now what....the toe saga continues

  1. i am sooo STUCK

    im not sure what to do next.

    my great toe is turning black. i am in excruciating pain most of the time. been like this for at least three weeks.
    the pain starts in my toes and now travels down the underside of all my toes and across the bottom of my foot. it BURNS LIKE HEll.
    i can honestly describe this pain as an 8 MOST of the time.

    needless to say it kills me to step down on it.
    if i have to walk any kind of distance at all i use a crutch.
    now the side of my foot is turning black as well.

    i went to my pcp and was diagnosed with gout and given indicin.
    that didnt touch the pain, in fact ibuprofen worked better i think.
    friday i called my pcp and told him i was getting no relief from the indicin and the pain was increasing. i was told to increase the indicin and give it time cos it takes 48 to 72 hours for NSAIDS to work (news to me)

    i have been to the podiastrist and was told the pain was from cutting my toenails too short and that i had a problem with the fascia in my heel. she gave me cortisone in the wrong spot. now its worse than before the shot.

    by 8pm friday night the pain was intolerable. i went to the ER. our doc said that it could indeed be gout (tho unlikely). he refused to do a cbc or a uric acid level cos they wouldnt tell him anything.
    he called in a podiatrist.

    now this doc thinks that there is a problem with the circulation in my toes despite good pedal pulses. she says that the color has a blueish tint to it and that poor circulation would cause that kind of pain.
    i crutched on home with the name of a vascular doc and a handful of vicodin. at least i got a little relief.
    first thing tuesday morning ....as instructed....i went right into the podiatrists office for my follow up. and of course it was podaitrist #1. she tells me she sees no discoloration...i said WHAT? YOU CANT SEE THAT?????????
    oh yeah that. ..somethings wrong with her.

    so she made an appointment for me to see the vascular surgeon JUNE 5!! ...said it was the first available. she gave me 10 vicodin to last me till then. A WHOLE DAMN WEEK. cos she cant write more than that cos its "only" a foot problem.
    and she signed me off.

    so i am going to be in limbo for at least a week.
    this morning i called work and left two messages ...one for my mgr calling off today and telling her i am applying for a leave of absence (ive missed so many days due to this toe thing i think they are going to let me go) and another msg to the personell mgr explaining my situation and asking her to call me back.
    neither one returned my call.

    i just got a call on my machine from the nurse who was waiting to give me report. this was 4 hours ago. i havent called back. i feel horrible. i would NEVER leave anyone hanging like that.
    ill bet shes mad as he11 and i dont blame her.

    so i dont know what im going to do now. i feel like im hanging in limbo. i dont have ANY doctor right now....if i do get a leave WHO is going to fill out the papers?
    (podiatrist # quack thinks i can work)

    i am so scared of losing my job....i really love where i work....and im so afraid some real damage is going to be caused by the time delay in treatment....pain like this doesnt happen unless there is a REASON.
    and im so afraid i am going to suffer because there is nobody to treat my pain.
    and im worried about paying my damn bills

    oh god im such a mess.
    can we gather our team of nurses for a little advice?
    i think im so far in this i cant see what to do next...im stuck
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  2. 9 Comments

  3. by   susanmary
    I'm a vascular nurse & have emailed you. Keep in touch.
  4. by   prn nurse
    I hope the vascular nurse answered all your questions. If your toe is turning black, it sounds like it is not getting adequate circulation. I would be in a cardiologists office pronto !! This is not something u wait until they have an app't to see u. He will get u started on meds and make any referrals you need. In the meantime, send someone over to the drugstore and buy one of those things u plug in to soak your feet in. and buy a couple of bottles of betadine. pour in enough betadine to turn the water a nice orange color and soak your foot 3 times a day for 20 - 30 minutes. dry well. no socks....no tight legged undies...keep it elevated the other 20 hours a day !!! take an aspirin a day ...no ibuprofens,,,, they undo the blood thinning action of aspirin......the excruciating pain is the same pain a person experiences when having a heart attack,,,,,, the tissue is not getting adequate oxygen and is dying. diabetics live with this pain all the time.... good luck
  5. by   moonchild20002000
    I think you should call the vascular surgeons office ASAP ! Tell them whats going on and see if they can get you in sooner. Good luck!
  6. by   thisnurse
    susan...thanks for the email but for some reason i didnt get it.....
    nursecathy@email.com

    i know that it looks like the tissue is dying...their theory is inadequate circulation r/t smoking
  7. by   NRSKarenRN
    Call the vascular surgeons office yourself, use nurse authority....got Doc to eval dads triple AAA same day doing this.
    Insist on doppler ultrasound of the leg. Hope susanmary helps.

