Botox Injections
 

Anyone had them?
Anyone worked with Dr Sheldon Jordan in Santa Monica? I just started seeing him and am interested to find if anyone has had any luck with this procedure.


Thanks
Johanna

I haven't but here is some info I found-
from this site- http://www.geocities.com/la_rsi/treatmnt.html?20066

Dr. Allen Weinberger, a rheumatologist at Cedars Sinai, has been given an excellent recommendation. He is said to be very good at treating TOS and an excellent diagnostician.

The following recommendations for healthcare providers in the West LA area were recently submitted by a member. These doctors and therapists have been helpful in the treatment of TOS.

"Dr Samuel Ahn at UCLA is a vascular surgeon who is a TOS expert (the most senior of the 3 in the vascular dept). He took over Herbert Machleder's patients (Dr Machleder is retired and is a well-known TOS expert). Dr Ahn also treats reflex sympathetic dystrophy (RSD) and knows how to recognize it, so this is an added bonus. 310-206-6294.

Dr Ernestina Saxton at UCLA is a neurologist who specializes in TOS and migraines. She performs a very thorough neurological exam. She does not take Workers Comp. 310-794-9551.

Dr James Collins at UCLA does the 3D brachial plexus MRI (a highly specialized MRI for TOS). If you have only one test, this is the one to have - Collins spends an additional 1 1/2 hours (after the 1 1/2 hour MRI) to walk you through what he sees in the films. Referral from doctor is needed. 310-794-1450.

Dr Sheldon Jordan (affiliated with UCLA) is excellent at giving nerve and muscle blocks. Trust this man with a needle! For TOS, he gives scalene blocks; for RSD, he gives stellate ganglion (SG) blocks. He also does BoTox. He is popular and has a long wait. His assistant can be reached at 310-829-5968.

UCLA physical therapists for TOS: Diane Maeda and Joyce Wilkinson are two of their senior physical therapists. 310-794-1323."

Should you want to learn more about your treating physician, under CA state law you now have access to information on doctors' histories that was formerly kept private. If a doctor has had a disciplinary action by a hospital or has had a court or private judgement against them, that information is now publicly available, even if the Medical Board of California has not acted against the doctor. Go to http://www.medbd.ca.gov for more information. You can also check your doctor's credentials and complaints against her/him (info for many states available) at the Association of State Medical Board Executive Directors.

A member of one of the Northern California support groups passed the two following names along to us:

Dr. Phil Harber (UCLA Occupational & Environmental Medicine) supposedly good for treating CTS: (310) 794-8144; COEH 204-8144

Dr. Anthony Alter at Cedars Sinai (310) 659-2910

Dr. JienSup Kim, Doctor of Physiatry in Loma Linda, (909) 478-6277.

Dr. William Mealer at (310) 546-3461. We are told that Dr. Mealer really listens to you. He's treating a member of LA RSI who has TOS. Dr. Mealer is in Manhatten Beach.

Dr. Auerbach at (818) 901-6600, ext. 3890 in Van Nuys.

Dr. Joan F. Wright is now at 2300 S. Flower #200, Los Angeles 90007, 213/747-6581.

and this-
http://www.tellmeabouttos.com/mytos/nc1.htm

botox
 

been there done that it was pure hell
the muscles you use are then paralized and you have no control.......so other muscles take over which means that you get more pain.......

feel freee to pm me if you want more info.

Victoria

I did once, but for the cost I have to wait on wokmans Comp for more.... They took 3 or 4 days to kick in and was bliss for about 5 weeks! Now due to cost when I am in a major flare I get trigger point injections... done by somebody who knows what they are doing these start working in minutes and the flare is sttled for a bit...only problem being bi-lateral I end up getting stuck in 8-10 places... but the pain is worth the gain>>>>>>> peace unto all !!!!

Markn- goober

Botox
 

The one doctor I saw said I was not a candidate for Botox - not sure why.

Before Botox, if your doctor is able, try Trigger Point injections, I feel that they work great, unforunately, they only last so long and if you do not play superman when give and give them a chance to work and some hot baths they give the body/nerve center a break away from all the pain.

Good luck... Mark-n-Goober;)

jamy - I'd see about some other opinions - but I think as Mark suggests maybe try trigg. point inj. first?? before Botox

Can anyone explain the difference between nerve bock injections and trigger point injections?
Thanks
Johanna

Differences?
 

Like Johannakat asked - what are the differences between 'trigger point injections' and 'nerve blocks'? I assume nerve blocks use some sort of local anesthetic but not sure what a trigger point injection is....

