Three month update on my elbow Platelet Rich Plasma (PRP) treatment

On Monday, I had a followup visit with Dr. Mishra to evaluate and discuss progress and prospects for the restored health of my right elbow, three months after my treatment with Platelet Rich Plasma (PRP). One week after treatment, things had gotten worse (though, as Dr. Mishra had warned, this is often the case shortly after treatment). At the one-month mark, my elbow was feeling pretty much like it had just before the treatment. At this point, I'm happy to report that my elbow feels better than it did before the treatment, though still not as well as it felt before the initial injury.

Among the daily activities that I have resumed doing with reduced pain are

• drinking my 22-ounce mug of coffee with my right hand
• doing full-form yoga sun salutations (including the elbow-loading cobra pose and downward-facing dog pose, which I'd been omitting from my routine until recently)
• flossing my teeth with regular dental floss (vs. floss picks)
• scrubbing pots & pans

On Sunday, I was moving our four 20-pound Lafuma recliner chairs from the deck to the garage (one at a time), requiring a relatively significant amount of elbow strength and agility (given the rather cramped state of our garage). Although my elbow was sore afterward for a few days, I was surprised I was able to pick the chairs up at all - and, as with some of the activities I mentioned in my last update, I probably should not have pushed (or pulled) that hard.

During the visit on Monday, I was able to exert 120 pounds of grip strength with my right hand with a subjective pain level - at the limit - of about 4, and was able to resist Dr. Mishra's attempt to pull down my upturned hand with a pain level of 3. During my first visit, I was only able to exert 65 pounds before I hit the wall (of pain) at level 9, and my resistance was lower and pain higher for the upturned hand exercise.

I was feeling pretty awful at the one-week mark, and was [still] rather disheartened at the one-month mark (though the email and comments on that post helped cheer me considerably). I have to say that I'm feeling much better at this stage - physically and emotionally - about my present condition and my future prospects for continued healing. I think Dr. Mishra is also encouraged at the progress in the last two months.

So, the current plan is to continue doing the stretching and theratube resistance exercises, hold off on resumption of more comprehensive strength training (for the right arm at least) and repetitive exercises (e.g., elliptical trainer with moving arms) and very gradually [continue to] extend my activities to accommodate more loading of the elbow.

I'll be going back for another followup at the six-month mark (second week in January), by which point I should have achieved about as much progress as I can expect from the treatment. I'm a little more optimistic about full - or nearly full - recovery, but there is still a chance I'll ultimately need surgery.

I've been in communication with a number of people who are considering or undergoing PRP treatments for their ailments. I wish you all the very best progress in your consideration and/or healing processes, and will do my best to honestly share my experience, strength and hope through exchanges of comments on this blog or via email.

[Note: I prefer communicating via blog comments, as many of the emails also contain gems of wisdom - and inspiring experience, strength and hope - that I'd like to share more broadly, i.e., through this blog, but I understand that some (many?) people are not comfortable posting public comments on blogs - er, perhaps particularly on this blog, given my recent tirades on spampliments - and so anyone who prefers email can also use the "Email me" link below my "thinking spot" photo at the top left.]

[Additional note (2007-10-11): NPR ran a story on Morning Edition today on how and why Patients Turn to the Internet for Health Information, based primarily on the recent Pew Internet study on E-patients With a Disability or Chronic Disease and a University of Wisconsin 17-year study called Comprehensive Health Enhancement Support System (CHESS) ... one of the programs in the similarly acronymed Center for Health Enhancement Systems Studies.

Here's an abstract from the Pew study:

About a fifth of American adults say that a disability, handicap, or chronic disease keeps them from participating fully in work, school, housework, or other activities. Half of those living with a disability or chronic disease go online, compared to 74% of those who report no chronic conditions. Fully 86% of internet users living with disability or chronic illness have looked online for information about at least one of 17 health topics, compared with 79% of internet users with no chronic conditions.

Those with chronic conditions are more likely than other e-patients to report that their online searches affected treatment decisions, their interactions with their doctors, their ability to cope with their condition, and their dieting and fitness regimen.

My decision to seek PRP treatment for my elbow was due to chronic tendonitis / tendinosis. I didn't do all that much research on the Internet (compared to other things I research), but since Dr. Mishra offers an alternative treatment (to surgery), is located very close to where I work, and is a blogger himself (!), I decided to visit him. I did get second (and third) opinions, from the doctor I'd seen for earlier episodes of elbow "flare ups", and from one of my cousins, who is an orthopod, and both agreed that non-surgical intervention was generally preferable over surgical intervention, and PRP seems to offer a reasonable cost/benefit ratio (based on how little we know yet on its long-term efficacy from larger-scale trials).

