Piriformis release surgery, anyone???

Member

Hello Margie,

You must not have seen, but I wrote earlier today...

The injection has flared my pain, and I was soooo looking forward to the 3 hours of relief you experienced.

Dr. Chin said this can happen and not to be discouraged...said it could take several weeks for any benefit to show. I did e-mail her with multiple questions this morning.

I am very anxious to hear of what you learn from past surgery patients. I attempted to quiz everryone that I dealt with while at UCSF reagraing the surgery....did not receive any guarded responses, but reading on this forum isn't real reassuring.

Keep in touch, Sadie

Yes, UCSF does take my Blue Cross and is regarded as in-network for my plan, I'm very fortunate.

Member

That's what I get for not proof reading.....it is suppose to be REGARDING the surgery....sorry.

Sadie

Member

Member

David,

Filler's study did report about 80% good outcome. And if you want to try this surgery and you have the financial means, he is your man. I also do not believe he would intentionally alter his data. However, I bet if you took the 80% who reported improvement and if you had them doing the same post-op rest and slow return to normal activity, that at least half, or 40% overall, would report improvement. Also, note that Dr. Filler and his assistant Jodean are the first two authors of the article, and even the most honest people sometimes are often biased in favor of all of their hard work--even unknowingly. But, again, I do believe some people do get improvement with this surgery. Although if these 80% are out there they sure are not speaking up on this message board. Some would argue though that those that got better are out playing and not searching the internet like most of these readers, looking for answers.

Tomorrow I will be 3 weeks after Filler's surgery on me where he released adhesions at the ischial tunnel, and the nerve to the obturator internus muscle, and also an adhesion from a remnant of my piriformis muscle taken down two years ago in North Carolina. So I am like a lot of you in that I will be hopeful he helped me--he certainly did a beautiful job as far as minimal post-op soreness and just about a 3 centimeter scar, but my symptoms have not changed at all so far.

Does the piriformis muscle impinging on the sciatic nerve cause pain? It seems that it could. However, during my piriformis surgery the surgeon found that it was very impressively impinging on my sciatic nerve(one could see an obvious groove left in the nerve)--yet the surgery did not, in the least, change the nature, severity, or quality of the pain after over 2 years.

Do adhesions cause pain? I hope so. I was actually disappointed that Dr. Filler told me during surgery that one of the adhesions he found was from the piriformis remnant to the sciatic nerve--because obviously that wasn't there before my piriformis surgery, yet the formation of this adhesion did not increase my pain.

Does the Seprafilm reduce adhesions? I have no idea. Fillers article cites, I believe, a reduction in post-op adhesions from 50% to 2-3%. Not sure where he got this data from. Maybe this is his own experience on people he re-operated on. If it was a company sponsored study that he just got his data from, then I would use that information with caution. But the idea of some type of film makes sense to me, although it does mean leaving a foreign body in the wound. But he used it on me and I was glad he did.

Hope this helps. Soon I will give my two cents worth on doctors and how they approach problems dependent on their training and how your medical insurance affects your treatment. Stay tuned.

Member

And what if you are not covered by an insurance plan, are coming in from Canada where the provincial health insurance plan denied your application for out of country coverage on the basis that Filler's work is "experimental" and "not readily acceptable in Ontario". How is your care and cost affected if you are paying on your own and from out of country?

Out of curiosity, what did Cedars Sinai bill you? Donna and David got bills way over the estimated amount. That makes decisions somewhat more complicated when deciding if you can afford it.

Thanks for all you information. Those seeing Dr. Barbaro keep us informed. I have a study done at the university in San Francisco on MR Neurography and piriformis surgery but I can't remember who did it. Will have tolook it up in my files.

Shirley

Member

LOL Dr. Huggable,

I wasn't in a position to get back to the computer but I realized over dinner that I had inadvertently put you on the spot regarding the phrase "spin the outcome data". I can now think of about 3,217 better ways to have phrased that question. My apologies but you handled my clumsiness well.

Good news about the seprafilm. I had not heard any data regarding adhesion reduction due to this material but I must agree with your caveats.

Thanks for answering. Again, please forgive my wording. I'll blame it on my medications and age.

David

Member

Sadie,

So sorry you didn't get any relief. I'm wondering if the injection you had was the same as what I had. The injection I had was something similar to novacaine and it was injected into the space around the sciatic nerve where it comes into contact with the piriformis. Is that the same thing you had? The doctor who did my injection said it would provide immediate relief (which it did) but she said she could not guarantee how long it would last. I have previously had botox injections into the piriformis and they provided little or no relief. I was told they might take a few weeks to kick in but it never really did. Was yours botox?

I will be sure to let you know once I hear from the individual that Dr. Barbaro is putting me in contact with.

