More on Piriformis Syndrome

I have now had two steroid injections into the piriformis. The first one was great and I felt normal for a short time. The second time, the radiologist managed to hit the sciatic nerve and that was a bit disastrous. I completely lost any feeling in my right leg. I couldn’t believe that the hospital let me go. They just told me  to be careful. But the leg wouldn’t take any weight and it felt like my knee was going to bend backwards…my husband had to get me out of the car and to the bottom of the stairs and he hurt his shoulder. I had to climb up the stairs on my bum and for the rest of the day, I had to ask for help to move. It was unbelievable.

The next morning there was still parts of my foot that were “frozen”. And the sciatic nerve was really irritated. Totally different. It took about a week for the irritation to go away but the piriformis is still hinkey although it is better. On Sunday Oct 11 the muscle went into spasm and would not stop. Horrible. The next day, the leg was so fatigued I couldn’t walk around the block. It’s coming and going which I’m grateful for. Before it was spasming all the time.

I saw Dr. Devonshire on Friday and she agreed that it was time to do the Botox. At least there will be a more lasting effect. I asked her what would happen if the nerve got hit again and she said that it would stop the pain fibers which is all right by me.

I have had tremendous relief from the lift in my shoe. I also had the left shoe built up all along the bottom. It is unbelievable what a difference this has made. Physio said that my leg length discrepancy was only seen on standing. Anyway, the lift puts me back in a more neutral alignment. That translates into less pain. All of a sudden I am standing straight. It’s so strange. I have exercises to do to strengthen the surrounding muscles (first stretched the piriformis but now it’s good). And we’re trying to move the ribs separate from the hips. I have been locked for a long, long time so even being able to do the side bend and move the ribs separately is a huge big deal. I”m just watching the end ranges of movement. Also strengthening proximal hamstrings. Amazing how those little things are so hard to do. One day I expect to get back on that reformer. I’m also doing the elliptical everyday or walking.

Using a TENS unit for Pain Management

I had someone ask me if I tried a TENS unit for pain management. It’s worth a try so I told her I would post the info. Back in 1994 I bought a TENS (transcutaneous electrical nerve stimulation) unit. You get one or two leads that glue or stick onto the area of pain. The opposite end goes into the unit control mechanism. I paid $600 for my unit and now they are around $150. I had two leads which gives you 4 pads. I would put them on the upper and lower limits of where I felt pain. And then you can set the amplitude, strength, pulsing or not and depending on your unit – other controls. I think that they basically work by scrambling the pain signal to the brain. It might sound hokey but I was able to get off my anti inflammatories and continuing running using just the TENS unit.

The problem lies in allergic reactions to the glue that is used to stick the pads on. It’s a very common problem and the company, Medtronics, has gone into surgical implants. It didn’t take long for the allergy to get going and I got around it by using pads without glue and then taping them in place with paper tape. That worked very well but unfortunately, the unit wasn’t so effective this time.

And I have to tell you it only works while you are wearing it. And the leads can get caught in things plus you always have the control unit and what to do with it. No dresses. You have to have something to attach the unit to.

Anyway, it does work for some people and it’s drug free. Most physio therapists will have a unit so you can try it out with their guidance and see if you are one of the lucky ones.

Still Doing Well

I feel quite fortunate to be able to say that even though the piriformis is still inflammed, I’m able to manage things. It is taking a little bit to get used to the new drug regime – cymbalta and nortriptyline – but I am getting  used to it. I really felt out of it for the first 5 weeks. The doctor told me to play around with the timing and I think that I have found a balance. I take the cymbalta at 1:30PM instead of at bedtime. I had a terrible time with my gut and pain which is what prompted the desire to change. That has been resolved and I am also no longer sleeping so much. I awake on my own between 6 and 7 which is my normal time.

How to Fix Piriformis Syndrome

It’s interesting how the body heals. It’s been about a year since my last surgery and until a month ago I was far from normal. After a lot of searching, going from doctor to doctor a neurologist found that my piriformis was really tight. Dr. Devonshire in North Vancouver tried to give me a steroid injection herself – I do not advice this as the muscle is really deep and altogether too small compared to the other muscles in the area.

Long and short is that I had a steroid injection using a CT scanner to find the exact location and after a few days I actually felt normal…unbelievable from my perspective.

So now it’s coming back and it’s only been a few weeks since that injection. Dr. Devonshire is making another appointment for a repeat injection and has referred me to a neurophysiotherapist. The idea is to get the piriformis to relax on its own. She gave me a couple of stretches and these ones on YouTube are also good.

