symptoms of nerve damage after bunion surgery symptoms of nerve damage after bunion surgery

After the surgery, the surrounding specific area of the incision becomes numb, and it may remain for a long period of time after surgery. You may not be able to prevent varicose veins. Meditation, acupuncture, light exercise, or changes in nutrition can all provide some relief for nerve pain as well. To ensure successful bunion surgery recovery:Keep the foot elevated as much as possibleKeep dressings in place and the area dry until the stitches are removedKeep walking to a minimum, wearing your special shoe and keeping all the weight through your heel (using crutches if necessary) for the first few weeksDo not wear high heels for at least six monthsFollow your exercise programme Patients may lose control of urine and bowels due to numbness. PNI is classified as either a qualifying condition or a non-qualification condition in many cases using either the Seddon or Sunderland classification systems. Tips for Living with a Person who is Depressed. Bunions. The use of radiofrequency ablation as a treatment of symptomatic advanced knee arthritis and total knee replacement was discussed in a review. Bunion pain symptoms include: A bony bump or protrusion on the outside of the big toe joint Pain around the big toe joint, which typically worsens while wearing shoes and walking Swelling or redness at the big toe joint Callus formation where the big toe rubs against the next toe Reduced mobility in big toe Get Directions Get Directions This incision is located very close to a nerve, making it difficult to miss. Nerve-targeting medications can control pain and increase function. This can cause weakness, numbness, and tingling in the foot and leg. Approximately 20% of patients are dissatisfied with the results of total knee arthroplasty, often due to residual pain. or 817-882-2400, 5323 Harry Hines Blvd. The severe condition of tingling and numbness is complicated to deal with. And always keep your physician in the loop! For example, if we can see that a nerve is severed or excessively stretched or torn, we know self-healing is not possible and surgery may be a good option. They might involve: It's possible that you'll be able to walk on your foot right after a bunion procedure. This is generally very rare however. Gonzalez estimates that C-RFA could benefit up to 100,000 people. FAQs We have a wide variety of clinical trials available if you qualify and meet specific criteria. Wound WebSome patients get neuritis after bunion surgery. Nerve damage is split into three types: damage to the surface of the myelin sheath, known as neurapraxia, damage to neurons is known as axontomeis, and when the nerve is cut in half or torn, it is neurontomesis. WebCertain body-wide conditions can also cause single nerve injuries. Symptoms of peripheral nerve damage depend on the severity of the injury and the type and location of the nerve injured. You can also buy over-the-counter pain relievers such as ibuprofen, acetaminophen, or naproxen. Recommended Reading: How Much Does Laser Eye Surgery Cost 2021. This could be due to an insufficient sample size or a faulty reporting process. American Academy of Orthopaedic Surgeons. Swelling. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Its a hollow area that allows important veins and nerves to travel down your leg. Although there are few side effects, dizziness and sedation are more common. What, if anything, appears to worsen your symptoms? If you require an injection, your doctor may recommend giving you a corticosteroid injection to help alleviate your inflammation. Is postoperative analgesia increased risk of this condition? So this bone can damage and hit into that nerve, depending on how the fracture is situated, as well as if the fracture creates a lot of swelling. Accessed Aug. 11, 2019. WebA nerve repair is not like an artery or vein repair, where blood starts flowing immediately. If you have been living with mobility deficits, you may need ongoing therapy with our physical medicine and rehabilitation (PM&R) team. All these issues arise because of numbness that needs emergency care. The bunion surgeries are their bread and butter with regard to the risk involved. The C-RFA procedure involves inserting a needle into the knee that targets specific nerve regions. A 60-year-old woman was admitted to the district hospital due to left knee pain. Alternative treatments such as Endovenous Laser Treatment and Radiofrequency Ablation have high success rates with few complications reported, a significant benefit of these therapies. You seem to be describing symptoms related to a nerve irritation. Total knee replacement (TKR) is a common and effective treatment for end-stage knee osteoarthritis. Less extensive injuries typically offer a better chance at full recovery. These factors make it a preferred option for those who wish to avoid