Huggable,
THank you so much for your post. I look forward to your future thoughts. I do hope this surgery works out for you for the best. Again, thank you so much for sharing your experience.
Julie
THank you so much for your post. I look forward to your future thoughts. I do hope this surgery works out for you for the best. Again, thank you so much for sharing your experience.
Julie
Leesa,
No. In fact, I spoke with Sheila and she said it was a personal decision and that I had to make that call. So, my wife and I decided to let everything ride like real life. That meant no heat pads, return to bicycling, etc..
The elimination of heat pads brought back some pain. Then, a VERY LIGHT bicycle ride really brought it back full force. Waited a day or so and the pain stayed. Four days before the surgery, we committed.
I'm hoping it was the right decision. It certainly was for the right leg.
Huggable,
Thanks for the background. Look forward to hearing more. You must be way tougher than I am to be out on a golf course two days later. Way tougher.
David
No. In fact, I spoke with Sheila and she said it was a personal decision and that I had to make that call. So, my wife and I decided to let everything ride like real life. That meant no heat pads, return to bicycling, etc..
The elimination of heat pads brought back some pain. Then, a VERY LIGHT bicycle ride really brought it back full force. Waited a day or so and the pain stayed. Four days before the surgery, we committed.
I'm hoping it was the right decision. It certainly was for the right leg.
Huggable,
Thanks for the background. Look forward to hearing more. You must be way tougher than I am to be out on a golf course two days later. Way tougher.
David
David:
Thanks. Sounds about right. If I lay down all day my pain is tolerable. If I walk too far (more than a couple of blocks), etc. it comes back full force. I haven't even tried doing any real exercise. I guess part of me is looking to heal without surgery but I know the truth. The truth hurts almost more than my butt!
If I may say, I believe you made the right decision. Based on what you've written over the past few months I know you had to do something.
Leesa
Thanks. Sounds about right. If I lay down all day my pain is tolerable. If I walk too far (more than a couple of blocks), etc. it comes back full force. I haven't even tried doing any real exercise. I guess part of me is looking to heal without surgery but I know the truth. The truth hurts almost more than my butt!
If I may say, I believe you made the right decision. Based on what you've written over the past few months I know you had to do something.
Leesa
David, before comparing yourself remember you had bilateral surgery and were in for 7 hours.
Dr. huggable (feel funny calling an emerg doctor huggable) I too have a grade 1 L4-5 spondylolisthesis with stenosis but an EMG confirmed no nerve damage from that and I too have always felt my main pain is from a muscle in the butt. That is where my predominate pain is and y pain goes right to the foot. Keep us informed re: your recovery. You have sure gone through lots so I hope this is the final answer.
Shirley
PS There is a recent study in The New England Journal of Medicine saying that surgery for grade 1 spondylolisthesis at L4-5 with stenosis was considerably more successful than conservative treatment at a 2 year followup. I am not considering that at this point but wondering what you thought of that study.
Dr. huggable (feel funny calling an emerg doctor huggable) I too have a grade 1 L4-5 spondylolisthesis with stenosis but an EMG confirmed no nerve damage from that and I too have always felt my main pain is from a muscle in the butt. That is where my predominate pain is and y pain goes right to the foot. Keep us informed re: your recovery. You have sure gone through lots so I hope this is the final answer.
Shirley
PS There is a recent study in The New England Journal of Medicine saying that surgery for grade 1 spondylolisthesis at L4-5 with stenosis was considerably more successful than conservative treatment at a 2 year followup. I am not considering that at this point but wondering what you thought of that study.
I had my surgery mid September last year. Dr. filler removed my piriformis because it so full of scar tissue. I have a PERFECT GAIT. No one would know. BUT I am still in major pain 24/7 I will say sciatic pain 100% gone thank god after sugery. Aching pain reduced probaly 2 notches I will take all of this as a plus. But I know it can take up to 18 months for nerve pain to end. But my pain is an aching pain not tingling, electric pain. So I think its NOT nerve pain. Anyone still have this this long after surgery. Just nonstop deep aching in buttock and trochanter also in hip flexer area. David?? Anyone?? I saw someone also had surgery when I did.
