CT-Guided Pudendal Nerve Block: The Jury Is Still Out

I've been very reluctant to post about my CT-guided pudendal nerve block because I haven't seen any positive change.  I actually think I've had a complication or two.  

I don't want to frighten anyone away from considering this procedure.  There were a lot of factors that have tainted the results for me.  

I've had a lot of pain in my left butt cheek, which at times radiates down my left leg.  I feel badly bruised in my left knee, the top of my left foot and my left heel.  Very strange.  It hasn't been constant and it appears to be dissipating.  Thank God.  

In the wake of my yeast infection, my area has been on fire!  I wasn't sure whether it was a nerve flare or if the skin was actually inflamed.  After ignoring it and not sitting at all for a few days it got no better.  There was more of a sharp itch to the burning than my usual pain, so I tried a course of hydrocortisone suppositories.  It was definitely a skin issue and that's finally clearing up as well.  I'm glad I had those lying around.  

My doctor had prescribed them for me a few months back and I hadn't used them.  Boy, am I glad I kept them!  I was going crazy.  

During this time of heightened pain, I've noticed that even standing makes me flare.  It makes sense.  If you stand for too long in one place, blood starts seep out of the capillaries in your lower extremities.   This can lead to swelling and even fainting.  My theory is that there is also a fluid buildup in my moose knuckle.  

I guess I just need to find a balance between sitting and standing at my job.  What I really need is to be able to recline at times, but that's not an option.  

Pain in the Ass: CT-Guided Pudendal Nerve Block

On Wednesday I had a CT-guided pudendal nerve block.  I hadn't anticipated it would be such an ordeal.  2 days before the appointment I received a call from the office saying that I had to come over an hour before the procedure, I couldn't eat or drink after 6:00 am that day.  I'm under a ridiculous amount of stress at work and unfortunately, I have my fair share at home as well.  I began to have some misgivings.

My mom was kind enough to go with me for the block.  I had to get completely undressed and wear gown.  I got an IV on the top of my left hand.  I was hungry, but cool as a cucumber.  One of the nurses even said, "I've never seen a woman this calm before this procedure!"  

I guess she jinxed me.  I finally got to meet the doctor who was performing the block.  He was very nice, but I think I got a little more information than I needed.  He told me that I needed to be awake enough to tell him if he punctured the nerve.  

That sent me into a bit of a panic.  I was all ready to be knocked out.  I thought all I had to do was lie there and look pretty.  I didn't want to be awake and in pain!  What if he did puncture the nerve!?!  What if this little procedure only made me worse?!?  

I started to feel hot and nauseous.  My mom got one of the nurses and I told her that I didn't want to do it, that I had changed my mind.  She was very surprised.  I was no longer her super cool patient.  I was a hot mess.  I was ready to rip the IV out of my hand myself.  

My mom suggested that I speak to the doctor and see if he could put my mind at ease.  I have to say, everyone on staff that day was just wonderful.  They were patient, understanding and kind.  The doctor and the nurse administering the anesthesia assured me that the risks were minimal and I would be well cared for.  

I decided to go for it.  I had to lie on my stomach with my arms stretched out in front of me.  My ass as in a tube for the CT.  Once they had everything lined up, I was given a local numbing injection in each butt cheek.  It hurt.  Then the big needle was placed on the left side.  "OW!"  Then another big needle was placed on the right side.  "OW!"  I'm not gonna lie.  It hurt.  Those needles were long!

After that second "ow" I was out.  I woke up feeling very happy and very relaxed some time later.  That was a wonderful sleep.  I felt so relieved about everything when I woke up.  Apparently, every time I said "ow" the nurse gave me another dose of twilight.  Good deal!  

I'm not nearly as numb as I have been with the previous nerve blocks.  Unfortunately, I have another raging yeast infection from a course of antibiotics.  And let me tell you, I can feel that!  I wish I couldn't.  

My butt is still very sore from the injections.  I feel like I got a tetanus shot in both cheeks.  

The steroid in the injection is not supposed to take effect for about a week, so I'll keep you posted on if I see some improvement.  I really need to nix this yeast infection first.  It's completely tainting my results and ruining my day!

I have a followup with my doctor some time in the next two weeks where we'll discuss surgery.   The CT-guided nerve block is supposed to be a good indicator of whether or not you should have surgery because it is so much more accurate.  The needle is in the potentially compressed canal.  

Hopefully, I'll have a clear indication of where to go from here.    

The Anatomy of a Pudendal Nerve Flare

I finally got the replacement part for my kneeling chair and not a moment too soon.  I'm in bad shape.  

Last Thursday night I got injured doing my favorite activity in the world.  It's amazing how the slightest shift in position can be the difference between pleasure and days of pain.  Essentially, my partner came down and scraped the front of my snooch a couple times.  Now everything around the opening of my urethra (sorry, I haven't found a better term for that) feels inflamed. 

The next day when I became aware of the extent of the injury, I found myself thinking, "Ha, what would a pudendal nerve decompression surgery do for this?  Nothing!"  

Oh, how short-sighted we can be...

The initial trauma sent pain signals through my pudendal nerve to my brain.  Those pain signals caused the nerve to flare.  It was only a minor scrape.  I have no doubt that it has healed by now.  The flare is drastically worse than the original injury.  At this point, the only source of relief is lying on my back.  I can't even stand without pain.  

I have my first CT-guided pudendal nerve block next Wednesday.  At this rate, I should definitely be able to test of efficacy of that procedure.

The results should also verify if the decompression surgery is right for me.