Going to a neurologist - Questions/worries

PNMLT, EMG, SSEP, and other Nerve function testing.
The different techniques, results and opinions.

Going to a neurologist - Questions/worries

Postby Rane » Tue Aug 26, 2014 2:01 am

Is there a list of nerves I need him to test? Do I just tell him I'm having pelvic pain or do I say that I suspect PN? Will an MRI help at all to rule out PNE? Also, do I request a skin biopsy?

I'm not that forceful with my doctors, something to do with "respecting authority". I have never been to this doctor before, I don't know his personality and if he'll end up thinking I'm crazy. You see, my GP and another dr know I have anxiety. When I told them that my rectum was numb they didn't seem too concerned. They finally agreed that I should get an MRI to see if my back was okay from falling down and tried to get me in faster to the neurologist. That did nothing. I'm still going on the same date. I have no idea what they told the neurologist, so I don't know what he'll think of me. I'm so upset, having anxiety does make things worse, but any physical anxiety symptom I had disappeared after a few days, this has been going on for months. Should I be very insistent that he covers everything despite any preconceived notions he might have?

One more thing, someone here said that the EMG was useless in diagnosing PN. Is that true?
Rane
 
Posts: 19
Joined: Tue Jul 29, 2014 9:36 pm

Re: Going to a neurologist - Questions/worries

Postby Violet M » Wed Aug 27, 2014 4:35 am

One possible strategy is to just list your symptoms and see what the doc comes up with but if what he says isn't making sense to you and he doesn't consider the possibility of a PN diagnosis on his own then you might want to start asking questions like "what nerve innervates that area?" Be specific about exactly where your pain or discomfort are and how long you've had it, what incident might have started it, etc. If you feel like the doc is way off base on the assessment maybe you might as well go ahead and be assertive and bring up the possibility of PN. I will say this about my neurologist -- when I brought up PN she didn't have a clue. She actually said that neurologists don't treat nerves. There may not be any point in wasting time with docs like that who are uninformed. The best you might get from them is a referral to another doc.

If you are having an MRI it would make sense to have it done using Dr. Hollis Potter's protocol that is listed on the home page. It may or may not give you some valuable information although, the PNE surgeons say that MRI's are not accurate at determining whether you have pudendal nerve entrapment.

Regarding the EMG, it could depend on what type of EMG you have. EMG of the legs probably isn't going to tell you much about the pelvic area. EMG of the pelvic area including assessment of the ischioocavernosus and bulbospongiosus muscles might be worth it. I definitely got some valuable info from my pelvic EMG. http://onlinelibrary.wiley.com/doi/10.2 ... 05049/full
If you have an MRI you definitely want them to check for tarvlov cysts which have been associated with PGAD. http://www.ncbi.nlm.nih.gov/pubmed/22594432
There are no tests that are 100% accurate for pudendal nerve entrapment so sometimes your docs just have to put all the test results together and see what the diagnosis is pointing to. History, exam, and symptoms are typically considered very important in the diagnosis.

Other pelvic nerves that are frequently considered in addition to the PN are the ilioinguinal, genitofemoral, inferior cluneal and poster femoral cutaneous nerves. I can't say whether to ask for a skin biopsy. Are you seeing problems with your skin?

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
User avatar
Violet M
 
Posts: 5467
Joined: Mon Sep 06, 2010 6:04 am
Location: United States

Re: Going to a neurologist - Questions/worries

Postby Rane » Wed Aug 27, 2014 6:18 pm

Thanks for the list. Fortunately the place I'm going to has a 3T MRI. Thing is, he has to scan my back because we don't know if I have a slipped disc, I guess I'll have to ask him to scan my pelvic area as well. As for the skin, I thought you got better results from a biopsy than just from an EMG.
Rane
 
Posts: 19
Joined: Tue Jul 29, 2014 9:36 pm

Re: Going to a neurologist - Questions/worries

Postby Violet M » Mon Sep 01, 2014 12:26 am

MRI of the lumbo sacral area and lumbo sacral plexus are important to make sure there isn't pathology in those areas although I have been told by an orthopedic surgeon that he sees MRI's that look perfectly fine in people who have severe pain but he also sees MRI's that look horrible on people who have no pain. Go figure. But certainly something like a tumor growing on a nerve should be ruled out and also tarlov cysts have been associated with PGAD. So lumbo scaral area, lumbo sacral plexus, and pelvic area are all 3 important from what I understand. Also labral hip tears should be ruled out. You can read Lernica's posts for more info on femoral acetabular labral hip tears.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
User avatar
Violet M
 
Posts: 5467
Joined: Mon Sep 06, 2010 6:04 am
Location: United States

Re: Going to a neurologist - Questions/worries

Postby Rane » Tue Sep 02, 2014 8:29 pm

Alright, I went to him and he says getting off of SSRIs make you have bad feelings. I don't know, he doesn't seem to care about it. He wants to take an MRI of my back however.

Interestingly enough, I went to a pelvic therapist in Iowa City and she said I have very tense on my left side; both the vaginal muscles and the hip muscles are tensed up. When she poked around down there my toes on my left foot went numb. She said that the muscle is hitting the sciatic nerve! I'm going to tell the neurologist this, maybe he'll have second thoughts.

Also, the gynecologist in Iowa City thinks I may have endometriosis. I have heard of sciatic endo before, and the symptoms always get worse when I get my period.
Rane
 
Posts: 19
Joined: Tue Jul 29, 2014 9:36 pm


Return to NEUROLOGICAL TESTING

Who is online

Users browsing this forum: No registered users and 1 guest