Quote:
Originally Posted by Millerprof
It's been quite a while since I've posted a thread here. I developed RSD in 2007 after a foot surgery. I was actually fortunate to recover from RSD after about 1 1/2 years of intensive therapies. Now my 8 year old daughter recently hurt her foot. She apparently bruised a bone (ironically the same bone that I broke, only on the opposite foot, and she also hurt her foot doing an arcade type game--like dance-dance revolution, in gym, similar to how I broke my foot on the "Jumpin' Jackpot" arcade game). Her doctor believed she would be back to running around quickly since the MRI found only a brusied bone. It's been 3 weeks now, and she's not doing well. She won't bear any weight on it, she complains of "fiery burning pain" and numbness. Her foot turns a red/mottled color like mine did when I had RSD. I took her back to the the orthopeadist on Friday and voiced my suspicions. He told me that RSD is very rare in children. But at the same time she should be getting better and she's not, and the burning pain is a nerve issue, not a bone issue. He suggested we cast it for 2 weeks in case there was a hairline fracture missed in the MRI. I didn't like that idea, as I know what casting can do to an RSD limb. But I want her to be able to walk on it, so the compromise was a Cam walker that she can take off to exercise her foot. She still won't even bear weight in that. He says if it's not better in 2 weeks that he'll do another MRI to see if there is anything they are missing; if not--it's physical therapy. I am so sad for her. I know the awful pain she's going through, and at the same time I know that she needs to move her foot as much as possible or things are just going to get worse. She won't take any meds for it--not even any ibuprophen or acethaminphen, as it makes her nauseas. I can't imagine she would be able to deal with nerve blocks or many of the other therapies I had. She's in competetive figure skating; she's obviously missing that. I just can't believe she may have RSD--as awful as I remember the pain being I really wish it were me instead of her. I have not heard of this being genetic, but I certainly have to wonder--what are the odds that we would both get this?
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Dear Millerprof -
I completely agree with you UNDER NO CIRCURSTANCES SHOULD HER FOOT BE CAST. Immobilization is absolutely one of the worst things that can be done to a fresh case of RSD.
But the good news is that only three weeks out, there are a number of good treatment options available to her. Treatments that may well knock the RSD out of the box once and for all, whereas a few months from now, they would only be treatments and not potentials cures. Stuff like continous regional infusions of a mixture of a local anesthetic and ketamine. And even if they don't want to give a little girl ketamine, another NDMA-receptor antagonist such as dextromethorphan may fill the bill very well: it would mean about 3 - 4 days in the hospital, but without the discomfort of a LSB. (Which, being a kid, she would have under sedation in any event.) For an amazing tale regarding the treatment of a 17 y.o. female West Point cadet, check out:
A unique presentation of complex regional pain syndrome type I treated with a continuous sciatic peripheral nerve block and parenteral ketamine infusion: a case report, Everett A, Mclean B, Plunkett A, Buckenmaier C, Pain Med. 2009 Sep;10(6):1136-9. Epub 2009 Sep 9, FULL ONLINE TEXT @ http://www.rsds.org/2/library/articl...n_Plunkett.pdf
But heck, at this stage, she might respond to mirror box therapy just as well. (It's just a matter of finding a qualified therapist . . .)
I know of members on the forum who have have had good experiences with pediatric pain specialists, primarily in the Northeast. But this one is worth hauling you and and your daughter wherever she needs to be. And under the circumstances, I live little doubt that she would have to wait more than a few days to be seen. Her's is what anyone would call a priority case.
But help us out here, if you can give those who know of good pediatric options a general idea of where you live, it might be useful.
Mike