Answers from my podiatrist

[cjsmith]

1. No, we don't know why these nerves hurt. Sometimes trauma to an area (even long ago) can make the nerves more prone to getting wildly irritated. Sometimes stress is a factor. If I had back problems, she would suspect trouble at the nerve root that was affecting the ends. I have "vasospasm" in the small blood vessels of the area, and decreasing blood flow to the nerves can make them irritable. This is probably NOT a structural problem or a disease.

2. Yes, there is hope that I will run again. I have to take things very, very slowly though -- not just increasing my movement slowly and gradually, but being very gradual with applying or changing treatments.

I cried when she said there was hope.

3. Inflammation can cause purely mechanical problems. Often when they go in surgically to remove a nerve that's inflamed or has Morton's neuroma, they see that it has an inflamed bursa (sac of fluid, apparently) around it. I thought bursa were around ends of bones, and yeah that's the common understanding associated with the word "bursitis", but they can show up around nerves too. So perhaps inflammation is squeezing/pinching/rubbing the nerves in the area.

4. People's bodies do not, in general, "adjust" to anti-inflammatories like they do to narcotics. The doctor had no explanation for why I'm having rebound pain related to the anti-inflam. One thing we can try eventually is an anti-seizure drug that is frequently used for nerve pain. For now, we're switching me to a different anti-inflammatory and not doing too many things at once.

5. To learn more about a potential system-wide inflammation problem, see a rheumatologist. I told her I understand that I'm not presenting with the classic signs or symptoms of the big autoimmune diseases. She said this would be worth looking into just for peace of mind or for the sake of completeness.

6. Yes, the Myofascial Therapy Center sounds like a good idea. So does another thingy I can get at a physical therapy center in downtown San Jose (sigh): a machine of some kind that is designed to increase blood flow and calm down the "vasospasm".

So now I'm googling:

- An article on vasospasm in the brain, with some more general info. I've had no specific tests for this, but in an extremity like the foot, maybe it's easily observable by a trained physician. My feet ARE almost always cold, even when the rest of me is warm, so a circulatory problem is believable.
- Bursitis - indicates that "bursae" form in various places, not always on bone, and that different people have different numbers of them. This might explain one really really weird thing an ex-boyfriend of mine had on/in his wrist...
- Anti-seizure meds and nerve pain. Neurontin is the one Dr. O mentioned. Sadly, no anti-seizure medication is FAA-approved for pilots -- apparently regardless of whether or not I have seizures -- so trying this could mean I would never fly again.

Comments

[dawnd.livejournal.com]

I'd hazard a guess that the weird thing your ex had on his wrist was probably a ganglion cyst:
Ganglion cysts
A ganglion cyst is a fluid-filled sac that arises from a joint capsule or tendon sheath. Many ganglion cysts don't cause pain and don't need treatment. But when they do cause pain, treatment may include removal of fluid from the cyst or surgical removal of the cyst. (http://www.ohiohealth.com/healthreference/reference/nav-10020.htm)

yay for progress, anyway.

(hugs)

[cjsmith.livejournal.com]

Ooo, following that link gives this image, which looks VERY like what he had. Interesting!

(hugsback) thanks!

[platypus]

I've had a recurring ganglion cyst for the last ten years. It flares up and goes away on a schedule entirely its own. It rarely interferes with functioning, or when it does a few days in a wrist splint help a lot. I nearly reached the point of surgery a couple of years ago, but I had it drained by needle as a stopgap measure first (and got to help a med student learn!). It has recurred since then, but only very minorly, so I think it really did help.

[cjsmith.livejournal.com]

I think my ex-bf mentioned having had his drained once, too.

[layer.livejournal.com]

nice to see she at least answered your questions and provided additional information instead of just giving you the run-around.

and as for that last, very upsetting sentence, trying this should mean you wouldn't fly again as long as you're on the medication, right? not never again...

[cjsmith.livejournal.com]

I thought that for some medications, it's "never again" (at least without a lengthy appeal process). I don't have my AOPA number handy to go look this up on the web, but I seem to recall anti-depressants fall into this class. For others, it's only while you're on it.

Fortunately, I get to try a bunch of other things first. It may be a while before I get to the Run Or Fly choice. And I'll call my AME about neurontin.

[layer.livejournal.com]

ugh. hoping it's not one of those.

