Newby needs advice

[george159]

I'm trying to figure out how to use this forum. My buddy had back surgery for a herniated disk and now he can't control urination, bowels and says his penis has no feeling. I didn't know what it was, but I knew it wasnt good. His surgeon said his pudendal nerve was damaged during back surgery. I don't really understand it, but the dura lining got punctured and the fluid pooled on top of the nerve. Anyway, he had to have the surgery over again by another surgeon because his surgeon was on vacation! Now, he will have to go to a rehab place to try to get the nerve function back. Personally, I think he should be looking for a good attorney. Of course, he's only interested in getting his life back. This is just a horrible complication. I guess it could be worse, but I don't know how. And how could a surgeon go on vacation knowing he had a patient in this predicament! I'm looking for help here for my buddy. Anybody have any suggestions? Thanks.

[janetm2]

Welcome George,
I am so sorry for your buddy. Bad to worse is never what we expect from surgery and having the surgeon off vacationing(this could be the only good part because who knows what else he could have done wrong). Well you just need to try and get help. Only thing I can think to suggest (others may have ideas as well so please keep an eye out for responses) is to have your buddy checked out by a PN aware Physical Therapist (PT). The PT may find and loosen up muscles that may relieve some of the symptoms. There is a list off the homepage by location to find one nearby. The FAQs on the homepage have info about PN and may be helpful. Best of luck.
Janet

[HerMajesty]

The closest I have ever heard to this is the concept of chemical radiculopathy, which is where a disc with an annular tear changes the chemical environment surrounding the nerve root to cause pain. This sounds similar in that whatever leaked onto the pudendal nerve must have caused some kind of chemical damage. The question is, would the damage be reversible over time? You would want a concrete answer from a physician on that but I think it would be a yes. Nerves do heal, albiet very slowly. The solution to chemical radiculopathy is to eliminate the leaking disc (in favor of a fusion or artificial disc), and then the pain resolves itself when the chemical environment ceases to be toxic. In the same way, if the surgeon is correct that fluid has leaked onto the pudendal nerve but it is no longer leaking, my guess is the nerve should heal with time. A medication such as gabapentin (Neurontin) might help with nerve conduction in the meantime. I am not an expert of course and you need an expert (Neurologist) opinion on whether a nerve damaged in this way will recover or not.
While PT will not fix the underlying problem, it might help to prevent pelvic floor dysfunction (PFD), PFD is short, tight, spastic pelvic floor muscles and it generally happens with bladder / bowel problems and pelvic pain because the person's reaction is to frequently clench the pelvic muscles. Pelvis Floor PT works on keeping the pelvic floor relaxed to prevent damage.
I think the #1 thing is to see a Neurologist who is not in any way associated with the surgeon, to get a second opinion on whether a fluid leak did in fact cause the pudendal problem - and if so whether it is treatable / reversible.

[Violet M]

I'm assuming in addition to considering the chemical radiculopathy they considered whether there are any new mechanical impingments on the nerve root as a result of surgery and just for additional safety reasons whether he had an MRI to rule out cauda equina syndrome which is a medical emergency. I would be requesting that if he has not had a post-op MRI or possibly a CT scan already. http://www.webmd.com/back-pain/guide/ca ... e-overview
Is he having any problems with any extremities?

As far as getting an attorney, unless there is evidence that there was some sort of negligence and the surgeon did something out of the ordinary to cause the puncture of the dura then there may not be a case here. Unfortunately, there are always risks associated with spinal surgery (as with any surgery) and most likely a consent form was signed stating that the patient had been informed of the risks. I'm sorry your friend has ended up with complications but it can be difficult to prove negligence.

Take care,

Violet

[george159]

Thanks for the responses. No, he's not having any problem with his extremities. He is taking Neurontin. I told him he should call in a neurologist. His doctors have not suggested that. He may do that later. There is some evidence that he may be getting better. I guess they are waiting to see if he makes a sudden recovery. Long term plan is to put him in a rehab facility. This is all very complicated and over whelming for me. The surgery was to improve his life, not make it worse. I hope he can make a full recovery.

[Patty]

He is very lucky to have you for a friend. I also think post op MRI is needed.

[george159]

They did call in a neurologist and had his third mri today. The surgeon's notes indicate that "these nerves were damaged during surgery." The neurologist is now consulting with Mayo for what he thinks was a "hiddren" nerve disease that was activated by the surgery and is causing this problem. To me, the surgeon's notes explain the current situation and why it may take a significant amount of time for the nerves to recover, depending on what he means by damaged. But, I'm not a doctor and we will just have to see where tihis goes. He is now in a rehab hospital with no improvement noted.

[george159]

Well, he now has 7 doctors, who are divided into 3 camps. One wants to send him to Mayo inJax. Another wants to send him to Shands in Gville. Others favor watchful waiting. I saw him yesterday and he's very tired and just wants his life back. Urinary and bowel functions show little progress. But, there is a little progress which I think may be significant. Any improvement would be significant because these nerves take such a long time to heal and any progress would indicate the nerves are indeed trying to heal. I'm in the watchful waiting camp. He is getting 3 hours a day of physical therapy. Does anyone know if there is a pn therapist or pn doctor in or near tallahasse, fl? I have not been able to find any. His original surgeon is now back from vacation. He thinks the problem stems from previous surgery wherein the nerves and dura were stuck together to the bone with scar tissue and he could not find a surgical plane. When he tried to separate them, the dura was punctured and the nerves damaged. But this was in the lumbar region well above the sacral and pudendal nerve area. Fluid from the dura came to rest on the pudendal nerve and horse's tail area (equina something). What doesn't add up is that only the pudendal nerve was affected? The second surgery was apparently to remove the fluid from compressing the nerves. But now the mri indicates additional fluid build up in this area. My feeling is that the body will absorb this fluid and additional surgery will not actually help? Any help would be greatly appreciated.

[Violet M]

So it sounds like the surgeon didn't do anything negligent -- it's just that when he got in there to perform surgery, he found there were some unexpected difficulties to deal with which can happen during surgery. I guess your friend is the only person who can decide whether he wants to take a wait and see attitude. If he's not in a lot of pain, that might be the best course of action because further treatment could cause pain to develop and make his life even more miserable. If there is a definite nerve impingement showing up on the MRI, that coincides with the symptoms, then it might make sense to pursue further immediate treatment to relief the impingement.

Violet

[george159]

Thanks for your help Violet. What still doesn't add up is why only the pudendal nerve was affected. I am still trying to find a PN Doctor or Therapist near Tallahassee. How would I find the closest available? He's still in the rehab hospital. He's doing well except for the pudendal nerve functions. Any help greatly appreciated.