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question for Sharon

Posted by Stacey on 10/03/03 at 21:27 (132123)

Hi Sharon,
I saw your reply regarding injections.
I have been asking the doctors question regarding this but have not received a full answer.
After a nerve block a couple months ago I have develped numbness, tingling, and increasing pain in inside ankle area.
It seems that it is from the doctor's injection-
but I have classic signs of TTS and have been diagnosed with it by 3 doctors. So my qustion is:
Would the damage caused by the injection be neuritis only or could TTS develop from the injury of the nerve?
If there is no way I could have developed TTS as a result of the injection then it is just a big coincidence that it developed right after the nerve block I guess.
Thanks for your time!
Stacey

Re: question for Sharon

Sharon W on 10/03/03 at 21:54 (132129)

Stacey,

I can appreciate your frustration. I'm guessing you had hoped that one of the doctors would acknowledge either that your problem was probably caused by a pierced nerve, and that it was neuritis, not really tarsal tunnel syndrome at all... or that piercing the nerve had CAUSED you to develop TTS -- one or the other.

But I am not the expert. I can't tell you whether piercing a nerve during a steroid injection could develop into TTS or not. I am just another patient who has had TTS... I know how painful it is and I'm trying to help any way I can.

I do know enough about medical terminology to explain what a couple of terms mean. Neuralgia means nerve pain. Neuritis means nerve inflammation. They would not have used that term unless they believed the nerve was inflamed and (probably) damaged in some way (but that does not mean they're admitting it was damaged by that injection). Chances are, it was worded very carefully. Doctors do tend to be VERY careful how they word things like that, to avoid saying anything that might get them supoenaed to testify in a lawsuit later on...

I hope you realize that the doctors here are bound by certain legal limitations. They have not examined you, and have not seen your lab tests or X rays or MRIs or nerve conduction tests, etc. Yes, of course they are experts... and they do want to help. But they could potentially get into legal trouble if they publicly criticize what another doctor has done under these circumstances. Dr. Ed and Dr. Z have hearts as big as Texas, to spend hours and hours every month helping people here the way they do, but there are some things they just can't do. They don't post anonymously, as the rest of us do... They use their full names and anyone can find and identify them. They can't afford to risk being sued.

Sorry I couldn't help more.

Sharon
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Re: question for Sharon

Stacey W on 10/04/03 at 13:42 (132182)

Hi Sharon,
Thanks for your reply.
I understand exactly what you are saying and don't blame the doctors for being vague.
I want to reiterate this so that others may know where I am coming from.
the reason I am asking is because 2 doctors are telling me I need TTS surgery (and I am seriously considering doing it soon because of all the pain), but if it is indeed neuritis or something that cannot be repaired by surgery, then I do not want to be cut. I don't care how it happened. I am actually quite devoted to the doctor who may have done it (if he even did) I just want to get better. I guess I am just confused with the TTS/neuritis-I looked nueritis up on internet and they kinda threw it together like it was the same thing. I will just try and do some more research.
Thanks for your reply, I appreciate your help.
Stacey

Re: question for Sharon

Sharon W on 10/04/03 at 16:35 (132200)

Stacey,

It is my understanding that TTS would typcially involve neuritis (inflammation)and or compression of the posterior tibial nerve in the tarsal tunnel area, but there also might also be inflammation and/or nerve compression higher up the leg along the posterior tibial nerve, or further down, in the area where the posterior tibial nerve branches into three smaller ones.

Neuritis could happen to ANY nerve, not just to the posterior tibial nerve. But I guess you might argue that neuritis of the posterior tibial nerve is usually TTS.

Again, I am really out of my league here -- maybe one of the doctors will clarify on a theoretical level.

Sharon
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Re: question for Sharon

Stacey on 10/04/03 at 18:34 (132215)

That is my understanding also. I still was not able to find much info. about neuritis.
And really the only way that I see that surgery is helpful is if there is something compressing the nerve that can be removed (scar tissue, varicose veins, etc.) Anyone disagree?
Thanks Sharon.

Re: question for Sharon

Sharon W on 10/04/03 at 21:27 (132237)

Stacey,

Just for the sake of argument, let's suppose that you were referred by your doctor to a new doctor, one who looked over your records but noone had explained to him (at least not the other doctor) that the posterior tibial nerve was probably accidentally pierced during an injection and it may have resulted in some damage. [I really don't know whether this is how it happened not.]

