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Piriformis release surgery, anyone???


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Tucson1
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PostPosted: 04/20/11 - 14:28    Post subject:
Regarding Piriformis Syndrome and Surgery.
I have been to Dr. Aaron Filler at the Institute for Nerve Medicine in Santa Monica, CA. I did like him! He did have an MRN (Magnetic Resonance Neurography) done on my hip. I understand that this is a 3D MRI. It did show that I appeared to have Piriformis syndrome. I had injections to verify.
He would not accept my insurance which is Medicare. I could not afford his fees for surgery.
I found out however that The MRN was developed at UCLA while he was working there. UCLA uses the MRN also and advertises it on their website in the Neurology Department. A Dr. Nader Pouratian Director of Neurosurgery
at UCLA also does the Piriformis Decompression Surgery. UCLA does accept most all insurances. However I apparently made the mistake of mentioning DR. Filler's name and that I had been to see him, etc. There appears to be a bit of animosity between the two. I could definitely tell by his remarks about Dr. Filler he did not care too much for him. Dr. Pouratian blew me off and simply refused in my consensus to work with me. I have heard nothing but good things about the UCLA Medical Staff. A bump in the road for me but not necessarily for others.
armypain
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PostPosted: 04/21/11 - 20:17    Post subject:
txpilgrim, I was injuried in the army so all my medical treatment is through the VA and that limits alot of treatment options and what they are willing to do. My doctor already told me surgery isnt even an options for my ps. I will gladly take any information that you have though. I will bring it to my doctors attention and see what he says and can do.
LindaV
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PostPosted: 04/25/11 - 11:55    Post subject:
Hi, all - I'm not online much anymore because of neck problems and the ps, but did want to say this forum has been helpful. I've had the ps severely since Nov 2007. Still no solution found. I developed my piriformis syndrome from sitting too much at a computer over time.
I have stood the last 3.5 years, which is the only way I could cope, but now even my legs are getting tired. I talked to my neurologist about surgery, but she was against it. Didn't think it was a good idea. So far, the only things that help minimize the pain are lidocaine patches. They don't do much, but they take the pain level from a 9 to an 8 or 8.5! Have any of you found any medicine that helps? Ibuprofen, lyrica and neurontin just don't seem to do anything for me, and my body apparently can't tolerate opiates (vicodin, percocet).
LindaV
armypain
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PostPosted: 04/26/11 - 10:57    Post subject:
Tomorrow morning I am going to be having a ultrasound guided piriformis injection. Im going to a civilian doctor that is contracted by the va so I am rather nervous about tomorrow but praying for the best. I will keep everyone up to date on how it went and if my pain goes down from this. I'm at an 8.5 this morning so if it goes down to an 8 I will be happy.
LindaV
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PostPosted: 04/26/11 - 11:13    Post subject:
Sueinjuneau - i haven't tried botox injections. Are they any repercussions to trying those? The cortisone injections did nothing. Cymbalta helped a lot, but it turned me into a zombie and gave me bad nightmares, and made my legs jerk at night. Very odd.
Armypain - interested in how it goes for you - keep us posted.
I really try to focus moment by moment, day by day. If I try to think of the future, I get overwhelmed. My career is long over - I'm just trying to exist at this point without being a pain in the ass to someone else!
filmfest
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PostPosted: 04/26/11 - 15:42    Post subject: INJECTIONS
Armypain - Do you know what kind of injection you will get - cortisone or botox? It is probably cortisone. Don't have high expectations for cortisone injection. It is more a diagnostic test for PS than a treatment. Very short pain relief - often 24 hours. Don't be nervous. Relax & enjoy the pain relief while you have it. Don't overdo.

Personally, I don't see a point to cortisone injection into the piriformis muscle. You get the same test results by injecting the muscle with anesthetic only. Doctors will probably say - well if the pain is caused by inflammation, then the steroids will reduce the inflammation. However, inflammation is not usually the problem in PS. And if the muscle is inflamed, it is because the muscle is overworked. A cortisone injection does nothing to reduce the workload of the muscle.

