Health for a Lifetime

Carpal Tunnel

Three Angels Broadcasting Network

Program transcript

Participants: Don Mackintosh (Host), John Clark

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Series Code: HFAL

Program Code: HFAL000198


00:01 The following program presents principles
00:03 designed to promote good health and is not
00:05 intended to take the place of personalized
00:07 professional care. The opinions and ideas
00:10 expressed are those of the speaker. Viewers
00:13 are encouraged to draw their own conclusions
00:15 about the information presented.
00:16 Hello and welcome to health for a lifetime.
00:51 Today we are gonna talking with Dr. John Clark,
00:53 he is an orthopedic surgeon and
00:56 one of the things you see a lot
00:58 Dr. Clark and by the way thank you for being here.
01:00 Oh you bet, thanks for having me.
01:02 I know you have a very busy schedule
01:04 and of course because so many
01:05 people have orthopedic problems,
01:06 I mean back pain, arthritis, all
01:09 these things they come to see you,
01:10 osteoporosis, but we're talking about carpal tunnel,
01:14 what exactly is carpal tunnel syndrome?
01:16 Well you know carpal tunnel syndrome is a
01:19 name we gave to a set of symptoms people
01:22 come presenting to us with,
01:24 it's usually numbness in the thumb,
01:28 index finger, long figure and this part
01:31 of the ring finger. So the thumb,
01:33 the ring finger, or the, then. Index finger,
01:37 long finger, and this part of the ring finger. Okay.
01:42 And this numbness often wakes them up
01:45 at night they will tell me about 3:00 am
01:47 I wake up and my hands are just numb
01:49 and they hurt, they say they have to
01:51 shake him to try to get them wake up
01:54 they find they tend to drop things,
01:56 they can't feel things as well as
01:58 they should and so they can't work
02:01 with fine objects as well, it often hits
02:03 them when they're driving, when their wrists
02:05 are up like this on the steering wheel
02:07 or when they hold a paper they'll drop it.
02:10 A lot of different things happen to them
02:12 as a result of basically losing feeling
02:15 in those fingers and thumb. Not good for a
02:19 violinist, not good for a flutist, not good
02:21 for a computer operator, not good for
02:22 any thing with those fine motor movements.
02:24 That's right. So you know I like to
02:27 kind of know how things works and you're
02:28 kind of a handy man, always have been.
02:30 That's right. How does this happen,
02:33 is there some impingement on a nerve,
02:35 what happens? That's right.
02:37 It all has to do with what we call the median nerve
02:40 and the median nerve travel's up
02:43 the forearm and goes into the palm
02:45 through this area right in the center. Okay.
02:48 There is a canal there and that canal
02:51 houses all the tendons that work your fingers
02:54 and your thumb to flex them.
02:56 That's like your like your, like your little
02:58 piece of conduit. A piece of conduit,
03:00 that's right. It's only has so much room
03:02 though and if the room for all these
03:06 structures starts to decrease,
03:08 it's usually the nerve which begins to complain
03:12 about it. I see, so that's what happens,
03:16 any other causes for that, I mean what causes it to
03:20 shrink. The tissues here are especially vulnerable
03:25 to different types of activity at work,
03:28 one of things we found although
03:32 some what debated is that repetitive motion
03:35 tends to cause carpal tunnel
03:38 and that is using the wrist a lot,
03:40 doing the same thing putting the same screw,
03:43 in the same hole, on the same object
03:45 time after time, assembly line work.
03:47 I see. And then they are certain positions
03:50 we call them ergonomics that are prone
03:54 to carpal tunnel syndrome. Like? Where you have
03:56 your wrist, bent way over when you to work or way back.
04:01 And so where would that be? Tennis.
04:02 Well, not necessary tennis, but if you're
04:05 running a screw driver like this or maybe
04:08 you're working a knob like this,
04:10 or you have to have your wrist back like
04:12 this or you're working on the ceiling
04:14 or something, any place where your wrist
04:15 is way flexed or way extended.
04:19 Tends to decrease the space in the carpal canal
04:22 causing pressure on the median nerve,
04:25 and you get the carpal tunnel syndrome.
04:27 So, I mean my sister had carpal tunnel
04:30 and but you know she's like a, she does,
04:32 you know, parties where she prepares a lot food,
04:36 she does a lot of mixing, she does all this
04:39 so that's probably maybe related to the situation.
04:42 It can be, it very much can be.
