Re: Epididymitis but don't want Cipro or Bactrim...options?
- From: bbgator <frankenferley@xxxxxxxxx>
- Date: 7 May 2007 15:34:25 -0700
On May 6, 11:01 pm, NoFun <PDStayA...@xxxxxxxxx> wrote:
History:
Male, Mid 20's
Acute prostatitis 7 years ago (can't remember how it was treated)
Epididymitis 2 times in last year - resolved spontaneously after 1
week - no treatment (I was traveling).
Small epididymal cyst and small varicocele on same side.
Now:
Minor case of epididymitis began 2 weeks ago and some urinary symtpoms
(slightly increased frequency, minor occasional burning). I went to my
uro and he gave me a choice of either Cipro or Bactrim DS and no tests
were done (except chlamydia which was negative).I am nervous about
taking either med because:
Cipro: I have severe tendonitis in my knee and it seems that Cipro on
its own can cause tendon problems including spontaneous rupture.
Medscape is full of citations and the Illinois Attorney General has
been pushing for a warning about Quinolone induced tendinopathy.
Bactrim DS: I am hesitant to take Bactrim because of the allergic
reactions including regular old anaphylaxis and also the often fatal
Stevens-Johnson Syndrome which results in one's skin "sloughing off".
I'm sorry but even though this is rare...it scares the %$%#$^% out of
me. I have never taken a sulfa drug.
My doc is saying that I have no options except Cipro/Bactrim and Doxy
(I can't take Doxy due to an esophageal ulcer caused by NSAIDs). Can
this be true? Are there no other non-quinolone antibiotics effective
for prostatitis/epididymitis ?
How about Zithromax?
I feel like not treating this could be a serious mistake, but I dont
exactly like options number 1 and 2,
Myofascial Pain Syndrome (MPS) is a is a painful musculoskeletal
condition, a common cause of musculoskeletal pain. MPS is
characterized by the development of Myofascial trigger points (TrPs)
that are locally tender when active, and refer pain through specific
patterns to other areas of the body. A trigger point or sensitive,
painful area in the muscle or the junction of the muscle and fascia
(hence, myofascial pain) develops due to any number of causes. Trigger
points are usually associated with a taut band, a ropey thickening of
the muscle tissue. Typically a trigger point, when pressed upon, will
cause the pain to be felt elsewhere. This is what is considered
"referred pain".
These factors can cause trigger points:
·Sudden trauma to musculoskeletal tissues (muscles, ligaments,
tendons, bursae)
·Injury to intervertebral discs
·Generalize fatigue (fibromyalgia is a perpetuating factor of MPS,
perhaps chronic fatigue syndrome may produce trigger points as well)
·Repetative motions; Excessive exercise; Muscle strain due to over
activity
·Systemic conditions (eg, gall bladder inflammation, heart attack,
appendicitis, stomach irritation)
·Lack of activity (eg, a broken arm in a sling)
·Nutritional deficiencies
·Hormonal changes (eg, trigger point development during PMS or
menopause)
·Nervous tension or stress
·Chilling of areas of the body (eg, sitting under an air conditioning
duct; sleeping in front of an air conditioner)
The fascia is a tough connective tissue which spreads throughout the
body in a three dimensional web from head to foot without
interruption. The fascia surrounds every muscle, bone, nerve, blood
vessel and organ of the body, all the way down to the cellular level.
Therefore, malfunction of the fascial system due to trauma, posture,
or inflammation can create a binding down of the fascia, resulting in
abnormal pressure on nerves, muscles, bones or organs.
This can create pain or malfunction throughout the body, sometimes
with bizarre side effects and seemingly unrelated symptoms. It is
thought that an extremely high percentage of people suffering with
pain and/or lack of motion may be having myofascial problems; but most
go undiagnosed, as the importance of fascia is just now being
recognized.
Many of the standard tests, such as x-rays, myelograms, CAT scans,
eletromyography, etc., do not show the fascia. (John Barnes, P.T.,
1992)
Occassionally, trigger points produce autonomic nervous system changes
such as flushing of the skin, hypersensitivity of areas of the skin,
sweating in areas, or even "goose bumps." The trigger points cause
localized pain, although TrPs can involve the whole body.
In three studies, the prevalence of myofascial TrPs among patients
complaining of pain anywhere in the body ranged from 30% to 93%;
(among patients with chronic craniofacial pain, 55%; and for
lumbogluteal pain, 21%.)
The characteristic electrical activity of myofascial TrPs most likely
originates at dysfunctional endplates of extrafusal muscle fibers.
