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To Elliott

Posted by Laurie R on 11/14/02 at 14:15 (100156)

Hi , I know someone at one time was on here talking about Vain wrapping the nerve . Do you know anything about this ? I think you were posting to them . It was a while ago and I know it was here I read about it . Or could you tell me any sites I could look it up ... Thank you very much , Laurie R

Re: Laurie

elliott on 11/14/02 at 15:19 (100161)

Laurie, sorry for your continued troubles. I posted elsewhere asking how you know you have TTS again, but I don't think you responded. Could you elaborate? Also, what are your current TTS symptoms and when was your first release? It may help.

Vain wrapping is what Britney Spears does when she gets dressed. :-) Sorry, excuse my manners. There is a procedure, usually for those who have had a failed first release, where they cut your saphenous vein from your calf (I guess you don't need it anyway :-)) and wrap it around your posterior tibial nerve (hence vein wrapping) to act as a barrier against scar tissue and other things re-forming over that same area, likely to give you TTS all over again with a second standard release. You may want to know that in order to get that vein out of your calf, they have to make an incision running from your ankle all the way up the side of your leg till your knee. It doesn't look pretty, but if you need it, you need it. The selection criteria for this surgery are high. It usually does not give complete relief, but offers the lucky ones a last chance to cope with life and return to work. The observed median is 75%; that is, 75% get at least 50% better. There are only a handful of docs in the country who perform this procedure. I forgot where you live, but one is in Baltimore (who did the procedure on Henry C of this board); I believe another is in Ohio. We could track them down if you need. I have an article describing the procedure further. If you want it, give me an address and I'll send you a copy.

[]

Re: Laurie

Laurie R on 11/14/02 at 15:54 (100164)

Hi Elliott , Thank You so much for your fast reply . I knew you would know about this . Ok I will explain what is going on . I had my surgery on May 7 th . My PF is doing much better and my tendon pain ..... Now what the problem is , I have been having nerve pain in my inner ankle and it goes to my big toe .. They are shooting pains and hurt like H%^& ...
I have been getting injections in the inner ankle for it . My Pod has been doing blocks . No cortisone just the numbibg med... See when I get the nerve block done , the pain goes all the away .

The Ortho that I saw today was for a second opinion . He is suppose to be one of the best doctor around. His father wrote the book on foot and ankle surgery , this is how they are known . Even Dr Z has heard of him. My Pod and this Ortho doc say the same thing . I have something wrong with the PT nerve .... I just had the MRI a few weeks ago . This is when my Pod said I had TTS again ...

The Ortho today told me that he wants me in a AFO brace , he thinks it will help . Then he said if I still have pain in three months to go back and he will talk about doing the vein wrap . Now he showed me the vein he would use .... It was in my ankle ... This just happens with having a tt release . It is not my Pod fault . Then of course we have to worry about the RSD . I have had 10 SNB so far to control the RSD .....

Ok you need my address , home or email ? let me know . I would love to read the article describing the procedure .....

You know Elliott , I have been dealing with foot pain now for over three years , I am so tired of it . This has taken over my life ... If this type of surgery will take my pain down I will do it .... Of course I need to read all I can on it first....

Thank you again , I know in this post I just did , I jumped around a lot , I have been under a lot of stress for the past few weeks...

Thank you again . Tomorrow I have to go for a QME appointment . This is a doctor that works for WC .. I went a few months back , the thing was , he was so very kind to me and wrote a wonderful report for me . Most times the comp doctor will write the report favoring comp ..... I hope he is just as kind tomorrow ..

Thanks again , Laurie

Re: Laurie

elliott on 11/14/02 at 16:34 (100166)

Did you have that same nerve pain you're describing before the surgery, or only after it? If you had different nerve pain or location before, please describe what you had before. Did you first get relief and the na return of symptoms, or was it right from the start? Some shooting pain post-op is normal. I wouldn't get too many injections either, even of the non-cortisone variety. Did the MRI show anything?

I still claim that the vein wrap requires an incision all the way up the calf; you may want to ask your doc if this is so.

My initial thoughts are that it is way too soon to have another nerve surgery, I don't care how important the doc is and what he says. My left foot got much worse starting about three months after TTS surgery, so much so that I couldn't keep shoes on, almost passed out from the pain and thought my life was completely over. It started improving somewhat about a year later. It's now 2 1/2 years, and while still not completely perfect, I now rule the surgery a raving success. The only reason I didn't get another what would have turned out to be unnecessary surgery at that time when things were so bad is that I had other serious problems (terrible sciatica and my other foot weak and near collapse) that I just couldn't do anything at all. Now I'm glad I waited, despite a year of pure agony.

