Lady Gaga’s Synovitis

Lady Gaga had to cancel some shows because she has Synovitis. Can you get that from wearing raw meat?  Just checkin’.  Actually, I know a little something about this. Synovitis, I mean.  Not the wearing meat part; I much prefer to eat mine.

Go back to me at 18.  Yes, I know it was a long time ago.  But there are some things you do not forget, like my first days in the emergency room at the ancient and venerated Massachusetts General Hospital.  It had been open since 1811.  I read the log; the first patient was a French sailor — ships could dock at the front door, then — with what was politely referred to as a “social disease.”  It was a work-study job assigned to me as an undergraduate, allegedly pre-med, at the sprawling Boston University. They laughed when I said I was going to be a doctor. I took people’s wallets from their pockets, looking for identification and insurance cards and I was good at that nefarious profession.  I loved the moments when it was quiet up front and I could sneak back to an operating or treatment room, stealing a generally useless tidbit of medical knowledge.  Such tidbits seemed so precious then. I remember sneaking back to the cast room when a handsome, muscled, orthopedic surgeon was casting a leg.  He was laughing at me, like everyone else.  He told me to ask him questions. The lady with fake blond hair, whom he was casting, was laughing, too.  “Go ahead, honey.  Ask him questions.” I asked him, I guess she hurt her knee.  “How do you know how high up and how low down to build the cast?”  Above and below the injury.  Knees were kind of a mess, but you always worried about the articulations above and below.  The orthopedist was not particularly articulate.  I started thinking that any idiot could be one, and medical school should not be that hard to get into. I thanked him and turned to leave when he hit me with something I have never forgotten.  “Casts are easy.  Broken bones are easy.  The tough stuff is soft tissue.  Nobody knows a damned thing about soft tissue injuries.  They act like they do, but they don’t.”  I repeated my thanks, and felt bad that I had to slip back to the front desk and the business of who people were and who paid for all this. 

Lady Gaga’s “Synovitis“ is an inflammation of the capsule around a joint, known as the “synovium.”  I am not sure which joint and not sure anyone but me wonders.  I know a lot of people must be losing money because she is cancelling shows, and that probably worries someone.  If she had broken something, she would have been immobilized and visibly unable to dance.  Shows would have started being cancelled a month or so ago when she actually had the injury.  It would have been easy to say she broke her hip or knee or ankle or foot and had to cancel shows for a predictable amount of time. Inflammation is something that is visible when it is on the surface, but damned hard to visualize when it is beneath the surface. Flash back to my first lesson from my very dapper Professeur of Pathologie, who was always groomed like a Parisian male fashion model — which amazed folks because he was North African in origin and I later learned, Jewish.  But he was a venerator of Latin and classical terminology, which I loved because I had sat through so damned much Latin at Beaver Country Day School I could speak it fluently.  I love it that something this classical made it onto the internet under the rubric “medical news today,” but here are, under the special turquoise-marked text, the classical Latin descriptors of inflammation.  “The so-called cardinal signs of inflammation are rubor, redness; calor, heat or warmth; tumor, swelling; and dolor, pain; a fifth sign, functio laesa, inhibited or lost function, is sometimes added.  All these signs may be observed in certain instances, but none is necessarily always present.”

Lady Gaga seems to have lost her function, and it is impossible to tell if she has redness, heat, or swelling; but she’s sure got pain.  When people start personifying something, like saying the affected organ is trying to get rid of its insult — the sort of thing they are saying here — they are really saying that my orthopedic surgeon was right and nobody knows what the hell is going on with soft tissue injury, anyway.

Far and away the most commonly used anti-inflammatories in our society, both prescription and over-the-counter, are the non-steroidal anti-inflammatories, or “NSAIDs.”  I once had the unenviable task of presenting them to a class of massage students who did not believe me when I said they could be quite dangerous.  “No way,” said a veteran attending class on the GI bill.  “They give them out like candy in the military.” I tried to hide my horror.  “You poor guy; did you actually believe everything they told you in the military?  They kill about ten thousand people a year from GI bleeding, world-wide.  If there is anything else the military told you that might not be true, you can talk to me after class.”  He didn’t.  He stared at me kind of funny and just kept walking.  Estimates for NSAID-related deaths, as reported here, are higher than what I knew about from the literature at the time.  I stopped recommending NSAIDs to my patients several years ago.

If Lady Gaga’s physical confirmed the diagnosis, the most potent anti-inflammatory I know — the one I used after dental implants and give to my own beloved husband for any kind of inflammation — is MSM.  Yes, even the conservative folks at web.md have something to say.  This MSM is a way of getting organic sulfur — attached to carbon and oxygen and hydrogen — to enzymes that help with inflammation.  It is the first-pass metabolite of DMSO, which means that it is the product you get when DMSO goes through the liver.  It can be taken orally, sprayed on, or whatever; there is lots about it on the internet. I’m not one to give fashion advice, so no further comment on Gaga’s meat dress.  But I do care about health and wellness, so let me simply suggest we all question authority.  Especially when it seems to come from drug companies through doctors, many of whom simply do not deserve the pedestal society has placed them on.  They may have some merit for emergent situations.  But I question anything I hear from mainstream medicine about chronic disease.