Visiting Dr Beco

[Zachco]

Hi everyone,
I would like to share this time my experience after visiting Dr Beco's office . I first had to answer his questioner. Many of it's questions were concerning urine and annal incontinence. Luckily ,I don't suffer from such problems .The Urinating frequency, urge and incomplete feeling of voiding, was a big problem for me, 4 years ago when I had the big aggravation of symptoms, but after between one to 2 years it has disappeared . My problem is pain and in this part of the questioner I find that I was usually painful in all spots that I've been asked : those spots are:" bones on which you are set, testicles, tip of penis below your waist or in pubic bladder area, anal area". Later I had some physical exams :
First, Dr Beco looked at my feet and than he marked that in each feet my two fingers near to the big toes are longer than those to toes and I have a flat feet. He told me that this kind of structure can be related or contributing to the pain in my foot , both because it is bad for the foot and also because it puts a lot of pressure on the piriformis area where the sciatic nerve is passing . After, I laid down on my back with my legs spread and he made the dry needle test. in this test he had found that I don't have an equal sensation on both sides. left appeared more sensitive than right side and there was an increased\ abnormal sensation in both sides . he also found some inner trigger points in the piriformis and ligaments .
The main reason I visited Dr Beco, is because I wanted to hear from him his explanation about my surgery dilemma = Do I suffer only from PN pain or do the inferior cluneal pain are also involved . From the short email he answered me for some related questions about this subject I understood his opinion about this issue is quiet different from Professor Robert. When visiting him we had a long discussion about it. Dr Beco does not believe in an isolated clunealagia as he told me. he said that he have had many cases in which after decompressing a patients pudendal nerve, other pain like feet and groin have disappeared. The Idea of isolating the exact site of pain and see what nerve innervate it, presented by Dr Dellon is not Beco's method. He also told me , there is a record for a case in the US in one of the teams, when a patient was examined for PN, and while she was palpated on the left side by The Dr, she reported she experienced pain increased on the right side. In his questioner I was asked as I mentioned do I have pain on "the bones on which you are set" this spot is not a pure pudendal spot. Dr Dellon wrote on his book "THE PUDENDAL NERVE DOES NOT GO TO THE BUTTOCK OR THE ISCHIAL
TUBEROSITY, AND SO PUDENDAL NERVE PROBLEMS CANNOT CAUSE PAIN IN THOSE AREAS." the PN pass along icheal tuberosity and reaches the perineum, and genitals, but does not innervate it . The icheal tuberosity is innervated be the inferior cluneal nerves which are branches of the posterior femoral cutaneus nerve. this is a little hard to understand but another example for a similar situation is with the obturator nerve that pass through the obturator muscle but innervates the inner-thigh . the nerve that innervate the obtrator internus as I understood is, called nerve to obturator internus and is a small branch of nerve from the sacral roots between the pudendal and posterior femoral cutaneus nerve. The bottom line is that in order to take my decision of whether I prefer following Dr beco or Professor Robert I must decide what explanation for the source of my pain sound more accurate to me situation. Here is how Dr Beco answered me to my last Mail I wrote him after visiting him :

I understand it is difficult for you to take the right decision but follow your intuition.
In summary two possibilities:
1. two nerves are entrapped: pudendal and infra-cluneal
2. only one nerve entrapped with either trigger points in the piriformis muscle induced or not by pudendal neuropathy and/or neuroplasticity of the spinal chord inducing strange radiation of the pain.

Prof Robert believes in the first and believe in the second (because I have had some patients with this refered pain who were cured just after PN decompresison). No proof, no randomized control trial...no real scientific data to tell you or us who has the right answer.

I must add that when visiting Professor Robert, I asked him how he relates the symptoms and pain I sometimes feel in my inner-thigh (medial/ aductors area) and also my pain the front of the ilium , because as far as I've found in my research, those spots are not innervated by the pudendal nor the cluneal nerve . He told me that I have an "over-reaction" to my PN . When reporting of my case he marked I have a defused pain my pelvic.
All I'm trying to say, is Professor Robert is not completely with the same approach as Dr Dellon.

