Intro for new MN patient diagnosed with PN

Welcome to HOPE. We have tried to provide a place for newcomers to make their introductions. We will try our best to make you welcome and guide you through our website and Forum and assist you as best as we can through any questions you have regarding Pudendal Neuralgia.
bergdalm
Posts: 7
Joined: Wed Mar 14, 2012 3:03 am

Intro for new MN patient diagnosed with PN

Post by bergdalm »

Hello everyone! My name is Mel and I live just south of the Twin Cities in MN. I've had a very painful and busy 8 weeks but was recently diagnosed with PN by Dr. Antolak at his Edina clinic. I am nervous and hesitant on his diagnosis but I thought I would join the forum and ask some questions, as often patients are better resources than the doctors themselves. Normally I would write some whitty remarks, but I'm finding my liveliness has run out a bit :( My apologies if this is long, I find more is better than less at this point!

To give a little background about myself, I am 25 and have a quite extensive history with lower right quadrant pain. I was born with a hernia and an extra set of ureter tubes on both sides. I had both conditions repaired as a child through surgery and now have crossed trigonal reimplantation of both uterers (essentially each set was fused together in a Y formation and then pulled across the top of my bladder and reimplanted on the opposite sides of my bladder that the tube originate from). In 2007 I had multiple episodes of ovarian cysts, all of which ruptured. Due to continued pain I underwent a laproscopic surgery to look for endometriosis and though they did not find any they did remove a pooling of blood from underneath my cervix. A few years later my pain came back and I had multiple ER visits in which they found I had multiple kidney stones on my left and right side, though my right side was where the stones seemed to be stuck. Another year later I experienced kidney stones again but this time was admitted to the hospital under the care of Dr. Glesne with the Kidney Stone Institute. Because my ureters were stretched thin during the reimplantation process and there was an excess of scar tissue inside my right ureter, I was unable to pass the stones on my own and underwent surgery to remove them.

Most recently in January I began having lower right quadrant pain again with pain that radiated to my back. I also had frequent urination and painful/burning urination and noticed a tingling/pins and needles sensation on both of my sides when I laid down and tried to sleep. I have also been constipated though I have thought that was due to the narcotic pain meds I've been living on. My first step was seeing the folks at the Kidney Institute where they did a CT. They found no evidence of stones but the report showed L4 AND L5 pars defects with an improperly healed fracture to my L4 lamina with some sclerosis and hypertrophy. Because of my history I was referred to an OBGYN to consult about cysts/endo again. The pain worsened after his pelvic exam and I was forced to begin taking short term disability from work. We opted to do a laproscopic surgery again to rule out endo/PID and make sure there were no cysts or torsion happening with my tubes/uterus. The surgery was uneventful and I was sent home. I underwent a renogram with the Kidney Institute to double check on kidney function, but that came back normal as well. We did a lumbar MRI which showed no nerve compressions, only normal arthritic changes. The only GI workup thats been done is various blood testing, though I plan on keeping my appts with MN GI this week and had an additional CT with contrast done to double check appendix/pancreas/etc. I also have seen a neurologist who sent me home with a pat on the shoulder and a confident statement that there was nothing neurologically wrong with me.

My primary care physician referred me to Dr. Antolak (when my doc. ran out of ideas) and I was able to get in two days ago to see him due to a cancellation. I felt as if he already had decided his diagnosis before he met me. I was a gymnast for 14 years and did recently start a modern dance class that I could see aggravating my condition, if its what I really have so that information made sense to him. I told him about my symptoms, though my main problem has been abdominal pain, he continued his examination thinking I had PN. He did the spikey pinwheel test (no idea what that instrument is called) and found that I have sharp pain bilaterally along my T11 and T12 (basically around my hip bones). He did his pin prick test and I was almost jumped off the table when he tested my labia and clitoris, though I did not feel much pain when the area around the anus was examined. The heat test that he did came with normal results. He also did the Pudendal Nerve Motor Latency Test through my rectum (even though I requested that happened vaginally,he seemed to have forgotten the request in the minute it took him to hook up his machine). That test came back abnormal. I was very offput by his bedside manner and felt as if he was not actually listening to me and seemed frustrated at my questions. He offered to do some local nerve blocks and I ended up having 8 injections in my abdomen and pelvis, though if he had taken a moment to explain to me how painful they wouldve been with only 4 hours of some relief, then I would not have done so. I have now been in awful pain that not even my pain meds are helping with since the injections and have opted to stay in bed mostly as sitting does seem to irritate the pain. He sent me home with a self-care kit (that he seemed to have written himself, with plenty of typos!) and directions to get his series of 3 injections in my back in the coming months. In reading about him on the forum, it seems as if not many of you trust him and his history with Mayo seems a bit sketchy to me. I am becoming weary of the diagnosis and am not ready to change my entire lifestyle habits and request special equipment from my work until I get a second opinion. I called and told them that the procedures and testing were too overwhelming for me the other day and I'm not comfortable not knowing exactly why he believes this is my diagnosis. Because he is such a busy man and "people come from all over the world to see him", I am on a long waiting list to hear back from him. It bothers me that I saw him, he diagnosed, and then left as if I understood what the diagnosis meant for me in my life. I'm not even sure if I understand if this can be cured or not, or if I'll ever be allowed to sit again :(

