Growing pains

So Matt: Tuskegee - did you do your home work? Did you really start to read about the subject? - ethics, that is? And please, do not come back with some excrement about what has syphylis got to do with paediatric orthotics. If you cannot get outside your square, you do not deserve to be there.

 

I can see that you're really struggling with the concepts of informed consent and non-regulated orthotics by the FDA here in the States. Perhaps the following jpeg may help you out:

http://library.downstate.edu/EBM2/pyramid12.jpg

Then again...perhaps not.

 

Err, no. I am not struggling with the concept of informed consent. Have you been to Tuskegee yet?

And, where was you researched published?

your Jpeg is a classic obstructionist argument. I have dealt with Creationists for years - while this is clearly not one of theirs, the constructs are the same. I am losing enthusiasm to deal with this rubbish.

 

Struggling to see how a jpeg of the pyramid of evidence relates to informed consent.
What it does do is remind us that opinion pieces (or being charitable) case series are fairly low down the hierachy of evidence

 

Barrels of fun.

We could always set this piece of " research" aside for a minute and talk about the model it suggests...

Still interested.

 

That jpeg merely showed the different levels of research, from the most common/easy, to the most complex/rigorous. No big deal.

I'll tell you what...just forget my article, this thread, this topic, referred pain, transient synovitis, forefoot varus, etc...you, and Isaacs, and Griff, blinda, etc, etc...just forget that we ever had this "conversation"...ignore the fact that this problem has existed for 192 years, with over 290K articles written on it and just continue to instruct your patients and parents that it's nothing more than an overuse syndrome. Hey...I mean after all...it's what Kirby does! Treat the GP's with orthotics...chances are you're going to get it right. But just ignore the RLS patients out there, as they gobble up large quantities of Lyrica, Cymbalta, Requip, Mirapex, tramadol and Neurontin waiting for someone to figure it out.

But most of all...please ignore me. The topic is certainly beneath the intellectual levels of Brits and Aussies, and I can only hope to one day achieve the superior clinical skills as those that are restricted to performing only that.

 

If you insist. Goodbye.

 

GPs need more support and training to spot childhood cancers

 

Growing pains & Channel 4

CR the Growing pains pilot study post. (Where I thought I was posting, until the thread was closed down).

When my grandparents were alive, my grandma would ask grandad what show was ?on the telly? of an evening that they could watch together. Grandad would only ever tell grandma what was on the BBC and ITV, he never told her about Chanel 4 as he decided that channel ?would not do her any good?.

The previous threads you mentioned never particularly caught my attention, perhaps this was the case for other visitors to the site either. Maybe, if I were to read through the five threads that discuss that topic, I could add something now to a new discussion? Maybe there will be nothing to add ? which is evidence in itself of nothing new. Maybe there would be no interest in the thread, indicating a lack of relevance. Or maybe I could even decide for myself what I contribute to, read, discuss, learn from, discount, ignore, decide what is worthwhile or not, or what the point is. Hells, teeth, pass me that t.v. remote.


Claire

 

Re: Growing pains & Channel 4

Thanks, Claire. In a nutshell, my pilot study research, (plus dozens of patients since that time), has shown me that GP's in children is a continuum with RLS in adults...they are the same problem...which is, referred pain from the STJ. The article that was published back in April is a condensed version of the original manuscript I wrote which was over 3 times as long, complete with videotaped interviews, animation, illustrations and jpegs. The videos can be viewed here:

https://m.youtube.com/watch?feature=youtu.be&v=7BSetRI_UH4

and here:

https://m.youtube.com/watch?feature=youtu.be&v=O-5qHOOSaQs

FWIW...my patients love and appreciate the information offered in these videos. They love resolution of pain even more. Many of them have been to MANY other doctors, without ever having their problem solved or explained. Does having GP's as a child mean that one is doomed to having RLS as an adult? No...not necessarily, and there are many reasons why that would be. Same is true for the reverse...does having RLS mean that the patient had GP's as a child? Nope...again, it is my speculation at this point, but they are not mutually inclusive groups, and there are many reasons why that might be.

Simple clinical test: If you think your patient presents with these maladies, simply press on the sinus tarsi, (thus increasing intra-capsular pressure in the STJ), and/or press on the posterior facet of the STJ from medially and laterally. Patients prior to treatment with orthotics are symptomatic, and demonstrate a guarded response. After dispensing the orthotic, these clinical signs disappear or are much reduced. The analogy I use in discussing the effect of a maximally everted STJ with my patients is this: If I forced someone to run a series of 100 yard dashes without being able to bend their knees, ie., straight legged, how would their knees feel that night or the next morning?

The clinical exam is the only manner I know to diagnose this problem, (as well as a complete record of the history), because transient synovitis and temporary inflammation is a clinical diagnoses, not amenable to further testing, ie., MRI., etc. Let me know if there's more information you require.

 

Re: Growing pains & Channel 4

Thank you for your response Matthew.

I will take the time to read and understand your offerings. I will also read through the related posts listed at the bottom of this page. I started to read through the The Myth of Growing Pains thread, but the disrespectful manner in which some individuals 'speak' to each other made me feel entirely unwell, sick to my stomach, and more than a touch embarrassed to be linked to such individuals by profession.

Claire

 

Re: Growing pains & Channel 4

Claire-thanks again...and I completely concur with your sentiments. And the thread you mention wasn't even the start of the disrespect...it went well before that. No need to offer the gruesome details...let's just "say" that it appears I've upset several people's apple cart.

Let me know what you think about the videos and article.

 

Growing Pains
When to Be Concerned
Patrick J. Lehman, MD, Rebecca L. Carl, MD, FAAP
Sports Health: A Multidisciplinary Approach March 1, 2017

 

The treatability of “growing pains” in children - a mini
review
Daniel Kai-Yip Pang and Ng Shu-Yan
Pediatr Dimensions, 2016

 

I would discount this discussion solely based on the use of the term "growing pains" which is dangerous and right up there with "metatarsalgia" as a terms that should be banned

 

Almost 500K Google Scholar hits on GP's in children...almost double that what my search found prior to my submission in PM for publication. There is a LOT of interest in the topic...but one thing I will agree upon with the authors of the above article...no protocol. That really needs to change. PCP's are still inadvertently "lying" to their patients and their parents about the cause. Not a lot has changed since 1939...except my article...

 

Approach to Growing Pains in Childhood in a Familial Mediterranean Fever Endemic Region
Beyitler I, Kavukcu S.
Iran J Pediatr. 2017 ;27(6):e11546. doi: 10.5812/ijp.11546.

 

Is there a correlation between growing pains and parent-child bed-sharing?
Smith, Patrick, J.a; Moisan, Aliceb; Sawyer, Jeffrey, R.c; Spence, David, D.c; Warner, William, C., Jrc; Kelly, Derek, M.c
Current Orthopaedic Practice: March 29, 2018 - Volume Publish Ahead of Print - Issue - p

 

Correlates and predictors of paediatric leg pain: a case–control study
Angela Margaret Evans Trupti Berde Leila Karimi Prajakta Ranade Nehal Shah Raju Khubchandani
Rheumatology International: 24 May 2018

 

Schoolgirl thought she had 'growing pains' - weeks later her leg was amputated