Various Doctor's Diagnoses and Notes
I've seen many medical practitioners about the groin pain resulting from my 1998 surgery. Most have prescribed stretching and more stretching. In early 2004 I saw Dr. Strom who suggested I see a nuerologist. I saw Dr. Grim, who made a few other referrals and things have proceeded from there. Below are copies of some of the notes from the people I've seen.
Dr. Strom Chiropractor 04/24/04:
1. Left Iliopsoas weakness
2. Femoral nerve L1, L2, L3
3. Marked Left Ankle pronation
4. Foot flare on the > on <
Dr. Grim Nuerologist 04/28/04:
For this veteran of examining rooms, and multiple physician reviews, I suspect that (i) a post-surgical neuroma in the region of the inguinal canal that was surgerized (herniorrhaphy), behind much of the localized pain & paresthesia described with activity, to which has been added over time (ii) additional neurological losses from some other quarter to damage the R ilioinguinal nerve, the L1 nerve root, and to invoke chronic low back pain. The etiology remains undefined.
1. Probable entrapment of L ilioinguinal/obturator nerves with a post-traumatic neuroma (herniorrhaphy Feb/ 1998).
2. Bilateral L1 sensory losses; in association with additional odd regional sensory losses (including S4, S5) in addition to non-radiating low back pain: etiology unclear.
3. Aspects of a now-chronic central de-afferentiation neuropathic pain syndrome.
Dr. Tyrone Wei Chiropractic Radiologist 05/03/04
Lumbosacral Spine and Pelvis
AP and lateral lumbosacral
There is minimal disc space narrowing at L4-5-S1. Mild hypertrophic changes of the facet joints are noted at L3-4-5-S1. There is no spondylolisthesis. The sacral base angle is 50 degrees. Upright pelvis reveals the left femoral head 1 mm inferior in relation to the right. There is no significant variation in iliac crest height. Minimal dextro thoracolumbar curvature is noted. There is no evidence of recent fracture or dislocation.
1. Mild degenerative changes L3 through S1.
2. Inferiority of the left femoral head (1 mm)
3. Negative for variation in iliac crest height.
4. Minimal dextro thoracolumbar curvature.
Dr. Earl Schuman General Surgeon 08/16/04
On physical exam this overweight man moves well with no sign of discomfort. His general exam seems reasonable and his heart is normal sinus rhythm and no obvious breathing problems. His abdomen is obese, soft, and nontender. He has active bowel sounds and a well healed left inguinal scar. There are no nodules in the area. There is some discomfort near the pubic tubercle that resolved when he went from a recumbent to a standing position. There is slightly more tenderness with traction on the left testicle versus the right. The right side is completely without discomfort. There is no sign of a hernia bulge. No trigger point could be found along the scar or into the scrotum.
It is my impression that he probably does not have a nueroma, but may have some degree of nerve entrapment in the scar. He may also have a very small hernia recurrence that is causing the pain when he exercises and to delineate that we will obtain a CT of the area.
Dr. Andew Cox 08/23/04
CT Pelvis with Contrast Report:
1. Inguinal hernias are not identified
2. The visualized gastrointestinal tract appears unremarkable
3. The visualized portions of the liver, kidneys, and pancreas appear unremarkable
4. No adenopathy or ascites.
5. The urinary bladder and prostate appear unremarkable.
Dr. Earl Schuman General Surgeon 09/13/04
CT showed no hernias, no abnormalities. He continues to not have a trigger point. Pain is only with exercise while running, weightlifting, sex. I suggested he revisit Dr. Grimm.
Dr. Kevin McEvoy Urologist 05/05/04
This is a follow-up for the patient for chronic prostatitis, which manifests itself as painful ejaculation. He took a short course of Cipro, but did not tolerate it, although it improved his symptoms after only two days. He has no been on Levaquin for two weeks. Most of his ejaculatory pain has resolved. A diagnosis of chronic prostatitis, responding to Levaquin. Continue Levaquin, 500 mg, p.o. for two weeks at a minimum. If still at all symptomatic, continue on for an additional four weeks, which would be a six week total course.
