cont'd....

from: beyondbasicsphysicaltherapy
Hi.You could try
Dr. David Kaufman - urologist
Dr. SUbash Jain - pain managment
Dr. Kenneth Chapman - physiatrist
If you have any more questions, email us :)
Take care,
Nazneen Vasi.

So, we drove. My wife was incensed. I turned and asked her to immediately call the Dr. I had researched earlier in the week by this nice Phy Ther. place. They had so readily accommodated my request for information and references. I could only remember the Dr.'s last name and that he was located on 72nd Street in Manhattan. Quick Blackberry search and he popped up. http://www.nycpain.com/. The wife made the call as I drove past LaGuardia Airport. They set the appointment for the following Thursday 11:30 AM.

During the next week I copied and packaged all of my medical reports, test results, scan images into a few envelopes. Kinda like a grab and go set of information I could rely on, in short notice. I was now tossing back and forth on what to do about Houston. Dr. Renney's office was getting it together. We were exchanging insurance info, I was speaking with schedulers, sending records out to them, etc. In the back of my mind I continued to think about the ramifications of having nerve blocks done so close together. What if the first nerve block, just a week ahead of the trip to Houston began to work. Do I still go to Houston? I let things play themselves out. If I needed to cancel Houston, for any reason, I was only out $100 in cancellation charges. I could use my now purchased airline tickets to Houston at some other time. The hotel and car were easy to cancel last minute.

Thursday arrived. Wifey and I hopped in the borrowed small car (basically anything is smaller than Ford's largest vehicle) and were off to see the Dr. We arrived a bit early. I got the placement of the address wrong in my head and we ended up parking a few extra blocks away. The brisk walk felt good though, even on a rainy day. Now in the office we found it very nice, small in relation to most of the other hospital related Dr.'s but very accommodating. We sat there and at 11:50 the Dr said good by to an earlier patient and saw me in to his office.

Dr. Jain appears to be well regarded. Plaques surround his office pronouncing him one of NY's best Dr's by New York Magazine and also US News' America's Top Doctor's (same media service though.) He's highly diploma'd and Board Certified (as every doctor should be.) His birthplace is India. He speaks very well in a moderate and extremely calm and assuring Indian accent. He's quite well mannered and very professional. He's got a HUGE LCD monitor on his desk as well as a multitude of reference material, PDR, medical encyclopedia, and my very favorite desktop knickknack, NEJoM (current edition, thankyouverymuch.)

The Dr. is very quiet and unassuming. He's laid back but direct. He's open to dialogue and discussion, as well as lengthy explanation for the many questions a normal patient might have. I don't consider myself a normal patient (having a medical background) and he entertained even my much more in-depth and lengthy suppositions.

Having sat down he opened the floor to me. He asked what brought me to him and how could he help. I started by explaining that I'd take a direct approach to explaining things, begin at the sudden onset on 6/19/08 and take him to the present day. When finished in present day, I'd take as far back as 1989 when I had knee surgery and then into the late 90's when I was diagnosed with RA. About 15 minutes into my explanation he begins making the clicking sound one makes when poohpoohing something. Almost as if to confirm a sadness. He also began shaking his head slightly from side to side. I just passed that off and continued on not letting it interrupt my unusually clear thought process (now being on Neurontin.) When I finished, about 30 minutes later, he began questioning me. The questioning lasted for about 15 minutes. When he was satisfied with the answers he was getting (he attacked each supposition of his, and my associated response, from many different directions, as if playing a CSI role on TV trying to trip up a perp.) Finally he said, any questions so far? I said, "no". "Okay then, lets go examine you."