Thanks,
Kym
Thanks,
Kym
Kym,
I'm only 6 weeks post op so I'm not the person to ask. I still have nerve pain in the left leg, my butt can get sore when it's spasmed but my GT joints have(knock on wood) settled down almost completely.
Shirley,
Good point. Apples and oranges.
Leesa,
Only time will tell if I made the right decision. I think I did if for no other reason than I didn't feel like I had a choice. Dr. Filler told my wife after surgery that, due to the tissue he found along the nerve in my left leg, there was no way I could have rehabbed my way back to health. So, it appears that my justification was warranted. Now, I just need time, patience and a very solid positive attitude.
I'm only 6 weeks post op so I'm not the person to ask. I still have nerve pain in the left leg, my butt can get sore when it's spasmed but my GT joints have(knock on wood) settled down almost completely.
Shirley,
Good point. Apples and oranges.
Leesa,
Only time will tell if I made the right decision. I think I did if for no other reason than I didn't feel like I had a choice. Dr. Filler told my wife after surgery that, due to the tissue he found along the nerve in my left leg, there was no way I could have rehabbed my way back to health. So, it appears that my justification was warranted. Now, I just need time, patience and a very solid positive attitude.
Margie,
How did your appt. with Dr. Barbaro go for you yesterday? I had a CT guided piriformis injection on Tuesday, it actually flared things up more, but am hoping that it is short term and the injection will be effective.
Sadie
P.S. Thank you to everyone, I am learning much from your info.....
How did your appt. with Dr. Barbaro go for you yesterday? I had a CT guided piriformis injection on Tuesday, it actually flared things up more, but am hoping that it is short term and the injection will be effective.
Sadie
P.S. Thank you to everyone, I am learning much from your info.....
Shirly,your spondylolisthesis does confuse the picture, just like mine, and just like other people with abnormal MRI's of the lumbar spine that suggest for example a disc problem in the spine.
Here is my take on all of us with similar pain/symptoms:
There should be a diagnosis such as regional buttox syndrome that encompasses all these pains including piriformis that may include a neuropathic pain radiating down leg to foot. For many the etiology is multifactorial, perhaps part from the spine, part muscle pain (one of many muscles in the buttox/hip area), part impingement on the sciatic nerve somewhere in the pelvis/thigh area. For some who have this problem after injuries it may be a direct sciatic or other nerve contusion(bruise) type problem or a neuropraxic (stretching of nerve) problem--if so no surgery or rehab will not work---I think my hip replacement may be part something of this nature as the hip has to be dislocated in the OR to repalce it with an artificial one and that is when my problem began.
Piriformis syndrome is controversial and many doctors do not believe in it. The reason is, however, if everyone who had the surgery got better it would be more readily accepted--unfortunately, many who have the surgery do not(as happened to me--see my previous note). I do believe many do have this problem and they will tell you they got better with the surgery, but I would say 50% at most really are improved with this surgery and then only improved some. If you could do a study where half got a piriformis release and half got "sham" surgeyr(ie same surgery incision, anesthesia, etc), there would not be a huge difference in those who reported improvement in one year.
Many painful problems will just get better in time, and a lot of people operated on that feel better a year later contribute it to the surgery, but what really happened is they finally altered their activity (ie you hard core runners), perhaps did some physical therapy, and they would have gotten better anyway.
Even saying this, however, after a few years if things don't improve, I believe it is worth a try. It is not major surgery like a spine fusion or disc operation--that can often leave a person worse(I see many failed back surgeries in the ED with chronic pain). All that is done is the piriformis is cut in half (I think Filler actually takes out a segment of it), to in theory take pressure off the sciatic nerve. If you have the financial resources Dr. Filler probably does this better than anyone as he does it endoscopically (uses a small scope to go in to do the work), whereas, my piriformis release done in North Carolina was done openly with a large incision.
If you have limited resources you could at least see Dr. Filler and let him do his neurography and at least get an opinion from him.
Here is my take on all of us with similar pain/symptoms:
There should be a diagnosis such as regional buttox syndrome that encompasses all these pains including piriformis that may include a neuropathic pain radiating down leg to foot. For many the etiology is multifactorial, perhaps part from the spine, part muscle pain (one of many muscles in the buttox/hip area), part impingement on the sciatic nerve somewhere in the pelvis/thigh area. For some who have this problem after injuries it may be a direct sciatic or other nerve contusion(bruise) type problem or a neuropraxic (stretching of nerve) problem--if so no surgery or rehab will not work---I think my hip replacement may be part something of this nature as the hip has to be dislocated in the OR to repalce it with an artificial one and that is when my problem began.
