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Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions?

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Orthopaedic Surgeon
Practicing since : 1998
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My name is XXXXXXX I would like to speak to a neurosurgeon regarding an accident I had last December I have already seen submitted this question and paid to speak to the specialist. Have you received my query and are you ready to chat with me now?


I have chronic fibromyalgia and multilevel disc compressions as well as tarlov cysts and meningoceles. The cysts have been there a long time and so has one of the meningoceles, but one meningocele is new and happened when I was in an assault in December 2012. I was hit with a bat on my rear, behind my knee, on the outside of my knee and outside of my ankle, I laid unconscious in my house for3 or 4ndays before my husband found me. I still have visible scars at each place. I contracted rrhabdomyelytis and ARF and awoke with a paralyzed foot and most of the lateral leg numb. I went to XXXXXXX and they did an MRN and found a lesion at the ischeal tuberosity. My surgeon up there (400 miles fdom my house) is going to explore the lesion as well as do a peroneal decompression at the lateral knee. The worst pain I'm having is from slightly above my ankle throughout my whole foot ex ept for some sensation in the medial ankle and foot. I have about 4 positive tinels from the lesion down and there is still visible scarring on my hip/glute level as well as the lateral aspects of my thigh (actually thigh is more posterior) but the knee and ankle hurt and numb laterally all the way down. I cannot bear weight at all. I can't control the leg. I can't flex or dorsiflex the foot but I can move it side to side although it is very painful. The foot instantly turns purple and gives me excruciating pain as soon as I bring it below heart level. I tried shaving my leg and just touching the area slightly above my ankle all the way around forces a scream and tears and I have to fight not to pass out. I told my surgeon about these symptoms and he said he didn't want to deal with my foot until he saw how the first surgery (ischeal tuberosity and peroneal) came out but meanwhile I'm scared of what the compression may be doing to my foot and he doesn't want to give me a straight answer about it. Can you help me to understand his thinking?

Current Medications : Pristiq, Lexapro, xanax, flexeril, keppra, oxycontin, oxycodone 5 for breakthrough
Gender : Female
Age : 43
Posted Thu, 25 Jul 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. Vaibhav Gandhi 3 hours later
Hello,

Thanks for writing to us

I have studied your case.

Its almost 7 months from injury and due to your ischeal tuberosity lesion there is paraesthesia/paralysis of lower limb due to nerve injury [may be sciatic or peroneal nerve], therefore you are not able to dorsiflex or plantarflex your ankle.

I would like to know some details from you: Is there any fracture in your leg or ankle ? [ If you have done X-ray], can you passively move your ankle and leg?
Do you have your EMG [electromyography] report?

Pain may be neuropathic variety due to nerve injury. Or there may be injury to meniscus or ligament in your knee and ankle due to trauma.

If compression to your ankle is painful then you can use splints. If there is no fracture to your leg or ankle then I will advise for physiotherapy of joints to avoid stiffness. Physiotherapy like muscle stimulation and TENS [transcutaneous electro stimulation] will help you in pain relief.

Once decompression of nerve is done then we will have to wait for regeneration of nerve and rehabilitation.

Continue your medication.
Hope I answered your query

Take care
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 11 hours later
Xrays were done and no fractures were found. I cannot move my foot and toes at all. No brain injury found with CT. I was fitted with an APO to wear inside when I sleep and another that goes in a s hoe. Also feeling detached and sad at times. Not sure what you mean by "passively" moving my ankle and leg, though.
 
 
Answered by Dr. Vaibhav Gandhi 3 hours later
Hello again,

Thats good that there is no fracture.

Continue your splint for your ankle and leg.

Passive movements mean- as you are not able to move your ankle and foot , another person or with your hand you hold ankle and do its movement . This will avoid stiffness of your joints.

This is due to nerve injury and you will have to wait for recovery after decompression of nerves.

Due to post traumatic stress you may feel sad at times, so listen to your favorite music, do some creative things at home, read inspirational books, learn piano ,etc.

Take care
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 11 hours later
What do you think the odds are that I'll lose my leg from the knee down? I mean personal, off the record solely opinion from what you have seen so far. I'm a big girl and I can deal with and plan for something much better if I have a good idea what to expect

Also, I don't know whether this is relevant or not, but I feel flushed and have been running a low grade fever since yesterday. I feel like I'm coming down with a cold. My heart rate has been 100 and 160 bpm since the accident. I'm assuming that's from pain. Should I reschedule my surgery (dated July 5th). I'm really in a bind here because it took a month to get THIS time scheduled! Ugh! I'm pushing fluids and doing the best I can to get it out of me.I don't want to delay any further. What do I do? Discombobulatedly yours, XXXXXXX
 
 
Answered by Dr. Vaibhav Gandhi 11 hours later
Hello again,

Fever indicate some underlying infection,so consult your treating doctor and as advised by him start investigation or medicine.