[rfrench.livejournal.com]

I don't think it will be nearly as bad as you think. I looked up "neurontin" and it's true that it's on the FAA bad list. So you wouldn't be able to fly while taking it, at least not without a special appeal. However, the FAA looks at the reason one took drugs for future certification. For example, I just had a student who had been on Wellbutrin for smoking cessation - not for depression - but was now off it. The FAA let him have his medical with no problem. No special evaluations or delays.

But definitely call an AME and find out for real.

[cjsmith.livejournal.com]

I said "could mean", granting that I hadn't looked it up. The example of your student who had been on Wellbutrin is heartening. I'll call our AME before trying any anti-seizure drug.

(I'll also ask Dr. O whether she's required to send that information to the CA DMV. It would be interesting to know.)

[buzzy-mcbuzzer.livejournal.com]

SHE had a burcitis on her heel once (it was a bone thing), and she had to go to the physiotherapist and have this ultrasound thingy on it. It made vibrations that were supposed to increase the blood flow and induce healing to the damaged area.

I took note of this and I decided to try to purr her foot better. Sounds like you need your kitty to step up to the plate here. No walking means less treats, and less litter emptying, and that's just not acceptable to any kitty :E

[cjsmith.livejournal.com]

More kitty-purrs? That sounds like an excellent therapy! I'll ask jackiecat what she thinks of it.

[datagoddess.livejournal.com]

jackiecat will probably look at you like you're nuts. I think Duchess is your better bet, or (I have no brain - I can't remember her name!) the little one.

I would remember her name if I'd met her. Hmmm, I think I need to consider another visit in that direction ;-)

I've had bursitis in my shoulder. Hurt like a big ole hurty thing until I saw the orthopod who gave me good anti-inflamatories for it.

Here's to hope - and both running and flying again...

[cjsmith.livejournal.com]

I'm sure you're right. Either Duchess or Little Girl (yep, that's really her name, and don't feel bad, she hasn't learned it herself) would be better for purr-therapy.

Ow, shoulder bursitis sounds bad. I hope this next anti-inflammatory works for me.

Thanks!

You might want to check with the DMV also

[samtosha.livejournal.com]

Physicians in some states, Texas included, MUST report the use anti seizure medications to the DMV. I did not find this out until after I had my craniotomy surgery but thankfully a note from my neurologist kept me from losing my drivers license. In Texas, regardless of whether or not you have had seizures, there is still a mandatory reporting law. Just information I thought you might like to know. Good luck with your decisions.

Re: You might want to check with the DMV also

[cjsmith.livejournal.com]

Oo, thanks! I googled briefly and found nothing for California; I'll make sure to ask my doctor before attempting that medication.

I bet my anger at the medical profession -- ok, my *reasons* for it -- pale next to yours. You're in my thoughts.

Re: You might want to check with the DMV also

[dawnd.livejournal.com]

If that's the case, then I've been driving illegally for a year and a half. I don't think CA has that law. (Seizure meds are also sometimes used as mood stabilizers.)

Also, if all antidepressants fall into that class (can't ever fly if you've ever used them), I'm betting we have an awful lot of illegally-flying pilots in this country, given how much they're prescribed these days.

Re: You might want to check with the DMV also

[cjsmith.livejournal.com]

I heard that about a third of people whose condition warrants a no-fly medication actually don't fly. Another third lie on the forms, and the rest who have the condition don't take their medication and fly untreated. I don't have a reference for this, but I find it believable.

I sure do feel safe with those rules looking out for me.

Re: You might want to check with the DMV also

[dawnd.livejournal.com]

Umm.... yeah. REAL safe!

Re: You might want to check with the DMV also

[rfrench.livejournal.com]

I don't know about seizure meds, but CA does have the law for sleep apnea. I found this out late but was lucky. In CA if you have _untreatable_ sleep apnea they have to report it to the DMV and they'll cancel your license.

Re: You might want to check with the DMV also

[cjsmith.livejournal.com]

Ooo, even if you pass a maintenance of wakefulness test and are therefore at least as good as most of the caffeine-dependent bozos out there? Or would that make it "treatable"?