Been a long time for me too. My TTS problems started in '96, and in outright agony from nerve pain from '99 until about 6 months ago. Right foot still has major problems (not nervy, though), and several big name docs disagree big time on what if anything to do about it. That drink where I drop in to your bar in the middle of my run is looking ever more distant.

If you could give me your home address that would be great.

[]

Re: Laurie

tammie on 11/14/02 at 19:09 (100172)

A quick note to u , I am using sons putor for a few, I am soooo sorry to hear things are crazy for you, Darn it to heck. With your new move and stuff I was hoping your life was starting to give back some happiness to you. After such a long time I do feel badly for u!!I sure hear you on things.

I got a call from my pain man, said wants to see me first appt, he can to discuss some recent xrays of my good legs knee, it has been killing me. I have been worrying that maybe I have bone cancer or something worse tho not sure what else I could call worse. I hope it is a bit of arthritis. But you know how are minds work, (nothing seems to be good).This cold here is not making my body happy we have rejusted my meds as I told him i want to live not sleep my life away. So meds are not working for me to much. He has also sugested several options, none sounded to good.

Have u heard of triger point injections to kill nerve? He scared me about that cause it can have bad effects to. He has all kinds of things that we can try he said but the outcomes are scary if it doesnt work. Have yopu heard of thease?

Laurie I hope our computor fixed soon,I have to get out of here son will be hone and then I will be found out hahah I snuck in here to check some mail. I seen you here and wanted to let u know I am thinking of u and please know I am keepimng my fingers crossed that all is going to be right for u ! Love to u Tammy

Re: Elliott excuse me sorry I should have used social!( eom)

Tammie on 11/14/02 at 19:11 (100174)

sorry

Re: Laurie/sorry for your troubles

Kari B on 11/14/02 at 22:41 (100198)

Laurie,
I am so sorry to hear about the run around you are getting. I hope that someone is able to do something for you soon! I'll keep you in my thoughts and prayers. Try to find time to relax and buy some Calgon... tell everyone to go away for for 1 hour (haha... I know how hard that can be sometimes... my 4 yr old autistic son hates it when I try to take a bath!) and take a nice relaxing bubble bath, light some candles, and pamper yourself. Not only do we deal with this pain day in and day out, but we still have to be moms, wives, and do the things that are expected of us. Dealing with everyday things in pain like this can certainly make things crazy and seem way out of perspective. Anyway, I just hope you get to feeling better soon and don't lose hope!!!!!
Kari B

Re: Laurie

Julie on 11/15/02 at 02:11 (100214)

Hello dear Laurie

I'm really sorry that you're having so much trouble!

As you know, I know nothing about TTS, but my instincts tell me that it's too soon for you to start contemplating another surgery. It's only five months since your first surgery - no time at all. I'm sure Elliott is right that you should hold off before thinking about another surgery. I know it has been a long time, and the continued pain must be terribly discouraging, but if you hang in there now you may find, as Elliott has, that another year will make the big difference for you.

Whatever you decide, you know I'm behind you 100%.

Love to you

Julie

Re: Laurie

elliott on 11/15/02 at 07:17 (100224)

I re-read the section on vein wrap. It's a little unclear, but maybe you don't need an incision all the way up to the calf afterall; perhaps it depends on how much vein is needed. I saw someone in the waiting room who had the incision all the way up; maybe that was just her.

Re: Julie and Elliott and Kari

Laurie R on 11/15/02 at 10:05 (100244)

Hi , Thank you all for your input . Here is the thing , I have nerve damage and no matter how long I wait it is not going to get better. Yes it has only been 6 months since my surgery , but this nerve got bound down .It is no ones fault, it just happened...

I am not going to rush into surgery ... Their is much to read on this and I would get a few opinions . I will be going today to see a comp doctor. The funny thing with this doctor is , I was warned before the first time I saw him. I was told to be very careful what I said and what I did .... That he would be writing everything down ....

I get there and he was nice as can be... My hubby and my youngest went to this appointment with me . He was talking to my hubby like he knew him for years... So I had told my attorney and my PM doctor and my Pod how very nice he was to me . Well they all told me it was a front and just wait for his report.....

Guess what ? I got the report and he agreed with me and my work related injury .... After reading the report my attorney said that was the best WC report he has ever read...My attorney does not like this WC doctor at all.

I went in and I was just myself , no different , I would not act any different for any doctor . All they have to do is see my foot and read my history ..... As always all the doctors say I am a very difficult case...

So today is 6 months post opp and they want to see me again . I thnk WC wants to put an end to my case. That is why they are sending me to their doctor ....

Like I said , I won't rush into any type of surgery ... Elliott ,I am not saying you are wrong , it is just the Ortho I saw yesterday , did not say a word about how long the incision would be . He just showed me what vein he would use ...It was just a little tiny one inside my ankle . But of course this little tiny vein most go somewhere and not just in my ankle.

