Tuesday, February 5, 2013

Post-Opertive Infection With Hardware

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Hi i had surgery on a heel fracture 2 stainless pins inserted i had 2 cast changes they were on a little over 1 month each. finally cast was off my parents and friends questioned the color of my foot they said it didn't look right but i said doc gave it the ok.the next check up the doctor said now infected. gave me prescription 2 antibioitics 1 cream. my next appointment was 1 week later skin graph doc. at app. doc looked at wound said admit yourself in hosp now. on i.v.s 5 days now on wound vac. can infections become that critical in 1 week. when the cast was 1st off. my heel was extremely painful to touch and yellowish . now i can touch my heel after iv.s it seems to me the infection was overlooked ?

Gender: Male
How tall are you (feet and inches)?: 5 10
What is your weight in pounds?: 148
How old are you?: 52
How long has this been going on?: More than a month

Describe associated symptoms not listed above: had tingling feeling in heel while cast were on i was told bone growing

What have you done so far to remedy this condition? Please include tests and relevant studies here. Wound vac.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): need maybe 2 more operations

Please list any medication allergies that you have : : none

Please list any medications you are currently taking (and dosage if known) :: 2 antibiotics per day doxycycline hyclate 100mg

When was your last menstrual cycle?: Now
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely

What can i do if the infection was overlooked some reason i seem to be backpedaling on getting better.

________________________________________

I wish I could give you a definite answer but I can't because your question calls for speculation... guessing on my part. The fact is that you broke your calcaneus. This is from a high energy injury, in other words, an injury with lots of force transmitted to your foot. The repair of this kind of injury is very difficult to start with. The fact is that the surgery you had to repair your broken heel carried with it a known risk of infection to start with. And if your original injury was bad enough to break the skin (an 'open' fracture) then the chance of infection would be even higher. 

But let's assume that there was no infection introduced during your injury or the repair. It is possible that a small break in the skin near the surgical site introduced bacteria deep into the wound. 

The fact that you have metal screws in your foot makes the infection MUCH worse, because now the screws probably have to come out. 

To answer your question about the infection being 'overlooked', it is not that simple. There is no test that tells if there is infection or not. As you learned, a wound infection is diagnosed by physical exam. Lab testing can help, and bone scans and the like are often used to tell if the bone itself is infected, but there is no way to say if it was overlooked. 

If you wish to consult a medical malpractice attorney they can probably answer this better than I can.

Unfortunately, not even your doctors know right now how long this will take to clear and how many operations you might need (though I see you think there are two surgeries upcoming). You had a bad injury that shattered your calcaneus bone. Even without the infection your chance of getting back to near-normal was very low and you would likely have had some pain and lack of ability to fully use your foot for the rest of your life. 

With the infection the end results are unknown at this point. 

I'm not sure if I have answered your question, so if I have not, please respond in the comment section. Good luck. 


Saturday, January 12, 2013

Acute on Chronic Abdominal Pain

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

6 months ago my 3 yr old landed a perfect knee to my solar plexus causing intense pain and vomiting. A month later he did it again. I am now very sensitive there. Last week while dusting myself off a lite pat to the area created considerable discomfort for the rest of the week. Saw family doc on Thursday. They feel it acid reflux. I didn't have discomfort until I was hit. Lucky me, my son landed another one last nite while giving me a hug. I'm able to flex 6 pack abs and pecs, do push ups everything as normal. I can take deep and shallow breaths normally. Normal appetite. Normal digestion and movements. Normal sleep. The problem is a constant mild to  dull radiating pain in my solar plexus area. It almost feels like a hollowness in the center of my chest behind the muscles and sternum. Sounds a little strange but not sure how to describe.


Gender: Male
How tall are you (feet and inches)?: 5 10
What is your weight in pounds?: 175
How old are you?: 39
How long has this been going on?: A week or two
Check all symptoms you are currently experiencing: Chest Pain
What have you done so far to remedy this condition? Please include tests and relevant studies here. Blood work for Gall Bladder and Pancreas. Results normal.

