and colleagues, will never know how else her movie might have ended.
Well, see you on the next post. I gotta get out to get some flowers before they close.
Monday, July 12, 2010
Saturday, July 10, 2010
Caveat Emptor, or, What Have I Done To My Head?
It seems I forgot my manners with that last post, by failing to disclose my connections with the sellers or manufacturers of products recommended. Yes, I am a principal owner of Amazon, and no, I can't tell you how much I'm worth. Mostly because I'd have to lie, and, - - what? Oh, yes, sorry. The above is a lie. Well, wishful thinking, actually. The only thing I own shares in is the right to pet and feed my dogs.
But I do want to make it clear - I used links to Amazon for those products because they show the broadest array of choices in one page than other sites do, and if I am about anything at all, I'm all about choices. Something we clubbies have too few of.
But, I regress. Lets do a few more push-ups, and then talk about pain again. So much fun.
The (nearly) Unthinkable
One of the primary features we clubbies have to contend with (features? What, are we new cars?) is muscle atrophy, not just of the calf muscle, but all the muscles in the lower leg. There is some evidence, though not well researched (what a surprise) that this atrophy may cause additional muscle deterioration later in life. I am starting to have symptoms (with an MRI to support it) of just such deterioration, currently in my right calf, but I strongly suspect in my left, as well. And, as I mentioned in the last post, this can lead to another type of cascade effect - muscle weakness, reduced activity, more weakness. What's needed, clearly, is a balanced approach.
As part of my current physical therapy (for the bum knee,) my very good PT, taking my post-club feet into the equation, has started me on some very tough exercises to strengthen my feet and ankles. These are done using those colored rubber/elastic bands, starting with the yellow one, and working my feet in all planes of motion. These are pretty tough, but I have already begun to feel a difference. Because the work is non-weight-bearing, it is just about the muscles and tendons, with very little pressure on the joint surfaces. So while difficult in the early stages, the work causes little pain (well, except for all those disused or poorly employed muscles getting woken up so rudely,) and therefor is less discouraging than weight-bearing exercise.
Now, I don't recommend you just go and start this on your own. Find a good physical therapist - they are worth their weight in gold (and believe me, I'm billing the US Treasury for their time - hey, that's where they keep the gold, right?) I learned the hard way there is a difference between understanding biomechanics, and having knowledge about exercise physiology. Our feet have a lot of small ligaments, tendons, and a fairly complex array of muscles, and if we can build up strength in them, even to a small degree, they can help work against the constantly deforming forces we all experience with our bad doggies. Put yourself in the hands of a good PT, but be sure to also educate them about your specific set of issues. They may not know initially how your post-club feet calls for changes in standard strengthening exercises. Hey, we all need to learn new things all the time, right?
So, again, what are your experiences with pain management, exercise, etc? We don't seem to be generating many comments, so maybe its my breath, who knows? But this is your place, clubbies, and as I keep saying, we have many of the answers we need right in our own heads, if we are willing to share what works for each of us.
Come on in - the water's fine!
But I do want to make it clear - I used links to Amazon for those products because they show the broadest array of choices in one page than other sites do, and if I am about anything at all, I'm all about choices. Something we clubbies have too few of.
But, I regress. Lets do a few more push-ups, and then talk about pain again. So much fun.
The (nearly) Unthinkable
One of the primary features we clubbies have to contend with (features? What, are we new cars?) is muscle atrophy, not just of the calf muscle, but all the muscles in the lower leg. There is some evidence, though not well researched (what a surprise) that this atrophy may cause additional muscle deterioration later in life. I am starting to have symptoms (with an MRI to support it) of just such deterioration, currently in my right calf, but I strongly suspect in my left, as well. And, as I mentioned in the last post, this can lead to another type of cascade effect - muscle weakness, reduced activity, more weakness. What's needed, clearly, is a balanced approach.
As part of my current physical therapy (for the bum knee,) my very good PT, taking my post-club feet into the equation, has started me on some very tough exercises to strengthen my feet and ankles. These are done using those colored rubber/elastic bands, starting with the yellow one, and working my feet in all planes of motion. These are pretty tough, but I have already begun to feel a difference. Because the work is non-weight-bearing, it is just about the muscles and tendons, with very little pressure on the joint surfaces. So while difficult in the early stages, the work causes little pain (well, except for all those disused or poorly employed muscles getting woken up so rudely,) and therefor is less discouraging than weight-bearing exercise.
Now, I don't recommend you just go and start this on your own. Find a good physical therapist - they are worth their weight in gold (and believe me, I'm billing the US Treasury for their time - hey, that's where they keep the gold, right?) I learned the hard way there is a difference between understanding biomechanics, and having knowledge about exercise physiology. Our feet have a lot of small ligaments, tendons, and a fairly complex array of muscles, and if we can build up strength in them, even to a small degree, they can help work against the constantly deforming forces we all experience with our bad doggies. Put yourself in the hands of a good PT, but be sure to also educate them about your specific set of issues. They may not know initially how your post-club feet calls for changes in standard strengthening exercises. Hey, we all need to learn new things all the time, right?
So, again, what are your experiences with pain management, exercise, etc? We don't seem to be generating many comments, so maybe its my breath, who knows? But this is your place, clubbies, and as I keep saying, we have many of the answers we need right in our own heads, if we are willing to share what works for each of us.
Come on in - the water's fine!
Friday, July 9, 2010
Another Post About Pain - I'll Try Not to Hurt You
In some respects, there's almost no end to what can be said about chronic pain - maybe that's why its called chronic (little attempt at humor there, folks.) Seriously, pain management has both upsides and downsides, as well as being something difficult to quantify in any general manner. That is, its mostly a specific "art," rather than a clear, objective science. And when you begin to understand how feeling pain is a critical feedback mechanism for the organism, well, it get's pretty frustrating.