Like I said , he wants me to try this AFO brace and see how things go for three months.... Hey just maybe this will work ...:)

I try not to look to much ahead and just stay with the day ... This has helped me to keep my anxiety down ...

I will keep you all posted . Thank you again .

Julie , much love to you to sweetie ... Thank you Elliott . I have one question for you ... How did you get so smart? really you know so much about feet. I try to learn as much as I can ......

Thank again , Laurie R

Re: Julie and Elliott and Kari

elliott on 11/15/02 at 10:57 (100248)

Laurie, I'm just not sure what you mean by your nerve getting 'bound down'. You can have an adequate release and still have problems, which sometimes resolve or at least improve over time; this has been documented in TTS articles. You can have an inadequate release, and if you somehow know or strongly suspect this, that would be one of the best justifications to have a second standard release. Then there's the possibility of the nerve being injured at surgery. I'm trying to distinguish between all of these and more. That's why I'm asking you questions about what you felt before and what you felt after surgery. Can you please answer that in detail? It is very important. I'm just trying to help.

I know it hurts, it hurts so bad, it's just about unbearable.
But you just shouldn't having another TTS surgery so soon after the first; it's way too close unless there's a very compelling reason. I'm not one to say don't have TTS surgery, because for most cases little else works. But I will say that you have to take it real slow the second time around, since the risks of things turning out way wrong go up out of proportion to the potential gain. I will also say that the docs just don't know enough about all this, e.g. how much time to give it, unexpected flareups, etc. If you beg them or they're a bit knife happy, they can try their best with another surgery, but if it doesn't work out, they make a note of it and continue taking care of more patients. You are then left to pain mgmt and suffering for the rest of your life.

Re: Julie and Elliott and Kari

Laurie R on 11/15/02 at 11:14 (100265)

Hi Elliott , I hear you loud and clear... I already go to PM for my RSD ... Also live with a lot of pain, so this is nothing new for me. I don't have much time now, Ihave to get ready for another appointment . I should of been off the computer a while ago. I will answer all your questions when I get home later.....

Please understand that I really appreciate you time. I know you know a lot and you have done your homework , that is why I asked you to help me .

I want to take my time to answer you in detail , I just don't have the time right now .

I know you are trying to help me and without all the details you won't be able to . I am very dyslexic and it takes me more time to write things out . I don't want to rush and to do it now .

If you don't mind as soon as I get home from my appointment , I will give you all the details...

Thank you again for helping , I do so appreciate it ....

Laurie R

Re: Elliott

Laurie R on 11/15/02 at 21:00 (100328)

Hi Elliott , Ok I am back from a very long day .... The doctor I saw today works for WC . I tried to ask him questions about my case and he really did not want to help me . I also asked him if I was not a comp patient would he take me on as his patient. He flat out said NO .... He said he does not like difficutl cases at all and I am one...

Ok I am going to try my best to answer your questions. I had my first and only foot surgery on May 7 th of this year.... He did a TT release and a PF release and removed a groth on the bottom of my foot . He also cleaned out my FHL tendon . I had a Tenogram and it showed a lot of tenosynovitis in the FHL tendon.....

I also had a epidural catheter implanted in my spine. It catheter was pumping Fentanyl in my spine .. Thisi was to stay in my spine for 6 weeks post opp to help control the RSD ... Well I was taking a shower after my surgery and my hubby was helping me get dressed and the catheter line broke . So it had to be removed due to the high risk of infection . It only stayed in for 1 week and half. I was happy to have it removed. it was a pain to have in my spine, plus I was very drugged up . One good thing , I hardly had any post opp pain .

Ok my pre opp TTS symptoms were , nerve pain in my inner ankle that would go from there to my big toe .... Also when my Pod would block that area the pain would go away before surgery ...My FHL tendon gave me much pain and I could hardly stand on my foot...And one of the worse pains were my fascia ... I had much arch pain as well...... If anyone would even move my big toe the pain would send me through the roof..

Now after surgery the fascia pain is pretty much gone. Also the tendon pain is gone .

The symptoms I have now are , now I want you to understand my RSD pain is totaly different .... Now I have this terrible nerve pain that goes from my inner ankle down to my arch and to my big toe .Sometimes it feels like my nerve is dancing . Does that make any sence ? My arch feels like it is broken .. If you press very litely on my inner ankle just below my ankle bone , the pain is really bad .... My pain is 24 /7 and worse right before I even get out of bed. But some of this is due to the RSD .....

Now when my Pod gives me the blocks in the PT nerve the pain goes all the way away until the block wears off. The Ortho I saw yesterday and the QME doctor I saw today and my Pod all say it is TTS again ....They all read my MRI's and my surgery report ..... I am only going by what has been told to me . I have told them all my symptoms and they all checked out my foot and ankle ....

