[Coffeebean]

Hi all. I am a 50-year old female who has been dealing with CRPS II in my left arm since I had ulnar nerve surgery (moved the nerve) one year ago. This surgery resulted in a second compression on the nerve and the beginning of RSD (CRPS II). I had a second surgery six months ago to relieve the second compression.

I have been doing months of OT, PT, meds, etc. but have just learned I need to have a surgery on my right ring finger. It was discovered last week during a routine x-ray that I have a bone tumor in my finger. It was found by accident because the doctor wanted to see if I had bone loss in my left had so he needed to compare. Then he stood there in shock looking at the tumor on my right hand. He said the bone is thinner than an egg shell and that surgery is needed ASAP. I have consulted with a second hand surgeon and he said the same thing.

I am so scared because I don't want this miserable condition to spread. What can I do to help myself? I am so scared.

[dreambeliever128]

I am so sorry that you are going through so much. A person does panic when they have to have surgery with RSD.

My suggestion would be to ask for a SGB before surgery. They do it right before you go into the operating room. You are asleep by the time they get ready to do them.

I just had surgery on my right middle finger in Sept. to release a nerve and the Dr. did a block. Most Drs. nowadays seem to know to do blocks before you have surgery with RSD but it don't hurt to ask.

I had ulner nerve surgery in 2004. Sometimes I am wrong with the years but I believe it was then. Since RSD I have had about 12 surgeries. I am getting ready to have another one in Jan. Just about the time you think you have things going good then something else goes on. I usually wait until I can't wait no longer to get my surgeries. This pelvic problem I was diagnosed with about 2 years ago but have had it about 5 so I am ready to get things done. I will ask for a block for it too.

I strongly suggest you ask for a block. As I said, most Drs. nowadays do them but be sure to mention it to your surgeon and he can make arrangments with the Anesteologist ahead of time.

Good luck and I do hope that this next surgery does what you need it to do.

Ada

[ali12]

Hi there,
I am so sorry about everything that you are going through ((hugs))
Please talk to the hand surgen about your RSD and see what he recommends.
I wish I could help you further
Take care
Alison

[Jomar]

is the tumor in your finger malignant {bad} or benign {ok}?
Or is it a problem just being there?
Is the bone just thin at the tumor area or in all of your fingers/hand?

sheesh sorry I'm so full of questions...

[wakegirl]

sorry to hear you have been struggling...crps often feels like you are walking through quicksand...the more you progress you feel like you are making the deeper you find yourself. i too had an ulnar nerve transposition a few years ago and my crps flooded the area. on a positive i had a revision of a scs on dec 12th and while the surgery itself is not much fun i am happy to report my crps didn't flair as a result. i know the idea of surgery with a disease with such a propensity for spread is scary but when it is the only option available a well educated surgeon is the best defense. i agree with the suggestion to ask the anesthesiologist to do a sgb prior to surgery. crps spread especially in individuals who have been dealing with it for some time is most often the result of some form of trauma, the greater the trauma the more likely a problem will result. the best way to avoid a bad result is to make the area as calm as possible and a block prior to the procedure should help.
i am so sorry you are experiencing so many road blocks...good luck

[Coffeebean]

Thank you for the replies. I have been so nervous about this (and RSD in general). I do not know if the tumor is malignant or not. It is called an enchondroma and they typically are not cancerous when found in the fingers or toes. However, they usually are found by the time the person is in their 20s or 30s. Studies show the longer you have the tumor the chances of it being cancerous increase just a bit. I was told the tumor would have to be removed and then carefully examined for cancer, as it cannot be determined by a simple biopsy.

After the tumor is removed the first surgeon I consulted wants to fill in the area with bone from my wrist. The second surgeon would prefer to use bone from a cadaver as it would be less invasive but increases the risk of rejection. I do not know which way to go with this. I may seek a third opinion from a hand surgeon in the next state just to help me decide.

I know I will have to do something soon because both doctors said to have the finger break on its own is the worst scenario for RSD because that would most likely increase the chance of a spread. Plus my finger does hurt so that is an indication the bone is very thin (confirmed by the x-ray).

I had not thought of a stellate ganglion block. Would that block be done to the arm needing surgery or to the arm that already has RSD? I have not had one. I was scheduled several times but I chickened out due to my miserable luck with medical procedures.

I have been in denial about this disease for months. Just asking for help on this forum has helped me start to face this problem. Wakegirl, you are so right when you say it is always something. I would not ever think twice about this surgery before RSD; now I just get paralyzed with fear trying to make a decision. In fact this afternoon I backed out of the EMG test. I was just too afraid of a spread. I am diabetic but have not had a blood draw in over one year because I don't know if it is okay. I am so confused about choosing what is the proper medical treatment for this disease. Thank you for listening...

[Imahotep]

One of my docs suggested avoiding surgery as much as possible but if there's no choice, do it under an epidural.

[Jomar]

I also was wondering how your ulnar nerve had gotten compressed?
from an accident, repetitive work injury??
where was the second compression that you had surgery for?

The reason I ask is I have TOS {thoracic outlet syndrome} due to repetitive work postures and uses, and often TOS symptoms show up as ulnar nerve, hand, wrist , arm, shoulder, neck and upper back troubles. And some will get RSD/CRPS along with TOS.

So I was wondering if you have any of those other problems with your RSD and ulnar compressions?

We have a TOS forum here too.
here's our thread with tons of info about TOS if you'd like to skim thru it-
http://neurotalk.psychcentral.com/thread84.html

[Tiril]

This is from rsdfoundation site; (you can read more on the site)
Print aout and give your anestesiolog from the site


The above algorithms are for surgery for CRPS patients. These treatment protocols are intended to minimize the risk of exacerbating CRPS. The protocols suffice for minor surgical procedures. For major surgeries, more aggressive / invasive interventions may be required. However, the risks and expense of more invasive procedures need to be weighed in relation to the potential benefits on a case-specific basis.