I cane testify that my burning feet pain is gone by itself almost completely , only throw time and resting ( it took about one and a half year) on the other hand the groin pain , if to be accurate the pubic ramus pain , is a strong stubborn pain I have with me for about 6 years and I experience it as up to 50 % of all my symptoms . in the last year , I even had more of this pain than the rectal pain. However the rectal and genital pain is a lot harder to mange.
Dr Beco also told me that he is not completely convinced a surgery is necessary in my case , since my average level of pain is between 3 to 4 and 4 years ago it was 6 to 7 . I told him this is because I have stopped sitting and when ever I increase my sitting activities , pain attacks and climb up. I also already tried 3 different courses of physiotherapy . I told him I am aware from the forum of a much worst cases of patient than mine, but ass a young man my life is stuck . He replied he will accept my as a patient for a surgery , in case I will choose his method.
I can testify that with no relation to how he chose to view this pudendal/cluneal isseu , I have the impression ,he is the most caring, patient and honest Dr I have ever met. and I recommend his service to any pationt who can reach him.

[helenlegs 11]

Hi Zachco,
You have put in such a lot of hard work, time and effort to research this problem. It's not something that is easy to decide.
Will either of these surgeons be able to de-compress the inferior cluneal nerve if it is entrapped?
If I understand you correctly, Dr Beco does not think that will be necessary but would Prof Robert be able to access it with TG approach?
Let us know what you decide to do, and good luck.
Helen

[sam]

I too had a similar experience with Dr. Beco. He is truly very caring and patient, I wish I have the courage to pursue some treatment by God's grace.

[Faith]

Prof Robert believes in the first and believe in the second (because I have had some patients with this refered pain who were cured just after PN decompresison). No proof, no randomized control trial...no real scientific data to tell you or us who has the right answer.

I must add that when visiting Professor Robert, I asked him how he relates the symptoms and pain I sometimes feel in my inner-thigh (medial/ aductors area) and also my pain the front of the ilium , because as far as I've found in my research, those spots are not innervated by the pudendal nor the cluneal nerve . He told me that I have an "over-reaction" to my PN . When reporting of my case he marked I have a defused pain my pelvic.
All I'm trying to say, is Professor Robert is not completely with the same approach as Dr Dellon.

I found your post Zacho.

I am a bit confused by what I have quoted above. So Prof Robert believes that the two nerves (PN and inferior cluneal) are entrapped but Dr. Becco believes it is likely only the one nerve (being pudendal I guess because as you said earlier he doesn't believe in isolated inferior cluneal neuralgia?) and the other pain you are experiencing is basically from a nerve "cross-talk" of sorts due to a sensitization of the spinal cord/nervous system? But then you say that Prof Robert told you that you have an "over-reaction" of the PN? That seems in direct contridiction to what Dr. Becco said that Prof Robert believes that two nerves are entrapped. Am I right? I am not trying to cause a dispute only to understand inferior cluneal neuralgia as I am afraid I am dealing with it.

I too have sit bone pain, more like ishcial ramus pain. I tend to think it's more of a nerve "over-reaction" going on, but I worry that if I have PN decompression surgery it will only get worse or won't help my pain.

[hushpuppy]

I am from the USA, and had PN decompression surgery with Dr Beco in Belgium in Sept 2011. I will try and post more about my (positive) experience soon, but anyone who is so inclined, feel free to contact me by PM or post a reply here.

[helenlegs 11]

Hi hushpuppy,

It would be good to find out more about your experiences and surgery for PN with Dr Beco. Hope you have already found some benefit from your recent op and continue to improve. What made you choose to go over there?
Take care,
Helen

[PaulSa]

I am from the USA, and had PN decompression surgery with Dr Beco in Belgium in Sept 2011. I will try and post more about my (positive) experience soon, but anyone who is so inclined, feel free to contact me by PM or post a reply here.

Please do tell!

I will be flying down to see him on the 25th. How are you feeling after surgery? How did you find the whole process overall?

TIA

In dealing with Dr. Beco through email and by phone, the man is a saint!

[AliPasha1]

Hi,
But I think that Beco results are the worst.

Regards,
Ali

[PaulSa]

Hi,
But I think that Beco results are the worst.

Regards,
Ali

From what information are you basing this? I have spoken to two people from this forum that has had positive outcomes.

Thanks for the encouraging words Ali, can always count on you!

[hushpuppy]

If you want to read more; here is published information from Dr Beco:

http://www.biomedcentral.com/1471-2482/4/15

Here is a video presentation he gave (see Workshop 12) in Toronto in 2010:

http://webcasts.prous.com/icsiuga2010/h ... &p=7,13111#

If you want me to share my personal experience, feel free to PM me. I'll post more here later, as time allows!

(F, age 53 - high pain PNE for the past 7 years; began with pelvic floor reconstruction surgeries in 2004; have seen many doctors, and subsequently suffered through several unnecessary surgeries, many procedures, many misdiagnoses and have even been mocked by a well-known MD, all a result of what minimal knowledge the medical community currently has regarding this condition)