They all say it is the PT nerve .... So to answer you , yes it is different then before my surgery . As you know I am not a very good writer , adn sometimes I have a hard time to explain things. I know you just want to help . If their is something I did not explain right , PLEASE just ask me again and I will do my best to explain . I hope this has given you a little more so you can understand .

Like now , my foot feels broken my arch is killing me . See with RSD I am suppose to move around and use my foot , but with the PT nerve the way it is , I am suppose to rest my foot... So that is why they call me a difficult case . Also they say it is a catch 22 situation which I agree....

Then I get the shooting pains that run from my inner ankle through my arch that make me jump .....

Ok let me know if this is better and if you understand . Thank you again for taking the time to help me . I so appreciate it...

Laurie R

PS now let me understand your case . YOu have only had one tt release right ? Or have you had two ? How would you rate your pain now ?

Re: Elliott I forgot

Laurie R on 11/15/02 at 21:02 (100330)

Ok it is me again ,You had said you were not sure about the Bound down . What I ment was ,the PT nerve is bound down with scar tissue ..... Which as I understand now from all these doctors , it happens after the TT release surgery ...... Laurie R

Re: Elliott

elliott on 11/16/02 at 19:19 (100447)

Laurie, can you clarify a bit more between the before and the after? Both before and after you complain of nerve pain in the same locations: your ankle, arch and big toe. I see you're saying you have dancing or shooting pain after. Other than that, can I ask specifically what kind of nerve pain did you have before (e.g. numbness, burning, tingling, electric shock, shooting pain, feeling of nerve entrapment) and what after?

[]

Re: Elliott

Laurie R on 11/17/02 at 10:26 (100490)

HI Elliott , Before the surgery I had a lot of the FHL tendon pain . Which I feel was the worse of my pain . Well that is not really true , I had a lot of PF pain as well. Which was not the same as the nerve pain I have now . Before I also had shooting pains that would go through my arch and to my big toe , tingling ..... Now after the surgery , I have more of the electric shock feeling , I still get numbibg . My foot always burns on and off , but I feel this is due to the RSD ..... Since RSD effects the nerves as well ....

RSD pain is all over my whole foot and ankle. As soon as I get a SNB that pain is gone. But the arch pain and the inner ankle pain is still here. For me the best way to tell where the pain is coming from is to have a block in my spine...

The shooting pains for me are the worst . They make me jump , then it leaves my foot with the feeling of my foot is broken ......

I hope you understand what I am trying to explain..

Thanks , Laurie R

Re: Elliott

elliott on 11/17/02 at 18:47 (100519)

Laurie, please leave out details of all your other foot problems not having to do with your nervy problems. I am not asking about those. Please give a list of just your nervy symptoms both before surgery and after surgery, in as much detail (type, location, severity, etc.) as will make things as clear as possible:

nervy symptoms BEFORE surgery:

nervy symptoms AFTER surgery:

Please include when nervy symptoms started after surgery, and how RSD seems to have affected your nervy problems before and after as well. Thanks.

Re: Elliott

Laurie R on 11/17/02 at 21:19 (100532)

Ok , I guess to answer your question only on nerve pain , I would have to say it is the same as before surgery as after. It probably started three months after my surgery . My RSD is the same post opp as pre opp , it does not change. The only time it changes is after a block ...

Location of the nerve pain: inner ankle through my arch to my big toe .. Numbing my whole foot and ankle ..... tingeling my whole foot and ankle .

I hope this will answer your question . I don't know why you only want to know about nerve pain . I have so much more then just nerve pain going on and also different things...

Thank you , Laurie R

Re: Elliott

elliott on 11/18/02 at 07:52 (100547)

Laurie, I'm focusing on your nerve pain because you're considering another surgery to relieve your nerve pain.

So basically, you're saying (please correct me if I'm wrong) you had a lot of relief for around 3 months after surgery, after which your nerve pain returned to more or less the same as you had before surgery. In that case, the fact that you had initial relief post-surgery is suggestive that you initially had a sufficient release without damage to the nerve, but that perhaps scar tissue did indeed form (it certainly is one possibility). Yes, according to its proponents a vein wrap might give a better chance for this than a second standard release. But it's too early for that.

Have you tried massaging your foot at the ankle and arch? For several months, I would massage that area vigorously for around 3-5 minutes, would feel slightly better for the next hour, would then feel much worse for the rest of the day, but then would feel better than before I massaged it. I did this around 3 times a week (only 3 times because I couldn't bear to constantly face that pain for the rest of the day), and after several months, I finally started noticing some improvement.

If you haven't yet, you could consider ultrasound (not that I have much faith in that), and Dr. Ed always talks about some injections of wydase or other compounds which may break up the scarring (although the shot itself can scar or injure too, and you may be having too many as it is). Certainly worth a try. Again, it is still far too early for another surgery; it sometimes takes a year or two to settle down. I know only too well it's a long time to suffer, but it's better than even worse permanent suffering. Hang in there.

