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I'm Giving In--I'll Take the Shot

Posted by Sweetfeet on 7/25/00 at 13:42 (023903)

I am going back to my pod tomorrow. I have been on an inflammtory for almost 2 weeks (1 once a day). It has helped, but the pain is still there. I supposed I will do what he suggested before...cortisone. Yipes! I know it will hurt, but maybe it will stop the inflammation. What do you all think? Do you think I should go with the shot, or should I try more medicine by upping my dosage to twice a day. Of course, I may not have much of a choice after I talk with the Doc. He seems to want to do the shot more than anything as you may recall.

Re: I'm Giving In--I'll Take the Shot

JudyS on 7/25/00 at 13:54 (023906)

SF - you've read a lot here about those shots. On this board the remarks are about 80% negative. Have you researched them enough to feel comfortable? I was wondering - if you have the opportunity to double the meds, are you thinking about going that route for a test period, say a month, before going to the shots?

Re: I'm Giving In--I'll Take the Shot

john h on 7/25/00 at 14:28 (023908)

it did not hurt that much for me. remember to take in a very deep breath as he inserts the needle and exhale as he inserts the cortisone. i have had a lot worse shots than that.

Re: I'm Giving In--I'll Take the Shot

john a on 7/25/00 at 14:48 (023911)

But also keep in mind that this board is WAY HEAVILY biased towards people who have chronic problems with their feet, and these are the same people who likely have had bad experiences with cortisone shots. I would ask your pod what his success rate is with cortisone. If he gives you a number over 70% AND you feel you can believe him, I say go for it. Also ask how many shots he has administered - the more experience, the better. Make sure the shot goes in from the side, not the bottom. Finally, I might be inclined to trust an orthopedic surgeon rather than a pod for a better result, thought others may disagree - but a pod who's done a thousand shots will probably get better results than an ortho who's only done a hundred. I am darn near to trying 'the shot' by an ortho myself (I detest my pod) after 16 months of little to no improvement. Be sure to let us know how it goes!

Re: I'm Giving In--I'll Take the Shot

Mike D on 7/25/00 at 14:57 (023914)

It is the most painfull shot I have ever had. The Dr. stuck it in a little then injected, stuck deeper injected, stuck deeper injected the hole process took about 30 seconds of tourcher for me

Re: I'm Giving In--I'll Take the Shot

Beverly on 7/25/00 at 15:58 (023919)

Sweetfeet,

Good luck if you go through with the shot. I've been too spooked by the rupture risk to try it. I will be very interested to hear how you respond to the shot. I would not mind the initial pain... no matter how bad it is. It's that risk of rupturing that keeps me from giving into the temptation.

Beverly


Re: I'm Giving In--I'll Take the Shot

BJC on 7/25/00 at 16:34 (023923)

Many of the people who are against the shots have never had them. They work for many, many people, including me. The chances of a rupture from one shot are minimal. While the shot may be painful (some are, some aren't too bad), it may be worth the short discomfort for a few months or longer of pain-free existence. I would not hesitate to have a shot again if necessary. Good Luck!!!

Re: I'm Giving In--I'll Take the Shot

wendyn on 7/25/00 at 17:36 (023928)

Ultimately it's your choice. If it works - you're the one that benefits from the recovery - and you're the one that has to put up with all the pain now. There is however, a risk of rupture and shrinking the fat pads (although I seem to think your doctor is the one that claims that this procedure is 100% risk free - I still think he should put that in writing for you).

Is two weeks long enough on a small anti-inflammatory dose? Probably not - at least according to everything I was told. But, there's always the possiblity that the shot may be just what you need....I don't know - maybe flip a coin. Do you trust the doctor? I guess that's what it boils down to.


Re: I'm Giving In--I'll Take the Shot

Kim B. on 7/25/00 at 17:45 (023930)

I tend to think that the poeple who are most helped by the shots either don't hang out here or never ended up here in the first place. Both my Ortho and Primary Care doc seem to express that about 50% of the folks they inject get better with the shots. Of course they would tell me that. They wouldn't dare plant the notion in my head that only 20 percent of the folks are helped by injections. You know how docs are, they think we all live off the placibo affect, but they can't go so far as to (lie) and say that shots help 100% of the time. It's part of the CYA class they took at medical school. OK, I'm done with my ranting over docs.

