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I got my records from surgery have a few questions

Posted by Tammie on 4/19/02 at 18:46 (080368)

I have been doing alot of work and research on my foot troubles ,I asked for all of my records from the surgeries.Upon reading them I have learned that the decompression of tibial nerve was done by endoscope. I wonder if there is more information on what he wrote about it, as I do not completely understand his words .

He wrote the medial aspect of the left foot and ankle overlying the abductor hiatus where a 2cm oblique skin inc. was made following the course of tibial nerve.The inc. was deepened upon dissection along the lucinate ligament. All Bleeders were identified and bovied.Luciniate lig. was incised as well as the fibrous opening to the hiatus tarsal tunnel was identified and incised. Blunt dissection continued thru the tarsal canal followed by the cannulator obturator system. A small stab inc. was made at the exit portal in the arch. The endoscope was introduced and the roof of the tarsal tunnel identified and incised. The area was examinied along for further constrictions and none were noted. The cannula was removed. Then is tells how it was flushed and stitched.And tourniquet was removed.

Then on another sheet he has listed decompression of tibial nerve,supine,power,endoscope,LMAC, tourniquet,Bovie,suction,Pneumatic walker length of surgery 1 hour

My questions are this , Does this seem like the usual type of surgery that is done for this? I have been reading a lot of contridicting things with endoscope. I am now left with being much worse than I was before the first surgery which was the resection of calcaneal spur and fascial release.Then this last surgery for the tibial decompression. I am now left with a hole lot of pain and a few Dr.s saying I had way to much surgery and that I may have RSD which seems to be the dx they are all giving me. I do have a appt. with pain management May 20 takes so long to get in there. So therefore I am reading my records and researching them , which might be worse for me , haha as I am not a Dr. I am just curious why no mri was ever done? Would it be any use now? I also never had a nerve test done. Was convinced it was not needed then or now.

I want to be sure that I find out the real dx of my troubles and am trying to find out. I will also go to the appt, with pain managent. It is extreamly interesting that i am being treated VERY well from his office, anything I need type of thing and even gave me samples when I picked up records of ultracet, I did not ask, the office girl said it is a bit before your pain appt. here thease may help till then. It really upsets me about this, I do not blame my dr. for anything as there are always good and bad outcomes that is the thing nothing is 100%. But I am angry that all along he paid little attention when I told of my pain, in fact he or someone put in my records I was 100% better and that i supposedly said that. I NEVER EVER stated that .They always pushed me to give a % I always said I feel uncomfortable of using % as I dont know how to figure it, ask me like on a scale of 1-10 they would insist I give a %. My husband was with me almost all of my appt. Now I am not out to get anyone in trouble I am by FAR that type of person. I jsut want to know honestly if something happened and if there is a chance there is nerve damage, and not really this RSD? Would any Dr. be brave enough to give a opioion? I am very curious, as I want to be in control of my care now and understand and know what to ask and do .Thanks so very much I do appreciate it. I am in possesion of all my records from my pod, and the ortho that seem me last stating I have rsd in his dx. Also , when I got my records from pod, the nurse made a statement that dr thought i may have this RSD also and would have referred me to a pain mangement also. It really seems odd to me that He NEVER mentioned anything even remotely about anything but working to many days and hours that was the main concern he had. Thank u

Re: PS. He would like me to see him if any more troubles

Tammie on 4/19/02 at 18:52 (080373)

As I also have something now with my large toe. I like him but at this point I am a bit uneasy and unsure if he is an the right track. Do you think I might just stay with the pain management and if needed let them recomend another pod or dr.? I want to be safe and in charge this time. NO MORE SURGERY!!! Would this eswt be something that might help me?

Re: I got my records from surgery have a few questions

Carole C in NOLA on 4/19/02 at 21:27 (080402)

Tammie, getting all your records finally is a BIG step in the right direction.

My rheumatologist is like that. He would ask me if I had pain in any joints other than my knees, and I would tell him my shoulders and elbows were even worse, and he would write down 'no joint pain except in knees'. I could read it upside down. I would correct him and he wouldn't change it. He has been doing this for a couple of years. When I feel I need to go to another rheumatologist and really find out what's wrong, I won't take the records from him and maybe that's the idea.

You could always get another opinion, but would it affect the treatment? I don't know enough about RSD to know. If you are going to a pain management clinic, they will treat the pain, not the cause of the pain. That may be all that can be done even if there was nerve damage. I don't know whether a misdiagnosis would make much difference in the prognosis.

Carole C

Re: I got my records from surgery have a few questions

Pauline on 4/19/02 at 21:59 (080404)

Tammie,
I don't know what advice others will give you, and more importantly, I don't know if you'd even consider following their advice as this has not been your practice.

Personally, I think although you will get good postings to the questions your asking, your best answers will come by way of an attorney who with the help of a jury will determine if you have cause for mal-practice.

I doubt any physician on this board would tell you that you had a botch job or that mistakes were made. The information you are seeking doesn't occur in this type of forum.

If you truly want to know if your additional problems were caused by poor medical techniques you need to seek out any attorney to work in your behalf.

Re: I got my records from surgery have a few questions

Laurie R on 4/19/02 at 22:56 (080409)

HI Tammie , I think I am asking the same questions you are asking . I am shocked your doctor did not have you get an MRI before the surgery . My Pod said it was a must to have it done. Even though he knew I did not want to have it done. He explained to me how important it was to see the inside of my foot and ankle. Also with all the nerve pain you have had , I am wondering why he never had you have a EMG test ..... X-Rays are just not enough ....

Now are you saying you don't think you have RSD , or you don't think that the diagnosis was right ?

I think your best bet at this point is to go to the pain management doctor and see what they have to say .. I am sure they will have the answers you are looking for .