Please list any chronic medical problems and also list any prior surgery: Total Hip Replacement
Appendectomy

Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Daily

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible.

Can you bruise the solar plexus?

What is the best method of diagnosis for a non muscular skeletal injury?
What are possible treatments?
__________________________________________________


Sir, 
This is a puzzling case indeed. 

Can you bruise in the solar plexus? Well, you can get an abdominal wall bruise, but six months ago? If this were the cause then you should be well by now.

The next question is the real money question... What is the best method of diagnosis? The answer is a contrasted CT Scan, perhaps an MRI of your abdomen and pelvis. 

I think you should have this as soon as possible. I think your logic is sound in thinking back to the incident with your three year old, but from a doctor's perspective, I am concerned about your story. 

The nature of the pain concerns me. The chronicity of the pain concerns me. In short, being ER trained, I think automatically of the worst possible cause, and this is, of course, cancer. Do I think you have it? No, but it IS on the list. As long as it is 'on the list' it's time to take it off the list as quickly as possible. This requires imaging studies as mentioned above.

You can not rule out disease of the pancreas or gall bladder with blood tests, though the results can suggest disease. It's time for you to get back with your family doctor and let him know that your pain has been present for six months. And it's time to request either a CT scan of your abdomen or pelvis, OR, referral to a GI specialist or surgeon. 

If you have questions about my answer please leave them in the comment section. 

Be well



Sunday, January 6, 2013

Sudden, Painful, Abdominal Wall Bulge

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I was practicing Yoga today, lifting myself up in a pose that uses arms, and lifts the legs up, so there is a lot of pressure in the abdominal muscles, suddenly I felt a sharp pain 2 centimeters to the right side, and one centimeter down of my solar plexus, I had to stop the pose, and touched what it felt like a bump, maybe a hernia, it was really painful, I put some pressure and it went down, but I still feel a little pain, and I'm concerned as to what that could be. I had to put a few days ago because the site wouldn't let me leave it at started today, but this, started today.

Gender: Female
How tall are you (feet and inches)?: 5'7
What is your weight in pounds?: 123
How old are you?: 43
How long has this been going on?: A few days

Describe associated symptoms not listed above: I had a really bad cold, was bedridden for almost 13 days, first 3 days I had a fever and chills, I was so tired, I got up on day 13, I'm still not strong enough, this was 4 days ago when I got up, I feel as though my body aches, which it does because I also teach Yoga and practice daily. I haven't been eating as much as I usually do, I'm a raw vegan, I'm very healthy, but I have some stress going on in my life now so I haven't been very diligent or disciplined when it comes to eating.

What have you done so far to remedy this condition? Please include tests and relevant studies here. Just happened today, pushed the bulge down.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): I've had 2 myomectomies, 2 laparotomies to remove uterine fibroids, and a cyst in the right ovary. I've also torn L4 and L5 a year and a half ago.

Please list any medication allergies that you have : : None that i know.

Please list any medications you are currently taking (and dosage if known) :: I started taking Opti Gyn Formula from Eclectic Institute. I have uterine fibroids and don't want to get surgery yet again, besides they pressure my bladder so I cannot get over 4 hours of uninterrupted sleep, sometimes even less than that.

When was your last menstrual cycle?: 2 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never

I'd like to know what this is and the steps I should take. I'd like to know whether I can shrink the fibroids without surgery and whether there is something I can take to stop going to the bathroom all night so I can sleep.


___________________________________________________

So I think it is fairly safe to say that you have given us the textbook definition of an abdominal wall hernia here in your question. The fact that it occurred suddenly during exertion and produced a  bulge in the abdominal wall is nearly diagnositic. 

Abdominal wall hernia's are not as common as umbilical hernias or inguinal hernias, but they do occur, and they do require repair by a surgeon. 

This link here might be helpful to you, I'm not sure, you seem to understand what a hernia is but I will provide it for your information.

