I need some advice. I have an appt. so see Dr. Hal Martin Aug. 1 for a surgery workup. I also have an appt. to see Dr. Conway for Surgery the end of Aug. The only reason I am considering Dr. Martin is because he does endoscopic surgery. The recovery is faster and of course there is no big incision, no cutting through all those muscles. Dr. Martin only operates in the sacrotuberous, oburator internus area. He read my 3T MRI and believes I am entrapped in that area. The MRI was done in Denver. He cuts no ligaments. Most people would consider that an advantage, but my problems started when my spine was fused to my sacrum. The pelvis was not fused in the neutral position, and it is pulling on the ligaments and muscles in the pelvis. Anyway, that is the theory I got from a surgeon. It may be reasonable to believe that cutting the SS ligament will relax things in the pelvis.
I might add that up until now, Dr. Martin is only experienced in decompressing the sciatic nerve. He will begin decompressing the pudendal nerve in Aug.
So what would y'all do in my situation? It is so tempting to try out the simpler surgery and not have such a long recovery. Yet I may be guaranteed a better outcome in the long run with Dr. Conway.
Choosing a Surgeon
Re: Choosing a Surgeon
What is your goal? To have the shortest possible recovery, or to get the most pain relief?paulette wrote: It is so tempting to try out the simpler surgery and not have such a long recovery. Yet I may be guaranteed a better outcome in the long run with Dr. Conway.
PNE as a result of childbirth, 2002. Treatment by the Houston team, with neurosurgery by Dr. Ansell in 2004. My left side ST and SS ligaments were found to be grown together, encasing the pudendal nerve.
I am cured. I hope you will be, too.
There are no medical answers on the forum. Your only hope is to go to a doctor. I was very happy with the Houston team, which has treated the most PNE patients (well over 400), more than any other US provider.
http://www.tipna.org
I am cured. I hope you will be, too.
There are no medical answers on the forum. Your only hope is to go to a doctor. I was very happy with the Houston team, which has treated the most PNE patients (well over 400), more than any other US provider.
http://www.tipna.org
Re: Choosing a Surgeon
Good point, Celeste. But I do wonder if there is residual pain from the surgery. For example, when I had scoliosis surgery, it took away one kind of pain and left me with severe muscle spasms and myofascial pain.
Re: Choosing a Surgeon
Then you have first-hand experience with uncertainty, and are surely aware that no one can predict what the result will be. It's your choice whether to take a chance, or not.paulette wrote: But I do wonder if there is residual pain from the surgery. For example, when I had scoliosis surgery, it took away one kind of pain and left me with severe muscle spasms and myofascial pain.
PNE as a result of childbirth, 2002. Treatment by the Houston team, with neurosurgery by Dr. Ansell in 2004. My left side ST and SS ligaments were found to be grown together, encasing the pudendal nerve.
I am cured. I hope you will be, too.
There are no medical answers on the forum. Your only hope is to go to a doctor. I was very happy with the Houston team, which has treated the most PNE patients (well over 400), more than any other US provider.
http://www.tipna.org
I am cured. I hope you will be, too.
There are no medical answers on the forum. Your only hope is to go to a doctor. I was very happy with the Houston team, which has treated the most PNE patients (well over 400), more than any other US provider.
http://www.tipna.org
Re: Choosing a Surgeon
Hi Paulette,
Yours is such a complicated case and I understand your indecision about what would be best for you. I wish I had some words of wisdom for you, but, sadly, I don't. I do have lots of HUGS for you, though!
I can also offer you love, support and an ear when you need to vent or toss ideas back and forth.
I can see why you would be considering Dr. Martin. I just don't know enough about him, anything really to comment.
And one final question, my friend: Did Dr. Conway give you any indication that he could decompress your ligaments AND the oburator internus area at the same time?
With love and hugs,
Karyn
Yours is such a complicated case and I understand your indecision about what would be best for you. I wish I had some words of wisdom for you, but, sadly, I don't. I do have lots of HUGS for you, though!
I can also offer you love, support and an ear when you need to vent or toss ideas back and forth.I can see why you would be considering Dr. Martin. I just don't know enough about him, anything really to comment.
What kind of doctor/surgeon is he? Do you feel comfortable with him? Does he seem knowledgeable about the PN? Where would your endoscopic incision be? Did he fully explain the logistics of the surgery to you?paulette wrote:I might add that up until now, Dr. Martin is only experienced in decompressing the sciatic nerve. He will begin decompressing the pudendal nerve in Aug.
