Not sure why I am obsessing here. I think that I truly believed INM was the only place to be, and for years did not even consider other options. I noticed also on the INM website that "piriformis surgery is a small procedure that can be carried out under a local anasthetic" You can have a hip replacement with a local if you don't mind listening to your bones being sawed. And virtually every person I have read describes their surgeries as being from 3 to 7 hours, which I would argue, is not a small procedure. Donna, I am very happy for you, although I do belive the likelihood of you having an abscess would have been diminished with the traditional incision. Also, I feel the likelihood of having the pain relief you experienced was equal with whatever surgical approach was used.
I am so pleased to hear that things are improving today....what a wonderful sensation it must be.... to be looking for pain and not find it!!!
I had been confused on the benefits of the different type of incisions, why one Dr. would do it one way and another the other....but after cruising through the Bodies Revealed, an exhibit with real bodies, real muscles....I feel very confident that the larger incision would definately be the advantagous way to go....the muscles are just so very dense and deep in our gluteal area.
I certainly appreciate all that I've learned from each of you, for the first time in the last several years, I feel that someone can relate and that it's not "in my head."
Healing thoughts to all of you, SAdie
Margie, I'm grateful for you.
As far as your insurance paying $5,000, was that the reasonable and customary amount they considered for ONLY Dr. Filler's sugery fee? I'm hoping the separate fees for the hospital are completely covered for anything over $7,500. Is that correct?
Thank you.
Like I said I'm glad you've presented other options and another picture. Even though I went to several other well known clinics and surgeons, I was never presented other options, so I made the only decision open to me. If others had been posting on this forum or elsewhere so I had knowledge of others who did this surgery, I would've happily evaluated them. As it was, my insurance company gave me the names of 2 surgeons I could use, Dr. Filler being one. The other charged the same amount for his surgery, said up front my gait would be altered and I'd be on crutches for 3 months. Doesn't seem like much of a choice to me.
This is why I feel its so important that others can make decisions based on other options. And, I'm not trying to say the longer incision doesn't work or wouldn't have worked just as well, just that I know what worked for me and I'm glad that it did.
Donna
Hey all,
Wow. Lots of activity on here. Hope everyone is well.
Ronnyjotten, glad to hear you are doing well(foot pain). I think I want to weigh in a little on your comments about Dr. Filler. The traditional surgery he is referring to is where they cut all the muscles off the GT joint in an effort to release the piriformis. I've seen comments from others, on other sites, who have had this procedure and the crutches issue is real. It appears that your surgeons and Dr. Barbara do it in the "new" fashion with the only real difference being the size of the incision. However, if you read some of the posts above, there was one who said Dr. Barbaro moves the uninvolved muscles by having his strongest assistant pull on them. LOL, retractors or not, one would be sore.
The 20 minutes rotation is for incision healing. At least, that was how it was explained to me. I moved every 20 minutes just because I was sore and I wanted to get my body moving. LOL, I'm still sore but this is from the resumption of life, going back to work, carrying groceries, etc. The nerve pain I had in my right leg is gone and the left leg is greatly diminished. In fact, the only time I have it is when my left butt cheek spasms which is getting less and less every day.
I went to Filler because of his experience in this procedure. I never even knew about Dr. Barbaro until afterwards and I certainly never even dreamed about going to India. It's such a personal decision and it's impacted by many, many variables. Everything from patient/physician chemistry to experience to finances, etc.. Very subjective. With regard to him advertising, I have no problem with that. Who doesn't advertise? With regard to him taking advantage of desperate people, I disagree. I know this. There is NO ONE in this part of the US that does this surgery. I'm thankful he does have a web site and that he does the procedure. Otherwise, I would still be where I was before December. Desperate for relief.
Leesa, wishing you the very best. The 20 minute thing is no big deal. LOL, constipation is. Trust me.
Julie, that's great about the discogram. I too have heard that it is quite uncomfortable so I'm glad it's over for you and especially that your discs are HEALTHY.
Have a great day everyone.
David
What type of surgery did you get?
1- the piriformis muscle tendon was cut,
2- a section of the muscle was removed, or
3- the entire muscle was removed.
As a physio, what do you think of the standard physical therapy protocol for treating Piriformis Syndrome? Do you have any suggestions for patients going to physio - what should they ask for?
Does one treatment work better for those who have fallen on their butt & another work better for runners?
