September 1, 2008
Torn Achilles Tendon is Common Injury
DEAR DR. DONOHUE: I am a reasonably fit, 61-year-old male who exercises several times a week by walking and the use of Nautilus equipment. I am 5 feet, 8 inches tall and weigh 170 pounds. I recently ruptured my Achilles tendon while jogging across a parking lot to my car in a futile attempt to stay dry during one of our frequent rain storms.
How could this happen? I wasn't doing anything I haven't done many times before. I regularly use the calf machine and lift almost the full stack of weights. I didn't fall. My orthopedic surgeon suggests old age, bad luck or sin. I had participated in a clinical trial of cholesterol-lowering drugs and have read there might be a correlation between statin use and tendon damage. How can I keep this from happening again? I am not ready to resign myself to sitting around and being careful all the time. - R.N.ANSWER: Tendons connect muscles to bones so the muscles can move those bones. The Achilles tendon attaches the calf muscles to the heel bone. It's the thickest, strongest tendon in the body, and it is also the most commonly torn (ruptured) tendon. That sounds contradictory, but it's true. It's evidence of the great stress that this tendon endures when we move about.
A person knows the tendon has torn from the popping or snapping noise that occurs and from the pain felt in the lower back of the leg. That area often swells. Without Achilles tendon attachment, a person cannot stand on the toes, and walking is painful and difficult.
Statin drugs have been reported to influence Achilles tendon tearing. It's a rare occurrence, but it has happened. It's possible you did not take a statin drug. At the end of the study when they broke the code, did they tell you whether you took a placebo or the drug, and if it was a statin drug?
The antibiotic Cipro and antibiotics related to it have been known to cause tendon ruptures.
Unless your doctor forbids certain activities, you can do anything you want. You don't have to resign yourself to a rocking chair. Recurrences can happen, but they are not all that frequent and the thought of them shouldn't force you to a life of inactivity.
DEAR DR. DONOHUE: I take high-impact aerobics three days a week. I am fit and happy to keep my heart healthy. The problem is that I don't sweat. At best, my neck and forehead get damp.
So here's my question. If I don't sweat, am I burning fat? The instructors say sweating is how you know you are burning fat. I love my classes and will always go, but burning big-time calories would be nice. - H.N.
ANSWER: Some people are light sweaters, and some are heavy sweaters. You're a light sweater.
Sweating is a sign of hard work and calorie-burning, but it's not an infallible indication of exercise intensity. It fails as an indicator for people like you.
Take your pulse rate while you exercise or shortly after you stop. Pulse rate is a much better indicator of exercise intensity. I bet your rate is similar to your sweating classmates. You're burning as many calories as they are.
An equally good indication of strenuous exercise is the person's own perception of how hard it is. If you judge you are exercising hard, you are. You have to be honest, of course.
DEAR DR. DONOHUE: What's the best way to apply an ACE bandage? - R.C.
ANSWER: Apply to what?
For something like a sprained ankle, you apply the wrap from a distance below the joint to a distance well above the joint. You want to immobilize the joint. For the ankle it would be from the base of the toes to at least midcalf.
The wrap should be applied firmly, but not so tightly that circulation is impeded.
DEAR DR. DONOHUE: My dad lived with us for five years. He was in his late 80s. All during those years, the only medical problem he talked about was constipation. About a month ago, he said he had a stomachache, and he thought it was due to constipation. This was on a Friday night, and I let things pass until Monday, when the pain got worse. I took him to the emergency room, and my dad was admitted to the hospital. For a full week he underwent testing. Then they diagnosed him with diverticulitis. That same night, he died. His death certificate said he died of peritonitis from diverticulitis. Would he still be alive if I had acted more quickly? - J.O.
ANSWER: You're torturing yourself about something that doesn't deserve the slightest bit of guilt. Your dad was in a hospital with doctors all over the place and with testing facilities that you certainly don't have at your home. It took a full week for his physicians to diagnose his trouble. There is no way you could have made the diagnosis.
One of your father's diverticula burst, and colon bacteria flooded his abdominal cavity causing the infection of peritonitis. That's a very difficult infection to cure, even in an otherwise healthy, younger person. You did everything appropriately.
The topic of diverticulosis is discussed in detail in the booklet of that name. Readers can order a copy by writing: Dr. Donohue - No. 502, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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