Not an end, just a pause for now

Well, as any of you know already, pain sucks. But, for a change, it is not my pain. I still seem stable for now as far as that goes. One who is close to me is not so well off at this point. I am in the recently odd position of having to help someone else with fairly basic adult daily living type things, and I am glad I can still do this. And the person I am helping now has a deeper understanding of what I have gone through the last ten years or so. The jury is still out as far as the issues being faced.

As I said, I am stable. What that means is that I am still weak. My shoulder blades still are winged. My right thumb is still basically worthless. But as I may have mentioned, if my right hand was stronger, I would still be unable to lift much with it at this point.

I have to wonder about all of the websites that suggest that NA/PTS only usually impacts the right shoulder. Yes, that would mean that the causal agent can determine right from left, and up from down. Yes, the agent that causes PTS/NA knows that the right side is the right side and the left should be left out of the attack. And while we are at it, it also knows to stay out of the other plexus sites. No need to go there. It is too far away to matter.

Well, in my case at least, the causal agent is just not that smart. Sure the left shoulder is not impacted as obviously as the right, but the weakness is exactly the same right to left. The weakness goes into my lower back and upper legs. There is not anything obvious down there to be winged as the scapulae do, but that does not mean the nerves are not being impacted just the same. Most websites suggest that not only should my damage be restricted to my right shoulder, but also that I should have recovered by now. That does not seem to be happening either.

I have to wonder what my occasional need for super deep breaths might mean. Is my phrenic nerve also compromised already? For the most part I am breathing just fine. But in certain positions I do find I have to take an extra deep breath every so often. I know people who are on oxygen due to PTS. Is that in my future too? Maybe I am good for now. But what about the next attack that is sure to come in the next few years? Just like the killer earthquake that the San Francisco area is bound to have at some point, I am waiting for my next attack.

I try to stay physically strong, but how do you exercise muscle that has no nerves to fire it? In my brief returns of strength, the muscle still works, and seems to be able to get stronger as long as it works. But then, it disappears again and I return to being weak. I have always been thin. I guess it is time to give up on ever looking any different.

Good bye for now. I hope you all are doing better than I am, and maybe you will be able to recover as the websites suggest you will, at least on average. I guess I have never really been average. No reason to change that now.

I will be back at some point.

Be well. . .

Strength gone again

Just now I am back to around 5 push ups.

I am curious if anyone else with PTS by whatever name you know it- has this sort of fluctuation in strength. My doctors will not discuss it, which is just as well since they do not understand anything about it.

Timolol and strength update

Well, it has been a bit more than a week since I have stopped the beta blocker eye drops, aka Timolol. The theory is that they may have either caused or exacerbated my tremor and muscle weakness. The timing suggests at least a probable cause enough to be suspicious.

Initially, I felt that my fine motor control was much improved, and the few twitches I have had ongoing appeared to have stopped.

But then I had to go and spoil it all by attempting to do a bit of yard work today.

Trying to lift things is still a problem. But, overall my lower back and upper legs felt much stronger than they have in previous similar outside work. My hands, particularly on the left, still tremor after any exertion. At one point I had my left hand resting on a board trying to hold it steady, and it was shaking quite a lot. I just tried to work through it.

During the work period, I had a few instances of just not knowing how to proceed. I am not good at building things anyway, but this was a fairly simple thing to attempt. I am not sure why things like this seem to happen. I guess there was a symptom for confusion listed in the Timolol. And I also know that can happen for magnesium deficiency. It has got to be the Timolol unless there is still something else at work here other than NA and its associated weirdness.

I got to a point, I just had to quit though. It was not quite done, but I was at a point that going on would have been prone to my making mistakes, and some of those could be dangerous when weakness takes over while using power tools. My shoulders were done. I could feel my scapulas trying to hold my shoulders stable- and it hurt a bit. Now I have trouble reaching my arms out away from my body. I may have over done things.

But I also just did 30 push-ups with only minor shaking towards the end.

Another blunder- What What else is new? Tremor and many other symptoms may be side effect of eye medication

Some of you may remember from earlier posts that my latest official bout of NA hit in the end of 2006. By the early part of 2007, I was having the start of eye pressure increases. After a few tests, I was given a prescription for Timolol. In the period after this, I noticed that I had tremor and fatigue that seemed to go beyond anything seen discussed for people who are recovereing from an attack of NA.

When I went to a Neurologist to see what the tremor was caused by, I told him that I was taking Timolol to control the high eye pressure. He prescribed Propranolol for the tremor. I asked him if it was a problem if I was already taking Timolol, since I knew they were both beta blockers. I knew to ask- He told me there was no problem.