And one final question, my friend: Did Dr. Conway give you any indication that he could decompress your ligaments AND the oburator internus area at the same time?
With love and hugs,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
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pomegranate
- Posts: 157
- Joined: Sat Sep 18, 2010 3:12 am
- Location: Oklahoma
Re: Choosing a Surgeon
Paulette,
So, Dr. Martin plans to only decompress the pudendal nerve by cutting away at the obturator muscle? While I'm sure this is a feasible idea, and I don't doubt his sciatic decompression experience, what if the SS or ST ligaments are part of your problem? Will he be able to see this endoscopically? If so, can he also decompress the nerve from a ligament once he's in there and sees areas of entrapment?
I'm not really up to date on all the PNE surgery changes, as I quit considering surgery for myself some time ago. Dr. Conway now uses Antolak's method, correct? So he COULD address ligament issues? But not obturator?
Also, doesn't Dr. Ansell cut both the ligaments? Would that be an option for you?
I know you asked me to come respond to your post, and I'm sorry to do so with nine questions. You're definitely a unique case, and you need to feel comfortable that the surgeon you choose fully understands your background. Like I said in our earlier communication, let me know if I can be of any assistance to you in terms of OKC questions.
Lauren
So, Dr. Martin plans to only decompress the pudendal nerve by cutting away at the obturator muscle? While I'm sure this is a feasible idea, and I don't doubt his sciatic decompression experience, what if the SS or ST ligaments are part of your problem? Will he be able to see this endoscopically? If so, can he also decompress the nerve from a ligament once he's in there and sees areas of entrapment?
I'm not really up to date on all the PNE surgery changes, as I quit considering surgery for myself some time ago. Dr. Conway now uses Antolak's method, correct? So he COULD address ligament issues? But not obturator?
Also, doesn't Dr. Ansell cut both the ligaments? Would that be an option for you?
I know you asked me to come respond to your post, and I'm sorry to do so with nine questions. You're definitely a unique case, and you need to feel comfortable that the surgeon you choose fully understands your background. Like I said in our earlier communication, let me know if I can be of any assistance to you in terms of OKC questions.
Lauren
2008: mild pelvic pain and PFD began
2009: true PN/PFD pain, two PN blocks, normal PNMLT
2010: PT and conservative management with moderate improvement in PN/PFD symptoms
2011: surgery for extensive endometriosis; arthroscopic hip surgery to repair labral tear and FAI (right hip)
2012: C-section delivery of first child
2014: arthroscopic hip surgery to repair labral tear and FAI (left hip); C-section delivery of second child
Ongoing physical therapy since 2010 for both pelvic floor and hips.
2009: true PN/PFD pain, two PN blocks, normal PNMLT
2010: PT and conservative management with moderate improvement in PN/PFD symptoms
2011: surgery for extensive endometriosis; arthroscopic hip surgery to repair labral tear and FAI (right hip)
2012: C-section delivery of first child
2014: arthroscopic hip surgery to repair labral tear and FAI (left hip); C-section delivery of second child
Ongoing physical therapy since 2010 for both pelvic floor and hips.
Re: Choosing a Surgeon
Laura,
Thank you for responding. I haven't been to see Dr. Martin yet, so I don't have many, if any, answers to your questions. Since he told his nurse I am entrapped in the ST ligament and the obturator internus, I assume he can decompress the nerve in both of those areas. From what I understand, the obturator internus forms part of the alcocks' canal, and the alcock's canal is partly made from the ST ligament. Correct me if I am wrong.
From my spine surgeries, I have learned that more is not necessarily better. My surgeon was willing to fuse just the last levels of my spine, mainly from L3-L5. But the first surgeon I had seen said that the level above the fusion would immediately begin to deteriorate. So I opted for the bigger surgery. Unfortunately, the surgeon did not place my lumbar curve in the correct place on my back, and I was unable to stand up straight without severe pain. I also developed SI joint pain and dysfunction. It was a bad decision, for if he had only fused two levels, he would have used BMP's for bone fusion, instead of my bone. He also wouldn't have had to mess with my lumbar curve. It would have saved me from two additional surgeries AND from PNE and SIJD.
It might be advantageous to see Dr. Martin even if I don't choose him as a surgeon. He is adept at reading MRI's and detecting problems with the sciatic nerve and pudendal nerve. As far as what Dr. Conway can do, I can only go by what Karyn has said. He decompressed the nerve at several sites. I don't think he is restricted a lot as to where he can go. I have appreciated him, because he is so flexible. He allowed me to get my injections near home since I am so far from NH. As I write all this, I am quite sure I will choose him, partly because of your question about being entrapped at the ST/SS.