Allow me to illustrate that last point a bit. Let's say you turn the corner and one of your kids just happens to be swinging a bat at that exact moment. And fate, (gotta love fate, eh?) intervenes, and said bat smacks you right in the shin. Now, besides being a possible entry on America's Funniest Videos (you should be so lucky,) the more important result is, well, pain. And this pain causes several things to happen, besides screams, passing out, and threatening to boot the rug rat into next week. First, you are almost certainly going to sit right down and start rubbing that shin, maybe get some ice, or at least an aspirin. And sweatheart, you are gonna limp, trust me.
Now, all these reactions occur because of the pain, caused of course by said injury. And this is at it should be - the pain is telling your body, hey, settle down, and attend to this trauma. And, not being entirely without a clue, most of us do exactly that. I say most of us, because there is a class of people out there who will have substantially different reactions to such a trauma. I am speaking about people with peripheral neuropathy, most such folks being diabetics. Feeling can be lost as high as mid-thigh, in some cases. So, they don't feel pain, or perhaps only vaguely. Now, this doesn't mean diabetics are the only folks like that, but they make up a serious percentage. The results for such folks is, without the pain signal, they do not react in a manner designed to treat or ease the trauma, and thus, can become far more seriously damaged than everyone else suffering the same trauma.
I explain this to illustrate something about the necessity of pain - it is designed to allow the organism time to heal before going out and doing something else that might injure them anew. But chronic pain is quite different than immediate, unique trauma. It has more complex effects and "sequelae," which is just a fancy word for extra surprises. For one thing, there is insufficient time for healing. So the organism, (that's us) has to make a difficult choice - keep doing the things we want and need to do to live our lives, or sit down until the pain stops - not the best set of choices, is it? With some types of chronic pain, management can be accomplished with somewhat simple methods - pain medications. Yet, it can often be difficult to get the right drug and the right dosage, but with the right pain management specialist, its doable.
But when the cause of the pain is not a systemic condition, or is isolated in the upper extremities, as opposed to, in our case, the feet, and its being caused by bone-on-bone or minimal cartilage left to cushion the joints, its a very different ball of wax. Can we use pain management drugs to reduce the pain? Sure. Absolutely. But. There are two potential consequences we have to be aware of. First, we may require substantially higher or more frequent dosages to achieve the desired level of pain reduction. This increases odds for addiction, increases odds we could injure ourselves or others while so impaired, and clearly increase the odds we will be less than desirably functional to do our jobs, maintain our relationships, etc. So, big downside.
Second, by significantly reducing pain - no, let me correct that - we are not "reducing" pain, we are reducing our conscious awareness of pain - a very critical distinction - we become like someone with peripheral neuropathy - we are unable to tell when its time to respond to the on-going trauma. Thus, we end up increasing the very conditions causing the pain in the first place. Which causes a cascade effect - we need more medications, more frequently, or higher dosages, continue to cause the trauma, increasing damage, and so on, and so on. Really BIG downside, because while we may feel like we are somehow controlling the pain, we are really just worsening our situation.
So, What Other Options Do We Have?
None of us like the idea of sitting on our butts. We want to get out there and enjoy our lives, do our jobs, stay fit, etc. But we also have to face a very painful truth - we are not the same as everyone else, no matter what the surgeons told our parents. We are, in fact, more like people with post-polio syndrome who, when they were first afflicted, were told they needed to use their unaffected limbs more, in the mistaken belief about the disease that it only affected what it obviously affected. But twenty, thirty, forty years on, those same folks started to get symptoms of polio, but this time, on their what was assumed to be unaffected side. This was because the disease actually had a systemic affect on the body's myelin sheaths around the nerves, as opposed to only the apparently damaged parts of the body. So now, belatedly, these same folks are told to "just take it easy," don't overdo it, rest, relax. Well, we are somewhat like that.
Many of us have tried to live our lives like we are normal folks - hell, that's what they told us we were, wasn't it? But the long-term effect has been to place ever increasing wear and tear on those poor little joints, and the more we do, the worse it gets. And if we do less, well, there's that weight-gain thing, and further muscle weakness, etc. So, what's a clubby to do? How can we stay healthy, while at the same time learning better how to take it easy, in order to keep our pain manageable?
Well first, we have to come to terms with our very real limitations. This doesn't mean we just lay down and give up, or stop doing the things we love or want to do. We just need to acknowledge the limits are real, and learn to act within them. One example - when I go out walking, I've learned how to pay attention to my "half-way point." If I go one way, I gotta come back, so I need to know my distance limitations, and act consciously to honor that limit. It may be that you need to learn to take more shorter walks, with time to rest between, rather than that long walk to Half-Dome and back, with the resultant five-day vacation from your now painful vacation.
I am not suggesting, by the way, you never employ medications. Just do so with moderation, and only as an adjunct to your pain management regimen rather than a centerpiece. Use it in addition to, rather than a line of first defense.
Here are a few other ideas for your consideration: you may have some of your own you'd like to share, so please leave your comments to share with all the other clubbies out there.
iSqueeze foot massager, or other brands of foot/ca;f massage units - here are a few options.I use mine nearly every evening - it increases my circulation, and relaxes my feet considerably. I would urge you to by the best one you can afford - the higher up the calf it goes, the more effective it will be. Yes, they aren't cheap. But neither is a year's worth of dilaudid, ya dig? By making this a part of my day, I can look forward to some pain relief before going to sleep, and find I sleep considerably better for it. Remember - we are more likely to get a reduction in pain, than a end to pain. And each percentage we lower that pain makes our lives that much better.
Inversion table. This is a device that you lay down on after clamping your feet (with your shoes on, usually) and then lean back and slowly turn your body upside down. Essentially, you are reversing the effects of gravity. It allows gravity to pull you down instead of pushing you down. It actually mildly distracts your joints - that is, it pulls the joints slightly apart so they are not compressed as they are when we stand and walk. And even with your feet in the clamps, it has the same effect on your ankles, and to a lesser degree, on the subtalar joints. Here are some options. Yes, again, they aren't cheap. But you need to see such expenses as essential to your well-being. Compare it to all those latte's you have over the course of a year, which do less to reduce your pain.
