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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Osteomyelitis In The Toe

Hello, Doctor. I am a 45 year old diabetic with severe neuropathy (have taken a nerve test given by a neurologist), and I ve lost 3 toes already. I am currently in wound care to treat a large ulcer and osteomyelitis on my remaining big toe--treatment includes hyperbaric and IV meds thru a picc line. I also see a pain management specialist. He prescribes me Lyrica, Morphine ER 60mg 1-2 every 12 hrs., and Oxycodone 15mg for breakthrough pain. I am thinking about relocating to Rhode Island due to family issues and because I d be living with a nurse with 20 years experience who could help me manage my condition. However, I am fully aware that this country (perhaps with some reason) has developed a paranoia about prescribing pain meds and we ve let the government take over what SHOULD be a doctor s job. I am very anxious about making this move, because you can t just call doctor s in another state and say: Hi, I need Morphine and Oxycodone. Is that okay? and you ALSO can t pay for a round of consultations to see who the right doctor is. My pain doctor helped write Florida s controlled substance laws (he also has a law degree and works in consulting) so I m comfortable he s not overprescribing. What do you suggest I do to find a doctor before I run out of the meds I will be taking with me to move?
Fri, 25 Nov 2016
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General & Family Physician 's  Response
thank you and pleased to answer you.
firstly as I do here for patient like you, I always ask for a vascular Doppler ultrasound of your leg artery to visualize a slowing down of the blood flow linked to diabetes artery transformations, and much more interesting, if the exam find this transformation, we must add to treatments Anticoagulant medications. in that way, the wound will be better controlled and eradicated(the blood flow will be much better and the antibiotics will target the wound more efficiently).
The essential component of treatment is the management of chronic neuropathic pain.
Many analgesic neurogenic drugs are available in this indication. These drugs come from
Several families: antidepressants (tricyclics: LAROXYL, serotonergic-noradrenergic:
EFFEXOR, CYMBALTA) neuroleptics (RIVOTRIL, NEURONTIN, LYRICA).
All these treatments Have notorious adverse effects and should be initiated at low doses (especially if renal insufficiency is present), Then adapted very gradually according to the clinical response.
So you have several medications choices with a high response rate, you should definitely consult a neurologist.

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Suggest Treatment For Osteomyelitis In The Toe

thank you and pleased to answer you. firstly as I do here for patient like you, I always ask for a vascular Doppler ultrasound of your leg artery to visualize a slowing down of the blood flow linked to diabetes artery transformations, and much more interesting, if the exam find this transformation, we must add to treatments Anticoagulant medications. in that way, the wound will be better controlled and eradicated(the blood flow will be much better and the antibiotics will target the wound more efficiently). The essential component of treatment is the management of chronic neuropathic pain. Many analgesic neurogenic drugs are available in this indication. These drugs come from Several families: antidepressants (tricyclics: LAROXYL, serotonergic-noradrenergic: EFFEXOR, CYMBALTA) neuroleptics (RIVOTRIL, NEURONTIN, LYRICA). All these treatments Have notorious adverse effects and should be initiated at low doses (especially if renal insufficiency is present), Then adapted very gradually according to the clinical response. So you have several medications choices with a high response rate, you should definitely consult a neurologist.