Julie,

Yes, Dr. Barbaro takes insurance and he also indicated that if someone did not have insurance, his office would work out a payment plan of some sort for them.

Margie

Member

I'll give my experience on Huggable's statement

" However, I bet if you took the 80% who reported improvement and if you had them doing the same post-op rest and slow return to normal activity, that at least half, or 40% overall, would report improvement."

I suffered pain from piriformis syndrome for over 2 years before my surgery. Among the many varied treatments I received, rest and slow return to activity were tried many times, with no improvement. I got no relief during the "rest" periods nor the slow return to activity afterward. In fact, two of the rest periods were actual post op rest, one from knee surgery and the other while I was in a cast following a broken ankle. Believe me I did almost nothing during those periods.

Of course, my case did not involve a specific injury or strain. As I have said before, the sciatic nerve was compressed as it went through the center of the piriformis muscle. So I can imagine that my experience might not apply to those who are experiencing pain coming from a specific incident.

I would also concur that most of the 80% who have gotten relief are probably not checking in on these boards. 3 months out of surgery I feel almost 100% better and I find its hard to make time to come back and give reports. Returning to daily life has taken my time and I don't focus on the pain. I am choosing to keep posting because I know how important it is for those who are in the search process to hear post-op results. But I can certainly see how easy it would be drop off this type of forum. I don't think its wise to base results on how many success stories are posting.

I am glad to see that we are getting reports from Dr. Barbaro's patients and others have opportunity to check out another option. And I'm also glad to hear others report who have not had good surgical results. More food for thought to add balance and perspective to the decision making process.

Donna

Member

Donna,

I am glad to hear of your success story. I have "seat envy". I just want to take my wife out someday to a long dinner and a movie, and do the driving.

I did read where you had a post-op infection. I had asked Sheila what the infection rate was and she didn't know exactly, but said she they only had one this past year-so I guess you were it.

Member

Good Morning Margie,

My injections was directly into the piriformis muscle, it was a novacaine/steroid combination. Dr. Chin informed me that they start with the muscle injection because it is less risky than the injection you received, close to the nerve, but will then move on to it if this gives no relief. The good news is that things are better today than yesterday, maybe not much, but better.

I have not had botox. I live in Southern Oregon and had never considered it to be "back woods," but the idea of piriformis syndrome to most physicians and therapists here is like speaking a foreign language. It was the neurosurgeon who did my micrdiscectomy 18 months ago who finally referred me to Dr. Barbaro. He actually studied under Dr. Barbaro at USCF.

I am curious about your history. I had been an avid runner for 20 years, just for pleasure though, me and my dog on early morning runs. Then June of 2005 was rear ended and everything went south from there. Had a microdiiscectomy in August of 2006, two weeks after surgery did some major squatting preparing for my daughters wedding which would be in another two weeks in our backyard, had a horrible burning in my behind and things have been awful since. Have gone to 3 physical therapists, had 29 acupuncture treatments which were extremely painful, have tried rest, swimming, 2 pain specialists and currently take Oxycodone daily.

What do you use for pain control just to keep going?

Hope I haven't asked too many questions, I appreciate everyones insight.

Sadie

Member

Donna,I remember you recommending that people get an injection guided by fluoroscopy before going and then he may not feel the necessity for his guided injection. Did those injections give you relief and if so how much relief? Was it something like marcaine or was it botox? Dr. Ko used EMG for my last botox injection and for the most part it was better than before and I was able to sit longer, walk longer and generally get by wiht more. Before going, I am wondering if I should wait to get the fluoroscopy guided injection as I think this pain clinic I am going to in early Feb. will probably schedule me for one. Sheila, Dr. Filler's NP told me that I would have to wait at least 2 months after a botox injection to come for the consult wiht Filler. I am geting anxious to just get this appointment made as I am so fucused on this that I have trouble thinking of much else.

I am thinking I will do as Jennifer said she was goingto do and lhuggable suggested--just go for the diagnostics and then come home and make up my mind if I would go for the surgery, if it was recommended.

In spite of the last botox injection, I still reach a limit and then I have a very bad day with severe buttock pain and leg/foot pain as I did yesterday. That makes me want to just go.

Donna, thanks for staying on as I know it is harder once you are better. I think I speak for everyone in being really appreciative of your continued feedback.

Shirley

Member

Shirley,

That was my course of attack as well. I went to Filler to obtain a final confirmation of my self diagnoses(no one around here had any experience with PS) and obtain the injections to verify and hopefully be one of the 15% with lasting relief. Alas, I was not one of the lucky ones so we came back here, tried a little more conservative treatment and said the heck with it. Went back for surgery a couple of months later.

