Ivan - email@example.com
Ivan, 27 years old, work at a desk job. Height: 1.70 m. Weight: 76 kg.
Previous medical history: no history of hypertension, heart disease, diabetes and/or cancer. No prior surgical procedure. Non-smoker. Social drinker. Physically active.
Main complaint: pain while sitting/remain sitting (initiated after trauma – slip and fall from own height).
February 17 2011: Fall on a wet granite floor (my own height). I slipped in a puddle of water and landed with the final part of the back/beginning of the buttocks (legs upward, as shown in the figure). It was the beginning of trouble sitting and pain sensation in the midline of the buttocks.
February 17 2011 to August 28 2011 [7 months of conservative treatment], during which the follow attempts were tried:
a) Rest (home/medical leave for 4 months);
b) Nonsteroidal anti-inflammatory drugs;
c) 50 sessions of physiotherapy;
d) 20 acupuncture sessions;
e) Local infiltration (blind - tip of the coccyx) Marcaine+Diprospan
f) Opioid medication.
September 28 2011: After 7 months of conservative treatment without response, I decided to go for the surgery – coccigectomy. The symptoms were still intense - impossible/difficult to stay long periods in the sitting position. Even changing the way of seating (angled sideways or forward), there was always a moment that it became intolerable/excruciating. The surgery had no complications, no infection or wound dehiscence. When I reached 6 months post-surgery, as the symptoms persisted, the Orthopedic surgeon requested an MRI and it showed that there was still part of the coccyx (partial resection of the coccyx, remaining the first vertebrae/segment). According to the Orthopedic surgeon, he decided to remove only the loosen/hypermobile part of the coccyx.
September 29 2011 to June 15 2012 [post-surgical recovery - eight months], 3 months of rest/medical leave. Since the fourth postoperative month, I tried the following attempts:
a) 20 hydrotherapy sessions;
b) 10 sessions of physical therapy - use of devices ultrasound and laser
c) currently practising swimming 2x/week (more than 20 "sessions" by now)
d) NSAIDs and Opioid drugs
Duration of symptoms/pain: 16 months (beginning on the date of the injury in February 17 2011)
Factors that worsen the pain/condition:
- sitting (mostly leaning back *** and in soft surfaces *) x [time]
Tolerance to remain seated, leaning forward or sideways = 40 to 60 minutes
Pain intensity [scale 0-10]:
Best case scenario (rested / morning / standing / lying on my stomach): 0-2
Worst case scenario (sitting / leaning back / driving): 5-6
Imaging exams performed:
X-ray on February 21 2011 (post-trauma)
2 X-ray on April 25 2011
Magnetic Resonance on May 02 2011
Computed Tomography on August 20 2011
2nd MRI on April 20 2012 (7 months post-surgery)
Attempts of treatment / therapy:
a) Arcoxia for 10 days (immediately after the trauma) - NSAID
b) Meloxicam for 20 days (3 months after injury) - NSAID
c) Infiltration (Diprospan + marcaine; blind - at the tip of the coccyx ( July 06 2011)
d) Codaten (codeine + diclofenac), 50 mg, since July 07 2011 (post-infiltration) - Opioid
e) 50 physiotherapy sessions + 20 sessions of acupuncture + walking / elliptical + stretching
f) Ice compress/packs (3 - 4x/dia)
g) Several types of seats:
Pneumatic round cushion (recommended for hemorrhoid)
Neck pillow (U format)
Baby nursing pillow
Float Pool / spaghetti (U format)
Sit on books / phonebook
h) Surgery - Coccigectomy (PARTIAL) - on September 28 2011
i) 10 sessions physiotherapy + 20 sessions of hydrotherapy
j) swimming 2x/week (25 sessions and continuing)
No difficulty or pain to evacuate
Pain does not irradiate to the legs
Mobility preserved (no restriction of movement, except sitting)
No significant weight gain or loss before or after the injury / symptoms
Serious/severe restrictions in:
Work and physical activities;
Leisure (cinema seats, theater, bars, etc.)
I usually try to stay calm and objective, considering other possibilities that I still haven't tried (or even thought). You can't surrender to the despair and distress brought by a chronic pain condition (although it's hard sometimes). I'm investigating if it's still possible to try the ganglion impar block after the coccigectomy (and if it is worth visiting a physician in a different country - maybe Dr. Foye?). I guess you guys can imagine the sacrifice that a 10 hour plane travel represents...
I believe my main options are: 1) neural block, 2) resection of the remaining segment (a second surgery scares me a bit...) or 3) a neurostimulator/neuromodulator device (haven't done my research on this topic yet).
Any thoughts are welcome and greatly appreciated!
I wish better days for all of us, coccyx friends! Don't give up! Best regards!