RSD Puzzle #070

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #70
Minor Injury, Common Cause Of RSD

Dr. H. Hooshmand M.D.
Neurological Associates
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 a support group called Supporting Friends and Patients of Reflex Sympathetic Dystrophy, 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 first surgery.

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 narcotics since.

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 readily agrees.

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 the altogether.

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.

Sincerely,

Judy

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.