RSD PUZZLE #70
Minor Injury, Common Cause Of RSD
Dr. H. Hooshmand M.D.
903 E. Causeway Blvd
Vero Beach, Fl. 32963
August 20, 1996
Dear Dr. Hooshmand:
How can I thank you enough for making your written clinical studies entitles
"RSD Puzzles 1995" available to RSD patients around the country. My college son
did a lengthy internet search for me early this summer, and your valued
information was sent to me several days later from The
International Reflex Sympathetic Dystrophy Foundation, in Lakeville, MA.
Since I was diagnosed with RSD last fall, I have done extensive research into this disease
and know that most of the case begin with trauma to one's extremity, and that, if treated
early, success rates increase. My RSD/Sympathetically mediated pain resulted in a very
different area, through a quite unusual set of circumstances, so I wanted to present my
case to you. Not much has been written about this particular situation.
In March 1992, I injured myself at home through an improper lifting accident, which
separated my right sacroiliac joint. Not being one to run to doctors (I had always been
very healthy, very active in sports-tennis, skiing, outdoor activities, had a great career
in Corporate Training, etc.) I tried to ignore or manage the increasing pain for several
months. by August of '92, the pain was so severe that I saw an Orthopedic surgeon (by that
time, when I would try to walk, my pelvic bone would tip forward and wouldn't stay in
proper position). I was told I would need surgery to fuse the S.I. joint, but I insisted
on physical therapy first, which we tried until Dec.- to no avail.
In Jan.'93, I had surgery #1, anterior S.I. fusion with plate and 4 screws placed. Several
months passed, pain continued to worsen, and I got 3 more opinions and was advised to wait
6 months before doing another surgery. In July'93, I underwent surgery #2, posterior S.I.
joint fusion, bone scraping , and percutaneous placement of 5" screw through S.I.
into lower lumbar/sacral area for fixation. Pain was so severe after this surgery,
rendering me totally sedentary and bedridden until Sept.'93 when I underwent surgery #3,
posterior formal bone block, bone graft, with follow-up body cast for 6 weeks to totally
immobilize. I resigned my job and career in Nov.'93, and the pain never decreased. My pain
was all across my lower back, and deep into rt. S.I. posterior area, presenting constant
throbbing pain. I couldn't sit, stand, or walk more than 10 minutes before I had to lay
flat in bed. these were the symptoms I has since early on in the injury, even before the
Having been on crutches most of 1993, and taking Vicodin and Percodan daily to control
pain, I was at my wits end, because I could never get levels of pain below 6 or 7, even
though I was taking the narcotics. Every several months, we would repeat CT scans, only to
find the fusion wasn't happening. I was in physical therapy, pool therapy, hot tub
therapy during most of this. By May 1994, I had surgery # 4 to do a percutaneous pinning.
Results were still negative, I was still totally sedentary due to severe pain. By April of
1995, CT scan finally showed fusion, but pain levels were still, and I was symptomatic
exactly as I was soon after the injury. A month later (May'95), they decided to remove the
hardware, thinking maybe this was causing the pain.
Results were still negative as time went on, pain was still severe, and by now chronic and
I was living on between 5 & 8 narcotics daily, with no real relief. Last fall, the
surgeon had all but given up, and it was then that I was told he suspected I had RSD. He
referred me to an anesthesiologist for a series of Lumbar Sympathetic Blocks. I had 8
blocks which injected bupivacaine and the longest relief I got was about 5 days.
THIS IS WHERE YOU BECOME SIGNIFICANT. In early June'96, I received your RSD Puzzles and
began to study everything you recommended. (I had done research earlier from our local
medical libraries, only to keep reading how hopeless RSD was if it hadn't been diagnosed
early and how debilitating it would become). I WASN'T GOING TO GIVE UP!
Here are the key things I learned from you that I had never seen in print before or been
told, and the success I have had so far:
1. Get off the narcotics because of the pain dependence (I did this 3 days before the next
Lumbar block which I had scheduled for June 26, 1996) and I haven't had a need for
2. I got a prescription for Ultram in case I might need it after the block. I've only had
about 15 Ultram since that block. I had my anesthesiologist read your suggestions from RSD
Puzzle #31 where you recommend using Depo- Medrol in addition to local anesthetic, and he
3. I have combined physical therapy, moist heat, etc. along with the block.
Dr. Hooshmand, the block lasted from June 26-August 5, and I was free of pain the entire
time (other than normal muscle soreness resulting from so much activity). the pain began
to gradually return the first few days of August; we repeat blocked 3 days later,
and I'm again free of pain. My anesthesiologist was so impressed and said he had not seen
results like this very often in cases this severe. We are hopeful that the longer we can
keep the cycle broken, the longer I can go between blocks, until maybe we can eliminate
My husband and I feel so grateful to you for giving me my life back- if it hadn't been for
your material, I don't know how my life would have proceeded. Chronic pain for long
periods of time is so stressful, draining and debilitating. I have had a wonderful support
system through this ordeal, and after several years had passed and the pain remained, we
finally stopped praying that I would get well, but that I could put in the right direction
to at least find answers. THANK YOU SO VERY MUCH for providing most of the answers.
Sometimes I worry that the pain will keep returning once the steroid wears out of my
system, and that maybe I will become immune to it, but for now, we're trying to catch up
on lost time and enjoy life.
I would welcome any other suggestions you might have based on my unusual case, and in the
meantime, I want to thank you from the bottom of my heart for taking the time to make
available such valuable information. I will always admire you and will pass on your
information to others suffering from RSD whenever I can.