Re: Laurie

elliott on 11/14/02 at 15:19 (100161)

Laurie, sorry for your continued troubles. I posted elsewhere asking how you know you have TTS again, but I don't think you responded. Could you elaborate? Also, what are your current TTS symptoms and when was your first release? It may help.

Vain wrapping is what Britney Spears does when she gets dressed. :-) Sorry, excuse my manners. There is a procedure, usually for those who have had a failed first release, where they cut your saphenous vein from your calf (I guess you don't need it anyway :-)) and wrap it around your posterior tibial nerve (hence vein wrapping) to act as a barrier against scar tissue and other things re-forming over that same area, likely to give you TTS all over again with a second standard release. You may want to know that in order to get that vein out of your calf, they have to make an incision running from your ankle all the way up the side of your leg till your knee. It doesn't look pretty, but if you need it, you need it. The selection criteria for this surgery are high. It usually does not give complete relief, but offers the lucky ones a last chance to cope with life and return to work. The observed median is 75%; that is, 75% get at least 50% better. There are only a handful of docs in the country who perform this procedure. I forgot where you live, but one is in Baltimore (who did the procedure on Henry C of this board); I believe another is in Ohio. We could track them down if you need. I have an article describing the procedure further. If you want it, give me an address and I'll send you a copy.

[]

Re: Laurie

Laurie R on 11/14/02 at 15:54 (100164)

Hi Elliott , Thank You so much for your fast reply . I knew you would know about this . Ok I will explain what is going on . I had my surgery on May 7 th . My PF is doing much better and my tendon pain ..... Now what the problem is , I have been having nerve pain in my inner ankle and it goes to my big toe .. They are shooting pains and hurt like H%^& ...
I have been getting injections in the inner ankle for it . My Pod has been doing blocks . No cortisone just the numbibg med... See when I get the nerve block done , the pain goes all the away .

The Ortho that I saw today was for a second opinion . He is suppose to be one of the best doctor around. His father wrote the book on foot and ankle surgery , this is how they are known . Even Dr Z has heard of him. My Pod and this Ortho doc say the same thing . I have something wrong with the PT nerve .... I just had the MRI a few weeks ago . This is when my Pod said I had TTS again ...

The Ortho today told me that he wants me in a AFO brace , he thinks it will help . Then he said if I still have pain in three months to go back and he will talk about doing the vein wrap . Now he showed me the vein he would use .... It was in my ankle ... This just happens with having a tt release . It is not my Pod fault . Then of course we have to worry about the RSD . I have had 10 SNB so far to control the RSD .....

Ok you need my address , home or email ? let me know . I would love to read the article describing the procedure .....

You know Elliott , I have been dealing with foot pain now for over three years , I am so tired of it . This has taken over my life ... If this type of surgery will take my pain down I will do it .... Of course I need to read all I can on it first....

Thank you again , I know in this post I just did , I jumped around a lot , I have been under a lot of stress for the past few weeks...

Thank you again . Tomorrow I have to go for a QME appointment . This is a doctor that works for WC .. I went a few months back , the thing was , he was so very kind to me and wrote a wonderful report for me . Most times the comp doctor will write the report favoring comp ..... I hope he is just as kind tomorrow ..

Thanks again , Laurie

Re: Laurie

elliott on 11/14/02 at 16:34 (100166)

Did you have that same nerve pain you're describing before the surgery, or only after it? If you had different nerve pain or location before, please describe what you had before. Did you first get relief and the na return of symptoms, or was it right from the start? Some shooting pain post-op is normal. I wouldn't get too many injections either, even of the non-cortisone variety. Did the MRI show anything?

I still claim that the vein wrap requires an incision all the way up the calf; you may want to ask your doc if this is so.

My initial thoughts are that it is way too soon to have another nerve surgery, I don't care how important the doc is and what he says. My left foot got much worse starting about three months after TTS surgery, so much so that I couldn't keep shoes on, almost passed out from the pain and thought my life was completely over. It started improving somewhat about a year later. It's now 2 1/2 years, and while still not completely perfect, I now rule the surgery a raving success. The only reason I didn't get another what would have turned out to be unnecessary surgery at that time when things were so bad is that I had other serious problems (terrible sciatica and my other foot weak and near collapse) that I just couldn't do anything at all. Now I'm glad I waited, despite a year of pure agony.

Been a long time for me too. My TTS problems started in '96, and in outright agony from nerve pain from '99 until about 6 months ago. Right foot still has major problems (not nervy, though), and several big name docs disagree big time on what if anything to do about it. That drink where I drop in to your bar in the middle of my run is looking ever more distant.