04:46 There's also other factors that are related,
04:49 people who have stress on their job
04:51 are more apt to get carpal tunnel. Why is that?
04:54 That's because this is a nerve and of course
04:56 stress affects your nerves and some times
05:00 we are not exactly sure why it
05:03 happens that way, there is one hypothesis
05:06 out there and that is that the sympathetic
05:08 and parasympathetic systems which control
05:11 the blood supply of the nerves shutdown the
05:15 blood supply to the nerve as a result of stress.
05:17 The body is shutting off the blood to
05:19 periphery, and we kind of see that,
05:21 people who are stressed out might have
05:23 white fingers or cold hands,
05:25 it's because the blood supply has been shutdown
05:27 to those areas. So you're saying that the,
05:30 in other words some emotional
05:31 or stress related factors ergonomics,
05:34 or in other words positions at work,
05:35 repetitive trauma and then you mentioned also
05:40 confounding diseases what do mean by that?
05:42 There are diseases that due tend to effect
05:45 the tissues and thus they effect the tissues
05:49 surrounding the carpal tunnel. Diabetes is a
05:52 well known confounding diseases,
05:54 it creates the environment for carpal tunnel
05:58 it makes the tissues themselves stiffer they get
06:01 glycosylated, or either they got
06:03 lot of sugar stuck in them. Okay.
06:05 And then that also effects little vessels
06:09 small vessels they go to the nerve,
06:11 they go to the tissues and so the tissues
06:14 become stiff they become glycosylated,
06:18 they become hypoxic and as result they become stiffer,
06:23 they become more acidotic and that
06:26 is a problem for those tissues
06:27 that surround the carpal canal.
06:29 There's other diseases, one associated
06:31 with drinking too much and that is amyloidosis,
06:35 it is the deposition of a extra tissue elements
06:38 in the area we're talking about
06:41 and when the canal which is only so big
06:43 has to have something besides nerve and
06:45 tendon, the space for each structure become smaller.
06:50 So how does that alcohol lay that deposit down
06:53 and go through the blood stream and then that
06:55 just kind of goes into the third space
06:57 and there and leaves a refused, is that
06:58 what you mean? No it's actually
07:01 related more to the kidneys and effective
07:02 alcohol in the rest of the body,
07:04 amyloid is kind of a material that, that is
07:09 collected in the tissues as a result of breakdown
07:12 in other body parts. Okay so it's secondary
07:15 to drinking and it's impact on the kidney and all that
07:19 That's right. Alright, so how can I know
07:22 for sure maybe you know, some people have
07:23 diabetic neuropathy which is probably
07:26 different than carpal tunnel or maybe they have
07:28 other reasons that they have numbness,
07:30 maybe they have some kind of impingement
07:31 in the joint or something. But how can
07:33 you tell for sure that it's that it's a conduit
07:36 here you're talking about of carpal tunnel.
07:38 First thing you want to do is go see your
07:40 doctor and they'll do a diagnoses on you,
07:44 there is a number of different tests
07:45 they use, physical exam test that help them
07:48 decide if what you're feeling is really
07:50 carpal tunnel or not and when they get
07:54 through with all those physical exams
07:55 they will also if they want to know for sure
07:58 order what's called an EMJ this is a test
08:03 that usually a neurologist performs
08:04 where they study the nerve conduction
08:08 across the carpal canal, this test tells
08:12 him if it's a slowed nerve response
08:15 or a normal nerve response, if it's slowed
08:18 across the carpal canal, pretty sure, then they know
08:22 that it's carpal tunnel syndrome.
08:24 Have you ever had carpal tunnel syndrome?
08:27 Well you know one day I was
08:29 working out in garage and I started
08:31 feeling a little bit of numbness in my fingers
08:33 and I was wondering if I was getting it.
08:35 Of course if you just have one incident where
08:37 this happens we don't call it carpal tunnel syndrome
08:39 but I have had that feeling before.
08:42 So you know it's like in being, you know,
08:45 an orthopedic surgeon that would be concerning.
08:47 It sure is, I sure was, I began to wonder
08:50 what I should do and, you know I had
08:52 treated a number of patients with this
08:54 and so I tried doing a few things
08:57 that I teach them to do to see if it work. Okay.
09:00 And what I teach patients to do who come
09:03 to me with carpal tunnel I tell them
09:05 okay we have a procedure we can do,
09:07 we can do an operation on you,
09:08 but a lot of patients I can cure using
09:12 some more natural methods, not so invasive,
09:16 the first thing I tell them to do is to drink
09:19 lots of water, you want to keep these tissues
09:22 well hydrated, keep the blood flowing to
09:24 them very well and so I teach them to drink
09:26 plenty of water, the second thing I had them
09:29 to do is stretches. Now when I have them
09:32 do the stretches, I have them do three stretches
09:35 in particular, the first stretch is one
09:39 where they put their elbow out straight
09:41 and they grab the last three fingers
09:45 of the hand and they bend those fingers
09:48 back as far as they can when you do
09:51 that you're stretching, yeah, it's good.
09:55 It's something feel like sticking needles in my hand
09:59 at the same time, you know. Keep your elbow
10:01 real straight while your, alright done. Like that?
10:03 That's right. And when you're doing that you feel the
10:05 stretch. I do. All the way up here.
10:07 And that is important for the muscles through
10:11 which the median nerve travels up in the forearm
10:14 and also for stretching out the ligaments and
10:17 tendons as they go through the carpal canal. Okay.
10:20 So that stretch I'll have them hold. For, how long?
10:24 For two minutes. Two minutes It's a long time.
10:27 Oh Man. And they do it twice a day.
10:31 Well you know. We can stay here for two minutes.
10:35 I am gonna go on to the next one. Okay.
10:38 It's basically the opposite, again we're
10:40 keeping the arm out straight, alright, and
10:43 I am grabbing the last three fingers again
10:45 and I am bringing them as close as I can
10:49 to the wrist, I am bending the wrist as far
10:53 as it'll go, I am bending the first joint
10:56 of the fingers as far as it will go and I'm trying
10:59 to get the fingers to actually touch the wrist
11:02 and you feel the stretch up here and curl up here.
11:04 So I know it's usually not touching your wrist.
11:07 I am not as flexible as you I guess.
11:10 Well, I'm like some kind of freak of nature
11:14 or something you know. I won't call them that,
11:18 but go ahead and pull those three fingers
11:19 toward you a little further, there you go. Alright.
11:22 Alright. So that's the second one. Okay.
11:24 Hold it for two minutes. Two minutes. Twice a day.
11:27 Twice a day. And that's a stretch,
11:29 now the third one is probably the most important,
11:31 I guess I saved the best till last and
11:33 maybe we say the third is the charm.
11:35 Put the hand out like this, grab the thumb
11:39 with from underneath. Underneath.
11:41 It's kind of a, this isn't yoga. Okay.
11:44 But I am grabbing the thumb and then I am
11:47 pulling the thumb.
11:50 Now you gonna say this was all a joke
11:52 right after this turns here, okay. Good. Alright.
11:58 This is like carpal tunnel twister alright.
12:00 And again for two minutes twice a day
12:05 and now in that stretch you're stretching out the
12:07 carpal tunnel. Okay. Which is very important,
12:09 you're stretching out a muscle up here,
12:13 pronator which the nerve passes through
12:16 also and so you're doing two things
12:19 that are very important, for getting more
12:21 space for the median nerve and so in studies
12:26 of patients who are given stretches to do,
12:29 if they'll do their stretches about of half of
12:33 them who'd otherwise have had surgery can avoid
12:35 surgery. Really? Yes. Now do most
12:38 orthopedic surgeons share this with people
12:40 before surgery? No they don't.
12:43 Lot of time they'll send him to a therapist
12:46 who are supposed to share some of these things
12:48 with them. So a physical therapist only
12:49 will share this. Well I, not always,
12:53 no I don't think this is generally thought
12:56 across the board but physical therapist that
12:58 I have had in my centers I have trained them
13:01 to show patients this but there are
13:03 some physical therapists that will do this.
13:05 It's called in some other terms tendon gliding
13:09 and nerve gliding exercises. So those three,
13:13 is there been any sturdy says to the effectiveness
13:16 of those exercises, that you gave us?
13:19 Yes, and patients are given these exercises,
13:22 about half of them can avoid surgery by
13:25 doing these exercises, it decreases the number
13:29 that have carpal tunnel syndrome.
13:30 So when I was out working in my garage
13:33 I started getting that tingling, I thought okay
13:36 I better do my own stretches and so I went
13:38 to doing my own stretches for two minutes
13:41 and the reason I did it for two minutes is because
13:44 if you do it for less than a minute it
13:45 tends to rebound get tighter. I see.
