So much has happened! I’ll break it up in Parts. Part 1-toe amputation. Part 2- I WON at my disability appeal hearing for SSDI. Part 3-My favorite pain doc accidentally hit my vein with lidocaine and I became UNRESPONSIVE!
PART 1 – TOE AMPUTATION
A week ago I had my 4th toe right foot amputated. It’s still wrapped up. I have a little phantom pain-but not too much and I think it’s just the nerve remembering-soon to forget. I had it done in the hospital in the early afternoon and was home by 4pm!
I’ll take a pic of what my foot looks like as soon as I have the bandage wrap taken off. Here is my right foot-bandage on.
In the foot, there are the long bones (metatarsals) and thin nerves running between them. The nerves split in a Y-shape when they reach the toes. If the metatarsals move abnormally, they can pinch the nerve between them, which causes inflammation and, eventually, permanent nerve damage. Morton’s neuroma is the most common of this type and affects the nerve between the third and fourth toes.
A neuroma is a painful swelling of a nerve, usually in the ball or heel of the foot. Neuromas may occur after a nerve has been injured, either from a traumatic wound or from damage suffered during surgery. Symptoms include sporadic pain; burning, tingling or numbness of one or more toes; and a popping sensation when walking. Pain is often soothed by taking weight off the foot or by massaging the area.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a condition classified by chronic pain in the ankle, foot and toes caused by abnormal pressure on nerve roots. It is similar to carpal tunnel syndrome in the wrist and hand, but is not as common. The specific cause of tarsal tunnel syndrome is not known, but it can be a result of inflamed tissues around the tibial nerve, injury or other conditions that may affect the area.
The main symptom of tarsal tunnel syndrome is tingling or burning pain while standing or walking that starts in the ankle and spreads to the toes. Pain is usually relieved during rest. Doctors diagnose this condition by trying to induce the tingling sensation when tapping the nerve.
Treatment for tarsal tunnel syndrome depends on the cause of the pain but can include anti-inflammatory medication, orthotics, corticosteroid injections or surgery. Surgery is usually used as a last resort to relieve pressure on the nerve.
I had a failed median neurectomy July 12th and this amputation was a last resort for intractable nerve pain. I’m 52, married 23 years and perfectly willing to take the risk of surgery if it means less pain. Having several painful conditions, lupus, spondyloarthritis, recurring sacroillitis, osteoarthritis, PN, carpal, tarpal and ulnar neuropathy-this toe was the camel that broke the camel’s back. That is why I decided on the total solution. Also between surgeries I have to go off my lupus meds-and THAT is very difficult. I have experienced a low grade fever almost every day, tons of mouth and nose sores, fatigue, muscle and joint pain, worsening anemia, etc. This was my third surgery this year. I am very positive I made a good choice FOR ME. 🙂
After just over three years I had my day in court for social security disability. I WON my case. I had a wonderful lawyer who did a tip-top job of organizing and preparing my medical files which were over two feet high, lol! I’m still in shock! I will talk more about this in another post where I hope I can be helpful for other people like me with lupus who are applying for disability.
Here’s the short list: One thing is to keep all your medical records. Have a good repore with your doctors, especially your rheumatologist and GP, neurologist if they are a big part of your case, etc. Prepare them that you are coming to the end of your working days-and hopefully get their support. Enough to have them fill out paperwork for your lawyer or to write you a letter describing your inability to work and why.
If you worked and had to stop-get a letter from your previous employers. Hopefully this letter will reflect that due to no fault of your own you had to stop working-that your condition symptoms, doctor appointments and medication side effects all effected your ability to work but that while you did work you were an exemplory employee! This is very beneficial to your case.
Of course, find a lawyer who specializes in social security disability, hopefully one that has been doing this type of work for many years-a local attorney is always better because they have dealt with the particular judges that you will be seeing should your case go to a hearing. Any lawyer you do find should work on contingency-with about a 25 to 33% of your backpay reward as a fee. There is a cap at $6000, so no worries there. If a lawyer wants to charge you upfront I would look around for another.
I was considered unresponsive! First let me say that I adore this doctor-he has given me back quality of life with radiofrequency ablations, cortisone and alcohol shots, and nerve blocks in addition to effective pain management medications.