Foot soaks. Again, many kinds, even if a bit more labor-intensive (you have to fill and empty them, and clean them once in a while.) But soakin' them sore puppies at the end of the day, well, bliss, right? Here are a few to look at. Be sure to get one slightly bigger than your feet - no reason to feel cramped, eh? And be sure the sides slope sufficiently - you want to be able to sit back and relax - too straight of sides will make you have to sit more erect. personally, I like the basic deep dish type - gets the water up on the calf, ya see?
Paraffin baths. This is a major escalation of foot soaking technology, the big gun, if you will. And while even more labor intensive, it gets the heat much deeper into the foot. When all else fails, this thing will hit the mark, every time.
Finally, at least for this post, there is the ultimate pain reliever. Get your significant other, or even some total stranger, to give you a serious foot massage. Nothing like it. Nothing at all. Unless, that is, you happen to be ticklish.
AAhhhh.
So, what is your technique? Share it with us all.
Allow me to illustrate that last point a bit. Let's say you turn the corner and one of your kids just happens to be swinging a bat at that exact moment. And fate, (gotta love fate, eh?) intervenes, and said bat smacks you right in the shin. Now, besides being a possible entry on America's Funniest Videos (you should be so lucky,) the more important result is, well, pain. And this pain causes several things to happen, besides screams, passing out, and threatening to boot the rug rat into next week. First, you are almost certainly going to sit right down and start rubbing that shin, maybe get some ice, or at least an aspirin. And sweatheart, you are gonna limp, trust me.
Now, all these reactions occur because of the pain, caused of course by said injury. And this is at it should be - the pain is telling your body, hey, settle down, and attend to this trauma. And, not being entirely without a clue, most of us do exactly that. I say most of us, because there is a class of people out there who will have substantially different reactions to such a trauma. I am speaking about people with peripheral neuropathy, most such folks being diabetics. Feeling can be lost as high as mid-thigh, in some cases. So, they don't feel pain, or perhaps only vaguely. Now, this doesn't mean diabetics are the only folks like that, but they make up a serious percentage. The results for such folks is, without the pain signal, they do not react in a manner designed to treat or ease the trauma, and thus, can become far more seriously damaged than everyone else suffering the same trauma.
I explain this to illustrate something about the necessity of pain - it is designed to allow the organism time to heal before going out and doing something else that might injure them anew. But chronic pain is quite different than immediate, unique trauma. It has more complex effects and "sequelae," which is just a fancy word for extra surprises. For one thing, there is insufficient time for healing. So the organism, (that's us) has to make a difficult choice - keep doing the things we want and need to do to live our lives, or sit down until the pain stops - not the best set of choices, is it? With some types of chronic pain, management can be accomplished with somewhat simple methods - pain medications. Yet, it can often be difficult to get the right drug and the right dosage, but with the right pain management specialist, its doable.
But when the cause of the pain is not a systemic condition, or is isolated in the upper extremities, as opposed to, in our case, the feet, and its being caused by bone-on-bone or minimal cartilage left to cushion the joints, its a very different ball of wax. Can we use pain management drugs to reduce the pain? Sure. Absolutely. But. There are two potential consequences we have to be aware of. First, we may require substantially higher or more frequent dosages to achieve the desired level of pain reduction. This increases odds for addiction, increases odds we could injure ourselves or others while so impaired, and clearly increase the odds we will be less than desirably functional to do our jobs, maintain our relationships, etc. So, big downside.
Second, by significantly reducing pain - no, let me correct that - we are not "reducing" pain, we are reducing our conscious awareness of pain - a very critical distinction - we become like someone with peripheral neuropathy - we are unable to tell when its time to respond to the on-going trauma. Thus, we end up increasing the very conditions causing the pain in the first place. Which causes a cascade effect - we need more medications, more frequently, or higher dosages, continue to cause the trauma, increasing damage, and so on, and so on. Really BIG downside, because while we may feel like we are somehow controlling the pain, we are really just worsening our situation.
So, What Other Options Do We Have?
None of us like the idea of sitting on our butts. We want to get out there and enjoy our lives, do our jobs, stay fit, etc. But we also have to face a very painful truth - we are not the same as everyone else, no matter what the surgeons told our parents. We are, in fact, more like people with post-polio syndrome who, when they were first afflicted, were told they needed to use their unaffected limbs more, in the mistaken belief about the disease that it only affected what it obviously affected. But twenty, thirty, forty years on, those same folks started to get symptoms of polio, but this time, on their what was assumed to be unaffected side. This was because the disease actually had a systemic affect on the body's myelin sheaths around the nerves, as opposed to only the apparently damaged parts of the body. So now, belatedly, these same folks are told to "just take it easy," don't overdo it, rest, relax. Well, we are somewhat like that.
Many of us have tried to live our lives like we are normal folks - hell, that's what they told us we were, wasn't it? But the long-term effect has been to place ever increasing wear and tear on those poor little joints, and the more we do, the worse it gets. And if we do less, well, there's that weight-gain thing, and further muscle weakness, etc. So, what's a clubby to do? How can we stay healthy, while at the same time learning better how to take it easy, in order to keep our pain manageable?
Well first, we have to come to terms with our very real limitations. This doesn't mean we just lay down and give up, or stop doing the things we love or want to do. We just need to acknowledge the limits are real, and learn to act within them. One example - when I go out walking, I've learned how to pay attention to my "half-way point." If I go one way, I gotta come back, so I need to know my distance limitations, and act consciously to honor that limit. It may be that you need to learn to take more shorter walks, with time to rest between, rather than that long walk to Half-Dome and back, with the resultant five-day vacation from your now painful vacation.
I am not suggesting, by the way, you never employ medications. Just do so with moderation, and only as an adjunct to your pain management regimen rather than a centerpiece. Use it in addition to, rather than a line of first defense.
