Piriformis release surgery, discussion and information

Hey Huggable,

Glad you're here. I'm not post surgery but would love to hear your experience thus far. I'm seriously considering it, as are a few of us, and are so, so interested in how you got to Filler, the diagnostics, pain pattern and how you are doing post surgery.

Do read back on all the posts. David and Donna are our surgery "vets" and a few are in line to be the next, and others of us are just trying to make the decision on whether or not to go out to CA. You'll find a ton of info here, and (lucky you!) you can also provide a ton of info for the rest of us.

I'm so glad you found this forum. It has been great for me, to vent, find out info, experiences, etc.

Take care, many hugs
Julie

Tomorrow is 3 months since surgery so I thought I'd give you all an update. The incision has completely closed up and the infection is gone. Even the itching from the tape has stopped. So that area is all good.

During the past month, I've done a lot of 'firsts" since surgery:

*We went hiking...not quite mountain climbing, but there were significant hills that I wouldn't have done before. We spent about 2 hours on the trails. Its true I was sore the next day, but it was muscles complaining that they haven't been used that way in a while.

*I sat through an allllll day(9am -8:30pm) meeting without pain. I even gave my seat cushion to another participant, since I didn't need it. No one should be subject to that kind of punishment, especially when followed by another all dayer the next day. But I lived through it!

* I cleaned the shop at the seminary where we work. This shop hasn't been cleaned in over 4 years and I did a lot of lifting, pulling, pushing, etc and came out very tired, but not in pain.

*I lifted a 40 pound bag of dog food, without feeling it.

While I realize that not all of you will recover like I have, I hope you read this as hope and encouragement that there is a day coming when you will feel better too. Hang on to that hope.

By the end of a busy day, especially when I've been on my feet a lot, I do feel a bit of nerve pain in the piriformis area. Resting is all it takes to get rid of it. That pain is only level 2 or 3, so its not bad at all.

I got a note from Sheila, Dr Filler's NP, with the go ahead for "gentle" stretching and strengthening. She said there was no specific program to follow, but if I was in more pain afterward, that I had done to much. I'm not much on planning my own workout program, so I hope I can figure something out.

So far, so good. I continue to be very glad and thankful that I had the surgery and that it has been successful so far.

Donna

Donna:

WOW, such great news. A 40lb bag?!!! Good for you. Extremely happy to hear of your progress. I know it will continue and thank you so much for the update. .

Huggable:

Yes, PLEASE give us some details on your history and how you are feeling. You found a very good place for information and support. I hope you are doing well after surgery. Take it easy and get better.

Leesa

Dr filler does a minimally invasive surgery, my incision is about 1.5 inches. So, as I understand it, he doesn't slice the gluteus Maximus and move it out of the way in order to get to the piriformis. The orthopedic surgeons go in through the hip and use an endoscope. Totally different methods.

Donna: One more thing......it doesn't sound like you are following doctor's orders "gentle stretching and strenghtening"....sounds more like you are getting ready for a heavy weight fight with all the lifting, hiking, etc. (said with a smile) Again, good for you. Keep it up.

David, a friend of mine was here today who is a nurse and I was talking about the forum and how great it kwas. We were talking about post surgery and she said that it is very common for people to feel worse at some point after surgery and that what you are going through is very normal. She also said that people are often on a high immediately following surgery but then when they realize that the recovery is longer and harder than they think it is difficult both physically and mentally so again to confirm that what you are experiencing is just what to expect but then things do get much better.

Good to have a new person on who has just had surgery. That should be helpful for you also. It is helpful for those of us who are considering it also. I hope I will be very realistic if and when I do decide to go through with it. I am now 95% certain that I will go, but still a little scared about the surgery.

Bye for now.

Shirley

Donna, I somehow missed your update until after I did the former one but your news is great and gives me lots of encouragement to get moving on my decision. Congratulations to you for feeling so good and thanks for your encouragement to the krest of us.

Leesa, the 21st is fast approaching or is it the 23rd. How are you feeling about that? Hope there are no more postponments.

I tried to take somelonger than usual walks, carried my granddaughter up and down steps today and am paying a big price today. On the positive side it felt so great mentally to walk in the brisk air and the sun and a beautiful fresh snowfall.

Off to rest my poor old butt.

Shirley

I took my daughter to see Dr. Filler on 1-7-08. We flew to LA on Sunday.

