My foot saga

I sent this rather long, chatty email to my family recently to fill them in on all the sordid details of the saga of my feet. I decided that I would post it on my blog, masking the references to the various doctors, to protect me from any potential lawsuits. One of them deserves to be sued, and you'll figure that out if you don't fall asleep first. Some of you, if you don't get a sore back reading it, might use it as a cautionary tale if you ever find yourself in my position.

OH MY ACHING FEET!

Getting old is a bitch, as anyone who gets old can tell you. Betty Davis once said, in her distinctive voice, "Getting old is NOT for sissies!" She didn't mean gay guys.

To date, I have had two surgeries on my feet: the first, in January of 2006, by one (belatedly-discovered-to-be-a-quack) Dr. G--- L---- (heretofore known as POD 1 - for Podiatrist 1), who performed a bilateral (both feet - but I don't need to tell you educated folk that) "de-compression".

I'd been diagnosed with a "Morton's Neuroma" in both feet, what some people might call a pinched nerve, or others might call a tumor, or what still others might call getting old. For me, that meant getting horribly sharp shooting pains in the balls of my feet that could last anywhere from one second to ten seconds. It was those ten-second long, I-think-I-have-to-commit-suicide pains that drove me to see a doctor in the first place.

POD 1 said that I had very flat feet, which can certainly lead to problems later on with the feet. Hey, I didn't have to sweat the draft for Vietnam after all! I would have been rejected because of my flat feet!

After some conservative therapy, which consisted of fitting orthotics (which helped a LOT), to periodic injections of steroids and/or powerful anti-inflammatories, with no real reduction in my shooting pains, I decided it was time to cut.

The frequency of the shooting pains was actually increasing. They would make me literally cry out in pain, and there was nothing I could do during an attack to make it stop. Some people thought I had Tourette's.

I trusted POD 1 at the time. After all, he's got this gorgeous office in the Medical Center in Houston, and there were all these awards hanging on the walls for this, that, and the other, and he was a teacher at Baylor College of Medicine. And besides that, he was the brother of my long-time dentist K------ L---- (Dentist 1), who referred me to him in the first place.

Aside: After I left Dentist 1, I came to learn that he was in fact as big a fakir as POD 1. So, apparently, bad medicine runs in the family. How's that, you might ask? Well, every time I went to Dentist 1, I had a cavity. And over the years that I was seeing Dentist 1, he put about six crowns in my mouth. After we moved downtown and it was no longer convenient to visit Dentist 1, I switched to Dentist 2 in the underground tunnels, where I work downtown. Talk about convenient.

In the three years that I have now been seeing Dentist 2, I have had not ONE single cavity, nor has he seen any need to put in any crowns - and I do have some crownable teeth left. So, considering that I made no great changes to my diet or brushing my teeth after changing dentists, or flossing - which I rarely do - I determined that Dentist 1 was making a lot of shit up. Thanks, pal. How did your kids enjoy college?

Back to the feet...POD 1 suggested a relatively new method of dealing with neuromas: "decompressing" them instead of excising them. Decompression consists of cutting the ligaments surrounding the inflamed nerves, to "decompress" the nerves, give them some room to breathe, relax (and to GROW!) and reduce friction. POD 1 said he had around a 95% improvement rate, and that sounded good to me. Let's go.

So, we did it. BTW, my decompression consisted of cutting from the front of the foot, between the second and third toes, and between the third and fourth toes (counting outward from the big toe), and snipping the metatarsal ligaments on either side of the neuroma. Snip, snip. Hey, look! No visible scar! Recuperation was a little tough, though, but I figured it was worth it. I lost some mobility in my toes since the ligaments were cut, but the pain did diminish.

For about six months.

By August of 2006, I was starting to have those shooting pains again. Just. Fucking. Great. On top of that, the medical bills were flowing in, and as it turns out, POD 1 charged my insurance company an astounding $44,000 for my four-hour January 2006 outpatient procedure. As it turned out, we did the procedure in one of those now-very-popular private surgical hospitals. POD 1 just happened to be one of the five doctors that went in together to build this particular private surgical hospital, I soon discovered. Sounded to me like a conflict-of-interest, or more popularly described as an insurance scam. I consulted with an attorney about the situation and the outrageous charges, and he said I really had no case, especially since I was mobile and not debilitated. And not dead. Ok, so POD 1 will get away with it.

