DEAR DR. DONOHUE: I haven’t seen you write about my condition, reflex sympathetic dystrophy. I wish you would. I sprained my ankle about five months ago. I took care of it myself, but the pain didn’t go and it got worse. I finally saw a doctor, who said I had reflex sympathetic dystrophy, and he told me to take Advil for it. It helps some, but how long does this last? I have to use crutches. – L.F.

ANSWER:
Reflex sympathetic dystrophy has a new name: complex regional pain syndrome. The name change does nothing to alter its distressing symptoms.

After an injury – and it can be a minor injury – healing doesn’t occur and pain doesn’t leave. Typical injuries include sprains, bone breaks and even heart attacks. The injury somehow spawns the production of noxious chemicals that impede healing and promote pain.

In the first stages, which last from weeks to months, the pain is burning, throbbing or aching. The skin over your ankle is mostly red, and the surrounding tissues are swollen. Three to six months later, the skin thins and becomes shiny but the pain persists. In the last stages, both skin and underlying tissues greatly shrink and the joint becomes immobile.

Lest you think the situation is hopeless, it isn’t. Pain control is one priority. If Advil relieves your pain, fine. Other, stronger pain relievers are available, and things like nerve blocks can help.

Physical and occupational therapy are a must to prevent the joint from losing its motion and to prevent calcium loss from the nearby bones. If you aren’t getting physical and occupational therapy, start now. The sooner, the better.

Most people do recover, but it can take a year or more to reach that goal. The odds are in your favor.

DEAR DR. DONOHUE: My 5-month-old grandson has glaucoma. He is soon scheduled for surgery. Is this rare for an infant, and how does one so young have this condition? Are there outside factors involved? His mother was 36 at the time of his birth, and his father may have been using illegal drugs. Could these have been the cause? – G.J.

ANSWER:
Neither his mother’s age nor his father’s drug use caused the baby to have glaucoma.

Glaucoma, whether in an infant or an older person, comes about from an increase in fluid pressure in the eye. The increased pressure compresses the optic nerve at the back of the eye. Unless the pressure is relieved, glaucoma ends in blindness.

The “pressure” in the eye isn’t blood pressure. It’s fluid pressure. The front one-third of the eye is filled with fluid that is constantly being made and constantly being drained. If drainage doesn’t match production, fluid pressure rises.

Infantile glaucoma is rare. It occurs in about 1 in 10,000 births. The infant eye is more elastic than the adult eye. One sign of infantile glaucoma, therefore, is bulging of one eye.

For infants, surgery to promote fluid drainage is the treatment most often chosen. It reliably lowers eye fluid pressure and preserves sight. Sometimes it is necessary to repeat the surgery.

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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