I am frustrated that there is not more information about this condition and regulated/studied treatment plans available, so I appreciate all of the activity and support I've seen here on the forum thus far. If any of you have words of advice or know of anyone else in the MN area, including PT folks that I could visit that would be great. I do have appt requests in progress with Mayo Clinic and the U of M Medical Center (per referral from the previous neurologist). One of my main questions is what other conditions/disorders should I definitely get ruled about before accepting the diagnosis of PN? Again, my apologies for the long post, I really appreciate anyone who took the time to read this and to help me!! I will have more questions soon, I'm just a bit worn out to think of all of them now. Is there any group in MN that meets to talk about PN?
janetm2
Posts: 987
Joined: Sun Jun 12, 2011 10:54 pm
Location: Maryland

Re: Intro for new MN patient diagnosed with PN

Post by janetm2 »

Mel,
Welcome and sorry you had to come join us and we do not have more info. We do have a wealth of info in the faqs off the home page , I think I saw what to rule out, etc. Also see the PT list off the home page for a MN PT. Hang in there!
Janet
2007-08 pelvic muscles spasms treated by EGS. 6/27/10 sat too long on hard chair- spasms, EGS not work Botox help, cortisone shots in coccyx help, still pain, PT found PNE & sent me to Dr Marvel nerve blocks & MRN, TG left surgery 5/9/11. I have chronic bunion pain surgery at age 21. TG gave me back enough sitting to keep my job & join in some social activities. I wish the best to everyone! 2019 luck with orthotics from pedorthist & great PT allowing me to get off oxycodone.
deBBieW
Posts: 162
Joined: Tue Oct 25, 2011 2:59 am
Location: Milwaukee, Wis

Re: Intro for new MN patient diagnosed with PN

Post by deBBieW »

Hello Mel,
So glad you found this forum, you will get some of your questions answered. As suggested, just start reading the FAQ's, and feel free to post whatever you need to. We all have long stories, I know I sure do. I feel so bad for you after reading about your experience with Dr. Antolak. By the time people come to a specialist like him, he should know how frazzeled patients are, and they are looking for an understanding doctor, and someone that explains all of this complicated medical stuff.

I would try going to a pelvic floor PT. I love my pelvic floor PT, even though she really has not changed my state of pain, she is mental therapy for me too. So far she is pretty much the ONLY medical professional that gets what I'm talking about, and we are like a team. At least I can ask her all the questions I want.... and my PT has always been willing to call a doc for me and just suggest different things. You need someone to talk to that understands. So check the list on this site for a good start. There are other people on this forum from Minnesota, so perhaps they will be able to suggest a PT too. (look for MNMom)

I hope your pain levels go back down soon, take care.

Debbie
Vag pain, leg burning 3/11, SIJ inj 7/11, Pelvic PT, Chiro/acupuncture,
2-CT pudendal blks 11/2012, did help, less deep vag pain
Potter MRI 04/2012 - Scar tissue/thickening at SS/ST, scar in Alcock canal -bilateral,
Hibner 6/12 suggests Botox (didnt do), 8/12 more pelvic PT w/ dry needling
Gabapentin 1800 mg, Lyrica 200 mg, 5mg valium, vicodin as needed
Trying to get rid of central sensitization burning pain in my legs, Valium seems to be helping
Looking into more mindfulness options. . . . .
konedog4
Posts: 192
Joined: Thu Sep 01, 2011 3:42 am

Re: Intro for new MN patient diagnosed with PN

Post by konedog4 »

While I welcome you to the forum, I am sorry you are here due to your condition.