I sure do feel safer knowing that of all the sleep-deprived people out there, only the ones who do it to themselves deliberately and/or are too stupid to see a doc are driving. I suppose it would explain some of what we see on the roads though. :-)

[msmichelle.livejournal.com]

CJ, I'm so glad there's progress today. I am so frustrated for you. I hope the next course helps.
L is your kindred spirit over here. He's just started steriod injections for not one, but three damaged disks in his back, this is not even related to his disk that ruptured when he was 24. He quit playing volleyball for good with that. Once N reached a certain weight, it really became not ideal for him to lift her. He can still bike though. This is partially genetic and some extreme sports through the years probably didn't help matters much.
I just wish I had a magic wand for to make this incredible hinderance and pain go away for you two active people.
Keeping up hope though, and good thoughts. :)

[cjsmith.livejournal.com]

Yowtch, partially genetic? That sounds rough. I feel for him -- back problems can be incredibly life-altering. I hope he can stay active.

[kimatha.livejournal.com]

Yes, there is hope that I will run again

Hooray!

[cjsmith.livejournal.com]

I so didn't expect that answer that it didn't occur to me until now to ask for a guess at a timeframe.

Still. I might get better. That's pretty cool!

[lkeele.livejournal.com]

Aww, hugs. I'm so glad there's hope.

[cjsmith.livejournal.com]

Thanks - me too! *sniffle*

[anisoptera.livejournal.com]

The Myofascial Therapy Center. Hopefully they will have a wholistic approach and work with more that just your foot. I've had some success with this sort of approach and I hope you can find a good therapist and your body cooperates.

[anisoptera.livejournal.com]

Whoops, that posted before I had a chance to preview.The first sentance should read: "The MFT Center sounds good to me."

[cjsmith.livejournal.com]

Thanks! I'm thinking that even if myofascial therapy doesn't immediately help my foot, it may save me from other injuries or problems lurking in the background.

[anisoptera.livejournal.com]

Exactly. MFT should help repair/relax tight/taut tissue, re-align your body so it works more effciently in the field of gravity and help you tune into your body in a new way.

nerve pain

[aelfie.livejournal.com]

you might also try eithe amitrypline or nortrypline. These are anti-depressant in high doses (normal antidepressant dose is 75 mg), but they act as a nerve synapse inhibitor in the lower doses (10mg, which is the dose I took). I've taken both for the carpal tunnel crap. I did not like the side affects of amitrypline, so after consulting a chronic pain specialist the surgeon switched me to nortrypline. Which worked fine.

As a note I tried looking them up in PDR, but couldn't find it for some reason. (Its really f*cking picky about your spelling. Drives me insane!) Found entries on PubMed spelled as amitryptiline and amitriptyline. Using those various spellings I finally found the entry on PDR where I also found a reference to it being Elavil. Nortriptyline seems to be the generic of Pamelor or Aventyl

Have your Doc talk to a pain specialist for more info (they would know more).Hope this helps!

[jupiter29.livejournal.com]

I'm happy to hear there is light at the end of the tunnel. As always, things to try is better than nothing worth trying. That totally stinks about the flying, though. I'm glad that's the last option for now. I'll keep my fingers crossed.

[platypus]

I know several diabetics who take Neurontin for nerve problems, and my boyfriend's mom has taken it for back pain. It has a pretty intimidating list of side-effects, but I know people who have gotten relief from pain with it when they haven't gotten relief anywhere else.

[dizzdvl.livejournal.com]

Ok, I read that as vagospasm and thought, hey that might not be too bad! ;)

I have a ganglion cyst which is a sac of fluid on a nerve in my wrist. I hate it, but it doesn't bug me as much as yours do.

Glad you have a doc that explained it well to you!

[cjsmith.livejournal.com]

*snort of laughter*

Does a ganglion cyst ever fully go away again? I mean, unless you have surgery? I hope it's not painful.

Yeah, I'm glad for this doc too, even though I didn't get huge solid answers like "you have globular zyzytoneal syndrome and here's exactly how it gets cured".

[dizzdvl.livejournal.com]

You could have surgery to remove it, but it's mostly an annoyance. It freaked me out until I knew what it is. Now I just press on it to release the fluid every once in awhile.

Yeah, but if you had a doc who said that after one visit it would almost be too easy. Sounds like this doc wants to figure it out and help.

[quasigeostrophy.livejournal.com]

*crosses fingers & toes*

I hope you can both run and fly again. Sounds like you got some decent information for a change.