Dr. Kevin McEvoy Urologist 10/01/04
Follow-up on the patient. He was seen last May. He had a markedly tender prostate on exam and symptoms consistent with chronic prostatitis. Mostly this was pelvic pain and painful ejaculation. He was treated with antibiotics. He improved somewhat but still has discomfort and is now having rather severe lower urinary tract symptoms with urgency, frequency, and nocturia. He has seen a nuerologist. He had a CT scan and an MRI scan. The cause of his pain remains unexplained. The rectal examination is difficult as his sphincter spasms and is quite tender. The prostate is flat but also very tender. He insisted that I stop the exam and he ran to the bathroom urgently to urinate. Ejaculatory and pelvic pain and sever lower urinary tract symptoms. Diagnosis is somewhat uncertain. PARQ conference held for transectal ultrasound of the prostate, repeat examination under anesthesia as well as Cystourethoscopy under anesthesia. He understands and desires to proceed. Will arrange surgery at Emanuel Hospital in the near future.
Dr. Kevin McEvoy Urologist 10/14/04
Cystourethoscopy (Examination under Anthesthesia)
Transrectal ultrasound of the prostate (Examination under Anthesthesia)
Digital examination of the rectum and prostate was unremarkable. Cystourethoscopy wa normal with no urethral stricture or bladder outlet obstruction. The prostate was 2 cm long with slight elevation of the bladder neck. The bladder was smooth without tumor, stone, or trabeculation. The trigone and ureteral orifices were normal. Overall, the picture was not obstructive. Transectal ultrasound was performed with the B and K ultrasound machine. The gland was imaged transversely and longitudinally. The gland measured 26.9 mm in height, 38.6 mm in width, and 32 mm in length. Overall architecture was normal. There were clearly some calcifications at the peripheral zone transition cell junction, supportive of a diagnosis of prostatitis. The seminal vesicles were normal.
Dr. Kevin McEvoy Urologist 10/26/04
The ultrasound of the prostate did show some calcification at the peripheral zone transition cell junction that goes along with chronic inflammation, but is not specific. I advised watchful waiting for the urologic symptoms and following through the pain clinic.
Dr. Stephens Acupuncturist 11/29/04
I saw Dr. Stephens approximately once every three to eight weeks from late 2004 to the early 2006. I donít include his notes here partially because I canít read his writing and partially because his notes donít follow a traditional Western medicine format. He has mostly removed the pain from my lower back, my knees, my left buttock, and my abdomen. Almost all of the remaining pain now comes from where my left leg meets my groin, essentially right at the 1998 surgery scar.
Dr. David Rosencrantz Urologist 04/08/06
I don't have his notes. But when discussing my symptoms with me he said it has be a neuralgia of some form. He's started me on Levaquin again.
Dr. David Katherine Morris General Surgeon 04/15/06
I don't have her notes either. She also says it has to be neurological related somehow. She suggested that I continue with the acupuncture and try a nerve block. Surgery may help. It may not. It may worsen the situation.
Dr. Stuart Rosenblum General MD (The Director of The Legacy Emmanuel Pain Clinic) 10/28/06
I don't have his notes either. He says my injury is indicate of a "reflex sympathetic dystrophy" involving the ilioinguinal nerve. He believes that I had a nerve injury shortly after the surgery that is causing my problem. It wasn't the surgery itself.
He's recommending pain relieving patches first, and then trying a new drug called "pregabalin." He's made me promise to do two things over the next 6 months. First, I am to use my exercise bike for 45 minutes each day. And I am to walk for 45 minutes to an hour each day.
Dr. Stuart Rosenblum General MD (The Director of The Legacy Emmanuel Pain Clinic) 4/02/07
The pills were absolutely magic at first! Then they started to wear off. The pain has returned. Dr. Rosenblum seemed to almost expect this. He said my body had gotten used to them. So I need to double the dosage. That does seem to take me back to the old "no pain" situation. But I'm now having some sexual side effects that were unexpected. And the double dosage sometimes makes me feel a little inebriated. I'm not sure if this is worth it. The patches are only moderately successful, but they do help. However, I'm getting a rash there now which is annoying.
Dr. Stuart Rosenblum General MD (The Director of The Legacy Emmanuel Pain Clinic) 10/07
I stopped the pills after their effectiveness seemed to no longer outweigh the side effects. And the patches never really worked in the first place. Even so the pain is mostly gone. In fact, I'm jogging now. The pain is finally gone when I run. Well, mostly gone, I still have the numbness and soreness. However, my knees now really hurt from time to time. I also still have the old pain during urination and pain during ejaculation, though not always. I'm starting to think that this is as good as it's going to get. It's not so bad. Now I need to focus on my knees.