I like to share so, I’ll share the details of my situation. I failed the pudendal nerve block but I still am thought to have PN. Sometimes the block isn’t strong enough because the signal migrates over to the ganglion impar nerves. That’s nociceptive versus sympathetic pain. Neuropathic versus neuropathic with sensitization. These are terms I found around it.

If you have sensitization, you have to be extra careful with things like rough and tumble PT or trigger points but with any kind of PN, nothing aggressive is recommended. So I’m going to cancel dry needling of the pelvic floor I had set up.

pt got me flared because they had me sit on a tennis ball. So it’s day five after my ganglion impar block (for sympathetically based pudendal pain) and I do not feel good. Could take two weeks to start to feel better, i guess. i asked questions about “is this it, is there no major peripheral contributions to my pain anymore.” the way to know would be to repeat the nerve block. Because I want to quantify this. There’s a sort of gray scale it’s not black and white. There’s always some peripheral sensation feeding the pain. How bad is it. Is there a place for relief from the pudendal nerve block in my care. I wanted to sort that out.

basically it had been suggested to try the pudendal nerve block again to see if the first time was a miss. This doctor doesn’t want to dilute the experiment of the ganglion impar. It would muddy the waters if I had a positive response to the pudendal nerve block. So she wants me to wait a month or realistically two to fully get it on the schedule. Or perhaps even later because if the ganglion doesn’t work there’s still the caudal block to try. To me there are no real downsides to knowing SOMETHING works. And also presumably if the pudendal nerve block worked this time I’d feel some response to lidocaine. She seemed to waver but then went back to no. I could have it elsewhere - the issue might be that the first injection totally missed. And I don’t want to do it with someone who will miss again. This is something I have to look into. She didn’t want to answer any of these questions which I can understand but as a patient there’s got to be the consent and autonomy aspect of it. So the conversation was cut off but I rescheduled for a follow up in a few days to just double check there won’t be negative consequences for our collaboration if I do something she doesn’t want me to. (getting things done as a patient is like being a Byzantine courtier or something).

finally there was discussion of that you can have a baby possibly with a spinal cord stimulator. Unlike ablation a stimulator doesn’t necessarily require any of these blocks to work to be a good option. My doctor seemed interested in this question.

on the emotional front there was the typical preamble of “why are you asking these questions theyre too hard, it’s hindering the acceptance process for yourself it’s blah blah blah,” (which seemed like refusal to answer the questions - I always feel on such thin ice in every appt, no matter who it’s with). I did cry and literally begged. That worked this time. I feel from my perspective hopefully a doctor having had this conversation can see its utility. I feel like in any objective world you can see why a person would ask all this stuff. but every time I see this doctor heck every time I see any doctor they make you go through the begging and pleading to just hear if the question is important. I consider it a good appt these days if the crying and polite argument only takes five to ten minutes before they allow me to ask questions. And that’s all it took. Still the appt ran late and it was suggested I could continue at another appt, which I suppose is progress relative to starting the appt with an argument against having it.

This has been dispatches from my care, thank you for coming on this journey, the end