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Pain Management Exam

Posted by SteveWG on 3/07/03 at 13:43 (112152)

Would it be considered unusual if the pain management specialist never examined my feet during the visit? He asked questions but never examined my bare feet. My podiatrist sent me to him out of concern for RSD. Any thoughts would be appreciated.


Re: Pain Management Exam

Sharon W on 3/07/03 at 14:14 (112156)


That's what the neurologist did - he never even had me take off my shoes when my podiatrist sent me to him for a consult to be examined for peripheral neuropathy - and it seemed very strange to me because the original (and primary) problem was with my feet!


Re: Pain Management Exam

SteveWG on 3/07/03 at 19:49 (112195)

Thanks for your time Sharon,

I see that you've had TTS surgery, hope that continues to go well for you. You're in 'Backwoods Texas?' I'm in Arlington.

My situation is beginning to turn into an ordeal. My podiatrist sent me to the pain management specialist last month after my pain turned into burning / tingling pain in both feet. I found it odd that he asked if I had any color or temperature change in my feet but he never actually examined them. I never brought that up with my podiatrist because he has quite a bit of respect for the specialist and I in turn have a great deal of trust in my podiatrist.

Last week my podiatrist sent me to another podiatrist for a second opinion. This new podiatrist was very confident and I have no doubt that he is capable. His thought process was of TTS. He administered a cortisone injection in my left ankle. This was a week ago today. It did bring some relief but by Sunday evening I felt that any effects were wearing off. Tuesday morning I was back in his office in tears. My right foot has been much worse overall but the symptoms were back in the left foot.

I could tell that his concern had switched to RSD after observing my feet and the fact the shot wore off quicker than we both would have preferred. Told me he wanted to talk with podiatrist #1 (apparently they're good friends) and find out a bit more about the pain specialist and neurologist that I have seen.

Fully recognizing that how I may 'think' the exam with the pain specialist should have gone may not be correct. Even though I realize that it may be perfectly acceptable, it just seems odd he never looked at my feet and chose to accept my answers to his questions. Especially now that all of the above seems to add up to heading down the RSD path again.

I've been the good patient since June. I really trust both podiatrists and the neurologist I was sent to, have yet to feel the need to find another opinion but I'm starting to wonder. I have yet to say 'I think this...' or 'I want...' but I'm beginning to think I may need to start working that into my vocabulary. I believe that I have presented some challenges. Diagnosed hypoglycemia in 2001, carry HLA-B27 gene, back problems in 1998 but since resolved. All of this began after changing cycling shoes and has progressed into these neuropathy symptoms. I did get a call from podiatrist #1 today wanting to see me Monday to discuss further, we'll see.


Re: Pain Management Exam

Sharon W on 3/08/03 at 11:11 (112246)


You're in Arlington? We're in Woodway, if you know where that is. One of our daughters goes to school at UT Arlington. In fact we'll be there this afternoon, going to pick her up and then hang out with my nephew tonight.

It doesn't seem odd that the pain management specialist would take your word for what your signs and symptoms are, assuming he knows your profession. On the other hand, HE is supposed to be the specialist in this case... I'd still think there could be a chance he would notice something you might have misssed.

I've had the corisone injections in the medial ankle. For me they work pretty well -- they gave me relief for about 3 weeks each -- but others have said they only made a difference for a couple of days.

Perhaps you already have all the information you need -- but if not, doing a search on RSD among the messages here would give you some idea what it's like from the patients' point of view. Or, you could search the name, Janet -- she has RSD and has posted some very good info on this subject.

Actually, I am 'the good patient' too. I stuck with the same podiatrist from the beginning, she did my (successful) TTS surgery; I have considerable respect and chose not to look elsewhere. I would recommend her to others.

I'm amazed at all the things doctors have to learn and (somehow) retain to practice their profession, and I realize that an exam may seem inadequate to me because I don't realize that the doctor has already ruled out the things I'm concerned about.

But I'm not willing to accept a diagnosis that I would have to live with for a long time to come, when the only empirical tests so far have not supported that conclusion and other appropriate tests haven't been done.

It does sound like you've presented some challenges to your doctors! I really hope it won't turn out to be RSD, but if it does, I know you'll deal with it appropriately.