RSD Replies Part 2

RSD Replies Part 2

Derek Kozar

11/13/2001

I hope this message gets through as the second part of my replies.....

I have
done TONS of research on RSD and my residency project will be on this
topic
as well (because I suffer from it). For patients with RSD, amputation
IS NOT
recommended. It is a contraindication. The reason for this is that RSD

is a
progressive disorder and many times after amputation is done, RSD
develops in
the remaining stump. It will then travel because that extremity has
experienced excessive trauma. THIS IS NOT RECOMMENDED. Furthermore, I
have
traveled all over to Dr.'s around the country, and found one that is THE

BEST
in treating RSD. I can almost guarantee relief for this person.


My thoughts on this subject are that RSD is a little known disorder.
With the limited research on it, no one can determine the
cause
or cure.
I have dealt with several patients and a family member that have RSD,
and it is a very difficult task to treat. It is an even greater
task
to understand what these people experience. My fear for your patient is

that if an amputation does take place, who is to say
that
the disease does not spread. I have had a few patients where that has
happened, and it is even more traumatic than dealing
with it
in the first place. Can cause even the strongest of individuals to slip

into depression.
My suggestion is to tell your patient to explore all avenues before
continuing with an amputation.

Encourage the patient to try a course of true elevation of the lower
extremities, by which I mean feet higher than knees, knees higher than
hips,
hips higher than heart. This can be done by laying on a sofa with the
head
cushion removed and added the the foot area and try to stay down in this

position for an extended time. Most people with swollen extremities
report
the feeling of the water starting to soon flow from the swollen limb.
Then
other conventional methods of orthotic support can be tried if this
helps,
the cost is cheap and benefits can be very efficient.

I've worked with several RSD patients. First one elected amputation
with no relief of the pain. Watch him go slowly downhill, get depressed

and eventually commit suicide. It was an eye opening experience and a
very sad one. I have not EVER heard of a case of RSD who elected
amputation and had success. I would advise this gentleman to really
research amputation as an elective because it likely won't help the
situation.

I am dealing with a RSD case now and am also in that debating phase.
They are really so different that it is difficult to offer advice. I
was honest with my lady and stated very clearly that my orthosis may not

assist with her pain at all. I say it's just like medicine. Sometimes
it's successful, sometimes it helps a little, other times it is rendered

totally useless. RSD is a very horrible thing. My advice is to treat
the PROBLEM and not the PAIN. I don't think you'll be successful at
reducing the pain. Don't end up being the escape goat and explain this
to your patient right up front.

NO.. although Dr. Hooshmand and Hashmi have done lots of RSD research
and I
am sure are very fine Dr.'s for this disease.. I have found one that I
as
well as many others feel is the best in the country. He is at Cleveland

Clinic and his name is Dr. Stanton-Hicks. He has done lots of research
and
written many pieces on RSD. He also sees hundreds of patients a month
with
this disorder. I was on crutches for five months before treatment
through
Dr. Stanton-Hicks. Although I still have lots of pain, I am off
crutches and
working on P.T. to decrease the pain and ROM. IF you have any other
questions or comments, do not hesitate to call or write.