 The Clarinet BBoard
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Author: Cindy
Date: 2003-07-10 19:44
Does anyone know of any doctors in teh northern Claifornia area (San Francisco, Sacremento, Modesto area) that work with musicians a lot? I have problems with my hand and have seen my doctor quite a few times but he says every time to just rest it and take ibproufen. I have, it does nothing. He doesn't understand that it mainly hurts when I play, and no matter how long I rest it still hurts to play. I think I need a doctor who basically knows where I'm coming from. So, yeah, please, if anyone knows of any that are somewhat nearby(like, no more than three hours away) that would be wonderful. Thanks.
So many instruments to play........so little time to play them!
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Author: CrazyCanuck
Date: 2003-07-11 05:19
Hey Cindy, I have been unable to play for 3 years (just getting back into it) send me an email... and we can chat about stuff
Nick
(nick_stabler@hotmail.com)
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Author: Mark Pinner
Date: 2003-07-12 00:29
Maybe it is not a doctor you need. Physiotherapists, I think you call them physicaltherapists, can help with this sort of thing. The ibuprofen suggested is a pain killer with some anti-inflammatory effects and a typical suggestion from a doctor. They are specialists at syptom masking and not much else. I would be wary of non steroidal anti-inflammatory drugs too such as Brufen, Voltaren etc. as they can mask symptoms without addressing the underlying symptoms thereby exacerbating the problem. The problem with modern medicine is that apart from surgery it is about 99% pharmaceutically based. If you have a sore hand take a pill. It is complete rubbish to suggest this and in my opinion there are many in the medical profession that need to be re-educated away fron this practice. It sounds like there is some soft tissue damage in the muscles/tendons/ligaments between the carpal bones these would generally be causes by repetitive strain and further complicated by the weight of the instrument on the thumb, all in all the left hand activity on the clarinet is unnatural. A strap may help in conjunction with rest. There may be some calcification, or a foreign body, on a bone, rheumatism or arthritis all of which are better treated by attacking the problem not maskig it. I look forward to a debate with any medical practitioner that puts forward the pharmaceutical approach to a physical problem. Do not treat these people as gods because most are just pill jockeys. Likewise do not consult them about diet they are just not trained well enough in this area.
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Author: Karel
Date: 2003-07-12 05:13
Hi Mark, I hope that your statements are intentionally "over the top" in order to provoke a response. Firstly, unless a problem is psychological, or psychosomatic, it is physical. And that covers the vast majority of problems. Medications such as "anti-inflamatories" have a clear place in the treatment of temporary problems such as the body's adjustment to an unusual function. They partly mask the symptoms, but mainly reduce swelling in an irritated tissue and allow it to function without, hopefully, further damage. They will not help in situations caused by basic STRUCTURAL incompatibility with the desired function. I feel no animosity towards physiotherapists, but find that their recent rise to an independent and autonomous profession has led to an aggressive "know-all and cure-all" stance (I am allowing myself to exaggerate a little). This is not helpful to our patients, not least because it may make a doctor hesitate before referring a patient to a physiotherapist. Attempts to deal with problems such as carpal tunnel syndrome without surgery are unlikely to succeed, leaving the patient with a long period of struggling with splints and other treatments; and before I hear a chorus of protests and anecdotal stories, let me say that I mean neurologically (nerve conduction studies) confirmed median nerve compression at the wrist. In the same breath, let me say that aids like a strap, the Kooiman thumbrest etc, are definitely preferrable to "pills".
Secondly, doctors get only a relatively basic teaching on diets, and unless a doctor makes this field a "special interest", a dietitian is a more suitable professional (in conjuction with a medically qualified person who has a better understanding of physiology and disease).
To conclude: disrespectful attitudes between professions which should be cooperating with each other are clearly damaging to the overall patient care by limiting cross-pollination of ideas and improvement in communication. As you may have guessed, I belong to the group you choose to call "pill jockeys", and found your post rather rude. Would I be right in thinking you are a physiotherapist, or are you offering detailed health care advice from way out in left field???