Arrived for 8:oo appt at 7:40. They informed us the Dr. Was trying to fly back to the state and wasn't sure if he would be in that day or not, if he did, it wouldn't be till late afternoon. I started to cry, and said we would wait to see if he did arrive. They have a wonderful large L shaped couch, so my daughter waited, as she could lay down. Yeah, the Dr. arrived at about 1:00. We saw the Dr. by about 2:00. Nice man, he went over the films that I had provided, and sent us on Tuesday for the MR Neurography. Had our original appt been kept she would have had her MRN on Monday and an injection on Tuesday. We had to wait until 1-11-08 for her injection. It was a weird week the staff all said, and they also said it usually is a lot more flexible. The staff was really nice. Because of their weird week, on Friday when it came time for my daughters injection, they were just going to do it without talking to me about the findings, the nurse CiCi, said there wasn't enough time. And that generally people do not know what they are looking at, I explained that if there wasn't anytime for "Talk Time," then they needed to get my kid out of the injection room. Tadaaaa, I was escorted in, saw my daughters images, Dr. Filler started to talk to me, I explained what I was seeing as I looked at my daughters films/images. He said yep, I have spent a long time researching piriformis, thank goodness. Anyways, she had 3 injections. No real big changes, but on Sat, Sun, she said as she awoke the pain was still there just maybe calmer, her own word. I held my breath because I don't want to jinx it. Monday she actually had a point, temporarily, rated her pain down to a 3. Could it actually be working??????? I am so very afraid, but trying to be cautiously optimistic. Today she was her normal 9 self, I left for work slightly sad, with a fake smile for all of my firstgraders who I haven't seen since the break. I am just praying that she can be in the 15% healed by the injection. They told us 72hours to up to 10 days to notice anything. Not sure, I will keep you all posted. I had originally thought we could be there for two weeks, but Dr. Filler is again out of the state this week. I loved all the weird skulls he had on his desk LOL.

Shirley:

Yep, the 21st it is. I'm counting the hours, thanks for asking. As for your walks, sometimes we just need to do things that make us feel good mentally and pay the price later. Oh well, we try out best right?!

Menzie:

What a week you and your daughter must have had. I'm glad Dr. Filler showed up and you got everyhing done in the end. I"m sure different people have different reactions to the injections but for me, it took up to around 14 days to start feeling any noticable relief and it was very minor at day 14. Then after the 14 days the best I've gotten out of it is that I can be on my feel a little longer now but when the pain comes it's pretty much the same.

I too was hoping I would be in that 15% healed by injections. It's not looking that way so I just have to come to some acceptance that it is what it is and I need to just keep moving forward and stay as positive as possible.

Glad you are in the solution and I hope your daughter gets some relief or at least can have hope that she's on her way to some answers.

Take care everyone,

Leesa

Menzie, do you know what he injected? When I get botox Dr. Ko does an anaesthetic injection along with the botox but the botox can take me as long as a couple of weeks. The aneasthetic injection lasts for a short time but gives immediate relief so I wondered if that was what was going on wiht yur daughter. However I have no idea what Dr. Filler injected so don't pay attention to my experience if it doesn't fit.What did the MR Neurography show? Good for you for saying you wated to ksee the imaging first. Hope things get better. Know it was hard to go smiling into your first grade class with so much on your mind and a daughter at home in so much pain.

What did he inject you with Leesa? You may have told us in the past but I don't remember. I think he does short term injections sometimes but also uses botox. My botox injections act somewhat like you described. I can last longer on my feet and maybe get by wiht a little more walking but I still get the pain once over that limit. However the leg pain is better after the injection but not the butt pain which is like a knife in the kbutt with burning all around it and painful at the attachments at the sacrum and greater trochanter. But as we know botox wears off after 3-4 months.

Jennifer what's up with you? Julie, have you gotten the "butt fund" going? Hope you get to go.

I may make my appointment either end of week or early next week. I am like you Jennifer and may go and then come home before making the decision. I have forgotten who said she was coming from the east as I will be coming from eastern Canada. I am going to be double checking that rumour that people who have to pay for themselves are charged less by Cedars Sinai. I sure hope it is true as my portfolio has dropped so much it is scary with the market down and the US dollar so low.

The group has grown so much so hello to all you even if I haven't mentioned you.

Bye for now.

Shirley

Wow,

Lot of posts. Hope all is well.

First, Donna way to go. VERY happy for you and it's news like this that gives people hope. As one who knows and has paid for it though, please go S-L-O-W! You've got this thing licked so keep it that way.

Menzie, the injections had little or no effect on me either while I was in CA. In fact, and someone may cry BS on this, I think mine took more than 14 days to kick in because it was 3-4 weeks after my injections that I had a wave of improvement. Enough so that I nearly canceled my surgery. When I asked Sheila about the plausibility of this delayed effect, she said it was very possible as we are all different. So tell your daughter(and yourself) that the effect may come later. We all are hoping this to be the case(good effect part, not the later part).

Someone asked about what Filler injects. For me, and I don't think I'm atypical, he injected Lidocaine(sp??) and Celestone.

LOL, now I'm a "vet". I'm not sure I like that distinction in this context. Kick a guy when he is down if that makes people feel better. I'm laughing.

Went to work again today. Yippeee! I have an extremely understanding boss. He told me that in this day and age, work out of the house if I want. I have been but my staff needs to see my ugly old mug every once in a while just to keep things in line. Actually, I'm a very blessed man in that the people who work for me are true professionals and I never really do anything but point and then get out of their way lest I take the risk of getting run over.