If you could give me your home address that would be great.

[]

Re: Laurie

tammie on 11/14/02 at 19:09 (100172)

A quick note to u , I am using sons putor for a few, I am soooo sorry to hear things are crazy for you, Darn it to heck. With your new move and stuff I was hoping your life was starting to give back some happiness to you. After such a long time I do feel badly for u!!I sure hear you on things.

I got a call from my pain man, said wants to see me first appt, he can to discuss some recent xrays of my good legs knee, it has been killing me. I have been worrying that maybe I have bone cancer or something worse tho not sure what else I could call worse. I hope it is a bit of arthritis. But you know how are minds work, (nothing seems to be good).This cold here is not making my body happy we have rejusted my meds as I told him i want to live not sleep my life away. So meds are not working for me to much. He has also sugested several options, none sounded to good.

Have u heard of triger point injections to kill nerve? He scared me about that cause it can have bad effects to. He has all kinds of things that we can try he said but the outcomes are scary if it doesnt work. Have yopu heard of thease?

Laurie I hope our computor fixed soon,I have to get out of here son will be hone and then I will be found out hahah I snuck in here to check some mail. I seen you here and wanted to let u know I am thinking of u and please know I am keepimng my fingers crossed that all is going to be right for u ! Love to u Tammy

Re: Elliott excuse me sorry I should have used social!( eom)

Tammie on 11/14/02 at 19:11 (100174)

sorry

Re: Laurie/sorry for your troubles

Kari B on 11/14/02 at 22:41 (100198)

Laurie,
I am so sorry to hear about the run around you are getting. I hope that someone is able to do something for you soon! I'll keep you in my thoughts and prayers. Try to find time to relax and buy some Calgon... tell everyone to go away for for 1 hour (haha... I know how hard that can be sometimes... my 4 yr old autistic son hates it when I try to take a bath!) and take a nice relaxing bubble bath, light some candles, and pamper yourself. Not only do we deal with this pain day in and day out, but we still have to be moms, wives, and do the things that are expected of us. Dealing with everyday things in pain like this can certainly make things crazy and seem way out of perspective. Anyway, I just hope you get to feeling better soon and don't lose hope!!!!!
Kari B

Re: Laurie

Julie on 11/15/02 at 02:11 (100214)

Hello dear Laurie

I'm really sorry that you're having so much trouble!

As you know, I know nothing about TTS, but my instincts tell me that it's too soon for you to start contemplating another surgery. It's only five months since your first surgery - no time at all. I'm sure Elliott is right that you should hold off before thinking about another surgery. I know it has been a long time, and the continued pain must be terribly discouraging, but if you hang in there now you may find, as Elliott has, that another year will make the big difference for you.

Whatever you decide, you know I'm behind you 100%.

Love to you

Julie

Re: Laurie

elliott on 11/15/02 at 07:17 (100224)

I re-read the section on vein wrap. It's a little unclear, but maybe you don't need an incision all the way up to the calf afterall; perhaps it depends on how much vein is needed. I saw someone in the waiting room who had the incision all the way up; maybe that was just her.

Re: Julie and Elliott and Kari

Laurie R on 11/15/02 at 10:05 (100244)

Hi , Thank you all for your input . Here is the thing , I have nerve damage and no matter how long I wait it is not going to get better. Yes it has only been 6 months since my surgery , but this nerve got bound down .It is no ones fault, it just happened...

I am not going to rush into surgery ... Their is much to read on this and I would get a few opinions . I will be going today to see a comp doctor. The funny thing with this doctor is , I was warned before the first time I saw him. I was told to be very careful what I said and what I did .... That he would be writing everything down ....

I get there and he was nice as can be... My hubby and my youngest went to this appointment with me . He was talking to my hubby like he knew him for years... So I had told my attorney and my PM doctor and my Pod how very nice he was to me . Well they all told me it was a front and just wait for his report.....

Guess what ? I got the report and he agreed with me and my work related injury .... After reading the report my attorney said that was the best WC report he has ever read...My attorney does not like this WC doctor at all.

I went in and I was just myself , no different , I would not act any different for any doctor . All they have to do is see my foot and read my history ..... As always all the doctors say I am a very difficult case...

So today is 6 months post opp and they want to see me again . I thnk WC wants to put an end to my case. That is why they are sending me to their doctor ....

Like I said , I won't rush into any type of surgery ... Elliott ,I am not saying you are wrong , it is just the Ortho I saw yesterday , did not say a word about how long the incision would be . He just showed me what vein he would use ...It was just a little tiny one inside my ankle . But of course this little tiny vein most go somewhere and not just in my ankle.

Like I said , he wants me to try this AFO brace and see how things go for three months.... Hey just maybe this will work ...:)

I try not to look to much ahead and just stay with the day ... This has helped me to keep my anxiety down ...

