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that second opinion.......

Posted by Claudia on 7/18/01 at 09:31 (053571)

Hi everyone. Just wanted to stop in to say......my foot doc is now sending me to a rheumatologist; he has decided that my continuing pain and disability from it (*after the bunionectomy/EPF in january and MRI and aspiration of hematoma/injection of four shots of cortisone in may)has nothing to do with any of the surgeries or procedures i have had done. i went back to him yesterday and when he said all of this i POLITELY said i would like to seek a second opinion which is when he said he would strongly suggest a rheumatologist....part of his reasoning is that i have fibro/myofascitis and HAVE been having flare ups since the cortisone injections have worn off since the may procedure.....he thinks that since the inflammation/pain respond so well to cortisone there must be 'something else' going on, that this continual pain is not connected to the surgeries. hmmmmm.....can't wait to see what the rheumatologist has to say. should be interesting. all i know is that when i did the prednisone five day treatment my neck and shoulders and lower back never felt better!!!! maybe this will even help someone else who knows. take care.

Re: that second opinion.......

Dr. Zuckerman on 7/18/01 at 10:27 (053578)

Let see what happens . There is unforunately a group of patients that just won't get better from EPF .

Re: that second opinion.......

Paula G. on 7/18/01 at 17:33 (053611)

Is your doctor thinking arthritis?? There is a blood test that can show if a person has rheumatoid arthritis.

Re: that second opinion.......

claudia to paula on 7/18/01 at 18:05 (053614)

yes he is thinking rheumatoid arthritis since in his opinion the soft tissue just isn't healing and inflammation is causing continual debilitating pain. if the rheumatologist says 'no' i'll go elsewhere in my quest for help....and relief from pain. i have other joint problems too and myofascial pain on a regular basis. maybe he is grasping at straws but this is his notion of a 'second opinion'.

Re: that second opinion.......

claudia to dr. zuckerman (NOT to wendyn....) on 7/18/01 at 18:06 (053615)

the doc says that the MRI shows that both the bunionectomy and the EPF 'were successful', and complete. but you can still have PF problems even though the surgery was ' a success'? can you tell me about this dr. z? thanks........i do appreciate it.

Re: that second opinion.......

Dr. Zuckerman on 7/18/01 at 19:54 (053627)

Ok
Some times the pf doesn't heal back to its orginal strength . So you are now placing your weight bearing weight on other areas of the foot. Usually the lateral band but some time the lateral aspect of the ankle. So a pf release can create weight bearing shifting of weight. This is the main complication that pf causes even when the original pain is gone. So the pf release solves the first pain and now create new pain.

Please tell me do you have the same pain in the same spot that you had before the epf surgery

Re: that second opinion.......

Dr. David S. Wander on 7/18/01 at 20:26 (053634)

Claudia,

I'm sorry if I missed this before, but I never noted on any of your prior postings that you had fibromyositis/fibromyalgia. This certainly can be playing a major role in your continued discomfort, and can also help explain why the prednisone was helpful. In my practice, I've always found it difficult when treating patients that have been diagnosed with fibromyalgia/fibromyositis and plantar fasciitis. It is difficult to determine how much of the discomfort is from each component, sort of like determining which came first, the chicken or the egg. I am extremely hesitant to perform EPF surgery on a patient with fibromyalgia/fibromyositis, since the soft tissue pain can linger/recur or never subside. Now that I've learned that you have this condition, it sheds more light on your continued discomfort. I certainly think a rheumatology work up would be indicated. Good luck.

Re: that second opinion.......

claudia to dr. wander on 7/18/01 at 20:51 (053639)

i don't think i have ever really got into my fibromyalgia situation when i have posted here before. but it sure is interesting to hear you say that you yourself hesitate to do EPF on someone who has it.......at this point i hope it explains the duration of my pain.....i just want an end to it! back when i did the five day prednisone pack i remember saying to my podiatrist that i really liked how pain free my neck was...and at that time he did not make the connection with the fibromyalgia/mysofascitis. my foot doc was surprised, too, when i told him that no, i wasn't under any doctors' care for the fibro.....my internist deemed it not necessary to treat it in any way ...i really think that is because i didn't complain enough about pain!!! i can't wait to see how this pans out now! not only for pain relief but just because seeing the rheumatologist might just be the beginning of the unraveling of a big mystery!!! don't mind me, i have quite a theatrical leaning.......