    My dad threw a clot in L leg post triple A repair and pain was so excrutiating he was on PCA Morphine + Duragesic patch + IV Toradol...they did thrombectomy and applied NTG paste to foot. Little toe was farely dark blue/black 24hrs post op. Now 10 days later is 1/2 black and still pulpy with great pulses.

    Sending hugs...PAIN IS WHAT THE PATIENT SAYS IT IS. Hope you get relief.
  8. by   thisnurse
    well i did the impossible....i got my own damn appt with the vascular surgeon TODAY...imagine that.
    he feels that although the color is funky there is adequate circulation to my toes. if anything there is a 5% chance of an embolism. just to rule it out im having the pressure studies done.

    he feels that its gout. he said that he has seen cases where the pain was in the whole foot and not just the toe. one of his patients had pain shooting up his leg.
    he wonders why i havent had a uric acid level. i keep asking for this stupid little blood test along with a cbc and keep getting told i dont need it. tomorrow I GET A URIC ACID LEVEL. i am going to call my pcp's office and talk to MY doc. not a PA and not an associate...i am going to talk to MY guy. and i will get my blood work ordered and i will get ADEQUATE pain relief...or i will find another doc.
    been calling my mgr for two days now and she wont return my calls...im thinking they are letting me go. probably time for a change anyway. been thinking about working for the dept of aging or doing home health. i need to set my own hours and i cant stand what they do to us where i work.
    i dunno. i LOVE nursing but dont think i can physically handle much more of the floor thing.
    thanks guys for all your input.
  9. by   micro
    dang nab it, this nurse........

    get that toe saga fixed and write the book.....

    "the toe"
    by this nurse...

    seriously, be well and all

    micro
  10. by   mother/babyRN
    Oh my God! I feel so badly for you! PLEASE keep us updated! And good for you for INSISTING you see your own doc. REMIND them that they work for you and not the other way around! I am saying prayers for you! Hugs!
  11. by   CATHYW
    When it walks like a duck and quacks like a duck, it is probably a....DUCK, DADGUMMIT! What is the deal-these people can't see the forest for the trees, or what?
    You didn't mention anybody doing pedal pulses or ultrasound studies-those would have been first thing done in triage, and first order by MD, in addition to coag studies and a total chem profile and CBC. I can't be lieve this crap-you could've lost your foot!

    BTW-PRN Nurse, Ibuprofen is contraindicated when taking ASA because it potentiates the effect of the ASA by inhibiting prostaglandin synthesis.

    Now, ThisNurse, about your job. I am playing Devil's Advocate here.......before your toe began bothering you so acutely, what was your attendance like?.......and, did you keep your Nurse Manager updated (as soon as you knew what was going on) as to what was going on?.......does your facility allow you to work with restrictions that are not due to a work-related problem?.......could you have worked, and chose not to, because of the pain?........we were not allowed to leave messages when we called in, because they often were not received in time. We had to speak with the Nurse Manager, or the Charge Nurse so there wouldn't be any incident of a nurse waiting 4 hours to give report! I would've called a lot sooner than she did!

    I know your biggest concern is your health, but you also have the responsibility to yourself to provide for yourself. If you have to go over to your facility (not a bad idea at all-let them see what your toe and foot look like) to talk with your manager, get yorself on over there. Tell her that you will provide whatever type of documentation she requires, and request FMLA leave. Do NOT wait for them to call you-it indicates a blase' attitude. Remember also, the adage; "decision by indecision." If you don't actively intervene on your behalf, your future will be decided by somebody else, and probably not in the way you would like.
    Keep us posted!

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