[just-cyd.livejournal.com]

hooray for answers, and for HOPE!!! being able to run again someday is better than a flat-out "no way, are you nuts??"

didn't even think about the implications on your pilot status or (as others mentioned) driving if you went on anti-seizure meds. i should research this myself! eeep!

bursitis in the feet, eh? i know how painful my hip bursitis is, and how any movement at all irritates it, so i could imagine the same thing happening in your feet. ouch!

have a rheumatologist check out out coudln't hurt. i had no idea something was really wrong with me til i had all that bloodwork done "just in case" by my Fabulous Family Doc.

here's hoping you continue to get answers and find solutions.

[firecat]

Speaking of Myofascial Therapy, did you ever get the book you mentioned, and did you try it?

[cjsmith.livejournal.com]

The trigger point therapy book? I did.

I found a few things that felt like they might be trigger points. I massaged them. So far, none of them have become markedly less tender (a signal that I might no longer have the little micro-knot in that location) and so far my foot pain seems to be completely unaffected. But who knows -- so far my foot pain has been completely unaffected by a lot of fairly healthy things, like good vitamins and stretching. The trigger point stuff could simply be taking a while. Or maybe I don't know how to massage them right. :)

[sunnydale47.livejournal.com]

To learn more about a potential system-wide inflammation problem, see a rheumatologist. I told her I understand that I'm not presenting with the classic signs or symptoms of the big autoimmune diseases. She said this would be worth looking into just for peace of mind or for the sake of completeness.

There are systemic inflammation problems that are not autoimmune diseases. Like the one I have (http://www.merck.com/mrkshared/mmanual/section5/chapter55/55c.jsp). Although the ones that aren't don't show up on a blood test -- mine didn't, and it took two or three years before my nonspecific arthritis turned out to be CPPD. The doctor called it seronegative sponyloarthropathy, which is a fancy term for non-rheumatoid inflammation in the spinal area! Turned out it wasn't just in my spine, but that's where it was when I had the flare that got me diagnosed with arthritis at all. With hindsight I realized I'd been having minor flares since my late teens.

trying this could mean I would never fly again.

Oh, Ceej ... I hope it doesn't come to that! That's the choice I had to make, so I know how it feels. I tried to just deal with the pain, but I couldn't -- it got to where I couldn't have climbed into the airplane anyway (especially not the Cherokee I was flying!) without the Percocet. So I couldn't fly without it, and I certainly couldn't fly with it. It's been more than 15 years, and I still miss it and think about it sometimes.

But hmm ... I almost never take Percocet any more -- I just assumed tramadol (Ultram) was on the FAA's shitlist as well. Do you know if it is or not? (I don't go to aviation-related sites when I can help it -- it still makes me feel bad.) I'm pretty sure nothing else I take would be verboten. Not that I can afford to fly any more anyway (thanks to George Bush ), but it would be nice to know I could if I wanted to....

[cjsmith.livejournal.com]

Yeah, I figured there might be, but that they would be rarer. Yowtch, yours sounds... weird. Do the crystals cause damage mechanically?

That's the choice I had to make, so I know how it feels.

Oh Sunny, I never knew that! I never knew why you didn't fly any more! I could just cry. That is heartbreaking. I wish no one would ever have to make a decision like that. And that you tried to just deal with the pain in order to keep flying, until it got so bad you couldn't get in the plane... That's just brutal.

I can look up Ultram if you like. It might be close enough to narcotics that it would be troublesome, but I have no idea. Can't look 'til I get home though. If you feel like shipping me the rest of the laundry list I can look at those while I'm at it. My name at livejournal works.

[sunnydale47.livejournal.com]

Yeah. My late husband was a CFII and taught me to fly. We were just beginning to start on my instrument training when he got sick -- my logbook has been long since packed away, but I think I had about 5 hours of hood time at that point. During the 10 months he was sick, of course, I didn't fly at all, but the spring after he died I went out to Montgomery County Airpark and found myself an instrument instructor.

But it wasn't going well for several reasons. One is that he was a terrible misogynist, and instead of bolstering my confidence as a pilot, he actually sapped it. I was a well-trained, licensed pilot, and I could fly VFR just fine, thankyouverymuch. But every time we came back from a lesson, as I was landing the airplane, he'd grab it somewhere between 10 feet and 40 feet, say "I've got the airplane" in a faintly disapproving voice, and complete the touchdown and rollout.

