History of foot

June '94

	First big attack: middle of the night, woke up with burning in arch of left foot.
	Burning lasted 4 days. Soreness lasted 2 weeks.
	Saw ER doctor and podiatrist
	Diagnosis: plantar fascitis

Sometime '96

	Big attack: middle of the night, woke up with burning in arch of left foot.
	Burning lasted 4 days.

Sometime '98

	Big attack: middle of the night, woke up with burning in arch of left foot.
	Burning lasted 4 days. Pins and needles in big toe and arch.
	Lower leg became very swollen.
	Dr. Cabales (internist) put me in hospital for tests for blood clot; results negative. Did blood work looking for other causes. He prescribed Apap/Codeine 300-30mg, 4Xday.

November '98 - March '99

	Little attacks every night: Middle of the night, woke up with burning in arch of left foot. Sometimes, the big toe would be numb. Would walk for 20 minutes, and then could sleep in a chair with the foot on the ground.
	Had a few more attacks where lower leg would swell quite a bit; swelling would last 2-3 days.

March '99

	Diagnosis: tarsal tunnel syndrome (confirmed by EMG).
	Did blood work looking for other causes.
	Doctor: Sheldon Lin performed tarsal tunnel decompression surgery; didn't help. He prescribed Elavil; I didn't like side-effects of Elavil (25mg, then 10mg). Percoset; Percoset didn't seem to help. Vioxx (25mg); didn't help. Roxicet (5-325mg, every 4 hours)

April '99 - May '01

	Most months have big attacks with swelling.
	Numbness in big toe after some big attacks (March '00)
	Most months have 2 weeks of small attacks.
	Small attacks normally begin on the first night of my period OR on the last night of my period.
	Walking during small attacks helps with pain.
	Use Demerol (50mg every 4 hours) with big attacks for 36 hours.
	When sitting, cannot have left foot on ground or get electric shocks or pins/needles feeling in foot.

July '01

	Small attacks every night. Biking helps. Cold water baths with ice helps.
	Walking doesn't help anymore.

August '01:

Saw Geraci (neurologist); he performed EMG; said there was no nerve compression in the tarsal area. He ordered MRIs of the lumbar (8/18/01) and pelvis, which came back normal. He prescribed MS Contin (15 mg first, then 30 mg). He sent me to a pain management clinic; he thinks it is RSD.

Sept 18 '01 (description of pain in mid-Sept '01)

	7 out of 8 nights, wake up 1/2 hour after go to bed or napping
	pain is normally burning, sometimes itching
	walking helps sometimes; biking almost always helps
	very hot or very cold foot baths help
	pain last 1-4 hours
	have swelling at ankle
	during the day have moderate pain; burning and a heavy numbness that is difficult to walk on. socks and most shoes bother me; have hypersensitivity

Sept 26 '01

got RF nerve block from Thomas; no change. (Gary Thomas at the Cabrini Pain Management Center; pain management doctor)

Oct 12 '01

	Thomas started me on neurotin; wants me to get to at least 300 mg, 300mg, 600mg per day
	He gave a steroid injection in medial ankle at mid scar (triamuinolore and bupivicaine). the steroid injection caused a big attack within 5 hours. The swelling was worse than i ever had; gained over an 1" around the calf; it went down within 24 hours
	The pain was very very bad; biking hurt, water baths didn't help; took 1200 mg MS Contin, which seemed to help after 3 hours - the calf muscle and tendons tensed up; i needed a muscle relaxant to help keep the muscle relaxed; i was on crutches for 5 days do to muscle pain
	Had very bad lower back pain for 7 days

Oct 26 '01

	current nerve pain
	NO burning at the ankle area
	frequent electric shocks, numbness over entire foot bottom, mottleness over entire foot bottom
	sensitivity to touch increases; esp. bad on bottom of toes and side of foot by little toe.
	current other limited toe mobility; can only flex toes in a limited manner; cannot point toes at all, or spread toes. when I try to point, the toes have no resistance.
	Pain in foot while peeing and coughing
	Saw pain management doctor. he prescribed an anti-inflammatory for the muscle/tendon (diclofenac sod / voltaren, 75mg) (this bothers my stomach; sour stomach). he suggested creative movement for the toes to help heal the nerve. he prescribed vitamins to help heal the nerves; should take 6 months. multi-vitamin lecithin: 1000mg, 2X day. flax seed or primrose oil: one capsule, 2X day. GNC, Parmassure, Neurosyn. he seemed surprised with the toe problems.

