Things I know

My RSD was NOT caused by restricted blood flow, IRI, lack of oxygen to the arm etc etc etc.

My RSD WAS caused by nerve injury.

People who know me know the full story.

People who refuse to accept my account of how I contracted this don't know me at all and sure don't know my history (or maybe just choose to take the parts they want to hear).

In keeping on topic... this will be my only post on the subject.

Ladies, I hope you all have a wonderful day today. Keep up the good work

Hi Farm Wife,

You are no way alone with the aetiology of your RSD. As I have said in a previous post that if RSD can come from a paper cut or a mosquito bite then there is absolutely no restricted blood flow causing it.
Sorry, I don't know your history but you can be sure that there would be no reason why I would question your account of your injury, you sound like a very well educated and I would gather a resourceful women.
Wishing you heaps of luck
Tayla

Hi Farm Wife,

I try to avoid talking about the personal views of forum members, but I do think it appropriate to point out that in previous posts I have said that diagnoses of CRPS-II have not been discussed in the literature, that some tissue injuries can also injure nerves, and there is nothing in the literature that describes how a nerve injury can cause the signs and symptoms of this disease.

Also, I don't know how one can say: My RSD was NOT caused by restricted blood flow, IRI, lack of oxygen to the arm etc etc etc. Unless tests have excluded IRI or tissue hypoxia. The absence of cyanosis does not exclude either of these, as cyanosis is only visible when the microvascular systems at the skin surface are ischemic.

Many people diagnosed with RSD don't present with cyanosis because the injury involves fractures, ligament injuries, nerve entrapments (which can initiate the immune response to trauma), etc, that don't involve blunt force trauma to the skin.

Finally, while I don't claim to have read all the literature on what might cause painful hypersensitivity to cold, I have look for other explanations for this symptom and couldn't find any that didn't involve diminished cell metabolism due to tissue hypoxia.

I am not arguing with you; I'm simply pointing out that a diagnosis of a nerve injury does not exclude tissue hypoxia. At this stage in my life, I would be relieved to learn that I am wrong about IRI. If that were to happen, I could refocus back to reading history and even possibly write a thesis that could earn a Master's degree in that subject.

Until and unless that happens, however, I feel compelled to explain why RSD is an IRI and that IRI is treatable...Vic

Hi Vic,
First, before I get in trouble, let me state that I enjoy everyone fo your postings and think you do lots and lots of homework. i agree with a lot of what you say and then there are times when i am confused my it. so that being said:
I would like you to explain something to me. i had hip surgery and awoke with nerve damage, unable to control my left foot and numbness here and there from the knee down, then the crmaps started and then the pain and the sweeling and the cyanosis, all within a matter of days. i was of course later diagnosed with RSD. so could you please explain to me, what you think the exact process was?
I ask you this because i can't quite connect the fact that i had a nerve damaged, that caused the nerve palsy, and then the RSD symptoms emerged, and i would like to fit this into your IRI theory and see how i feel about it because i do think you make a good point there.
i will say right out, i do not have a clue what rsd is, or how i got it, or how anyone gets it, or why, or what to do for the pain, or what a cure might be or when ...but i am intersted in your opinion.
thanks, joan

CRPS II is nerve damage, and it sounds like what you have experienced Joan. You might read up on that. That is what I have also, a known nerve damage.

That said, I wonder if anyone has thought about the relationship of the nerves and the vascular system? If you have nerve damage, wouldnt you think it would influence the vascular system?

I mean the nerves control the muscles, and that means all, even the muscles in the vascular system. It could be quite possible that the 2 camps are both "right" here. It seems logical to me that no matter how you got RSD, once you have it there would be complications with anything the nerves had anything to do with.

In my case I got CRPS II from ischemia, which in turn caused nerve damage.
Now there is symptoms of both going on in my body. Kinda like everything is spiraling out of control. Now if we can get blood oxygen flowing in to the damaged areas it would make sense that the nerves could have a chance at healing. Maybe the nerves are not allowing enough oxygen to flow in enough to get any healing, and after a length of time the damage is so far gone nothing is working properly?

I think we should all keep an open mind since even the experts cannot agree completely on the hows or whys of RSD. In my mind the two, nerve damage and vascular go hand in hand, and can both be resultant in RSD no matter which came first.

Tayla,

If you would take the time to learn about the immune response to trauma (IRT), you would know that both paper cuts and mosquito bites are trauma, and the immune response always involves ischemia: blockage of arterial blood flow.

It happens this way: White blood cells respond to the site of the trauma, where they release reactive molecules called oxygen free radicals (OFRs), OFRs are responsible for the inflammation and swelling that are obvious in injuries such as hitting your thumb with a hammer, but even if unnoticed, is present in the IRT to a paper cut.

Swelling compresses the tiny nearby arteries and veins that deliver blood to the capillaries and return "used" blood to the veins. This compression is ischemia.

IRI is a disorder that involves an IRT that doesn't end as it's supposed to; instead, the inflammation and swelling (ischemia) spreads over an increasingly widening area. The second stage of IRI is the blockage of arterial blood flow to the capillaries, which means that the cells no longer receive the O2 and Gl they need in order to function properly.

As I have said before, IRI is a complex series of events which I can't possibly explain in just a few hundred words. In fact, I haven't been able to explain IRI and OFRs in less than several thousand words. I am working on a briefer explanation, which would make it easier to understand, but necessarily means that I won't be able to provide all the information necessary to describe how all of this takes place.