Strangely, it is the small hernias that are the most dangerous. For this reason I think it is critical that you see a surgeon soon to get this looked at. Small hernias are prone to 'incarceration' which can lead to 'strangulation', where the herniated tissue becomes trapped and dies. This then can lead to rupture and peritonitis and then, instead of an elective repair of a small hernia defect, you face major surgery and days if not weeks in the hospital. 

My recommendation about your second question is simply that you consider a hysterectomy. At age 43 you are likely not thinking about having children, and I can only assume that the myomectomies were performed in an attempt to preserve fertility. There is no medicine that will allow for you to sleep through the night as the problem is mechanical, the fibroids are compressing the bladder. 

Interestingly, since it is likely you will need surgery for this hernia that we think you have, you might be able to get the hernia repair and a laparascopic or trans-vaginal hysterectomy done at the same time. This will require agreement between two surgeons (not an easy feat), but it's certainly something I would pursue if I were you. 

Finally, if you have not had your blood count checked lately you will want to do that. Uterine fibroids, with the chronic bleeding that often accompanies them, can cause ANEMIA, and it may be that you have anemia and are experiencing some of the common symptoms associated with it (link provided). 

If you have any questions about my answer please ask them in the comment section. Thanks for your question, and good luck!




Monday, December 17, 2012

Chronic Redional Pain Syndrome and Neuroligical Symptoms

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

I've had RSD/CRPS for> 2 years CRPS2, stage 3. It is in both legs from my hips to toes and 5 mos ago started with symptoms in one of my arms. Since then, I have had more symptoms in my head that I am wondering if they can be due to the RSD. They are- ear pain, dizziness - like vertigo.  I went to an ENT MD, but she wasn't very acquainted with RSD. I am very accustomed to my meds, this is not from them. She indicated that I would have to come off all my meds to find out what was going on. I can't come off them - not with my pain. I do have a spinal cord stimulator which helps,but not enough to come off my meds. Thoughts?

Gender: Female
How tall are you (feet and inches)?: 5 ft 8 "
What is your weight in pounds?: 145
How old are you?: 54
How long has this been going on?: More than a month

Check all symptoms you are currently experiencing:
Palpitations
Ear/ Nose / Throat
Musculoskeletal Pain
Neurological

What have you done so far to remedy this condition? Please include tests and relevant studies here. Saw ENT. Cannot have MRI.

Please list any chronic medical problems and also list any prior surgery : RSD / CRPS 2 (damaged rt.  peroneal nerve from a bad pre-surgical block.

Menieres dsease
C5-6 fusion
Rt great toe surgery
Pelvic thrombophlebitis

Check all conditions present in your immediate family... :
Cancer
Cardiac Disease
History of Back Pain
Please list any medication allergies that you have : : None

Please list any medications you are currently taking (and dosage if known) :: Gabapentin 600 tid
Ultram 100mg tid
Cymbalta60mg
Dyazide

When was your last menstrual cycle?: 4 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: Within the next few days

Just want to get information.

__________________________________________

Wow. This is a very complicated question.  I am going to say right off the bat that in terms of RSD I wouldn't say that there were any doctors 'very acquainted with it' in that we do not understand it. We have treatments for it and research is ongoing, but it's a puzzle to us for the most part. 

Your ENT doctor may be more aware of RSD than you think. The current consensus seems to be that RSD can occur at the site of a prior trauma or surgery. There is nothing to suggest that it can affect the brain and produce the symptoms you are describing. 

I notice you have Meniere's disease. This was my first thought when I saw your question... that you might have Meniere's.

I think what your ENT is doing, or wanting to do, is to see if your many medicines could be causing side effects. I agree with you that stopping them may not be wise, but if you go to this website here (click on link), and add your medicines, you will see that the interactions alone could be causing some of your symptoms. This is quite apart from the side effect profile of each individual medicine you are on,

Here are the some side effects for your medicines....

Ultram, dizziness or spinning sensation
Cymbalta, headache, trouble concentrating, memory problems, weakness, feeling unsteady, loss of coordination, fainting, seizure
Gabapentin, dizziness, drowsiness, weakness, tired feeling, nausea, diarrhea, constipation, blurred vision, headache

And that is a very partial list of all known side effects. 