Here are a few other ideas for your consideration: you may have some of your own you'd like to share, so please leave your comments to share with all the other clubbies out there.
iSqueeze foot massager, or other brands of foot/ca;f massage units - here are a few options.I use mine nearly every evening - it increases my circulation, and relaxes my feet considerably. I would urge you to by the best one you can afford - the higher up the calf it goes, the more effective it will be. Yes, they aren't cheap. But neither is a year's worth of dilaudid, ya dig? By making this a part of my day, I can look forward to some pain relief before going to sleep, and find I sleep considerably better for it. Remember - we are more likely to get a reduction in pain, than a end to pain. And each percentage we lower that pain makes our lives that much better.
Inversion table. This is a device that you lay down on after clamping your feet (with your shoes on, usually) and then lean back and slowly turn your body upside down. Essentially, you are reversing the effects of gravity. It allows gravity to pull you down instead of pushing you down. It actually mildly distracts your joints - that is, it pulls the joints slightly apart so they are not compressed as they are when we stand and walk. And even with your feet in the clamps, it has the same effect on your ankles, and to a lesser degree, on the subtalar joints. Here are some options. Yes, again, they aren't cheap. But you need to see such expenses as essential to your well-being. Compare it to all those latte's you have over the course of a year, which do less to reduce your pain.
Foot soaks. Again, many kinds, even if a bit more labor-intensive (you have to fill and empty them, and clean them once in a while.) But soakin' them sore puppies at the end of the day, well, bliss, right? Here are a few to look at. Be sure to get one slightly bigger than your feet - no reason to feel cramped, eh? And be sure the sides slope sufficiently - you want to be able to sit back and relax - too straight of sides will make you have to sit more erect. personally, I like the basic deep dish type - gets the water up on the calf, ya see?
Paraffin baths. This is a major escalation of foot soaking technology, the big gun, if you will. And while even more labor intensive, it gets the heat much deeper into the foot. When all else fails, this thing will hit the mark, every time.
Finally, at least for this post, there is the ultimate pain reliever. Get your significant other, or even some total stranger, to give you a serious foot massage. Nothing like it. Nothing at all. Unless, that is, you happen to be ticklish.
AAhhhh.
So, what is your technique? Share it with us all.
Shauna's Life in Pain
Just found this excellent blog, that deals with many of the things us clubbies deal with - chronic pain, having an "invisible" health issue, and trying to maintain a good outlook, despite the issues we face. I urge readers to check her out, at http://www.blogcatalog.com/blog/shaunas-life-in-pain-and-other-fun-things
Thursday, July 8, 2010
Doctor, Doctor, Who'se Gotta Doctor?
I am starting to compile a list of orthopedic and podiatric surgeons who do a lot of work with adults with post-club feet, for inclusion here as a resource. No matter what country or state or province, its only important they have actually worked on post-club feet. There are plenty of and easy to find pediatric surgeons, but let's face it - we ain't pediatrical!
Be sure to give the doctors name and hospital, as well as some contact information - phone, email, address, plus be sure to supply country/state/city, etc.
This is your opportunity to help fellow clubbies, all over the world!
Be sure to give the doctors name and hospital, as well as some contact information - phone, email, address, plus be sure to supply country/state/city, etc.
This is your opportunity to help fellow clubbies, all over the world!
Wednesday, July 7, 2010
The Wisdom of the Past
I have just finished reading a paper put out in 1953, August, in fact, the month and year of my birth. It is called "The Kite Treatment of Congenital Talipes Equino-Varus," by A.T. Fripp and Martin Singer from the Institute of Orthopaedics, Royal National Orthopaedic Hospital, London. It was published in the Postgraduate Medical Journal. The paper described the Kite technique for conservative correction of club feet using plaster serial casting, and was a primary technique before (and during) the emergence of the Ponsetti method, which has now largely supplanted Kite. But in the Introduction comes a very curious piece of history, which I quote here:
"Among English surgeons interested in the deformity of club foot, the early work of W. J. Little stands out. Himself a victim, (italics mine) he traveled to the Continent and submitted to a tenotomy, which was performed by Stromeyer. Subsequently he practiced the operation in England, and his book, published in 1839, is based upon his experiences. But even more important than the introduction of the tenotomy was his statement:
"In many cases the slightest pressure exercised by the instrument will suffice to overcome the deformity without producing pain, provided attention be daily paid and the straps and screws be tightened whenever they become loosened by the progress the foot makes in the required direction. The surgeon must constantly bear in mind that after the performance of an operation he must not always to expect to restore the foot rapidly to its material position; he must guard against violence.""
Yes, the language is a bit old-fashioned, and like most medical writing, somewhat obtuse, but here is a real gem. First, Little himself had club feet! So I must correct my statement to Ms. Phipps - she will not be the first clubby to become an orthopedist! She will still be the only one in that situation today, however. And look what position he arrives at when writing his professional experience "...he must guard against violence." Even though his primary purpose in writing the book was to teach more doctors the tenotomy procedure, he remains focused on the patient's well-being, and retains the good sense of conservative treatment as the foundation of his practice.
He speaks of "...the straps and screws be tightened whenever they become loosened by the progress the foot makes in the required direction." At that time, bracing was very crude, and often caused more damage than it cured. Here, he is saying to other surgeons, "be gentle" with the child, yes, maintain pressure in the direction of correction, but do so gently.
I will try to get my hands on the work of Little. I suspect it will be worthwhile, and I promise to share more gems with you when I do.
By the way, I searched for a copy ofLittle's book, and found one. Its available, really. A mere $5,512.50.
"Among English surgeons interested in the deformity of club foot, the early work of W. J. Little stands out. Himself a victim, (italics mine) he traveled to the Continent and submitted to a tenotomy, which was performed by Stromeyer. Subsequently he practiced the operation in England, and his book, published in 1839, is based upon his experiences. But even more important than the introduction of the tenotomy was his statement:
"In many cases the slightest pressure exercised by the instrument will suffice to overcome the deformity without producing pain, provided attention be daily paid and the straps and screws be tightened whenever they become loosened by the progress the foot makes in the required direction. The surgeon must constantly bear in mind that after the performance of an operation he must not always to expect to restore the foot rapidly to its material position; he must guard against violence.""
