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.
Comments
12 responses to “An update on my elbow, one month after Platelet Rich Plasma (PRP) treatment”
Hope it’s better after another month. My eye surgery felt not so great up to 4 months after the procedure. Another two months did it to a state where I am pretty much all happy about it. Of course these things are not comparable, but I guess I am just pointing out that biological processes may take time.
B)
Pertti: thanks for sharing your story and for your encouragement to be patient. Pete had sent an email linking to yet another story of a drawn out recovery period, punctuated with highs and lows, though in this case it was for a PRP treatment for a knee injury (I posted that in an update on the main blog post). Patience is, indeed, a virtue.
Just wanted to say good luck with this, Joe.
Mile Naked Sex
Nude MPEG movie clips of American Pie 5 – The Naked Mil
Can you update your recovery progress? Just today my orthopedist recommended this treatment for my “golfer’s elbow” which is essentially the same thing as the condition known as “tennis elbow” but is on the other side of the elbow. I’ve tried the steroid injections with virtually no relief and today he told me about this procedure. According to him, this procedure is now approved by the FDA, but I’ve spent a couple of hours this evening looking for some official evidence of that with no success. I do have medical insurance (Aetna PPO), but he was unsure if it would be covered and his administrative person is going to check with my insurance carrier.
I’ve read quite a bit of the literature available on the web tonight and it seems to me that most of the clinical studies involved pretty small groups of participants. The results seem to be positive, but there also appears to be some skepticism amongst the medical professionals as to the efficacy of this procedure. I had rotator cuff surgery last year, so I have no interest in surgery on my elbow.
I did not see any posts from you updating your condition since August – how are you doing? I hope you are “feeling no pain”…
Three month update on my elbow Platelet Rich Plasma (PRP) treatment
On Monday, I had a followup visit with Dr. Mishra to evaluate and discuss progress and prospects for the restored health of my right elbow, three months after my treatment with Platelet Rich Plasma (PRP). One week after treatment, things
Bill: thanks for your kind wishes. Your comment prompted me to post a new entry with a three month update on my elbow Plasma Rich Platement treatment. If the PRP treatment has been approved by the FDA, Dr. Mishra has not said anything about it. My understanding is that we’re still at least a year away before final approval (pending successful outcomes of the trials, of course). I suspect there is suspicion and skepticism about most new medical procedures (and I’m grateful that there is!). I try not to make any broad claims about the procedure, but simply report on my own experience with it (and its aftermath). I wish you all the best on whatever course of action you choose!
Six month update on my elbow Platelet Rich Plasma (PRP) treatment
Amid the broad range of emotions and activities in which I’m engaging this week – a sad last week at Nokia before an exciting new start at MyStrands – I was able to schedule an appointment for my 6-month followup
16 month update on my elbow Platelet Rich Plasma (PRP) treatment
In November, I visited Dr. Allan Mishra’s office for a belated followup on the platelet rich plasma (PRP) treatment for elbow tendonitis he’d administered in July 2007. As was the case before my six month followup visit, I was feeling…
Joe: Thanks for sharing this great overview of your experiences with PRP thus far. I see a lot of questions in the comments regarding Prolotherapy, which is good to see as some of us work hard to educate people on the benefits of the procedure, especially when it comes to avoiding surgery. Surgery is a dramatic solution to problems that can often be handled via other routes.
We share a balanced evaluation on the medical proof of the effectiveness of the procedure on our website. Prolotherapy is what we call “conservative treatment” — for the vast majority of patients, we find that chronic pain can be mitigated or eliminated without surgery, definitely a worthwhile aim.
I’ll be checking out your other articles for further experiences. Good luck!
Hi- I am 4.5 weeks out from having had PRP done on my plantar fascia for a partial tear. I feel super discouraged because I am feeling continual pain at the 1 month mark. It sounds like from your reflections that 1 month out from PRP does not indicate what the end result will be. Do you remember feeling ALOT of inflammation about a month after? When was it that you REALLY started to feel improvement? What was weird for me also was the fact that at about 3 wks I felt great for about 5 days. Then that great feeling went away.
I would love to hear others’ PRP experiences.
Thank you!
JB
@Judi: I don’t remember anything beyond what I wrote in this post about how I was feeling at the one-month mark (one of my motivations for writing the posts was to be able to track my progress … and share that with others). The most recent post I wrote about my experience was 16 months after my platelet rich plasma elbow injection, in January 2009, at which point I was still somewhat disheartened in not having made greater progress. At that point, I wrote:
At the 4 year mark now, my elbow rarely bothers me (unless I overuse it), and I believe I’ve achieved a recovery of approximately 95% … so perhaps by the 5 or 6-year mark I’ll achieve 100% recovery.
Others’ experiences can be found in comments and links in this and other posts on the Platelet Rich Plasma thread on this blog. I also recommend the Total Tendon Network online community that Dr. Mishra created for patients and providers of PRP treatment.
I hope you will achieve similar gains in functionality – and reduction in pain – over time!