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Desperately need input regarding a recent foot injury (HMO patient)

Posted by Kathie F on 11/29/01 at 12:22 (065630)

I am dealing with an HMO and I feel they are not doing enough testing to discover the real extent of my injuries before diagnosing and treating me.

On 8/26 I injured my foot by stepping in a hole. My right foot went into the hole with inside edge of the ball of my foot behind my big toe first. The other toes folded up over my foot...the whole foot bent to the inside...I wend to the other way and fell on top of my foot.

I suffered from extreme pain for almost a week. My foot was almost completely black (especially on the bottom). The appearance of my foot was like a severely club foot with very fat toes sticking out of the end.

I was originally sent to a podiatrist who then sent me to an orthopedist who casted my foot (incorrectly). After 6 hours I was in such pain I had to go into the ER and have the front of the cast cut off. I wore the remainder of the cast as a splint for 6 weeks. When I saw this doctor again he simply told me I should start walking on it. This was impossible as there was still excruciating pain when I applied any pressure on the foot. He ordered an air cast for me which worked well for the pain but seemed to increase the swelling. Also during this last visit I asked him if he would order an MRI as I wanted to know the extend of the soft tissue damage, etc.. He looked at me with disgust and said that most people trusted his diagnosis, stormed out of the room and I never saw him again. Whatever I received from his office after that was through contact with his nurse. I want to make clear that the reason I asked for the MRI was that even though the foot was clear of the black color it was still very red and discolored (like there was a circulation problem). Needless to say I did not receive the order for an MRI from him and I changed primary care physicians so I could have access to a different specialist.

My current symptoms are discoloration of my foot and leg, swelling of my foot, ankle and leg (the ankle and leg were not injured in the fall), and pain in the ball of my foot where the second and third toes connect to the ball of my foot. By the end of the day that area is bright red.

This new doctor x-rayed my foot and determined there had been no breaks and feels I have RSD and wants to do complete nerve blocks to my foot.

I'm uncomfortable with this as no one has tested the circulatory system in my foot to see if I might have sustained a major injury to a vein or might I have a blood clot which is inhibiting my circulation and causing the discoloration and swelling?

Please advise me of all the tests that need to be performed so that an accurate diagnosis is made before treatment.

Sincerely,
Another victim of an HMO

Re: Will try to help......

Carmen H on 11/29/01 at 13:56 (065638)

Kathie~

I am not a doctor but have spent the last 6 months trying to find a diagnosis for myself (I TOO have HMO...not for long) and have run across MANY things in my quest for information. RSD information is one of the things I researched to the death! (I don't have it) If the X ray showed no breaks or fractures it is doubtful that there is anything like that wrong. The dr. that diagnosed RSD may be onto something. Your symptoms sound like that could be the problem. Have you researched it at all? I would research it and get a second opinion on the RSD diagnosis AS SOON AS POSSIBLE. If RSD is caught in the early stages the prognosis is MUCH BETTER. DO NOT let this go. Call that dr. back though and ask him if he has any recommendations for a 2nd opinion before you go ahead with the nerve blocks...he will (if he's a good doc) be happy to refer you to someone for the opinion. But go back to him for treatment if that is what this turns out to be. He seems to know what RSD (otherwise known as Complex Regional Pain Syndrome I think that's the new term) is and wants to help you and that is VERY important!!!!
I hope this helps...I don't mean to alarm you but RSD is a VERY serious and painful disease that can REALLY get BAD if not treated EARLY. I have a dear friend on this board who has it and bless her heart she goes through a lot.
Good Luck!!!

Re: Bone scan and MRI ??

BrianG on 11/29/01 at 18:59 (065679)

Hi Kathie,

When I first got my PF symptoms almost 8 years ago, I belonged to an HMO. In my stubborn head, I was convinced that I had to have something besides PF. I saw the Pod from the HMO and had the standard treatments. After some time went by, I was no better, and I really hammered the HMO for extra tests, films, etc.

I'd advise you to read the HMO manual about your treatment, your rights, and the appeals process. All will come in handy if you decide t persue this. I decided that I need an MRI to find out what was happeneing with my heel. They denied it, but agreed to a bone scan. I went along with the scan, and it came back negative. This made me wnt the MRI more than ever.

I read the HMO manual and put it to use. 1st I asked the Pod for an MRI, he refused. The next step was to ask
the Pod, i writing, which I did. He again denied it. I wrote to the appeals board and asked for the MRI, they denied it. Finally I was at the last step, I had to appeal the boards finding, and ask to go before a panel of HMO doctors and Exec's. It was pretty uncomfertable, but I stood up, and asked again, telling them why I felt I needed the test. I ended my appeal with something like 'and if you deny the MRI, and I am found to have an injury, or illness, that could have been healed with the MRI, I will consider contacting a malpractice attorney'.

Anyways, I won, and got the MRI. It too came back mostly negative, just a small amount of swelling, same as the bone scan. I needed to know for myself that all tests available, had been done. The HMO never held it against me, it was just business as usuall after the MRI. Would I do it again, you bet !!!!

