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Alcock's nerve block - take 2

Posted Apr 29 2013 6:39pm
When I last wrote, I told you that Dr. Westesson was going to try the genitofemoral nerve block this time around if the Alcock's canal nerve block didn't work.  Well, Dr. Westesson ended up doing the Alcock's canal nerve block again.  Last time I wasn't sure if he had numbed me -- but indeed he had.  And the fact that I couldn't tell he had numbed me meant the blocks had missed their marks.

So the doctor did a second round of blocks on the Alcock's canal.  This time I could tell that I was numb throughout the area, but I still had pain.  That means that the Alcock's canal site along the pudendal nerve is probably not involved in my pain -- if it were, numbing the site would've taken away my pain.  The first blocks, in the ischial spine, took away about 90% of my pain.  Dr. Westesson said it's possible the entrapment is somewhere else along the nerve.  If you ask me, geometrically, this is making less and less sense.

When he was doing the blocks -- one on each side -- I could feel the pain traveling up each side of my crotch as if highlighting the nerve's path.  Ever since, the pain has seemed worse.

At the end of the day on Friday, even after standing for most of the day, my pain was in what I think of as the "exquisite" zone.  When I saw a dermatologist for my pain, the resident working with her said that pain conditions in the genitals can be "exquisitely painful" because of all the nerve endings down there.  It seemed strange word choice.  Apparently it has a medical meaning ("extremely intense, keen, or sharp").  But at the time all I could think of was chandeliers.

The "exquisite zone" for my pain is a blend of both medical meaning and chandelier meaning.  My pain is "exquisite" when it's as if I can see every little nerve ending down there, and each one of them is being traced by a tiny razor.  In my synesthetic view, my exquisite pain literally looks like a chandelier.

So after work on Friday, I sat my exquisite self down in my car and the pain immediately started to jack up.  Imagine walking closer and closer to a hive of bees.  That's what the pain sounded like as it grew -- and I knew I was headed for a heap of pain if I didn't lie down when I got home.

I lay down all weekend, and my pain stayed relatively low.  I really, really appreciated that.  Today I stood all day at work, feeling extra-thankful for my standing desk.

When I go back in a few weeks, if this nerve block doesn't work, Dr. Westesson will try the genitofemoral block.  I think it's possible that the genitofemoral nerve is involved in my pain.  I have had a lot of weird hip issues over the years, including super-sensitive skin over the area and pain.  However, I don't think the genitofemoral nerve is as involved in the vulva as is the pudendal nerve, and that is the main area of my pain.  Plus, as Dr. Westesson pointed out, if the entrapment were in the genitofemoral nerve, I wouldn't have increased pain with sitting.

As I am sitting right now and hearing those bees approach, I am thinking that yes, the pudendal nerve must be the one involved.

So I'm hoping this nerve block works.  The doctors have both said that some people report that their pain gets worse after a nerve block before it gets better.  Maybe, hope against hope, that is why I am feeling worse.

As I mentioned before, both doctors have hypothesized that interstitial cystitis might be involved in my pain; this past visit, Dr. Westesson said there is a doctor at U of Rochester who has studied IC extensively.  I had two urologist here in Cleveland tell me I don't have IC -- now I have two pelvic-pain doctors in Rochester telling me I very well might.  I think I'll think about that one later.
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