I am trying to get up the nerve to have the shots done myself because I am tired of the suffering and tired of the unpredictable flair ups. I do feel that I have a greater chance of benefiting from them since my case is less severe than it used to be.

One question, if I show up for a shot appointment sloppy drunk, do you think the doc will throw me out?

Regards, Kim B.


Re: I'm Giving In--I'll Take the Shot

mike on 7/25/00 at 18:02 (023932)

sounds like you had mr hyde or dr frankenstein for your doc.

Re: I'm Giving In--I'll Take the Shot

john h on 7/25/00 at 18:05 (023933)

probably millions of shots are given each year without causing ruptures or any bad side effects. many people are actually cured by shots early on. i would not let a few failures keep me from a low risk potentially pain reducing shot.

Re: I'm Giving In--I'll Take the Shot

john h on 7/25/00 at 18:08 (023935)

kim i do not think a very dry martini (beefeaters of course) would interfere with the shot at all. make sure you have a driver if you go this route.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 19:14 (023944)

There is an abstract on this web from the American College of Foot Orthopedics. Rupture of the pf occurs in about 7-8% of cases with an average of two injections. IF it was my foot I would get one injection to see if I am lucky to get relief.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 19:19 (023945)

What I will offer patients that hate needles and shots etc. Is to offer them an injection into the muscle of the shoulder. Same dosage
as the foot. This is called an Intramuscular injection. This is alot quicker and alot less change of pain period. I like to use this with patients that have alot of pain in the foot in a larger area. The use of a needle into an already inflamed area can be very painful sometimes.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 19:24 (023946)

Another way to give a less painful injection is to use a 27 gauge needle. I always use this small diameter needle. It is the size of a fine thread. Don't let them use an 18 or even a 22 gauge needle. I would just explain the fear of needles and tell them could they use a 27 . Don't let them use the horse needle #18. There are some docs that feel that alot of quick short pain is great for you. Also take the drink or a Valium before the procedure. Now don't get mad I let a patient last week smoke a cigarette during the ESWT procedure. Please don't report me to the police.

Re: Thanks for the suggestions John and Dr. Z!

Kim B. on 7/25/00 at 19:44 (023950)

Thanks for the input guys. All information is useful.

Dr. Z., I applaud you for letting your patients 'have it their way'. Smoke, drink, cuss, whatever gets them through it. I'll bet some even want bring their Bibles. Whatever.

BTW, when I'm slamming doctors, I'm talking about the other 75% of Doctors, not you. It wouldn't suprise me if YOU fall in the 25% that are actually a credit to humanity...OK?

Regards, Kim B.


Re: I'm Giving In--I'll Take the Shot

suzi on 7/25/00 at 20:22 (023953)

Dr. Z. if cortisone shots have not worked wonders for me in the past, is this an indication that they will never work for me? I'm thinking about having one.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 20:39 (023956)

This is a good question that I ask patients before I give them any steriod shots in the foot. If it didn't work in the rest of the body or they had a flare up from the injection. You can get post steriod flare up . which is painful. I have no proof but believe that if they didn't work in the past why would they work now. There are different types of steriods long acting and short acting. If you had a short acting that worked for only a few days then I would go for the long acting

Re: Thanks for the suggestions John and Dr. Z!

Dr. Zuckerman on 7/25/00 at 20:49 (023957)

I was lucky to have some doctor early on in my life teach me that laugher is the best medicine. As a doctor you must place yourself in the patients shoes. Surgery,shots, pain isn't a party. I just finished reading a magizine called Medical Economics . They show an ad that was run years ago in their magizine. It shows a doctor smoking a camel cigarette and stating that most docs smoke camels and that in a test trial there was no throat irritation over a thiry day trial. I am going to try to take a picture and e-mail this so Scott would place on this site. I think we should all give it to doctor who think they know it all!!!