If you happen to raise these issues with the doctor, I would be very interested to know what he thinks.

LindaV -As long as the botox is injected into the right muscle, most people like the 2-3 months of pain relief they get. (Some people get no pain relief from the injection. When that happens, doctors often say, the piriformis was not the problem.) Once the botox wears off, it is back to square one.

The published studies of Botox injections usually stop follow-up at 6-8 weeks, when the paralysis is maximum. They conclude the injections are effective treatments. BUT, I find most patients get no long term benefit from the injections.

The downside with botox is the muscle atrophies & becomes more fibrous. And the more botox injections you get, the more damage is done to the muscle. The injecting doctors don't see that as a problem or they think muscle will eventually recover. But they don't see the patient long enough to find out.

According to Drs. Spinner & Tiel, repeated diagnostic &/or treatment injections (botox &/or cortisone) cause scarring, which when viewed on radiological imaging misleadingly supports the diagnosis of Piriformis Syndrome.

I know you have tried a lot of things to treat the PS that have not worked. Have you considered treating your neck & piriformis pain as one interrelated complex pain problem - rather than as two separate problems?? I think you are in AZ & are self-employed. Right? May I suggest you try the Comprehensive Intensive Treatment Program in Sedona.

http://www.myofascialrelease.com/fascia_massage/public/treatment_comprehensive.asp

I wonder if your neck problems are a result of how you have changed your working on the computer to reduce sciatica pain. In other words - bad ergomonics. Just an idea.

Good luck to both of you. Filmfest
armypain
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PostPosted: 04/26/11 - 16:20    Post subject:
I have a 2 or 3 cortisone injections before into my si joint and your are 120% right they little to nothing, but if I get a few days of relief from the injection I wont complain to much. The only bad part about is I have a 2 hr ride home after the injection and sitting getting worse and worse for me. I'm praying that I get some relief so I can start college and not feel like i dont stick out any more then I already do... 20 yrs old and I walk with a cane not my idea of how I wanted to start college!
armypain
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PostPosted: 04/27/11 - 17:12    Post subject:
Today i had my ultrasound piriformis injection, they injected me with kenalog and lidicane(sp). they gave me a pain chart I started at a 9 this morning to a 10 after the injection. Im know i have to give it a few days for it to take affect so hopefully by monday or tuesday im hoping to feel some type of relief.

armypain
helenlegs11
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PostPosted: 05/02/11 - 08:39    Post subject:
Fingers crossed for the botox Army Jen. Mine is wearing off now but I've had 3 months of part relief from it which was great. Just realising how great as the muscle pain returns.
Hopefully because your injury is more recent you will experience even greater relief.
I would definitely get a second opinion LindaV as Sue suggests and perhaps get a botox injection too, as long as it is guided. You may never want surgery but your neurologist doesn't seen to be offering any good alternatives which do exist.
Helen
Meg
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PostPosted: 05/02/11 - 09:44    Post subject: injections & pt exercising
Army girl, I got 3 months relief in SI and piriformis from guided steroid injections, I had 3 sets of them, but a GOOD therapist that does graston, massage and works the muscles with stretching and strengthening has really helped me. The sciatic pain is calming down, and muscles are strengthing (unless I way over do). I can now stand and cook meals, wash a floor and last week I actually painted my living room and all the 6" crown molding, baseboards and door frames. I was sore in muscles I didn't know I had, but it was a good sore. Mind you I am still on morphine 15 mg extended relief which is a fairly low dose, that allows me to stay awake and not feel drugged. I am also going to start Biofeedback, imaging and possibly acupuncture all of who helped end a 7 year cycle of pain from a 1971 car accident involving neck injury with hideous headaches and mioptic migraines. When you fall and injury yourself it is instant rather developing it over years of sitting or biking etc.