The people who have contacted me through email and comments on my blog posts have clearly done far more online research - and in many cases, suffered more and longer from chronic conditions - than I have ... and, of course, I'm not quite sure how much online research has been conducted by other readers of my PRP-related posts. In any case, I think we offer, collectively, a number of data points to corroborate the Pew findings.

I can't find the CHESS study referenced in the NPR story, but I did find another one that is interesting and somewhat relevant (and also related to my recent rant on fundamentalism in a post on Blessed Unrest), Effects of prayer and religious expression within computer support groups on women with breast cancer (press release), where they found:

As hypothesized, writing a higher percentage of religion words was associated with lower levels of negative emotions and higher levels of health self-efficacy and functional well-being, after controlling for patients' levels of religious beliefs. Given the proposed mechanisms for how these benefits occurred and a review of the support group transcripts, it appeared that several different religious coping methods were used such as putting trust in God about the course of their illness, believing in an afterlife and therefore being less afraid of death, finding blessings in their lives and appraising their cancer experience in a more constructive religious light.

I do not know the religious beliefs of the scientists who conducted the study (or other studies purporting to find a link between prayer and health), but as scientists, we have to be extra careful to not fall into the very human trap of seeing what we want to see (particularly when trying to study others' behavior that I believe amounts to seeing what they want to see). The New York Times ran an article on "Long-Awaited Medical Study Questions the Power of Prayer" last March reporting an American Heart Journal study - "Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer" - that reports intercessionary prayer - praying for someone else's health (without their knowing about it) - has no measurable impact on the recipient of that prayer. What's interesting in the CHESS study (to me) is that it looks at the impact of prayer on the sender vs. receiver (or subject vs. object) of prayer - the person who is praying ... and although I don't know of any scientific justification for this, I do believe in  the power of positive thinking (and speaking (and writing)) ... which is why I so often find myself preaching what I want to practice, if not praying about it.]

[Yet another update (2007-10-12): Another study verifies the power of positive thinking:

Research is showing the power of expectations, that they have physical -- not just psychological -- effects on your health. Scientists can measure the resulting changes in the brain, from the release of natural painkilling chemicals to alterations in how neurons fire.

Among the most provocative findings: New research suggests that once Alzheimer's disease robs someone of the ability to expect that a proven painkiller will help them, it doesn't work nearly as well.

It's a new spin on the so-called placebo effect -- and it begs the question of how to harness this power and thus enhance treatment benefits for patients.

"Your expectations can have profound impacts on your brain and your health,'' says Columbia University neuroscientist Tor Wager.

The report referenced above contains yet another link to a study reporting that optimists live longer, but I think I've done [more than?] enough lateral drifting for one post.]

Comments

[kevin]

I've been seeking PRP treatment for tennis elbow for some time now. Where might I find someone in the Boston (MA) area who practices this method of treatment?

-Kevin

[Joe McCarthy]

Kevin: I don't know of any PRP practitioners in Boston (or, indeed, outside of Menlo Park, CA), but Dr. Mishra is pretty well connected with a large number of other PRP practitioners. I'd recommend checking his PRP home page, which has a links to his research blog as well as the Total Tendon Network (which requires registration, and may be intended only for providers - first time I've encountered a Ning-based social network site "in the wild" (!)).

If you can't find anything online, I'd recommend that you contact him or his staff at the Menlo Sports Medicine clinic directly (650.498.6645).

BTW, thanks for the ping, as it reminded me I need to schedule my 6-month followup visit!

[cm bailey]

i had the prp shot last Thurs, on both elbows and today, on tues, i am able to bend my elbow at 90*-i was probably too optimistic on the recovery period and am going a little stir crazy-i am praying this works for me

[Joe]

cm: I, too, was impatient at times during the recovery period. Your comment prompted me to add more trackbacks to my other blog entries about PRP so that it will be easier for readers to track my progress over the last several months. At around the 9-month mark now, I'm very close to normal use of my arm. Yesterday, I spent an hour and a half with my family whale watching by kayak off the coast of Maui (the photos in the referenced link are not of us, but give a sense for the experience ... though we did not approach as close as some of the kayakers I photographed from shore). My elbow is a little sore today, but this was an activity I would not have even attempted at the 3-month mark, and expect I would have been in far more pain today if I'd attempted this at the 6-month mark. I hope you enjoy a similar return of functionality - and diminishing pain - as you progress in your recovery!

[cm bailey]

Thank you! I am hoping to be able to drive by Monday and get back to work. Not that I want to be back there-but I need to be....I have had 3 years of arm pain, physical therapies, diagnosis, misdiagnosis, ect and am anxious for the day I can put it behind me. It is nice to know other people understand.