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Dr. Margaret And Anyone Else---Need Advice, Please!
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angelswife posted:
Hi Everyone,
As you know, I injured my leg in April and was just told it will take 18 months to fully heal. (I had a Tri-Malleolar ankle fracture along with a broken tibia and fibula.) Can anyone offer some suggestions for dealing with swelling and nerve pain?

My ankle and foot have been swelled 24-7 since the cast came off. (I am not complaining about losing the cast, though!) It goes down a bit when I have my leg up and when I sleep, but otherwise it's constant. My MD said I'd be dealing with it indefinitely so I guess I have to live with it, but it's a pain. When it gets bad enough my toes get paralyzed because the nerves are messed up too.

It goes without saying the swelling makes the nerve pain worse...When the nerves act up I get shooting, burning or throbbing pain, weakness in my foot and ankle, and numbness. Some places have been numb since the surgery. The MD said if the nerves hadn't healed after 18 months they wouldn't.

What can I do to manage the nerve pain and swelling? I do soak my foot and ankle in cold water, but I can't do it 24-7. I'd appreciate some suggestions. Thank you!
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xperky responded:
Hi again angelswife. Your write-up of your problem is well written and descriptive. I hope things will improve as your foot adjusts to its new freedom.

I wonder if your doctor can give you a sample/rx of Voltaren Gel to try. It is a topical NSAID, usually used for arthritis pain and swelling. It might help you some, and any relief is good!

Another very helpful product designed for nerve pain is the Lidoderm patch, which numbs the area for hours. That can give you a good night's sleep. They are extremely expensive, unfortunately. Again, a sample from your doctor would be ideal.

I hope the doctors can help you here! You might want to post this question in the pain management forum too.
With Compassion,
Margaret
 
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rudyandirmouse replied to xperky's response:
Angelswife, I'd suggest 2 items: the Lidoderm patch and Voltaren Gel. I have used both and have gotten relief from both without side effects. And both work very quickly.

Perhaps you can get your doctor to give you a few boxes of samples? And as for the Voltaren Gel I tub goes a long way because you don't need much to get relief.
Gentle hugs, Linda R.
 
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Anon_408 responded:
Do you take Neurontin, or generic name is gabapentin. It is used for neuropthy, as is Lyrica, which is the more expensive of the two. Sort of the same category of medicine.

It is prescribed for nerve pain,my mother used it for her neuropthy, being a diabetic.

If not, maybe you could ask your Dr. about it, would be worth a try. Neurontin in generic form is really inexpensive, I think, well I know it is compared to Lyrica. I used to pay about $7 a month CoPay for mine, then Dr. decided to try Lyrica, since they advertise it as specific to FM.

I couldn't afford the $135 a month I had to pay. Hope someone will chime in with other thoughts on your question.
 
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ggladieux replied to Anon_408's response:
Yes I take gabapentin at night to help with pain and sleep, unfortunately it can knock me out for 10 hours or better, I only take it on days where I know I can sleep in.
 
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angelswife responded:
Thanks, everyone, for the input. I will be talking with my PCP on Monday to see what I can do, and I will ask about the Voltaren Gel and the Lidoderm patches. I have been taking half a Percocet at night so I can sleep, but I know long term use probably isn't good, even though the dose is very small. I have never had to use long-term meds for anything and I'm finding it a little annoying! I am trying to hold off on any other prescriptions, though, because Husband is laid off until September. I appreciate all the suggestions!
 
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Mark Pellegrino, MD responded:
Hi Angelswife,

I've been asked to respond to your question on how to manage the nerve pain and swelling.

Neuropathic pain can be brutal. Nerve injuries are a common cause of nerve pain or neuropathic pain. Swelling is common because the nerve injury affects blood flow, and because weakened/inactive muscles can't pump back the blood. The swelling can further aggravate the neuropathic pain because of increased mechanical pressure, and the vicious cycle continues...