Laurie R

Re: I got my records from surgery have a few questions

Dr. Cozzarelli on 4/20/02 at 06:06 (080415)

Hi Tammie:

Real simple, your right your not a doctor. I don't mean this in a condescending way, meaning when lay people read detailed medical jargon you think the worts. First and foremost get an appointment with a neurologist. have an NCV performed. Tis non invassive test will show the conditon of the tibial nerve. An Mri would help to see what occured with the plantar fascia. If you have pinpoint pain I would consider sterotactic radio frequency lesioning to knock out the pain sites.

Dr. John Cozzarelli

Re: I don't know

Tammie on 4/20/02 at 08:20 (080423)

I am not sure if it would make a difference if it is nerve damage or RSD I dont know enough about it. I guess I am a bit afraid of the dx of RSD. But in any case I really am just trying to be sure I do the best things for me and my body! I am going to see the pain management I have got a appt. and I will see them. The trouble is it takes weeks and such along time to get in . I have been waiting along time for my appt. and there is no way I am not going to keep it! Thank you for the nice reply.

Re: Interesting, sorry you feel this way, but I am who I am

Tammie on 4/20/02 at 08:39 (080426)

Thank you for the support again.I must differ with your post. I am sorry that you do not understand the person I am I am also sorry that you believe I dont listen to peoples advice, but you are very wrong! It sometimes takes me a bit to do things,as I am very frightened about this whole ordeal as I have never had to take care of myself for medical reasons as I have never been hurt or sick, and if I was I kept going without seeing a medical profession. This has been something very new to me and it has been very difficult to understand how one little foot could make my whole life turn upside down.

I really am not interested in getting a attorney, I am not a person who sues, I know that the dr. is a human being and mistakes happen also nothing is ever gaurenteed a 100%. I have no intention of seeing a attorny.I just am trying to learn about my foot and my body and how to be in charge of my care so that I might get the best!I am not a DR. nor do I ever try to be, as I do not feel comfortable advising any one about there medical care also my own. That is why I ask others opioions as some have been going thru this much longer then I .I just want to know why my foot and body is much more worse then before any surgery, not that I ever would have thought it could be.

I am sorry if you dont see the changes I have made , I have been learning how to handle the stress in my life with help from some dear friends who care, and getting my records was very very hard for me but I did it. Making a apt. with a pain clinic was also very very hard, but I did it.Also reading and trying to understand and learn more about my foot and the problems I have has been hard for me also as I dont seem to understand all as I need a childs version to understand sometimes, if that makes me less then so be it I am me and I like me the way I am . I just want to learn more and I was always taught the more questions you ask the better informed you can be. So Pauline,if you dont want to support me or you feel as tho I am not trying to learn and actually do something about my feet or my care then please skip reading my posts as If you had been following me I have made positive steps in changing things! Maybe small things to you but they are huge steps for me! Reading your post to me hurt my feelings , see another positive step telling someone how I feel! I am trying to do more in the way of learning and you are telling me and others that I dont listen by saying I dont tend to follow there advice!You are wrong, I have been listening and I have been following some advice but you should know since you are so worldly that I dont have to agree with all advice.Thank you and have a good day , I hope you are not in to much pain.

Re: Laurie

Tammie on 4/20/02 at 08:48 (080427)

Laurie, no I am not saying I think the dx is wrong, I am just trying to learn about my feet and what it means in the surgical report and what has been done. I really dont know if nerve damage and RSD are different that is why I posted. But I am you can be assured that I am keeping my appt. with the pain clinic may 20. I have had to wait such a long time for it and no way am I going to miss it.

With all the reading I have done thru my pt and dr. notes and reading about rsd I am pretty convinced that it is indeed possible that the dx of RSD is correct. They even have this in there notes. I am upset that they did not share this with me or send me sooner to a pain management to help me as I have read it is very important to be seen and be treated so it does not spread. A long time agao DR Z told me to get to a pain management, I made that appt, but youcan back me by knowing that it takes forever to get in there I have had to wait a very long time for my appt. Thank you Laurie for always being there for me and listening and helping me sort things out, I am making steps even if they are baby steps to others in the direction of taking care of my self and DOING things instead of fearing . You understand what I am talking about I know that. Love to you and again I thank you for helping me thru this and being so patient.

Re: Ok can you expain what that sterotactic is

Tammie on 4/20/02 at 08:59 (080428)

Thank you . I don't at all think you are being condescending. That is why I posted my report, I just want to learn about it and take more charge in finding something to help me and understanding what is happening. I do have a appt. with pain management, which was suggested to me Dr. Z told me a while back on board, I made the appt. but it takes weeks and months to get in I can not believe it but it is true and everywhere it seems. No I dont think the worse, I just want to understand it, there are things in my records that I was never told and also things I did not understand that is the post reason. I would never sue my Dr. as I know that they are not GOD things happen mistakes or just not perfect results happen I just wish he would really tell me what happened , instead of being so concerned now and when I was seeing him weekly he did not seem to care about the pain I persitedly told him about.Even after mentioning himself that I looked tired and answering him that I have not been able to sleep cause the pain.

What is that sterotactic radio frequency? So I should get a appt, with a neurologist , Ok I can do that . Thank you for listening and trying to give me a answer. I appreciate it as I am learning how to care for me and be in charge of my medical care to a point.

Re: Ok can you expain what that sterotactic is

Dr. John Cozzarelli on 4/20/02 at 09:52 (080432)

Stereotactic Radiofrequency Thermal Rhizotomy is a procedure where a needle is inserted under fluoroscopic guidnace (Moving picutre X-RAY). It allows exact placement of the needle. The needle has a catheter around it. The needle is removed and the catheter is in place. A monofilimanet wire is inserted and the area of pain is then stimulated with the Radionics unit. If we are in the motor aspect of the nerve we see movement and redirect the needle. If we are in the sensory aspect we then lesion the site. The tip of the needle is heat to 180 degrees F and the site is lesioned for 90 seconds. The desensatizes the peripheral nerve ending that is causing pain. There are no incisions, stitches or post op shoes. There is just a band aid applied. Recover is about two days. I think first get an NCV. I hope this helps you.