After the pains came back and I began studying my situation even more, I gravitated to a second Podiatrist, Dr. J------- H---- (POD 2), who was referred to me by the wife of my wife's boss. It just so happened that SHE had just had surgery on HER Morton's Neuroma. Geez! It's a freakin' epidemic! She was reporting good results with POD 2.

So, I went to see POD 2 and he tells me that decompression is an "unreliable technique," and HIS method of treating neuromas, after exhaustive conservative therapies, of course, was actual removal of the offending nerves. By now, this sounded better to me. Yeah, pluck those bad boys out of there.

So, after several months of more shots, X-Rays, and an MRI, we decided upon surgery. In April of 2007, he surgically removed both neuromas, this time going in from the top of the foot. It did leave rather nasty scars, but the recovery was easier than the last time, and having a nasty scar is better than having those mind-ripping pains.

This procedure seemed to top out at around $15,000, a far cry from POD 1's rape of my insurance company. (Hey, for all I know, doctors are in collusion with some insurance companies. Wouldn't surprise me. After all, this is America.)

Unfortunately, after the April excision, my feet began to exhibit DIFFERENT types of pain. Now, I'd get shooting pains in the SIDES of my big toes, where I'd never had pain before, and I'd get bizarre rippling pains along the bottom of my feet, also new.

POD 2 said these new pains were not unexpected, because the now-decapitated nerves are reaching out for their severed heads, and, not finding them, are screeching and groping and, well, I think you get the picture. I just wish POD 2 had told me all that BEFORE the surgery. I WAS somewhat freaking out about it. And now my right knee is popping with every step down the stairs, caused by .... what? old age? or my screwed-up feet changing my gait?

Ok. Great. Over time, POD 2 said, these pains will diminish. By August, I was having such frequent odd pains that I thought it might be a good idea to see yet another Podiatrist (I'm a slow learner) and get another opinion on my situation.

POD 2 had cut me off of pain meds (he's of the "old school" where you only give out the absolute minimum). And it was still painful to walk, or stand, much. His post-op treatment, to get the nerves to calm down, consisted of hooking me up to a machine and running electric shocks into five parts of my leg and feet. Instead of calming the nerves, it seemed to wake them up, and they were howling more than ever. Ok, that's expected too, he tells me after the pains were getting worse. First they wake up, and then they calm down. Well, they were not calming down, so I decided to seek the opinion of a third doctor.

Now we're almost up to the present day. Wifey has been seeing a Pain Management doc, K---- D--------, (Pain 1), who has been giving her shots in the neck to relieve wifey's pain. Pain 1 has helped her a LOT. Naturally, during the course of wifey's seeing Pain 1, they chatted about my foot condition, and Pain 1 suggested that I go and see her next-door pal, Dr. D---- J-----, (POD 3) a Podiatrist specializing in Peripheral Neuropathy. That is, he deals with nerve problems in the feet. Since Pain 1 had helped wifey so much (and that whole story is a different saga), I figured, well, if she does so well with wifey, perhaps her office-mate POD 3 would be good too for me.

So, I finally got around to setting an appointment with POD 3. Within the first few moments of meeting him, I was just a little uneasy. Ever see the TV preacher Joel Osteen? The guy that inherited "The Oasis of Love" Lakewood Church when his dad died? He's so popular that they bought the Summit, a 15,000-seat concert hall on Highway 59 in Greenway Plaza, to become his new church. The Summit is where the Houston Rockets NBA team used to play basketball before they moved to the Toyota Center downtown. The Summit was also the home of hundreds of rock concerts over the years. I've lost more than a few hearing cells in that place. Good times. Ringling Bros Barnum and Bailey Circus used to perform there. Now, it's a different type of circus.

ANYWAY...Joel Osteen has this permanent-type of smile on his face. This huge, toothy, shit-eating grin. Maybe because of all the money flowing in? Anyway, POD 3 has that same, permanent smile. No matter what I told the guy about my saga and my pain, he would just smile and smile and smile. When he spoke, he had that smiling sound in his voice. This guy is seriously happy. Bet you anything he goes to Lakewood Church. Haven't asked him that yet.

The constant smiling unnerved me a little, and I'm already working on my last nerve, so to speak. He suggested that we do a test that would tell me how damaged my nerves were. Sounds like a good idea. No MRI's? Not yet. Maybe later. X-Rays? Nuh-uh.