Please continue to work with your doctor regarding your specific pain. What exactly is causing your pain? What nerve or nerves are affected? Are your nerves repairing themselves? (this is a good thing, but reinnervation is painful). Sometimes a complication occurs called complex regional pain syndrome that your doctor could check for.

I treat neuropathic pain and swelling with oral medicines, compounded creams, TENS unit trial, pressure garments and more. Your doctor can prescribe specific treatments based on your specific situation.

Take care and feel better soon.

Dr. P
 
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angelswife replied to Mark Pellegrino, MD's response:
Thanks, Dr. P---both my MD and the PT have agreed that RSD is an issue (something I'm not thrilled about). But my MD is holding off on treatment until the swelling resolves to see if some of it will settle down. If I am still having the same levels of pain, sensitivity and weakness six months down the road then we will talk again about treatment.

The two main sensory nerves that run from my ankle into my foot are affected. Also the nerve along my inside anklebone. I have numbness along the incisions, on the inside of my heel, and in one toe; and the entire top of my foot has reduced sensations. Everything is hair-curlingly sensitive to pressure of any sort---for example, the nerves "translate" the edge of my pillow as the edge of a brick wall, and they react accordingly. Any fabric dragging across my ankle sends me through the roof. Also, my foot no longer perceives temperature accurately---if I walk on a cool floor, the nerves say I've stepped in a puddle of cold water. Really odd stuff.

The pain is shooting, stabbing, burning, throbbing---you name it, I've got it. Sometimes it feels like spikes are being rammed through my anklebones. I would assume there's at least some regeneration, because once in a while I'll get a wicked "bee sting" in a numb area. The PT thinks at least 70% of the pain is from the nerves and the rest is just from trying to get my ankle and foot working again.

I don't know if the motor nerves are affected; I do know if I overuse the ankle it stops supporting me and my foot becomes paralyzed. The PT thinks this is at least partly from swelling. All I know is, it's been a long year and it's getting longer!

I've been taking half a Percocet at night to keep things quiet so I can sleep. My MD suggested Aleve instead, but it doesn't seem to work as well. I know I shouldn't keep taking the Percocet though. Since my MD wants to see if some of the RSD will resolve on its own, I'm not sure what other options I have. Thanks for all your help!
 
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booch007 replied to angelswife's response:
Sharon,

When I had my second to last vascular surgery they cut a main branch of nerve to the inner thigh of my right leg. I had a circumfrential disc the size of a basketball, that burned, tingled and hurt when I walked....

As I see neurology all the time I mentioned about the neuropatic pain in the leg. She told me nerves heal an inch a month.....so I could figure out how much he damaged...

It is 4-5 years now and I am finally able to touch it without an "ouch"...just glad it would heal itself. I am hopeful as they are speaking out and sparking away there....that they are growing and healing...alot went on down there.

Hoping day by day it gets better. We definitly have a knowledge of pain here right? Lots of ((((hugs))))) Nancy B
 
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crystalscats responded:
Hi Angelswife, boy do I feel for you. I hate the nerve damage more than anything! I laughed when you used terms bee stings (I still look see if bee did sting me lol) and sledge hammer to your ankle. I use the Voltaren Gel and Liticane patches too as others have listed. However for my neurophy pain I use Neuragen cream. It is for diabetics and the nerve damage I have from it. You can get it over the counter, Walmart, etc. Sometimes Walgreens has it on sale. It helps me thought it might help you too.

Crystal
 
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angelswife replied to crystalscats's response:
Thanks, CrystalsCats---I didn't know there was such a thing! I will have to have Husband pick some up next time he goes to Wal-Mart. I am so ready to get off the Percocet...I know it's a small dose but I still hate taking it!
 
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fitzgift replied to crystalscats's response:
I also have been having trouble with my ankle it tingles constant ache numbness I don't know what the problem is it just started my calfskin on both legs give me a lot of trouble at night in the past I have had restless legs and have been of my medicine for this I just hate taking pills , but I think I am going to have to get back on and will try this Naurogen you suggest. Thanks


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