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» LymeNet Flash » Questions and Discussion » Medical Questions » Anyone tried Physical Therapy for Levaquin Tendonitis?

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Author Topic: Anyone tried Physical Therapy for Levaquin Tendonitis?
Jill E.
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Hi everyone,

I've had nearly disabling Achilles Tendon and feet problems either from the quinolones or from the Bartonella - I had to quit the quinolones so the Bart is still testing very positive.

Has anyone tried physical therapy or ultrasound therapy to help with tendon pain?

A fellow Lyme friend of mine is going to try physical therapy for Levaquin-induced Achilles Tendon problems. This was a suggestion of her internist, not her Lyme practitioner.

I know that physical therapists will often recommend stretching for plantar fasciitis, but this is not plantar fasciitis and when I try to stretch the tendons, it's worse.

But I had used ultrasound physical therapy years ago for car accident whiplash injuries and it helped. I'm wondering if that would be helpful.

I'm already doing all the topical things like icing the area, using homeopathic creams,plus taking some natural oral anti-inflammatories, etc.

I'm ready to try something that might help because it's been months, but don't want to do any damage.

I doubt any physical therapists in my city have ever dealt with Lyme patients, and I'm not sure how much insurance will pay, so I'm trying to investigate this before I take the plunge.

Thanks,
Jill

--------------------
If laughter is the best medicine, why hasn't stand-up comedy cured me?

Posts: 1773 | From San Diego | Registered: Apr 2006  |  IP: Logged | Report this post to a Moderator
surg
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I'm a PT. If I saw a patient like that I would be hesitant to stretch the tendon and there are lots of achilles tendon stretches not just plantar fascia.

The PT has alot of tools for decreasing inflammation like ultrasound, phonophoresis(ultrasound with local corisone cream), ice, soft tissue work, and electrical stim. Gentle ROM of motion exercises might help like ankle pumps and ankle circles.

If I didn't go to a PT I would ice, massage and take anti-inflammatories at home.

I'm not sure how much of this would help but more often than not it does help.

Posts: 293 | From healdsburg, ca , sonoma | Registered: Feb 2005  |  IP: Logged | Report this post to a Moderator
Jill E.
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Thanks, Surg, I appreciate receiving a reply from an expert in the field!

Jill

--------------------
If laughter is the best medicine, why hasn't stand-up comedy cured me?

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Aniek
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Jill,

If you go to a physical therapist, make sure it is a good one.

I would not go to a chain or other center that's like a factory. Some places the therapists work on multiple patients at once and just leave you to exercise while they deal with somebody else.

You may also want to ask beforehand if the therapist has worked with people with quinoline induced tendon problems. That's not a Lyme only issue.

--------------------
"When there is pain, there are no words." - Toni Morrison

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Jill E.
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Thanks, Aniek. You're right, quinolone problems are not just limited to Lyme patients. A neighbor of mine had Cipro-induced tendonitis from being treated for a bladder infection!

Jill

--------------------
If laughter is the best medicine, why hasn't stand-up comedy cured me?

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lymie tony z
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I got a lot of tendom pain from levaquin(quinalones in general)....

I never did any PT...

I would be VERY cautious in this area...

Rest and do not stress these tendons would be my recommendation...the tendonitis WILL go away on it's own once the quinalones are stopped.

Anti-inflamms lower the immune system and I NEVER do them anymore accept for advil...mainly cuz my lyme symptoms come on like crazy whenever I take any of those steroids or NSAIDS...

A Tens machine may help the pain some....pads placed in strategic accupressure/puncture areas....to reduce pain...and may even fry the little critters....

Good luck.......zman

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I am not a doctor...opinions expressed are from personal experiences only and should never be viewed as coming from a healthcare provider. zman

Posts: 2527 | From safety harbor florida(origin Cleve., Ohio | Registered: Jan 2004  |  IP: Logged | Report this post to a Moderator
Jill E.
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Thanks zman,

I've been very cautious about not stretching out the tendons - I only tried it once and it was worse - I don't want them to snap. That's why I've been cautious about PT. Also, I only took a brief course of Advil with my LLMD's permission.

