Getting a diagnosis

[AliPasha1]

Hi scaredgal,
Isn't it the scar tissue around the Pudendal nerve which eventually becomes seclorosis of the tissue and subsequently restricts the movement of the Pudendal Nerve which in turn causes Pudendal nerve Entrapment.

In addition,all other Neuropathic related surgeries are performed on the basis of the MRI findings.It had always been a problem that the PN could never be visualized because the PN has such a small radius.

That's why they were relying on EMG/PNMLT testing,doppler test as well the PN blocks which caused horrific flares and caused permanent damage in some patients.


As far the PNE surgey is concerned,it definitely needs to be evolved drastically because of such poor surgical outcomes whether they use the Nantes criteria or the TIR approach of Dr. Bautrant.




Regards,
Ali

[Charlie]

In addition,all other Neuropathic related surgeries are performed on the basis of the MRI findings.

...... which caused horrific flares and caused permanent damage in some patients.

It is my understanding that a standard MRI can not visualize a nerve so I don't believe all neuropathic related surgeries are based on MRI findings. I do support however the benefits that Potters 3T MRI has brought to patients.

I would also argue that if a nerve block causes permanent damage it has been performed incorrectly. A nerve block remains an important diagnostic tool.

[Celeste]

In addition,all other Neuropathic related surgeries are performed on the basis of the MRI findings.

...... which caused horrific flares and caused permanent damage in some patients.

It is my understanding that a standard MRI can not visualize a nerve so I don't believe all neuropathic related surgeries are based on MRI findings. I do support however the benefits that Potters 3T MRI has brought to patients.

I would also argue that if a nerve block causes permanent damage it has been performed incorrectly. A nerve block remains an important diagnostic tool.

Correct. The MRI is to rule out other causes of the pain, to either rule in or rule out PNE--which remains a diagnosis of exclusion.

[AliPasha1]

Charlie,'
Nantes claims that 70% of their patients have become better due to the nerve blocks,where in the US we are seeing major flare ups from the nerve blocks lastings from a few weeks to a few months and in some cases permanant damage.

So who is telling the truth and who is lying.What are the real facts?


As far as the diagnostic value of the Nerve blocks is concerned,does it tell you that whether it is the distal branches which are the source of pain or the main trunk.

Oh, I forgot that is not even a concern because there is no improvement needed in the PNE surgery.It has a 100% successs rate and the patients are indeed very happy and satisfied with the respective results.In addition,the severing of the ligaments have no impact because they don't cause any sort of SIJD,Piriformis muscle syndrome or any other Pelvic stability issues.



Regards,
Ali

[Charlie]

Charlie,'
Nantes claims that 70% of their patients have become better due to the nerve blocks,where in the US we are seeing major flare ups from the nerve blocks lastings from a few weeks to a few months and in some cases permanant damage.

So who is telling the truth and who is lying.What are the real facts?


As far as the diagnostic value of the Nerve blocks is concerned,does it tell you that whether it is the distal branches which are the source of pain or the main trunk.

Oh, I forgot that is not even a concern because there is no improvement needed in the PNE surgery.It has a 100% successs rate and the patients are indeed very happy and satisfied with the respective results.In addition,the severing of the ligaments have no impact because they don't cause any sort of SIJD,Piriformis muscle syndrome or any other Pelvic stability issues.

I do not dispute the fact the PNE surgery success rates need to be improved. You are right to question that and I think we should welcome any Dr trying to develop pne surgery further. However I was just pointing out a standard MRI can not visualize nerves.

In regards Nantes claiming 70% of people are cured by nerve blocks again I think you are right to question that. I also find that hard to believe. However I also don't think we should discourage people from nerve blocks at least for their diagnostic value. The Potter 3T MRI is a welcome development for patients and I would encourage any innovation like this. I also appreciate that you have helped to publicize this. Nerve blocks though are still an important diagnostic tool and I think we need to be careful about scaring people away from them.

I understand from reading your posts that you were made worse by a block and I am not disputing your experience with that. I don't agree though that you can make a generalization that we are seeing patients flare up after nerve blocks or even suffering permanent damage here in the U.S.

Lastly regarding the ligaments again I am not disputing the reports of people who claim to have been made worse from having their ligaments operated on and I sympathize with them. However what I am still yet to hear is a mechanical explanation of why cutting the ligaments would cause pelvic instability. I say that in a non confrontational manner. I too have had PT's tell me it would cause pelvic instability but when I have enquired further they can never give me a solid, logical, mechanical explanation of why it would do this.

[AliPasha1]

Hi Charlie,
There are 900 ligaments in our body and God created them for a purpose. Please read the following text regarding the ligaments as well as their functionality.

