Piriformis release surgery, discussion and information

I totally agree on the insurance hassle. The one thing that changed my companies mind was I ask them for referrals to someone on our plan that did the surgery. After the agent spent several hours on the phone and couldn't find anyone, she finally relented and approved Dr. Filler. At first, they had even said that the botox injections were not medically necessary nor was surgery. It took two months of daily emails, phone conversations, sending in my imaging and a written report of EVERY appointment I had had over 2.5 years to prove to them something needed to be done. What a pain! But finally they did give in. Maybe if you have your insurance suggest another surgeon, it would help? Hope so.

Donna

So I'm guessing it would be a good idea for me to ask my PM doc to do a guided steroid injection into my piriformis.

Currently we are trying to knock out pain generators. I'm starting with an SI block, then I'm assuming piriformis is next. I'm planning on doing one at a time to make sure that we can narrow it down.

Did you ever have SI blocks? Did they help?

Did the piri injections releive your nerve pain?

Sorry, lots of questions but I'm on a mission to find a solution. I can't live like this any longer.

Recently my left leg started burning, front of thigh down to knee...back of hamstrings down to calf. Right anterior thigh has burned for months. I'm getting worse and it's starting to scare me.

Julie

I just spoke with their office. There is no way I can afford that. No way. Not sure where to turn to now. I just don't have the money to fly out there for all the testing and live there for a week and pay all of the deposits. I don't know what to do.

Julie

No problem for all the questions. I totally understand the need to get it all solved.

I have had both SI and piriformis injections, sometimes at the same time, some times alone. I could tell the difference between the two pains and especially when the SI injection was done I could feel the relief in that area immediately. The nerve pain relief came from the piriformis injections, but generally took a bit longer to kick in.

The last SI treatment I had was radio frequency and that really seemed to work. All the other injections only lasted for a month at best, but I'm at two months and the SI pain has not come back.

I would think you would want to do CT guided injections as a next step and probably doing one thing at a time is a good idea.

Keep working away and asking questions. I just hope my experience can serve to help someone else, sooner rather than later. 2 and a half years looking for answers is too long!

Donna

Thanks Donna. That's exactly what I am going to do. I will request that Blue Cross come up with someone in the network that does the surgery. My cncern is that they probalby will come up with someone who will slice all the muscle off the hip joint. Dr. Filler's procedure is much less invasive. Then I will ask them to justify why I should use the alternate physician.

Did I mention I absolutely despise insurance companies(all types)? Ran into equally frustrating issues with our home owners after Hurricane Rita wiped us out. It is very difficult to fix stupid.

Julie,

Call them and see if you can't work something out with them payment wise. The worse they can do is say no but most physicians will work out something as necessary to be able to treat someone.

Again, it's worth a phone call.

Julie,

When I had my surgery, they did offer a payment plan. They asked for 30% up front, which we put on our credit card. They also said they could work that out if we needed. We don't usually carry things on credit, but decided that to deal with this pain, it would be worth it.

If you choose to go ahead with the guided injections before you go, be sure you take all your records with you. Because I had the injections before, he didn't feel the need to redo them, so the wait was much shorter than we anticipated. You might even see if his office would tell you exactly what injections he would be looking for. Just a thought about saving time in LA.

As far as staying in Los Angles and living expenses for the week, we choose a motel near the airport, which made it quite a bit cheaper than in the Santa Monica area, where the clinic is. Driving time to the clinic was about 30 minutes in traffic. By getting a room with a refrigerator and microwave, we were able to prepare simple but cheap meals in the room, rather than eating out all the time. When we told the motel manger why we were in town, he gave us a week discount, which helped some. We chose to rent a car from Fox, which was way cheaper than other companies. I think you could probably use public transportation if you're braver than we were in trying to figure it out.

Don't give up until you've checked every possibility. Let Dr. Filler's office at least have a chance to work out payments.

Donna

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Kayti,

You're symtpoms sound so much like mine, except I have burning right SI pain with back spasms. And my left calf aches. But foot burning on the left, for sure.

Did Dr. Filler believe that most of this was due to piriformis syndrome? Did he say that the surgery would help with the bursitis like symptoms? How muc of your pain did he think might go away with surgery?