I will keep you all posted . Thank you again .

Julie , much love to you to sweetie ... Thank you Elliott . I have one question for you ... How did you get so smart? really you know so much about feet. I try to learn as much as I can ......

Thank again , Laurie R

Re: Julie and Elliott and Kari

elliott on 11/15/02 at 10:57 (100248)

Laurie, I'm just not sure what you mean by your nerve getting 'bound down'. You can have an adequate release and still have problems, which sometimes resolve or at least improve over time; this has been documented in TTS articles. You can have an inadequate release, and if you somehow know or strongly suspect this, that would be one of the best justifications to have a second standard release. Then there's the possibility of the nerve being injured at surgery. I'm trying to distinguish between all of these and more. That's why I'm asking you questions about what you felt before and what you felt after surgery. Can you please answer that in detail? It is very important. I'm just trying to help.

I know it hurts, it hurts so bad, it's just about unbearable.
But you just shouldn't having another TTS surgery so soon after the first; it's way too close unless there's a very compelling reason. I'm not one to say don't have TTS surgery, because for most cases little else works. But I will say that you have to take it real slow the second time around, since the risks of things turning out way wrong go up out of proportion to the potential gain. I will also say that the docs just don't know enough about all this, e.g. how much time to give it, unexpected flareups, etc. If you beg them or they're a bit knife happy, they can try their best with another surgery, but if it doesn't work out, they make a note of it and continue taking care of more patients. You are then left to pain mgmt and suffering for the rest of your life.

Re: Julie and Elliott and Kari

Laurie R on 11/15/02 at 11:14 (100265)

Hi Elliott , I hear you loud and clear... I already go to PM for my RSD ... Also live with a lot of pain, so this is nothing new for me. I don't have much time now, Ihave to get ready for another appointment . I should of been off the computer a while ago. I will answer all your questions when I get home later.....

Please understand that I really appreciate you time. I know you know a lot and you have done your homework , that is why I asked you to help me .

I want to take my time to answer you in detail , I just don't have the time right now .

I know you are trying to help me and without all the details you won't be able to . I am very dyslexic and it takes me more time to write things out . I don't want to rush and to do it now .

If you don't mind as soon as I get home from my appointment , I will give you all the details...

Thank you again for helping , I do so appreciate it ....

Laurie R

Re: Elliott

Laurie R on 11/15/02 at 21:00 (100328)

Hi Elliott , Ok I am back from a very long day .... The doctor I saw today works for WC . I tried to ask him questions about my case and he really did not want to help me . I also asked him if I was not a comp patient would he take me on as his patient. He flat out said NO .... He said he does not like difficutl cases at all and I am one...

Ok I am going to try my best to answer your questions. I had my first and only foot surgery on May 7 th of this year.... He did a TT release and a PF release and removed a groth on the bottom of my foot . He also cleaned out my FHL tendon . I had a Tenogram and it showed a lot of tenosynovitis in the FHL tendon.....

I also had a epidural catheter implanted in my spine. It catheter was pumping Fentanyl in my spine .. Thisi was to stay in my spine for 6 weeks post opp to help control the RSD ... Well I was taking a shower after my surgery and my hubby was helping me get dressed and the catheter line broke . So it had to be removed due to the high risk of infection . It only stayed in for 1 week and half. I was happy to have it removed. it was a pain to have in my spine, plus I was very drugged up . One good thing , I hardly had any post opp pain .

Ok my pre opp TTS symptoms were , nerve pain in my inner ankle that would go from there to my big toe .... Also when my Pod would block that area the pain would go away before surgery ...My FHL tendon gave me much pain and I could hardly stand on my foot...And one of the worse pains were my fascia ... I had much arch pain as well...... If anyone would even move my big toe the pain would send me through the roof..

Now after surgery the fascia pain is pretty much gone. Also the tendon pain is gone .

The symptoms I have now are , now I want you to understand my RSD pain is totaly different .... Now I have this terrible nerve pain that goes from my inner ankle down to my arch and to my big toe .Sometimes it feels like my nerve is dancing . Does that make any sence ? My arch feels like it is broken .. If you press very litely on my inner ankle just below my ankle bone , the pain is really bad .... My pain is 24 /7 and worse right before I even get out of bed. But some of this is due to the RSD .....

Now when my Pod gives me the blocks in the PT nerve the pain goes all the way away until the block wears off. The Ortho I saw yesterday and the QME doctor I saw today and my Pod all say it is TTS again ....They all read my MRI's and my surgery report ..... I am only going by what has been told to me . I have told them all my symptoms and they all checked out my foot and ankle ....

They all say it is the PT nerve .... So to answer you , yes it is different then before my surgery . As you know I am not a very good writer , adn sometimes I have a hard time to explain things. I know you just want to help . If their is something I did not explain right , PLEASE just ask me again and I will do my best to explain . I hope this has given you a little more so you can understand .