nerve damage. Risks of Bunion Surgery Local anesthetics have been linked to the development of peripheral and central nervous system damage in a study of 380,680 patients at a single institution over a 10-year period. Following varicose vein treatment, some patients experience mild nerve damage symptoms. Ferrari J. Hallux valgus deformity (bunion). This site complies with the HONcode standard for trustworthy health information: verify here. But be patient, the pain will not last forever. In some cases, it exists for days. Nerve regeneration and damage recovery are both very slow processes. Why or why not? Poor posture can put extra stress on the rotator cuff and cause pain in the bicep. Wound complications, infections, problems with blood flow and prolonged swelling are more likely. It is theoretically possible to have neuralgia after a procedure, but usually this resolves spontaneously. Physical therapy is one good way to help nerve pain after surgery. Sutter M., Hersche O., Leunig M., Guggi T., Dvorak J., and Eggspuehler A. Are there other self-care steps that might help? I have considered amputation, but I know that will likely make it worse. Sometimes there is swelling there as well. In a Mount Sinai Hospital study, women undergoing Cesarean section were given a single pre-operative dose of 600mg gabapentin versus placebo. Researchers, including some in our labs, continue to make advances in understanding the nerve-to-muscle connection and time-sensitivity of surgery. Here are some questions people often ask about femoral neuropathy: Recommended Reading: Rotator Cuff Surgery Workers Comp Settlement, If you are experiencing the above symptoms, your biggest question is likely, can nerve damage be repaired? In many cases, the answer is, Yes.. Sept. 27, 2019. In most cases, time is an important factor in treatment. Look at his degree. If you have nerve damage in your knee, you may experience symptoms such as numbness, tingling, or weakness in the affected area. According to the Medical Research Council (MRC), nerve injuries are classified as grades 4/5 or lower in motor strength. It divides again further down your leg, providing sensation to your lower leg, ankle and foot. Each of our hundreds of individual nerves has a particular job, controlling movement or sensation in specific parts of the body. In 23% of patients with nerve injuries, the affected area of the leg shown below is numb. The peripheral nerves those outside the brain and spinal cord carry motor and sensory signals that allow us to blink, high five, or tap our toes. Plus, we review all the potential side effects as well as the steps involved in aftercare to ensure each patient has the best possible experience. lmarieparks303784 Foot drop, reduced sensation in the lower limbs, and numbness in the palms are all possible side effects. Some treatment options do not require any surgical procedures, and thus pose no risk of nerve damage. or 214-645-8300 Lower extremities tingling, weakness, and numbness are the most common symptoms of knee replacement surgery. In PNI, the most important diagnostic tests are nerve conduction studies and needle EMG. Accessed Aug. 12, 2019. 2023 Brandon Orthopedics | All Right Reserved, The Knee: A Complex Joint That Can Be Damaged Easily, The Truth About Spinal Stenosis: Causes Symptoms And Treatments, Can Years Of Surfing Contribute To Spinal Stenosis, The Effects Of Spinal Stenosis And Carpal Tunnel, Should I Apply Ice Or Heat To A Compression Fracture, How Does A Soft Bed Prevent Healing Of Herniated Disc, Herniated Discs: How To Sleep Without Worrying About Rupturing Your Discs, If You Have A Herniated Disc You Know The Excruciating Pain It Can Cause. Other risk factors include a lower than normal pressure during anesthesia, as well as a longer anesthesia period. The patient failed to show up for an outpatient appointment with neurology the week after discharge. WebA herniated disc becomes an emergency when there are signs of nerve damage, such as neurologic deficits (numbness, tingling, weakness). Most of the time, varicose veins that happen while youre pregnant go away on their own within two or three weeks after you have your baby. An X-ray revealed marginal osteophyte formation as well as a subchondral sclerosis of the tibial plateau in the left knee. Fortunately, advanced treatment options can help patients manage pain symptoms and reduced function: Managing a peripheral nerve injury is a team effort. Be careful, Podiatrist is a doctor. Remember: wearing compression stockings and moving around after ablation helps prevent blood clots from forming! Complications from surgical procedures can cause numbness in up to 85% of surgical candidates. If you have nerve damage in your knee, you should consult a orthopedic surgeon who specializes in this type of damage. A severe kind of nerve damage can be picked up by this test. Permanent damage is rare (around 5%) but if your toe stays numb after surgery, it may be because You may experience stabbing pains in your legs when you stand up after lying down for a while, stand for long periods or walk uphill. Could this pain be associated with the procedure? platelet-rich plasma PRP) may help in this regard. Dr j sardines palm beach fl. In: Orthopaedic Knowledge Update: Foot and Ankle 6. Sciatic nerve palsy, combined with motor power weakness and electromyographic evidence, is uncommon after total knee arthroplasty. over a year ago. Patients who are at risk should be carefully examined after surgery, particularly if their surgical techniques and neurovascular exams have been compromised. Tingling, numbness, muscle weakness, or burning are the most common signs and symptoms of nerve damage after surgery. For many people suffering from knee osteoarthritis, gabapentin and duloxetine are effective medications that can be used to reduce pain. This often feels like a numbness or tingling feeling in the extremities. We talk through every option available to a patient to help set realistic expectations about regaining function. The mechanical deformation of peripheral nerves can be directly caused by both stretching and compression. Many times nerve issues after surgery are temporary, for example, many patients have nerve problems after surgery that only last for a few weeks to months (2,3). WebAutonomic nerve damage may produce the following symptoms: Inability to sense chest pain, such as angina or heart attack. But there is a limited window of time in which surgery might help. What is Ramsay Hunt syndrome, the virus affecting Justin Biebers face? If your tingling or numbness is severe, you should seek medical attention. You can also try to warm it up by applying a cold compress. You're likely to start by seeing your primary care doctor or a foot specialist (podiatrist or orthopedic foot specialist). Diabetes. I'm much less able to move normally. Each nerve has a single long axon inside a sleeve that is like a bundle of long axons. Bunion pain is often the result of pressure on the toes from shoes. This includes rounding your shoulders and hunching your back. Fortunately, most of these symptoms improve over about a year. The quadriceps, hamstring, and calf muscles work together to straighten the leg. In the end, the bunion wasn't nearly as bothersome (though very bulbous and ugly) as the permanent damage to my foot from this unnecessary surgery. Too much sweating (known as hyperhidrosis) or too If a known underlying neuropathy can be identified during a pre-operative neurologic evaluation, surgical techniques can be adjusted. In: Campbell's Operative Orthopaedics. Hallux rigidus, sometimes called turf toe or stiff big toe, is when you have big toe pain. If you are experiencing nerve pain, be sure to talk to your doctor about your options. Mayo Clinic is a not-for-profit organization. Dallas, TX 75390, 2023 The University of Texas Southwestern Medical Center, Too gruesome for video: The high-energy injury of Dallas Cowboy Allen Hurns, What's causing electric facial pain? Doctors use Orthobiologics as a neuropathy pain treatment that works to enhance the function of nerves by providing healing. A catheter with a 20-gauge thread was threaded through a 5-cm-deep channel and secured. It should be noted that the risk of nerve damage during vein treatment is relatively low when performed by an experienced professional. If the symptoms are severe, you should consult a physician. Common sclerosing substances include heat, chemicals, hypertonic saline, or detergents. Our surgical team provides patients with complete care instructions after their treatment so they can feel confident theyll get the results theyre looking for while also minimizing side effects and reducing the risk of complications. Some signs of nerve damage include: https://orthoinfo.aaos.org/en/treatment/bunion-surgery/.Accessed Aug. 12, 2019. The hamstring muscle group is responsible for bending (flexing) the leg. UT Southwesterns team of specialists works together to personalize treatment plans, and we have an excellent record of achieving good outcomes for our patients. Patellar tendonitis can cause pain, numbness, and tingling around the knee. It usually takes six to three months for the patients recovery to begin. There are several causes for numbness and tingling after surgery. Compression stockings usually have to be replaced every 3 to 6 months. This is a condition in which the patellar tendon, which attaches the kneecap to the shinbone, becomes inflamed. Search Conditions & Treatments This procedure uses cyanoacrylates, a type of medical glue, to seal the affected vein and redirect blood flow elsewhere in the leg. A peripheral nerve is made up of parallel nerve axons embedded in connective tissues. Inflammation and prolonged immobilization are important factors in the development of