Cause dictates the treatment

DEAR DR. GOTT: My healing wasn’t complete a year following rotator-cuff surgery. My shoulder became red and swollen. My doctor opened it up to see what was going on and found “rice bodies†— thousands of them. I understand this is a rare thing and that little is known about the cause or the treatment. I am specifically interested in knowing what antibiotics should be used. I am now on infusion therapy. Also, could these be elsewhere in my body?

DEAR READER: Identified and documented as far back as 1895, rice bodies were originally thought related to tuberculous arthritis. The name originated because of a similarity in appearance to grains of polished white rice.

Today, rice bodies are commonly linked with chronic rheumatoid arthritis (RA), as a complication of bursitis or an underlying systemic disorder. They appear to represent an unrelated group of particles that may contain fibrin, fibronectin, mononuclear and blood cells, collagen and amorphous materials.

Diagnosis is accomplished through X-ray, ultrasound or MRI. I cannot tell you which antibiotic to take because management depends on the underlying cause. For example, if your rice bodies are the result of chronic bursitis, an antibiotic may not be appropriate. Only your physician can direct you in that regard. Elimination of the offender in conjunction with treatment for any possible underlying disease should provide relief.

Infusion therapy is a means of administering medication through a needle or catheter intravenously. Infections and disorders unresponsive to oral medications, dehydration, diseases of the gastrointestinal tract, congestive heart failure and immune deficiencies are commonly handled through this form of therapy.

Thirty years ago, patients being infused were required to remain in the hospital for the duration of the treatment. However, with expenses as they are in a hospital setting, the same service can now be provided in an outpatient setting or at home.

I remember when a woman remained in hospital for close to a week following childbirth. Surgical patients undergoing relatively simple procedures spent almost the same amount of time recuperating before being sent home. Now, however, the sooner a patient returns to normal activity, the better.

Rice bodies can be found in joint areas such as the shoulder, knee or ankle. If your condition is the result of chronic bursitis or RA, multiple joints can be affected, but I can’t guess whether that will occur in your case.

To provide related information, I am sending you a copy of my Health Report, “Managing Chronic Pain.†Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my Web site at AskDrGottMD.com.

DEAR DR. GOTT: Many publications have inserts in them for discounts on prescription drugs. When I see these, I tear them out, take them to my pharmacy, and present them at the window where prescriptions are filled. Employees save them to use for customers who don’t have insurance. Why do I do this? Because I have insurance and can help others who do not.

DEAR READER: Target and Wal-Mart offer $4 prescriptions for a one-month supply of medication. There may be other large chains I am unaware of that provide a similar program.

This is of enormous assistance to everyone, but primarily those on a fixed income who must watch every penny.

Over the years, I have known patients who cut their medication in half, making a prescription last twice as long. If we all take your lead and make an effort to help others in similar ways, we will be doing something good for our communities and perhaps might even feel better about ourselves.

Peter Gott practiced medicine in Lakeville for 40 years.