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My Feet Are Killing Me

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On 5/5/2022 at 8:50 PM, SunnyBeBe said:

I cannot imagine going through the procedures we are seeing.  Man…..

I was surprised to see Dr, Brad in NYC too!  So, he moved a medical office to the heart of NYC during covid!  Wow….I would imagine rent would be incredibly high.  I wonder how that works for a solo practitioner.  My law practice is in a trendy, high rent district in my state’s capital, but it’s manageable because the space is shared by multiple attorneys.   I guess he’s bringing in a lot. 

There is another older Dr. in the practice with Dr. Brad. My guess is that they teamed up, with the older Dr. bringing an established patient base and Brad leveraging his TV popularity. Seemed from the practice description on the web that the older Dr. was easing his way into retirement.

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The woman with the extremely rare condition that causes thick calluses to grow on the bottoms of her feet was on again last night. The ones that Dr. Sarah had removed grew back even worse than before so she tried a different approach this time. She cut off the calluses and then attached skin grafts hoping that normal tissue would grow where the calluses were. I hope it works. The poor woman basically has to crawl around her house on hands and knees because walking is just too painful for her to manage.

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23 hours ago, mmecorday said:

The woman with the extremely rare condition that causes thick calluses to grow on the bottoms of her feet was on again last night. The ones that Dr. Sarah had removed grew back even worse than before so she tried a different approach this time. She cut off the calluses and then attached skin grafts hoping that normal tissue would grow where the calluses were. I hope it works. The poor woman basically has to crawl around her house on hands and knees because walking is just too painful for her to manage.

That was an awful affliction, wasn't it.  At the end, when she showed Dr. Sarah her healed feet, it looked to me as if the horny calluses were growing back, right through the mesh of transplanted skin.  As I watched that poor woman crawl around her home, I wondered if it wouldn't be better for her to have below the knee amputations and to be fitted with prosthetic lower legs and feet.

As I understood it, and I could easily have mis-heard, this is an auto-immune situation; in other words, it's not something that can just be cut off--it's part of her system to over-grow skin on her feet, leading to the calluses.  If that's the case, it seems to me (and I'm not a doctor--I just watch them on tv) that amputation might be the best and really only way to go to give this woman permanent relief.

Well, I got off my duff and looked Olmstead Syndrome up on the NIH website.  Here's what they have to say about how you get it:

Olmsted syndrome is caused by genetic changes (DNA variants) in the TRPV3 and the MBTPS2 gene. Many different forms of inheritance have been reported, although many cases of Olmsted syndrome are sporadic (a new case in a family). Diagnosis is based on the symptoms, and genetic testing can be helpful.

So it's not auto-immune, but it is the result of genetic mutation, so it would still not be something you can just cut off.  Gene therapy, which is it seems as million  years away, could probably treat this awful condition.

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40 minutes ago, Mothra said:

As I watched that poor woman crawl around her home, I wondered if it wouldn't be better for her to have below the knee amputations and to be fitted with prosthetic lower legs and feet.

There is much permanent aftercare with amputations...complicated treatments and infections.  I wish there were more education for the public. I had to go to wound care for several weeks (skin cancer gone wrong) and most of the patients in the waiting areas were older men with amputations on various parts of their legs. Ongoing treatment for decades. Some were Vietnam vets.  Disheartening. 

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2 hours ago, Back Atcha said:

There is much permanent aftercare with amputations...complicated treatments and infections.  I wish there were more education for the public. I had to go to wound care for several weeks (skin cancer gone wrong) and most of the patients in the waiting areas were older men with amputations on various parts of their legs. Ongoing treatment for decades. Some were Vietnam vets.  Disheartening. 

I worked in a rehab hospital in Philadelphia in the 1970s and was responsible for running the prosthetic clinic.  My experience was very different from what you describe.  We didn't see people until their stumps had completely healed, so there were virtually no infections with the prostheses.  Aftercare, assuming the prosthetic was fitted properly in the first place, mainly consisted of replacing worn-out equipment.  Most patients were able to resume the lives they had before the amputation, only without the symptoms and pain that made the amputation necessary--which were mostly open wounds which would not heal in diabetics.  I remember a 90-year-old lady who went back to her third-floor walkup with two artificial legs!  She was exceptional.

These days, with things like the "blade" foot for runners, I suspect prosthetics are more comfortable and versatile than ever--you may even know someone who has a false leg but not realize it.

What I have said refers to lower-limb amputations (since the patient's problem was in her feet).  I don't know what the state of upper-limb prosthetic science is today; I do know several upper-limb amputees who prefer to use the old-fashioned hook instead of a fake hand.

Since Olmstead syndrome is caused by genetic abnormalities, so that cutting off the affected parts won't work, amputation might not work, either, because the genes involved will still be active in the body and may express themselves in the palms of the hands, essentially the same skin as we have on the soles of our feet.

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3 hours ago, Mothra said:

I worked in a rehab hospital in Philadelphia in the 1970s and was responsible for running the prosthetic clinic.  My experience was very different from what you describe.

I'm very happy to know that.  Perhaps the men I saw were living in dire circumstances--maybe driven in from shelter situations.  As I recall, all of their bandaging was dirty (and worse). I didn't see prostheses. I observed 4-5 of those patients every time on my weekly appointments...early 2000s.

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