I too had a very similar impression of Dr. Antolak. He can be quite personable one moment, and then say something completely off the wall a moment later. I wish he had the time to really listen to his patients. It seems like his schedule is quite hectic. For a specialist, he should take more time and listen more. I agree with you, in that he sort of jumps into the diagnosis quite fast. He did all the same tests on me too. He gave me the same diagnosis. The injections (steroids and Marcaine anesthetic) , 4 in all, did not help me much. Perhaps the Alcock's canal injection helped a bit. Dr. Antolak missed my pudendal blocks 2 of 3 times. (In other words, I was not numb where I was supposed to be numb). Rather than just admit he missed the blocks, he blamed it on my nerve not taking up the anesthetic. Unfortunately, Dr. Antolak is all we have in this area. There are no other urologists or perineum specialists in this area.

In reading your symptoms, you do not seem to present with classic pudendal nerve disorder. Your tingling sensations seem to indicate a different nerve source than the pudendal. Classic pudendal symptoms (at least in my mind) are:

1. Being unable to comfortably sit due to a painful sensation in the perineum or rectal area.
2. Rectal and/or perineum tension.
3. Symptoms almost always relieved by sitting on a toilet seat or lying down.
4. Urinary symptoms such as frequency, urgency, weak stream.
5. Penile or vaginal symptoms (dorsal branch of the pudendal)
6. Shooting electric sensations anywhere from the anus to the front of the pelvis.

Have you called the University of Minnesota Fairview system for an evaluation? I don't know what they have there, but they are a comprehensive clinic and have many specialists. Mayo Clinic does not do any pudendal evaluations. They refer to Dr. Antolak.

I know how frustrating this is, especially the lack of reliable data to make decisions on! Please look over the site carefully. There is a lot of information to digest and consider. Whatever you do, do not jump into surgery, as the surgery has highly unpredictable results. I am not saying surgery is out of the question, just don't consider it before doing everything else to help yourself get better.

There are several of us from Minnesota on this board.

It is easy to get discouraged, but don't give up. Advances are being made, and someday the surgeons and therapists will actually get together, share data, and come up with a definitive protocol to treat this disorder. I don't think we are there yet however.

kone
MNMom
Posts: 27
Joined: Fri Jan 13, 2012 7:03 pm
Location: Mpls, MN

Re: Intro for new MN patient diagnosed with PN

Post by MNMom »

Hi, Mel. I am so sorry for your pain. It sounds like you have a complex history.
I read about your experience with Dr. Antolak. I also am a patient of his and opted for injections. The third injection appears to have helped me more than the rest. The jury is still out as it was only 11 days ago!
I think he does make assumptions about his patients, particularly that they have exhausted all other resources and seen other urologists or ob/gyns as well as PTs for pelvic pain. He then concludes that these other conservative treatments have failed and you must be a candidate for something more. Also, the tests he does only prove that you have pudendal neuralgia, not PNE. You could potentially improve with conservative treatment!
I agree with the others who suggested you try out PT and see if it helps you.
Best of luck, I hope you are on a road to find a resolution to your pain.
MNMom
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Karyn
Posts: 1655
Joined: Fri Sep 17, 2010 12:59 pm
Location: Lowell, MA

Re: Intro for new MN patient diagnosed with PN

Post by Karyn »

Hi Mel,
I'm sorry about the way your appointment went with Dr. Antolak. I'm really not sure if you have PN(E) or not, but a few statements you made caught my eye:
bergdalm wrote:In 2007 I had multiple episodes of ovarian cysts, all of which ruptured.
bergdalm wrote:my main problem has been abdominal pain, he continued his examination thinking I had PN.
bergdalm wrote:found that I have sharp pain bilaterally along my T11 and T12 (basically around my hip bones).
Has anyone mentioned ilioinguinal neuralgia to you? The lower quandrant, abdominal and hip pain sounds more like this than PNE.
Warm regards,
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.
acw
Posts: 43
Joined: Mon Sep 20, 2010 8:33 pm

Re: Intro for new MN patient diagnosed with PN

Post by acw »

bergdalm wrote:I felt as if he already had decided his diagnosis before he met me.
I recently saw a PT to discuss some of my issues, and mentioned my history with Dr Antolak. I said the exact same words you did, and she pretty much nodded her head in agreement. I also had a consult a month or so ago with a MAPS PT who had treated me several years ago. Again, when I told her of my experience with Dr Antolak, I got the feeling that she couldn't really say much "on the record", but implied that she also questioned his diagnosis.

Many of my symptoms didn't fit with PN/PNE, but he took a few facts, threw a "label" on me, and built a case for my diagnosos. He then proceeded to explain his treatment protocol, and stopped just short of proclaiming how he could "save me" from a terrible life of doom and dismay.

There were a few other things during my appointments that just did not sit well with me. I know that some people have had a good experience with him, but I'm not one of them.
bergdalm
Posts: 7
Joined: Wed Mar 14, 2012 3:03 am

Re: Intro for new MN patient diagnosed with PN

Post by bergdalm »

Thanks everyone for your replies! Its so nice to know that there are other people out there!

I definitely have the same feelings about my diagnosis, that the symptoms don't match too well to the things I've read about PN. The pain while sitting is definitely apparent and when he was testing the lower pelvic region (vaginal/clitoris/anus/etc.) it did hurt, but I feel like a good sturdy safety pin to those areas is always going to hurt. The abdominal pain is really where it gets me and yes my main doc mentioned the ilioinguinal nerve entrapment and that was the cause for the referall to Dr. Antolak. I do have an appt request in to Mayo for the internal medicine department, just to get a good overall look at things and check out other options besides PN. A coworker of mine has an uncle in Kansas City that isn't a specialist but he's got connections up here so he's going to try to help me get into Mayo and at least get other things ruled out.

I had a colonoscopy today that was scheduled awhile back that I decided to keep my appt on and it was all fairly normal. I would think that if i had PN I would be in a large amount of pain after having a camera and tube inserted into my rectum--but its not too bad, then again, maybe the sedation is still talking :D they only removed one polyp and are doing a biopsy so I should know more later this week!

As far as more follow up goes, Dr. Antolak gave me the names of 3 docs across the US that I could try to call to get a second opinion but it just seems a bit overwhelming and drastic to travel so far at the moment. One question I do have is that I'm on baclofen, amytriptiline and tramadol for pain at the moment (I had a bad reaction to the gabapentin) and they are prescribed by Dr. Antolak. His office told me they do not prescribe narcotic pain meds for nerve pain, even though he gave me them after my injections. None of those meds are working very well for me--has anyone found any meds that work well for their pain?

Also, if anyone would be willing to get together in MN I would love to sit (or stand of course :) ) and chat with some of you in person, its a bit easier for me that way. Please feel free to send me a PM!
Last edited by bergdalm on Fri Mar 23, 2012 1:41 am, edited 1 time in total.
bergdalm
Posts: 7
Joined: Wed Mar 14, 2012 3:03 am

Re: Intro for new MN patient diagnosed with PN

Post by bergdalm »

konedog4 wrote: Have you called the University of Minnesota Fairview system for an evaluation? I don't know what they have there, but they are a comprehensive clinic and have many specialists. Mayo Clinic does not do any pudendal evaluations. They refer to Dr. Antolak.
I did talk to someone at the U and they said in my case that they would refer to Dr. Antolak so they probably wouldn't be much help. I explained a little more that I don't agree with the diagnois and don't trust him right now, so I would like more of an overall evaluation of things so she said that she was going to talk to some more people and get back to me again.
ritak
Posts: 51
Joined: Fri Jan 20, 2012 1:31 am
Location: st paul mn

Re: Intro for new MN patient diagnosed with PN

Post by ritak »

Hey,
First off, sorry you have had to go through all of this. I too feel the same way about Dr Antolak so you are not alone on this. I had my evaluation with him in January. I feel he had his diagnosis of my condition b4 any of the tests were given to me.He seemed more involved in his statistics than me as a person. Even though I was uncertain at the time as to whether I had PN or not of course he confirmed it. I chose not to have any of his shots after reading that only a handful of people get more than a week or few days at most relief from pain. I saw Beth a PT at Metro Urology In Woodbury for 8 sessions and now I am done with her.Beth was very helpful. I am now seeing the massage therapist at that same clinic named Gigi, A Sensetive Touch. I also see a Pt that uses a technique called MAT, muscle activation technique. I have a rotated pelvis and right leg, very weak hamstrings and gluts and a bad foot. I danced for many years and then after that did many different forms of exercise.My main problem I have found out was a muscle called the obteratur internus muscle in the pelvic floor. The pudendal nerve runs adjacent to it.I know that this nerve was inflamed due to the muscle problem. Its a work in progress. I still take pain meds at night. I am hopeful that continuing on with my PT exercise will allow my body to function normally and I can live my life pain free. Teacing a 57 year old body to be in a different posture and walk differently is not an easy feat but it can be done!
Hang in there. If you do not like a certain medical professional do not allow them to work on you. There are lots of choices out there!
Peace,
Rita
perineal pain started may 2011
continue to take Tramadol daily, Vicodin as needed
Dr Antolak diagnosed PN in Jan 2012, not sure about his diagnosis
recomendations he gave me were injections....which I decided not to do
currently seeing Dr Chad Beiler for chiropractic treatment. all of my many practitioners have diagnosed me with pelvic instability, a rotated right leg and pelvis,femoralacetabular impingement left hip,muscle spasm in obturatur internus muscle
about 70% better
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