Thank you for responding. I haven't been to see Dr. Martin yet, so I don't have many, if any, answers to your questions. Since he told his nurse I am entrapped in the ST ligament and the obturator internus, I assume he can decompress the nerve in both of those areas. From what I understand, the obturator internus forms part of the alcocks' canal, and the alcock's canal is partly made from the ST ligament. Correct me if I am wrong.
From my spine surgeries, I have learned that more is not necessarily better. My surgeon was willing to fuse just the last levels of my spine, mainly from L3-L5. But the first surgeon I had seen said that the level above the fusion would immediately begin to deteriorate. So I opted for the bigger surgery. Unfortunately, the surgeon did not place my lumbar curve in the correct place on my back, and I was unable to stand up straight without severe pain. I also developed SI joint pain and dysfunction. It was a bad decision, for if he had only fused two levels, he would have used BMP's for bone fusion, instead of my bone. He also wouldn't have had to mess with my lumbar curve. It would have saved me from two additional surgeries AND from PNE and SIJD.
It might be advantageous to see Dr. Martin even if I don't choose him as a surgeon. He is adept at reading MRI's and detecting problems with the sciatic nerve and pudendal nerve. As far as what Dr. Conway can do, I can only go by what Karyn has said. He decompressed the nerve at several sites. I don't think he is restricted a lot as to where he can go. I have appreciated him, because he is so flexible. He allowed me to get my injections near home since I am so far from NH. As I write all this, I am quite sure I will choose him, partly because of your question about being entrapped at the ST/SS.
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pomegranate
- Posts: 157
- Joined: Sat Sep 18, 2010 3:12 am
- Location: Oklahoma
Re: Choosing a Surgeon
Paulette,
If you can afford it, I agree it might be advantageous to see Dr. Martin, even if you don't pursue surgery with him. Like I said, I don't doubt his surgical abilities. He is THE arthroscopic orthopedic surgeon in this region, although it seems he has only done hip arthroscopy and piriformis releases until now.
I'm so happy to hear you're having a good experience with Dr. Conway. Sounds like he has good patient communication, which is so important. I wish you the best of luck with your decision and upcoming surgery.
Lauren
If you can afford it, I agree it might be advantageous to see Dr. Martin, even if you don't pursue surgery with him. Like I said, I don't doubt his surgical abilities. He is THE arthroscopic orthopedic surgeon in this region, although it seems he has only done hip arthroscopy and piriformis releases until now.
I'm so happy to hear you're having a good experience with Dr. Conway. Sounds like he has good patient communication, which is so important. I wish you the best of luck with your decision and upcoming surgery.
Lauren
2008: mild pelvic pain and PFD began
2009: true PN/PFD pain, two PN blocks, normal PNMLT
2010: PT and conservative management with moderate improvement in PN/PFD symptoms
2011: surgery for extensive endometriosis; arthroscopic hip surgery to repair labral tear and FAI (right hip)
2012: C-section delivery of first child
2014: arthroscopic hip surgery to repair labral tear and FAI (left hip); C-section delivery of second child
Ongoing physical therapy since 2010 for both pelvic floor and hips.
2009: true PN/PFD pain, two PN blocks, normal PNMLT
2010: PT and conservative management with moderate improvement in PN/PFD symptoms
2011: surgery for extensive endometriosis; arthroscopic hip surgery to repair labral tear and FAI (right hip)
2012: C-section delivery of first child
2014: arthroscopic hip surgery to repair labral tear and FAI (left hip); C-section delivery of second child
Ongoing physical therapy since 2010 for both pelvic floor and hips.
Re: Choosing a Surgeon
I just talked to Dr. Conway. That's what I like about him. I don't have to go through a middle person. In answer to Karyn's question, he can definitely decompress the nerve if it is entrapped in the obturator muscle. He said it actually abbutts up against the alcock's canal. He said with the TG approach, it is possible to reach distally into the Alcocks's canal, reaching most branches. He said an exception would be the clitorial nerve.
So it was a good educational experience, talking to him, and I will definitely be going with Dr. Conway. Thank you Celeste, Karyn, and Lauren for your comments and encouraging words.
So it was a good educational experience, talking to him, and I will definitely be going with Dr. Conway. Thank you Celeste, Karyn, and Lauren for your comments and encouraging words.