Good luck I hope the shots help. MEG...
LindaV
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PostPosted: 05/03/11 - 15:07    Post subject:
Interesting info on Botox - getting only a couple of months of pain-free existence might be worth it, but probably not. I need a stronger solution. Been seeing a number of specialists over the last 4 years - as you all know, it sure is expensive. Filmfest - the neck pain started years ago and was diagnosed as degenerative athritis - the cartilege in my neck has worn away. I stay off the computer as much as I can. I will check into the Sedona link you provide - thank you!
armypain
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PostPosted: 05/03/11 - 17:00    Post subject:
I have had a little relief but not a whole lot. I went from being at a nine every days and tens on my real bad days to a consent 8 for right now. And with college starting in 2 weeks im hoping this shot lasts a little longer.
menzie
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PostPosted: 05/04/11 - 00:19    Post subject:
Menzie Here, Not sure if any remember me, but I have all our computer issues cleared and I am back up and running (computer wise.) My D is a fighter and after 4 1/2 years, I do see a lot of improvments. Very Happy Very Happy Very Happy Very Happy I am not counting the days as much, 1,7++ jk. Very Happy It will take me a while to update my self on each one, but I am a good reader. I hope that all is well, and honestly after so many years with the evil darkness, I think I see some light.

I can say this for sure, from a mother who has watched my daughter fight this fight, this site and a few key people have truly touched my life, and maybe even helped to continue on. Thank you each and everyone of you. I am hoping my daughters life and successes have just been defferred and not permanently taken away.
helenlegs11
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PostPosted: 05/04/11 - 05:43    Post subject:
Menzies. thats such good news, excellent!! I hope your daughter continues to improve and with her (and your) fighting spirit I think thats a given. Did she manage more college?
Attitude is so important.
Army Jen, Sue said that her botox didn't kick in fully for a few weeks, and I can confirm that. I wasn't 100% pain free (scar tissue) ever but kneeding the muscle had always been v painful and wasn't after the shot. Yours might take a little while, I found the best results were after around 3 weeks (which I also think is wierd, foreheads react immediately must be the size of muscle)
LindaV, get the shot and take it from there ? ? I know what you mean when you try SO many different things and absolutely nothing works you know that surgery is probably the only way but I would exhaust every other avenue first. I'm English but I'm sure someone else here can advise you about who wil take insurance for botox. The Yahoo site can advise too.
How are you doing Shirley, have you made any decisions about more surgery?
Not that I advising lots of shots. I've had 3 steriod (waste of time but only thing on offer) and 1 botox. All this did was confirm that surgery will be my only chance for improvement. Meg and Mary are both managing conservatively however, it's an individual choice.
Take care everyone,
Helen
scamp
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PostPosted: 05/08/11 - 15:55    Post subject:
Hi everyone. I haven't been posting but just wanted to give an update. I have finished with the different injections and now they are looking at trying different meds which I am not thrilled about but I would be happy if I could just walk a good 45 minutes to an hour instead of 15 minutes before my pain elevates to a feeling like I have something like acid all through the butt and down the leg. Sitting lots is cumulative in that I can sit for a couple of hours out to dinner but if I do that say for 3 nights in a row, I am in trouble.

I am still trying to decide if I would ever go back to Filler for a 2nd surgery as he told me I have post surgery scar tissue that is flattening the sciatic nerve in the ischeal tunnel area and that is where I hurt the worst if I sit a lot. Superior gluteal nerve is also entrapped and my glute medious and minimus are extremely weak as a result.

Hi to Menzie. I think I have your correct email but not sure. I'll try to get in touch.

Good to hear Sue has some good doctors in Washington. Hello to Helen and glad you got temt. relief from botox. Good to hear armypain (Jen) is getting some help. LindaV--not the other Linda who has has surgery with Filler??

Bye for now.

Shirley
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