Good morning Kathy,

I've been with a specialists who did his residency (and was offered a permanent position but turned it down to my amazement) at Mayo's for 11 years now and yes we've grown rather close over the years. Since this wonderful guy has never once turned me down the wrong path, I've just learned to trust his counsel and his brilliant mind. With a career that makes almost any doctor envious, this most humble of man never overreacts, but instead just works the problem.

One other point that's commonly discussed during my 30 - 45 minute appointments is that usually there's another contributing factor(s) that go hand in hand and can't be either fixed or fully repaired when a patient finds themselves further along the RSD phases. We also talk about the importance of maintaining as decent of mental outlook as possible even when you do think you're going half nuts. The recuperative effects of keeping a positive attitude are well documented but still not fully understood.

The hardest part during phase I and II is when to proceed with this treatment or when to back away because no two patients or situations are alike hence the very reason why some patients do so much better than others even though they both had for example sympathetic nerve blocks.

Another way of determining which stage you're at is by looking at the additional complications other than just pain such as severely decreased circulation, infections, blood clots and morphed appendage. It's these additional complications that eventually become just as severe and in some situations even life threatening that sort of push a person into the final aspects of phase II or into full blown phase III where you're just along for the ride, but there's just not a whole lot more you can do about it other than damage control while the doctors try to save your bacon.

One other thing. I guess you might say I've been exposed just enough to what RSD is that I've picked up a couple things along the way, but trust me, I am always the first person to embrace my own inadequacies about everything because the more I learn the less I really know after all. Gee, it does keep it interesting doesn't it? Do take care, Bob.