Going back to sqaure one - Reflex Sympathetic Dystrophy Message Board

BabeeBonehead · 10-16-2004, 12:26 AM

Hi Everyone! Well after lots of thinking things over in my mind I have decided to cancel my appointments for the 4 SNB's given to me by my PM Doctor. I went over everything he said and did during our visit {my first and only visit with him} and I realize that I wasn't really comfortable with things he said or didn't say.

Although my bone scan says "Suggestive RSD of my right foot" and after him telling me it seems to be more of a Neuropathic pain...I've decided to go to an Orthopedic Doctor for a second opinion. The SNB's did scare me but moveover...I think it was the PM doctor NOT looking at my bone scan....
X-Rays or MRI films at all

He barely examined my foot. I think its best if I take all my test results and see what the ortho Doc says and take it from there. I really don't think this is RSD and want to be as sure as possible.

Thanks for listening!

Babee

Baileysmum · 10-16-2004, 06:58 PM

Hi Babee

It is good to make sure the diagnosis is right, but if it is RSD, then you really need to act quickly and these blocks could be a good idea. RSD doesn't always show up on scans, its diagnosed by a physical examination and by the dr asking questions about your symptoms etc.

I understand you want to be sure you're getting the right diagnosis, and aren't happy with that dr. There are plenty of doctors out there and not all of them know a lot about rsd, so you need to find one that you are confident that they know how to treat you. No one wants to have RSD so I can understand your hesitation! I would just advise that you see your ortho doc asap, because if it is rsd, the first 6 months are crucial in keeping the rsd at bay.

Good luck with it!

BabeeBonehead · 10-16-2004, 09:24 PM

Quote:

Originally Posted by Baileysmum

Hi Babee

It is good to make sure the diagnosis is right, but if it is RSD, then you really need to act quickly and these blocks could be a good idea. RSD doesn't always show up on scans, its diagnosed by a physical examination and by the dr asking questions about your symptoms etc.

I understand you want to be sure you're getting the right diagnosis, and aren't happy with that dr. There are plenty of doctors out there and not all of them know a lot about rsd, so you need to find one that you are confident that they know how to treat you. No one wants to have RSD so I can understand your hesitation! I would just advise that you see your ortho doc asap, because if it is rsd, the first 6 months are crucial in keeping the rsd at bay.

Good luck with it!

But thats the thing....I've had this pain since April 5th. The PM doc says although the bone scan says suggestive RSD that hes not so sure because my foot is not discolored....doesnt sweat...and isnt sensitive to touch. Oh well...time will tell. I will post how my appointment with my ortho goes on tuesday.

Thanks so much for your response

Babee

Baileysmum · 10-16-2004, 11:46 PM

Hi again Babee

My rsd wasn't diagnosed until 6 months after the event. I saw an ortho within weeks of the injury, but he said it wasn't rsd because there's no colour change, sweating or swelling. He told me it was just nerve damage and to wait 6 months for it to go. Of course, now I know that was the worst thing to do- important time wasted.

I think its important to know that not everyone has all these symptoms. I've had it for 4 years, seen countless dr's for my medical negligence case and even the ones against us didn't disagree on the fact that it is rsd now. In my case, I had occasional swelling, but not constant. Occasional colour change, usually when it was swollen, but not constant. There wasn't a constant temperature change, either. Now, after 4 years, these things are starting to happen and quite often. But not before that.

I had the deep burning pain, pain after touch, weakness, shooting and stabbing pains, sensitivity to cold on my skin, and sensitivity to touch, but not the colour changes, swelling or sweating. For a long time I was in denial, thinking all the dr's were wrong and it couldn't be rsd because my arm doesn't look any different from normal. But then I found that the opinions of dr's on rsd is changing, that you don't need to have ALL the symptoms in the right order anymore. There is info out there on the web that came from the last rsd conference in LA (I think it was) where they are changing the list of symptoms that need to be present, you don't need all of the symptoms, just a couple out of each category. I think someone wrote these details in a thread here a few weeks ago, it might be worth looking back at it.

Anyway, I'm going on a bit. I just wanted you to know that its still possibly rsd, even though you don't have those obvious visual symptoms. But hopefully your ortho doc will know about rsd and tell you whether you do have it or not. I hope its the latter!

x Kate

Sunnycal · 10-17-2004, 02:42 AM

I am the one who posted originally about the conference in San Diego. I was able to figure out how to copy the criteria for diagnosis of CRPS from my previous post.

They spent a long time discussing the difference between signs (something that the doctor sees upon examination), and symptoms (reported by the patient as happening at some time). They have decided that the doctors need to take both into account, not just what they see in the office. Hope this helps. If you want more detail, let me know. Sunny

Stephen Bruehl, Ph.D. Vanderbilt University School of Medicine
CRPS diagnostic criteria from 1994 need to be changed [name was changed from RSD to Complex Regional Pain Syndrome (CRPS) because there was no evidence that the syndrome was necessarily a reflex or sympathetically mediated]. The old theory of stages is not valid, except for the progression of warm to cool; there may be subtypes instead.
New proposed criteria (from 2003 meeting in Budapest);
For a positive diagnosis of CRPS: Need--1. Continuous pain in the region disproportionate to the inciting event
2. At least one symptom in 3 or more of the following categories:
3. At least one sign in 2 or more of the following categories:
Categories: 1. Sensory: Allodynia; Hyperalgesia; Deep somatic allodynia
2. Vasomotor: Temperature; Color change/asymmetry
3. Sudomotor: Abnormal sweating; Edema
4. Motor/Trophic: Decreased range of motion; Skin, hair, nail changes
(Allodynia=pain from innocuous tactile stimuli; hyperalgesia=increased response to painful stimuli)
Diagnosis is made on clinical evaluation, but thermography, Quantitative Sweat Test, bone scan, diagnostic blocks, etc., may help support the clinical diagnosis. Lack of a positive response to SNS block does not mean it is not CRPS.
New guidelines for traditional treatment involve 3 core elements: rehabilitation (including physical therapy), pain management, and psychological treatment.