Yes, the language is a bit old-fashioned, and like most medical writing, somewhat obtuse, but here is a real gem. First, Little himself had club feet! So I must correct my statement to Ms. Phipps - she will not be the first clubby to become an orthopedist! She will still be the only one in that situation today, however. And look what position he arrives at when writing his professional experience "...he must guard against violence." Even though his primary purpose in writing the book was to teach more doctors the tenotomy procedure, he remains focused on the patient's well-being, and retains the good sense of conservative treatment as the foundation of his practice.
He speaks of "...the straps and screws be tightened whenever they become loosened by the progress the foot makes in the required direction." At that time, bracing was very crude, and often caused more damage than it cured. Here, he is saying to other surgeons, "be gentle" with the child, yes, maintain pressure in the direction of correction, but do so gently.
I will try to get my hands on the work of Little. I suspect it will be worthwhile, and I promise to share more gems with you when I do.
By the way, I searched for a copy ofLittle's book, and found one. Its available, really. A mere $5,512.50.
It's Not Just Us, Clubbies!
Now, some of you out there may be surprised to learn that there are other critters out there who also have club feet:
"Club foot, which may involve one or more of an affected horse's feet, is a flexion deformity caused by fixed contracture of one or several flexor tendons in the leg. The deep digital flexor tendon is usually involved; the superficial digital flexor tendon and suspensory ligaments may also participate in the deforming forces of club foot. When the foot and leg are in upright conformation, the foot axis, which normally averages about 45 degrees, will exceed 60 degrees. If the club foot is diagnosed in a young horse, it is likely either congenital or the result of diet-related problems that affect limb growth. Older horses with club foot probably develop it in response to an injury or other painful condition. The affected horse avoids weight bearing on the painful limb. Disuse of the limb results in contracture of the flexor tendons, which produces the deformity."
So, when next you have the opportunity to ride a horse, lean down and whisper in his or her ear, "welcome to the club."
However, according to at least one source, the term club foot for this condition is a misnomer.
"So-called “clubfoot” has long been a vexing problem for horsemen, veterinarians, and farriers. The term clubfoot is a misnomer for the condition in the horse and correctly refers only to a congenital anomaly of the human foot. Lungwitz (1910) properly defined and described the condition for the horse. There are three forms:
1. Stumpy hoof. (Figs. 1, 2) This is bockhuf, goat hoof, in German, but will be translated here as stumpy hoof. The hoof angle is greater than normal, 60-90 degrees. The pastern is short or appears so and is usually more or less in line with the hoof axis as seen from the side.
2. Bearfoot. (Fig.1) This is ba¨renfuss in German. The hoof angle is greater than normal, as above, but the pastern appears longer and has a more sloping angle, “...broken strongly forward at the coronet.” Lungwitz(1913).
3. Stiltfoot. (Fig.1) This is stelzfuss in German. It is the extreme or final case of 1. and 2. with the foot supported only at the toe."
It's interesting to see there are different types, just as in human club feet. But I want to propose a very different classification system for human club feet:
1. Stompfuss, or stompfoot, in English. This type of club foot results when over-zealous surgeons have a field day on the affected foot/feet, resulting in a foot with a distinct "stomped" appearance. It also describes the resultant manner of walking, also referred to as "clomping."
2. Ouchfuss, or ouchfoot in English. This type of club foot is distinctive in that it's possessor, or "wearer," is heard to utter "ouch" many times a day. There may of course be variants on the actual utterances, some of course unfit to print in a family-oriented publication such as this.
3. Tenderfuss, or tenderfoot in English, characterized by the appearance of placing the foot very carefully upon the ground with each step. It is also characterized by the owner of such feet often being heard to tell companions, "Its OK, I'll catch up."
4. Yamaguchifuss, or Olympicicefoot, in English. This type is very rare, but embraced as an equal within the highly secretive club foot community, often referred to as "clubbies." Those so afflicted often act to deflect too close scrutiny on the rest of the community, but are often sited as proof of "normalcy" by those of the equally secretive cabal known as "surgeons," not to be confused with sturgeons, as sturgeons have yet to afflict anyone with poorly thought-out fishing techniques.
There may indeed be many different types within the human community, but suffice to say, clubbies tend to refuse classification other than as fully normal and beautiful examples of their species. And who are we to argue with such an elegant response?
"Club foot, which may involve one or more of an affected horse's feet, is a flexion deformity caused by fixed contracture of one or several flexor tendons in the leg. The deep digital flexor tendon is usually involved; the superficial digital flexor tendon and suspensory ligaments may also participate in the deforming forces of club foot. When the foot and leg are in upright conformation, the foot axis, which normally averages about 45 degrees, will exceed 60 degrees. If the club foot is diagnosed in a young horse, it is likely either congenital or the result of diet-related problems that affect limb growth. Older horses with club foot probably develop it in response to an injury or other painful condition. The affected horse avoids weight bearing on the painful limb. Disuse of the limb results in contracture of the flexor tendons, which produces the deformity."
So, when next you have the opportunity to ride a horse, lean down and whisper in his or her ear, "welcome to the club."
However, according to at least one source, the term club foot for this condition is a misnomer.
So-Called Club Foot in Horses
by James R. Rooney, DMV
"So-called “clubfoot” has long been a vexing problem for horsemen, veterinarians, and farriers. The term clubfoot is a misnomer for the condition in the horse and correctly refers only to a congenital anomaly of the human foot. Lungwitz (1910) properly defined and described the condition for the horse. There are three forms:
1. Stumpy hoof. (Figs. 1, 2) This is bockhuf, goat hoof, in German, but will be translated here as stumpy hoof. The hoof angle is greater than normal, 60-90 degrees. The pastern is short or appears so and is usually more or less in line with the hoof axis as seen from the side.