No need to reschedule your surgery , just go ahead , if possible get admitted couple of day prior to surgery so that your parameters come to baseline.

Think positive ,and surely your leg will be saved , but you need patience and confidence for physio and rehabilitation.


Take care
Life is beautiful
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 2 days later
I am in South XXXXXXX I had to book a hotel on the 4th of July so that I can have my scheduled surgery on the 5th. I called my doctor's cell phone Saturday morning with laryngitis. He called in a Z-Pack which I started Saturday. It seems to be working fast. My fever has gone down but since my blood work was done last Monday maybe it was showing elevated white count I don't know yet. My anxiety level is so high. I also have a sore on my ankle of the paralyzed foot. It isn't open but it's brown and indented like it could turn into an ulcer. It took 3 weeks for me to get this hospital time with my Johns XXXXXXX neurosurgeon, in Baltimore, 9 hours away, on a holiday weekend. I'm totally freaking out now. I don't know what to do. Get the blood drawn again? Try to reschedule for next week? I can't believe my luck. I haven't spoken nwith the neurosurgeon's office to see if the bloodwork cleared yet. I guess that is the next step. Probably sick from all the damn doctor visits in all these different hospital in different states. If I weren't so desperate to have this operation done I would probably laugh at the pure absurdity of this situation. I'm going to check the web portals for my surgeon and see if he has found a problem and if not I guess I'll just keep pushing fluids and rest until it's time to drive up. It's a 9 hour drive. Anyway, rambling now. If you have anything to add I'll be checking back frequently. Sincerely, XXXXX
 
 
Answered by Dr. Vaibhav Gandhi 28 hours later
Hello again

As you have started antibiotic , infection will subside and you may be taken for surgery.

Your foot ulcer needs regular care and dressing.
Anxiety will lead to poor results , so work upon reducing anxiety.

All the best
Take care.
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 3 days later
Still feverish butgetting better. Have to reschedule when my regular doctor approves me.
 
 
Answered by Dr. Vaibhav Gandhi 2 hours later
Hello again

It's good that you are getting better, take care of your foot ulcer.

Try not to delay your surgery; mean while learn technique to reduce anxiety. Continue ankle and foot physiotherapy.

Take care
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 15 hours later
Too late. The surgeon forcedme to delay the surgery. I couldn't hide my voice on the phone and they said they won't operate with a fever. They won't even reschedule until I'm cleared by my regular doctor again.
 
 
Answered by Dr. Vaibhav Gandhi 3 hours later
Hello

Keep regular visit to your doctor and get fit for surgery as early as possible.

Take care.
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 9 hours later
I want to thank you for all your help. You're very kind. Is there an address I can send a card to? Blessings to you and yours, Dr. XXXXXXX Sincerely, XXXXX
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 22 minutes later
Oh hey one more thing. I'm cocerned about my foot. I know you don't want to upset me and my doctor avoids questions about my foot too. I am a vet and I've seen and been through a lot of bad stuff. I am ready tomaccept if I'm going to lose my foot or even my leg. Frankly, I'm starting to get tired of dragging it around behind me. In answer to your query, there is a definite lesion on my sciatic nerve at the glute level and there is no distal activity on EMG. I Know the prognosis is dubious because of how far the nerve has to heal. Can you give me a straight answer? Do you think it will heal? If so how long willmit take? I know you can't tel me for sure, just your best guess please. Not knowing is for my personality harder to deal with than preparing for what I may be realistically up against. Thanks for your honesty. Sincerely, XXXXXXX
 
 
Answered by Dr. Vaibhav Gandhi 9 hours later
Hello again,

Yes neural anastomosis has good results when operated under microscope for fine anastomosis.

Yes lesion will heal if anastomosis is good. It may take around 1 year after operation to heal significantly . Recovery is progressive it will start from lesion and progress towards your foot. So hope for the best.

As you wish to send a card you can send on - Dr XXXXXXX XXXXXXX , N-5 ,F-1 ,CIDCO,Aurangabad -0000,maharashtra ,INDIA.

Take care.
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia, multilevel disc compressions, tarlov cysts and meningoceles. Taking Pristiq, Lexapro, xanax and keppra. Suggestions? 7 hours later
Thank you. Thank you so so much,
 
 
Answered by Dr. Vaibhav Gandhi 19 hours later
Take care ,bye.
Above answer was peer-reviewed by
 
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