perioperative PNI. WebAs with any surgery, bunion surgery involves certain risks and complications. Feeling like youre wearing a tight glove or sock. Understanding Nerve Damage In Diabetes: What Is Diabetic Neuropathy? To prevent a recurrence, you'll need to wear proper shoes after recovery. If you experience any of these symptoms, you should see a doctor to determine the cause and get proper treatment. Our colleagues in neurology administer and interpret these tests, which can tell us whether a peripheral nerve is being compressed or how badly it is injured. A single copy of these materials may be reprinted for noncommercial personal use only. Disc protrusion, facet overgrowth, and ligamentous flim thickening are some of the most common causes of spinal stenosis. Then, the nerve fibers have to grow In addition, the nerve is surrounded by a fatty sheath that acts like an insulator covering a wire. Compression of the Occupational and physical therapy can prevent and reduce stiffness, and patients can learn new or different movements to perform daily tasks. The side effects in both groups were the same in terms of somnolence, apart from a reduction in it. The Ann Plast Surg 2005; 55:63842 ten. Causes of nerve damage during surgery include the scalpel, a bruise that occurs on the nerve, inflammation of the tissue around the nerve, forces caused by patient positioning during surgery, or prolonged contact with rigid surgical equipment. The ankle and foot cannot be extended without the use of these muscles. The management of peripheral nerve and palsy postarthroplasty is described in this article. This includes rounding your shoulders and hunching your back. Welcome to Brandon Orthopedics! Severe nerve damage followed by complex regional pain syndrome. It can stretch, shift, and crush nerves, inducing pain, and damage. That swelling can create a lot of local compression. They may experience discomfort but dont develop complications. When symptoms such as allodynia, hyperpathia, or hyperesthesia are present, they must not be considered peripheral nerve injury. If this occurs, the nerve can be freed from the scarring with a procedure called a nerve decompression. Disorders of the hallux: Hallux valgus (bunion). An investigation conducted by the Mayo Clinic discovered that nerve damage caused by hip surgery can also lead to inflammatory neuropathy. When peripheral nerve surgery might help. Varicose veins usually dont bother people unless they become very painful or cause swelling that interferes with everyday activities like walking or exercising. UTSW is one of the few centers in the region that can perform advanced peripheral nerve procedures we have a deep bench of cross-functional nerve experts, including neurologists and neurosurgeons, rehabilitation medicine and pain management experts, plastic surgeons, orthopedic surgeons, hand surgeons, radiologists, and occupational and physical therapists. Numbness or tingling around the medial ankle and sometimes pain can be signs of a saphenous nerve problem. Varicose veins usually dont cause symptoms unless they become enlarged or twisted. Peroneal, sciatic, and lateral cutaneous nerves are the most common peripheral nerves that are injured in the lower extremities. This is more common with dorsal medial approaches. American Academy of Orthopaedic Surgeons. 2022 SurgeryTalk.net Contact us: contact@surgerytalk.net, Varicose Vein Ablation | UCLA Vital Signs, Treatment for Varicose Veins | Nucleus Health, How Much Does Laser Eye Surgery Cost 2021, Nasal Valve Collapse Treatment Without Surgery, Long-term Side Effects Of Colon Resection Surgery, Rotator Cuff Surgery Workers Comp Settlement, Eye Color Change Surgery Before And After, Laser Eye Surgery For Astigmatism Pros And Cons, Diet After Heart Bypass Surgery And Diabetes, How Long After Meniscus Surgery Can I Walk, Shoulder replacement surgery: 21% had temporary nerve damage, 2% had permanent nerve damage. To read the PMC article, you can use the link provided. Web6. Maybe you have nerve damage after the bunionectomy. This is a cell therapy approach that is used to relieve nerve pain. However, full recovery can take weeks to months. Swelling after bunion surgery often lasts for nine to 12 months, according to MedlinePlus. To help reduce swelling, patients need to elevate the affected foot whenever seated or lying. A bunion is the result of a foot deformity, states the American Academy of Orthopaedic Surgeons, where one of the big toes bones protrudes toward the inside edge of the foot. The Mayo Clinic attempts to treat persistent knee pain that is difficult to diagnose or resolve. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License . Pairing their skill with our specialized understanding of how peripheral nerves function, we can gain a more precise picture of whether surgery might restore sensation or movement. An anterior incision is located at the front of the knee during the ACL reconstruction and the total knee replacement surgeries. When one of our peripheral nerves is torn, separated, or compressed due to an injury, patients may lose sensation or movement in a muscle or limb. A more serious problem is injury to a nerve that affects muscle or sensory control. For other people, varicose veins may keep coming back after treatment. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. In the event that a nerve injury does occur, early recognition and prompt treatment is essential in order to maximise the chances of a successful recovery. She only thought about making money. MR Neurography is defined as Magnetic Resonance Neurography used to check the damaged nerve. Peripheral nerve surgery may be able to restore part or all of these deficits when self-healing isnt possible. Numbness can also be caused by an injury that engraves the nerve. Stretching and compression are the two most common local mechanical insults caused by position-related PNI. Contracture can be thought of as an important predisposing factor for the formation of CPNP in previous studies. The most common type of perioperative nerve injury is a neurapraxia, which is a transient conduction block due to pressure or traction on the nerve. These include the use of nerve monitoring during surgery, careful surgical technique, and avoidance of prolonged surgery. The pain can make it hard to walk or even stand. Good candidates for bunion surgery commonly have: Significant foot pain that limits their everyday activities, including walking and wearing reasonable shoes. There also is a risk that another part of the foot will become irritated. In these cases, nerve damage symptoms may start to appear days or weeks after treatment. https://www.uptodate.com/contents/search. Wear roomy and comfortable shoes. 2430 Esplanade Dr A, Algonquin, IL 60102. 2430 Esplanade Dr A, Algonquin, IL 60102. You may experience a range of Many patients have pain under the second and third toes at the ball of the foot after a bunion surgery. Peripheral nerve surgeries may involve moving or removing bone and tissue along with nerves, and we work as a team to get the best outcomes for patients. After surgery, neuro electrodiagnostic tests can be performed at 23 weeks to assess the extent of PNI. or Call214-645-8300. With time, the nerves typically heal and the symptoms resolve. While many different health problems can cause nerve damage, there are several common culprits. Ast explained that total knee replacement can take time to heal, and impatience can be a factor. American Podiatric Medical Association. Various symptoms of nerve damage after knee surgery affect feeling in the limbs and affect the way people move. Thus, positioning is one of the reasons that someone may feel numbness. The term refers to surgery involving the cardiac, major vascular, or spinal areas. If a person has undergone spine or back surgery, he is more inclined to experience numbness below the surgical incision site. Furthermore, if their motor weakness was largely or completely resolved in the hospital, patients were ineligible. In a nerve repair surgery, your hand surgeon may be able to stitch the nerve back together. During the operation, these nerves may be injured. Many neurons (nerve cells) compose nerves and are clustered into a bundle that creates a giant nerve. Damage to the nerve disrupts the myelin sheath that covers the axon (branch of the nerve cell). It is a rare and troublesome complication of traumatic knee injury (TKA) that affects patients and surgeons. Some of the peripheral nerve procedures we perform include: In our research lab, we are developing techniques to increase our ability to resupply the muscles with nerves. But there are other treatment options to heal nerve damage more quickly and effectively. If a person feels numbness and tingling due to nerve damage after surgery, he should consult the doctor as soon as possible. With the help of ultrasound imaging, the nerves that are healthy arise as ongoing clusters of neuronal fascicles isolated from surrounding connective tissue. In some cases, nerve damage can be permanent. Signs and Symptoms of Nerve Damage Tingling, numbness, muscle weakness, or burning are the most common signs and symptoms of nerve damage I did not know that a podiatrist was not a real doctor until it was too late. Nerve damage is split into three types: damage to the surface of the myelin sheath, known as neurapraxia, damage to neurons is known as axontomeis, and when the nerve is cut in half or torn, it is neurontomesis. Because of the proximity of the veins and nerves in your legs, there is often a risk of inadvertent nerve damage. It feels numb all the time, like there's a tight band wrapped around the nerves surrounding my second toe. Start by applying pressure to the area where the nerve was injured to relieve symptoms of nerve