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An update on my elbow, one month after Platelet Rich Plasma (PRP) treatment

I had my one-month followup visit with Dr. Mishra today, to review progress since undergoing a platelet rich plasma (PRP) treatment for chronic elbow tendonitis (or, based on an earlier comment, tendonosis) on July 12. I'd posted an update at the 1-week mark, and given all the comments I've received on the blog and via email, I wanted to post an update at the 1-month mark (well, the 5 1/2 week mark, technically speaking).

At this point, my right elbow feels pretty much like it did before the treatment - normally very little pain, a dull ache that starts after even light exercise (e.g., just standing / walking around for 20 minutes with the elbow unsupported ... or typing / mousing for that long), and occasional very sharp pain when I pick up something too heavy or otherwise overextend the elbow. I've regained most if not all of the flexibility in my elbow, e.g., I can now touch fingers from both hands with arms crossed diagonally behind my back, and can use my right hand for eating, drinking (though not my 20 ounce coffee mug) and brushing my teeth - though I'm still using the floss sticks. I can also wash and [towel] dry my hair with relatively little discomfort.

I confessed to Dr. Mishra that I had not followed some of the recommendations he and/or his assistant, Amy, had made on both specific activities and general actvities. They had recommended against taking both the dune buggy tour and the jet boat tour on our recent family vacation down the Oregon coast, as well as prolonged driving; I did all of the above. They had also recommended that I slow down on my typing speed (and duration), which I did, but only for the first two weeks - I suspect I'm back up to my normal speed, which is probably somewhere in the range of 80-100 wpm. I also did some vacuuming around the house yesterday, which, although they did not specifically recommend against it, I knew would not be good for my elbow - and Dr. Mishra confirmed that vibration, in general, is bad, and recommended that I not do more vacuuming for a while. I have, however, been diligent about avoiding anti-inflammatory medications and have been pretty good about doing the gentle stretching exercises.

Dr. Mishra said it is not at all uncommon for the condition of a PRP-treated elbow to be at the same level - or even slightly worse - at the one-month mark after treatment as it was prior to treatment. He re-iterated earlier recommendations (especially about the typing - so I'm going to try to keep this short), and I have started some theratube strengthening exercises. I'll have another followup visit on September 24, after which I'll post another update.

I'm glad that what I was interpreting as a lack of progress is not necessarily indicative of failure of the procedure. I have to say that during the vacation, I was feeling sad about not being able to so much ... though in writing this, I'm a bit embarrassed, as I know many other people have far more extensive disabilities (or, I suppose I should say, challenges). I still feel a bit disheartened, but writing this has been therapeutic - as has been the support offered through comments and emails - and so I will do my best to practice acceptance.

Update, 2007-08-23:

Pete sent me a note with a link to a Runner's World forum topic on My Platelet Rich Plasma Prolotherapy Journey (so far), started 24 May 2007, detailing a series of ups and downs with a PRP injection for knee tendonitis - including the ability to run 5 miles 3 days after the injection (!) - and ending with a report of 100% recovery on 15 August 2007. I'm glad to read of both the eventual success, and the ups and downs that were part of the journey, but I am a bit confused about the conflation of PRP and Prolotherapy, which I'd thought were different procedures. Clearly I have much to learn (and experience). [In a followup note, Pete sent me a link to the Prolotherapy Nashville page, along with some commentary that suggests that Prolotherapy is the more general term for injecting a specific substance - which may be saline, glucose or PRP - into the region around an injured ligament or tendon in order to stimulate healing. (Thanks^2, Pete!)]

Mark sent me a note detailing extensive experiences with various treatments that included an overuse of Cortisone; he now urges people to avoid the use of Cortisone. Fortunately, the doctor's I've seen about my elbow problems over the years have all been averse to using Cortisone, but I did have two Cortisone injections, and one of them was effective (for a while). I wanted to pass along Mark's (and my doctors') recommendations to avoid using Cortisone, as it is a complicating factor in the potential efficacy of PRP.

While I'm on the topic of avoidance, I'd meant to include a few recommendations for things I would have liked to avoid more (well, things I might have avoided more ... clearly, these are things I like), in the course of the healing process, if I were a bit more disciplined. I already mentioned [not] avoiding prolonged or fast typing [... he types, quickly]. Another strategy is to not buy a new 10-megapixel digital SLR camera during the recovery period. Holding the camera for shooting photos during our recent family vacation along the Oregon coast, resulted in significant pain, but I kept repeating the procedure many, many times, reveling in my renewed appreciation for [digital] photography. Another thing I wish I was more disciplined about is avoiding handshakes, at least with the right hand. I was pretty good about this during the first week, but the social discomfort I feel in reaching out with my left hand - or giving a less than firm handshake with my right hand - often overcomes my good sense about protecting my elbow. I still feel sharp pain during - and lingering pain after - firm handshakes. Another area in which I've not been able - or willing - to be more disciplined is [elbow] safe sex. I realize there are many, er, variations available, but [for me], it just is not a "hands off" (or "hand off") activity. My wife, of course, is far more disciplined than I am - fortunately, she doesn't read my blog, or I might get some extra, unwanted help, in practicing greater discipline in this dimension. In general, It seems that any activity that involves the use of the right arm in which I typically enter a flow state (typing, photography, sex) is a candidate for avoidance ... or perhaps more mindful attention.

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