So, in summary, I can not tie RSD into the symptoms you mention. I can tie it to your medicines. I can also tie it to your Meniere's disease. I think the best thing for you to do is to get your RSD physician talking to your ENT physician. Right now it seems they may be working at cross purposes. 

Other than that I suspect this is likely related to your Meniere's disease than anything. Even though you may not be able to comply with your ENT physician's request to stop your medicines, I would continue to work with the ENT to find a solution, yours is a very complicated case.

Saturday, November 10, 2012

Liver Enlargement?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

This morning, while lying flat on my back in bed, I noticed that if I press around the area of my my solar plexus I can feel something rather firm and shelf-like. It doesn't hurt but was a little tender to pressure. It seems to be my liver, but why would it be firm? I have been overindulging in alcohol for the last month or so (I know, I will stop) so could that be a cause? Should I worry? I was recently laid off and do not have health insurance so am reluctant to visit a physician right now... Thank you for any input. 

Gender: Male
How tall are you (feet and inches)?: 6 feet, 0 inches
What is your weight in pounds?: 225
How old are you?: 44
How long has this been going on?: A few days

Describe associated symptoms not listed above: Odd firm structure, maybe my liver, in upper abdomen. Easily palpated.

What have you done so far to remedy this condition? Please include tests and relevant studies here. Nothing

Please list any chronic medical problems and also list any prior surgery: Cholecystectmoy (laproscopic) two years ago

Check all conditions present in your immediate family... Diabetes
Please list any medication allergies that you have : : None
Please list any medications you are currently taking (and dosage if known) :: Metformin ER 1,000mg/day

Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Daily


Is the structure I feel my liver?
Is it abnormal for it to feel firm/hard?
Is it abnormal for the liver to be easily palpated?
-----------------------------------------------------------------------


Very hard to say what this is. If you have been a regular drinker for many years you may indeed be feeling your liver, as a long drinking history WILL cause liver enlargement, and, in many, Cirrhosis. 


I understand your reluctance to see a doctor because of money issues, but you really need to get an ultrasound of your liver. This will tell if it is enlarged and if you have cirrhosis. If you do, you MUST change your alcohol habit and now. 


If this is not your liver or cirrhosis then the alcohol is not so important, at least right now. But it is hard to imagine, from the way you describe this, that this would be something OTHER than your liver. 


An ultrasound is not expensive. It is the test you need, along with a good exam by a good physician. 


Good luck, and if you have further questions please ask them in the comments section.

Thursday, October 25, 2012

Irritating Cough

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Ask your medical question here. : Two years ago I had a bad cold that turned into a chronic cough.  Eventually, I was diagnosed with asthma by an urgent care clinic doctor.  I took my meds faithfully, but they never really helped.  A year later, I got very sick with chest pain and breathing problems.  The same clinic diagnosed me with pneumonia; however, after their review of my x-rays, they said I did not have pneumonia.
Later, my GP said I did not have asthma, so I stopped taking my meds.

I now take Allegra only, and only occasionally (I forget to take them).  I have constant phlegm in my throat, but the cough only occurs after I eat or drink, even water.  It occurs every single time I swallow something, and lasts about an hour. I do not have (or don't notice) mucus in my sinuses.  I would like to know if it is possible to have tests show what is causing this symptom, and how it can be controlled.
Gender: Female
How tall are you (feet and inches)?: 5' 5"
What is your weight in pounds?: 128
How old are you?: 51
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing: Ear/ Nose / Throat
What have you done so far to remedy this condition? Please include tests and relevant studies here.
: x-ray of lungs
Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): whole body peripheral neuropathy - idopathic
Check all conditions present in your immediate family... :
Cancer
Hypertension
Stroke
Please list any medication allergies that you have : : penicillin, sulfonamide, tetracycline
Please list any medications you are currently taking (and dosage if known) :: Allegra - 4 or 5 a week
When was your last menstrual cycle?: I no longer have a menstrual cycle
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Weekly
I would like to know if this could be caused by a new allergy to food, and if I should get food allergy studies, or if it is possible that my neuropathy is causing my esophagus problems.
May we send you a satisfaction survey after your question is answered? It takes a minut to fill out.: Yes