Re: that second opinion.......

wendyn on 7/18/01 at 23:12 (053655)

Claudia, I spend an awful lot of time on this board helping trying to offer support to lots of different people. You are welcome to do that as well as asking questions about your own situation.

I realize that you took exception to my opinion of your care - and I have not commented since you asked me politely not to. I don't appreciate being singled out as 'not welcome to have an opinion' in a public forum.

If you have a problem with me personally - my email is mailwendy1@home.com

Other than that, don't expect to see my name in your threads - I don't expect to see you mention it either.

Re: that second opinion.......

Julie on 7/19/01 at 03:21 (053678)

Claudia, like Wendy, I'm another whose comments on your 'second opinion' saga were dismissed, and I too have refrained from contributing to your threads since. But I would like to say that like Dr Wander, I am surprised to learn that you have fibromyalgia and even more surprised that in all your posts a few months back, you never mentioned something that is so relevant to your problem.

Re: that second opinion.......

claudia to dr. z. on 7/19/01 at 10:11 (053709)

thank you for the explanation even though it is not a real positive situation you describe. i would say that yes, it is mostly the same pain as pre-surgery with the additional ankle pain.

Re: that second opinion.......

Dr. Zuckerman on 7/19/01 at 16:42 (053753)

Sorry. In addition I agree with Dr. Wander that the fibro may be a factor. I have had no real sucess with heel spur surgery in the fibro patient period. In fact I still remember one patient that steriods were the only thing that calm the foot down after the foot surgery. I still see the patient. She has many other joint problems in addition to the heel spur pain problem

Re: that second opinion.......

RalphP on 7/20/01 at 19:43 (053856)

I'm prompted by Dr. Wander's reply, regarding the difficulty of treating PF that co-exists with fibromyalgia, to re-ask a question I first asked on this list 10 days ago or so: Dr. Wander, do you have any familiarity with ESWT therapy for PF, when the patient also has fibromyalgia? (I have both; the FM predates the PF by 16 years, and the PF has greatly aggravated the FM by preventing me from exercising. I'm considering ESWT treatment for the PF, but am trying to find out if my FM should be viewed as a contraindication for that.)

(Note: Dr. Z kindly responded to this question when I first asked it. One of his suggestions was that I try to contact David Lowy, of Sonorex, whose firm I noted I was considering using for ESWT treatment. I e-mailed Mr. Lowy, but did not receive a reply -- despite the fact that his messages have appeared on this list since the time I e-mailed him.)

Ralph

Re: that second opinion.......

Dr. David S. Wander on 7/21/01 at 19:31 (053936)

Ralph,

ANY treatment for plantar fasciits, whether it is an injection, medications, therapy, orthoses, change of shoes, ice, rest, surgery, ESWT etc., is very difficult in a patient that has fibromyalgia. As I stated before, it is difficult to determine which came first, the chicken or the egg. Is the plantar fasciitis/heel pain a symptom of the fibromyalgia, or is it simply isolated plantar fasciitis. Any treatment that is aimed at healing/curing the plantar fasciitis, will have limited success if the fibromyalgia is the cause of the heel pain. The treatments are not directed at treating the fibromyalgia, which is a chronic and inflammatory condition. It is for this reason that I avoid surgery and would probably avoid ESWT on patients that have both fasciitis and fibromyalgia. In my experience with these patients, all treatments provide some relief, and the patient has good days and bad days with total resolution of pain followed by periods of recurrent pain. I would have no problem recommending ESWT for a patient if I was able to determine that the plantar fasciitis was isolated, and not part of the fibromyalgia.

Re: that second opinion.......

RalphP on 7/23/01 at 22:35 (054071)

Dr. Wander, I'm late in replying, but thanks a lot for the clear and thoughtful response on this. Your response rings true, and is exactly what's been making me put off ESWT (at least for now) despite what looks like a pretty impressive track record.