Re: I'm Giving In--I'll Take the Shot

Pauline on 7/25/00 at 21:43 (023961)

I think it is very noble to stay away from medication including
injections, however on the other hand sometime these things are
necessary and prove to be very beneficial. I have had one shot
in each foot. It was not as painful as you may immagine. The
Dr. sprays something cold on the area and when its starts to sting
in inserts the needle. You can't tell if you are feeling the sting
from the cold or the needle. There is a slight pain as the medication is being injected until the xylocane(sp) takes effect, then
there is no pain. It's over very quickly. I usually laydown
when he does them.

When I had PF in 1993, I had three shot in each foot. They
were spaced out. I just stayed off feet more than normal in between
the injections. Never had any problem. I had the best results
when the Dr. injected directly into the bottom of my feet. I may
ask for my New Dr. to consider this on my next visit.


Re: Dr. Z: What are the odds good and bad for one shot in each foot?

Beverly on 7/25/00 at 21:59 (023962)

Dr Z and all,

You have raised very interesting points. A 7-8% rupture chance sounds high to me, but then you said that is with 2 injections. (Would that be two injections to the same foot?) Then, do you know what the rupture risk is with one injection in each foot? Besides rest, is there anything one can do to futher reduce the risk of a rupture?

And if the foot did rupture, does one end up in a hard cast?
How many days or weeks after the shot is one in the 'danger zone'?

Since I have just now started PT, I am not wanting to run out and get a shot (given my fear of them), but it is certainly something to gather research on for the future.

Thanks a bunch,
Beverly


Re: I'm Giving In--I'll Take the Shot

Mike D on 7/26/00 at 05:16 (023970)

the risk of rupture was addresed by casting for 3 weeks

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/26/00 at 05:36 (023973)

Another way to do the shot and enhance the benefit is do a posterior nerve block and then do the shot. This will do two things first nerve the foot. two increase circulation to the foot. I do this when I do the injection on the bottom

Re: I'm Giving In--I'll Take the Shot

Barbara on 7/26/00 at 07:55 (023978)

What scares me about the shot is that because it makes you feel so good in the short run, you tend to really overdo it thinking you're better, and then you end up worse in the long run when it wears off.

I had five shots in parts of my wrist for tendonitis (they didn't work for longer than a few days each) and two shots in my elbow for tennis elbow which also relapsed afer a few weeks each.

I, personally, would never get a shot in my feet. For that matter, I'll never take another shot anywhere again. For me, it's just a temporary solution at best.


Re: He Would not Give Me the Shot!

Sweetfeet on 7/26/00 at 09:04 (023980)

Ironically, after I posted my message here, his office called saying that my appointment was today, NOW! I was already psyched about having the famous SHOT, but he said that my inflammation had gone down soooo much that it was not necessary. He said for me to stay on the medication for another week and call him. Gee, I really wanted that damn shot... In any case, I was more than thrilled with the thought of actually having my foot heal (hee, hee, hee). At the end of my visit, all I could say was 'when can I run again Doc?!' You see, once you have the endorphin high from a great run, it's all you want to be able to do again. What could be better, listening to the Beatles and running around the monuments in downtown Washington, DC. 'Just give me feet, that's what I want, that's what I waaanttt, that's what I want'...

Re: Dr. Z:

Kim B. on 7/26/00 at 09:43 (023982)

I'd love to see and be able to print that pic if you can manage to get it posted.

Regards, Kim B.


Re: I'm Giving In--I'll Take the Shot

suzi on 7/26/00 at 10:34 (023995)

Dr. Z how and when will you know if the fascia has ruptured? How soon after the injection can this happen, and how is it treated if it does rupture?

Re: He Would not Give Me the Shot!

john h on 7/26/00 at 10:36 (023996)

i hear you loud and clear sweetfeet about the great feeling of getting on the open road or in the forest and go for a run. i have been unable to replace this in my life but everyday people are paralyized or crippled for life and they go on. where they get their inner strength i do not know. i knew a local football place kicker here in little rock who was drafted #1 by the the St Louis Cardinals NFL football team. His first year in the NFL he lost control of his car on a rain slick road and was paralyized from the shoulder down. He recently died in his 40's. How do you go from a young star in the NFL to a wheel chair for life? A young teenager at my health club has no legs! he comes to the club nearly every day and plays basketball from his wheelchair with his friends. He appears to be a happy normal teenager. How does he do that? must be tremendous support from home and friends and faith!