At first I thought, "Well, I'm out of practice, I haven't flown for a year and a half." Then I thought, "Well, maybe I'm just tired from the effort of learning instrument flight, it's so tiring." But as it happened lesson after lesson, I started feeling uncomfortable about flying solo, since I hadn't actually landed an airplane in quite awhile. But I finally figured out what was going on from other remarks he made about women. He simply didn't believe a woman could actually pilot an airplane, at least not without supervision and help.

He also said something that made me furious. We ran into each other in the parking lot and he saw me getting out of my car, noticed the handicap symbol on the plates and said in a slightly dirisive tone, "Whose crip tags?" It took me a minute to even figure out what he meant! Finally I realized and told him, "They're mine!" "They're yours? What do you need crip tags for?" I don't remember what I said -- I was too angry by then. I swallowed my irritation and didn't say anything about it, but I deeply resented the derogatory attitude. I have an acquaintance who is much more handicapped that I am, and she refers to her license plates as "crip tags" -- and that's fine. But his use of the word was like a white person using the word "nigger" -- African Americans can call each other that and it's fine, but it's not taken kindly if someone outside the group uses it.

So eventually I realized I was going to have to find another instrument instructor. Meanwhile it was getting harder and harder to do the preflight, climb into and out of the airplane, and then tie it down at the end of the flight. The hood was getting heavier and heavier. I'd park in the closest handicrap spot I could get, and sometimes I'd have to rest in the terminal for a little while just to be able to walk back to the car. I had a prescription for Percocet, but I didn't take it within 8 hours of a flight (I didn't take it if I had to even drive somewhere, although I allowed a shorter interval.)

If I'd had a good instructor I might have been able to continue a little longer, but I don't think I would have been able to finish my instrument rating even with the best instructor in the world. Now I'm in much better shape, thanks to the introduction of Ultram and Ambien (neither of which was out yet), acupuncture, and the exercise and weight loss that the meds and acupuncture made possible. I'd still have trouble getting in and out of a low-wing airplane, but I could do it -- provided I'd taken my Ultram. I doubt Ambien is allowed either, even though it makes me more awake and alert the next morning because I got a decent night's sleep. Catch-22.

[cjsmith.livejournal.com]

GRRRRRRRRRRRRRR WHAT A JERK! And yeah, aviation is full of them. I have had sexist instructors too. Fortunately, I have to say that for the most part the instructors I have had have been decent folk who care more about how I fly the airplane than what shape my body is.

Oh, I am so ticked off on your behalf. He was bilking you out of your instruction fees, *and* insulting your intelligence and capabilities, *and* wasting your time. And since it's about sexism instead of fraud he won't go to jail for it. After all, it's okay to cheat people as long as it's based on bigotry instead of outright dishonesty.

Gah. Humans are sometimes pretty scummy, huh? I suppose I shall have to declare that they are not always worthy of sharing the planet with my exalted self. ;-) ;-)

[cjsmith.livejournal.com]

Damn, aviationmedicine.com says Ultram is out. I suppose there's always the attempt at a waiver. :-( :-( :-(

[sunnydale47.livejournal.com]

Well, I'm not surprised -- that's actually what I've been assuming. Ultram was originally said to be non-opioid, but since then they've decided it's a "weak opioid" -- as I understand it, it's not actually an opioid but it fits into the opioid receptors, so there's some connection, and that's usually enough for the FAA.

I don't see how I could get a waiver. Just because I've been taking it for 7 or 8 years and found that it not only doesn't diminish my energy and concentration, it improves it, doesn't mean an AME would accept that just because I said so. =sigh= Thanks for checking for me, though. I have wondered about it, and it's nice to at least know for sure.

[cjsmith.livejournal.com]

doesn't mean an AME would accept that just because I said so.

The AME (or the two overworked guys in Kansas City) might accept that the doctor who's been prescribing it to you and monitoring your case for some time would have a good idea of what it does to you. But still, the appeals process for a no-fly drug is probably prohibitive. (Gee, I sure do feel safe with all those RULES looking out for me.)

You mentioned Ambien. "Those pilots taking Ambien (zolpidem), another prescription medication, must wait 24-48 hours after the last dose before flying." Hrm. Seems to negate the point of it, but if you're not taking it daily then that one wouldn't be a showstopper.