--Julie

Donna,

Did you have steroid injections directly into the piriformis, or botox or both? Which brought you the most relief and which do you recommend as being the most diagnostic?

Also, I contacted Dr. Byrd's office in Nashville and sent my records. WHat do you know about him and his procedure. He is only 2 hours from me, so is an option. However, I don't want to be butchered, either. :(

--Julie

Hi to all PS sufferers! I've read pretty much all of the posts on this subject. I'm seeing Dr. Filler tomorrow morning. Based upon my symptoms I have PS. We'll see what he says. I've been dealing with this for over a year and have seen SO many doctors, have had spine injections (when they thought it was a spine problem), x-rays, MRI, pain meds, acupuncture, and on and on. Nothing works. I guess my main question is: is there any reason I should try injections with Dr Filler before I do surgery? At this point I just want it fixed and don't want to prolong it with more injections, doctor visits = MORE EXPENSE. I'm done with "conservative" measures. Does anyone have an opinion on this? Since some of you have seen Dr. Filler, do you have a feeling either way on whether or not he would "make" me do injections before surgery? Assuming he diagnoses PS? Thank you and THANK YOU for sharing your experiences. Thank God I found people who understand.

I went to see Dr Byrd in August and after only 20 minutes with him, spending more money on just plain x-rays, another round of airfare etc, he decided I wasn't in sufficient pain to do anything. He didn't suggest a different treatment plan, but suggested that I might have fibromalagia, or maybe I should see some other type of doctor.

IF he would've done surgery, his nurse said he would have wanted me to stay in the area for 6-8 weeks, he would only do one side at a time, I would be on crutches for a few months. YUCK! I'm now very thankful that he wouldn't do surgery. His failure to diagnosis saved me bunches of pain, time and expense.

His office gave an price estimate in the same range as Dr. Fillers.

I mentioned to Dr. Filler's nurse practitioner that I had seen Dr. Byrd and she said that they get a lot of Dr Byrd's patients that he had missed the diagnosis and wouldn't do surgery, but Dr Filler successfully does surgery which gives relief.

Donna

Thanks. You just saved me a trip and probably alot of tears and frustration. I still have to get some sort of diagnostics done here close to home before I even think of a trip out to Dr. Filler because I just don't have the money to go out there. That's why I was asking what exactly they injected into your piriformis to aid in diagnosis...lidocaine, sterioid, botox, etc.

PS--did Dr. Byrd palpate your piriformis vaginally?? His nurse/PA said that that is how he gets to it. Sounds kinda weird to me.

Julie

During my 2 years of treatment prior to going to Dr. Filler I had both steroid and botox injections. I got just about as much pain relief from both. Dr Filler considered the injections which were done under fluoroscopic / guidance or CT guidance to be the most diagnostic since it was certain that the injection was placed correctly.

Since I had had the injections under guidance, and got good, although short term relief from them, Dr. Filler didn't see any reason to repeat the injections.

Good luck with your appointment

Donna

Also...how are you doing??

julie

Julie.

Yes Dr Byrd did do the vaginal exam. He claims that is a sure fire diagnostic method. I was supposed to have been in enough pain from that to kick him through the wall, according to his nurse. I was still getting a bit of relief from the last botox injection, so I think my reaction was less than he expected. Also, I generally react by becoming quieter rather than acting on the pain, so he didn't read my reaction correctly. Another thing he said was that since I had so many other things going on (SI, etc), just fixing the piriformis wouldn't be worth it.

Dr. Filler found that there were "other things" going on, and was able to release another nerve as well, which was at least part of the cause of the other pain.

The reason I went to Dr Byrd instead of Dr. Filler to start out with is that Dr Byrd is on our insurance plan, while Dr Filler is not.

You might be able to get some diagnostic exams or injections from him or maybe another pain specialist before going to Dr. Filler.
Here's a very strange thought. A flight to San Pedro Sula, Honduras only costs around $500 RT and you could make a few appointments with Dra Haylock, my pain specialist here and accomplish the exams etc for a LOT less than the US. Dr Filler was very impressed with all the exams and diagnosis etc that she had done. Based on the previous care given by her, he was able to go right to surgery the next day. Dra Haylock does speak English, so communication would be ok. Think about it.

Donna