__________________________________________________________

Sorry for your problem. It strikes me that you probably need to see an Ear Nose and Throat specialist. This problem could well be related to chronic sinus inflammation. Allergies are often associated with this. The sinuses drain to the back of the throat so this problem often causes a chronic cough which can be mistaken for asthma, though I must say that diagnosing you with Asthma without proper testing seems a bit off to me. Also consider the possiblity that you could have GERD (reflux) which can also cause a chronic cough and is also sometimes mistaken for asthma. My money would be on the first based on your symptoms.

I hope this helps. Please click on the links above for more information. Ask any follow up questions you may have in the comment section.

Be well.

Mononucleosis, Abdominal Pain, and Chocolate

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For the past 5 months or so ive hard sharp pains in the solar plexus area. Occassionally this pain has traveled to my lower back. This pain always shows up while im asleep keeping me awake from 30 mins to an hour or two which consists of me trying to find a comfortable podition to lie in. Ive recently just gone away to college a month and a half ago and the pains have gone from once a month to once a week or once every two weeks.

5 months agoi was very physically active and did have slight back ains only when doing pushups.

Around 4 years ago i was hospitalized and diagnosed with mono. There was inflammation around my liver, my gallbladder, spleen and kidneys. I couldnt eat and had to work my way up from an all liquid diet. After getting released i was forbidden from doing exercise for at least 3 months and did not fully heal til at least 3 months after that.

The doctors said it would take 1 to 2 years for my body to fully recuperate and that i would carry the virus.

As of now my appetite is fine, the only thing bothering me being an itchy throat ive had for the past 4 months or so.
Ive been monitoring my diet and have seen that sometimes i may have worked out or eaten chocolate before sleeping.
My stomach has not reacted well with me eating chocolate since the mono sometimes causing stomach aches after eating it in the day.

And if its not too much to ask what could be causing this constant itchy throat?

My throat feels dry or itchy and it gets hard to try to cough. I try to always keep water near me to stop it. I end up coughing a couple of times. Hard enough that i end up tearing every time.
Gender: Female
How tall are you (feet and inches)?: 5'4
What is your weight in pounds?: 130
How old are you?: 20
How long has this been going on?: More than a month
Check all symptoms you are currently experiencing: Abdominal PainAbdominal Pain
Describe associated symptoms not listed above: Lower back pain
What have you done so far to remedy this condition? Watched my diet
I had thought that it was only when i ate chocolate before going to bed last two or three times but thats not the case this time. Ive also seen it may occur after working out.These are just guesses on my part.
Check all conditions present in your immediate family... :
Asthma / Lung Problems
Please list any medication allergies that you have : : None
Please list any medications you are currently taking (and dosage if known) :: None
When was your last menstrual cycle?: 3 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never
Causes for pain
Any suggestion for treatment?

_____________________________________________________

Wow, these questions are very hard to answer without testing. My first thoughts are that you need a good pelvic exam by a qualified physician and that the most likely cause of your abdominal pain is going to be Gynecological. My money would be on ovarian cysts. These occur and reoccur.

Here is a helpful link for you.

This has, almost certainly, nothing to do with your recent bout with mononucleosis.

Getting to the bottom of female abdominal and lower back pain is complicated. I am simply giving you my best guesses. You definitely need a pelvic exam, and, based on that and other data, you might need an ultrasound or even a CT scan. An ultrasound would be optimal for finding ovarian cysts, a CT for most other problems in the abdomen. This does NOT sound like something bad lurking... It just doesn't sound that way.

You can certainly take Ibuprofen for this as long as you are not allergic. Tylenol would be my second choice until you get this properly diagnosed.

You may need to lay off chocolate for a bit if that seems to be a trigger. I would also suggest to you that your itchy throat may be due to allergies. It is the right season for them. Taking Loratadine over the counter might be a reasonable thing for you to try, but again, no substitute for having a doctor take a peek.

I hope this helps.