Saturday, January 28, 2017

Don’t Be Afraid to Question Your Doctor

Warning: this post will be only tangentially about knees.

First, I was going to write about crashing my bike last week. I went down hard at 25 miles an hour after the guy in front of me braked hard and our wheels brushed, and I ended up bouncing and sliding on the pavement. My goodness, the litany of injuries: road rash on my face, swelling over one cheekbone, sprained wrist and finger, scrape on one forearm, bruising on my hip, and then knees banged up with cuts on both and a little swelling on the right one.

I was fully clothed, this being winter, yet still the crash was violent enough that I had bloody rashes under my garments. But the upshot: a week later, I’m in pretty decent shape, and the two knees feel pretty good (the scabs aren’t pretty, but they’ll go away soon). I’m a healer! :)

So that was going to be the post, then my daughter caught the flu, and my wife called me yesterday from the pharmacy to say she had bought Tamiflu for both Joelle (7) and Elliot (three and a half). Elliot didn’t have the flu, so he would be given the Tamiflu in a prophylactic way – to hopefully lessen his chances of contracting the virus.

It cost a heckuva lot -- $78, and that’s reduced from $600 with no insurance. But something else was sticking in my mind as I got off the phone with her. Tamiflu ... Tamiflu ... hmm, what do I know about Tamiflu?

I started poking around on the internet, and immediately started getting a bad feeling about this drug. It sounded a bit controversial. It also sounded like it was of uncertain efficacy. And one side effect I found rather chilling: “neuro-psychiatric events.” So kids can have nightmares, insomnia, delusions. Those aren’t typical side effects of say aspirin or Ibuprofen.

Now for those of you who don’t know me well, let me be clear. I’m not some nutter when it comes to medicine. I’m not anti-vaccine. I’m pro flu shot. I try to keep an open mind, and always consider the scientific evidence and the statistical likelihood of outcomes.

And I have loads of respect for well-run scientific studies. I’ve cited the Cochrane Collaboration before, as they tend to do “meta-analysis,” sifting through a wide range of studies for the best ones, and then combining all the findings to reach a conclusion. Here’s what they reportedly had to say in the BMJ in 2014 on Tamiflu (underscoring is mine):
Compared with a placebo, taking Tamiflu led to a quicker alleviation of influenza-like symptoms of just half a day (from 7 days to 6.3 days) in adults, but the effect in children was more uncertain. There was no evidence of a reduction in hospitalizations or serious influenza complications; confirmed pneumonia, bronchitis, sinusitis or ear infection in either adults or children. Tamiflu also increased the risk of nausea and vomiting in adults by around 4 percent and in children by 5 percent. There was a reported increased risk of psychiatric events of around 1 percent when Tamiflu was used to prevent influenza.
That “psychiatric events” warning bothers me. Now, taken literally, an increase of pyschiatric events of 1 percent may not be much at all. As in, say that among 10,000 people with the flu, there are normally 100 “psychiatric events.” On its face, this statement implies that there would be 101 among Tamiflu takers, an increase of one in a population of 10,000. Not much to worry about there, right? Hardly even statistically significant.

Yes, seemingly, but – the nightmares and delusions appear to have a long anecdotal tail when it comes to Tamiflu. Japan banned its use for teens after a couple of suicides and other incidents, including some kid running into traffic. Now, a hundred anecdotes don’t make a statistic, and it could be just some bad batches of Tamiflu, or the kid was going to dart into traffic anyway – but it is a little disconcerting that these cases pop up with some frequency on the internet.

What’s Tamiflu doing in the brain anyway, you fledgling biologists might wonder. Isn’t there this thing called a brain-blood barrier that effectively blocks most chemicals from crossing into the seat of our reasoning mind? Apparently, Tamiflu normally can’t cross the channel. But when the tissue is inflamed, as with a flu, the barrier may become more permeable.

May be. Perhaps. Some incidents. Anecdotes. This isn’t hard science. Hell, I’d the first to admit that I haven’t done a helluva lot of research. But I did call the doctor who prescribed it. Once upon a time, before my knee pain saga, I never would’ve done such a thing. But I’m a bit bolder now. Doctors don’t always get things right. So I asked her reasoning for prescribing this drug.

She explained that she presented it as an option; she didn’t recommend it. She was very nice the whole time we spoke. My tone was perhaps a touch less friendly. But something she said surprised me: A mother had called her office that very day saying her daughter was taking Tamiflu and having delusions. The doctor, thank goodness, told her to take the child off the drug. (Full disclosure: she did say it was the first case of delusions directly reported to her in 14 years of practicing.)

