Dr. Nel Gerig in Denver
Posted: Sat Feb 08, 2014 12:08 am
I recently spoke to Dr. Gerig. She generously spent 30 minutes on the phone with me after a colleague forwarded an email I sent him about his PubMed.com paper on neuromodulation. She told me she wants to "change the world". She is very bright and enthusiastic and is taking on patients from other specialists who are OBGYNs. Apparently there is some new rule - or law - that OBGYNs can no longer treat male pelvic pain. She is now training to do pudendal nerve release surgery, although I can't remember the surgeon's name, it was one of the most prominent names.
Here are a summary of her recommendation for me.
Nel E. Gerig, MD
Medical Director
The Pelvic Solutions Center
1601 E. 19th Avenue, Suite 5500, Denver, CO 80218
Ph: 303-260-5092 F: 303-260-5093
My telephone assessment without examination is that you may have a biomechanical issue related to
compensation for the right hamstring issue. There are likely other underlying factors in your history
which were not obtained today. I suspect you may have compression of the pudendal and/or
ilioinguinal nerves from malalignment and/or muscle spasm.
My recommendations for you are as follows:
You need a team of providers who can help you determine why that certain posture/position
relieves your pain, and how to address the issues that uncovers.
1. Assessment by a physical therapist. This should be someone who can identify and treat any
potential trigger points which you may have.
Other physical therapy techniques that may be useful include
the Egoscue method, or Postural Restoration Therapy.
A rolfer may be able to address some of these issues as well.
2. Assessment by an osteopathic physician.
3. For medications, you need a neuromodulator ( or combination of same) that provides pain
relief without significant side effects. For now, would consider change of gabapentin to
Gralise, which is extended release gabapentin, and may be less sedating. Other
possibilities would be to change to Lyrica, or to use Cymbalta or Savella instead of the
Wellbutrin. This would require monitoring by the physician who is treating your
depression.
You also need a muscle relaxant. There are several options; again the goal is to find a
medication that provides relief without significant side effects. I have had good success
with tizanidine. You could also consider flexeril, baclofen, skelaxin, etc.
It is sometimes useful to add in a rectal suppository compounded by a special pharmacy
with some combination of lidocaine and a muscle relaxant. I commonly use lidocaine 50
mg with valium 5 – 10 mg +/- baclofen 5 – 10 mg used at night, twice a day for bad
days but this could cause some sedation.
4. If the above methods do not result in relief, would consider further nerve blocks and
the possibility of Botox injections for any recalcitrant trigger points.
5. If you are not making progress, I would be happy to help you arrange a trip to Denver for
evaluation by our team.
I respect your journey and wish you strength to continue.
Here are a summary of her recommendation for me.
Nel E. Gerig, MD
Medical Director
The Pelvic Solutions Center
1601 E. 19th Avenue, Suite 5500, Denver, CO 80218
Ph: 303-260-5092 F: 303-260-5093
My telephone assessment without examination is that you may have a biomechanical issue related to
compensation for the right hamstring issue. There are likely other underlying factors in your history
which were not obtained today. I suspect you may have compression of the pudendal and/or
ilioinguinal nerves from malalignment and/or muscle spasm.
My recommendations for you are as follows:
You need a team of providers who can help you determine why that certain posture/position
relieves your pain, and how to address the issues that uncovers.
1. Assessment by a physical therapist. This should be someone who can identify and treat any
potential trigger points which you may have.
Other physical therapy techniques that may be useful include
the Egoscue method, or Postural Restoration Therapy.
A rolfer may be able to address some of these issues as well.
2. Assessment by an osteopathic physician.
3. For medications, you need a neuromodulator ( or combination of same) that provides pain
relief without significant side effects. For now, would consider change of gabapentin to
Gralise, which is extended release gabapentin, and may be less sedating. Other
possibilities would be to change to Lyrica, or to use Cymbalta or Savella instead of the
Wellbutrin. This would require monitoring by the physician who is treating your
depression.
You also need a muscle relaxant. There are several options; again the goal is to find a
medication that provides relief without significant side effects. I have had good success
with tizanidine. You could also consider flexeril, baclofen, skelaxin, etc.
It is sometimes useful to add in a rectal suppository compounded by a special pharmacy
with some combination of lidocaine and a muscle relaxant. I commonly use lidocaine 50
mg with valium 5 – 10 mg +/- baclofen 5 – 10 mg used at night, twice a day for bad
days but this could cause some sedation.
4. If the above methods do not result in relief, would consider further nerve blocks and
the possibility of Botox injections for any recalcitrant trigger points.
5. If you are not making progress, I would be happy to help you arrange a trip to Denver for
evaluation by our team.
I respect your journey and wish you strength to continue.