Example:

Major surgery on an upper or lower extremity (e.g., revision rotator cuff surgery, shoulder or hip replacement):

1. Place cervical epidural catheter immediately preoperatvely under fluoroscopy to produce unilateral epidural block

2. General anesthetic or regional anesthetic at the anesthesiologist's and surgeon's discretion. Low dose ketamine infusion is recommended (1/2 mg / kg / h)

3. Restart acetaminophen, gabapentin and celecoxib as soon as possible

4.Continuous epidural infusion of a clonidine-bupivacaine-fentanyl infusion for 5 days to 6 weeks to facilitate early physical therapy. For catheter infusions longer than 5 days, a tunneled catheter is recommended

5. Weekly evaluations by the pain medicine specialist to monitor the effects of the infusion both in terms of pain relief and side effects

6. If a longer infusion period is used the patient will need to be weaned off the clonidine and fentanyl to avoid withdrawal syndrome with PO clonidine and hydrocodone or transdermal preparations of clonidine and fentanyl

Acetominophen, celecoxib and gabapentin should be started with a sip of water just prior to surgery. However, if NSAIDs are discontinued three days prior to surgery to decrease intraoperative bleeding, these three pain medications should be started three days prior to surgery to avoid breakthrough pain.

Acetominophen, celecoxib and gabapentin should also be started according to the above protocol for oral surgery/dental procedures. In addition, generous infiltration of local anesthetic at the operative site for oral surgery is recommended.

Early ambulation and mobilization of the affected extremity is essential to the optimal rehabilitation of the patient. The cornerstone in the treatment of RSD / CRPS is normal use of the affected part as much as possible.

[ali12]

Hope this helps you, it is off of the American RSD hope website.

PAIN AFTER SURGERY - HOW PAIN MEDICATIONS AND ANESTHESIA CAN HELP
Mayo Foundation for Medical Education and Research

Excellent article from MayoClinic.com

You don't have to suffer through severe pain after surgery. Modern pain medications and anesthesia can control post-surgical pain and help your body heal.

If you're scheduled for surgery, it's natural to have concerns — or even fears — about the pain following the procedure. Although some pain is likely, you don't have to endure severe pain after any surgery. In fact, your nurses and doctors consider effective pain management a key part of your recovery, because well-controlled pain can speed your healing and lead to fewer complications.

The best treatment for post-surgical pain requires a careful balance between benefits and risks. If your pain medication is too strong, you may have side effects, such as sleepiness, nausea or vomiting. But if your pain medication is too weak, you may suffer unnecessary pain. The goal is finding the right balance for you at each point during the procedure and during your recovery.

Plan now for post-surgical pain relief

The time to talk about post-surgical pain relief isn't after surgery. Here's how to start:


Discuss previous experiences with pain. - Before surgery, talk to your doctor about your experience with different methods of pain control. Mention what worked for you and what didn't.

Talk about chronic pain. -If you have chronic pain, you'll likely have to deal with that pain, in addition to the post-surgical pain. And your body may be less sensitive to pain medication — a phenomenon called tolerance — if you're taking medications for chronic pain. Discuss this in detail with your doctor before surgery.

Be honest about your alcohol and drug use. -Tell your doctor if you are a recovering alcoholic or drug abuser. If so, you can plan for pain control that minimizes the risks of relapse. If you're currently abusing alcohol or drugs — even legal drugs, such as benzodiazepines — let your doctor know. Withdrawing from these substances can be difficult, and the post-surgical period is not the time to try it.

Make a list of your medications. -Include all prescription and over-the-counter medications, plus any supplements or herbs you've taken in the past month. Your doctor needs to know about anything that might interact with post-surgical pain medications. Be sure to list any pain pills you take on a regular basis, because your body may be tolerant to their effects and require higher than usual doses to achieve adequate pain control. In most cases, you can take your regular medications with a sip of water on the morning of your procedure, but confirm this with your doctor.

Ask questions. -Find out how severe the pain typically is after this type of surgery, and how long it lasts. What kind of pain medications will be given before and after surgery? What are the possible side effects of these medications? What can be done to minimize side effects?
After surgery, you'll need to communicate with your doctors and nurses. Controlling your pain is important to them, too.


Be honest about the pain you feel after surgery. -Let your doctors and nurses know how much it hurts and where it hurts. Pain often changes through the day and night, and with activity. Your medical team may ask you to rank your pain on a scale of 0 to 10, with zero meaning no pain and 10 being the worst pain you can imagine. Don't downplay what you're feeling. Your honesty will help control your pain. The more specific you can be, the better your doctors can help you.

Don't ignore side effects.-Tell your care team if you experience sleepiness, constipation, nausea or other side effects of the medications. A different pain medication or dose can sometimes reduce uncomfortable side effects.
Postoperative pain control usually involves a succession of different medications and routes of administration — beginning with the most intense efforts to relieve pain during and right after surgery and moving to less-powerful, oral medications by the time you go home. Of course, if you undergo major surgery — such as chest surgery, abdominal surgery or joint replacement — your recovery will probably start at the top of the list of pain relief options. For minor operations — such as dental work or skin lesion removals — you'll likely skip the most potent strategies and start somewhere in the middle. What follows are some of the most common options.


This is the website to read the rest of the article:
http://www.rsdhope.org/Showpage.asp?...1&PGCT_ID=4242

Love
Alison