Flare up of widespread tendonitis, saw Rheumatologist today

by Amy
(Meridian, Idaho)

I have a very demanding job as a lab tech, processing and transporting lab specimens, walking up to approximately 8 miles per day.

I have moved furniture both of the last two weekends because we sold two homes and had to get all our stuff out.

I was in so much pain yesterday morning that I called in to work but felt like I needed some kind of documentation to give my boss because this is a chronic problem for me (I have HLAB27 gene marker, and am very prone to muscle and soft tissue injuries that take longer than normal to heal and cause a lot of pain).

When I saw my rheumatologist today, she told me the best thing for tendonitis is to stay active and did not give me any time off work, and even though I have the positive HLAB27 and positive ANA in the past, one parent with rheumatoid arthritis and the other with reactive arthritis, as well as personally tentative diagnoses in the past of reactive arthritis, mixed connective tissue disease and Still's disease, today she would not give me documentation of any type of diagnosis to offer my employer.

She ignored my complaints about my wrists, ankles and shoulder, and took an x-ray of my lower back, which showed some bone spurs and osteoarthritis. I am 51 years of age and have stayed in pretty good shape in spite of my health problems.

I am in a lot of pain, and I left the specialist's office feeling like a big pansy who needs to stop complaining.

Your thoughts?

Thank You!


Joshua Comments:

Hi Amy.

My thoughts:

1. Personally I wouldn't put so much weight on the genetic marker thing.

In that, having the gene or whatever doesn't doom you to having anything rheumatoid arthritis related.

MAYBE it makes you more easily succeptible to the causes of inflammatory 'disease', meaning, you're more sensitive to inflammatory foods like gluten, processed vegetable oils, sugar, etc.

People often say 'it's genetic' or 'it runs in my family'. Which more accurately means that familes can share sensitivities/tendencies, AND generally share lifestyles.

So if others in your family have rheumatoid arthritis, 'reactive' arthritis, inflammatory related connective tissue issues, etc, then I HIGHLY advise you to get off all inflammatory foods like gluten and processed vegetable oils (and ya know, sugar).

2. If you have RA to any degree, and/or other auto-immune issue, then you have Leaky Gut.

If you want to fix it, then of course, you need to heal your gut...and that requires the stopping/reducing of the intake
of gluten, processed vegetable oils, sugar, etc.

3. If you have leaky gut (you do) then you are nutritionally insufficient (for a variety of related reasons) and that is part of the muscle pain/slow recovery.

The gene marker itself isn't the cause of weakness/pain/RA, it's your overall ecology/functional ecology.

4. The other reason for the muscle pain/slow recovery is your overall inflammatory status. Meaning, you have systemic inflammation going on, and that's bad in a variety of ways.

Inflammation causes increase in pain and problem, which causes the brain to turn up mechanism that increases inflammation that causes increase in pain and problem....repeat, repeat, decades pass, doctors are clueless, etc.

5. I do agree with your doctor who says to stay active with tendonitis (In the last 18 years I've never heard of a doctor saying that, so that's good), but tendonitis symptoms are from a much larger dynamic that just 'resting' or 'too active'.

See: What Is Tendonitis?
Of course, now she's probably going to focus on the bone spurs and osteoarthritis as 'causes' of pain, etc, again missing the deeper causes entirely.

Do you have 'real' tendonitis? Maybe.

Do you have tendonitis symptoms from your larger inflammatory and nutritonally insufficient dynamic? Almost certainly.

Point being, laying around isn't going to help or fix anything. And if you do have 'tendonitis', what you REALLY have is a deeper, underlying mechanism causing those symptoms.

6. You're definitely not a pansy who needs to stop complaining.

You are a woman with some common and predictable results of lifelong intake of inflammatory foods and (probably lifetime of chronic) nutritional insufficiency, and who has spent time and money with the modern hospital doctor industry who for some mind boggling reason aren't aware of/don't believe in/have never bothered to take 10 minutes to investigate WHY you are suffering as you do.

RA is reversible and fixable, despite the AMA declaring it to be an incurable disease (like diabetes, fibromyalgia, chronic fatigue, arthritis in general, etc).

