Major dilemma

[albie]

Don't even know if this will make sense, but here goes. Saw a new work comp dr yesterday for the fx'd foot that never heals. He is a foot and ankle ortho specialist. It seems that now since the fx hasn't healed, xrays yesterday revealed that the bone is dying. They call it avascular necrosis and it's apparently already stage 4 or 5 plus the fat pad under the ball of that foot is gone. a nurse from work comp was there to hear all this because he said that I will now have a permanent disability, probably need surgery and orthotics. But here's the dilemma, he asked y I took Enbrel. I said for PA and he said that would effect my healing. He asked y the Prednisone dose pack (2nd in a month) and I said because this mess with my leg and foot caused a major flare. Well he wants me off the Pred because that effects the healing of the bone. As i'm coming off the Pred my back is starting to flare again, I've been in this damn boot for 3 and a half months, on a bone growth stimulator for 2 and a half now he wants me back on crutches non-weight bearing. What do I do, if I treat my PA aggressively it hampers my foot healing. If I don't it's not just my foot that hurts. Thank God for my Rheum. The foot hurts so bad (and I'm sure partly the PA not just the fx problem) by the end of the day in order to sleep I take 2 7.5/500 lortabs and 2 lunesta (BTW i don't get the metal taste). Damned if I do and damned if I don't. Sitting here now with intense low back pain and one throbbing foot. I think I'll just go into one of those (like DW calls it) drug induced hazes. Maybe when I sober up it will all have gone away. There is absolutely no need to reply to this, I just needed to get rid of it. I know you guys understand. I wish DW and others did. Thanks for listening. Love you all.

[Re]

albie so sorry your mate doesn't get it. I am blessed because my hubby gets it. He is wonderful but he read everything he could so he would understand it too. He is better about it than me. Let your wife read some of the post about all our pain and maybe if she hears/reads it from some one else she may recieve it better. I'll pray that she gets it or is atleast more sympathetic. Vent and get it out. We are all here for you. Hope it is as warm as I remember it being. Do miss it.
Re

[deemah]

Albie,

Wow! That's a real tough situation that you are in -- either treat the PA or treat the foot/bone. I hope there is some type of resolution that won't keep you in pain from either problem. I really feel for you and wish you the best. As Re said, vent as much as you want/need to. We are here to listen.

Ruth

[ouchyk]

Al,

Sorry to hear about your foot. Ahhh boy.

My good friend Steve ( makeitgoaway ) was in a horrific motorcycle accident a few years back and broke a bunch of bones evil knivel style... including his pelvis/hip and underwent major surgeries... he never missed a shot of enbrel during that time and it didn't seem to impede his healing.

Every case is different though. To be honest if I were to have any type of surgery I'd jump off my bio and prednisone.. :o

Sometimes our loved ones don't get it and ya know I try to understand how difficult it must be for them, they don't live in our bodies...

Anyway now I'm rambling! I do hope that you find some relief from all of this pain your experiencing if a haze works then go for it.

Wishing you much comfort,
Karen

[Eeyore]

I don't think you have much choice. Scale back on the PA meds and follow the WC doc's orders as best you can. At least TEMPORARILY.

The last thing you need is to end up permanently disabled.. or worse.. permanently disabled ANYWAY but no compensation because you didn't do as the WC doc required.

Give it a set period of time. Scale back the PA meds as best as you can. But be sure to ask the WC doc when he would resonalbly expect improvement. And if there isn't any. To heck with them and treat your PA. But if you don't at least go thru the motions you could end up in a serious bind financially.

just my .02

[Ihurt]

:( Im sorry you are going through this Albie.

My cousin had the same exact thing happen-necrosing of the bone-an accident at work in NJ. He too has P and was on Prednisone and MXT-both had to be stopped.

Your doc is right, you will not heal while on bios. Pred only thins the bones and interferes as well.

"I" think if I were you...I WOLD PUSH THEM TO SPEED UP THE HEALING OF THE FOOT so that you spend less time in flares! Why can't you go on IV antibiotics at home? Have they suggested this to you? WHY does it seem that both docs are not talking to each other? Your treatment needs to be coordinated. Out of two different serious health problems another is growing...your pain management is getting decreased and PA will progress!

This is significant.

Push your docs to talk to each other...you CANNOT stay like this. PA will get more progressive and more of a jump on you by the time the foot heels. There has to be another option!

Hang in there...stay on your pain meds as directed...and remember we are all here for you!

PS: Family doesn't always understand but we shouldn't hold it against them. Remember how long it took us to understand this da(m disease! My mother wouldsay "forgive them, they know not what they do". Show them the SPOON THEORY...keep it on the refrigerator/



Hugs
Elaine

[albie]

Thanks for the replys guys. Eeyore, I know you're probably right and Elaine I wish there was some way to speed it up. One of the things that scares me is that some 6 or 8 weeks ago the wc nurse did a phone interview with me and until that point I did not think they knew about my PA. All thru the interview it sounded like she was wanting to lay off my entire injury on my PA which is a croc of #$@%. Yes I have PA but fighting a 250 lb 18 year old is what caused the injury.