Dr. John Cozzarelli

Re: May I ask what kind of Dr. does this?

Tammie on 4/20/02 at 10:32 (080435)

This is something I had not heard of . Now may I ask what kind of Dr. does this procedure? And does it hurt when they do it? Are you awake as it sounds as you would be? This is really interesting, does it work forever, or for a amount of time? I will try to do a search on this and see what it says. Thank you for the answers! I appreciate it very much.

Re: Interesting, sorry you feel this way, but I am who I am

Pauline on 4/20/02 at 11:11 (080440)

Sorry Tammie if my post was upsetting. You don't have to be sue happy, but you should be aware of your options. The question you posed asking if your surgery sounded like the correct kind are questions for mal-practice attornies to sort out in a court of law.

No physician in an open forum is going to tell you that all the treatments you had performed contributed to the situation which you now experience. That why each side brings in their own expert witnesses.

A question for you to consider is: Not being physicians, nor performing your surgeries or being able to digest the tremendous medical trail of tests that you have had, how accurate do you really think our answers will be to your very important question?

The question you asked is a very valid one, your beginning to have doubts in the treatment you've received, and you certainly deserve the best answer you can get. I'm only suggesting that the answers you truly deserve and seek may not be available in an open forum.

Eventually you may come to the conclusion that continual surgeries did more harm than good and your only recourse may be the help of a good attorney. Will it rid you of pain, probably not but you might find out the real answer to the question you posed.

Re: Laurie

Laurie R on 4/20/02 at 11:11 (080441)

Dear Tammie , You go !!!!! Yes you have come a long way , please give yourself credit . Any steps ahead are for you to be proud of . Wheather they are baby steps as you call them or big steps . Taking control of ones life can be hard no matter what we are dealing with . Don't I know this .. It has been a long road for you and I , but as long as we keep hope and do the best we can do it is all good.....

Yes you are right , most pain clinic are very , very busy and it can take months to get in for your first appointment .

I know you are scared , I was also , but i have to tell you my pain doctor is awesome . He treats pain and only pain so he understands . I hope you find the same type of doctor with the clinic you will be going to .....

I feel healing one's mind is the most important thing ......

Much love Tammie , your friend ,Laurie R

Re: Tammie, good for you!

Sharon W on 4/20/02 at 11:29 (080445)

Tammie,

Like Carole, I congratulate you on getting those records from surgery. I understand why you wanted them, and I understand 100% when you say that you have no desire to try to sue anyone, you just want to understand what happened. I would help you with that if I could but I have only witnessed 3 surgeries in my life and even though I understand most of the WORDS in that report, I don't know enough to help you figure it all out.

It is true that they probably should have done more tests BEFORE your surgery, but It's still important to know exactly what's going on so your doctors from now on will know what they're dealing with. I really think it is more important to find out exactly what is going on NOW with your feet, and for that you probably do need an NCV and maybe some other tests done. It sounds like Dr. Cozz is giving you very good advice!

All of this must be pretty confusing and frustrating, and I'm sorry you have to go through it. My good thoughts are with you always and I believe you are doing the right thing.

-- Sharon

Re: Tammie, good for you!

Dr. David S. Wander on 4/20/02 at 12:08 (080454)

Tammie, prior to considering any procedure that is recommended by myself or Dr. Cozz, it is imperative that you have a diagnosis that you are comfortable with, and that has been fully explained to you by your doctor. It appears that after reading your doctor's records, there were some entries that you don't agree with. When you seek another doctor, please be very straightforward with him/her and let the doctor know that there was an obvious communication problem between you and your previous doctor, since his notes did not reflect your comments. Let the new doctor know that you want to have an active role in your care and would like to be informed on a regular basis. If you have doubts regarding whether RSD exists, etc., seek the care of a respected doctor at a University setting that will have the most up to date treatment options available, including those suggested by others and Dr. Cozz.

Re: Dr.s Thank you

Tammie on 4/20/02 at 12:48 (080460)

Thank you for the advice, I am taking all that I have been told and am going to try to do the best in searching for the help I may need. First I will go to pain management as I have waited long enough for this appt. I need to find a way to help with the pain as it is controlling me and my life my brain my sleep and just about everything. So this will be my first step.I am hoping that I am on the right track, I do feel comfortable with some of the answers I have found but there are many questions, going back will not change anything I am looking foward and trying to understand what could have happened and how do I change this or learn to go on with my life in the best way.

I am seeing a group of dr.s it is a pain management clinic at a hospital associated with the Cleveland Clinic. I understand that this is a very good hospital and I feel comfortable going to them. I am trying to keep a open mind to any and all information. Actually I tend to think that the dr.s now that have been looking into my care are on the track as I seem to fit most symtoms in this dx. I will try to be more assertive with my care , with the new DR.s as I have learned quite a bit. Thanks to all on this board! I also want to Thank you also for the help. I am anxiious to get in to my appt. I am a bit frightened that I may be expecting to much again, but I have to deal with this pain first,if I dont it will destroy ME as well as my family. Thank u!

Re: Thanks Sharon

Tammie on 4/20/02 at 13:00 (080464)

Yes I understand , this is a frustrating part trying to figure out where how and what does one do at this point. In actualality I am feeling much stronger and much more in charge of my feeling and the difference I can make in my care. I know the reports have alot of information, I have many many papers in my file, but it is interesting to me that the most part of each page has something about my working to many hours and that i should quit my job and search for different employment. It is interesting to me as before the surgeries, they new I was working and they encouraged me to continue as I was told that the damage was done and that it wouldnt hurt to continue working. Funny that was left out of my records. Also they told me several times that the surgery would help me and I could continue working it was 90% sure that if I had the sugeries (both in fact) that I would be better. Hmmm interesting that that also was not in my records any where. In fact alot of what we talked about was omitted I don't understand why he chose not to put that information in. Like I said before I can not do anything that is in the past, but I can and will take care and be more involved in my care in the future.