Piriformis syndrome is controversial and many doctors do not believe in it. The reason is, however, if everyone who had the surgery got better it would be more readily accepted--unfortunately, many who have the surgery do not(as happened to me--see my previous note). I do believe many do have this problem and they will tell you they got better with the surgery, but I would say 50% at most really are improved with this surgery and then only improved some. If you could do a study where half got a piriformis release and half got "sham" surgeyr(ie same surgery incision, anesthesia, etc), there would not be a huge difference in those who reported improvement in one year.
Many painful problems will just get better in time, and a lot of people operated on that feel better a year later contribute it to the surgery, but what really happened is they finally altered their activity (ie you hard core runners), perhaps did some physical therapy, and they would have gotten better anyway.
Even saying this, however, after a few years if things don't improve, I believe it is worth a try. It is not major surgery like a spine fusion or disc operation--that can often leave a person worse(I see many failed back surgeries in the ED with chronic pain). All that is done is the piriformis is cut in half (I think Filler actually takes out a segment of it), to in theory take pressure off the sciatic nerve. If you have the financial resources Dr. Filler probably does this better than anyone as he does it endoscopically (uses a small scope to go in to do the work), whereas, my piriformis release done in North Carolina was done openly with a large incision.
If you have limited resources you could at least see Dr. Filler and let him do his neurography and at least get an opinion from him.
Sadie,
Just following up with you after your appt. with Dr. Barbaro. Did you get your injection? Did you get any relief? I saw Dr. Barbaro yesterday and he told me that the results I got from the injection (combined with other factors) indicate to him that, yes, it is definitely Piriformis Syndrome and he recommended the surgery. I went in with loads of questions and he spent a lot of time answering them all. He also offered to put me in contact with some of his other patients who've had the surgery so I can pick their brain as well. I'm looking forward to speaking with them.
Hope your injection provided you with some relief. Let me know how you're doing.
Margie
Just following up with you after your appt. with Dr. Barbaro. Did you get your injection? Did you get any relief? I saw Dr. Barbaro yesterday and he told me that the results I got from the injection (combined with other factors) indicate to him that, yes, it is definitely Piriformis Syndrome and he recommended the surgery. I went in with loads of questions and he spent a lot of time answering them all. He also offered to put me in contact with some of his other patients who've had the surgery so I can pick their brain as well. I'm looking forward to speaking with them.
Hope your injection provided you with some relief. Let me know how you're doing.
Margie
To Dr. Barbaro's patients:
Does he take insurance or is he out of network like Dr. Filler. I'm looking into all my options.
Did you that found relief in the injection just have the butt pain or did you have sciatic pain as well?
I'm glad that you are on this forum, it's good to see that there are other doctors who are doing this, along with neurography, which give us patients a little more to chose from.
Thanks again,
Julie
Does he take insurance or is he out of network like Dr. Filler. I'm looking into all my options.
Did you that found relief in the injection just have the butt pain or did you have sciatic pain as well?
I'm glad that you are on this forum, it's good to see that there are other doctors who are doing this, along with neurography, which give us patients a little more to chose from.
Thanks again,
Julie
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.
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.
That's what I get for not proof reading.....it is suppose to be REGARDING the surgery....sorry.
Sadie
Sadie
Dr. Huggable(yes, that's even odd to type), the 50% number you cite - is that for traditional piriformis surgery? Filler's outcome study claims a much higher success rate(80-85% good to excellent outcome). Is this due to a different procedure or a spin on outcome data? Bottom line: Your informal(understood) thoughts regarding his outcome study? Also, as I understand it, Filler places a film(Seprafilm?) between the cleaned up and released nerve and the surrounding tissue to prevent future adhesions. Is this typical and what are your views regarding effectiveness of this material? I ask because this was one of the issues/risks that Dr. Filler told me that could impair my outcome. He said that he had really improved his anti-scarring agent and adhesion risk over the years.
Thanks very much regarding your thoughts.
David
Thanks very much regarding your thoughts.
David
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.
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.
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
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