Thank you for your thoughts. I hope your recovery is speedy & you can get on with your life. Thank you for posting here. People considering surgery need to hear about the successes & failures in order to make an informed choice about treatment.
ronnyjotten: We are all passionate about our need to recovery- no need to apologize, all the best to you.
I forgot to add a couple of other thoughts to my previous thoughts.
My incisions were longer than I expected. I think Dr. Filler said each would be around 3 cm(for those of us who are metric system challenged, that's just a little over an inch). Mine are more like 3 inches long. Donna, does that jive with yours or are mine longer because he had to traverse further down my nerves?
I don't think that the majority of cases of PS surgery are like discectomies in terms of when done, instant relief. There are some and Donna is one of those. I was told to expect 3-4 months for full healing. My Mom and a lady I work with both had pregnancies where the babies trapped the sciatic nerve. In both cases, they said that it took 3-4 months for the nerve to go from intense pain to a point where the nerve chilled out. LOL, that expalins why my Mom doesn't like my brother very much. At least, that's what I tell him.
Hope that helps a little.
David
The $5,000 was what my insurance considered reasonable and customary for just the surgeon's fee. So they paid 80% of that.
Even though Cedars Sinai is not in my insurance net work, my insurance agreed to pay at in network rates and was able to negotiate some with them. Somewhere working through the bill, I reached the $7,500 out of pocket mark, so the first part of that bill was paid at 80% and the remainder was paid at 100%.
I got a note from my insurance today saying that if Dr. Filler's office will submit surgical notes justifying the higher charges, they might reconsider paying more. I sent an email off to his office and haven't heard back yet. If I don't hear early Monday, I'll give the office a call.
Donna
Day 4 post op. Continued improvement. I woke up this morning without that 90 year old back feeling. Still not having foot pain. Did a dressing change and what I have here is exactly the same as the incision for a total hip replacement. I have seen many total hips and this incision looks great. It isn't small by any means, probably about 7 inches long. Interestingly, my adductor muscle on the same leg was very tight and painful and I can feel it letting go as well. Nice tingling feelings in my buttock, hip, back, and leg. Unbelievable. As far as my advice for physiotherapy. First of all I will say that I practiced orthopaedics for only 4 years so am not a guru by any stretch. I much prefer home care and getting people wheelchairs and walkers than trying to manage pain. However, it's been my experience that highly trained physios, and trust me I've seen many many, move so far away from the basics that they just don't make sense. I had one tell me my TMJ (jaw) was causing this. I was diagnosed with sacroiliac upslip, pubofemoral ligament laxity (that one was true, although not the direct cause of my pain), facet joint entrapment, you name it. I was even at a manual therapy course dealing with SI joints and nobody could even agree on the position of my ISIS and PSIS, relative to the other. (fancy names for boney prominences in case you're interested). Everybody was always talking secondary. The pirifomis is in spasm secondary to this, the hip joint is out of alignment secondary to the sacroiliac joing, the lumbo sacral joint was out of alignment secondary to...it was endless. Meanwhile, I had done the splits and knew for a fact I tore the hell out of some muscles, primarily the piriformis. I had no strength with external rotation, it was tender to palpate, I have a positive pirifromis test etc, yet everyone was reinventing the wheel. I wished, in all honestly, I had me treating me, but I am not that flexible. My whole hearted advice is to stick with the basics. I helped many people recover from this in my own practice. Lying on your unaffected side with the affected leg flexed, internally rotated, and adducted, applying a mild stretch with a hot pack, for a good while, and faithfully, worked wonders for many. The cross frictioning with the elbow was also a great method, but dont' get too vigorous. Neural mobilizations, ie straight leg raise, back off adduct, back off internally rotate, back off dorsiflex, and oscillating between the various positions, makes sense mechanically and works. Don't keep shifting from one treatment to another, and don't let people sell you ridiculous treatments. I had an osteopath, which is a different profession in Canada than the States, do what I call the "shakey wakey" treatment, and I almost died laughing. And other ridiculous theories proposed like movement in the fontanels of my skull. People feeling for oscillations of cerebrospinal fluid in my leg and claiming this had diagnostic capability. When you are desparate, you lose your objectivity. Give everything the common sense test. If somebody can't explain to you why it should work, then it won't work. And rest it, rest, rest, rest. Quit all that running. Hit the pool. Muscle stims will provide temporary relief if that is what you are looking for. I dont' believe therapeutic