If you are unwilling to accept this necessarily brief discussion of the IRT and IRI, I suggest you should learn for yourself what takes place. With your nursing education and experience, it should take you less time to learn than it took me...Vic

Hi Joan,

I just want you to know I will reply to your questions, but I've been awake all night, and my brain simply refuses to help me out right now. I really do appreciated your questions, because they give me the opportunity to explain a little more about IRI...Vic

Vicc,

Just wondering also how you can get your statement below..

"Also, I don't know how one can say: My RSD was NOT caused by restricted blood flow, IRI, lack of oxygen to the arm etc etc etc unless tests have excluded IRI or tissue hypoxia. The absence of cyanosis does not exclude either of these, as cyanosis is only visible when the microvascular systems at the skin surface are ischemic..."

I had a neuroma removed from my foot. Now a neuroma is a growth on the nerve and i had that removed and just like Joan my symptoms started after the surgery. Cramps, swelling, color changes, skin temp changes, and skin changes and then my foot started to invert. I did not have any thing on my leg during surgery that would cause restricted blood flow or lack of oxygen. My total surgery time was 9 mins. What else would cause RSD expecially since they removed sometihng from the nerve itself and I have nerve damage on 2 toes due to the surgey. (it was expected damage, just a result of the neuroma surgey, i knew that this would happen before the surgery.. just not that RSD was also part of it)

Now I may be repeating my self but cant go back a reread all the other posts, but what test are there to test for IRI??

Amber

I must say that Vicc you have your point of view as I said befor you may be right, who knows but I still have to say that it is just your theory, I do not agree with saying all docs who study this are wrong. Vicc my friend you cannot say that, based on what? your theory that is why more money must be made to study this, and why it is called COMPLEX so many diffrent things happen with RSD/CRPS and why no one test can prove it and diffrent people have a wide range of symptoms, it seems as if one patient has symptoms 1,3,5 patient # 2 has 2,4,6 see it is complex that is why they changed the name.
Again Vicc you should argue this with the medical field first, but do not call the docs who study this all wrong your research material you have did come from the medical field you say are wrong, and are you a doc? please to give some respect to men and women who do study this most with a MD with PHD's in front
I'm not targeting you, or flaming you just disagreeing with you thats all and it is healthy to disagree friend.
I also feel it is wrong to target this site on a another board, I wish you well and please if you can stay here it is good that you are here
sorry if I miss spell it is getting very hard to remember as of late and pain is way up,I may have to have another surgery everyone wich in a way I have nothing to lose, this one deals with my TOS and may help a little so I wish you all well.

Hi Joan,

You wrote: First, before I get in trouble, let me state that I enjoy everyone fo your postings and think you do lots and lots of homework. i agree with a lot of what you say and then there are times when i am confused my it. so that being said:

I have become increasingly impatient with two people who have followed me from thread to thread and repeatedly misquoted me, falsely summarized my views and asked questions that I have already answered more than once. In my view they are harrassing me. On the other hand, I consistently ask for questions and for arguments.

Replying to them has sapped my energy and made it appeat that I object to legitimate questions or debate. I don't.

You and Amber ask essentially the same question in different ways: You apparently suffered nerve damage during your surgery, while she suffered nerve damage that led to the surgery and possibly more nerve damage during the procedure; these injuries are in addition to what appears to be classic models of IRI.

I think that neither group of surgeons recognized that both of you suffered a classic ischemia reperfusion injury: Some sort of tourniquet ischemia done in order to prevent blood loss, followed by a widening area of inflammation and then by a new ischemic stage in which the arterial blood is blocked from reaching the capillaries and thus the cells.

The fact that they failed to correctly identify an IRI is easy to understand: The disorder was long believed to only occur after surgeries involving internal organs. In the 1980s, researchers learned that it can happen in skeletal muscle, but very little has been written about this, and the little I was able to find involves transplanted tissue or restoring amputations (cases that involved long periods of ischemia due to being completely disconnected to the circulatory system).

I believe that physicians who understand IRI believe they completely understand how it is caused and haven't shown any interest in looking for other examples of possible IRI. This makes sense.

I think it important to point out than in just 20 years they discovered a completely new disorder, learned how to prevent it and how to effectively treat it. Contrast this with RSD "experts", who can't agree on a cause for this disease; have no idea how to prevent it, and; have no clue as to how to effectively treat it.

It is time that the RSD "experts" to look beyond nerves and nervous systems, which have led nowhere after 140 years, but they won't. They continue focusing completely on some sort of nerve damage thay hope to find someday, and have closed their minds against any other possible cause.

I believe if they were aware of evidence of tissue hypoxia in RSD, specialists in IRI might suspect what I concluded, that RSD is IRI; They don't know about tissue hypoxia in RSD because they are mostly thoracic surgeons who never see an RSD patient, and if they did have occasion to operate on a patient with RSD and looked up this disorder, they wouldn't see a word about cyanosis, which could provide the clue they need. They don't find it because RSD "experts" deliberately refuse to mention this most important sign.

In a previous post, I went out on a limb and said that every instance of RSD following surgery is, by definition, an IRI. I don't regret saying that, and believe it is only a matter of time before this becomes a uniform belief among medical professionals.

I believe that if cyanosis had not been deliberately omitted from the signs and symptoms of this disease, it is possible that someone familiar with IRI would have already figured this out.

Amber, while my reply was directed to Joan in order to keep it focused, it is the same reply I would make to you. I suggest that both of you suffered both nerve damage AND an IRI...Vic