Re: I'm Giving In--I'll Take the Shot

JudyS on 7/25/00 at 13:54 (023906)

SF - you've read a lot here about those shots. On this board the remarks are about 80% negative. Have you researched them enough to feel comfortable? I was wondering - if you have the opportunity to double the meds, are you thinking about going that route for a test period, say a month, before going to the shots?

Re: I'm Giving In--I'll Take the Shot

john h on 7/25/00 at 14:28 (023908)

it did not hurt that much for me. remember to take in a very deep breath as he inserts the needle and exhale as he inserts the cortisone. i have had a lot worse shots than that.

Re: I'm Giving In--I'll Take the Shot

john a on 7/25/00 at 14:48 (023911)

But also keep in mind that this board is WAY HEAVILY biased towards people who have chronic problems with their feet, and these are the same people who likely have had bad experiences with cortisone shots. I would ask your pod what his success rate is with cortisone. If he gives you a number over 70% AND you feel you can believe him, I say go for it. Also ask how many shots he has administered - the more experience, the better. Make sure the shot goes in from the side, not the bottom. Finally, I might be inclined to trust an orthopedic surgeon rather than a pod for a better result, thought others may disagree - but a pod who's done a thousand shots will probably get better results than an ortho who's only done a hundred. I am darn near to trying 'the shot' by an ortho myself (I detest my pod) after 16 months of little to no improvement. Be sure to let us know how it goes!

Re: I'm Giving In--I'll Take the Shot

Mike D on 7/25/00 at 14:57 (023914)

It is the most painfull shot I have ever had. The Dr. stuck it in a little then injected, stuck deeper injected, stuck deeper injected the hole process took about 30 seconds of tourcher for me

Re: I'm Giving In--I'll Take the Shot

Beverly on 7/25/00 at 15:58 (023919)

Sweetfeet,

Good luck if you go through with the shot. I've been too spooked by the rupture risk to try it. I will be very interested to hear how you respond to the shot. I would not mind the initial pain... no matter how bad it is. It's that risk of rupturing that keeps me from giving into the temptation.

Beverly


Re: I'm Giving In--I'll Take the Shot

BJC on 7/25/00 at 16:34 (023923)

Many of the people who are against the shots have never had them. They work for many, many people, including me. The chances of a rupture from one shot are minimal. While the shot may be painful (some are, some aren't too bad), it may be worth the short discomfort for a few months or longer of pain-free existence. I would not hesitate to have a shot again if necessary. Good Luck!!!

Re: I'm Giving In--I'll Take the Shot

wendyn on 7/25/00 at 17:36 (023928)

Ultimately it's your choice. If it works - you're the one that benefits from the recovery - and you're the one that has to put up with all the pain now. There is however, a risk of rupture and shrinking the fat pads (although I seem to think your doctor is the one that claims that this procedure is 100% risk free - I still think he should put that in writing for you).

Is two weeks long enough on a small anti-inflammatory dose? Probably not - at least according to everything I was told. But, there's always the possiblity that the shot may be just what you need....I don't know - maybe flip a coin. Do you trust the doctor? I guess that's what it boils down to.


Re: I'm Giving In--I'll Take the Shot

Kim B. on 7/25/00 at 17:45 (023930)

I tend to think that the poeple who are most helped by the shots either don't hang out here or never ended up here in the first place. Both my Ortho and Primary Care doc seem to express that about 50% of the folks they inject get better with the shots. Of course they would tell me that. They wouldn't dare plant the notion in my head that only 20 percent of the folks are helped by injections. You know how docs are, they think we all live off the placibo affect, but they can't go so far as to (lie) and say that shots help 100% of the time. It's part of the CYA class they took at medical school. OK, I'm done with my ranting over docs.

I am trying to get up the nerve to have the shots done myself because I am tired of the suffering and tired of the unpredictable flair ups. I do feel that I have a greater chance of benefiting from them since my case is less severe than it used to be.

