[TheForge] blacksmith's elbow and cortizone

[peter fels & phoebe palmer]

On 10/27/2010 5:58 PM, Clyde Wynia wrote:
>
> Here is an email I received from a retired doctor friend after I sent him
> the cortisone piece:
> DEAR CLYDE,
>      REMEMBER THAT PEOPLE WHO DON'T HURT DON'T PAY ATTENTION TO DOCTOR'S
> ORDERS ABOUT AVOIDING INJURIOUS ACTIVITY.
Therefore it is in the patient's best interest that he keeps hurting 
until fully recovered.
Right?...grin.

Clyde, any idea of what would cause your excellent rust formula to 
seemingly work well, but then areas of the patina float off when sprayed 
down with a hose the next day?
It's possible that my preparatory alcohol flush  caused some oils to 
rise up out of the clean plywood the piece was set on for the alc scrub 
down...(that's the bottom surface that has the problem) . But that's all 
i can think of. It was thoroughly wire brushed.
>      IMAGINE LONG LASTING NOVOCAINE FOR A SPRAINED ANKLE.  THE PATIENT GOES
> OUT AND WALKS ON A PLOWED FIELD(TOUGH ON ANKLES).  WHAT WILL IT FEEL LIKE
> WHEN THE NOVOCAINE FINALLY WEARS OFF. (WORSE LATER ON.)
>      I'LL BET THEY DIDN'T TAKE AN ACTIVITY HISTORY(VERY HARD TO DO, PEOPLE
> ALWAYS SAY THEY FOLLOWED DR'S ORDERS.)
>      IF I GET ONE OF THOSE, I'LL TAKE CORTISONE IF IT'S OFFERED.
>      MY SHOT IN THE KNEE HAS HELPED A GREAT DEAL.
> SANDY(NOT EMPLOYED BY THE CORTISONE COMPANIES) MACDONALD
>
> from NY times
>
> But a major new review article
> <http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961160
> -9/abstract>,
> published last Friday in The Lancet, should revive and intensify the
> doubts about cortisone's efficacy. The review examined the results of
> nearly four dozen randomized trials, which enrolled thousands of people
> with tendon injuries, particularly tennis elbow, but also shoulder and
> Achilles-tendon pain. The reviewers determined that, for most of those
> who suffered from tennis elbow, cortisone injections did, as promised,
> bring fast and significant pain relief, compared with doing nothing or
> following a regimen of physical therapy. The pain relief could last for
> weeks.
>
> But when the patients were re-examined at 6 and 12 months, the results
> were substantially different. Overall, people who received cortisone
> shots had a much lower rate of full recovery than those who did nothing
> or who underwent physical therapy. They also had a 63 percent higher
> risk of relapse than people who adopted the time-honored wait-and-see
> approach. The evidence for cortisone as a treatment for other aching
> tendons, like sore shoulders and Achilles-tendon pain, was slight and
> conflicting, the review found. But in terms of tennis elbow, the shots
> seemed to actually be counterproductive. As Bill Vicenzino, Ph.D., the
> chairman of sports physiotherapy at the University of Queensland in
> Australia and senior author of the review, said in an e-mail response to
> questions, "There is a tendency" among tennis-elbow sufferers "for the
> majority (70-90 percent) of those following a wait-and-see policy to get
> better" after six months to a year. But "this is not the case" for those
> getting cortisone shots, he wrote. They "tend to lag behind
> significantly at those time frames." In other words, in some way, the
> cortisone shots impede full recovery, and compared with those ''adopting
> a wait-and-see policy," those getting the shots "are worse off." Those
> people receiving multiple injections may be at particularly high risk
> for continuing damage. In one study that the researchers reviewed, "an
> average of four injections resulted in a 57 percent worse outcome when
> compared to one injection," Dr. Vicenzino said.
>
>
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