See Related: Osteoarthritis vs Rheumatoid Arthritis

See Related: Rheumatoid Arthritis Early Symptoms

See Related: Cause Of Rheumatoid Arthritis

More questions, more answers.

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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

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Feb 17, 2017
Thank you for your in-depth consideration of my symptoms
by: Amy

I have heard of the leaky gut as cause of inflammatory symptoms, and have undergone allergy testing, during which my diet was very limited and I ended up not having too many food allergies according to the tests. I absolutely agree that sugary foods and certain types of oils cause inflammation.

I cannot eat much sugar without feeling the ill effects of it, and if I don't eat plenty of vegetables I will pay for it. I eat a high Omega 3 bread with lots of nuts and seeds in my diet. I exercise a lot and avoid processed foods for the most part, try to get lots of whole foods in my diet.

I guess my main concern about my painful flare-up is that it is common knowledge that rest, ice, compression and elevation is approved treatment for acute injuries. To go walk 8 miles a day on painful, acutely injured joint tissue seems counterintuitive.

But you actually agree with my specialist's advice, correct?


Joshua comments:

Hi Amy.

In general, 'staying active' is overall better than 'sitting on a couch for a month'.

But, no, I would not agree that walking 8 miles a day on an acutely painful joint is a good idea.

For so many reasons, it's terrible, terrible advice. Maybe topmost is because it ignores WHY you're having pain, and the advice implies hope that if you stay active on something painful that it will just go away.

If you were going effective self care and.....kind of managing the level of activity with the level of pain, that would be one thing.

But I'm probably right in predicting that if you keep doing 8 miles on something that feels like it's acutely injured will 100% lead to more pain and problem.

Your body isn't functioning properly. Pushing through the pain etc isn't going to make it function properly.

In my experience, your number one priority is to fix your gut function (because if you don't, and focus on trying to fix the ankle/wrist/etc), you may get some benefit but the underlying dynamic will still be in full swing and sooner or later you'll be back in a painful state.

While there's nothing wrong with lowering symptoms while ignoring the cause of the symptoms (because less pain is better), I tend to consider that a waste of time...in that I'd prefer to fix the cause of the decrease in function than pretend that your wrist pain or ankle pain is 'tendonitis' (which as your doctors etc see it is an isolated, location-specific physical problem).

Your tendonitis pain is neither isolated, nor location-specific, nor specifically physical.

"common knowledge that rest, ice, compression and elevation is approved treatment for acute injuries"

Well, yes (kind of), but I'm guessing that you don't actually have an 'injury', meaning, rip/tear.

One can have debilitating pain with no actual injury (again, injury meaning rip/tear).

So again, not isolated, location-specific, nor specifcally physical.

Which isn't to say that you don't have 'real' tendonitis because you very likely do have the factors of tightness, inflammation, etc, but I'm guessing for you the larger (deeper) factor is nutritional insufficiency and the -source- of the inflammation (damaged gut function).

Some people's tendonitis symptoms are mostly physical (tightness) with some nutritional lack and inflammation.

Some people's tendonitis symptoms are mostly nutritional lack and thus inflammation and tightness.

Doctors and PT's etc tend to only see 'tendon pain' as a tendon problem. But it's (rarely) never a tendon problem, it's always a tightness/inflammation/nutritional insufficiency problem that ends up being felt as tendon pain (muscle pain, etc, let's go with 'tendon pain' as a general label for what you're feeling).

"I ended up not having too many food allergies according to the tests"

Good news/bad news..

I don't put a lot of faith in those results (for anybody in your scenario) for a variety of reasons, including that you're still in pain, moving towards more pain, etc, with the whole possible reactive arthritis, high ana, other possible 'diseases', etc.

From all you've said, my primary focus would be on fixing your gut (while also doing self care for ankles or wrists whatever's worse). And there is some overlap there, but the damaged gut function is the main driver (plus gluten which you with a healed gut should probably [definitely] avoid entirely).

Moral of the story: Rest/ice/elevation/compression etc is incredibly unlikely to fix your foot/ankle/wrist/muscle/tendon pain, because that's entirely the wrong toolset for what you have going on/for what is causing pain in your foot/ankle/wrist/muscle/tendon/etc.

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