One question, if I show up for a shot appointment sloppy drunk, do you think the doc will throw me out?

Regards, Kim B.


Re: I'm Giving In--I'll Take the Shot

mike on 7/25/00 at 18:02 (023932)

sounds like you had mr hyde or dr frankenstein for your doc.

Re: I'm Giving In--I'll Take the Shot

john h on 7/25/00 at 18:05 (023933)

probably millions of shots are given each year without causing ruptures or any bad side effects. many people are actually cured by shots early on. i would not let a few failures keep me from a low risk potentially pain reducing shot.

Re: I'm Giving In--I'll Take the Shot

john h on 7/25/00 at 18:08 (023935)

kim i do not think a very dry martini (beefeaters of course) would interfere with the shot at all. make sure you have a driver if you go this route.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 19:14 (023944)

There is an abstract on this web from the American College of Foot Orthopedics. Rupture of the pf occurs in about 7-8% of cases with an average of two injections. IF it was my foot I would get one injection to see if I am lucky to get relief.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 19:19 (023945)

What I will offer patients that hate needles and shots etc. Is to offer them an injection into the muscle of the shoulder. Same dosage
as the foot. This is called an Intramuscular injection. This is alot quicker and alot less change of pain period. I like to use this with patients that have alot of pain in the foot in a larger area. The use of a needle into an already inflamed area can be very painful sometimes.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 19:24 (023946)

Another way to give a less painful injection is to use a 27 gauge needle. I always use this small diameter needle. It is the size of a fine thread. Don't let them use an 18 or even a 22 gauge needle. I would just explain the fear of needles and tell them could they use a 27 . Don't let them use the horse needle #18. There are some docs that feel that alot of quick short pain is great for you. Also take the drink or a Valium before the procedure. Now don't get mad I let a patient last week smoke a cigarette during the ESWT procedure. Please don't report me to the police.

Re: Thanks for the suggestions John and Dr. Z!

Kim B. on 7/25/00 at 19:44 (023950)

Thanks for the input guys. All information is useful.

Dr. Z., I applaud you for letting your patients 'have it their way'. Smoke, drink, cuss, whatever gets them through it. I'll bet some even want bring their Bibles. Whatever.

BTW, when I'm slamming doctors, I'm talking about the other 75% of Doctors, not you. It wouldn't suprise me if YOU fall in the 25% that are actually a credit to humanity...OK?

Regards, Kim B.


Re: I'm Giving In--I'll Take the Shot

suzi on 7/25/00 at 20:22 (023953)

Dr. Z. if cortisone shots have not worked wonders for me in the past, is this an indication that they will never work for me? I'm thinking about having one.

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/25/00 at 20:39 (023956)

This is a good question that I ask patients before I give them any steriod shots in the foot. If it didn't work in the rest of the body or they had a flare up from the injection. You can get post steriod flare up . which is painful. I have no proof but believe that if they didn't work in the past why would they work now. There are different types of steriods long acting and short acting. If you had a short acting that worked for only a few days then I would go for the long acting

Re: Thanks for the suggestions John and Dr. Z!

Dr. Zuckerman on 7/25/00 at 20:49 (023957)

I was lucky to have some doctor early on in my life teach me that laugher is the best medicine. As a doctor you must place yourself in the patients shoes. Surgery,shots, pain isn't a party. I just finished reading a magizine called Medical Economics . They show an ad that was run years ago in their magizine. It shows a doctor smoking a camel cigarette and stating that most docs smoke camels and that in a test trial there was no throat irritation over a thiry day trial. I am going to try to take a picture and e-mail this so Scott would place on this site. I think we should all give it to doctor who think they know it all!!!

Re: I'm Giving In--I'll Take the Shot

Pauline on 7/25/00 at 21:43 (023961)

I think it is very noble to stay away from medication including
injections, however on the other hand sometime these things are
necessary and prove to be very beneficial. I have had one shot
in each foot. It was not as painful as you may immagine. The
Dr. sprays something cold on the area and when its starts to sting
in inserts the needle. You can't tell if you are feeling the sting
from the cold or the needle. There is a slight pain as the medication is being injected until the xylocane(sp) takes effect, then
there is no pain. It's over very quickly. I usually laydown
when he does them.