To end this diatribe up, I do have a sincere question because some of you good folks are in the medical field. As I stated previously, my aches and pains seem to be a direct function of butt spasms(especially and almost totally the left side). My answer to this was to obtain a prescription of a muscle relaxant that is milder than Valium and would allow me to drive and work. Sheila ordered Skelaxin and I tested it yesterday and I can, indeed, function acceptably. The script say take 3 per day but I am taking them in halves only as needed. Here's my question:

If I take these things for any extended period of time(say a few weeks) to get through this tedious period, will my body(buttocks) become so accustomed to them that it will simply return to chronic spasm when I try to eliminate them from my life? I know, it seems like a silly question but, again, I am no expert in this area. In fact, and has been demonstrated by my other misadventures with medication, I'm almost clueless. Thus, I am asking. Thanks for any replies.

Your friend,

David

Oh yea,

Sincere thanks for the information Shirley. My attitude has improved dramatically over the last few days due in large part to some of the posts on here about this cycle being normal and my talk with Sheila who echoed the same sentiment. I don't enjoy the down parts but I have cut myself a lot more slack and have granted myself a much larger portion of patience. You just reinforced this attitude and I'm very appreciative.

David

Shirley:

I was injected with Marcaine and Celestone....whatever that is!

David:

You said you almost cancelled your surgery because of the delayed improvement from the injection....did the Dr. or nurse tell you that the pain would ultimately return which is why you decided on having the surgery in the end?

Thanks.

Leesa

I am considering trying this instead of SI joint fusion. I can hardly take the pain anymore. Doctors don't want to give pain meds anymore so it's even worse thank you for your story it will help in my decision.

My history and searches for answers sounds all too familiar on this board. I am an emergency physician and have struggled with pain for over 4 years now. However, I feel I have much insight into "our" similar problems after exhaustingly researching the literature and meeting with multiple physicians.

I am 53 and otherwise in excellent health. My problem began within days after a right hip replacement over 4 years ago. Began having a burning neuropathic pain in right foot and pain in right buttox with sitting and relieved with standing and yoga, walking, light jogging etc. All my orthopedist who did my hip replacement has ever said is "it is coming from your back". Amazing, the problem has remained relatively stable over these years--most problems like this either get better or worse. The more I sit during a day the more the pain builds up.

Briefly, I had multiple steroid injections of spine and even the piriformis without relief. I have a known L4-L5 spondolisthesis (offset of L4 on L5) but no obvious nerve root involvement in this area by MRI. One surgeon wanted to do a spine fusion. Several others unsure of problem.

I had a piriformis release here in North Carolina over two years ago. The neurosurgeon was sure he found my problem because he found an impressive impingement of the piriformis muscle into the sciatic nerve. However, it did not change my symptoms at all-no better, no worse.

I saw Dr. David Kline in New Orleans about 2 years ago, he has since retired but was a world renown neurosurgeon on peripheral nerves (ie. nerves that come out of the spine). Dr. Filler even did a year fellowship under Kline during his training. Kline wasn't sure the etiology of my problem, but thought maybe it was a "double crush" phenomena--meaning that somewhere from the time the nerve roots exit the spine all the way to the toes there where two or more impingements that, together, caused the pain down to the foot.

Like many of you my research lead to Dr. Filler. I am now almost 3 weeks post surgery where he made a similar incision about 3-4 centimeters in buttox, as the piriformis proceedure. Of course my piriformis was already taken down. He thought my obturator internus muscle (another small muscle that has a similar function as the piriformis) was impinging on the sciatic nerve by his MR neurography. In the OR he released the nerve to this muscle (to get this muscle to relax) and also found what he felt were significant adhesions at the ischial tunnel area. He also found an adhesion from a remnant of the piriformis muscle to the sciatic nerve. Surgery took about 4 and 1/2 hours.

I stayed in the hospital overnight. Stayed the next day in a hotel. Flew home the next, all by myself(wife wanted to come but three young kids at home and out for the holidays). Went back to work full time 2 days later. I recovered quickly from his incision and postop soreness. I easily walked 18 holes twice last week(they said no heavy straining and I didn't consider this straining) and also swam a couple times without any problems. Today, my pain is still exactly as it was preoperatively. Still almost completely relieved with standing and stretching and worse with sitting. Although it was worse last week at night I considered this a good sign that at least maybe he was working at the area of the cause of the pain.

I will not regret if the surgery doesn't work. Filler thought my problem was what I had concluded after hours of research and living with it. I always felt I had some type of impingement on the sciatic nerve just distal (or further down) than the piriformis. That is what he found on neurography and that is what he tried to correct. However, even I was always a little doubtful he could fix it, but I felt his surgical technique with an endoscope was minimally invasive and not likely to make things worse(ie. anytime an operation is performed, adhesions will form afterward). So we'll see how it goes, it is still early. I will give more info later about my thoughts of his published study, MDs in general, meds etc. However, understand to all reading this: I AM NOT GIVING MEDICAL ADVICE TO ANYONE, I AM ONLY GIVING MY OPINION ON A MESSAGE BOARD.