The odd thing is, fibromyalgia is not as a general rule, nor in my case, an inflammatory condition per se. I have lots of painful body parts, but none of them register as inflamed -- except for my plantar fascia, which are inflamed to beat the band. My best guess is that my FM has induced my PF, and complicates treatment of it, and that my PF has significantly aggravated my FM, but that at root they're essentially distinct conditions. Which is why I'm still thinking about ESWT.

Anyway, thanks again.

Ralph

Re: that second opinion.......

Dr. Zuckerman on 7/18/01 at 10:27 (053578)

Let see what happens . There is unforunately a group of patients that just won't get better from EPF .

Re: that second opinion.......

Paula G. on 7/18/01 at 17:33 (053611)

Is your doctor thinking arthritis?? There is a blood test that can show if a person has rheumatoid arthritis.

Re: that second opinion.......

claudia to paula on 7/18/01 at 18:05 (053614)

yes he is thinking rheumatoid arthritis since in his opinion the soft tissue just isn't healing and inflammation is causing continual debilitating pain. if the rheumatologist says 'no' i'll go elsewhere in my quest for help....and relief from pain. i have other joint problems too and myofascial pain on a regular basis. maybe he is grasping at straws but this is his notion of a 'second opinion'.

Re: that second opinion.......

claudia to dr. zuckerman (NOT to wendyn....) on 7/18/01 at 18:06 (053615)

the doc says that the MRI shows that both the bunionectomy and the EPF 'were successful', and complete. but you can still have PF problems even though the surgery was ' a success'? can you tell me about this dr. z? thanks........i do appreciate it.

Re: that second opinion.......

Dr. Zuckerman on 7/18/01 at 19:54 (053627)

Ok
Some times the pf doesn't heal back to its orginal strength . So you are now placing your weight bearing weight on other areas of the foot. Usually the lateral band but some time the lateral aspect of the ankle. So a pf release can create weight bearing shifting of weight. This is the main complication that pf causes even when the original pain is gone. So the pf release solves the first pain and now create new pain.

Please tell me do you have the same pain in the same spot that you had before the epf surgery

Re: that second opinion.......

Dr. David S. Wander on 7/18/01 at 20:26 (053634)

Claudia,

I'm sorry if I missed this before, but I never noted on any of your prior postings that you had fibromyositis/fibromyalgia. This certainly can be playing a major role in your continued discomfort, and can also help explain why the prednisone was helpful. In my practice, I've always found it difficult when treating patients that have been diagnosed with fibromyalgia/fibromyositis and plantar fasciitis. It is difficult to determine how much of the discomfort is from each component, sort of like determining which came first, the chicken or the egg. I am extremely hesitant to perform EPF surgery on a patient with fibromyalgia/fibromyositis, since the soft tissue pain can linger/recur or never subside. Now that I've learned that you have this condition, it sheds more light on your continued discomfort. I certainly think a rheumatology work up would be indicated. Good luck.

Re: that second opinion.......

claudia to dr. wander on 7/18/01 at 20:51 (053639)

i don't think i have ever really got into my fibromyalgia situation when i have posted here before. but it sure is interesting to hear you say that you yourself hesitate to do EPF on someone who has it.......at this point i hope it explains the duration of my pain.....i just want an end to it! back when i did the five day prednisone pack i remember saying to my podiatrist that i really liked how pain free my neck was...and at that time he did not make the connection with the fibromyalgia/mysofascitis. my foot doc was surprised, too, when i told him that no, i wasn't under any doctors' care for the fibro.....my internist deemed it not necessary to treat it in any way ...i really think that is because i didn't complain enough about pain!!! i can't wait to see how this pans out now! not only for pain relief but just because seeing the rheumatologist might just be the beginning of the unraveling of a big mystery!!! don't mind me, i have quite a theatrical leaning.......

Re: that second opinion.......

wendyn on 7/18/01 at 23:12 (053655)

Claudia, I spend an awful lot of time on this board helping trying to offer support to lots of different people. You are welcome to do that as well as asking questions about your own situation.