I also echo your thanks to Donna for hanging on. As I've always said, even if I get back to 100%, I will also post to give people hope. I'm one of those people who believe everything happens for a reason. I'm pretty sure that my Maker decided it was high time I became more tolerant of some things and learned some patience. Mission accomplished. I will never, ever be "un-sensitive" to someone in pain again. EVER. My sister has been in pain for years and I tended to minimize her issues and not be as appreciative as I could have been when she expended a bit more effort to participate. I will forever be ashamed of this and have asked her forgiveness.

Point is: People in pain need hope. If I can provide some of that by taking 15 minutes out of my day to check in and answer questions, then I'll do it as long as people in pain have questions. I have been lifted up by many in here when I was down and intend to return the favor.

Member

Shirley,

My first four or five guided injections were some type of steroid with a anesthetic and they gave about 75% relief for about a month. Later I also had CT guided botox injections. The first one only deadened my muscle by about 30%, so I had two more, both of increasing dosages. The last one finally gave about 70% relief, again for about a month. Dr. Filler judged that since I had "impressive" response to the guided injections I was a good candidate for the surgery. I would ask Sheila what his opinion would be before assuming that any previous guided injections would rule out the need for him to do one. I suspect that since I came from so far away, he wanted to do what he could to facilitate treatment.

I really understand your anxiety just to get to the appointment. Its so hard to focus on anything else when you are in pain and you just want to get it taken care of. By the time I got to Dr Filler's office, my husband and I had already been through enough discussion, research, treatment and diagnostics that we were certain surgery was the answer. I had been under treatment with my pain management doctor here for 2 years and she had been very very reluctant to even discuss surgery. So when she and her peer review board came to the conclusion that surgery would be the answer, we were ready to proceed. However, I also think that having the diagnostics and a consultation with Dr Filler and then returning home to think about it has a lot a value. Its a big decision and not one to be rushed into.

Donna

Member

Yes, its true ignorance about piriformis syndrome abounds even in the medical community. I don't think it matters what part of the country or even world you're in. My insurance company told me they didn't know if they would cover surgery since they had never heard of piriformis syndrome. After "extensive" research, they discovered that the piriformis muscle is a muscle in your butt. I certainly could've told them that if they would've asked.

After discovering that the muscle did in fact exist, they continued to question the reality of piriformis syndrome claiming that "nobody knows what it is". The funniest part, though, was when they refused to pay for my botox injection, claiming it was for cosmetic purposes! As if I really care what my butt looks like!

Donna

Member

Hi Sadie,

No you haven't asked too many questions. I will try to answer them all and hope I don't leave anything out. I've also had injections directly into the piriformis - novacaine/steroid combination like you and when those didn't work, botox. Botox didn't work either. The injection I had in December was not intended to give me relief for a long period of time. It was just a diagnostic tool to confirm the PS diagnosis.

Like you, I was a runner. Not competitively, though. It was just my favorite form of exercise. I ran 5-7 miles 6 days a week. I was in an accident as well (1995) but my symptoms didn't start showing up until about 8 months later in 1996. It has gotten continually worse (long story and I won't bore everyone with details) but I've had every imaginable treatment - accupuncture, traction, rolfing, skin rolling (the worst pain ever!!!!), more injections than I want to count, discogram followed by a neucleoplasty (L4/L5), PT appts. for months on end, 3 years with weekly visits to a neuromuscular rehabilitation specialist (NOT covered by insurance!), and the list goes on and on and on.

As far as pain meds go, I'm managing very well with just Neurontin. It does not take the pain away, just makes it tolerable. I only take it at night to make sure I get a good night's sleep. During the day I use an IFS unit periodically to "mask" the pain. (IFS stands for Interferential Stimulator. It's similar to a TENS unit.) It is really a lifesaver for me. My doctor wrote me a prescription for it and my insurance paid for it. You might think about trying it. It doesn't cure anything but it really masks the "burning" pain and allows me to sit through a movie, fly on a plane or sit for a long car ride. It's like my security blanket!

So I've been dealing with this since 1996. I will say that my biggest reduction in pain came in 2004 from my weekly visits to the Neuromuscular Rehabilitation specialist. He taught me several techniques that have reduced the pain maybe 25-30%. I was all set to be happy with those results and just accept that this is how I'd spend the rest of my life when my primary care physician told me about the piriformis release surgery and referred me to Dr. Barbaro. So it looks like surgery is my next (and hopefully last) step!

Okay, I've yammered on and on and probably put everyone to sleep! Sadie, let me know if you have any more questions.

Donna, you are my inspiration! Thank you for continuing to post. You've given me so much hope for a positive outcome. It's a scary procedure but less scary when I read how well you are doing!

Margie

Piriformis release surgery, anyone???

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