An injury that doesn’t get better might be CRPS

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DEAR DR. DONOHUE: Four months ago, while getting out of my car, I slipped and twisted my ankle. It swelled quite rapidly. I went to the nearest emergency room, where they took X-rays. Nothing was broken, but the doctor called it a strain and told me what to do for it. Two months later, there was no improvement, and the pain was getting worse. I had to use crutches. I saw an orthopedic doctor, who diagnosed me with reflex sympathetic dystrophy. I have never heard of this. How long does it last? — R.T.

ANSWER: Reflex sympathetic dystrophy has been renamed as complex regional pain syndrome, CRPS. It’s a dreaded complication of things like a sprain, a broken bone, an operation, even heart attacks and strokes. The pain is intense and out of proportion to the inciting cause. Touching the involved area can be agonizing. What causes this has yet to be explained. It might be that the injury produces a reflex that heightens perception of pain. Or it might be that sympathetic nerves, nerves not under voluntary control, have gone berserk to intensify pain, swelling and other symptoms.

The syndrome has three stages. The first stage is the stage of burning pain and peculiar skin-temperature changes over the injury site. The second stage is one of continued swelling, thickened skin and muscle wasting. Pain persists. The third stage involves restriction of movement of the injured joint and a thinning of the skin.

In spite of the prolonged time for healing, most often healing eventually does take place. In the time when pain is present, the doctor has to prescribe a variety of pain relievers until one that suits the individual is found. Nerve blocks are sometimes helpful. Stimulation of the spinal cord is sometimes resorted to for pain control.

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Physical therapy helps keep the involved joint limber. Occupational therapy teaches a person how to use devices that permit the person to stay productive. Have heart. Things do improve.

DEAR DR. DONOHUE: I have a question regarding something my doctor called a quboid. It is on the outside edge of my foot. Sometimes it appears swollen and is painful, with a burning pain. I would appreciate any information you might share with me on this subject. — P.C.

ANSWER: I’m as sure as I can be that your doctor said “cuboid,” one of the foot bones. It’s on the little-toe side of the foot in front of the heel.

You have to ask your doctor what’s wrong with your cuboid. It could be a stress fracture, a site of arthritis or many other conditions.

DEAR DR. DONOHUE: I had a baby four months ago. I am left with scars all over the stomach area. I guess they came because my baby weighed over 9 pounds at birth. Can anything be done for them? Will they ever go away? — H.H.

ANSWER: Those scars are stretch marks, medically called striae. Your skin was stretched by the increasing size of the uterus to a point where it split. Stretch marks are quite prominent early on because they have a vivid red to purple color. In time, like all scars, the color vanishes, and they are hard to see, but they never completely go away.

Retin-A, an acne medicine, is said to lighten them.

DEAR DR. DONOHUE: My wife died from an aortic aneurysm in her chest. I had an abdominal one that was operated on. My doctor discovered it on a physical exam. How come my wife’s wasn’t discovered? She had a yearly physical exam with a different doctor. — J.K.

ANSWER: An aneurysm is a bulge, a weak spot on an artery. Abdominal aortic aneurysms can be felt because the abdomen is covered only by muscle. A doctor can detect the pulsations of the aortic bulge.

Chest aneurysms are not so easily discovered. The ribs and chest muscles make feeling any pulsations due to an aneurysm hard to feel. Your wife probably had no symptoms from it. You have my sincerest sympathy.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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