I don't have first hand knowledge of either injections but I looked up some interesting links about trigger points vs tender points and the treatments for them.
Links below- also explore the sites for more info

http://www.aafp.org/afp/20020215/653.html
http://www.neurologychannel.com/tpi/
http://www.spineuniverse.com/display...ticle1854.html
http://www.medicinenet.com/trigger_p...on/article.htm
http://www.painandwellness.com/spina...ger_point.html
http://www.trigger-point-injections.com/injection.htm

I guess that's enough for now - I get carried away when i start looking for info- LOL

Some of these have nerve block info also.

http://www.clevelandclinic.org/healt...asp?index=4417

Well, I looked a little on my own, too and answered my own question...According to this site a trigger point injection is a type of nerve block.


My understanding with the Botox is that it will relax the muscles longish term. Dr Jordan does both the scalenes and the pec minor and I think one more that i am forgetting. I am then supposed to be able to stretch and do more effective physical therapy resulting in a long term improvement. He said most people do not even require a second injection as long as they regulate the activities that cause them trouble. If they don't, then they often have to come back.

I am interested to see how it goes...because I am not in a lot of pain all the time unless I am doing something to aggravate it. So, if I work on the computer too long, my arm hurts. If I lift the kids too much, sit with my head drooping, carry to heavy of a bag, etc, my arms and my neck and shoulders hurt. But If I sit all day on the couch and watch TV (and the kids go to daycare) I usually feel just fine. I don't really take meds regularly, because I am still nursing my youngest, Just occaisional advil when it is really bad. (Except for the last two weeks I have been taking percocet at night because of the pain from the initial nerve block test procedure)

Anyhow, I really appreciate hearing others' stories. Thanks.

Johanna

I suppose they can inject either the nerve or the actual trigger point area in the muscle.

I thought since it was called trigger point injection that they did inject into the actual TrP spot.
I suppose it is a case by case decsion, what would be best.

I forgot about the many kinds of injections they can use- saline, novacaine/marcaine, botox, steroids or dry needle.

Dr Togut uses Marcaine, due to the longevity of the the medication, like I said with the trigger point injections is to respect the releif that you get, you will feel as though you are back to your old self and over doing it in the beginning will cause you to hurt more when the Marcaine wears off , though if you give the nerves and muscles a chance to relax after being injected and start doing stuff at a slow pace you may get up to several weeks of limited pain ! Like somebody here stated that each and everyone is different and it may or may not work. I also think it goes by the skill of the doctor administering the medication !

hmmmm marcaine......
 

we used these as post op pain nerve indwelling catheters for our below knee amputations for cancer usually young men with sarcoma.....worked well till catheter removed from nerve....

please tell me more about his if you know.

thanks
Victoria

just got one last week

the muscles he injected them into still hurt

I've had a spasm in my right trap for well over a year, and it's nearly deflated (really weird)

I'm still in a world of pain

I'm hoping some physical therapy and chiropractor vists will help

I'm not sure if I was better off without it

eeekkk
 

That dosn't sound good.....hope things turn out for the better knowing that marcaine is an anesthetic it should work quite quickly unless the doctor hit trigger points and flared things....but still the anest. should have calmed things down......I hope you get some relief soon.....

Take care,
Victoria
ps pt makes me wayyyyyyyyyy worse after any kind of treatment make sure they are well knowlaged about tos and your marcaine shots....not to make any accusations.....just thinking of your health and its possible poor outcome with bad pt....cause let me tell you that sucks and is a world of hurt been there done that comp made me go and I actually passed out doing overhead exercises.....contraindicated with tos......they denied I had it despite a doc's diagnosis....anyhow long story short....passed out due to lack of blood to brain......maybey that is my prob stilll:eek:

take care,
Victoria

injections hurt for me, too
 

This was a Botox shot, right? When I had my test nerve block (the pre-test to the botox with my doctor) I hurt really bad for two weeks. (really bad defined as: I missed 4 days of work and took percocet 1-2 times per day, could NOT sleep without it due to neck spasms), and then it started to get better. I am three weeks out from the block tomorrow, and this weekend I was finally feeling pretty good. Of course, I am scheduled for Botox in the same spots now on wednesday...

I am expecting the experience to be similar. My Doc promised plenty of pain meds, a doctors note to get out of work, and that the long term improvement would be worth it.

Anyhow, good luck..and keep us posted. I really hope it helps you. I'd give it at least two to three weeks before you give up on it.


Side note: I am only on percocet because I am nursing and though it can make my daughter sleepy, it is generally safer than other options. I don't take anything most of the time.


Johanna

Well, Just checking in to say I had my botox shots last week and I am doing OK. I had my doctor do both sides at the alst minute...figuring that I would eventually be back if he didn't do them that day. So far it hasn't been as bad as the nerve block. I have been taking vicadin off and on when things are really bothering me, but I am back to work today and thus far (2 hours in) I am OK.

Still planning to give it two weeks before I decide if it was really helpful. I do notice that when I do shoulder circles I am having a lot of popping and clicking. I don't think I had that before... don't know what to make of it.


Johanna

Another update...two weeks post procedure i am starting to feel better.
I have also been doing sharon butler's stretches (just moved to week 3) very regularly. Going to meet with a chiro today...to see if he can also help.