Like now , my foot feels broken my arch is killing me . See with RSD I am suppose to move around and use my foot , but with the PT nerve the way it is , I am suppose to rest my foot... So that is why they call me a difficult case . Also they say it is a catch 22 situation which I agree....

Then I get the shooting pains that run from my inner ankle through my arch that make me jump .....

Ok let me know if this is better and if you understand . Thank you again for taking the time to help me . I so appreciate it...

Laurie R

PS now let me understand your case . YOu have only had one tt release right ? Or have you had two ? How would you rate your pain now ?

Re: Elliott I forgot

Laurie R on 11/15/02 at 21:02 (100330)

Ok it is me again ,You had said you were not sure about the Bound down . What I ment was ,the PT nerve is bound down with scar tissue ..... Which as I understand now from all these doctors , it happens after the TT release surgery ...... Laurie R

Re: Elliott

elliott on 11/16/02 at 19:19 (100447)

Laurie, can you clarify a bit more between the before and the after? Both before and after you complain of nerve pain in the same locations: your ankle, arch and big toe. I see you're saying you have dancing or shooting pain after. Other than that, can I ask specifically what kind of nerve pain did you have before (e.g. numbness, burning, tingling, electric shock, shooting pain, feeling of nerve entrapment) and what after?

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Re: Elliott

Laurie R on 11/17/02 at 10:26 (100490)

HI Elliott , Before the surgery I had a lot of the FHL tendon pain . Which I feel was the worse of my pain . Well that is not really true , I had a lot of PF pain as well. Which was not the same as the nerve pain I have now . Before I also had shooting pains that would go through my arch and to my big toe , tingling ..... Now after the surgery , I have more of the electric shock feeling , I still get numbibg . My foot always burns on and off , but I feel this is due to the RSD ..... Since RSD effects the nerves as well ....

RSD pain is all over my whole foot and ankle. As soon as I get a SNB that pain is gone. But the arch pain and the inner ankle pain is still here. For me the best way to tell where the pain is coming from is to have a block in my spine...

The shooting pains for me are the worst . They make me jump , then it leaves my foot with the feeling of my foot is broken ......

I hope you understand what I am trying to explain..

Thanks , Laurie R

Re: Elliott

elliott on 11/17/02 at 18:47 (100519)

Laurie, please leave out details of all your other foot problems not having to do with your nervy problems. I am not asking about those. Please give a list of just your nervy symptoms both before surgery and after surgery, in as much detail (type, location, severity, etc.) as will make things as clear as possible:

nervy symptoms BEFORE surgery:

nervy symptoms AFTER surgery:

Please include when nervy symptoms started after surgery, and how RSD seems to have affected your nervy problems before and after as well. Thanks.

Re: Elliott

Laurie R on 11/17/02 at 21:19 (100532)

Ok , I guess to answer your question only on nerve pain , I would have to say it is the same as before surgery as after. It probably started three months after my surgery . My RSD is the same post opp as pre opp , it does not change. The only time it changes is after a block ...

Location of the nerve pain: inner ankle through my arch to my big toe .. Numbing my whole foot and ankle ..... tingeling my whole foot and ankle .

I hope this will answer your question . I don't know why you only want to know about nerve pain . I have so much more then just nerve pain going on and also different things...

Thank you , Laurie R

Re: Elliott

elliott on 11/18/02 at 07:52 (100547)

Laurie, I'm focusing on your nerve pain because you're considering another surgery to relieve your nerve pain.

So basically, you're saying (please correct me if I'm wrong) you had a lot of relief for around 3 months after surgery, after which your nerve pain returned to more or less the same as you had before surgery. In that case, the fact that you had initial relief post-surgery is suggestive that you initially had a sufficient release without damage to the nerve, but that perhaps scar tissue did indeed form (it certainly is one possibility). Yes, according to its proponents a vein wrap might give a better chance for this than a second standard release. But it's too early for that.

Have you tried massaging your foot at the ankle and arch? For several months, I would massage that area vigorously for around 3-5 minutes, would feel slightly better for the next hour, would then feel much worse for the rest of the day, but then would feel better than before I massaged it. I did this around 3 times a week (only 3 times because I couldn't bear to constantly face that pain for the rest of the day), and after several months, I finally started noticing some improvement.

If you haven't yet, you could consider ultrasound (not that I have much faith in that), and Dr. Ed always talks about some injections of wydase or other compounds which may break up the scarring (although the shot itself can scar or injure too, and you may be having too many as it is). Certainly worth a try. Again, it is still far too early for another surgery; it sometimes takes a year or two to settle down. I know only too well it's a long time to suffer, but it's better than even worse permanent suffering. Hang in there.