DEAR DR. DONOHUE: I read your article on complex regional pain syndrome. My son has it. He was in a motorcycle accident and injured his right shoulder. After several surgeries and the insertion of seven titanium studs, he is still in extreme pain. This was done in Manhattan, N.Y. He has had all sorts of treatments, including nerve blocks. He even saw a specialist in California and stayed with him for six months. Nothing helped. Is there anything new on the horizon for these patients? How long before healing takes place? — J.B.

ANSWER: What used to be called reflex sympathetic dystrophy is now known as complex regional pain syndrome. The type I variety happens after an injury in which there is no nerve injury. It’s the more common kind. Type II happens from nerve injury.

In type I, the injury doesn’t have to be as extensive as your son’s was. A simple strain can bring it on. So can a heart attack. It’s pain that lingers long after the injury has healed. Phase 1 of CRPS occurs within weeks to a few months after the injury. Burning, throbbing or aching pain arises, along with swelling of the involved area, and the overlying skin is warm. In three to six months, phase 2 arrives. The skin is now shiny, cool and thin. Pain persists. Once again, after a period of three to six months, muscles in the area have wasted and the involved joint is bent in a fixed, awkward position.

Most people do recover from it in about two years. Not all do. Your son is in that group.

I could list the many medicines and treatments that are routinely given. Your son has been to two institutions where the best and the brightest specialists in this illness can be found. I am sure anything I say would only be repetition of what he already has been told.

However, I recommend that your son and you contact the Reflex Sympathetic Dystrophy Syndrome Association of America at 877-662-7737 (toll free) or online at www.rsds.org. The association provides updated information and can suggest nearby doctors and locate support groups for your son.

DEAR DR. DONOHUE: I am a 66-year-old female with high cholesterol. (I’m enclosing a copy of my lab work.) My weight is 145 to 148 pounds, and I am 5 feet 4 inches tall. I work out at the Y three times a week and walk up to 8 miles a week. We eat healthy foods. I give myself four months. If my reading isn’t down, I’ll go on medicine. — P.I.

ANSWER: Your body mass index isn’t bad; it’s 25.3, slightly over the normal. A five- or 10-pound weight loss could bring down your cholesterol. Your diet should be one that is mainly fruits, vegetables and whole grains, with little animal fat and whole-fat dairy products. You’re exercising, which is good. Two fish meals a week are helpful. Cut down on consumption of sugar and sugar-containing foods and drinks. If this program, which is close to the one you’re on, doesn’t change things around, you definitely should go on a cholesterol-lowering medicine.

DEAR DR. DONOHUE: I take warfarin (Coumadin) every day. I went away on a 17-day vacation. I forgot to take my warfarin and went without it for three or four days.

A week or so later, I was found to have three blood clots in my groin, for which I had emergency surgery.

I have been told that going without the warfarin could have caused the clotting. Could that be? — H.F.

ANSWER: Warfarin prevents clots. Most people call it a blood thinner. It has a half-life of 40 hours. That means that after 40 hours, only half of the drug is still around in your body. You were without it for 72 or 96 hours. At least half of your warfarin was gone from your body. Missing the doses is a reasonable suggestion for the cause of your clots.

However, no one can be definite about this. I’d really have to know why you are taking the drug.

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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