I have been thinking about the first diagnosis i got before the TOS...tendonitis and wrist sprain, both sides. I wonder how much of that causes the wrist pain i experience on the computer? Or would it be tolerable but the TOS makes it worse. I sprained my wrists in march...seems like that ought to have gotten significantly better....but I can't relaly strengthen the muscles around because it aggravates my traps so much.

oh well...just thinking out loud.

Johanna

My very first dx was bilateral wrist strain in 99.
About half way up my forearms were affected too.
A weird vibration/buzzing inside the forearms/muscles.

Thinking back it very well could have been a precursor to TOS.
Was only a yr after I had recovered {about 85% anyway} from the "wrist strain" that I began to have the shoulder/neck/upperback sx {twice} and then the final combo of all of those and more in 2003.

I think your idea of a multi pronged approach is a good one- there was a few things that one provider /tx didn't catch and another did- and boy I am so grateful for that.

yeah...for sure.

BTW...Chiropractors are COOL...I just went to see one for the first time and I really did just gain about 15 degrees of neck rotatino on both sides from her adjustment. Once something starts to hurt and you favor it i think it is very easy to pull all kinds of things out of alignment.

But relating back to your post...she asked me when I started getting the pain in the back of my shoulders and meck...I couldn't rememebr. It wasn't one of my original symptoms, I only notice that when I was in PT for tendonitis and they would have me do certain arm strengthening excercises that my shoulder musles woudl hurt really badly. Eventually, I got to the point where they just atrted hurting all the time....but it was a later sx, not initial. I wish I could remember when it started.

damn yoga. and gosh i love my kids...but they ARE what did this to me. it is SO frustrating not to feel good.

johanna

Jo- How early on did you start to see the chiropractor?

I stumbled on to him in august of 2004 at his clinics demo booth at the county fair of all places.

But I had been thinking about seeing one & procrastinating about it for awhile. {comp PT eval finally assessed my whole body and found I was quite crooked - but the dr didn't think it applied to my claim-so no tx for that}

I pretty much believe in fate about some things - that this guy was supposed to be found by me, to help me - and the advanced PT guy too- that was able to drop my top ribs when they were stuck.
I think fate is how I met my hubby too & got all my jobs.

If I would have found chiro at the beginning in 2003 or even back in 99?/ who knows??
just happened.

new botox article .....fairly up to date
 

Botulinum toxin A for myofascial trigger point injection: A qualitative systematic review.Ho KY, Tan KH.


Pain Management Services, Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.

Botulinum toxin injection is used to treat various pain conditions including muscle spasticity, dystonia, headache and myofascial pain. Results are conflicting regarding the use of Botulinum toxin for trigger point injection in terms of improvement in pain. The aim of this study was to carry out a systematic review to assess the evidence for efficacy of Botulinum toxin A (BTA) compared with placebo for myofascial trigger point injection. Electronic databases on Medline, Cochrane Library, Scopus, CINAHL were queried using key words such as "botulinum toxin", "myofascial pain", "trigger point", "chronic pain" and "musculoskeletal pain". Relevant published randomized controlled trials that described the use of BTA as injection therapy for trigger points were considered for inclusion. The five-item 0-16 point Oxford Pain Validity Scale (OPVS) was used as a selection criteria for suitable clinical trials. Trials were also assessed based on quality using the Oxford Rating Scale. Data extracted from qualified trials included outcome measures such as pain intensity and pain pressure threshold. All studies were ranked according to the OPVS and the authors' conclusions were compared. Five clinical trials met the inclusion criteria. One trial concluded that BTA was effective, and four concluded that it was not effective for reducing pain arising from trigger points. OPVS scores ranged from 8 to 14 with the negative studies corresponding with higher validity scores. The current evidence does not support the use of BTA injection in trigger points for myofascial pain. The data is limited and clinically heterogeneous.

PMID: 17071119 [PubMed - as supplied by publisher]

ps the words in red are KEY!!!!!!!!!!!!!!!!!!!!!!!!!! always when reading a study rip it to bits then see if they make sense!!!

hugs,
V

V- It is true you should rip a study to shreds. It is also true to consider the source. No personal offence to anyone intended, but the chinese medical system...how advanced is it? What frame of reference do these guys have? What studies are they examining? Were they done by the experts in the field or by relatively unknown investigators? Can't tell any of that from the abstract. I think a thorough reading of the article woudl be needed to make any conclusions.

just another opinion.

JoHanna -

How are you doing since your botox shots? what should I expect? The pain is not as bad as after a nerve block? I have 7 days of pain after a nerve block adn then I feel better .

I just had 2 nerve block injections at C6 in 4 weeks. It will be two weeks since my second one and I am getting botox. The nerve blocks did a good job so far - I still have pain especially when I type at a computer - starts all the spasms all back up again - with the crackling and popping sounds etc. with the shoulder rotations -- ugh.

please fill me in when you get a chance!
regards, Conster