Piriformis release surgery, discussion and information

Jennifer, I did the injections by myself, took a cab back to my vrbo, they gave me a four footed cane or I could not have walked or balanced, I only had to walk a short ways which was essential, as the lidocaine wore off at least I could feel the toilet seat, early the next morning I took a cab to LAX, used the cane to limp in and then had signed up for the airline wheelchair assistance and that got me to the gate and to the plane. I had a seat assignment that was close to the front. Repeated for the second flight and was met at the gate at home. So, it is far better to do it with someone else but if you don't have any option like me, it is possible.
Laura

David - in regards to one of your posts yesterday. I find it hard to believe that Dr. Filler cut a nerve. Please ask him or nurse, what exactly he did in surgery. Thanks for the information. Mary

LOL Mary.

I got off the Ultram weeks ago. The Tylenol 3 was prescribed by Fillers office as a milder(less nausea side effects) alternative to hydrocodone.

You have to remember that you are talking to an engineer. I don't enjoy pain but I can only go with what "the experts" tell me. They tell me Tylenol 3 should work, I took it. It's worked okay until I push too hard.

Yes, of course I'm trying to get off the meds and yes, of course, I'm paying a price in my efforts. However, I'm learning.

I sincerely appreciate your comments. Please remember though, this is my first rodeo and I'm doing everything I know to do and am trying to get the best info from people who should know. I had never had surgery before now.

Keep educating me.

David,

You're doing good. I'm proud of you. I am the worst about not wanting to take pain meds...however I just downed a loratab a minute ago because, my god, this hurts. Follow doc's orders...and your own instinct. I'm no doc, just a nurse, and I think it's best to communicate with your doctor and also know how your body is responding and reacting.

Mary, I have read that when Filler releases the piriformis he essentially denervates the muscle which subsequently allows the muscle to atrophy. Sounds good to me.

I've decided to go ahead with the discogram because I do have low back pain on the right (which is SI, plus very pathologically tight paraspinals on the right) and who knows, maybe that pain isn't SI but a disc. I guess in an ideal surgical situation I could have the SI/low back pain treated along with the piriformis in one surgical sweep. It's hard to think of having a surgery for one thing and cross your fingers that the other gets better. Of course, who knows what the low back is coming from. SI, disc, etc, etc. By the end of this I will have the most comprehensive diagnostic work up imaginable. Funny, I still think after all of this, they still won't know whats wrong. I think Filler can give me the best answer.

Over the course of the past 2 months I am losing my ability to walk, load my right side. I have a wheelchair for the grocery store...I ran into my dad last friday while my fiance was pushing me around and I just burst into tears I was so embarrassed. I can't believe it has gotten this bad.

I'm going out their either the 4th or the 11th. My uncle is giving me his frequent flyer miles and my friends are trying to raise money. It's a "save julie's butt" fund.

I can't wait to hear from Menzie about how her daughter's appointment went.

Take care,
Julie

David (or anyone else who had the surgery by Dr. Filler),

Can you verify something for me? Did Dr. Filler cut through the glut when he did your surgery? I'm going to be seeing Dr. Barbaro on Wednesday and I want to be able to compare the two doctors and how they do the surgery. Thanks! And, by the way, David, with all you've been through, I really admire the strength you're exhibiting. You're a rock star!

Margie

Hi everyone. I haven't been on for awhile so there have been lots of posts since I was last on. First, David, so sorry to hear how hardit has been for you. I was amazed when you went back to work after about 3 weeks even if it was part time. Still, I can imagine what all you are trying to do with work, a family, and trying to make up to your wife for the pre-op time when you weren't able to help. I think there is a honeymoon period right after the surgery and then when things don't happen as fast as we would like there is a big letdown which it sounds like you are having from time to time. It was great that JBL got back ofn the forum and told you about his ups and downs. Keep letting us know how you are doing JBL. Anyway, keep plugging and with your determination I know that things will get better. Be glad you are a man who is willing to "whine" as you say and I just call it venting and venting is very healthy. I would concur that valium is a good muscle relaxer, probably one of the better. I take baclofen which helps to prevent some of the spasming but does not help me once the spasming sets in and is bad.

