3/18/19 New doctor today

We saw a new doctor today. This doctor said that he wants to try a lidocaine shot just under the surface of the foot by the second MTP joint, not in the joint. If this diagnostic strategy is positive, meaning that it anesthetizes where the pain is radiating from, the next step is to explore removing the sutures. We asked if this is considered a salvage procedure and he said, “no, that that’s more severe”.

4:35am update

The patient can’t sleep and neither can the advocate. This last weekend there was a visit to an ED and a blood lab. The blood draw had to be performed with the patient laying on the floor because she had a vasovegel response. I had mentioned this to her primary care physician but it was explained that the orders could not be sent to another lab. The lab finding were insignificant for preliminary findings for inflammatory disorder(s). Also last week the patient was screened by my neurologist,… nothing here either.

This is what I wrote yesterday to the PCP and her other point doctor with certification from the American Board of Psychiatry and Neurology :

As you know, I am trying to help advocate for *the patient*. I have created a blog for her. I hope you have seen it. The next thing I am thinking of putting up on the blog is how I’m trying to coordinate an effort to help speed up this process. I am not sure that an open line of communication would be a bad thing between her primary care, *the patient* , myself, you, and the specialists,….. rheumatology, Neurology, foot and ankle specialists, and the knee specialist and complementary medicine specialist. I think we need to speed up the process of the diagnoses and the prognosis involved with the whole of *the patient*. I do believe that *the patient* is not that complicated a patient and that keeping it simple maybe the solution, but we just need more of a coordinated effort in to opening up a good line of communication.

Foot pain still persists,….

also knee pain.

We went to a rheumatologist last week and he really didn’t have anything for us. He didn’t order up blood labs. He was aware that we can get blood labs ordered up through the primary care doctor.

We also went back to an orthopedic that does the lower and she didn’t have anything new for us, our focus with her was more about the knee.

We went seeking out pain management again and found an administrative assistant that said the patient isn’t a candidate for CRPS. She suggested that we schedule with a neurologist. So that’s where we are now, the next appointment is with a neurologist in three days and then the following day an appointment with a knee specialist.

In the meantime, because going to the physical therapist hurts too much, the patient will do exercises at home and we are going to go swimming in a pool.

Also, I keep asking about avascular necrosis for the knee,…. :

Part of the bone and hyaline cartilage of the medial femoral condyle is cut off the circultaion and dies off, but then gets regenerated. Technetium-99 bone scan or MRI scan can help in the diagnosis. Treatment consists of high tibial osteotomy or total knee arthroplasty (knee replacement), both of which would require a referral to an orthopedic surgeon.

Maybe the MTP joint too. I was told that it would show up in an MRI. I’m concerned about the quantitative (or lack of) imaging we’ve been getting.

Cortisone shot n.g.

14 days ago a cortisone shot was administered (ultra-sound guided). It seems that the shot was ineffective.

A pain clinic was visited and a diagnosis of enthesopathy insertional tendinopathy was given. Other than a 30 day dose of Tramadol, a suggestion of stretching and p.t. was advised.

A diagnosis from a college professor of podiatry gave a diagnosis of slight subchondral fracture of the distal 2nd MTP head.

Primary care doctor said that the only tests that she can think of would be blood – ESR and CRP. The tests would be looking for inflammation disorder.

Now it’s the knee too

This patient hurt her knee by sliding in to a table leg on Christmas Day evening, impacting the side and a little under the knee cap, on the inside. It is the right knee. After 5+ days of RI(-C)E,… (we didn’t start compression until day 6) we had an X Ray and examination by a orthopedic primary care doctor. His diagnosis is a sprain and to give it 2 more weeks of healing. The knee hurts when the patient walks on it and bends it. The area is soft and tender and there may be a slight sign of a bump. We suspect there may be a little fluid in the bump.

The toe might be getting better. It still hurts when walking on it.