Nov 1 - Nov 30 '01

Am using crutches; too much muscle pain and hypersensitity when walking

Nov 8 '01

	Geraci repeated lumbar and pelvic MRIs repeated (Oct 30 01); they came back normal.
	Saw Geraci: during his exam, he said that i have weak hips. he prescribed Ultracet (1 table 2 X day); it seemed to help with achy feeling

Nov 23 '01

	Off the neurotin completely; didn't like side effects.
	Had spinal MRI; no contrast was used.
	Geraci wanted to rule out a dural AV fistula.
	Results were normal; on 11/30, Geraci reported that there was a little thickening of the spinal cord that might occur with fistulas.

Dec 17 '01

Saw OB/gyn (Dr. Thomas at Mt. Sinia); he saw no evidence of endometriosis.

Dec 20

Current description

	Calf very tight; hurts to touch
	Quite a bit of muscle atrophy in calf
	Have severe tendon pain on left leg (outside of ankle, and outside of knee) going up back of thigh
	Cannot sit still, started muscle relaxant (baclofen again; 60 mg/day)

Dec 23

Shooting pain started at tail-bone area and goes down back of thigh

Dec 27

	Saw Dr. Weinberger at Columbia pain management center
	He prescribed an opioid (hydromorphone; 2mg as needed): (having problems with constipation)
	An anti-depressant (nortriptyline; 10 mg at bedtime).
	An increase in the muscle relaxant; 30 mg 3 X day
	His examine showed reflexes at ankle not working

Dec 28, 31

Current description

	Am not sleeping more than 2 hours/night
	Still cannot sit still; mornings and evening are worst
	Muscle between calf and ankle cramping a lot
	Either the peronius brevis or the flexor hallucis longus)
	Stopped taking muscle relaxant; calf is better
	My semimembrranous is sore; this is one of the hamstring muscles, starting at the top of the knee.
	My piriformis muscle is sore; this is one of the hips; the pain starts around the tail bone and goes 5 inches or so.

Jan 14 2002

	Increased nortriptyline to 20 mg at bedtime; started Ultracet again
	Am sleeping better and some of the achiness is gone; can mostly sit still
	Tom thinks he see atrophy at hamstring area
	Am having problems pointing the foot, both with the toes and ankle stopped taking extra vitamins

Jan 24 2002

Increased nortriptyline to 30 mg; still on Ultracet

Having problems clipping in pedals; when biking, left leg isn't useful due to inability to lock ankle.

Can sit still half the time.

Current description

	Tendon-like pain behind knee on outside of leg and on ankle (an hour/day)
	Calf, hamstring and piriformis muscles are sore; heat helps once every 5 days, have shooting pain from tail bone down back of leg
	The numbness on bottom of foot at big toe is coming back; electric shocks are back.
	Get goose-bumps in patches on entire left leg when i bike.

Jan 29, 30, 31 (full moon)

Burning pain in middle of night (small attack; first since Oct.)

Feb 4

	Saw Adams (neurologist at Columbia); he found a "mass" on the hamstring. He ordered blood work, MRIs of the calf, thigh, and butt, and another EMG.
	He prescribed trileptal to help with the shooting pain; got rash
	Saw Weinberger (pain doctor); he discovered that my left adductors and abductors are much weaker than the right ones.

Feb 6

Saw Fishman (Manhattan Physical Medicine and Rehabilitation) using EMC, he diagnosed piriformis syndrome; wants to give botox injection into muscle. Adams thinks we should wait until we see the results of the MRI.

Feb 12

EMG - post tibial nerve is very weak to calf muscles; peneal nerve is fine; have slight radiculopy at S1-L5; hamstring muscles have denervation.

Feb 13

Had knee xray; nothing abnormal

Feb 28

Had MRIs of calf, thigh, butt done; everything is okay, but have 5x5x8 cm soft-tissue mass

March 13

Saw Dr. Andrews (orthopedist at Columbia) to look at tumor.

Andrews thinks it is a nerve tumor and that a neurosurgeon should do a biopsy.

Current pain

	Pain in tumor area; achness
	Tight calf muscles; they feel too short tightness in hamstrings; feels like a band around the muscles.
	Pain when standing; some pain when walking.
	Skin color is poor on left lower leg; mottled or red; temp. is off in middle back of calf
	Electric shocks in foot, some burning in ankle
	Side of thigh (by knee) hurts after biking; feels very lumpy.

March 26

See Guy McKhann (neurosurgeon at Columbia) would like to do incisional biopsy and remove the tumor if is it benign

March 30

Got chest x-ray for surgery; nothing abnormal

April 4

	McKhann performed incisional biopsy of tumor; the results are an Ewing's sarcoma/PNET
	Since the biopsy: have shooting pains when straightening the leg or when putting weight on it. back on crutches. Have lost more sensory (back of the calf, by the knee)

Copyright © 2003 The Shriver Family: Last modified: 01/06/04.