I have all procedures in office and without sedation. I’m good about that. My theory is if your there for dealing with pain, you can make it through the procedures without being knocked out. That said, this accident KNOCKED ME OUT COLD!
I woke up in a recovery chair confused and bewildered to say the least. One of the nurses handed me my purse and coffee cup, which I dumped and spilled all over my lap in a dazed state. They slid the thingy off my finger and said I was done and to go up front and wait for my scripts. Huh? I was really out of it. I knew I was asleep but not why..really strange feeling.
As I wobbled down the hallway I looked back and my doctor half jogged towards me. He said he accidentally got a blood vessel with the lidocaine. I had no idea what that meant but it didn’t sound good. I asked the one question that mattered. I said, “AM I OK?” He said “YES”, so I continued my wobble down the hall to check out and make my next appointment. Really dazed…
Long story short when I got home I noticed I had bandages around my wrist and that both arms were black and blue. My right wrist was black and blue-looked a little like dirt, and my left wrist where the bandage had been was bruised also but with puncture marks both on the wrist and then up by the inside of my elbows.
My husband called the docs office after this fiasco to find out exactly what happened. They told him (they read it off the docs report) that I was unresponsive and that he accidentally injected the lidocaine into a vein. I still don’t know what that means exactly. I know I was unconscious since the last thing I heard was “Julie, your doing great-almost done” and then I WOKE UP in a chair. Huh? Was I unresponsive other than unconscious? Did my heart stop? Did my breathing stop? And WHAT DID THEY INJECT that they made all these holes in me?
Why did they not explain to me when I woke up, etc. I was expecting a call back from my doc but he had a nurse call. I wasn’t happy about that. She tried to make it sound like it was all normal and no big deal. SHE wasn’t the one UNRESPONSIVE. I told her I want to know what happened exactly. She spent her time defending why the nurses around me when I woke up didn’t know any better since they deal with people who are sedated waking up all the time. I recanted with the fact THAT I WAS NOT SEDATED EVER DURING A PROCEDURE, so it certainly wasn’t normal for me!!!!!!!
Lidocaine hydrochloride has proconvulsant and anticonvulsant effects, with CNS effects related to blood concentrations. Low doses (2–3 mg/kg) can terminate status epilepticus.
With increasing blood levels, CNS symptoms and signs of toxicity occur, from perioral numbness, lightheadedness, dizziness, tinnitus, and fine tremors to generalized seizures and coma. In animals, lidocaine produces epileptiform activity that is limited to the amygdala and hippocampus.86
Lidocaine doses that are commonly used for local anesthesia can cause CNS toxicity if they are inadvertently administered intravenously. For example, when administering epidural anesthesia, total doses of 5–8 mg/kg are commonly injected into the epidural space.84 Accidental intravascular injection of this dose can cause epileptic seizures.
In addition to direct intravascular injection and immediate toxicity, systemic lidocaine levels can rise to toxic levels by rapid systemic absorption from the area of injection. This can occur 10 to 20 minutes after injection. Anesthesiologists often add 5 mg/mL of epinephrine to the local anesthetic to decrease systemic absorption and peak serum lidocaine levels. When a regional anesthesia block is successful, early reinjection of local anesthesia can cause toxicity (including seizures), because peak absorption of the first injection occurs while additional medication is injected.
Efforts should be made to deliver minimum amounts of lidocaine to the lower respiratory tract in airway anesthesia (e.g., for bronchoscopy), because its pharmacokinetics at that site are similar to those with intravenous administration.87
High doses of lidocaine cause sedation. Increasing the arterial partial pressure of carbon dioxide (PaCO2) decreases the dose of lidocaine needed to produce a generalized electrical seizure.88 Higher PaCO2 levels increase cerebral blood flow, thus increasing the amount of anesthetic reaching the brain, and may directly excite the amygdala. In contrast to the usual pattern, in which hyperventilation activates seizure activity, hyperventilation may prevent seizures from occurring in patients with lidocaine overdose by decreasing cerebral blood flow.