I am goint to go to my appt with pain management and go from there as i stated to the post to dr.s. I must get my pain acknowledged and in some form of controlled so that It is more possible for me to think better and take more postitive steps in my care. Thank you for your support I am feeling very happy with myself and my baby steps foward as if you have been reading about me I am a wimp who expected to be taken care of and let them make all the decisions including my husband and my co workers and really most everyone lol. Not any more! Hope you are not having to much pain and that you to are taking charge in your treatment and moving foward.

Re: Thank you Laurie

Tammie on 4/20/02 at 13:01 (080465)

Thanks from my heart.

Re: May I ask what kind of Dr. does this?

Dr. Cozzarelli on 4/20/02 at 13:18 (080467)

I perform this procedure and sometimes pain managment doctors perform this if they have access to a Radionics unit. It is done under sedation. There results are permanent.

Dr. John Cozzarelli

Re: It is not a lawyers case,Nor do I ever intend on it

Tammie on 4/20/02 at 13:19 (080468)

Well it is not a lawyer thing , I am just trying to find answers and trying to not think of what was done but what can I do now to be sure i am getting the proper treatments . My questions are more this trying to understand what is happening and how this happened and to be sure I take more active part in my future .I also feel that I made a mistake allowing surgery as it was I who signed that paper I believed in what I was told so I feel I am as much to blame as anyone if this is the case. I am not without blame if there is blame. Things happen and sometimes noone has control of why or how they turn out.I am interested in getting my life together without living in pain that never quits and that continues to destroy me in a number of ways. I lost my self confidence thru this and I am planning on getting it back.

I was not exepecting any Dr. giving me the truth actually as they were not there they havent examined me or my records. It is sad tho that if my Dr. felt that something negitive happened that he could not admit to it as that surely makes him look guilty the way his office is treating me even tho I have not been back since a bit after xmas I believe. I do not mean to put anyone on the spot. As I have noted with the few posts the Dr.s are in there own safe way stating I need to find new medical care and to be active in my treatment !If I dont understand stay there till I do , and dont be foolish and pretend you understand as your pride tells you to , but be informed and find answers. I am entitled to this! I had alot in this as I of course did not exactly follow orders either. Thank you.

Re: Thanks Sharon

Sharon W on 4/20/02 at 15:05 (080478)

Tammie,

I do NOT think you are a 'wimp', and I doubt very much if you ever were.

Most of us probably grew up expecting that if we got sick we would go to doctors and follow their advice and that would take care of it. That's part of what I meant when I said that all of this must be frustrating; you are not a doctor and yet you have realized that you need to be more assertive in your own care in order to be sure you have the right diagnosis and get control over the pain. And to take an active role in your own medical care you are trying to make sense of medical records written by people who have spent many YEARS learning about feet and surgeries.

It must also be very frustrating to see that your medical records do not fit with your recollection of what advice your doctor gave you about working, what information you were given about your diagnosis, etc. etc. I think that would make me angry!

-- Sharon

Re: Thanks Sharon

Tammie on 4/20/02 at 20:16 (080507)

Well I am being honest when I say that I was a wimp while dealing with the DR>s not necessarly the pain. You know I did not follow directions like I should of in fairness to the Dr. I would have to admit he wanted me to stay off work and to take care to listen to the pain, funny tho I nevert seemed to hear the pain telling me to stop. I mean the pain was there, but my brain blocked it and said keep going dont let it take you down. Do you understand lol? My dr. from a long time in this has tryed to convince me to change jobs and try to find something as a sitdown type of work. Unfortuantly I am a nurses aide and there are not many jobs that you sit for that! I went thru alot of heck getting my licence and I love what I do so why should I not do it? I was under the impression that yes there is a period of healing but then there is also a point that life must continue. I am not really a angry person anymore I am just trying to get things straight and be fresh for the new dr.s and see what they have for suggestions.Feet are sure complicated and who in this life would understand how long it takes to heal or to fix a sore foot. Thanks for your support you are a very kind woman and I am glad I have met you!

Re: Tammie

Sharon W on 4/20/02 at 23:03 (080523)

Tammie,

I understand very well about knowing that the pain was there, but your brain blocked it out and said keep going... I did it, too, and I think it is called 'denial'. How could you 'listen to the pain' when (at least while you were at work) you were still denying that it existed?!

-- Sharon

Re: How very very true!

Tammie on 4/21/02 at 18:40 (080592)

You are a mind reader for sure! I have been in this denial for some time and am starting to wake up to the fact it is happening and getting worse daily, if there is such a thing as worse! I dont want to wait for a appt. with pain management I would like to go now! Take care.I think we have alot in common at least you seem to understand more of me then most!

Re: I don't know

Dr. Zuckerman on 4/21/02 at 21:14 (080607)

Pain management is the right way to go at this point and time. You asked about RSD and ESWT well they don't work well together Sorry

Re: It is not a lawyers case,Nor do I ever intend on it

Dr. Zuckerman on 4/21/02 at 21:27 (080610)

Here is another way to look at the way your doctor's office has been treating you . You are in alot of pain. No one can figure exactly what is going on . You had surgery still in alot of pain. Hey you are a nice person the office can do one of two things get rid of you. Or as we do in our office GO OUT OF WAY TO HELP IN ANYWAY. Will this prevent malpractice who knows and who really cares. I know that it is better to be nice and help and admit any mistakes to the pateints. Will you get sued maybe or maybe noy but who cares you sleep at nite and you treat all you patietns like human beings.

Re: It is not a lawyers case,Nor do I ever intend on it

Sharon W on 4/22/02 at 07:18 (080629)

Dr.Z,

I have a lot of respect for that.

