Question
Hi,
First off I will give you the patients case history:
Female, 56 years old. 5 years ago her Achilles Tendon snapped and she underwent an operation that attached some of her calf muscle to her ankle to ensure up down motor control of her foot.
During this operation the would contracted
an airborne pathogen, Pseudomonas aeruginosa.

The wound took 3 years to seal. In this time all the pain killers to their toll and the gall bladder has since been removed. Consequently, she was put on Morphine as this is all that helped for the pain and did not cause severe digestive pain.

At the moment the scenario is as follows:
Her operated leg is still in dire pain and the knee is swollen to thrice it's normal size, the arch of the foot on the other leg has collapsed as a result of incorrect walking due to the pain in the operated leg. All that works for the pain to ensure quality of life are high dosages of morphine (15MG ampules). However due to the legalities surrounding Morphine the dosage has been cut to 5 ampules for 3 days (about 1/4 of the "working" dosage). Patient is in such pain she blacks out from time to time. Medical advisors she has spoken to want to amputate, but that does not resolve the problem as it puts pressure on the leg with the damaged foot and their will still be ghost pains from the amputation for years.

WHAT DO WE DO?

Any help or advice will be appreciated

Thanks
Ivor


Answer
Hello Ivor,

Your question is a bit out of my line of expertise, but I will try to answer briefly.

Your friends' condition might be due to several reasons. Some are organic (meaning that they have a physical/bodily origin) and some are non-organic (meaning they stem from psychological/personality problems).
The organic reasons might be related to chronic infection, nerve damage, side effects of medication, and such. Your description does not outline in medical terms her precise problem currently, but from what I can discern, she is receiving proper treatment.
The non-organic reasons for her condition might include drug dependency (meaning she is addicted to Morphine), depression, chronic pain syndrome ?to name a few. One possibility which comes to mind from what you describe, is RSD or Reflex Sympathetic Dystrophy, which results from organic and non-organic reasons combined. Unfortunately there is no good solution for this condition, and amputation is at times the end result.

Sincerely,

Dr. N. Rahamimov