2. Bearfoot. (Fig.1) This is ba¨renfuss in German. The hoof angle is greater than normal, as above, but the pastern appears longer and has a more sloping angle, “...broken strongly forward at the coronet.” Lungwitz(1913).
3. Stiltfoot. (Fig.1) This is stelzfuss in German. It is the extreme or final case of 1. and 2. with the foot supported only at the toe."
It's interesting to see there are different types, just as in human club feet. But I want to propose a very different classification system for human club feet:
1. Stompfuss, or stompfoot, in English. This type of club foot results when over-zealous surgeons have a field day on the affected foot/feet, resulting in a foot with a distinct "stomped" appearance. It also describes the resultant manner of walking, also referred to as "clomping."
2. Ouchfuss, or ouchfoot in English. This type of club foot is distinctive in that it's possessor, or "wearer," is heard to utter "ouch" many times a day. There may of course be variants on the actual utterances, some of course unfit to print in a family-oriented publication such as this.
3. Tenderfuss, or tenderfoot in English, characterized by the appearance of placing the foot very carefully upon the ground with each step. It is also characterized by the owner of such feet often being heard to tell companions, "Its OK, I'll catch up."
4. Yamaguchifuss, or Olympicicefoot, in English. This type is very rare, but embraced as an equal within the highly secretive club foot community, often referred to as "clubbies." Those so afflicted often act to deflect too close scrutiny on the rest of the community, but are often sited as proof of "normalcy" by those of the equally secretive cabal known as "surgeons," not to be confused with sturgeons, as sturgeons have yet to afflict anyone with poorly thought-out fishing techniques.
There may indeed be many different types within the human community, but suffice to say, clubbies tend to refuse classification other than as fully normal and beautiful examples of their species. And who are we to argue with such an elegant response?
Tuesday, July 6, 2010
Real News about Talipes
This was released on July 2nd - http://www.medicalnewstoday.com/articles/193615.php#post - finally, real research yielding real information for club feet! I urge you all to read this - while it won't assist us adult clubbies, it may impact parents of children with club feet, at least by way of aiding them to understand their child's situation better.
An excerpt:
Initially, Gurnett and her researchteam , including Matthew B. Dobbs, MD, associate professor of orthopedic surgery at the School of Medicine, screened the DNA of 40 patients with inherited clubfoot. Two were found to have nearly identical DNA duplications on chromosome 17 in a region previously linked to limb abnormalities, developmental delays and heart defects. That DNA duplication was not found in the DNA of 700 control subjects without clubfoot.
An excerpt:
Initially, Gurnett and her research
Thursday, July 1, 2010
A Long Response to Lacey
Lacey,
Wow. I'm not sure where to start, so I'll start by saying how sorry I am you've been so poorly used by the very profession you seek entry to. However, I am certain if you prevail, you will be the kind of orthopedist I would want to work with. You have, through the fates, gotten lessons no medical school would ever be able to offer you, and which will make you both the more compassionate, and hopefully the serious detective all doctors should aspire to. The Hippocratic oath deserves a very close re-reading by most of the practitioners I've encountered so far in my own life and career.
But let me attempt to at least begin to dig a bit deeper, if I may? Surely you should be able to use the HIPPA Act to demand copies of all your surgical and treatment records, including copies of X-rays and MRI's - those records do actually belong to you. And unlike myself, whose records turned to dust on inferior quality microfiche decades ago, your records should be well preserved. So I urge you to go after them. In fact, I urge every clubby to do whatever they can to get copies of their own records. Not the least because, should any future surgeries be contemplated, such records will help the new surgical team better understand what they are dealing with. And while you might suppose every subsequent doctor automatically requests all such records, let me assure you, many do not, especially records twenty years old. So you have to be the one to keep a copy, so that you can be your own best advocate.
As for fusions: I have said this many times, and suspect I'll be saying it for the rest of my life - fusions are a good thing in music, and a bad thing in feet. Yes, they will stop pain in the immediate moment. However, they ultimately transfer the pathomechanics distal to (above) the fused joints. If the subtalar is fused, the ankle begins to deteriorate, and depending on your specific biomechanics, the knee may tag along for the ride. Fuse the ankle, and its a guarantee for the knee, then the hip, lower and upper back, etc. Dare this orthopod who suggests the fusion to deny this fact. And make him back it up with real data. I'm not normally someone who likes Vegas, but I'll put money on that.
To stay with the gambling metaphor: in poker, there's this thing called the "tell." This is what each of us has, in different ways, that gives away our bluff. Any doctor who cannot "complete the chain," for a recommended course of treatment, and merely expects you to trust "their knowledge," is going to lose at poker with me. tell them you are really from Missouri, and insist they "show you."
What I mean by "complete the chain" is simple, really. To address an issue, especially one of pathomechanics, as an isolated phenomenon, (the feet all by themselves) is an utter failure of medical knowledge. We stand at the bottom of a gravity well, and it is our feet that are the foundation of the rest of our body. They are also the beginning of the chain - the chain of joints, muscles, tendons, etc., that must work in concert to both resist that gravity, and provide efficient and stable locomotion and movement through space. To deny this is a chain is foolishness, pure and simple. Your feet do not have a separate existence from the rest of your body.
To that idea, add this: any change in one part of this chain causes changes in other parts of that chain. Change the function and the position of the foot, and the leg/pelvis/spine/shoulder/arm/head portions of the chain are directly impacted, sometimes subtly, and sometimes grossly. There is some evidence that our particular ligamentous "tonality" has a strong influence on the speed, degree, and impact of any pathomechanic compensatory response. This seems to mean that people with looser ligaments tend to compensate faster, more severely, and at more levels of the body than those with tighter ligamentous tonality.
