New Person with Pudendal Nerve Disorder

[konedog4]

Shockwave Therapy

For those of you considering shockwave therapy, I thought I'd write a little bit about my experience in Canada with Dr. Andrews.

First, I found out about shockwave therapy on this website. I contacted the person who was greatly improved from shockwave therapy and he gave me a primer on the treatment through exchanging e-mails. Once I decided I wanted to try it, I called the Cornwall office of Dr. Andrews and asked about setting up a visit. They sent me a package of paperwork to fill out before I made the appointment. Dr. Andrews evaluates the responses on the paperwork and then has a general idea if shockwave therapy can help. In my case he advised a week of therapy, so it was set up.

I flew into Ottawa, rented a car (expensive(!) so prearrange the car rental if at all possible), and then drove to Cornwall (90 minutes on good roads). I had a map given to me by my car rental agent. Having a portable GPS or renting one through the car rental might be a better option for most, but I am good with maps, so I saved some money on the GPS rental. I arrived in Cornwall and stayed at the Ramada Inn. Dr. Andrews has arranged a special rate of $89.50 per night. Figure on staying Sunday - Friday (or Saturday). The Ramada is an easy drive to De. Andrews' office - perhaps a 5-8 minute drive. He practices out of a house in a residential neighborhood, so it is easy to miss his office the first time around.

On the first visit, Dr. Andrews will examine you and then talk about the week of therapy ahead. Therapy begins that first day with palpation of trigger points and where he believes the pudendal is entrapped. This area is then worked on first. The shockwave machine is like a miniature jackhammer that pulses shockwave energy into the body. The intent is to jar loose any areas that are tight, have scar tissue or trigger points, and induce a healing response through inflammation. On normal tissue, the shockwave instrument is not that uncomfortable, but when it hits any tissues that are not supple and relaxed, the sensation is quite painful. Dr. Andrews uses the shockwave device for about 45 minutes at a time, treating the worst area first. He does this so that he can treat the same area at least twice more during the week. Dr. Andrews advises to be prepared with a heavy-duty pain reliever, such as Tylenol #3 or Vicodin, for the pain is intense and persists throughout the week. I was lucky in that I was able to get by on regular Tylenol, (3 tablets before therapy and three 4 hours later). The pain from shockwave therapy is intense, in fact, I had to hold on to the treatment table as I was laying there to steady myself to the pain. It is common to moan and groan during the therapy. Dr. Andrews will stop whenever a break is requested. At times the pain gets so intense as he is working a particular area that a break is a necessity.

After my first treatment, I was asked to sit on a chair normally. I was hesitant at first, as this always causes perineum pain, but after the first round of therapy, I could sit for about 5 minutes without pain. We knew that the therapy was going to have at least some success after that first treatment. My entrapment area is Alcock's Tunnel (from riding an exercise bike with a hard seat). Tuesday - Thursday I had two appointments each day. A different area was shockwaved each appointment. Treatments to all attachements to the hip girdle are given. In my case, my hamstrings and thighs were very tight, and the shockwave therapy was really painful and caused minor bruising and swelling. The Alcock's Tunnel area was treated on MOnday, Wednesday, and Friday. With each treatment, I became progressively sore and Friday's treatment was the most pain I have experienced in a doctor's office. I would rate it a 8-9 on a scale of 1-10. Yet, it is necessary to treat the area of entrapment with the most therapy minutes, so I endured the pain to hopefully gain the benefit of the treatment.

Dr. Andrews is very thorough. He leaves no stone unturned in seeking all the potential causes of pudendal neuralgia. He has exceptionally strong and perceptive thumbs and fingers. When he pressed on my pelvic and sitting bones in search of inflamed areas, the pain from his fingers and thumbs was very intense. He searches for trigger points and then tries to reduce and relax them through pressure and then treatment with the shockwave machine. It is essential to treat all potential areas of imbalance, muscle splinting, and inflammation, and he does so in a disciplined and orderly fashion.

As the week progressed, I was given gentle stretching exercises to do so that the tissues would remain supple and not contract. These are best done in the Ramada Inn hot tub, which feels really good after a session of therapy.

A week of continuous therapy is not the ideal way to treat pudendal nerualgia, but for those of us who come from out of town, it is the only feasible way to treat the condition. So expect to be very sore at the end of the week. In my case, I was quite sore in my pelvic bones and tissues that attach to the pelvic girdle. The soreness was not unbearable by any means, but one is definitely sore. If I need another session of therapy, I would not hesitate to do it again, for the pain is a minor inconvenience to treating the condition and making things better. Don't let fear of the pain dissuade you from trying the therapy.

On my last session, I was given a packet of post-treatment instructions and exercises to do. These are meant to keep the tissues supple and in balance. Follow-up with a physiotherapist (at home) is also mandatory.

The cost of the therapy is about $3600 dollars. My insurance would pay nothing. Six nights in the motel totaled about $600 dollars, and the car rental and plane fare were close to $1,000 dollars. Expect to total about $5000 dollars in cost for the week. Expensive? Yes, but if if saves you from needing surgery, it is an investment in your health that pays dividends. Unfortunately, you will not know if the therapy will work until you actually try it.