Julie, so sorry about your right leg just giving out. It must be very discouraging, especially given how active you were. It is great that you are going to see Dr. Filler and I hope he can be clearer about the diagnosis for you. It is very hard when you are always trying to second guess what isgoing. on. Your fiancee seems to be very supportive. Is he going with you to see Dr. Filler? I find that my paraspinal muscle get very tight when my piriformis is really acting up. I think it is like a cascading effect. Actually once my prirformis is bad then my whole right side tightens up,butt, paraspinal muscles and all the muscles in the leg as well as the IT band.


Best of luck to you Jennifer. Hope your friend out in California can be there for you at least part of the time.

A friend of mine has offered to go with me and then another friend has offered to be around if I have surgery when I come home so I feel very lucky.

The most progress I have made is to think I will go out to get the consult with Dr. Filler, the MR Neurography and the guided injection but if surgery is recommended I may have to come home and think about it. Being in this forum has made me much more realistic about the recovery. I think JBL is much more realistic about it than I would have been. Before this forum I was thinking I would just get on the plane, come home and maybe be down for about a week. Talking about a dreamer!! I guess it is hard for me to think about going through the recovery and not being able to do all the things I do with lmy grandchildren. But if it means I could be without this much pain then I guess it is worth it.But there is still this nagging doubt.

Nerve pain, I don't know how you remain so positive and not bitter and angry. Good for you after all you have been through. I agree, you are a very brave lady and thanks for sharing your story

Have been sitting for a long time and need to get prone. And Leesa you are right we are all lucky to have all the great people on this forum to share with and listen to.

Bye for now.

Shirley

Ladyjayy wrote "Mary, I have read that when Filler releases the piriformis he essentially denervates the muscle which subsequently allows the muscle to atrophy. Sounds good to me. "

I am absolutely gobsmacked. So if the muscle atrophies, all the other hip & pelvic muscles have to compensate & work harder. Plus, it seems that your sacrum will always be off. I would expect this to eventually lead to other back pain & problems. I find it a shocking solution to the problem. But I can understand to would be appealing to someone in constant spasm.

In light of this information, I consider the need for long term follow-up even more important.

Thanks so much for the information. Mary

Mary, In his journal article in 2005 he states, The sciatic nerve was partially mobilized and used, together with the greater trochanter and the sciatic notch, to identify and confirm the borders of the piriformis muscle. Ties were placed around the muscle in two locations (Fig. 4A) so that bipolar cautery and Metz scissors could be used to transect fully the muscle in two locations with complete ongoing hemostasis. Removal of a segment of muscle approximately 2 cm in length helps ensure against readhesion of the separated segments that can occur when a single cut is made. In this procedure the nerve to the piriformis muscle is also generally severed resulting in subsequent atrophy of any remaining components. That being said, he also states that there there is no change in gait and people get better. So, who knows. Julie

Thank you for the welcome! Pain is keeping me awake again, so I've been up most of the night, watching DVDs, surfing the net, and applying ice packs. Heat used to work really well for me, but about a year ago, I was using a heating pad in bad, had taken too much medication, and fell asleep, waking up several hours later with a third degree burn that required skin graft surgery and a couple of weeks in the burn unit. I was being stupid for falling asleep with a heating pad on, but after my experience, I'm scared of using any heat whatsoever!

Shirley is so right about the Baclofen; its peak effect isn't until 2-3 hours after you take it, and it never works when you're actually in severe pain. I take it every two hours, and by keeping a steady dose in my bloodstream, it makes the spasms halfway tolerable, but it's sedating. I always take a larger dose of Baclofen before bedtime, but the spasms are winning tonight. My physiatrist is repeating my Botox injections on Friday, and I'm really looking forward to it. They've been the only intervention that has given me some decent relief, but as someone said a few pages back, they're hit or miss. I had one injection last summer that got me functioning almost back to normal, but then again, I've had some with the same physician and same technique and they didn't work at all. The last one with a new physiatrist gave me about twenty percent relief, and although it wasn't enough to improve my ability to work/concentrate, it was relief. I'm having the same physician do them again on Friday - he's doing the piriformis, hamstring, and he's considering some other possibilities. I'm praying they're at least mildly effective.