This dysfunction appears to play a key role in the pathophysiology of
TrPs. (Simons 1996)
Subjective shortness of breath can be part of the myofascial pain
syndrome of the levator scapulae muscle. In one study, 75 patients who
reported neck pain & shortness of breath were examined. Trigger points
were located and inactivated with acupuncture needles (dry needling).
68 of the 75 patients in the study reported that their shortness of
breath and soreness were abolished immediately after inactivation of
the TrPs. The other 7 patients needed a second trial of inactivation.
Eliminating the trigger points eliminated the symptoms. (Journal of
Muskuloskeletal Pain, 1996)
Like fibromyalgia, Myofascial Pain syndrome is an often misunderstood
condition. Even today, some doctors either don't believe that MPS
exists or they don't understand its symptoms and treatment.
Treatment of MPS can only begin after an accurate diagnosis is
accomplished. Methods for managing this painful condition:
· Trigger Point Therapy {Myofascial release therapy, myotherapy,
massotherapy (medical massage therapy)}
· Spray and Stretch technique (stretching of the muscles involved with
a vapocoolant spray - a coolant is sprayed on the trigger point to
lessen the pain and then the muscle is stretched. this is often done
by a physical therapist.)
· Trigger Point Injections (local anesthetic,such as lidocaine,
injected directly into the trigger points)
· Dry Needling (the use of a needle without injecting anything)
[TrP injections and dry needling mechanically disrupt the tirgger
point. The use of lidocaine is no more effective, but it reduces the
soreness afer injection. For MPS there is no role for injected
steroids]
· Chiropractic or Osteopathic manipulation treatment
· Craniosacral Therapy
· Physical Therapy (hands-on)
· Exercise
· Improvement of nutrition
· Changing sleeping habits
· The use of tricyclic antidepressants in low doses
· Elimination of stress; Biofeedback; Counseling for depression that
may result from this painful condition
An active trigger point when treated well or with rest will become
latent (quiet, or not causing active symptoms). It can often resurface
after trauma after acute overload or fatigue, or even sudden exposure
to cold. Conversely, new trigger points may arise elsewhere, or at
least become more sinificant as others become latent.
For MPS, you should see a doctor knowledgeable in chronic pain such as
a physical medicine doctor (a physiatrist), or a neurologist. The
diagnosis is made by the history and physical exam. There is no lab
test nor imaging studies to confirm the diagnosis. A history of acute
trauma or chronic overuse should be looked for.. On exam, there is
typically restricted motion with pain of the affected muscle. Other
medical problems need to be ruled out with imaging or other studies.
For instance, if a patient presents with back pain, disc and other
problems need to be ruled out.
Altered Pain Perception Accompanies MPS: A Danish study indicates that
people with chronic myofascial pain perceive and transmit pain
differently than people without the syndrome. As many as 72 percent of
people with fibromyalgia may have trigger points associated with
myofascial pain.
Source: "Qualitatively altered nociception in chronic myofascial
pain," by L. Bendtsen, R. Jensen, and J. Olesen, Pain, 65 (1996),
pages 259-264
Fibromyalgia or Myofascial Pain Syndrome or both?
Differential features of Fibromyalgia & Myofascial Pain Syndrome
Feature
FMS MPS
Pain Diffuse
Local
Fatigue Common
Uncommon
AM Stiffness Common
Uncommon
Tender Points X
Trigger Points X
Prognosis Chronic
Resolves with treatment
A little humor for those who are tired of IAIYH doctors:
HOW TO TEACH DOCTOR ABOUT MPS
(This was posted to the newsgroup in April 1996)
NOT SERIOUSLY RECOMMENDED. Hanna Jones went to see Doc Smith, her
internist. The receptionist asked the nature of the visit and she
stated it was Myofascial Pain Syndrome. The receptionist took her
blood pressure and got her ready for the doc.
Ten minutes later Dr. Smith entered the room. "Hello Hanna, what are
we seeing you for today?" Hanna replied, "Myofascial Pain Syndrome."
Dr. Smith looked up from his chart and said, "That's a waste-basket
diagnosis. I don't believe it exists."
Hanna motioned for him to come toward her. She said, "Put your right
thumb and first finger on this wad of muscle at the outside of my left
forearm (a brachioradialis muscle), and gently squeeze it." He was
facing her, and as he did so, she drew back her right fist and socked
him across the mouth as hard as she could.
Dr. Smith went reeling out of the exam roon door into the nurses arms.
The nurse said, "So what does she have?" Dr.Smith said, "Myofascial
Pain Syndrome." The nurse replied, " I thought you don't believe in
that diagnosis." Dr. Smith said, holding his lip,"I've never had it
explained to me that way before."
.
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