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Author: William
Date: 2003-07-12 14:41
Check your local phone book for the American Federation of Musicians and give their office a call. They may have a list of physcians who specialize in musician health issues. I know that their was an artical in a recent Internatinal Musician (union newspaper) regarding pain during performance and I also seem to recall an add for medical doctors who specialize in working with musicians. Worth a try............
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Author: Karel
Date: 2003-07-13 02:50
Hello again Mark P., I read your post in "Careers in Music" and got your background. Perhaps I should not have responded quite so harshly, but I do get annoyed at what I would call ill-informed advice. I know that modern medicine does not have all the answers, but it tries to do its best. You would appear to have had a bad personal experience with it but your post, no matter how well intended is unhelpful, and possibly worse. While I would likely be happy for you to treat my clarinet, I would not choose to consult you on medical matters. When we make authoritative statements it is best to stick to our own field of expertise.
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Author: Mark Pinner
Date: 2003-07-13 11:15
A tablet will not fix an overuse/ muscular-skeleto adjustment problem. Playing the clarinet is not a normal function of the human hand, at least not primeveally. A pill will not fix the problem it just treats the symptoms!
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Author: Karel
Date: 2003-07-13 12:46
A simple analgesic treats the symptoms without curing the disease. On the other hand an anti-inflammatory will affect the damaged tissue itself and often allow return to normality. It is a pill which may HELP to fix the problem, not just treat the symptoms (pain). On the other hand, it may not. Such is the lottery of life. I do not have all the answers, nor do you.
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Author: Mark Pinner
Date: 2003-07-14 07:58
Why then, Karel, does the use of non steroidals only compound problems. If there is an improvement in the underlying condition as a result of these drugs why the high rate of re-lapse and re-use. I am not criticising medicine here but pharmaceutical medicine. People played clarinet, and I assume had hand problems, long before pharmaceutical medicine came up with their dubious products. The problem was gotten over somehow without them. Likewise were about a million other maladies. I haven't taken a prescription drug for 15 years and suffer less ill health than my contemporaries if more people did the same and just got over things with time and rest instead of resorting to symptomatic tinkering then immune systems would generally improve. Don't get me started on asthma for every legitimate case there are many who are fat, unfit and lazy which contributes as much as anything to shortness of breath. Some people would benefit from a bit of simple exercise and it would improve their woodwind playing also. Since the advent of penicillin the pharmaceutical industry has most world governments by the balls financially plugging products that are marginally effective, anecdotally, despite their wonderful statistical spin. It is truly amazing that those of us that are allergic to penicillin suffer no noticeable increase in bacterial infections. What about the practice of prescribing antibiotics to people with viral infections just in case they get a bacterial infection. What a load of crap. Why does the placebo in clinical trials have such a beneficial effect! I still suggest a physiotherapist or osteopath because they are going to work on the problem itself. Physical injury treatment. By the way doctors don't have a mortgage on medical knowledge others take the trouble to educate themselves and because they are not trained in the ways of pharmaceutical medicine their opinions have an objective basis.
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Author: Karel
Date: 2003-07-14 12:30
Mark, you may have heard of the "working through the pain" idea. Anti-inflammatories can help through this point by reducing tissue reaction and swelling in many instances, and forestalling further damage. I would also suggest that a more appropriate non-medical health care worker than a physio or osteopath might be an occupational therapist. Your stern opposition to "pharmaceutical" help for physical problems reminds me of a few doctors I know who reject all "complementary medicine" out of hand. Let me add that I enjoy and respect your music posts, however I think your medical ones are beyond the pale and must not go unchallenged.
Agreed that doctors don't have a mortgage on medical knowledge, but with 6 years of focused university study they are quite likely to have a better grasp of the underlying principles than for example a music graduate with an axe to grind, no matter how interested he may be in a topic. Just as a doctor without higher music education cannot be an authority on the different aspects of composition. Incidentally, there are no muscles/tendons/ligaments BETWEEN the carpal bones, only their own cartilage. They articulate with each other.