So, lets have a surgeon make a change in isolation, and then let many years pass, sometimes fewer, sometimes more. New pathomechanics, those arising out of the compensatory action of the chain, now cause new problems. The next surgeon looks primarily at the "existing identifiable problem," and so treats the symptom, but seldom the cause. (Treating the symptoms does not refer to the initial club-foot treatments in the infant, but to subsequent responses to the outcomes of those earlier treatments. Its what happens when you say, "it hurts here," or "when I do this..." and the doctor responds to only that one part of the body. This is fine for an immediate trauma, or a diseased organ, but in the area of biomechanics, a failure.) And so on, unfortunately.
In my view, a good doctor must think through the whole chain, both in space (the whole body, in motion,) and time - what will the effects of THIS surgery be upon THIS person for the rest of their life. Yes, sometimes that is very difficult to say with precision. But. And I want to say this very carefully, so it is not misunderstood - taking the full picture of the body's specific biomechanics into the initial equation of any planned response to a deformity as complex as club feet cannot help but lead to better outcomes for the entire life of the person being cut open and reconfigured. (Yes, I know, run-on sentence. Used to get flak for that in school. Sorry.)
I hope I haven't bored you too much. I sincerely would love to be able to help you find better answers, and I believe the first step must be to get those records. You need to understand, in detail, what was done to you. Without a foundation of real knowledge, any further decisions have a great possibility of being flawed. Please feel free to tell me more about when, how, etc., you got where you are today. You can contact me off the blog, if that is easier. email me directly at pisnoopy2003@yahoo.com.
One last thing for now:You may very well be the only, or one of the only orthopedists with club feet. So in fact, you will know more about club feet than any other surgeon alive. You may not believe that just yet, but think about this - they know club feet from the outside - you know them from the inside. And insider knowledge trumps everything else.
Wow. I'm not sure where to start, so I'll start by saying how sorry I am you've been so poorly used by the very profession you seek entry to. However, I am certain if you prevail, you will be the kind of orthopedist I would want to work with. You have, through the fates, gotten lessons no medical school would ever be able to offer you, and which will make you both the more compassionate, and hopefully the serious detective all doctors should aspire to. The Hippocratic oath deserves a very close re-reading by most of the practitioners I've encountered so far in my own life and career.
But let me attempt to at least begin to dig a bit deeper, if I may? Surely you should be able to use the HIPPA Act to demand copies of all your surgical and treatment records, including copies of X-rays and MRI's - those records do actually belong to you. And unlike myself, whose records turned to dust on inferior quality microfiche decades ago, your records should be well preserved. So I urge you to go after them. In fact, I urge every clubby to do whatever they can to get copies of their own records. Not the least because, should any future surgeries be contemplated, such records will help the new surgical team better understand what they are dealing with. And while you might suppose every subsequent doctor automatically requests all such records, let me assure you, many do not, especially records twenty years old. So you have to be the one to keep a copy, so that you can be your own best advocate.
As for fusions: I have said this many times, and suspect I'll be saying it for the rest of my life - fusions are a good thing in music, and a bad thing in feet. Yes, they will stop pain in the immediate moment. However, they ultimately transfer the pathomechanics distal to (above) the fused joints. If the subtalar is fused, the ankle begins to deteriorate, and depending on your specific biomechanics, the knee may tag along for the ride. Fuse the ankle, and its a guarantee for the knee, then the hip, lower and upper back, etc. Dare this orthopod who suggests the fusion to deny this fact. And make him back it up with real data. I'm not normally someone who likes Vegas, but I'll put money on that.
To stay with the gambling metaphor: in poker, there's this thing called the "tell." This is what each of us has, in different ways, that gives away our bluff. Any doctor who cannot "complete the chain," for a recommended course of treatment, and merely expects you to trust "their knowledge," is going to lose at poker with me. tell them you are really from Missouri, and insist they "show you."
What I mean by "complete the chain" is simple, really. To address an issue, especially one of pathomechanics, as an isolated phenomenon, (the feet all by themselves) is an utter failure of medical knowledge. We stand at the bottom of a gravity well, and it is our feet that are the foundation of the rest of our body. They are also the beginning of the chain - the chain of joints, muscles, tendons, etc., that must work in concert to both resist that gravity, and provide efficient and stable locomotion and movement through space. To deny this is a chain is foolishness, pure and simple. Your feet do not have a separate existence from the rest of your body.
To that idea, add this: any change in one part of this chain causes changes in other parts of that chain. Change the function and the position of the foot, and the leg/pelvis/spine/shoulder/arm/head portions of the chain are directly impacted, sometimes subtly, and sometimes grossly. There is some evidence that our particular ligamentous "tonality" has a strong influence on the speed, degree, and impact of any pathomechanic compensatory response. This seems to mean that people with looser ligaments tend to compensate faster, more severely, and at more levels of the body than those with tighter ligamentous tonality.
So, lets have a surgeon make a change in isolation, and then let many years pass, sometimes fewer, sometimes more. New pathomechanics, those arising out of the compensatory action of the chain, now cause new problems. The next surgeon looks primarily at the "existing identifiable problem," and so treats the symptom, but seldom the cause. (Treating the symptoms does not refer to the initial club-foot treatments in the infant, but to subsequent responses to the outcomes of those earlier treatments. Its what happens when you say, "it hurts here," or "when I do this..." and the doctor responds to only that one part of the body. This is fine for an immediate trauma, or a diseased organ, but in the area of biomechanics, a failure.) And so on, unfortunately.
In my view, a good doctor must think through the whole chain, both in space (the whole body, in motion,) and time - what will the effects of THIS surgery be upon THIS person for the rest of their life. Yes, sometimes that is very difficult to say with precision. But. And I want to say this very carefully, so it is not misunderstood - taking the full picture of the body's specific biomechanics into the initial equation of any planned response to a deformity as complex as club feet cannot help but lead to better outcomes for the entire life of the person being cut open and reconfigured. (Yes, I know, run-on sentence. Used to get flak for that in school. Sorry.)