-- Sharon

Re: I apreciate all that you have done DR>Z and thanks for letting me know that there are good caring Dr.s

Tammie on 4/22/02 at 14:01 (080670)

Thank you Dr. Z You are very smart I can tell but much more importantly you are honest and caring and for that your patients are very lucky! It gives me a good feeling to hear what you have said it gives me the feeling that there are some very good and caring Dr.s out there. I wish I had found one! I thought I trusted this one I really did even after he did a few shady or lets say questional things such as asking for the pain meds back after I paid for them and had the reaction!But then I should have done more at THAT time except that I wanted to trust him and I wanted him to fix my pain! He Didnt and evidently he cant but he kept seeing me and acepting payments to tell me each time I should quit my job and all would be fine my foot pain would be gone! Between us I dont think if I layed on my butt for 6 weeks I do not believe the pain would be gone! It is and has been with me night and day with night being its worse!

Anyways I really really want to thank you for your coments and your help I honestly apreciated it and you surley have given me hope that there are GOOD caring Drs. around I sure hope I find one at this pain place! I am ready to find out about getting some of this pain out of my life in ANY way I can at this point. NO surgery tho that is no no no! I respect you and am glad you posted it made me feel much better about my decision. My husband gets very upset to see me crawl, and cry in pain he gets angry and blames my dr. said look what he did to you, we are different as I feel things happen but we must go on! Thank u

Re: I apreciate all that you have done DR>Z and thanks for letting me know that there are good caring Dr.s

John on 5/22/02 at 18:04 (084902)

hey tammie im soo glad i read your post and thx to dr.z i will be asking about the same stuff to my doctor i was wondering if you could email me
(email removed) talk to you soon

Re: PS. He would like me to see him if any more troubles

Tammie on 4/19/02 at 18:52 (080373)

As I also have something now with my large toe. I like him but at this point I am a bit uneasy and unsure if he is an the right track. Do you think I might just stay with the pain management and if needed let them recomend another pod or dr.? I want to be safe and in charge this time. NO MORE SURGERY!!! Would this eswt be something that might help me?

Re: I got my records from surgery have a few questions

Carole C in NOLA on 4/19/02 at 21:27 (080402)

Tammie, getting all your records finally is a BIG step in the right direction.

My rheumatologist is like that. He would ask me if I had pain in any joints other than my knees, and I would tell him my shoulders and elbows were even worse, and he would write down 'no joint pain except in knees'. I could read it upside down. I would correct him and he wouldn't change it. He has been doing this for a couple of years. When I feel I need to go to another rheumatologist and really find out what's wrong, I won't take the records from him and maybe that's the idea.

You could always get another opinion, but would it affect the treatment? I don't know enough about RSD to know. If you are going to a pain management clinic, they will treat the pain, not the cause of the pain. That may be all that can be done even if there was nerve damage. I don't know whether a misdiagnosis would make much difference in the prognosis.

Carole C

Re: I got my records from surgery have a few questions

Pauline on 4/19/02 at 21:59 (080404)

Tammie,
I don't know what advice others will give you, and more importantly, I don't know if you'd even consider following their advice as this has not been your practice.

Personally, I think although you will get good postings to the questions your asking, your best answers will come by way of an attorney who with the help of a jury will determine if you have cause for mal-practice.

I doubt any physician on this board would tell you that you had a botch job or that mistakes were made. The information you are seeking doesn't occur in this type of forum.

If you truly want to know if your additional problems were caused by poor medical techniques you need to seek out any attorney to work in your behalf.

Re: I got my records from surgery have a few questions

Laurie R on 4/19/02 at 22:56 (080409)

HI Tammie , I think I am asking the same questions you are asking . I am shocked your doctor did not have you get an MRI before the surgery . My Pod said it was a must to have it done. Even though he knew I did not want to have it done. He explained to me how important it was to see the inside of my foot and ankle. Also with all the nerve pain you have had , I am wondering why he never had you have a EMG test ..... X-Rays are just not enough ....

Now are you saying you don't think you have RSD , or you don't think that the diagnosis was right ?

I think your best bet at this point is to go to the pain management doctor and see what they have to say .. I am sure they will have the answers you are looking for .

Laurie R

Re: I got my records from surgery have a few questions

Dr. Cozzarelli on 4/20/02 at 06:06 (080415)

Hi Tammie:

Real simple, your right your not a doctor. I don't mean this in a condescending way, meaning when lay people read detailed medical jargon you think the worts. First and foremost get an appointment with a neurologist. have an NCV performed. Tis non invassive test will show the conditon of the tibial nerve. An Mri would help to see what occured with the plantar fascia. If you have pinpoint pain I would consider sterotactic radio frequency lesioning to knock out the pain sites.

Dr. John Cozzarelli

Re: I don't know

Tammie on 4/20/02 at 08:20 (080423)

I am not sure if it would make a difference if it is nerve damage or RSD I dont know enough about it. I guess I am a bit afraid of the dx of RSD. But in any case I really am just trying to be sure I do the best things for me and my body! I am going to see the pain management I have got a appt. and I will see them. The trouble is it takes weeks and such along time to get in . I have been waiting along time for my appt. and there is no way I am not going to keep it! Thank you for the nice reply.

Re: Interesting, sorry you feel this way, but I am who I am

Tammie on 4/20/02 at 08:39 (080426)

Thank you for the support again.I must differ with your post. I am sorry that you do not understand the person I am I am also sorry that you believe I dont listen to peoples advice, but you are very wrong! It sometimes takes me a bit to do things,as I am very frightened about this whole ordeal as I have never had to take care of myself for medical reasons as I have never been hurt or sick, and if I was I kept going without seeing a medical profession. This has been something very new to me and it has been very difficult to understand how one little foot could make my whole life turn upside down.

