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New Hope for Patients with Rare Scleroderma Symptoms

Aug 17, 2004

Joan Pyzik of Villa Park was able to walk at her daughters wedding in June—a feat she wasn’t sure was going to happen as the throbbing pain in her feet worsened and talk of toe amputations loomed.

A new surgical procedure, done only at Weiss Memorial Hospital (Weiss), allowed Pyzik’s dream to come true. Lawrence Zachary, M.D., associate professor of clinical surgery at the University of Chicago and medical director of plastic and reconstructive surgery at Weiss, is believed to be the only physician in the nation performing toe sympathectomy.

The technique destroys nerves in the sympathetic nervous system, relieving the intermittent constricting of blood vessels caused by certain diseases. The result is increased blood flow and decreased pain.

Finger sympathectomy (more commonly known as digital sympathectomy) has been done for years on patients. Zachary has performed more of those procedures than any other physician in the country. “The anatomy in the toes are similar to fingers, so I thought this surgery would be effective in the lower extremities, as well.”

“I have no more pain in my right foot,” Pyzik said. “And my left foot is healing fast.” Pyzik had surgery on two toes on her right foot in March and two toes on her left foot in May. “The difference is amazing,” Pyzik said. Within the past year, the pain became more intense—not only did it hurt to walk, but also Pyzik said her feet were sensitive to the touch.

Pyzik has a rare autoimmune disorder called scleroderma. It’s a progressive disease that affects the skin and connective tissue that supports the nerves and blood vessels throughout the body. One of the complications of the disorder is a condition called Raynaud’s phenomenon—the fingers and/or toes suddenly lose blood circulation. The process could lead to open ulcers, tissue death (gangrene) and amputation of the toes or fingers.

“My toes became discolored, eventually turning black,” Pyzik said. “One doctor told me I would have to lose some of my toes, but I wanted to save them.” Zachary gave her that opportunity.

“When you lose one toe, the disease will eventually take them all,” Zachary explained. “Raynaud’s phenomenon even can progress to the point where a patient’s foot would have to be amputated.”

But Zachary’s toe sympathectomy is preventing the prognosis. The procedure involves making an incision on the top and bottom of the foot. Zachary then snips the sympathetic nerves that go to the blood vessels leading into the toes allowing for improved blood flow.

“This procedure is for people with Raynaud’s phenomenon whose medical therapies failed,” Zachary said. It’s not a permanent fix, but will help correct the blood vessel constriction problem.

“I was taking blood pressure and pain medication and it wasn’t helping,” Pyzik said. “My toes were being starved for blood. It was as if I was experiencing mini heart attacks in my feet.”

An estimated 300,000 Americans have scleroderma—a majority are women and most are diagnosed between the ages of 30 and 50. For patients with a form of the disorder known as limited scleroderma, like Pyzik, the prognosis is relatively good. About 65% of all patients survive more than 10 years after their diagnosis. The severity of scleroderma varies widely.

Pyzik was diagnosed with the disorder 11 years ago. “I manage it the best I can,” said Pyzik, who also deals with tightening of the skin, face redness and esophageal problems. Doctors don’t know what causes scleroderma or how to prevent it. “All you can do is treat the symptoms,” Zachary said. “Hopefully more doctors will start doing the toe sympathectomy. I’m glad I’m able to offer these patients an effective treatment option.”