13:49 But two minutes gives it a chance to totally
13:51 stretch out, relax and have the ability
13:54 to give more space for the median nerve.
13:57 Wow I mean these are the things you would try
14:00 and should try before you contemplate surgery.
14:05 That's right. I've been talking with Dr. John Clark,
14:08 we're talking about carpal tunnel syndrome
14:10 but we're gonna talk about some other things too,
14:12 have you ever heard of tennis elbow
14:14 we are gonna talk about when we come back.
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15:17 Welcome back we've been talking with
15:19 Dr. John Clark, we've talked about carpal tunnel syndrome
15:23 and during the break you were saying to
15:25 me you had a man that came and
15:26 just wouldn't do those exercises
15:29 he said he couldn't do them and you know, they
15:31 are you know, you have to have discipline to do that,
15:36 but he wouldn't do them. That's right.
15:38 And the therapist I sent him to
15:42 was also supposed to teach him the
15:43 exercises and the therapist was kind of
15:45 being you know very interested in the outcome
15:48 of this case he showed up at my clinic
15:50 and so when I went into see this patient
15:53 in the room the therapist came with me
15:55 and we both walked in the room
15:58 I am the patient was like okay, okay I didn't
15:59 do my exercises I am sorry I am sorry I am
16:01 sorry and I told him it's not a problem, I can
16:05 forgive you but that won't make your
16:08 carpal tunnel better, if you don't do
16:10 your part of the work you won't get better
16:14 and I kind of thought, you know as a
16:15 spiritual lesson to it you know God can
16:18 forgive us only once he's very forgiving
16:20 and unless we take hold of Jesus Christ
16:23 for strength and go and sin no more
16:25 we are gonna have carpal tunnel syndrome
16:28 or worst things. Interesting, those exercises
16:32 by the way I know are gonna be a great
16:34 help but there is another problem people develop,
16:37 I wanna talk about two of them,
16:38 tennis elbows and ankles, lets start with tennis elbow.
16:41 Okay. Tell us about tennis elbow,
16:44 why do people get it? How they know
16:45 they really have it, how you rule it out,
16:48 about what kind of things, you probably have
16:49 some more exercises, tell us about it?
16:52 Sure you know just because we call it tennis elbow,
16:55 it doesn't mean only tennis player will get it.
16:57 Tennis elbow is pain in what we call the lateral
17:02 aspect of the elbow is over here where the
17:06 muscles that extend your wrist.
17:09 You will feel them when you do it like this.
17:11 Yeah exactly Don, you can feel them right
17:14 there, you can feel the bony prominence of your elbow.
17:17 I got it. On this side. Where those
17:20 muscles are hooked to the bone. Alright.
17:22 That is where the tennis elbow takes place,
17:25 we call it in scientific term or medical terms,
17:28 lateral epicondylitis. No wonder, we
17:32 call it tennis elbow. Let's call it tennis elbow.
17:34 And what happens there is the patient gets
17:38 pain there, now we would think it would
17:41 be from inflammation or something like
17:43 that, but actually scientific studies
17:46 have shown that the pain is due to a lack
17:49 of blood supply, we call it ischemic pain,
17:54 kind of like pain you get in your heart
17:56 when you lose blood supply to your heart,
17:58 a heart attack or a myocardial infarction.
18:01 This area is especially prone to that
18:06 because the vessels there aren't very big
18:08 there is not a good blood supply,
18:10 and so a area of the tissue tends to be
18:15 vulnerable what happens is a person over
18:18 uses that area, the body's ability to keep up
18:21 with this pain. The lactic acid that build up there.
18:24 Yeah, the lactic acid, the pain, the strain,
18:27 and pretty soon you end up with the sore area.
18:30 Now it's not necessarily easy to treat,
18:36 and there's a lot of things in the
18:38 literature that have discussed thing,
18:40 anything from injections of both steroids
18:43 or even blood to doing surgery on
18:46 the area. I see these people who
18:48 wear these big bands. Yes and the bands are
18:52 also used. So, talk about those different things
18:55 with us, you know you have listed hydro therapy,
18:58 stretching, icing, all these different things.
19:00 That's right, when a patient comes to me
19:03 and they have a pain in their elbow
19:06 that I decide is tennis elbow, I put them on
19:09 a program designed to re-establish good blood
19:13 supply to that area. Okay. And so I will do
19:16 the stretching just like we talked about
19:19 for carpal tunnel, but mainly the one
19:21 where you're taking the fingers and pulling them
19:24 to the wrist. Okay, this is causing the stretch on
19:28 the muscles that's attached to the lateral epicondylitis.
