Severe ankle and achilles pain

[clinic_nurse]

I have a patient presenting in my clinic with severe ankle and achilles pain to feet bilaterally.  Small amount of  swelling noted, but not extreme.  All of the testing is so far negative....sed rate normal; ana norma; white count is normal even a ck is normal.  She is in excrutiating pain and i am at a loss on how  to help her or which way to go.  Trial of antiinflammatories was unsuccessful in relieving pain, tramadol doesnt work, tylenol # 3 isnt working.  I hate to just keep giving pain med to mask the issue.  Just dont really know where to go next.  She is on Predisone 10 mg daily, with no relief from that either.  It has progresses quickly ( within 2 weeks time) of her being able to care for herself, to being dependent on others, due to the degree of pain makes walking too painful.  I feel like this is probably one of  the rhuematological processes that doesnt follow the book or an infllammatory process. But I am stuck

I hope someone else has some ideas that they may share with me. Thanks

[rosielily]

This is a little off the subject but somewhat related. Be careful of tramadol and its numerous side effects. One that has happened to me just this week is bilateral achilles tendonitis (so it may be a particularly bad med to use in your case). This is a documented side effect with some antibiotics, but I haven't seen it mentioned as a side effect with tramadol. This is the only medication I take -- I almost never even take OTC meds and haven't had so much as an ibuprofen in weeks. Also, absolutely no trauma as a possible cause -- especially bilaterally. I've been taking 50 mg or less daily for over 18 months. It's a very bizarre side effect and I'm trying to see how it's totally coincidental, but I just can't. Sure, it's not scientific -- just something to think about.
I'm also an advanced practice nurse and very conscious of patient confidentiality. However, I think wishforchange's comments are stretching it a bit far. First, it seems a bit farfetched that an anonymous description would be considered a breach - the details aren't all that unusual. Also, if somehow a family member or friend actually already knew such details then how would your mentioning them be considered a violation of confidentiality unless the client is identified? Case studies and patient histories are EVERYWHERE on the internet easily accessible to EVERYONE and very helpful if you ask me.

[wishforchange]

hi,

I was rooting around on a few other sites before logging off and came across this post.  I noticed it had been posted on a few forums, which is fine when someone is in need of an answer.  Have done it myself.  But clinic nurse I have to tell you my opinion on this, as I've come across it before once with an intern and gave them a similar response.  What you are doing is not professional.  I know the patient is anonymous, but they or their family or friends are as likely to visit these sites as you and may well recognize your descripition.  This is a PUBLIC forum, open to all.  People come here with their own problems, ocassionally concern about a loved one, but I find it very uncomfortable when the private medical details of a patient are shared here.  You may be doing this for good reasons, to seek answers, but this really is not the place to do it.  As a nurse you have access to medical research facilities, specilalist doctors, colleagues, all able to discuss your patient within the boundaries of their confidentiality.  Throwing out the problem for the whole world to see is really not acceptable.  
Spastic I'm sorry to follow your answer with this.  I considered PMing clinic nurse but I feel this needs to be read by other health professionals who may be tempted to do the same.  
I have trained as a nurse.  In some of my posts I have talked vaguely about patients from long ago, not identifying either their medical problem or even their sex, just maybe as part of making some explanation clearer.
Clinic nurse you need to stop this method of dealing with uncertainty in your work.  All of us here know when we post our medical problems all and any can read them, and we take that on board.  Your patient has not made that choice.  This is not good clinical practice.
I have to say this as I feel very strongly about these matters.  Confidentiality is everything in medicine.  I would be mortified if one day I were to read some description of a patient and it was clearly my own problem.  This is the risk you have taken.  
Please, any medical professional who is reading this, do not do it.  This is the second time I have come across this use of Medhelp.  I may even talk to the moderators about their opinion on this matter.  
I was going to respond on another thread but then caught your response Spastic.  It is a great response, and you have done nothing wrong in trying to help, it is the nature of the post that is making me uncomfortable.
Feel free to talk to me about this but please bear in mind I cannot get involved in any lengthy discussions.  I have too many personal issues to deal with and hope that you can appreciated this post for what it is.  Really I have nothing to add.
This is not personal clinic nurse, I do not know you, this is about appropriate clinical etiquette, for want of a better word.

[spastic]

Welcome, I have been going through pretty much the same thing this last year.  Have you looked into Orphan diseases?  This is where my Dr's are looking because I have been baffling them for a long time now.  Could she have Reflex Sympathetic Dystrophy?  Did she ever injure her achilles?  Has she been checked for plantar fasciitis?  Have you tried her on any meds like gabapentin or Lyrica?  Have you tried any injections of cortisone into the ankle and/or achilles?  Any EMG's?  Any x-rays of the ankle?

I am not a Dr or nurse but I have been through quite a lot of tests, a few diagnosis that would never stick, treatments that would fail.  And now I have a book of Dr's reports, stating they have no clue what I have.  Just pain killers that don't work well, swimming is the only p.t. I can get because it hurts too much to bear weight.

In the meantime, I would get her on some gabapentin, and have her gently stretch out her achilles before she attempts to get out of bed.  Have you ran a metabolic panel on her?  Check her vitamin D level and have her start taking at least 1000 I.U.'s a day.

Please keep me updated!!!

Your Friend,

Spastic aka Ada