So I drove up to the Woodlands for this special test. I expected some high-tech gizmo that would measure my nerves with some accuracy, but what I got was quite different. The "nurse" gave me a little button that I was supposed to push when I felt her poke me with this little two-pronged electrode. When I felt the pressure and pressed the button, the computer would register my button and how much pressure the nurse was applying to my feet. We did this several times. She touched me with her electrode, I pressed the button when I felt it. Sometimes she had to push fairly hard for me to feel it, because I have a lot of numbness in my feet.

For the first series of tests, she used only one prong. After poking me with one prong and having me press the button several times, she then switched to the other, high-tech, two-prong electrode. Now I am only supposed to press the button when I felt BOTH prongs, not just one prong. I simply could not tell the difference between one prong and two prongs. So, it was a lot of, "Well, I guess I feel it." (Press the button). "Uh, I think I feel two." (Press the button).

This went on for about half an hour. To me, it was totally absurd. Absolutely subjective. I don't see any value to this test at all. It's totally dependent upon my pressing that stupid button! How about a stimulus/response type of test that measures responses electronically?! No, not this one. So, we get the results back and I go to see POD 3 again. SURPRISE! Not. The results indicate that I have SEVERE Tarsal Tunnel syndrome (in the feet and legs), which is the bastard relative of Carpal Tunnel syndrome (in the hands and wrists). Severe Tarsal Tunnel, you say? Wow. I'd never even heard of it, despite the fact that more than a couple of my female co-workers had had Carpal Tunnel surgery performed on them.

Sure enough, there it is in the Wiki. Yeah, yeah, we all know that Wikipedia is not reliable. But it's still a good info source.
http://en.wikipedia.org/wiki/Tarsal_tunnel

POD 3's suggestion to deal with Tarsal Tunnel is to make three incisions: one, close to where POD 2 cut me, close to the toes, but on the top of the foot; two, at the ankle where the tendons enter the foot; and three, just below the knee, where the allegedly tortured and squeezed tendons begin their journey down my leg. Three cuts? Based on that stupid subjective test on my nerve response? Now, just hold on a sec.

Not only three cuts, but he's pressuring me to set a date for the surgery. "How about between Thanksgiving and Christmas? You've met your deductible for the year. How about before Thanksgiving? If I were you, I'd want to get this done and out of the way," he says. Uh-huh. How many kids do you have in college? Two.

And all the while he's saying this, he's just smiling like he's the happiest doctor on earth. POD 3 also tells me that I have another neuroma. What?! Another neuroma!? I had it removed! How many neuromas can you have, per foot? POD 3 says FIVE. One for each toe! And he says I have another one, next to the one that was removed. Based on what? Squeezing my toes really hard and asking, "Does that hurt?" Well, yeah, asshole, you're squeezing my toes really HARD!

More surgery? I just HAD surgery in April! Surely I should take more time to heal before I undertake more surgery, right? Not necessarily, POD 3 says.

During this time, I had a regular check-up with my GP, Dr. G--- B------ (myGP). (Can you keep all these docs straight?) Wifey and I both see myGP as our General Practitioner and we both like him and trust him. After talking about my ongoing foot saga again, myGP asks if I'd ever gone to see Dr. W------ G-------- (myMD), an MD, as myGP had suggested a few months ago. Actually, no, I haven't. I've been meaning to, but I've also been getting tired of doctor after doctor after doctor.

But now, with POD 3 pushing me for a third surgery, I decided I would make that appointment with myMD. I met with him just last week. As usual, I recanted the whole sordid tale of my feet of woe. He listened politely but made a few interesting gestures during my tale. One was to roll his eyes (in disgust) when I told him I'd seen and been operated on by POD 1. He'd never heard of POD 2 or 3, but agreed that excision was the better method of dealing with Morton's Neuroma.

MyMD sent me for some immediate X-Rays of both feet, just to have a look at the structure of my feet. That seemed like a sensible start to me. There were a few takeaways from my meeting with myMD.

One, he said that, "Tell your friends and family that all Podiatrists are quacks." Hmmm. Ok. Could be just a little professional rivalry.

Two, "You don't have Tarsal Tunnel." (WHAT?!)

Three, "Your feet have a just-slightly flatter than normal arch. Not very 'flat' at all." It's right there on the X-Rays. (WHAT THE FUCK?!?!)