I really am not interested in getting a attorney, I am not a person who sues, I know that the dr. is a human being and mistakes happen also nothing is ever gaurenteed a 100%. I have no intention of seeing a attorny.I just am trying to learn about my foot and my body and how to be in charge of my care so that I might get the best!I am not a DR. nor do I ever try to be, as I do not feel comfortable advising any one about there medical care also my own. That is why I ask others opioions as some have been going thru this much longer then I .I just want to know why my foot and body is much more worse then before any surgery, not that I ever would have thought it could be.

I am sorry if you dont see the changes I have made , I have been learning how to handle the stress in my life with help from some dear friends who care, and getting my records was very very hard for me but I did it. Making a apt. with a pain clinic was also very very hard, but I did it.Also reading and trying to understand and learn more about my foot and the problems I have has been hard for me also as I dont seem to understand all as I need a childs version to understand sometimes, if that makes me less then so be it I am me and I like me the way I am . I just want to learn more and I was always taught the more questions you ask the better informed you can be. So Pauline,if you dont want to support me or you feel as tho I am not trying to learn and actually do something about my feet or my care then please skip reading my posts as If you had been following me I have made positive steps in changing things! Maybe small things to you but they are huge steps for me! Reading your post to me hurt my feelings , see another positive step telling someone how I feel! I am trying to do more in the way of learning and you are telling me and others that I dont listen by saying I dont tend to follow there advice!You are wrong, I have been listening and I have been following some advice but you should know since you are so worldly that I dont have to agree with all advice.Thank you and have a good day , I hope you are not in to much pain.

Re: Laurie

Tammie on 4/20/02 at 08:48 (080427)

Laurie, no I am not saying I think the dx is wrong, I am just trying to learn about my feet and what it means in the surgical report and what has been done. I really dont know if nerve damage and RSD are different that is why I posted. But I am you can be assured that I am keeping my appt. with the pain clinic may 20. I have had to wait such a long time for it and no way am I going to miss it.

With all the reading I have done thru my pt and dr. notes and reading about rsd I am pretty convinced that it is indeed possible that the dx of RSD is correct. They even have this in there notes. I am upset that they did not share this with me or send me sooner to a pain management to help me as I have read it is very important to be seen and be treated so it does not spread. A long time agao DR Z told me to get to a pain management, I made that appt, but youcan back me by knowing that it takes forever to get in there I have had to wait a very long time for my appt. Thank you Laurie for always being there for me and listening and helping me sort things out, I am making steps even if they are baby steps to others in the direction of taking care of my self and DOING things instead of fearing . You understand what I am talking about I know that. Love to you and again I thank you for helping me thru this and being so patient.

Re: Ok can you expain what that sterotactic is

Tammie on 4/20/02 at 08:59 (080428)

Thank you . I don't at all think you are being condescending. That is why I posted my report, I just want to learn about it and take more charge in finding something to help me and understanding what is happening. I do have a appt. with pain management, which was suggested to me Dr. Z told me a while back on board, I made the appt. but it takes weeks and months to get in I can not believe it but it is true and everywhere it seems. No I dont think the worse, I just want to understand it, there are things in my records that I was never told and also things I did not understand that is the post reason. I would never sue my Dr. as I know that they are not GOD things happen mistakes or just not perfect results happen I just wish he would really tell me what happened , instead of being so concerned now and when I was seeing him weekly he did not seem to care about the pain I persitedly told him about.Even after mentioning himself that I looked tired and answering him that I have not been able to sleep cause the pain.

What is that sterotactic radio frequency? So I should get a appt, with a neurologist , Ok I can do that . Thank you for listening and trying to give me a answer. I appreciate it as I am learning how to care for me and be in charge of my medical care to a point.

Re: Ok can you expain what that sterotactic is

Dr. John Cozzarelli on 4/20/02 at 09:52 (080432)

Stereotactic Radiofrequency Thermal Rhizotomy is a procedure where a needle is inserted under fluoroscopic guidnace (Moving picutre X-RAY). It allows exact placement of the needle. The needle has a catheter around it. The needle is removed and the catheter is in place. A monofilimanet wire is inserted and the area of pain is then stimulated with the Radionics unit. If we are in the motor aspect of the nerve we see movement and redirect the needle. If we are in the sensory aspect we then lesion the site. The tip of the needle is heat to 180 degrees F and the site is lesioned for 90 seconds. The desensatizes the peripheral nerve ending that is causing pain. There are no incisions, stitches or post op shoes. There is just a band aid applied. Recover is about two days. I think first get an NCV. I hope this helps you.

Dr. John Cozzarelli

Re: May I ask what kind of Dr. does this?

Tammie on 4/20/02 at 10:32 (080435)

This is something I had not heard of . Now may I ask what kind of Dr. does this procedure? And does it hurt when they do it? Are you awake as it sounds as you would be? This is really interesting, does it work forever, or for a amount of time? I will try to do a search on this and see what it says. Thank you for the answers! I appreciate it very much.

Re: Interesting, sorry you feel this way, but I am who I am

Pauline on 4/20/02 at 11:11 (080440)

Sorry Tammie if my post was upsetting. You don't have to be sue happy, but you should be aware of your options. The question you posed asking if your surgery sounded like the correct kind are questions for mal-practice attornies to sort out in a court of law.

No physician in an open forum is going to tell you that all the treatments you had performed contributed to the situation which you now experience. That why each side brings in their own expert witnesses.

A question for you to consider is: Not being physicians, nor performing your surgeries or being able to digest the tremendous medical trail of tests that you have had, how accurate do you really think our answers will be to your very important question?

The question you asked is a very valid one, your beginning to have doubts in the treatment you've received, and you certainly deserve the best answer you can get. I'm only suggesting that the answers you truly deserve and seek may not be available in an open forum.

Eventually you may come to the conclusion that continual surgeries did more harm than good and your only recourse may be the help of a good attorney. Will it rid you of pain, probably not but you might find out the real answer to the question you posed.