ultrasound can penetrate that deeply. So in a nut shell, stretch it, consistently and gently, apply the heat and the massage, strengthen it when it's alot better and not before. Sacroiliac mobilizations are good, but not manipulations. Do NOT let anybody lie you on your side and do the million dolllar move. Like that cracking sound was your sacroiliac joint magically finding its way back in place. Hardly. The core stability can't hurt either. Treatments that hurt alot don't typically help, for any thing. Don't be fooled, mild discomfort is all that should be felt. And remember, when chosing a therapist, "people don't usually care how much you know, they want to know how much you care" I had great successes, and i could not afford to take all the courses because i was self employed and working all the time, but I put my all into it and people noticed. General conditioning helps too. Like work the upper body. Pull downs, bench presses, bicep curls. Everybody who was able and willing got all these exercises at my gym. And AVOID what is aggravating. AVOID it. AVOID it. Our bodies have an amazing capacity to heal when given the chance. If you can sit for a half an hour before the pain gets to you, get up after fifteen minutes. If you can walk for an hour, rest after half an hour. Quit perpetuating the inflammmatory response, because that hinders the proliferation and remodelling of new healthy tissue. Ice and advil are good also. From what I have read, ice is the only absolutely proven modality. But if it's making it worse, stop. Use your head, trust your own judgement. Holy hannah I should go back to private practice, apparently I have some passion for it. Best wishes and prayers to all. Don't leave Jesus out of the equation, that's for sure.
I often wonder if the type of surgery one gets depends more on the surgeon you go to more than than your actual condition/test results. There is such a big difference between cutting the tendon & removing the entire muscle. And I suppose we can't say which surgical technique is better because everyone's case is different.
I wish there were easy answers. Mary
First I commend all of you who have given support to Ronny Jotten. You all have truly got to be the nicest people. When I hear people say that rest will take care of piriformis, it's like hello, my daughter has been on the couch resting for over 16months. I have got to find an answer to my daughters horrific plight. The postings from rj have absolutely put terror into me. Am I going to make my daughters life worse??? All of the posts up to this point have given me hope for my daughter, and I seriously sit here, with tears rolling down my face because I need a solution to give my daughter a chance. She can not sit at all....... Not even for 5 minutes. She is in pain, it doesn't change. No 3's, 5's ect. 999999999999.
We had her Phone follow up with Sheila. Surgical phone consult with Filler will happen on Feb 20th. My daughter cried because it is so far away. She like all of you is so ready for a healing. I guess I am rambling. I want to thank most of you for your postings.. Donna and David, I appreciate your updates, because at this point if I can give hope to the child, I give hope to her mother (me). Save the child, save the mother.
Did RJ say he had no pain?? Trying make pain in his foot. Did I mis-read all of his postings. I am slightly confused.
DON'T give up hope. As long as you are looking for a solution, there is hope. From what I read on this forum and others, it unfortunately takes people a very long time to find answers to this problem and ultimately get to the right doctor.
There will always be people with positive outcomes and negative ones. In fact, this is the case for probably most physical ailments. I believe we all have a certain path in life. Some will struggle a little, some will struggle a lot. That doesn t mean that there isn t hope.
I m sure you read on and found that a few of us have complete confidence in Dr. Filler. It all comes down to what you believe is right for YOU and your daughter of course. I don t think I m being na ve because I realize Dr. Filler may be able to help me and he may not. All I know is, I have to go with what I feel is right for me. For now, it s surgery with Dr. Filler.
There have been a few postings here and other sites that have put terror into me too. I take the good and leave the bad. That doesn t mean I ignore the bad and put my head in the sand, it just means I read the good and the bad and again, make a decision based on what I feel is right for me.
When I went to Dr. Filler s office Monday I found out that Sheila was leaving on the 1st. I REALLY like her and was sad to hear that. She s kind and very understanding. Hopefully, her replacement will be as good as she is.
I was really upset when my appointment got pushed amost two weeks past when I thought it was going to be. So I know how your daughter feels having to wait. It will come, please tell her to hang in there.
Leesa
One more thing.....here's what I do. If I read something bad or negative, I turn my thoughts to someone like Donna who says she has 0 pain. And David who, although has gone up and down, has significant improvement overall (hoping that's still correct David!!)
I just can't let myself stay in the negative for too long.
Leesa