I've been off quinolones for months and the pain actually continued to get worse, but started on quinolones. So that's why we don't know if it was the meds or the Bartonella continuing to worsen things.

I just started the Podi Patches last night to see if they might help at all.

If I do go to PT, I will definitely ask a lot of questions first, based upon all your good answers - perhaps ultrasound therapy, electrical stim, TENS unit, etc.

If I have a consultation, I will post as to what my experience is.

Jill

--------------------
If laughter is the best medicine, why hasn't stand-up comedy cured me?

Posts: 1773 | From San Diego | Registered: Apr 2006  |  IP: Logged | Report this post to a Moderator
Ann-OH
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I found rest and ibuprofen were the best. It took a couple of months to get past the tendonitis.

I think I have long-lasting symptoms, though, as a knee, or hip, or wrist or finger joint can seize up with sharp pain and be triggered again if I am not careful for a couple of days.

I am on ibuprophen steadily.

I just read that fluoroquinolone-induced tendonitis may be permanent.

Here is a bunch of good info I gathered for a friend just the other day. I split it up for easier reading.

Ann - OH

[quote]
http://www.drugs.com/pdr/cipro_xr_tablets.html

PDR information (Physicians Desk Reference) also known as "package insert"

Tendon Effects: Ruptures of the shoulder, hand, Achilles tendon or other tendons that required surgical repair or resulted in prolonged disability have been reported in patients receiving quinolones, including ciprofloxacin.

Post-marketing surveillance reports indicate that this risk may be increased in patients receiving concomitant corticosteroids, especially the elderly. Ciprofloxacin should be discontinued if the patient experiences pain, inflammation, or rupture of a tendon.

Patients should rest and refrain from exercise until the diagnosis of tendonitis or tendon rupture has been excluded.

Tendon rupture can occur during or after therapy with quinolones, including ciprofloxacin.

Here is the one from the National Institutes of Health and Medline.

from www.nlm.nih.gov/medlineplus/druginfo/medmaster/a688016.html
Ciprofloxin
....tell your doctor if you have ever had tendonitis (swelling or tearing of the fiber that connects a bone to a muscle) and if you participate in regular athletic activity.

If you experience symptoms of tendonitis, such as pain, swelling, tenderness, stiffness, or difficulty in moving a muscle, stop taking ciprofloxacin, rest, and call your doctor immediately.

Here is an excellent article:
www.medicationsense.com/articles/jan_mar_04/congress_ltr.html

An Open Letter To Congressman Holt on Severe, Disabling Reactions Linked to Cipro, Levaquin, and Other Fluoroquinolone Antibiotics.

Dear Congressman Holt,

Thank you for taking the time to speak with people concerned about, or injured from, reactions associated with fluoroquinolone antibiotics (e.g. Levaquin, Cipro, Floxin, Tequin).

I am the author of a study about severe, long-term fluoroquinolone reactions published in the December 2001 issue of the Annals of Pharmacotherapy.1

Actually, the publisher and I pre-released this article in October 2001, during the anthrax scare when Cipro was being prescribed indiscriminately and without warnings to patients.

Within days of publication of my paper, the U.S. Centers for Disease Control changed their guidelines, placing the antibiotics doxycycline and penicillin above Cipro as the preferred treatments for anthrax exposure.

Doxycycline and penicillin are associated with fewer severe side effects than fluoroquinolones, and they are not linked with the devastating, disabling, long-term reactions that my study identified.

These severe reactions are occurring in patients who are usually healthy, active, and young. Most often, the antibiotics are prescribed for mild infections such as sinusitis, urinary or prostate infections.

Most reactions occur very quickly, sometimes with just a few doses of the fluoroquinolone antibiotic.

Reactions are acute, severe, frightening, and often disabling. In most cases, side effects are multiple, involving many systems of the body.

In my study, nervous system symptoms occurred in 91% of patients, musculoskeletal 73%, sensory system 42%, cardiovascular 36%, skin 29%, gastrointestinal 18%.

These numbers do not adequately capture the severity and permanence of these reactions. Here are some examples:


Male, age 36, previously in good health, received Cipro for possible urinary infection: Chronic, debilitating multi-focal neuropathy, fibromyalgia, chronic fatigue, gastrointestinal problems, heart arrhythmia requiring pacemaker, carpal tunnel syndrome, chronic multiple joint pains, chronic pain.