When I had PF in 1993, I had three shot in each foot. They
were spaced out. I just stayed off feet more than normal in between
the injections. Never had any problem. I had the best results
when the Dr. injected directly into the bottom of my feet. I may
ask for my New Dr. to consider this on my next visit.


Re: Dr. Z: What are the odds good and bad for one shot in each foot?

Beverly on 7/25/00 at 21:59 (023962)

Dr Z and all,

You have raised very interesting points. A 7-8% rupture chance sounds high to me, but then you said that is with 2 injections. (Would that be two injections to the same foot?) Then, do you know what the rupture risk is with one injection in each foot? Besides rest, is there anything one can do to futher reduce the risk of a rupture?

And if the foot did rupture, does one end up in a hard cast?
How many days or weeks after the shot is one in the 'danger zone'?

Since I have just now started PT, I am not wanting to run out and get a shot (given my fear of them), but it is certainly something to gather research on for the future.

Thanks a bunch,
Beverly


Re: I'm Giving In--I'll Take the Shot

Mike D on 7/26/00 at 05:16 (023970)

the risk of rupture was addresed by casting for 3 weeks

Re: I'm Giving In--I'll Take the Shot

Dr. Zuckerman on 7/26/00 at 05:36 (023973)

Another way to do the shot and enhance the benefit is do a posterior nerve block and then do the shot. This will do two things first nerve the foot. two increase circulation to the foot. I do this when I do the injection on the bottom

Re: I'm Giving In--I'll Take the Shot

Barbara on 7/26/00 at 07:55 (023978)

What scares me about the shot is that because it makes you feel so good in the short run, you tend to really overdo it thinking you're better, and then you end up worse in the long run when it wears off.

I had five shots in parts of my wrist for tendonitis (they didn't work for longer than a few days each) and two shots in my elbow for tennis elbow which also relapsed afer a few weeks each.

I, personally, would never get a shot in my feet. For that matter, I'll never take another shot anywhere again. For me, it's just a temporary solution at best.


Re: He Would not Give Me the Shot!

Sweetfeet on 7/26/00 at 09:04 (023980)

Ironically, after I posted my message here, his office called saying that my appointment was today, NOW! I was already psyched about having the famous SHOT, but he said that my inflammation had gone down soooo much that it was not necessary. He said for me to stay on the medication for another week and call him. Gee, I really wanted that damn shot... In any case, I was more than thrilled with the thought of actually having my foot heal (hee, hee, hee). At the end of my visit, all I could say was 'when can I run again Doc?!' You see, once you have the endorphin high from a great run, it's all you want to be able to do again. What could be better, listening to the Beatles and running around the monuments in downtown Washington, DC. 'Just give me feet, that's what I want, that's what I waaanttt, that's what I want'...

Re: Dr. Z:

Kim B. on 7/26/00 at 09:43 (023982)

I'd love to see and be able to print that pic if you can manage to get it posted.

Regards, Kim B.


Re: I'm Giving In--I'll Take the Shot

suzi on 7/26/00 at 10:34 (023995)

Dr. Z how and when will you know if the fascia has ruptured? How soon after the injection can this happen, and how is it treated if it does rupture?

Re: He Would not Give Me the Shot!

john h on 7/26/00 at 10:36 (023996)

i hear you loud and clear sweetfeet about the great feeling of getting on the open road or in the forest and go for a run. i have been unable to replace this in my life but everyday people are paralyized or crippled for life and they go on. where they get their inner strength i do not know. i knew a local football place kicker here in little rock who was drafted #1 by the the St Louis Cardinals NFL football team. His first year in the NFL he lost control of his car on a rain slick road and was paralyized from the shoulder down. He recently died in his 40's. How do you go from a young star in the NFL to a wheel chair for life? A young teenager at my health club has no legs! he comes to the club nearly every day and plays basketball from his wheelchair with his friends. He appears to be a happy normal teenager. How does he do that? must be tremendous support from home and friends and faith!