The w/c doc said he wants to give it 1 to 3 more months in the boot with the stimulator and I think the only thing getting stimulated is somebodys wallets (definitely not mine). The research I have done, and there seems to be little info out there on AVN (avascular necrosis) of the metatarsal, indicates that the stage I'm at (4 or 5) about the only remedy is surgery. There a few different types. All requiring 3 to 12 months rehab. So, it appears there is no real short term solution. The fx seems to have interupted the blood flow to the metatarsal head which is necessary for the bone to heal and w/o that you get the AVN. The normal rounded shape of the bone in my case now looks like Dilberts head. Straight up the sides and flat on top hence the stage 4 or 5.

On top of this we add the roving nature of PA. I ended my dosing of Pred the day before yesterday and as I was reducing the low back and hands started their thing again. As of yesterday low back is better but now it's up around C6, C7 so that when I turn my head it feels like an ice pick going into the middle of my spine. When my Rheum gave me the last rx for Pred he gave me 50 pills even though I only needed 21 for the 10 day dosing. He either made a mistake or just figured since this was the 2nd time in a month, I may need it again. Add to this that last night my left hip started to act up for the first time (at least this type pain). The wc doc rx'd Indocin for the pain and inflammation in the foot but the Pharmacy can't fill that till the get auth from w/c.

So, as you can see I'm sitting here looking at a bottle of Pred with 29 10mg pills in it, knowing that it could help my current pain, knowing that I'm more than likely going to have to have surgery on the foot anyway and sick and tired of all these other pills that don't seem to do much. three 7.5/500 Lortabs in a 4 hour period last night took the c-spine pain down to about a 7. I threw in a Celebrex and a couple Lunesta and thankfully was able to get some sleep. No rest, just sleep.

[Ihurt]

I know your WC ins won't pay for it, but do try. I see that you live in Fla, but could you travel to NY? If you could you could see the people at NY's Center for Surgery.

I don't like WC doctors! I have worked as a nurse and practice manager for a very longtime. I see what goes on with WC docs. They don't work for you, they work for the Comp carrier. That's a dangerous place for you to be in the condition your in.

Even my cousin had to get a second opinion. The second opinion had better answers for him than the WC doc. Im the one that forced my aunt to take him.(BTW his accident was a forklift that went through his foot) It took an attorney to intervene to get him the REAL TREATMENT HE NEEDED!

At first they thought he was going to lose the foot! Even when he got past the bone necrosing...it was starting to heal and grow, he had a multitute of problems with the wound itself! More second opinions. Luckily we met someone my sister knows who went to a wound clinic for a diabetic leg (after already losing one) because they were again talking aboust amputating because of gangrene!!!!

I tell you all this because from what you are writing yours is a duplicate case of his., AND HE GOT OPTIONS. The una boot is now off, he's actually back to work working for the Iron workers! He's actually walking with a slight limp, but is back on his feet!!! Now...... without a foot that would'nt be the case, and he just had a new baby. He's 42.

I have a brother in law in Gainesville who is a nurse care specialist. He has great contacts down at Shands. I could ask him for the name of specialists there if you want me to. Im sorry...I don't believe that there's nothing they can do. THERE IS ALSO HYPERBARIC CHAMBER therapy. That would speed the healing as well.

PLEASE PLEASE ALBIE, get a second opinion and even a third. I know for a fact that you do have options!

[Re]

albie, my hubby Charlie and I went throught the same thing with wcomp. their docs work for them and will screw you to the end. Go outside their network of scam docs and get a second or third opinion. I lived in florida until I was 28. I got hurt working at a metal factory and workers comp tried to screw me over. Luckily I was in college taking business law classes and I got a great attny. Did not get a lump sum of money I just wanted lost wages and my medical bills covered. Florida's workers comp laws have really changed to protect the business. You can only get a certain amount and it has to be stretched out NO LUMP SUMS. This way if one goes back to work that wc company can cut them off of disability. Get a cut throat attorney and slit their throat. Here in Tennessee, my hubby tripped at work over a hose (TVA) He was a plumber pipefitter making about 24.00 an hour He worked for a contracting company. After two years and two brain surgeries and two shoulder surgeries he still got dinked. We later found out this attny was secretly working for them under the table telling all that got hurt to take $50,000.00. told us all that the judges were denying these cases. Longer story short. He got his in the end. After all was said and done hubby ended up with less than 20,000. We had so many bills to pay cause we lived on crdite cards etc., and still had so many medical bills. Not enough to pay for all so we filed for a chapter 7 last summe. That was that.
Get a second, third or fourth opinion. find an attorney that is a killer and get your slef protected. Hope the weather is warm. Get of your meds and have your personal doc give you something extra for pain so your foot can heal.
Re