Functional ability: disabled. Duration: 5 years (patient now age 41).

Female, age 32, previously in good health, received Cipro for urinary infection: After 5 days, developed pain in wrists, neck, back, knees, hips, elbows, shoulders, and Achilles tendons. Having difficulty writing. Medical workup normal.

Functional ability: greatly limited.

Female: age 47, previously in good health, received Levaquin for sinusitis: Within 2 days developed joint pain (severe in hands), insomnia, severe agitation, weakness, dizziness, severe fatigue, mental infusion, abnormal dreams, gastrointestinal symptoms.

Duration: Still severe after 7 months.

Female, age 49, previously in good health, received Floxin for a pelvic infection: Burning pain, memory loss, joint pains, palpitations, nerve pain, insomnia, abnormal sense of smell, tinnitis, panic attacks.

Duration: more than 3 years.

Male, age 34, previously in good health, received Levaquin for prostate infection: Muscle spasms and twitching, numbness, impaired coordination, weakness, increased sensitivity to temperatures, fatigue, multiple joint, muscle pain, palpitations, blurred vision.

Duration: more than 1 year.

Male, age 35, in good health, received Levaquin for prostate infection: 1 dose was followed by ringing in the ears and peripheral nerve symptoms lasting 2 weeks.

Then tendonitis began in shoulders, elbows, wrists, hands, and Achilles tendons, with burning pain and tightness in calves.

After 2 months, still unable to walk more than a short distance.

This man told me, "Prior to taking the medication I asked about side effects and was told there were none for adults except an upset stomach.

Afterwards I was told that what I was experiencing could not be related to the drug.

Obviously the doctor had never read the documentation that states otherwise."


These are not isolated cases. Since the publication of my article with its 45 cases two and a half years ago, I have received e-mails from more than 100 people seeking help for their reactions.

In most cases, their doctors have dismissed their complaints or outright deny that the reactions could occur with fluoroquinolones.

Yet extensive medical workups do not find any other cause.

Worse, there are no known effective treatments.

Thus, these people suffer pain and disability for weeks, months, years.


Overall, my sense is that these reactions are not rare.

I have spoken to the U.S. Food and Drug Administration about this.

I am shocked that the agency still hasn't acted.

Other major reactions such as Stevens-Johnson syndrome or Churg Strauss syndrome from medications are posted prominently on drug labels.

These reactions are much rarer than the ones occurring with fluoroquinolone antibiotics.

At the very least, black boxes should be placed in fluoroquinolone package inserts about severe, multi- system reactions.


I readily agree that fluoroquinolone antibiotics play an important role in treating infections diseases, but we must alert doctors and patients about the potential devastating effects linked to these drugs.

We must educate them that if any signs of reactions occur, such signs should be reported immediately and the drugs should be discontinued.

Patients have a right of informed consent, and this includes warnings of potential serious, disabling reactions.

Most of all, we must educate doctors to avoid prescribing fluoroquinolones for minor infections, instead saving them for serious infections, just as we do with other groups of antibiotics with serious toxicities.

I hope you will look seriously at this problem and respond accordingly. These people need your help. This is a largely preventable problem.

Thank you.

Jay S. Cohen, M.D.
Associate Professor (voluntary)
Departments of Family and Preventive Medicine and of Psychiatry
University of California, San Diego

President and Executive Director
The Center for the Prevention of Medication Side Effects
A Nonprofit, Tax-Exempt [501(C)(3)] Corporation

For more information on this subject, please see: Reactions to Cipro, Levaquin, and Other Fluoroquinolone Antibiotics in the July-Sept E-Newsletter.

http://www.medicationsense.com/articles/july_sept_03/reactions_cipro_other.html

REFERENCE:
1. Cohen, JS. Peripheral Neuropathy with Fluoroquinolone Antibiotics. Annals of Pharmacotherapy, Dec. 2001;35(12):1540-47.

