Dr. Robert G. Lewis, M.D.

If your husband has gout then you have most likely received that diagnosis from your primary care physician. With that said, you probably further understand that gout is a build up of uric acid in the body and can cause acute painful episodes when the excess acid crystallizes in joints or tendons. One should not exercise during these acute episodes as it will likely worsen the inflammatory response to the gouty crystals which can intensify the symptoms and prolong the gouty “attack”.

Exercising at other times is actually recommended. The benefits of exercise certainly outweigh the risks but must be done in moderation and sensibly. If your husband has mild knee pain following treadmill running then he may be experiencing some joint damage the gout has created over the years. Running is considered high impact and he should consider changing to a low impact activity like walking, bicycling, swimming, elliptical or stair climbing. These low impact exercises will likely provide good aerobic activity without the high impact to the joints and will help reduce exercise-induced pain and chronic damage.

Good luck!!

Educating yourself on the most common injuries hockey players sustain should be your first step. Knowing this information allows you to equip yourself safely and appropriately before playing. Next, know the people you play with and the type of league you're in so you'll know their level of play and if they are hard checkers or if the league is more "polite". Next, the best thing you can do to help prevent injury is increasing your skill level (practice) and become profoundly conditioned. The more conditioned you are from an endurance standpoint and strength standpoint allows you to increase your dynamic (muscle) protection of your ligaments and joints.

You may not need a sports med specialist to help you with this, but rather good research.

Good Luck!!

Ouch!! that can be quite painful and yes this could represent a fracture. Look in the mirror and at old pictures of yourself to see if you see any malalignment of your nose. Also, ask your spouse or friends if your nose looks different to them. It may be displaced if they say yes or you notice a difference.

If so, or if the pain does not resolve quickly, you should seek medical advice to see if a fracture is present.

Expect some bruising.

Good Luck!!

When pain or discomfort occur bilaterally, or on both sides, from activity, one typically can attribute the pain to overuse as the likelihood of the same injury to each side is rare although not impossible. Therefore, a treatment focused on overuse should suffice. Try resting the shoulders or even modifying how often and how long you play your activity. Apply ice to both shoulders several times a day and for 10-15 minutes each time. Over the counter NSAIDS, if not contraindicated, can be helpful if approved by your primary care physician. Rehab for the shoulders can also help prevent this from recurring.

Usually a little activity modification, ice, NSAIDS and some rehab will allow you to stay active. Good luck!

Overhead activities can affect our rotator cuff and/or biceps attachment in the shoulder. This could be your problem. Ice, over the counter anti-inflammatories and a couple of weeks rest should help significantly if this represents a simple overuse or strain.

If symptoms persist, then occasionally an injection (to help treat the inflammation), formal physical therapy or even an MRI may be necessary. Ask your primary physician for advice if this does persist and he/she may be able to treat or refer you to a Shoulder specialist.

Inside the ear, and more specifically the middle ear exist the semicircular ducts or canals. These are fluid filled structures that assist and allow us to maintain balance. When we move our heads, the head and ducts move but the fluid remains still in the ducts. Small hairlike structures within this system are then deflected which sends signals to the brain that we are moving and depending on the duct stimulated, we know if we are leaning left or right, turning left or right or going up or down.

If you spin one direction for several seconds, the fluid in the canals “catches up” and when we stop spinning the ducts stop but the fluid keeps going and deflects those hairlike structures giving us the sensation that we are spinning or are “dizzy”. You’ve probably spun around a baseball bat with your forehead on the knob of the bat and then tried walking or running and you lean to one side and often times fall down.

So, if we can get the fluid moving in the ducts or canals then we can feel dizzy. A test in the clinic for these ducts is called the “caloric reflex test” where clinicians can gently squirt cold water into the ear and this will cool the fluid in the ducts and as you know, heat rises so the warm fluid “moves” to the top of the canal and cooler fluid to the bottom which is creating fluid motion which then deflects those hairlike structures and the sensation is that you’re spinning or “dizzy”.

When you are swimming, either you’re head is rotating to one side so as to breathe which can get the fluid moving or you are experiencing one big “caloric reflex test” or a combination of both.

What to do? Trying alternating your breathing to both sides and maybe try some ear plugs so the pool water temperature won’t influence your semicircular duct fluid so much.

Good Luck!!

Blood inside a joint can be a common side effect of an injury to structures that may involve the inside of a joint. When you sustain an injury, you commonly bleed. If a skin injury, you see the blood, if below the skin you may see a bruise (blood under the skin) or the bleeding may deeper, ie, in a joint or in a deep muscle.

Good news!! The body is pretty clever and naturally tries to maintain joints in their normal state. So if blood develops in the joint (hemarthrosis), the body tries to resorb and digest the blood and restore the joint to normal. Most often, surgery is unnecessary to remove the blood from the joint.

Once the hemarthrosis has resolved, there are usually no long term side effects to this occurence. The only side effect would be from the injured structure, ie, ligament, cartilage, bone, etc.

A well-balanced diet is usually all that is needed for proper growth. As her activity level increases, her body will naturally "crave" more energy, which will typically increase her appetite. Balancing proteins and carbs as well as some healthy fats in moderation should support normal growth. Routine visits with her pediatrician are also highly recommended to make sure her growth is on track for her age.

Depends on what the knee pads are for. If they are for "runner's knee" or patellofemoral syndrome and they help keep your knee cap somewhat "quiet" and stable during running then it should be fine. If you have no symptoms at all, and you never have and the knee braces offer no support or pain relief, then you should be fine without the braces.