I had soreness in my pelvic area for about 2 and 1/2 weeks after therapy. I did not go back to work for one week, mainly because one is not supposed to sit for any length of time immediately after the surgery. I did my stretching throughout the week and continue to stretch each and every day.

I got better from the therapy. My previous postings will attest to how I feel better. I expect to continue to improve, as that is the pattern after shockwave therapy. I don't know yet if I got "cured" and will not know for some time, as it takes time for the shockwave therapy inflammation to subside and for the nerve to heal. I can attest to the fact that I can sit for much longer periods of time, in fact, I am sitting (with a cushion) as I type this note.

I'd encourage anyone who has pudendal entrapment to give Shockwave Therapy a try. It is certainly a valid form of non-invasive therapy for pudendal neuralgia.

kone

[Lernica]

Great post, Konedog! So glad to hear you're feeling better. What did you think of Dr. Andrews?

[konedog4]

Dr. Andrews is thorough, knowledgeable, and professional. He seems to be able to feel with his fingers where areas of entrapment might be. I was quite impressed with him as a chiropractor. I would certainly make him my permanent chiropractor if I lived near Cornwall. I recommend him without hesitation.

kone

[wendy7]

Hello Konedog,

Thanks much for that very detailed experience that you had. It seems that you are better from the treatments and that is great! I was wondering if you could tell me a bit more about the shockwave therapy? Is it that the doctor uses the shockwave therapy, to specifically cause inflammation in the tissues, to help break apart any scar tissue that may be there? Then, once the tissues are not inflammed, things go back to normal, with the hope that some of the scar tissue is no longer attached to the nerve?

Is that how the therapy works? It sounds interesting and would definitely like to learn more about it, ecspecially if you have had success with it.

Take care,
Wendy

[konedog4]

That is exactly how the therapy works. The shockwave machine emits sound energy into the body directed at the pudendal nerve to break up any scar tissue and to activate an inflammation (healing) response. I am certainly better after the first week of treatment, but I am not cured. I still have symptoms, although they are less intense. So progress was made. If I can afford the cost, I will go back, for I believe more targeted treatment will result in more improvement.

kone

[Lernica]

Yes I agree that that's an excellent explanation. In case some people might think it sounds a bit farfetched, I would like to point out that ESWT is now the gold-standard non-surgical treatment for dissolving kidney stones.

[Violet M]

Thanks for that great explanation, Kone. So glad to hear you are still doing better!

Violet

[kathyd]

Hi Kone
Thx for posting your experience with Dr Andrew. It was very thorough and informative.
I went to see him in May (was one of the last patients he saw with Glenn doing the shockwave. My experience there was much as you described.

However they said I had the tightest Psoas muscles ever with the exception of another patient. Like you I was able to sit on the 1st night following treatment... As the week progressed, I sat for meals ...and was generally in less pain, and was quite hopeful...Following the last treatment on Friday,, I could feel the inflammation kick in and the benefits wearing off..
By the time I arrived home in NJ I was feeling worse..I did the exercises faithfully for weeks afterward. but like another patient on this site, Dr Andrew kept pushing the improvement time for me out to more weeks mos etc... I have urinary issues as well and they worsened big time after I got home,....A few mos later they went back to baseline.... My worst pain is severe anal throbbing with began a few mod after an ill -fated peripheral nerve surgery with dr. Dellon..Before then I had sit bone pain and uirnary issues but they were nothing compared to the post surgical pain...Now it occurs with standing walking etc and makes sitting completely impossible...My guess is that the surgery created a new neuroma, but no one seems to know for sure..

Long story short, re Dr Andrew I did not experience long term improvement, tho Dr Andrew said it might take several sessions like his patient Jean....
I liked him very much when I met him but based on my experience and Faith's s experience I have lost trust . Faith is a patient who was up there the week I was there.

My pain meds thus far have not controlled my pain well,so thus I am scared to again subject myself to something which could put me further into pain...

Anyway I would appreciate if you could tell us how you are doing now? Do you have long term relief? and are you planning another trip to Dr Andrew.
Where is your pain? I assume you told your story on these boards. (not sure under what heading) I have been offline for some time and have missed much of the news
Does Dr Andrew do everything or has he brought in a new partner?

Anything you could tell about your experience might be helpful to me in deciding whether to give his treatment another try.
I wish you the best in your recovery! Thx very much !
Kathy

[konedog4]

So far I have maintained the gains from Shockwave therapy. I am still able to sit for as long as I want now. I still sit on a padded cut-out cushion. I can sit on a regular chair, but I am hesitant to at this point for I do not want to traumatize the area. I am doing my stretching each day with no ill effects. I would go back for more therapy if I need it because the first session helped me.

I think each person is different in terms of the scope of their problem. I have always believed (based on my bike riding incident which started this condition) that I was entrapped in Alcock's tunnel area. This is an area that is accessible with Shockwave, so I expected to get better if the shockwave could free up the nerve. Apparently some of the nerve became free again, for I can do a lot more things functionally than I could before.

With the high cost of this treatment, it is certainly something you don't want to rush into without considering the cost/benefit ratio. If you had one treatment that did not give you the results you wanted, I can understand your reluctance in deciding to go again.

I will keep posting as to my condition post shockwave.

kone

[Jax87]

Glad to hear you are doing well! Thanks for keeping us updated.