Copyright 2004, Jay S. Cohen, M.D. All rights reserved. Readers have permission to copy and disseminate all or part of these articles if it is clearly identified as the work of: Jay S. Cohen, M.D., the MedicationSense E-Newsletter, www.MedicationSense.com. You may not use this work for commercial purposes.

If you find this article informative, please tell your friends, family members, colleagues, and doctors about www.MedicationSense.com and the free MedicationSense E-Newsletter.

NOTE TO READERS: The purpose of this E-Letter is solely informational and educational.

The information herein should not be considered to be a substitute for the direct medical advice of your doctor, nor is it meant to encourage the diagnosis or treatment of any illness, disease, or other medical problem by laypersons.

If you are under a physician's care for any condition, he or she can advise you whether the information in this E-Letter is suitable for you.

Readers should not make any changes in drugs, doses, or any other aspects of their medical treatment unless specifically directed to do so by their own doctors.[end quote]

--------------------
www.ldbullseye.com

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Jill E.
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Thanks, Ann, for your excellent information. I skimmed through it because I have to go get my Bicillin injection, but will print out and read carefully upon my return.

I was aware of the tendon issues prior to starting quinolones, was very careful about reporting any possible side effects to doctors, etc. Plus, the only exercise I can do with Lyme is slow walking and I was even more careful with that while on quinolones.

But, when it hits, it hits. And in my case, it seemed to get worse even after being off - and I've read that can be the case, and is mentioned in the info you posted.

Thanks again,
Jill

--------------------
If laughter is the best medicine, why hasn't stand-up comedy cured me?

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DeniseS
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Hi Jill,

I have had migrating tendon pain while on Levaquin.

My acupuncturist (I see LLMDS, a PT/DC, ND) suggested I do very light, Tai Chi warm-up exercises and it makes my tendon pain go away. I just bend at the knees ever so slightly and go through the exercises. I do them two or three times a week for 5 to 15 minutes. I like Terence Dunn's Tai Chi Yang Short Form DVD but don't even think about bending knees as much as he does!

I'm also taking lots of magnesium separated from the Levaquin by 4 hours to be safe. I take magnesium glycinate 4-120 mg capsules at lunch and 5-120 mg capsules at bedtime. Am told this helps.

Good luck and take good care,
Denise

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Ann-OH
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Wow, Denise, great advice! I am going to try the tai chi route. I try to do stretching exercises, but it just aggravates the pain.

The magnesium dosages seem huge to me, but I will start ramping mine up.

Thanks!
Ann-OH

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Jill E.
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Thanks, Denise.

Yes I probably should have ramped up my Magnesium to far higher doses than I was on during Levaquin.

I used to take tai chi classes many, many years ago and I have Terrence's tapes. I stopped doing most exercise with Lyme but perhaps, as you say, tai chi with less of a bend in the knees and less pressure on the thighs would be doable.

Take care,
Jill

--------------------
If laughter is the best medicine, why hasn't stand-up comedy cured me?

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Hides1
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I was on Levaquin for 3 months and had bad pains. My doc told me to take lots of Magnesium. He recommended 2-3 tabs a day if you didn't get diahrea from it.
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DeniseS
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Hi Jill & Ann,

I'm so glad that was helpful for you. I hope it is helpful in practice. Go really, really slowly, okay?

Hey hides,

Certain forms of magnesium are less prone to cause diarhea than others. I think mag-oxide is particularly prone to causing diarhea. Mag-citrate is better. I take mag-glycinate because I'm allergic to the mold in citrates. One of my docs also mentioned that mag-glycinate is very absorbable.

I'm trying to make it another 5 weeks on Levaquin. 7 down and 5 to go but if I get persistent tendon pain in one area I'm jumping the Levaquin ship!

Best to you all,
Denise

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Jill E.
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Thanks, everyone, for replies.

If I end up trying physical therapy, I will keep all your suggestions in mind, and will go very slowly.

I recently starting trying the Podi Patches foot detox pads and will see if that helps at all.

Take care,
Jill

--------------------
If laughter is the best medicine, why hasn't stand-up comedy cured me?

Posts: 1773 | From San Diego | Registered: Apr 2006  |  IP: Logged | Report this post to a Moderator
   

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