I think an orthopoedic surgeon with an interest in music and/or hand function would be a good bet for Cindy. Good luck, Cindy.
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Author: Cindy
Date: 2003-07-20 07:26
I very much thank all of you for all of your opinions and great ideas. I find that anti-inflammatories do help to momentarily dull the pain when I go on crazy psycho moments and I have to play. I also think that there is need for something other than just medicine. So, I think both of you are correct. I will be looking into the American Federation of Musicians once I recover from jet lag tomorrow, and hope I will find someone there. I think in this post alone I have learned more words than in the past two years in english class. Honestly, thank you everyone for your help. It is reallly good to know that there are knowledgable people on this board with differing views. With information given, even if completely opposite, all views can be seen by people who don't know as much (ie me) andI can form an opinion from that. I agree that when it is possible it is better to go without medicine, like when you're sore from marching or walking a ton or something, because it helps the achiness go away faster. I also think that in some extremes (after surgery, extreme injuries, serious maladies) medicine really can help the symptoms while waiting for the cure for the actual malady. I actually found out that as a minor I am not able to just go see another doctor without being referred by my pediatrician (ooh, can't wait to be 18) so I'll have to deal with him before I can even start considering all these options. I will definitely discuss with him, with what limited knowledge he seems to have, both of these views and perhaps he will actually make a correct decision for once and maybe he'll know the perfect thing to do. For now I'll just keep trying to stay off medicine unless it hurts too bad or swells, then I'll take something, and let someone who can see my hand make a decision. I must admit, this is a very interesting debate to read, and thanks again to everyone!
So many instruments to play........so little time to play them!
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Author: hans
Date: 2003-07-20 14:10
Mark Pinner wrote:
"Do not treat these people as gods because most are just pill jockeys". In my experience that is not much of an exaggeration, since I have been on the receiving end of incompetence or negligence from doctors on several occasions; e.g., my MD gave me a prescription a few years ago that could (with my family history as clue) have triggered latent glaucoma and cost me my eyesight, and I have been given prescriptions of dangerous medicines with no, or inadequate, discussion. Although at each office visit for the last ten years I have given my MD an updated list of medicines I am taking and medical history, yet he only noticed last month for the first time that I had had malaria 50 years ago.
What I have learned is that I have to be vigilant, do my own research, and not trust my doctor without questioning. He is only human and therefore as error prone as anyone else, although I am certain that he does his best with a large number of patients under difficult circumstances and has my best interests at heart.
Hans
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Author: dfh
Date: 2003-07-21 04:55
Cindy - when I was around your age (I'm guessing you're almost 18) I had a ton of pain in both hands. My teacher asked her Physcial therapist (whom she credits for both her ability to still play and to walk, along with her own personal vigilance..but that's another story.) back to the pain. her p.t. said that I was really too young, and not playing enough for the pain to be cause just from playing, and he wondered how I sleept at night. Turns out I had been cutting of the circulation in my hands for years at night. After 3 weeks of modifying my sleeping posture, I had NO more pain.
Working on posture has relieved a great deal of a pain for me also. It may be how you hold your shoulder, tilt your wrist when you play (this is a big cause of pain!) type, walk your dog, any number of things. Getting your doc. to look at you when you play may help too. A really really good sports doc. may help. I know that the one that helped me is a top p.t. for the St. Louis Blues hockey team. Find and talk to some musicians in the area, they might know of someone. and now my hand hurts from typing too much tonight! so good night and good luck!
dfh
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Author: Karel
Date: 2003-07-21 09:17
Hans, what a sensible comment. I wish all patients added their common sense to what the doctor is doing.
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Author: BobD
Date: 2003-07-21 14:02
We practice scales, doctors practice medicine.....
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Author: diz
Date: 2003-07-22 06:39
Cindy, for a minor you're extremely erudite. I hope that your problem resolves itself with careful, considered attention. Keep your chin up and best wishes.
