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Doctors' detective work on Valpo man's foot pain leads them to a potentially deadly pain in the neck

Doctors' detective work on Valpo man's foot pain leads them to a potentially deadly pain in the neck

Second Chances

Imagine going to the doctor for pain in the foot and ankle -- supposedly remnants of a stubborn softball injury -- and finding out the problem actually had originated in your neck.

That's what doctors eventually told David Podguski after some medical detective work by two Crown Point podiatrists.

When the custom-made foot device doctors prescribed for the injury failed to alleviate his pain, the 49-year-old Valparaiso man sought another opinion from Dr. Michael Nirenberg and Dr. Michael Carroll.

"One of the things we do here is look at the whole person and not just the foot," Nirenberg says.

Because the most obvious diagnosis and treatment hadn't worked, it was clear the doctors needed to dig a little deeper. The doctors ordered a blood test that revealed an unusually high level of uric acid, which they said could only mean a couple of things. They confirmed that Podguski had gout, a form of arthritis that occurs most often in the big toe when uric acid builds up in the blood.

But the gout had shown up in joints where it typically doesn't occur, suggesting another cause was at work.

Convinced there was more to the story, the doctors sent Podguski for an MRI.

The test showed Podguski had a tumor on one of his parathyroid glands. Located on the thyroid gland, these four pea-sized glands secrete a substance that helps the body regulate certain chemicals in the body.

The doctors shared their findings with Podguski's family doctor who arranged for removal of the tumor. Within a month, his pain had vanished, but that's not all.

"Quite possibly we may have saved his life," Carroll said.

The doctors explained that the chemicals adversely regulated by the malfunctioning parathyroid might have led to life-threatening consequences, such as the development of a heart arrhythmia.

Somewhat shocked that a softball injury could lead him down such a perplexing path, Podguski has learned firsthand that persistence pays off. He's thankful the doctors stayed the course.

"I guess things are not always what they seem," Podguski says.

Parathyroid Adenoma -- David Podguski

Diagnosis: Parathyroid Adenoma

Definition: According to Medline Plus, a service of the U.S. National Library of Medicine and the National Institutes of Health, parathyroid adenomas are "non-cancerous (benign) tumors of the parathyroid glands, which are located in the neck."

Symptoms: In Podguski's case, pain in his ankle and foot eventually led to a diagnosis of gout, a form of arthritis caused by uric acid build-up in the blood, usually in the big toe. But since the gout had occurred in joints where it typically doesn't, doctors began searching for other causes.

Physicians: Podiatrists Dr. Michael Nirenberg and Dr. Michael Carroll with Friendly Foot Care in Crown Point ordered blood tests and an MRI, which eventually led to the discovery and removal of the tumor. Their article documenting the case was published in the May/June 2007 issue of the Journal of the American Podiatric Medical Association. It is titled "Atypical Gout in the Foot and Ankle Secondary to Primary Hyperparathyroidism."

Treatment: Once the tumor in his neck was removed, Podguski's foot and ankle pain disappeared.

What you should know: Nirenberg and Carroll say that many medical conditions can show symptoms first in the feet and that pain of any kind is not normal and should be investigated. As a word of advice to physicians, the doctors state in their article, "The foot and ankle may be the first area to show symptoms of a parathyroid adenoma. Early discovery of this tumor can limit or prevent the development of other debilitating medical problems that could ultimately result in death. This case reveals the importance of thorough evaluation of patients who have high serum uric acid levels in order to discover causes of gout in the foot and ankle."


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