Re: Laurie

Laurie R on 4/20/02 at 11:11 (080441)

Dear Tammie , You go !!!!! Yes you have come a long way , please give yourself credit . Any steps ahead are for you to be proud of . Wheather they are baby steps as you call them or big steps . Taking control of ones life can be hard no matter what we are dealing with . Don't I know this .. It has been a long road for you and I , but as long as we keep hope and do the best we can do it is all good.....

Yes you are right , most pain clinic are very , very busy and it can take months to get in for your first appointment .

I know you are scared , I was also , but i have to tell you my pain doctor is awesome . He treats pain and only pain so he understands . I hope you find the same type of doctor with the clinic you will be going to .....

I feel healing one's mind is the most important thing ......

Much love Tammie , your friend ,Laurie R

Re: Tammie, good for you!

Sharon W on 4/20/02 at 11:29 (080445)

Tammie,

Like Carole, I congratulate you on getting those records from surgery. I understand why you wanted them, and I understand 100% when you say that you have no desire to try to sue anyone, you just want to understand what happened. I would help you with that if I could but I have only witnessed 3 surgeries in my life and even though I understand most of the WORDS in that report, I don't know enough to help you figure it all out.

It is true that they probably should have done more tests BEFORE your surgery, but It's still important to know exactly what's going on so your doctors from now on will know what they're dealing with. I really think it is more important to find out exactly what is going on NOW with your feet, and for that you probably do need an NCV and maybe some other tests done. It sounds like Dr. Cozz is giving you very good advice!

All of this must be pretty confusing and frustrating, and I'm sorry you have to go through it. My good thoughts are with you always and I believe you are doing the right thing.

-- Sharon

Re: Tammie, good for you!

Dr. David S. Wander on 4/20/02 at 12:08 (080454)

Tammie, prior to considering any procedure that is recommended by myself or Dr. Cozz, it is imperative that you have a diagnosis that you are comfortable with, and that has been fully explained to you by your doctor. It appears that after reading your doctor's records, there were some entries that you don't agree with. When you seek another doctor, please be very straightforward with him/her and let the doctor know that there was an obvious communication problem between you and your previous doctor, since his notes did not reflect your comments. Let the new doctor know that you want to have an active role in your care and would like to be informed on a regular basis. If you have doubts regarding whether RSD exists, etc., seek the care of a respected doctor at a University setting that will have the most up to date treatment options available, including those suggested by others and Dr. Cozz.

Re: Dr.s Thank you

Tammie on 4/20/02 at 12:48 (080460)

Thank you for the advice, I am taking all that I have been told and am going to try to do the best in searching for the help I may need. First I will go to pain management as I have waited long enough for this appt. I need to find a way to help with the pain as it is controlling me and my life my brain my sleep and just about everything. So this will be my first step.I am hoping that I am on the right track, I do feel comfortable with some of the answers I have found but there are many questions, going back will not change anything I am looking foward and trying to understand what could have happened and how do I change this or learn to go on with my life in the best way.

I am seeing a group of dr.s it is a pain management clinic at a hospital associated with the Cleveland Clinic. I understand that this is a very good hospital and I feel comfortable going to them. I am trying to keep a open mind to any and all information. Actually I tend to think that the dr.s now that have been looking into my care are on the track as I seem to fit most symtoms in this dx. I will try to be more assertive with my care , with the new DR.s as I have learned quite a bit. Thanks to all on this board! I also want to Thank you also for the help. I am anxiious to get in to my appt. I am a bit frightened that I may be expecting to much again, but I have to deal with this pain first,if I dont it will destroy ME as well as my family. Thank u!

Re: Thanks Sharon

Tammie on 4/20/02 at 13:00 (080464)

Yes I understand , this is a frustrating part trying to figure out where how and what does one do at this point. In actualality I am feeling much stronger and much more in charge of my feeling and the difference I can make in my care. I know the reports have alot of information, I have many many papers in my file, but it is interesting to me that the most part of each page has something about my working to many hours and that i should quit my job and search for different employment. It is interesting to me as before the surgeries, they new I was working and they encouraged me to continue as I was told that the damage was done and that it wouldnt hurt to continue working. Funny that was left out of my records. Also they told me several times that the surgery would help me and I could continue working it was 90% sure that if I had the sugeries (both in fact) that I would be better. Hmmm interesting that that also was not in my records any where. In fact alot of what we talked about was omitted I don't understand why he chose not to put that information in. Like I said before I can not do anything that is in the past, but I can and will take care and be more involved in my care in the future.

I am goint to go to my appt with pain management and go from there as i stated to the post to dr.s. I must get my pain acknowledged and in some form of controlled so that It is more possible for me to think better and take more postitive steps in my care. Thank you for your support I am feeling very happy with myself and my baby steps foward as if you have been reading about me I am a wimp who expected to be taken care of and let them make all the decisions including my husband and my co workers and really most everyone lol. Not any more! Hope you are not having to much pain and that you to are taking charge in your treatment and moving foward.

Re: Thank you Laurie

Tammie on 4/20/02 at 13:01 (080465)

Thanks from my heart.

Re: May I ask what kind of Dr. does this?

Dr. Cozzarelli on 4/20/02 at 13:18 (080467)

I perform this procedure and sometimes pain managment doctors perform this if they have access to a Radionics unit. It is done under sedation. There results are permanent.

Dr. John Cozzarelli

Re: It is not a lawyers case,Nor do I ever intend on it

Tammie on 4/20/02 at 13:19 (080468)

Well it is not a lawyer thing , I am just trying to find answers and trying to not think of what was done but what can I do now to be sure i am getting the proper treatments . My questions are more this trying to understand what is happening and how this happened and to be sure I take more active part in my future .I also feel that I made a mistake allowing surgery as it was I who signed that paper I believed in what I was told so I feel I am as much to blame as anyone if this is the case. I am not without blame if there is blame. Things happen and sometimes noone has control of why or how they turn out.I am interested in getting my life together without living in pain that never quits and that continues to destroy me in a number of ways. I lost my self confidence thru this and I am planning on getting it back.