I realize that you took exception to my opinion of your care - and I have not commented since you asked me politely not to. I don't appreciate being singled out as 'not welcome to have an opinion' in a public forum.

If you have a problem with me personally - my email is mailwendy1@home.com

Other than that, don't expect to see my name in your threads - I don't expect to see you mention it either.

Re: that second opinion.......

Julie on 7/19/01 at 03:21 (053678)

Claudia, like Wendy, I'm another whose comments on your 'second opinion' saga were dismissed, and I too have refrained from contributing to your threads since. But I would like to say that like Dr Wander, I am surprised to learn that you have fibromyalgia and even more surprised that in all your posts a few months back, you never mentioned something that is so relevant to your problem.

Re: that second opinion.......

claudia to dr. z. on 7/19/01 at 10:11 (053709)

thank you for the explanation even though it is not a real positive situation you describe. i would say that yes, it is mostly the same pain as pre-surgery with the additional ankle pain.

Re: that second opinion.......

Dr. Zuckerman on 7/19/01 at 16:42 (053753)

Sorry. In addition I agree with Dr. Wander that the fibro may be a factor. I have had no real sucess with heel spur surgery in the fibro patient period. In fact I still remember one patient that steriods were the only thing that calm the foot down after the foot surgery. I still see the patient. She has many other joint problems in addition to the heel spur pain problem

Re: that second opinion.......

RalphP on 7/20/01 at 19:43 (053856)

I'm prompted by Dr. Wander's reply, regarding the difficulty of treating PF that co-exists with fibromyalgia, to re-ask a question I first asked on this list 10 days ago or so: Dr. Wander, do you have any familiarity with ESWT therapy for PF, when the patient also has fibromyalgia? (I have both; the FM predates the PF by 16 years, and the PF has greatly aggravated the FM by preventing me from exercising. I'm considering ESWT treatment for the PF, but am trying to find out if my FM should be viewed as a contraindication for that.)

(Note: Dr. Z kindly responded to this question when I first asked it. One of his suggestions was that I try to contact David Lowy, of Sonorex, whose firm I noted I was considering using for ESWT treatment. I e-mailed Mr. Lowy, but did not receive a reply -- despite the fact that his messages have appeared on this list since the time I e-mailed him.)

Ralph

Re: that second opinion.......

Dr. David S. Wander on 7/21/01 at 19:31 (053936)

Ralph,

ANY treatment for plantar fasciits, whether it is an injection, medications, therapy, orthoses, change of shoes, ice, rest, surgery, ESWT etc., is very difficult in a patient that has fibromyalgia. As I stated before, it is difficult to determine which came first, the chicken or the egg. Is the plantar fasciitis/heel pain a symptom of the fibromyalgia, or is it simply isolated plantar fasciitis. Any treatment that is aimed at healing/curing the plantar fasciitis, will have limited success if the fibromyalgia is the cause of the heel pain. The treatments are not directed at treating the fibromyalgia, which is a chronic and inflammatory condition. It is for this reason that I avoid surgery and would probably avoid ESWT on patients that have both fasciitis and fibromyalgia. In my experience with these patients, all treatments provide some relief, and the patient has good days and bad days with total resolution of pain followed by periods of recurrent pain. I would have no problem recommending ESWT for a patient if I was able to determine that the plantar fasciitis was isolated, and not part of the fibromyalgia.

Re: that second opinion.......

RalphP on 7/23/01 at 22:35 (054071)

Dr. Wander, I'm late in replying, but thanks a lot for the clear and thoughtful response on this. Your response rings true, and is exactly what's been making me put off ESWT (at least for now) despite what looks like a pretty impressive track record.

The odd thing is, fibromyalgia is not as a general rule, nor in my case, an inflammatory condition per se. I have lots of painful body parts, but none of them register as inflamed -- except for my plantar fascia, which are inflamed to beat the band. My best guess is that my FM has induced my PF, and complicates treatment of it, and that my PF has significantly aggravated my FM, but that at root they're essentially distinct conditions. Which is why I'm still thinking about ESWT.

Anyway, thanks again.

Ralph