Successful Pudendal Nerve Block

I thought the heat and the bathing suites were going to do me in, but in the end it was the actual trip that caused me pain.  It took us more than four hours to get to and from the beach.  Even though I was sitting on my cushion, my pudendal nerve flared. 

I started to feel pain in the second hour in the car.  I tried to shift around and find a comfortable position without much luck.  I had intermittent pudendal nerve pain during the holiday weekend, but I wasn't too worried.

After I returned to work, I realized I was in a flare.  Every day it got worse.  The pain was constant.  There was no position I could get into the brought me relief.  By Thursday, every step I took caused a shock of pain.  I've never had that before.  The pain was concentrated around the opening of my urethra.  The area was burning. 

After a trip the gym on Thursday, I knew I was in trouble.  The pain got so much worse after I did a series of sit ups. 

The next day I saw my doctor who suggested a nerve block.  He said it could really help with an acute flare.  He performed an extremely painful vaginal nerve block.  I couldn't help but cry as he located the nerve canal and performed the injections. 

Within a few hours, the tears were worth it, because the area was completely numb.  I wasn't in pain.  I continued to walk gingerly for the next few days, but the nerve block really seemed to knock out the flare. 

Busting My Ass In School and Causing a Nerve Flare

I am literally busting my ass in school. I work full-time and this semester I'm taking two classes. I normally only take one. Given the circumstances, I have to sit in a classroom for 4 hours a night, 3 days a week. Only 2 days in and I'm starting to feel the pain. Vulvodynia and academia don't mix.

I've got a manageable setup in my office: I've got me kneeling chair and my standing desk. I can get through the day without too much discomfort. My pain increases over the course of the day, but by 5:30, I'm usually home and reclining to take the pressure off my nerve.

I no longer have that luxury. I leave work, get in my car, drive to class and then plant myself in a rigid desk. I can't usually contort myself to tolerate an uncomfortable seat for a small duration of time. But last night, there was no comfortable position.

By the time I came home, I was in bad shape. I'm going to have to start bringing a cushion to class. Hopefully that will be enough. I don't want to draw negative attention to myself, but I don't have a choice. I'm not going to sit back and cause myself unnecessary pain.

Last night I found myself feeling frustrated and discouraged. I realized how much my pudendal neuralgia and vulvodynia have progressed over the last 2 years. They're getting worse and I don't know if I have the ability to stop them.

I still believe I made the right decision to put off the pudendal nerve decompression surgery, but I know it's on the horizon. Maybe I should try another nerve block.

Sometimes Being Sick Is the Best Medicine

I think I got myself in trouble for using the word “worst” in a previous entry. Pain is dynamic and scales are relative. What was worst then is peanuts now.

I strongly believe that the last round of injections caused a nasty flare. In my attempt to avoid the word worst, persistent and hopeless are two good words that come to mind. I couldn’t sit for half an hour without searing pain. I got desperate and emotional.

Honestly, the greatest blessing this past week was getting really sick. I felt horrible. Sore throat, fever, headache, dizziness and complete exhaustion. I got permission to work from home on Wednesday. Like a good patient, I stayed in bed all day. Subsequently, I had no pain for an entire day. Good start.

On Thursday, I stood almost the entire day. Some pain. Less burning. I still felt sick as a dog! Friday, I wasn’t strong enough to stand. I did everything I needed to do for the day and got permission to leave early. I got right back in bed. Again, less pain.

Meanwhile, I was getting worse instead of better. I had a blinding headache for 8 days. I was so weak, I got winded walking from my car to the house and I had to rest for a long time after completing simple tasks. My mother forced me to go to an urgent care center. There I was told that I had sinusitis. A doctor gave me antibiotics and a note excusing me from work on Monday.

I am feeling so much better. Modern medicine is incredible. I started to make a major comeback in a day and a half once I began my course of antibiotics.

Thanks to my sinus infection, I was able to rest and stay off my pudendal nerve. It was enough time to quiet a raging flare. I feel very fortunate for the time I had to recover. I thought I wasn’t going to bounce back from that flare. I read that if not done precisely, a nerve block injection could cause irreparable damage to the nerve.

I thought I was ruined.

Every Block Is Different...

Before I got my first block, my doctor warned me that it could last a week or it could last a day. Every block is different. The block I had on Tuesday didn’t quite last a day. I’m very disappointed and of course, uncomfortable.