19:31 Right. The area, where the. Two minutes again.
19:34 Two minutes again. Okay, but then
19:36 I have them do what the therapists call contrast bath.
19:42 Contrast bath. We call it hydrotherapy
19:45 or hot and cold. What that consists of is I have them
19:49 put their elbow in a bucket of hot water,
19:52 get up as high as I can. How long? For two,
19:56 for three minutes. How hard? As hard as they can
19:59 stand or if you want to check the temperature,
20:02 somewhere around 104 degrees is fine.
20:04 Okay, just don't burn the elbow.
20:06 Don't burn the elbow. Right.
20:07 And then after it's been in there for three minutes,
20:21 I'll turn around and have them put it
20:22 in a bucket of ice water, Oh! Preferably
20:23 with a few ice cubes floating around.
20:24 Okay. And then back to hot water again
20:25 for three minutes, cold water for one,
20:27 hot water for three, cold water for one
20:28 and they end with the cold water, and they do that,
20:29 For three times? Three times,. Okay.
20:32 And do it two or three times a day.
20:34 So, how many minutes again in the hot?
20:36 Three minutes on the hot.
20:38 And, how many in the cold? One minute on the
20:39 cold. Three, one, three, one, okay, that's three time.
20:43 Yeah, okay three times a day.
20:45 Three times a day would be good,
20:47 at least twice a day. Okay, and then what
20:50 next you do? Well, let me talk a little bit
20:53 about why that works because it's important
20:55 to understand, so that people don't think
20:57 this is hocus pocus, and that is because
21:00 when you put your elbow in the hot water,
21:02 it tends to turn red, it brings the blood
21:06 to that area, it washes out the inflammation
21:09 and it tends to bring in the healing factors.
21:12 Okay, when you switch over to cold
21:15 for a shorter amount of time,
21:17 it tends to construct the surface vessels,
21:19 driving the blood deep, down where the
21:23 avascular tissue is, down where you need the
21:25 blood supply, down where that sore
21:27 tendon insertion is. When you go back
21:31 and forth, it tends to pump the tissue a bit,
21:34 hot, the vessels expand, cold, they constrict,
21:38 hot, they expand, cold, they constrict,
21:40 also it wakes up the white blood cells.
21:42 In fact, Mayo Clinic showed, if you did this
21:45 to your whole body, you could raise your
21:48 white count to four times normal,
21:51 that's quite high. So, you could really fight
21:56 the infections off. That's right, that's kind of like
21:58 the polar bear club you know, the guys that
22:00 get in the sauna and then go jump in the lake
22:02 that has ice on it. Well, and that's getting their
22:04 white count up, but the white cells
22:06 are ones that help reduce inflammation,
22:09 they control inflammation, they work with healing,
22:12 they recruit fiber glass, which are the healing cells
22:15 that come in and work on that area.
22:17 And then when you end in cold,
22:20 the body goes Oh! It's cold down here,
22:22 and it goes and warms that area up.
22:25 And all of that process stimulates
22:28 vascular activity, and that's what you need
22:32 for lateral epicondylitis 'cause that's an
22:35 avascular, a problem without vessels.
22:37 The vessels have not covered that area well.
22:40 And the majority of patients I've never
22:42 had operate on a patient, who is willing
22:45 to follow these instructions, and do the hot
22:48 and cold stretching, so it's very effective
22:50 at dealing with lateral epicondylitis.
22:53 Now, the bands there they work for some people.
22:57 And why do they work? There's a couple
22:59 different reasons why they work?
23:01 One is that if I put a band here then I can reduce
23:06 the amount of tension back here at the elbow,
23:08 when I move my fingers, it basically reduces the
23:11 length of the tendon or the muscle.
23:15 I see. It's like putting your finger on a violin string.
23:17 The part between the point that you put
23:20 your finger on and the top of the violin
23:22 doesn't vibrate, the part over there. Right.
23:24 Yeah, so you have this whole area that is
23:27 isolated. The other thing is, when you put a
23:28 band here, it may serve to back up the blood
23:31 into this part of the arm, getting more blood
23:34 supply to that area. We may not know all the
23:37 reasons why that band works?
23:39 Now, if you have tennis elbow truly have it,
23:42 should you keep playing with it or doing
23:45 repetitive motions with it, if no why not,
23:48 if yes, why? Good question, Don.