So! After two years of thinking that I had some of the flattest feet this side of the Great Plains, now my feet have an almost normal arch?! Somehow, I do not think that this is the result of the Yoga that I have been practicing, which has included several exercises for restoring an arch to the feet. No, rebuilding an arch happens very gradually, and I haven't been that consistent with the exercises.

No Tarsal Tunnel? He said he could tell that just from examining my feet and legs and walking me walk around. He also said I'd had too much surgery. Probably the most wonderfullest thing he said was that he expected that my pains would in fact subside and I should heal without the need for any more surgery.

No more surgery? But POD 3 wants to cut me up good. POD 3, a Podiatrist, wants to cut just below the knee. When I told myMD about POD 3's technique, myMD says, "If that doctor came to St. Lukes with that surgical plan, he would not be allowed to perform the operation."

Yes, as someone else had suggested to me, a Podiatrist is supposed to work BELOW the ankle. Any work above the ankle, by a Podiatrist, would be "ILLEGAL," as myGP characterized it. But, if people don't know any better, and they are at their wits end and want to stop the pain, they will agree to just about anything and not ask enough questions.

MyMD then said that "hundreds of people will undergo POD 3's procedure, and within six months they'll be seeking someone else to fix their problem." Indeed, a search on the Internets revealed to me that only about 50% of people who undergo this treatment for Tarsal Tunnel report any improvement, and 15% report worse pain. These figures are not, how to say, in a good range.

So.....I see POD 3 again this coming Wednesday for the fifth of a seven-series injection of a powerful anti-inflammatory. This is part of the "conservative" treatment. I am also going to pick up from POD 3 the new orthotic that he made for me. Amazingly, everyone agrees - Podiatrists, MD's, GP's, friends, the homeless - that orthotics can be very helpful. So I am going to get the orthotic, take the next series of shots, then probably quietly slink away from POD 3.

Oh, another funny thing myMD said ... POD 3 has been giving me these weekly shots, right? They are two shots, actually. First, he sprays my foot with this ethyl chloride stuff that quick-freezes your skin. Then he injects a local anesthetic, which he says prepares the area for the second injection of the anti-inflammatory. I had noticed that the shots make my foot feel better almost immediately, but that the beneficial effects would seem to wear off within 12 to 24 hours and I'd be right back where I was. Well, haha! MyMD says that the only real benefit that I am likely to get is from the local anesthetic, which will wear off within 12 to 24 hours! Oh, ha ha!

Oh, yeah, still one more funny thing that myMD said. He said that you can have up to FOUR neuromas per foot, one for each space between the toes. Not FIVE as POD 3 said. Funny that, huh?

So, that just about brings everyone up to today. Hopefully, by this point of this email, your neck or back is not killing you, and you're still awake. I can be rather long-winded sometimes.

One last thing. I forgot to include some of the good news! MyMD gave me some samples of a new drug that he is getting good results with - LYRICA (aka pregabalin)

Sounds pleasant, doesn't it? The Lyrica part. This is one o' them new-fangled anticonvulsant drugs used for neuropathic pain, don'cha know. All hail Pfizer!!

I've used it for about six days now and my feet actually do feel better. I haven't had ANY shooting pains in my feet since I started taking it.

War on drugs!! War on drugs!! Better living thru chemistry. Just another contradiction in this crazy, mixed-up world.

Browse thru the contraindications for this one:

Adverse effects

Adverse drug reactions associated with the use of pregabalin include:

Very common (>10% of patients): dizziness, drowsiness

Common (1–10% of patients): visual disturbance (including blurred vision, diplopia), ataxia, dysarthria, tremor, lethargy, memory impairment, euphoria, weight gain, constipation, dry mouth, peripheral edema, loss or decrease of libido, erectile dysfunction

Infrequent (0.1–1% of patients): depression, confusion, agitation, hallucinations, myoclonus, hypoaesthesia, hyperaesthesia, tachycardia, excessive salivation, sweating, flushing, rash, muscle cramp, myalgia, arthralgia, urinary incontinence, dysuria, thrombocytopenia, Kidney calculus

Rare (<0.1% title="Neutropenia" href="http://en.wikipedia.org/wiki/Neutropenia" target="_blank" rel="nofollow">neutropenia, first degree heart block, hypotension, hypertension, pancreatitis, dysphagia, oliguria, rhabdomyolysis

Ah, Lyrica. You're like music to my feet. But all that just to reduce the pain? How lovely.

Hey, who's got time for politics?