Friday, September 16, 2016

Recovery from Tendonosis and Tendonitis

My tendon damage was caused by a disagreement with Keflex, but many have tendon and muscle damage from Statins, Cipro or other drugs. I am nearly recovered after several years and I see no reason my experience wouldn't help others. I am still a work in progress, but I am increasingly optimistic.

Nearly five years ago I had surgery in Bangkok from an excellent doctor. However, I got a rare bacterial infection that became evident when I returned home.  Normally, Ciprofloxacin would have been prescribed. However, in my case a previous medical provider thought I had reacted adversely to Cipro and so Keflex on a PICC line was prescribed. The PICC line was inserted into my right arm and threaded into a main artery. I was given Keflex in syringes to be injected into the PICC line. Keflex couldn't kill the infection.

Keflex is in the Cephalosporin family and I am now allergic to this as well. Later my urologist told me I needed to use Cipro and after 28 days at 250 mg the infection was gone. I avoided the 500 mg strength to mitigate possible additional damage to my tendons.  It seems that I was not allergic to Cipro and have used it since. If only that earlier error could have been avoided.  Everyone is different and some react to Cipro. But, Keflex damaged my tendons and it seems to have affected the cardiac pacemaker function causing arrhythmia which fortunately is not too serious.  A cardiac treadmill nuclear medicine study of my heart showed it worked well under load so I was able to avoid a pacemaker after consulting an Electro Kinesiologist, an advanced specially for cardiologists. Some arrhythmia patients may show progress with time and exercise and this seems to be my case.   

Tendonitis and Tendonosis are common physical conditions that cause discomfort and can be crippling. Both involve the tendons, and can be caused by physical exertion and modern medicines. Tendonitis can often be cured more easily, but tendonosis is less well understood and its effects can last a lifetime. First, let's address the structure of tendons which is necessary to understanding the difference and treatment of these two conditions.

Tendons consist of a tough central cord surrounded by a sheath. There is little blood circulation so healing time can be lengthy as blood is central to transporting nutrition needed for healing. The cord is composed of chains of cells aligned end to end to support stress of movement and exercise. One might envision this is like a cable suspending a bridge with many threads of wire held together to support great weight.

On one hand, we may have tendonitis which is caused by overuse. This can be remedied by not using that area as much.  Tendonitis is an irritation between the central cord and the sheath. With lessened use that area will often cure itself. Otherwise a doctor may be needed.

When the tendon is damaged by statin drugs or antibiotics it can cause crippling injury which can confine the victim to a wheelchair. Often this is mislabeled as tendonitis and this obscures understanding and rehabilitation. Tendonosis is a much more serious malady.  Statins and powerful antibiotics can damage cells including tendons and muscles. Tendons connect muscles to bones and when they are damaged one can be crippled or at least in pain. I've had tendonitis in my right ankle from statins and no longer take them.

The first symptom of my tendonosis was pain in the tendons behind each knee. We didn't understand and treated it as though it was tendonitis and walked less although there was mild pain. I stopped Keflex, but the damage was done and through Dr. Google, I discovered it was tendonosis, not tendonitis. I saw several doctors who didn't mention tendonosis and I later read that this is often misdiagnosed as tendonitis. My hands also had tendon issues which fortunately are nearly resolved.

I bought a walker so I could ambulate about the house, but the pain got worse so I became dependent on a wheelchair for a few months.  I became discouraged that I would ever recover. I dearly missed my 5-mile daily walks and began to research on power-chairs. My wife wouldn't give up and strongly discouraged me from buying  one so I continued using the manual chair and in time began to use the walker again. Over time, I gradually recovered my tendons so they no longer hurt. My favorite topical for pain was menthol gel 2.5% that I got at our local 99 cent store. I had other things, but this was the best for me. I often lived with pain preferring to avoid possible additional drug reactions.

As my tendons hurt less I became more mobile and began to go to our gym. I live in a 55+ community and we have a variety of equipment. The medical provider referred me to a physical therapist who said the pain was due to a need to stretch. Well stretch, I did, and perhaps that helped, but it certainly didn't improve my condition. They really didn't understand my condition. My tendons were damaged and needed to heal and be rehabilitated so they would regain their tensile strength.

I needed to gradually exercise without straining tendons or my now flaccid muscles. It was a process of try and fail, sometimes overdoing and causing myself a relapse of a couple weeks. I gradually figured it out and tried doing less than what I thought I could. Because of the damage to the tendon cord, the cells evidently did not align and link into a chain as they heal according to one article. They need mild stress, but excessive tension initially caused some strain. I assume muscle cells link in a similar manner. When strain is excessive, the tendon may part and require surgical intervention. Some materials may yield under stress, but tendons are built for strength and do not seem to demonstrate significant plasticity. When I over-exercised, I assumed the pain was from damaged cells and rested until the pain stopped. I gradually learned and recovery has been gradual.

I needed to pick the equipment I would use. I chose the rowing machine as it can provide a gentle workout without requiring me to carry my body, thus avoiding damaging strain on the knee tendons. Rowing also helped my heart, arms and back which hadn't been used much. As time went on, the pain in my tendons gradually subsided and I gradually walked more. First with the walker and then without. We still use the walker to more groceries from the garage to the kitchen, but I hope I never again to need it to walk.

The rowing machine also helped rebuild my legs and I continually discovered "new" muscles I didn't know I had. Gradually, this subsided and I began to use other machines. Gradually, gradually, careful to not cause strain, but encourage rehabilitation. Once, I walked two miles, a major victory, but my leg muscles complained, but in time, I should be back to my 5-mile daily walks and begin to lose the extra 20 pounds I gained.

It has often been discouraging, but I am recovering and I have more confidence to diet more effectively. I hope all of this is helpful. If you have tendon or muscle damage from statin drugs, keep the faith. You too, very likely, with patience and care can improve your tendon and muscle condition. Patience, patience... gradual, gradual is the pace I learned.

Now, I have learned that finasteride can slow healing. It is often prescribed for men to slow or stop growth of the prostate which grows around the urethra and compresses it causing difficulty passing urine. It converts testosterone into products which will not encourage prostate growth thus it is not recommended for women. Since my surgery eliminated my testosterone production it is no longer appropriate for me. Recently I noticed a psychological effect and researched the drug. I no longer take it.  I notice my tendons seem to be healing faster now although tendons heal very slowly due to poor blood circulation within tendons.