The ligaments in the Human body:-
There are nine hundred ligaments (Snáyus) in the human body, of which six hundred occur in the four extremities; two hundred and thirty in the trunk (Koshtha) and seventy in the neck and upwards. (Of the six hundred ligaments in the four extremities), six ligaments are situated in each toe making thirty (in the toes of each foot); thirty in the Tala (soles), Gulpha (ankles), and the Kurcha (ankle-joint); thirty in the leg (Janghá); ten in the knee-joints (Jánu); forty in the Udara (abdomen); ten in the groin (Vankshana); thus making one hundred and fifty in each leg. The same number is found in the other lower limb and in each of the two upper extremities. (Of the two hundred and thirty ligaments in the trunk) there are sixty in the lumbar region (Kati); eighty in the back; sixty in the sides; and thirty in the chest. (Of the seventy ligaments to be found in the region above the clavicles) there are thirty six in the neck (Grivá) and thirty-four in the head. Thus the total number of ligaments in a human body is nine hundred.

Function of the ligaments:-

The function of the ligament is where bones are held in place and joined together by tough bonds of tissue
Ligament has a structure of a strong white chord, allowing its function to support the limbs of the body. Also, another structure is a bluish, white rubbery material, letting the ligament to cushion between the ends of bones and prevent the rubbing of them.

There aren’t some sort of evolution of a body and thus have no functionality as claimed by the
Nantes team and that is an absolute false statement. You can ask any sensible Orthopedic surgeon and he will explain the functionality of the ligaments to you.

Regards,
Ali

[Violet M]

Hey guys,

I started an discussion about ligaments in another thread because I think it should be in a separate topic. Please continue the ligament discussion here:

http://www.pudendalhope.info/forum/view ... f=44&t=875

[Violet M]

I a looking for a way to visualize PN location in the body and I have heard that in the US you have a 3T MRI equipment which enables to see the route of the pudendal nerve and see where it is damaged or compressed. I would like to know if this type of equipment really enables to see the pudendal nerve and in which state it is. As of a month ago, I was told no equipment could really visualize this nerve.

Could someone confirm to me that it is really the case, also that he or she was diagnosed this way by dr Potter or another Doctor and had surgery and a good percent of improvement since then ?

I could be wrong but I think that it's too soon to know for sure how accurate the 3T MRI is. My guess is that it could give you some valuable information but it is not proven to show every possible type of compression/entrapment/stretch injury.

The TIR surgery from Dr. Bautrant works well for some people but it does not reach entrapments at the sacrotuberous ligament as well as the TG surgery does.

Best wishes,

Violet

[scaredgal]

Hi Ali,

Not sure about the progression from scar tissue to sclerotic tissue - I wish I knew more. I associate the word "sclerotic or sclerosis" with hardening. I believe (and I may be wrong) that when scar tissue initially forms, it's actually layers of protein tissue in response to injury. This tissue continues to harden and become "sclerotic". But what I'm not clear on is whether or not the visualization of the scar tissue actually means the nerve is entrapped in it. If, as physicians have told me, that the MRI cannot actually visualize entrapment by ligaments or scar tissue, then maybe the MRI is not definitive for entrapment, but only for thickened areas around the nerve and only surgery establishes definitive entrapment. Maybe if a nerve is in such a small area due to scar tissue and it's inflamed for any reason, it simply has less breathing room and become "entrapped" in that respect - I just don't know for sure and unfortunately, the only way to know for sure is surgery.

I guess which brings up my other question - if doctors such as Filler, Dellon and Aszmann can decompress the very, very small distal nerves, and they are possibly thread thin - then surgery by it's very nature causes additional scar tissue to form in response to the damage. How can you neurowrap such small distal nerves? Is there something else that can be used to prevent re-formation of scar tissue in these very small nerves? Something similar to Wydase?

And personally, not a fan of blocks. They may be somewhat diagnostic, but I sure as heck wish I didn't have my last one. I actually wonder if someone is prone to develop scar tissue, if as the steroid crystalizes, if it doesn't form irritants that actually cause additional scarring.

I wish I knew more - sometimes it seems like the more we know, the more questions there are. I wish someone could fix us all.

I wonder if Hibner would take a volunteer subject with him to Austria? I'd go in a heartbeat....

[AliPasha1]

Hi Scaredal,
Dr. Aszmann has already arranged for a patient that Dr. Hibner and him would be operating on together.I am concerned that whether Dr. Hibner can make it through this awful weather or not to Austria in time. I just hope that our efforts don't go to waste.

I sincerely hope that we start getting better results and better dianoses of this respective condition.THat's why I made sure that Dr. Potter works in conjuction with Dr. Hibner and Dr. Olga Kalinkin to get better imaging results.

Warmest of Regards,
Ali