23:50 You know, it would be good to give it a rest,
23:52 if you have been playing tennis and that's what's
23:54 stressing it, you might try playing some other
23:56 game for a while. And then you know,
24:01 if you have trouble still after that, then you
24:04 might try changing occupations?
24:06 Or if you want, you can have somebody operate on it,
24:08 but doesn't always guaranteed to fix the problem.
24:11 What about injections? Injections have been tried;
24:16 there's been a lot or discussion about that.
24:19 They've tried steroid injections, sometime it
24:22 works, sometimes it doesn't, it hasn't had a great
24:24 deal of success. And then some people
24:26 knowing that it was ischemic, i.e.,
24:28 wasn't a good blood supply there, started taking
24:31 a patient's blood and shooting some of the
24:33 patient's blood in there. In order to stimulate vessels
24:37 to grow into the area. And that' had limited
24:40 success also. So, I mean if I'm a
24:44 professional tennis player watching and I,
24:46 you know, don't want to switch jobs and
24:48 different things and maybe prevention,
24:49 if I know how to get out of this, would it be
24:52 good to every, so often be doing these exercises
24:55 and what not so, it doesn't comeback on?
24:56 That's right, it will be good to do the stretching,
24:59 but even as important, the more important
25:02 in that is keeping well hydrated. Okay,
25:05 we don't have much time two minutes or three
25:08 to talk about my ankle that's sprained.
25:10 Well, it's not really sprained, but let's say,
25:12 what do you do for the sprained ankle?
25:14 Well, when you sprain your ankle, you know,
25:16 Don I sprained my ankle a few months ago.
25:18 And I thought I had broken it,
25:21 I could not walk, I was crawling around
25:24 the house, I'm thinking oh no,
25:26 I'm gonna be in a cast, what am I gonna
25:28 do? I got to work, well there was a problem.
25:32 So, I started doing the same thing of hot
25:36 and cold we just described on the ankle.
25:39 I put it in hot water for three minutes,
25:41 ice water for one minute, back and forth
25:44 three times. Okay. You know, I did that
25:46 for couple days, and it felt so good,
25:49 I could walk on it. I turned around
25:51 sprained it again. So, I went back to
25:53 the hot and cold again, but it worked.
25:55 The same principles applied there as well.
25:57 Of course the best thing is probably
26:00 not to sprain your ankle to begin with.
26:02 That's right. What about ACE bandages,
26:05 anything else like that? ACE bandages are alright,
26:08 they tend to put a little back pressure on
26:10 the ankle and give you a little bit more insulation.
26:12 The hot and cold is probably the best thing
26:16 you can do. Some people wonder if you should do
26:18 hot and cold, if it's really swelling bad and
26:21 looking purple. Then you might just wanna ice it,
26:24 and if you ice it, what you wanna do is take a
26:26 large chunk of ice that you can hold in your hand
26:28 and put ice right on the bare skin.
26:32 And rub it over the most swollen areas
26:35 for 12 to 20 minutes. And this is very effective
26:39 for the first little bit, it'll hurt, it'll feel
26:42 a lot of aching pain, but when you get out about
26:45 12 minutes, it will totally go numb.
26:47 And it'll bring back and then we'll have
26:51 to rebound circulation to the area to help heal it.
26:54 And ice massage is very effective for a sprained
26:58 ankle. Fascinating, we've talked about
27:02 carpal tunnel, we've talked about tennis elbow,
27:04 we've talked about sprained ankles,
27:06 we have got, you know, a few seconds left,
27:10 is there any parting thought you would like to
27:12 leave, any spiritual lesson you've learned
27:14 in dealing with these bone issues?
27:17 You know Don, the biggest thing
27:20 I want to say here. Is that God does not
27:23 want us to suffer; often I tell my patients
27:27 especially when I pray for them before surgery.
27:29 God doesn't want you to suffer, we want you to,
27:32 God wants you to get back to doing the things you
27:35 enjoy doing without pain. What a wonderful thought,
27:39 we're glad that you have been with us today;
27:42 whether you have carpal tunnel syndrome,
27:43 or know someone who does, you have a game
27:45 plan for that. Tennis elbow the same thing,
27:47 sprained ankle, the same thing what a
27:49 useful program this has been, but it's only useful,
27:52 if you do it. So, we encourage you to do that,
27:55 try these things out and as a result
27:56 we hope you have health that lasts for a lifetime.


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Revised 2014-12-17