Saturday, 25 January 2014

A patient experience of Cryotherapy and Verapamil

About 5 years ago, I developed a bump behind my big toe on my right foot.  I had no idea what is was.  I mentioned it to my doctor, who is a very well connected Dr, in Philadelphia.  (I drive 2 hours to visit him from my home town).  He referred me to Dr. Robert Cohen.

I really had no idea what to expect, and sort of assumed that as long as it was not cancer, it was going to be no big deal.  Well, it was not a cancer, and Dr. Cohen confirmed it.  At this point, I had no real discomfort, but was worried about the bump.

He put me on Verapamil as the initial treatment, and it did not really do anything. 

Dr. Cohen subsequently did a cryosurgery on it, and I really expected it to be broken up and dramatically shrunken after the procedure.  I revisited a few weeks later, and the Dr. was quite happy with the change in size and shape.  I personally really did not notice any significant shrinkage, but it had become a bit elongated.

Over the next 2 years, I did the procedure 2 more times, with nominal results, that were duly noted by Dr. Cohen after he ran an ultrasound each time.

After the 3rd treatment, I stopped going.  I really did not feel any great change, and I had not really had any significant pain anyway. 

I had been given a pair of orthotics to lengthen my arch, with a small shaping around the fibroma to remove some of the impact on it as well.

I went through the next 2 years, with no real concern about the fibroma, and I felt like the cryosurgery was pointless.

I have recently changed my mind.  The fibroma has gotten a little bit larger, and is much more painful.  I get the burning sensation that others describe.  In particular, each morning when I first put weight on it.

I will be going in February to have it evaluated again, and have a new cryosurgery.  I am hoping it will disrupt the fibroma enough to set it back to where it was just an annoying bump without the intermittent pain and burning.

The Cryo process

The surgery is really simple.  They numb the foot, cut a small (size of a drinking straw) hole in your foot, and insert a tube that forces cold (like a dry ice) into the fibroma. They continue this insertion until the point where the cold my damage other tissues.  You are wrapped in a sterile bandage, and your foot is wrapped in a hard paper boot, that diverts weight around the arch, and you walk out.

After 3 days, you take the bandage off, and put anti biotic on twice a day like a normal cut, and go about your business.

Cryosurgery is NOT a cure.  Not even close.  It may not even reduce the fibroma.  But, my instincts tell me that it did delay any increase in size, prevented pain within the fibroma, and was a good thing.

I would like to emphasize that my final thought in cryo is that it is a tool to reduce pain, nominally shrink and reshape the fibroma and slow the process down.