In the end, I told my wife that it was partly her decision too whether to give it to the kids. Me, I wouldn’t. I’m ready to put the whole $78 of the stuff right out on the doorstep, if someone else wants to roll the dice with it. This anti-viral medicine seems to be powerful stuff. I don’t like giving my kids stuff that powerful unless they absolutely need it.

My daughter had a temperature of 104.7 yesterday. Today it’s about 101 and going down. I think she’s going to be fine.


  1. Here's the UK official guidance on treating flu.!scenario
    Basically they say you should only treat at risk groups which doesn't include otherwise healthy children. I had a similar visit to the doctors recently where they wanted to test for H Pylori which has now been fairly conclusively shown to lower the risk of heartburn and yet they wanted to test and then if present get rid of it! This was newly qualified doctor. Then followed some similarly dated comments around cholesterol.
    Anyway have you seen this recent study? There's been a lot of coverage of it in the press. Running reduces inflammation markers in knees.
    More evidence if needed that movement is good for your joints.

    1. Great! More good news about running. Glad to hear. Running has really gotten a bum rap.

  2. Hello Richard. can you please provide me with a way to purchase your book in PDF format (or other format that does not require a kindle or kindle app).

    i look forward to hearing from you soon.

    thank you very much

    1. One solution is probably "Kindle for PC" (you don't need an actual Kindle, just a PC). See this post where I address the issue of reading the book without a Kindle:

      Or Smashwords offers the book. It's in the Apple iBooks lineup as well. Barnes & Noble also sells it as an e-book, as does Kobo (I'm not even familiar with Kobo!)

      These are all electronic options, but there are many. Or, as I have said repeatedly to people -- no one should feel they have to buy the book. You can just browse the blog if you want. All the content here is free!

  3. Hello Richard, and all the community.
    Thanks for sharing your knowledge and experiences.

    I read your book and found hope in it.
    In my case, I have an ulceration on the patella. I can't walk properly, so it is affecting my other knee, hip and low back due to the imbalance.

    It is extremely painful and cant do a normal life.
    I have had PRP and HA suplementation with no effects.

    As well as you were able to get your knee stronger with the envelope function approach, do you believe I could get results for the symptomms of an open ulcer?

    Thank you!

    1. By ulceration, I'm assuming you mean defect in the cartilage, or lesion? If so, there's hope on two fronts: I really believe that cartilage can get stronger and heal (though very slowly). But the good news is it doesn't need to heal for the knee pain to go away. Here's a post I did recently on the subject (below). If I were you, I'd try to find a good physical therapist who believes what Doug Kelsey does (search this blog; you'll find lots of references to Doug and his philosophy).

    2. Thank you Richard for your kind response.

      Your words are a ray of right for me, as it was reading your book on your recovery journey.

      Yes, I meant a defect in the cartilage (fissure/blister) underneath the patella.

      The outburst was 14 months ago, and the main difficulty is that it does not allow me to walk properly, causing collateral pain in my other knee, hip and low-back.

      I follow your practice of waking in the pool, but am not able to do it for too long, then I swim using a foam on my legs and at least they do some isometric work.

      I keep faith on the natural ability of the body to heal, but after 14 months and seeing that my life has become severily limited, sometimes I amm concerned about the future.

      I do feel tissue behind my patella getting more homogeneus and soft, but still does not translate in less pain or confidence when walking.

      My cuadriceps suffers a big atrophy, and I am aware that does nt help, but I hardly walk outside the pool so it is hard to make it stronger.

      It does make sense when you say that pain can go away even if a deffect is still there- I believe we can achieve this through movement?

      I thought about finding a therapist, but I must confess that it scares me to get the injury more irritated). I have read about Doug's philosophy. I believe the movement theory as to roll a paper under the foot, many repetitions-low load.
      But since it was doing a wrong therapy (including squats)what made me worse, I am very prudent before giving a step forward.

      Thanks again for creating this forum to share knowledge and experiences.

      Warm Regards from Spain

    3. Thank you for writing -- and from Spain too! It's a beautiful country. You sound like you're in a tough place right now. If you can find a go-slow kind of physical therapist, that might be very good for you. Even when I had a bad physical therapist, I found that part of the benefit was just having someone I could talk to about my knees ... anyway, please check back later and let us all know how you're doing!

    4. Thank you Richard for your kind reply.
      I feel locked on a cage....
      My only hope was the pook, but now I injured my shoulder ...
      Swimming helped me to gain overall balance in my body, but now all my body aches and I hardly step on my right knee...

      I see paralised people doing sports and wonder how can I get out of this hole...

      thank you everyone