In a case like that, the new doctor, seeing in your records that the other doctor has referred in his notes to 'neuritis' of the posterior tibial nerve, tests you for TTS and finds that you have many of the symptoms. He concludes that TTS is your problem. Even if YOU tell the new doctor about your nerve being pierced during a procedure, he may discount what you tell him because he doesn't find any confirmation of that in your records from the other doctor. [The truth is, doctors almost ALWAYS believe what another doctor says, rather than taking the word of a patient, unless there is strong evidence to back up what the patient has told them. (Usually the only exception to this is if the doctor knows the other doctor and already has reason to distrust or disbelieve him.)]

If that's what happened in your case (and it sounds to me like it might be), I personally don't see how TTS surgery could solve your problem. HOWEVER, if you have 'neuritis' I would imagine that there is a chance steroid injections might be helpful in reducing the inflammation. That's just a thought, of course. (Something to ask your doctor about, though, maybe...)

I really wish there were more I could do to help.

Sharon
:)

Re: About having surgery without something to take out

Sharon W on 10/04/03 at 21:40 (132241)

By the way, no, I don't necessarily agree that TTS surgery can only be helpful if there is a THING in there compressing the nerve -- but I do believe the doctors who say TTS surgery is more LIKELY to be successful if there is something IN there that they can take out to relieve the pressure. The act of opening up the tarsal tunnel does create a situation where, even if the problem is just general swelling and inflammation in the area (assuming scar tissue doesn't pinch it off again afterward) there will be quite a bit more space there for the nerve and blood vessels after the surgery.

But scar tissue IS a big risk... especially since it sounds like you have had problems with it in the past.

Sharon
.

Re: question for Sharon

Dorothy on 10/05/03 at 02:48 (132272)

Sharon ~ I think you are right on about doctor's taking at face value whatever a previous doctor says/writes. It can be very frustrating, particularly when one is going for a second opinion. Too often, the 'second opinion' turns out to be, 'yeah, I agree with the first opinion, whatever it was...' !!

Re: question for Sharon

Stacey on 10/05/03 at 12:14 (132311)

Thanks Sharon
You have been a great help.
I think what I will do for now is just hold off on any procedure and try injections. I have had 2 already in the ankle area in the last 2 months-they help for a couple days. I may ask for ultrasound too.
Take care
Stacey

Re: For Dorothy

Sharon W on 10/05/03 at 13:02 (132316)

Dorothy,

Yes, and when the doctor just reiterates what the other one said, it really kind of defeats the whole purpose of going for a second opinion in the first place, doesn't it??!

Dorothy, I just wanted to say that I admire you for continuing to participate on the Social board after all the mud-throwing. Your participation there generally seems to be a needed stabilizing influence, a common-sense approach... I'm glad you've decided to stay there and try to carve yourself a niche.

Sharon
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Re: For Dorothy

nancy s. on 10/05/03 at 17:54 (132332)

dorothy, you and i don't know each other, but i've read a lot since i left, and i second sharon's view of your participation.

nancy
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Re: For Dorothy

Dorothy on 10/06/03 at 01:06 (132381)

Sharon ~ To your first point: exactly! That was also my point. It is one of those things that happen in a doctor's office that make you feel dismissed, discounted, not heard and - sad and angry.

To your second point: I appreciate very much your thoughtful words, especially since I respect your opinion, having read your comments to so many here.

Interesting that you said 'mud-throwing' - I recently saw this saying on a marqee: If you are mudslinging, you are just losing ground.

Whether I'm carving myself or digging myself a hole is a question up for grabs! Thanks, Sharon, for the good word. It was very nice of you to say so.

Re: For Dorothy

Dorothy on 10/06/03 at 01:09 (132382)

Nancy S. ~ And I will just second my thanks to Sharon - to YOU! It kind of seems like we various ones here do get to know each other, at least in a limited way, and I have to say it has become important to me. So, thank you - I appreciate your taking the time to say that.

Re: For Dorothy

Dorothy on 10/06/03 at 02:49 (132394)

I think I must be more tired than I realize. I meant to write:
Whether I am carving myself a niche or digging myself a hole.....etc.

'Carving myself' must be a Freudian slip for a chicken with control issues.

Re: Thanks Dorothy

Sharon W on 10/06/03 at 08:12 (132408)

Dorothy:

I LIKE that... 'If you are mudslingling, you are just losing ground.' I'll have to remember that one... Thanks, Dorothy!

And good luck with the Social board.

Sharon
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