Neurochick - Forgive me, but I just can’t agree. Based on everything I've read, Rich has a few weeks to initiate treatment in order to have a realistic chance of going into remission with those treatments currently available to the U.S. civilian population. Right now his diagnosis is CRPS. Unless someone know of any reason under the Sun why/how sympathetic blockage or the administration of therapeutic amounts of bisphosphonates could possibly exacerbate nerve entrapment, talk of looking for the proverbial zebras at the sound of encroaching hoof beats could just waste precious time. See, e.g., Early diagnosis in post-traumatic complex regional pain syndrome, Schürmann M, Gradl G, Rommel O, Orthopedics 2007 Jun;30(6):450-6 [ABSTRACT ONLY]:

Abstract
Since prospective studies confirmed an incidence of >10% of complex regional pain syndrome complication in patients after distal radial fracture, early diagnosis is important. Therapy should be commenced immediately with a systematic approach to avoid chronicity of the disease. Despite this, epidemiological studies revealed an extreme delay in effective treatment among complex regional pain syndrome patients, who were repeatedly referred to different physicians and often treated inadequately before being referred to specialized pain clinics. In post-traumatic patients, the clinical examination still is preferred to establish the diagnosis of complex regional pain syndrome. First, possible differential diagnoses must be excluded. Next the clinical criteria of the consensus definition should be checked and documented, if possible with the help of verifying procedures. Imaging methods could be applied; however, they are not useful for early diagnosis since sensitivity is low and the consequences of trauma may interfere with potential complex regional pain syndrome findings. In questionable cases repeated examinations after short periods detect the presence of complex regional pain syndrome in orthopedic patients, particularly if symptoms are progressive or an expected improvement does not occur.
PMID: 17598489 [PubMed - indexed for MEDLINE]

Rich - Please BEWARE ANYONE TALKING ABOUT ANYTHING IMPLANTABLE FOR SOMEONE WITH AS ACUTE CASE OF CRPS/RSD. SEE MY EARLIER POST. PLEASE!!!

I’ve gone through the directory of ABPM accredited specialists in the Houston area and came up with eight names, including information by specialty of origin, etc. Here’s what I’ve got:

Dr Lilly L Chen, MD
Specialty of Origin -Neurology
102 Travis St
Webster, TX 77598
Additional Fax : (281)218-9647
Office Phone: (281)332-4848
Office Fax: (281)338-1428

Dr Everton A Edmondson, MD
Specialty of Origin -Neurology
6560 Fannin St Ste 2202
Houston, TX 77030-2712
Office Fax: (713)797-0641
Office Phone: (713)797-1180

Dr Rangitkumar P Patel, MD
Specialty of Origin – Neurology
102 Travis St
Webster, TX 77598
Office Phone: (281)332-4848
Office Fax: (281)338-1428

Dr Shivarajpur K Ravi, MD
Specialty of Origin - Neurology
2802 Garth Rd Ste 207
Baytown, TX 77521
Office Phone: (281)428-7330
Office Fax: (281)484-3723

Dr Jack Anthony Chapman, MD
Specialty of Origin - Anesthesiology
50 E Ambassador Bend
The Woodlands, TX 77382
Office Phone: (281)793-2145

Dr Matthew Arceneaux, MD
Specialty of Origin - Anesthesiology
1923 Greenwood Oaks Dr
Houston, TX 77062-2354

Dr Marvin C Chang, MD
Specialty of Origin - Anesthesiology
6200 Savoy Dr Ste 150
Houston, TX 77036
Office Phone: (713)337-7246

Dr Barry F Bass, MD
Specialty of Origin - Anesthesiology
3906 Bratton St
Sugar Land, TX 77479-2980
Office Phone: (281)494-0755
Office Fax: (281)494-0757

Based on the list, one would think that there’s a practice group of some sort in Webster TX, but off hand, I couldn't get any online information on either of the doctors who shared an address in Webster. And I looked at the neurologists listed with pain certifications, and frankly nothing I saw particularly excited me there. That and the focus of pain program at the big show in town, the MD Anderson Cancer Center is clearly cancer pain, while nothing I’ve seen on the sites of either Baylor or Methodist Hospital really inspires me that they’re cutting edge.

Frankly, checking out the website of Jack Anthony Chapman, MD in The Woodlands led me to believe that if what you need right now is to start treatment in the next couple of weeks with some lumbar sympathetic blocks, coordinated with physical therapy, he could probably arrange it as quickly as anyone. (UNLESS OF COURSE, HE'S THE GUY WITH THE SPINAL CORD STIMULATOR HANGING FROM HIS BELT.) Even if – for the sake of argument – it’s being done prophylactically, I would plead with you to get a solid series of LSB’s ASAP and explore at the same time the initiation of bisphosphonate treatment, the sooner the better. (I’ve been on Zometa for years, which has, as its great advantage, the fact it’s quite concentrated, on account of which a full dose can be infused in 15 minutes.)

And in that regard, based at least on my experience, I would STRONGLY recommend that your PT be done – if at all possible – by a therapist with the relatively new, 4-year, post-graduate Doctor of Physical Therapy (DPT) degree. Their academic training includes cadaver studies and their knowledge of neuro-anatomy is unparalleled: while most of the PT’s out there are convinced in their heart-of –hearts that all pain is physiological in origin and what you need is “strength training,” which is the one thing that anyone with suspected CRPS DOES NOT NEED!!! “Mobilization” is more like it.

I hope some of this is useful.

Mike