So I’m in the midst of weaning down off the MS Contin, going from 60mg twice a day to 45mg twice a day. That for a week or more and then down to 30mg, etc

I have had the runs a couple of times during the two weeks I’ve been on Nortriptyline and we are separating the Cymbalta to take in the morning now and the Nortyptyline at night to see if that helps.

Keep in mind that this stretch isn’t meant to do after your back surgery. This is from a problem that developed because of the surgery.

Neuropathic Pain

I find it very interesting to see the pain managed so successfully with non-narcotic drugs. I’ve been in pain for years supposedly from my arthritis although my case is quite complicated. But isn’t everyone’s case different and complicated in other ways?

NSAIDs (non-steroidal anti-inflammatories) helped the pain but this was far from complete. And these types of drugs are not meant to be taken forever. The ideal case is that you get an acute inflammation from something eg spraining your ankle and you go on the NSAIDs for 10 days to aid with the healing.  Arthritis, however, is not an acute situation but rather is chronic. People go on the NSAIDs because of the pain and the drugs help to different degrees.Unless the patient is persistent about their level of pain, it often stops here. And the patients’ don’t know what is “normal” pain from arthritis. The one thing that they do know is they can’t manage many “normal” daily tasks and this can impact their quality of life (QOL) to varying degrees.

Update August 21, 2009

Well, I can hardly believe the difference between now and the last post. Let me start off by saying that the pain is well under control. In fact, most of the time during the past week I have not had any pain. That’s a show stopper.

Two weeks ago, I had to stop taking my Arthrotec (an antiinflammatory) because I was having the steroid injection into the piriformis muscle. I began taking Cymbalta several weeks prior to that. I’ve had to stop the NSAIDS before and couldn’t wait until the time I could start them again because of the increase in pain. Believe it or not, I didn’t even notice the difference. I was stunned. After a couple of days I thought the inflammation would come back and the pain would get worse. Nada. And now it’s been two weeks and I haven’t taken a single antiinflammatory.

Update August 8, 2009

Viddler News about the cymbalta and steroid injection coming up. The Cymbalta has really improved the pain picture after only 3 weeks. On August 25 we’re supposed to be eliminating the trazodone which was upped to 150mg and adding nortryptiline…there’s a big interaction btwn that and the cymbalta that I want to talk to the doctor about. At the same time, I’m supposed to start weaning off the clonazepam. I get so mad when I think about it. The Pain Clinic at St. Paul’s upped the dosage from 1.5mg to 2.0mg in 2007. And now I learn how it cuts out parts of your memory. Geez…what were they thinking? The interesting part is I haven’t seen that anywhere on the net. But my neurologist says they are seeing some really weird things going on with the drug.

Update Aug 3-09

Just an update on how things are going since my last video which seems like years ago.

http://www.viddler.com/explore/darmorrow/videos/41/

Take care. Stay Positive!
Darlene

Feeling a Lot Better Then Not

Yesterday, I felt terrific. It gave me new hope. The cymbalta is definitely working. Each day it has been a little better and then yesterday, I almost felt normal. Well you know how that works.

I did a nice walk – managed to go a little faster without trying. I was out there for about 30 minutes. Nice. Sunshine. Walking straighter. I really did feel better. By the time I got home, Bill was waiting to go to the beach where the Harmony Art Festival is taking place. I had thought we were going on Sunday or I wouldn’t have done my walk. Whoops. I didn’t say anything and without taking a little rest, we went to the beach. We were there about two hours. It was fun to walk around and see the different craft booths and the gallery. Outside they were doing art demos and Alan Wylie was there. Bill loves his stuff so he sat on a log and watched. I tried to sit next to him but after five minutes I knew it wasn’t a good idea. OK. I went to lawn and sat in one of the chairs.

Bill could tell I was reaching my limit but he wanted to see the gallery. He found a book there by an artist he would like to take a course in. Then we walked around the lawn area, found the schedule for the art demos and just wandered. I think I did something then. I was a bit of a tough go on the lawn, not even ground and there was a dip that I didn´t see. Darn. I could feel something in my back but it wasn’t sore immediately after.

Around and Around We Go

Well, there is no shortage of changes, no shortage of frustrations and sometimes no shortage of hope. The most recent news is difficult to get through. The physicians are getting risky with their suggested treatments and I’m really having to decide just how much I am willing to gamble. I feel, after the hyperthermia trial in Holland, that I am done with the experiments.

Now I am at steroid injections and am stopping that unless they are done radiographically. I was a neurologist’s office last week and she gave me 6 injections trying to hit the piriformis muscle. I feel terrible now and over the last week it’s been hell. I was supposed to go today for a shot into my neck and begged off. She’s made an appointment to do a repeat one radiographically but this being Canada I have to wait a couple of months…She wants to do botox injections into the muscles. I am totally uncomfortable with that and want a second opinion.