Info on Timolol interactions from http://www.medicinenet.com/timolol_ophthalmic_solution/article.htm

“DRUG INTERACTIONS: Combined use of oral beta- adrenergic blocking agents, for example, propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor) or carvedilol(Coreg) with ophthalmic timolol can result in additive effects. Thus, patients may experience excessively low blood pressure or reductions in heart rate.”

Note, it says “can result in additive effects” if Timolol is used with Propranolol. Who knew? Further down it talks about side effects of Timolol.

“SIDE EFFECTS: Ophthalmic timolol can cause irritation to the eye which may manifest as pain or dryness in some people. Rarely, timolol eye drops can result in side effects that are seen with other oral beta adrenergic blockers. For example, persons can experience fatigue, insomnia, nausea, slow heart rate, low blood pressure, cold extremities, and shortness of breath or wheezing.”

From another site http://www.drugs.com/sfx/timolol-side-effects.html

“All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Timolol Gel Eye Drops:

Blurred vision; dizziness; dry eyes; feeling that something is in your eye; headache; increased tear production; minor burning, itching, or stinging of the eye; nausea.

Seek medical attention right away if any of these SEVERE side effects occur when using Timolol Gel Eye Drops:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain or discomfort; confusion; eye irritation, swelling, pain, or discharge; eyelid pain, redness, scaling, drooping, or swelling; fainting; pain, numbness, weakness, or tingling of an arm or leg; severe or persistent headache or dizziness; shortness of breath; slow or irregular heartbeat; swelling of the hands, ankles, or feet; vision changes.”

It goes on to add among others, vertigo and tinnitus, both of which I have had since this all started. I have also had quite a few of the others at various times, always blaming NA for the ones not directly related to eyes. My new Eye Doctor asked me if I had any tremor, and when I said yes, he asked about exercise intolerance and depression. Here I thought all of my troubles were either from NA or that maybe other doctors had missed something obvious, and a lot of this could be due to my eye medication. It is no doubt a good thing that I stopped the Propranolol on my own. It may be my tremor was caused by its cousin Timolol.

Needless to say, he took me off of Timolol. If I truly need eye medication in the future, there are others without the mess of side effects.

Another cycle of improving strength?

Well, maybe I am about to start a new phase of improving strength again. I am not even going to hope it will last. More than likely it will not. The last few times I tried to do any push ups I was only able to do 3-4. Just now I was able to do 12 before having to drop to my knees. And now the next day, I have done 15. We shall see. I do not want to push myself to fast.

Over all the weakness is still worse now than it was a few years ago. I have sagging skin around my right bicep at the elbow joint. It does not look like how I remember my arm. I doubt I will be able to strengthen it enough to fill it out again. When I look at my right arm in a mirror, I can fully see the tremor of the muscles even without applying any tension.

Weakness, and tremor, and shaking. . .

From what I can see out on-line, and what I see in reports for my blog site, shaking and tremor of various kinds does happen with those of us attempting physical exercise while recovering from PTS or NA attacks. This generally is not covered specifically in sites I have seen, but there are enough general searches by my blog readers to suggest it is somewhat of a concern, and I have decided that it makes sense it would be a problem.

With PTS, you have something attacking the major nerve plexus sites in the body. If it is a big enough attack, you get the most severe symptoms everyone knows about. But, PTS/NA is not specific in the nerves it impacts. How would it determine only to attack the nerves that would lead to a winging scapula? The other nerves of the plexus sites must also be impacted, but maybe just not at the same level. It stands to reason, in my thinking anyway, that there can be ongoing weakness of the areas impacted, just as there is to the most obvious impacted areas. This weakness is caused by damage to nerves that serve other muscles through the body. If the nerves can’t fire effectively as they normally would, you have incomplete contraction of the muscle and this causes fatiguing of that muscle, leading to shaking of the larger muscles and tremor of the more fine controlling muscles of the hands and fingers.

For me, I have a recurring pattern of weakness followed by improving strength for short periods. But, the regained strength does not last. That may be normal also, depending on the way PTS is triggered for the individual. During the strong periods, I have normal strength and no tremor or shaking. As the strength wanes, the tremor and shaking returns and increases again. During this time, effective exercise is severely limited. It is hard to exercise when the muscles stop working. I may have said parts of this before, but you have to attempt to exercise once in a while to keep up on the cycles. During a strong period, exercise works and I think it is good to do it then to try to regain all you can in what may be a very short burst of normal or at least close to normal strength.

A better way for Scapular Pushups

My Physical Therapist originally showed me how to do scapular pushups to help strengthen and stabilize my shoulders. I never felt that it did much the way I was shown. Here is a bit more advanced way to try if you want.

http://www.youtube.com/watch?v=ALzFr2GT-Is