Going for Botox tomorrow

[ramana]

Sites of injection: left external sphincter, left transverse perineal and left obturator internus. 100 units of Botox. Conscious sedation. Not sure how much the doc will inject where. Keeping fingers crossed. Will update on the experience.

[superuse]

I see the obturators diagnosed in many cases. I can imagine what pain or spasm in the others is like but what does a spasm of the obturator internus or externus feel like? A pain in the hip, rectum or both? How are dysfunctions in them differentiated and diagnosed? Palpation, symptoms, other tests?

[scoobysnacks]

who is doing it?

[ramana]

O.I. is relatively new for me. I have been checked repeatedly for it but with no TrP. Right now I have pain that is like a thorn lodged in the flesh permanently. That is said to be originating from the sphincter and / or O.I

Scoobysnacks I don't know if I can post the name of the doc publicly. Can PM

Experience of the procedure: Relatively painless. If you are bedridden with chronic prostatitis / chronic pelvic pain syndrome pain for several months, then the procedure pain is nothing. Even otherwise with sedation it is just a few injections here and there.

Let's see how it turns out over the next few days. Keeping fingers crossed

[ramana]

48 hours over with not much changes in pain level. In fact, I am having constant headache (pain around the temples. They appear swollen) since the procedure. Pretty miserable on the whole.
In theory, if they keep on injecting more Botox at some points the muscles gotta relax right. So if 100 units don't do the trick will 300 do?

[rysocal]

Didn't the doctor tell you to wait a week or two for any results? I had two Botox injections. The first in the obturator internis and levator. Which gave me 50% relief for about a month and then wore off. I noticed the relief around the third or fourth day. The second into the piriformis and it flared me up and did nothing. I really dont think the Botox injections have long term effects. Plus they average around 2 to 3 thousand dollars for each visit and most likely your insurance won't cover it...I dont know how many CC's were injected.

[ramana]

Yes the doctor did tell me that the full effect may happen in 5 - 6 days. However, the key point is that some improvement should be noticeable within the first couple of days. Not that I have given up on Botox yet.

As for insurance, I have heard of a patient who was quite an activist. She sent letters to CA state insurance etc to show this as medical necessity. That helped her through. Did you try anything on those lines?

[superuse]

What does a spasm of the obturator internus or externus feel like? Hip pain?

[ramana]

As I posted earlier, for me it is thorn in the flesh feeling around the sphincter. The TrP is quite close to the junction of sphincter and O.I according to PT

[rysocal]

How did your Botox injection go? I really don't think Botox is good for a long term treatment. Although I think the doctor that did my injection is highly educated and intelligent, a part of me thinks he is ripping people off. He didn't call me nor ask me on my second Botox injection how the first went. You would think you as a doctor you would want to know how effective the injection is. I don't know how he knows that some patients get long term relief like he told me. Especially after the many "G's" he made off me, it would have been nice to see some concern or a call. It only took 10 minutes for each procedure too. Now I have his billers threatening me with collections every week mean while fighting with Blue Cross for a reimbursement. When I told him I had pain in my abdomen too he said "That's your psoas and we can inject that too". That's when I knew this guy was overboard with the Botox. . . can you say cha ching $$$$? Plus I asked him if he knew about A HEADACHE IN THE PELVIS book, he said "No". When I told him about it, he said "Sounds Freudian". If you want to get a Botox injection by a Dr who's completely clueless about chronic prostatitis / chronic pelvic pain syndrome but extremely good with anatomy, go see Dr Jordan in LA. He will be happy to inject you, forget about you and collect your money.

[ramana]

A month after Botox injection:
Testicular pain slightly less. Rectal pain wildly up and down.
Not sure if I can attribute the lessening in testicular pain to Botox. This is what happened.
For 2 days after Botox tremendous headache
From 3 - 5 days no headache - very painful rectal pain (thorn in the flesh) as posted earlier
After that for a week testicular pain.

Now the interesting thing is that it was discovered in a dry needling session that testicular pain is coming from psoas and obliques. The TrPs on transverse perineum that referred testicular pain are/were STILL there but causing pain only when pressed. For 6 months no one could find any trigger points on psoas and obliques. Suddenly after Botox, whole lot of TrPs. I would have left this as a red herring but I had a repeat experience
I had lidocaine injections on transverse perineum done last week. Immediately after that testicular pain INCREASED and I could find trigger points on psoas and obliques again.(They had quieted down in 2 weeks).
In a nutshell (and echoing a doc's sentence who has seen this) - once one muscle quietens down another takes it place. So Botox is doing something, but we need to address the whole system simultaneously. I have had other problems also that may be adding to the mix that I will post in another thread.

I am up for now 300 units of Botox spread out in different places in pelvic floor. I am stretching out psoas and abs to prevent a repeat of earlier experience even if there are no TrPs on them right now.

For Sheldon Jordan - I know a patient who has had great relief from him. That was back in the days when he was the only guy around. I have also heard of an account on internet where a woman had severe reaction and is suing. I never heard of a doctor who called and ask what happened after the procedure. I am really surprised.

I have problems with BlueCross too. Insurance is an important trigger point (metaphorically speaking) in CPPS. I have to file appeal now. You may want to utilize http://www.prepaidlegal.com services. I have a contract with them but have not used them so far. They have helped me in understanding the law and my rights.

[rysocal]

Has Dr Jordan been doing your injections?

[ramana]

Nope not Dr Jordan. Will PM you on the name

[tiger]

keep me posted, I am going in for 300 units on May 15.