Thank you so much for everyone's input on Filler. When I spoke to them on the phone, they said that if I'm coming from the East Coast, I should plan on staying three days, but that the tests and procedures he orders would depend on my appointment with him. I'm confident that my friend in LA will be able to help me out for the injection and possibly the appointment as well, and I have more friends working in LA who I can call on for backup. I'm not the type to do surgery right away, so if I do have surgery, it would be on a second trip out there. I'm realizing that I'd need to travel with someone who can be with me 24/7 and be dedicated to me, and I'm hoping that perhaps my brother or another friend will have a free week early this summer. If all else fails, I guess I can hire someone (a student from my university or a personal care attendant) to make the trip with me. I hate having to ask people to take time off work for me and I hate feeling like a burden - I'm always the one who runs around taking care of everyone else, and this pain is preventing me from doing that.

Morning all. Spoke with Filler's NP last night. She called me after an e-mail the prior night so the support is pretty good. She says what I am going through is about par for the course. She said that as the nerve comes back alive, expect just about anything. She thinks it may have been bad Saturday morning because of swelling and less due to cramping. She gave me a script for Skelaxin and she wants me to try before I up and go driving. I'm taking a half dose this morning for a test. Mary, both she and the pharmacist said there is a difference in relaxants. Valium is more of a central nervous treater and others are more muscular/skeletal treaters(albeit there has to be a nervous system treating component I would suspect). Also, the NP said that Filler did not cut the nerve to the piriformis. This surprised me because it seems contrary to his paper. Nevertheless, he must not have because she said the spasms are coming from the remaining flap of piriformis. Proof positive. With regard to atrophy, he cuts the piriformis in two so any compensation by other muscles would be required anyway. Per his outcome study, an 8 year follow-up said the compensation occurs and there are no changes in gait. None in mine so far except from soreness. I think Donna and someone way earlier reported the same thing. It doesn't feel like I lost any muscles actually. Someone asked about Filler cutting glutes. No. He moves them out of the way to get to the piriformis and that's the advantage of his surgery. Julie, I am so sorry. It's easy for me to say but do not be embarrassed. I can understand your feelings but any sane rational personal understands why you might be in a wheelchair in the grocery store. In fact, I applaud your courage and effort just to go. Keep fighting. You have firends on here that are fully in your court. Shirley, good to hear from you. Nagging doubts are healthy. I had them. I still have them but I'm committed now. I have to force the nagging doubts away and think pure positive. I completely agree regarding your comments about JBL and Nerve Pain. Nerve Pain is actually doing yoga and JBL's post really lifted me. See, there is hope. Fight, fight, fight!!!!!!! My wife and I have all of you in our thoughts and our prayers. Your friend, David

Leesa,

I meant to mention this previously. Now that my Cowboys have been knocked out of the playoffs, I will join you as a GB Packer fan. I'm tired of the Patriot arrogance and I am, and always have been, a huge Favre fan. He is the epitome of what a pro athlete should be and I have always enjoyed his pure love of the game and the manner in which he conducts himself.

I played competitively for 13 years through early college so I know how the love of the game can fade. The fact that he still is having real fun at an NFL level geritol age is truly amazing. He is a genetic freak but a kid at heart.

GO PACKERS!!!!!

David:

Glad you got in touch with the NP. Sounds like what you're experiencing may be normal for recovery. I have high hopes for you.

Sorry about your Boys. GO PACKERS. If Brett wasn't married, I may move to Wisconsin :)

Leesa

Hello everybody,

I've been reading this forum for the past few months trying to get a feeling for how it is to get surgery for PS. Thank you so much everybody for posting your experiences, this is a wealth of useful and honest, sometimes scary, information!

Tom

New post here. I am 18 days post surgery by Dr. Filler. I am interested in like patients and their outcome.

Huggable,

Really glad to have you. Very good people on here.

Read backwards. Several people who have had Filler's surgery have posted and some in detail. What is your background and how are you doing thus far? I hope well and I know we are all interested. I am 6 weeks post surgery today. My saga began December 4th.

Thanks,

David