I hope I haven't bored you too much. I sincerely would love to be able to help you find better answers, and I believe the first step must be to get those records. You need to understand, in detail, what was done to you. Without a foundation of real knowledge, any further decisions have a great possibility of being flawed. Please feel free to tell me more about when, how, etc., you got where you are today. You can contact me off the blog, if that is easier. email me directly at pisnoopy2003@yahoo.com.
One last thing for now:You may very well be the only, or one of the only orthopedists with club feet. So in fact, you will know more about club feet than any other surgeon alive. You may not believe that just yet, but think about this - they know club feet from the outside - you know them from the inside. And insider knowledge trumps everything else.
Wednesday, June 30, 2010
What I'd Rather Be Thinking About Right Now
Let me start by saying I don't assume to speak for everyone with post-club feet - that's why I keep encouraging comments and such, because we all have somewhat different experiences, while at the same time having very much in common. And let me further clarify that the way I have or am experiencing my feet and their effects on my life is, in fact, strictly mine. Though I am finding there is remarkable shared experiences on this issue by many. This is all by way of setting up what follows, so no one reading this thinks I am describing their experiences. However, if you should see similarities, please do let us all know. I sincerely believe that we, as a unique group of people with a unique set of issues, are the ultimate authority on our condition, and in the final analysis, those who most deserve the benefit of open and interactive communication. So, on with the show.
Some of you may have seen a post recently by someone wondering if amputation was a solution to the chronic and often agonizing pain we clubbies tend to live with. While this might seem a really radical solution (and I agree that it is), I also immediately understood where that thought came from - I've had it many times myself. But behind that urge, and in fact for me behind nearly everything and every time I feel my feet ruining my day, lies one overarching, yet seldom consciously thought, desire.
I want to go one day without ever thinking about my feet, from when I wake in the morning, to when I lay down to sleep at night. Scientists, especially those who study the brain, and those who study human consciousness, use a term - mindshare. This basically means the amount of time we allocate to think about any one specific thing over the course of our day. For example, in the news quite frequently these days is the impact cell phones and texting are having on driving safety. Scientists have studied this idea of "multitasking" quite extensively, and have come to believe that multitasking is a myth, in the sense that no one, and let me use their emphasis - no one - does multitasking well, and most people actually do the individual things they do while multitasking more poorly than they do when doing those same tasks individually. Something about walking and chewing gum at the same time, I believe.
I am one of those people who doesn't multitask very well, and I also know why - my painful feet are constantly grabbing mindshare. So adding one, two, three more things is a lost cause - I am already doing two things, constantly - whatever I am doing, plus my feet/pain. This colors nearly everything I do in ways I often come to resent. I don't really LIKE having to remember my "half-way point" when out walking with my wife. Nor do I like saying, "another time, maybe," to friends who want me to go on an outing. Its like being attached at the face with a mirror-image whose sole job it is to nag and rain on my parade.
This awareness, this confession, if you will, does not bring respite. What it does is to keep me always seeking solutions. Which at least has kept me from becoming a drug addict, I suppose. I have had people tell me, after they understand why I am reluctant to go on a romp, they are amazed I am not so addicted - they often say, "well, if anyone does, you sure have the right to be." So sweet, my friends.
But that desire to not have to think about my feet, even for just one day, never really leaves me. To be free at last is, I acknowledge, pretty far-fetched. But a man can dream, can't he? I think about what such a thing, were it to ever occur, would open up for me to better spend my time on. Learn the accordion? Study Italian so I can order with greater authority in my favorite restaurant? Increase my earning potential? Actually get a full night's sleep for once? Who knows?
But at least I'd be able to find out, wouldn't I?
How about you? Do you have mindshare problems, as well?
Some of you may have seen a post recently by someone wondering if amputation was a solution to the chronic and often agonizing pain we clubbies tend to live with. While this might seem a really radical solution (and I agree that it is), I also immediately understood where that thought came from - I've had it many times myself. But behind that urge, and in fact for me behind nearly everything and every time I feel my feet ruining my day, lies one overarching, yet seldom consciously thought, desire.
I want to go one day without ever thinking about my feet, from when I wake in the morning, to when I lay down to sleep at night. Scientists, especially those who study the brain, and those who study human consciousness, use a term - mindshare. This basically means the amount of time we allocate to think about any one specific thing over the course of our day. For example, in the news quite frequently these days is the impact cell phones and texting are having on driving safety. Scientists have studied this idea of "multitasking" quite extensively, and have come to believe that multitasking is a myth, in the sense that no one, and let me use their emphasis - no one - does multitasking well, and most people actually do the individual things they do while multitasking more poorly than they do when doing those same tasks individually. Something about walking and chewing gum at the same time, I believe.
I am one of those people who doesn't multitask very well, and I also know why - my painful feet are constantly grabbing mindshare. So adding one, two, three more things is a lost cause - I am already doing two things, constantly - whatever I am doing, plus my feet/pain. This colors nearly everything I do in ways I often come to resent. I don't really LIKE having to remember my "half-way point" when out walking with my wife. Nor do I like saying, "another time, maybe," to friends who want me to go on an outing. Its like being attached at the face with a mirror-image whose sole job it is to nag and rain on my parade.
This awareness, this confession, if you will, does not bring respite. What it does is to keep me always seeking solutions. Which at least has kept me from becoming a drug addict, I suppose. I have had people tell me, after they understand why I am reluctant to go on a romp, they are amazed I am not so addicted - they often say, "well, if anyone does, you sure have the right to be." So sweet, my friends.
But that desire to not have to think about my feet, even for just one day, never really leaves me. To be free at last is, I acknowledge, pretty far-fetched. But a man can dream, can't he? I think about what such a thing, were it to ever occur, would open up for me to better spend my time on. Learn the accordion? Study Italian so I can order with greater authority in my favorite restaurant? Increase my earning potential? Actually get a full night's sleep for once? Who knows?
But at least I'd be able to find out, wouldn't I?
How about you? Do you have mindshare problems, as well?
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