Part of my pain, I think, is due to just the ordeal of getting the injections. My doctor really has to get his fingers deep into my squish to find the best injection sites. As I’ve already discussed, my skin in that area is very sensitive and prone to irritation. I think I got a little roughed up in the process. No Pain, no Gain? I guess in this case it’s more like: More Pain, No Gain…

I honestly think I’m worse than I was before my appointment. With this problem you have to take chances, because you really don’t have a lot of options. I haven’t given up on this treatment. If anything I’m grateful for a chance to have more accurate injections. Hopefully, if they’re in the right place, I’ll see better results.

I also still have my surgery date for May, but my doctor said that he will only consider it if the pain is getting in the way of my daily life. I think I’m already there.

Another Day, Another Injection

I had my second round of injections last night. It wasn’t nearly as painful this time. I’m hoping that’s a sign that the steroid is helping to reduce the nerve compression.

I was the last patient of the night and I think my doctor and his medical assistant were a little punchy. It helps to have a good laugh before a big shot.

While my doctor was prepping me, I asked the medical assistant if I could take a picture of the needle for my blog. I said, “I just want a picture of the needle. I don’t want a shot of it in me.” “No that’ll be on my blog!” my doctor chimed in.

I started to go numb pretty quickly this time, but I’m not nearly as numb as before. That’s probably a good thing because that first day two weeks ago I was having trouble containing my business. I really want to hold onto my record of 23 years without crapping myself. I consider it a personal best.

The next round of injections will be with a radiologist to ensure accuracy. Right now my doctor feels around inside me for the ligament that houses the pudendal nerve, with a scan he will be able to deliver the medication more precisely.

I have to wait until next week to call and find out when I can get my next shots.

(I'll post that picture as soon as I can get a hold of my camera cable)

Faced with a Decision

Christmas came and went and as soon as I returned to my desk at work, my pain came screeching back. Now 8 weeks into this seemingly endless flare, I made another appointment with my doctor. I was becoming extremely agitated and uncomfortable. I was losing my ability to cope.

On December 28th, I saw my doctor again, the third time about the same flare. I was angry. I felt like I was getting much worse instead of better and I wanted to know why. My doctor explained that pain is dynamic, conditions can change and they can worsen. It seemed that my pain was getting worse and it seemed that sitting the culprit. Burning pain following sex was still a factor, but nothing compared to what sitting was doing to me.

My doctor said that I would likely be a candidate for a different surgery, the pudendal nerve surgery, where the ligament that surrounds the nerve and the nerve itself are severed. This surgery is much more serious than the vestibulectomy. There is a longer recovery time and involves much larger incisions. The pudendal nerve innervates the opening of the urethra and the anus, so incontinence is rare but can result from the procedure.

My doctor told me, “you have to decide which problem you think needs to be addressed, the pain with sitting or the pain with sex.” The answer was obvious to me: I have to sit for 8 hours a day for my job. I don’t need to have sex every day. In order to continue working I must have something done. I am not interested in going on disability. I have big dreams that I’m not putting aside because of vulvodynia.

That day I got my first in a series of three injections to better determine my candidacy for the pudendal nerve surgery. It was extremely painful. I had never had direct contact on the nerve before. Sweet Jesus it hurts! My doctor had to feel around inside me to find to right spot for the first injection. When he found it, I screamed. I couldn’t help it. I was shocked by the intensity of the pain. Oh my God! Those nerves have got to go!

The needle has to puncture through the wall of the vag and then through the ligament and into the nerve. That takes a lot of force and a pretty deep prick. I shouldn’t complain too much though. Before they learned to do the injection through the vaginal wall, doctors were making injections into the pudendal nerve through the back of your legs. Can you imagine how long that needle would need to be? Good God!

After the injections, I had to wait to see if my doctor had successfully hit the nerve on both sides. He did! And for 2 days afterward all my business was completely numb except for some burning pain in my ass. No joke. I couldn’t even feel myself pee. It was weird. But it was worth it. Those injections put an end to the worst flare of my life.

I’m getting my second round of injections tomorrow. The pain has come back with sitting at work, but generally it subsides when I get home. I’m anxious to hear what my doctor has to say about the way my body handled the treatment and I’m hoping he continues to believe that the pudendal nerve surgery will work for me.