We moved to his examination room. He asked that I lay down on the short exam table (covered with the dreaded tissue paper on a roll) and asked that I disrobe as well. He began his check of me. Extremely thorough. B/P, Pulse, eyes, nose, ears, neurologics, masses, lumps, abdominal etc etc. After 15 minutes of this "your very healthy for a large man," thanks. He then had me roll onto my side and took the tip of his thumb and a great deal of body effort and pressed deeply into my left butt cheek. He held it there for about a minute and then released. The pain came shooting back. I nearly went through the ceiling. He asked if the pain was the same that I typically had, or if it was different. It was the same, at least as far as I could tell in the throws of extreme discomfort. "Ahh, such as what I thought."

I dressed and hobbled through his waiting room back to his office, grabbing my wife in the midst. "I'm Dr. Jain" addressing my wife, "I'm here to help." We sat down and began the discussion. Earlier in his office, a few minutes in to my diatribe, the doctor began swaying his head from side to side and making saddened sounds. He explained that his initial impression appears to be accurate. He believes my pain is related to the genitofemoral nerve, instead of the Pudendal Nerve. I cross questioned him stating that I had all the hallmarks of PN issues especially since I had a heavy biking history in the 90's. He agreed with me but, holding up one hand, "with the exception of the pain referring to the medial aspect of the left thigh. He said "that's the smoking gun, I believe." Hmmm.

He then turned to my wife and looked deeply at her and said "do you have any questions for me?" My wife turned and began a barrage of questions. He answered all of them and did not pass even one, off. Then he said, "Neurontin. Its a scourge of a medication that Dr.'s prescribe like candy. Inexperienced Dr.'s, who are accommodating the drug salesman. Today's golden bullet of sorts, that in reality is just plated instead of solid. He further said that the efficacy of the drug was practically equal in qualified user reports, to those of placebo. He did say to take care though when withdrawing from the medication. While it does help on the anti-seizure front, it does little to help with associated pain. Th medication should be decreased daily by about 300mg-600mg. Do though expect headaches, even migraines and photo sensitivity when withdrawing.

In Neurontins place he'd give me Lyrica. Then also Celebrex, and Nortriptyline. Together these would accommodate the discomfort levels being experienced, at least as a first attempt. To please call him if the pain was any higher than when on the Neurontin and the Ketofen topical compound. He said he'd return the call immediately, day or night. (Was this a doctor I was speaking to?). Then the wife finished her additional questions and we thanked him for his lengthy time with us. Nearly 1-1/2 hours. He turned and said, in my business I've seen many patients. When the days of hospital regulation came, my administrator desired for me to take on many more patients. I tried explaining that I needed to spend time to understand the whole patient and all of their needs in treating pain. All to no avail. At that time I started my practice which continues to this day." Hmm.

He then said he'd be scheduling me for a PN block under guided CT (the only way he does blocks of that type) within the next week. I asked why the PN block and not genitofemoral. He said, the other Dr's focused on the PN nerve for a reason. You have symptoms of that type of pain. You also have imaging verifying an inflammation at the Alcock's canal. He said, it would be easy for me to overlook this and go right for the genitofemoral, but we have indicators here that we should listen to first. I also stated that direction would also alleviate my concerns as well. (I'd been focused on PN pain and problems for so long now, I wanted a direct answer.

I then asked about PT. Should PT be tried in advance of the block. He said if you can tolerate pain, then we can discuss that direction further now. He said though that if the problem is in fact genitofemoral related, the body may be its own worst enemy. He said that a muscle could be trapping the nerve. If the muscle is in tension because of spasm, even back to the original onset, it may never have subsided or relaxed. In such a case lactic acid builds up and concentrates over the course of a little less than an hour. Then with no where to go, the acid ions flux into the surrounding tissues, irritate the nerve sending signals to the muscle, which in turn cause signals to be sent to the brain, which then returns a signal to the very muscle contracting asking it to move. The process then begins anew. Under PT if muscles in the area are built up without knowledge of the causing factor, the now stronger muscle itself could pose a similar factor in creating pain and you'd further delay knowledge of origination. A wait in this case until a specific understanding of causation is well worth it.

I scheduled the block for September 11th.