Lidocaine is injected intravenously to provide local anesthesia (intravenous regional anesthesia or Bier blocks). In this technique, after an extremity is exsanguinated, and the blood supply is arrested by a tourniquet, lidocaine is injected into a vein to provide anesthesia. Doses of lidocaine up to 3 mg/kg of 0.5% solution without preservatives or epinephrine are used. Premature tourniquet release (less than 20 minutes) can result in high systemic lidocaine levels and possible seizure activity. Release after 20 minutes can also be associated with toxicity. Some physicians cycle the deflation of the tourniquet with an intermittent inflation-deflation-inflation cycle in an attempt to decrease rapid absorption of lidocaine from the extremity.
Seizures induced by lidocaine can be terminated with barbiturates.
Etidocaine hydrochloride, a long-acting derivative of lidocaine, as well as mepivacaine and prilocaine hydrochloride, share common pharmacologic properties with lidocaine hydrochloride.
Adapted from: Najjar S, Devinsky O, Rosenberg AD, et al. Procedures in epilepsy patients. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;499–513. With permission from Elsevier (www.elsevier.com).
Reviewed and revised April 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
This conversation is from ExpertLaw.com about the exact subject of a lidocaine overdose by vein during a pain procedure:
Yesterday I received lidocaine as a local anesthetic while getting a steriod epidural for bulging disc problems in lower spine. During procedure I began to have a severe allergic reaction that required I be taken by ambulance from the clinic to the ER. I was released after 4 hours of observation (and benedryl), but still not feeling very well today.
The ER doc (not me) raised the possibility of an overdose, but said he asked the doctor who adminstered the lidocaine who said I got the right dose. I suppose there is also the chance the lidocaine was injected directly into a vein by mistake.
How do I figure out what happened and if there is any fault here? I’m clearly not allergic to lidocaine or the steriod at normal levels since I’ve received both many times before.
Re: Lidocaine Reaction
What kind of severe allergic reaction? Cardiac or itching/swelling?
You could always get a copy of your medical record since the procedure, your reaction, and the fact that they had to call an ambulance should be documented.
Re: Lidocaine Reaction
Thank you for your response.
The reaction began on the table as really bad hot flash and nausea after the lidocaine injection. The doctor told me to hold on while he finished the ESI. It got worse when I got up.
After moving to a chair post-procedure, symptoms of strong dull pain in chest/upper body and difficulty breathing began, and continued to get worse. Doctor initially said this was “normal” and would go away in 10 minutes or so. My BP was high and O2 level was low (based on the finger clamp thing?). When it didn’t go away, I was moved to a laying position, and after another 10 minutes, the uncontrollable, severe shaking started. I think that’s when they called an ambulance and took me to the hospital.
In the ambulance they gave me a IV dose of benedryl. I also had tingling/itchy hands and blotchy skin.
After getting to hospital, shaking and chest pain stopped and breathing seemed to return to normal.
Also, isn’t the fact that they are billing my insurance company for the ambulance documentation enough that I needed that?
Re: Lidocaine Reaction
First, the informed consent you signed before the procedure listed the side effects/risks of the epidural, as well as the medications given during the procedure.
The fact that you did not have a previous reaction to Lidocaine doesn’t mean you’ll never have a reaction to it. It also does not mean the reaction you had was necessarily caused by Lidocaine.
The ambulance company billing your insurance is not he kind of documentation you need. You’ll need a copy of the office notes from the procedure, which should contain notation of your reaction and the fact that 911 was necessary. You’ll also need a copy of the hospital ER record.
Re: Lidocaine Reaction
Thanks. I guess one final question, and I don’t mean this to sound cavalier. If I signed the informed consent assuming all responsibility and risks, why do I “need” a copy of anything at this point?
Re: Lidocaine Reaction
You originally asked:How do I figure out what happened and if there is any fault here?
The answer may be in your medical record.Thanks. I guess one final question, and I don’t mean this to sound cavalier. If I signed the informed consent assuming all responsibility and risks, why do I “need” a copy of anything at this point?
you don’t assume all responsibility nor waive all rights to seek redress. You signed consent based on known risks and complications. That doesn’t mean if a doctor is negligent you have no redress available (not suggesting there were in this case, simply as explanation of what would not be waived by your consent form)
THANKS FOR LISTENING EVERYONE! ((((((((HUGS)))))))) Julie