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Author: Gretchen
Date: 2003-07-22 16:01
dfh,
Your post made me realize I wasn't alone!! I also wake up in the middle of the night having my hands numb from sleeping weird. How did you change your sleeping habits so that you didn't lose circulation in your hands? What did your physical therapist say about how the sleeping effected your playing during the day?
Gretchen
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Author: Sneakers
Date: 2003-07-23 05:39
I have been sitting here for sometime trying to decide how to respond to this post. As for Cindy's concern, I might suggest that you try excercises with you hands before you begin to play. My teacher has shown me some, but unfortuneately I have no idea how to explain them in writing. Also, you might want to consider using a neck strap or something like Phred to take off some of the weight from your hand.
As far as the discussion about physicians and medications, I work as a medical assistant in a physician's clinic and work for MD's, DO's, orthopedic doctors, physiatrists, etc. I agree that they are very human and make mistakes just like everyone else. However, I find as group they are very dedicated individuals working their own practices from 9:00 - 5:00 during the day and then giving up some nights to accomadate patients that can not be seen during the day. They work in the ER, go to nursing homes, visit home health patients, take care of their patients at the hospital and so on. I believe that all of the doctor's I have worked with are genuinely concerned with the health of their patients and try to give them the best care possible, which may or may not include medications. I would hate to think how much some patients would suffer without medications. I worked for a podiatrist who had a patient that waited too long to come in and see him about an infection. He had to amputate her foot to keep the infection from spreading. How much better it would have been for her if she had come earlier and taken an antibiotic to clear up her infection and still had that foot to walk on. Certainly both patients and doctors abuse the use of medications, but to say that people got by without pills before there were so many of them seems to simplify things a bit too much. How well did they get by without them? Some probably just got better on their own, others continued to suffer with their malady having no other recourse, and others just died because their was nothing to cure them.
I would like to make some suggestions about seeing a doctor and getting medications:
1. Know the names of all medications you are taking. If you can't remember them keep a list with you to show the doctor or nurse. It is not very often helpful to tell them you are taking a little blue pill. There are lots of little blue pills.
2. Know what you are taking all of your medications for.
3. When a doctor prescribes a medication ask him/her what the purpose of the medication is - what it is suppose to do for you. Don't ask the nurse this question - he/she is usually not trained to answer that question.
4. Ask the doctor if the medication will interact negatively with any other medications you are currently taking or if there are any over the counter medications that you shouldn't take with what he/she is prescribing.
5. Don't assume your doctor knows all the medications you are taking. They have a lot of patients and can't possibly remember what all of their patients are taking, even if you have been seeing them for 20 years. Once again, know the names of all your medications. There may be times when for some reason or another your chart may not be available and the doctor may not have that information.
6. Be sure you know the names of any medications that you are allergic to. Keeping a list of them is helpful. Sometimes when you are feeling very sick it is difficult to remember that very important information.
7. Pharmacies will usually give you an information sheet about medications you are taking. Read them to make sure that there is nothing the doctor missed that might cause you problems.
8. The doctor is the one who needs to know the details about your illness. Unless the nurse asks you for details, all you need to give him/her is the basics. Be sure you tell the doctor everything you want him/her to know. Don't assume the nurse passed along everything you said to them. Sometimes doctors and nurses don't even see each other between patients and often times the nurse can't write down everything you want the doctor to know.
Sorry for the long discourse, but the more you can tell the doctor and the better questions you ask them, the better care you will get.
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Author: Hank Lehrer
Date: 2003-07-23 18:09
Sneakers,
A fine post on a very tricky subject.
Your eight points are well thought out and very insightful. I have always considered myself a well informed consumer as well as a patient. We must all do our homework in preparation for an office visit as well as be ready to do the required legwork after seeing the doctor.
I look forward to your comments on future healthcare issues where you have expertise.
HRL
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The Clarinet Pages
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