I was not exepecting any Dr. giving me the truth actually as they were not there they havent examined me or my records. It is sad tho that if my Dr. felt that something negitive happened that he could not admit to it as that surely makes him look guilty the way his office is treating me even tho I have not been back since a bit after xmas I believe. I do not mean to put anyone on the spot. As I have noted with the few posts the Dr.s are in there own safe way stating I need to find new medical care and to be active in my treatment !If I dont understand stay there till I do , and dont be foolish and pretend you understand as your pride tells you to , but be informed and find answers. I am entitled to this! I had alot in this as I of course did not exactly follow orders either. Thank you.

Re: Thanks Sharon

Sharon W on 4/20/02 at 15:05 (080478)

Tammie,

I do NOT think you are a 'wimp', and I doubt very much if you ever were.

Most of us probably grew up expecting that if we got sick we would go to doctors and follow their advice and that would take care of it. That's part of what I meant when I said that all of this must be frustrating; you are not a doctor and yet you have realized that you need to be more assertive in your own care in order to be sure you have the right diagnosis and get control over the pain. And to take an active role in your own medical care you are trying to make sense of medical records written by people who have spent many YEARS learning about feet and surgeries.

It must also be very frustrating to see that your medical records do not fit with your recollection of what advice your doctor gave you about working, what information you were given about your diagnosis, etc. etc. I think that would make me angry!

-- Sharon

Re: Thanks Sharon

Tammie on 4/20/02 at 20:16 (080507)

Well I am being honest when I say that I was a wimp while dealing with the DR>s not necessarly the pain. You know I did not follow directions like I should of in fairness to the Dr. I would have to admit he wanted me to stay off work and to take care to listen to the pain, funny tho I nevert seemed to hear the pain telling me to stop. I mean the pain was there, but my brain blocked it and said keep going dont let it take you down. Do you understand lol? My dr. from a long time in this has tryed to convince me to change jobs and try to find something as a sitdown type of work. Unfortuantly I am a nurses aide and there are not many jobs that you sit for that! I went thru alot of heck getting my licence and I love what I do so why should I not do it? I was under the impression that yes there is a period of healing but then there is also a point that life must continue. I am not really a angry person anymore I am just trying to get things straight and be fresh for the new dr.s and see what they have for suggestions.Feet are sure complicated and who in this life would understand how long it takes to heal or to fix a sore foot. Thanks for your support you are a very kind woman and I am glad I have met you!

Re: Tammie

Sharon W on 4/20/02 at 23:03 (080523)

Tammie,

I understand very well about knowing that the pain was there, but your brain blocked it out and said keep going... I did it, too, and I think it is called 'denial'. How could you 'listen to the pain' when (at least while you were at work) you were still denying that it existed?!

-- Sharon

Re: How very very true!

Tammie on 4/21/02 at 18:40 (080592)

You are a mind reader for sure! I have been in this denial for some time and am starting to wake up to the fact it is happening and getting worse daily, if there is such a thing as worse! I dont want to wait for a appt. with pain management I would like to go now! Take care.I think we have alot in common at least you seem to understand more of me then most!

Re: I don't know

Dr. Zuckerman on 4/21/02 at 21:14 (080607)

Pain management is the right way to go at this point and time. You asked about RSD and ESWT well they don't work well together Sorry

Re: It is not a lawyers case,Nor do I ever intend on it

Dr. Zuckerman on 4/21/02 at 21:27 (080610)

Here is another way to look at the way your doctor's office has been treating you . You are in alot of pain. No one can figure exactly what is going on . You had surgery still in alot of pain. Hey you are a nice person the office can do one of two things get rid of you. Or as we do in our office GO OUT OF WAY TO HELP IN ANYWAY. Will this prevent malpractice who knows and who really cares. I know that it is better to be nice and help and admit any mistakes to the pateints. Will you get sued maybe or maybe noy but who cares you sleep at nite and you treat all you patietns like human beings.

Re: It is not a lawyers case,Nor do I ever intend on it

Sharon W on 4/22/02 at 07:18 (080629)

Dr.Z,

I have a lot of respect for that.

-- Sharon

Re: I apreciate all that you have done DR>Z and thanks for letting me know that there are good caring Dr.s

Tammie on 4/22/02 at 14:01 (080670)

Thank you Dr. Z You are very smart I can tell but much more importantly you are honest and caring and for that your patients are very lucky! It gives me a good feeling to hear what you have said it gives me the feeling that there are some very good and caring Dr.s out there. I wish I had found one! I thought I trusted this one I really did even after he did a few shady or lets say questional things such as asking for the pain meds back after I paid for them and had the reaction!But then I should have done more at THAT time except that I wanted to trust him and I wanted him to fix my pain! He Didnt and evidently he cant but he kept seeing me and acepting payments to tell me each time I should quit my job and all would be fine my foot pain would be gone! Between us I dont think if I layed on my butt for 6 weeks I do not believe the pain would be gone! It is and has been with me night and day with night being its worse!

Anyways I really really want to thank you for your coments and your help I honestly apreciated it and you surley have given me hope that there are GOOD caring Drs. around I sure hope I find one at this pain place! I am ready to find out about getting some of this pain out of my life in ANY way I can at this point. NO surgery tho that is no no no! I respect you and am glad you posted it made me feel much better about my decision. My husband gets very upset to see me crawl, and cry in pain he gets angry and blames my dr. said look what he did to you, we are different as I feel things happen but we must go on! Thank u

Re: I apreciate all that you have done DR>Z and thanks for letting me know that there are good caring Dr.s

John on 5/22/02 at 18:04 (084902)

hey tammie im soo glad i read your post and thx to dr.z i will be asking about the same stuff to my doctor i was wondering if you could email me
(email removed) talk to you soon