These are two tests you might want to consider. I also think you should stay off your feet as much as possible, I don't thnk you mentioned what kind of work you do. And no more dodge ball, Ya hear !! Good luck

BCG

Re: Desperately need input regarding a recent foot injury (HMO patient)

Laurie R on 11/29/01 at 21:24 (065692)

Dear Kathie , Welcome to the board .. Next I want to say I am so sorry to hear you have RSD .... I know it all to well. I am being treated right now for RSD in my right foot. The pain now is so terrible . As I am sure you know . I don't understand why your doctor wants to do nerve blocks in your foot. Or do you mean spinal sympathetic never blocks ? Which are given in your spine in the hospital or surgery center .

I have had two sets of the lumbar sympathetic nerve blocks done so far. I will be having my thrid this Tues ...

Their are many different symptoms of RSD or CRPS . It is very complex. I have a POd and I also see a Pain Management doctor . I would strongly advise you to see a PM doctor ,this is the doctor that does the injections to the spine. I also have a wonderful POd .

I also have PF and TTS and tenosynivitis in my FHL tendon and a fibroma on my fascia .. As well as RSD . RSD was the last thing I got ..

If I can help you in anyway , PLEASE feel free to ask . If you would like to email me let me know and I will give you my email address...

I can say I know and understand what you are going through , I am very sorry you also have RSD .. Laurie R

Also Carmen is very right , early treatment is very important when it comes to RSD....

Re: Will try to help......

Carmen H on 11/29/01 at 13:56 (065638)

Kathie~

I am not a doctor but have spent the last 6 months trying to find a diagnosis for myself (I TOO have HMO...not for long) and have run across MANY things in my quest for information. RSD information is one of the things I researched to the death! (I don't have it) If the X ray showed no breaks or fractures it is doubtful that there is anything like that wrong. The dr. that diagnosed RSD may be onto something. Your symptoms sound like that could be the problem. Have you researched it at all? I would research it and get a second opinion on the RSD diagnosis AS SOON AS POSSIBLE. If RSD is caught in the early stages the prognosis is MUCH BETTER. DO NOT let this go. Call that dr. back though and ask him if he has any recommendations for a 2nd opinion before you go ahead with the nerve blocks...he will (if he's a good doc) be happy to refer you to someone for the opinion. But go back to him for treatment if that is what this turns out to be. He seems to know what RSD (otherwise known as Complex Regional Pain Syndrome I think that's the new term) is and wants to help you and that is VERY important!!!!
I hope this helps...I don't mean to alarm you but RSD is a VERY serious and painful disease that can REALLY get BAD if not treated EARLY. I have a dear friend on this board who has it and bless her heart she goes through a lot.
Good Luck!!!

Re: Bone scan and MRI ??

BrianG on 11/29/01 at 18:59 (065679)

Hi Kathie,

When I first got my PF symptoms almost 8 years ago, I belonged to an HMO. In my stubborn head, I was convinced that I had to have something besides PF. I saw the Pod from the HMO and had the standard treatments. After some time went by, I was no better, and I really hammered the HMO for extra tests, films, etc.

I'd advise you to read the HMO manual about your treatment, your rights, and the appeals process. All will come in handy if you decide t persue this. I decided that I need an MRI to find out what was happeneing with my heel. They denied it, but agreed to a bone scan. I went along with the scan, and it came back negative. This made me wnt the MRI more than ever.

I read the HMO manual and put it to use. 1st I asked the Pod for an MRI, he refused. The next step was to ask
the Pod, i writing, which I did. He again denied it. I wrote to the appeals board and asked for the MRI, they denied it. Finally I was at the last step, I had to appeal the boards finding, and ask to go before a panel of HMO doctors and Exec's. It was pretty uncomfertable, but I stood up, and asked again, telling them why I felt I needed the test. I ended my appeal with something like 'and if you deny the MRI, and I am found to have an injury, or illness, that could have been healed with the MRI, I will consider contacting a malpractice attorney'.

Anyways, I won, and got the MRI. It too came back mostly negative, just a small amount of swelling, same as the bone scan. I needed to know for myself that all tests available, had been done. The HMO never held it against me, it was just business as usuall after the MRI. Would I do it again, you bet !!!!

These are two tests you might want to consider. I also think you should stay off your feet as much as possible, I don't thnk you mentioned what kind of work you do. And no more dodge ball, Ya hear !! Good luck

BCG

Re: Desperately need input regarding a recent foot injury (HMO patient)

Laurie R on 11/29/01 at 21:24 (065692)

Dear Kathie , Welcome to the board .. Next I want to say I am so sorry to hear you have RSD .... I know it all to well. I am being treated right now for RSD in my right foot. The pain now is so terrible . As I am sure you know . I don't understand why your doctor wants to do nerve blocks in your foot. Or do you mean spinal sympathetic never blocks ? Which are given in your spine in the hospital or surgery center .

I have had two sets of the lumbar sympathetic nerve blocks done so far. I will be having my thrid this Tues ...

Their are many different symptoms of RSD or CRPS . It is very complex. I have a POd and I also see a Pain Management doctor . I would strongly advise you to see a PM doctor ,this is the doctor that does the injections to the spine. I also have a wonderful POd .

I also have PF and TTS and tenosynivitis in my FHL tendon and a fibroma on my fascia .. As well as RSD . RSD was the last thing I got ..

If I can help you in anyway , PLEASE feel free to ask . If you would like to email me let me know and I will give you my email address...

I can say I know and understand what you are going through , I am very sorry you also have RSD .. Laurie R

Also Carmen is very right , early treatment is very important when it comes to RSD....