damage. The injuries to the nerves were classified as motor and sensory, with the sciatic nerve being 91 percent and the peroneal nerve being 9 percent femoral. It is basically losing sensation in a particular area of the body that affects a persons lifestyle. Our team of experts, doctors, and orthopedic specialists are here to share their knowledge and experience with you in order to help you make informed decisions about your health and well-being. Symptoms may include pain that radiates down the leg or arm, motor deficits, decreased sensation in the extremities, or weakness of the lower extremities. Symptoms of bunions include the following: Pain in the joint of the big toe, which gets worse while wearing tight-fitting shoes. Some of the most common causes of nerve damage following knee replacement surgery include infection, swelling, and debris from the operation. Nonsurgical treatments that may relieve the pain and pressure of a bunion include: If conservative treatment doesn't relieve your symptoms, you might need surgery. When this sheath gets damaged there can also be a problem with nerve function. Medications including Neurontin, Lyrica, Elavil, Topomax, and Ultram can help in order to treat nerve damage after surgery and relieve pain. Yes, it is true that there is a risk of nerve damage, as well as recurrence, continuing pain, infection, stiffness, numbness, etc. It is not uncommon for knee numbness after surgery. It is utilized by injecting medicine around the cluster of nerves to block pain. Accessed Aug. 30, 2019. Poor posture can put extra stress on the rotator cuff and cause pain in the bicep. A nerve injury occurred in patients who had anesthesia for more than 2 hours. Most of these nerve issues are self limiting but may take a year or more to resolve. If you can get relief from your pain for 6-12 weeks, it is very likely that your nerves will heal themselves. the widow's son in the windshield continuation Despite the fact that TKRs are generally successful, complications can occur. Women's Health, Cancer; Icing your bunion after you've been on your feet too long or if it becomes inflamed can help relieve soreness and swelling. Plastic Surgery, Next Article One study discovered that the pressure of a tourniquet greater than 400 mmHg was considered a predisposing factor. Because it spans the ulnar groove, an aponeurotic band between the medial epicondyle and the olecranon, the ulnar nerve is more vulnerable to injury. Related reading: Too gruesome for video: The high-energy injury of Dallas Cowboy Allen Hurns, 'Our team has an excellent track record of successful peripheral nerve surgery outcomes. Regular MRIs can show areas where muscles and tendons are injured or inflamed, which means nerve damage might be part of the trauma. It covers the myelin sheath and makes it more difficult for the nerves to function once it gets damaged. Peripheral refers to the peripheral nervous system, which consists of the vast network of nerves that connect our sense organs, muscles, glands, and internal organs to Nerve damage. Back and joint injuries can cause a bone or cartilage to pinch a nearby nerve. Dont Miss: Bariatric Surgery Post Op Diet. Symptoms may include excessive sweating, changes in blood pressure, the inability to tolerate heat and gastrointestinal symptoms. One of the safest vein treatment options available is VenaSeal from Bass Medical Center. Specialists scan the exact site of the damaged nerve through Magnetic Resonance Neurography. Bunion surgery. In some cases, severe varicose veins can lead to serious health problems, such as blood clots. New Patient Appointment If it happens, it is temporary in most cases, and very rarely becomes permanent. Lastly, physical therapy can help to stretch and strengthen the muscles around the knee, which can help to take pressure off of the nerves. Researchers Blumenthal S, Borgeat A, Maurer K, Beck-Schimmer B, Kliesch U, Marquardt M, and Urech J. Neuropathy are considered a risk factor for nerve injury when ropivacaine is administered continuously through a femoral nerve catheter. Some questions your doctor might ask include: Mayo Clinic does not endorse companies or products. The abbreviations for MA and WT in Smith have changed. If you must have the surgery, do NOT go to a podiatrist. Spider veins, which may surround varicose veins, are smaller red or purple lines that appear close to your skins surface. The physical exam after a traumatic injury such as a fall, severe joint dislocation, or vehicle accident is the starting In many such cases, the pain or discomfort caused by nerve damage will go away on its own. This is the podiatrist communities dirty little secret. But if the big toe joint pain is interfering in your life, hallux rigidus surgery can offer a permanent solution. Advertising revenue supports our not-for-profit mission. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions.