My doctor is fantastic. I love him.
In this age during which many physicians seem obsessed with getting in and getting out as quickly as possible, this guy takes his time. He listens. He runs tests if I want them. He knows I’m fascinated by anatomy and physiology, and explains things as in-depth as I’d like them. He has a great sense of humor. Did I mention how he listens?
Before we tested for gluten intolerance, we tested every aspect of my thyroid, we tested my estrogen levels and sundry other things. Barbara was telling me, “seriously, you have gluten intolerance,” so I pitched that at my doctor. He readily agreed to write the order for all the tests, and there we were.
I have to go in every three months, without fail, to renew my prescriptions, thanks to a Michigan state law that requires such a visit before I can have them refilled. It’s kind of nice, though, because then I can talk to him about niggling little things for which I wouldn’t have made a special appointment.
This time, there wasn’t anything new that came stampeding to mind. I know he’s a busy guy, and I don’t want to keep him for every little bodily weirdness I might have questions about. I would have endless questions.
But as he asked how I was, if anything was wrong, and I said all was well, he kept asking questions. Finally, he looked up from the laptop, looked me squarely in the eye and said, “Ok, you’re making this too easy for me. Tell me something that’s going on.”
There was something I’d toyed with asking about, but decided against. The last time I’d been in, he’d said there was an outside chance some of the symptoms I was exhibiting might be indicative of multiple sclerosis, and that he’d keep an eye on that possibility. I wasn’t sure I wanted to add anything to the pile of things that might indicate MS. But here I was, and he was asking.
In 1995 (yes, we’re going waayyy back now,) I started having these crazy muscle spasms in the early hours of the morning, before I woke up. I’d go to roll over, and what felt like a superficial muscle on the lateral aspect of my right leg would go into intense, yell-inducing spasms. I would literally wake up mid-scream.
At the time, I spent a lot of hours sitting with my right leg crossed under me in my office chair, and figured I was damaging the nerves or blood vessels in that part of my leg. I stopped sitting on it, and eventually, the pain went away.
Since that time, I’ve been mindful not to cross that leg under me (too often, anyhow.) Yet for the last two months, I have woken up nearly every single morning, trying not to scream in pain and scare the pants off of poor Mike Neir. The pain always happens when I am lying on my back, and attempt to roll onto my left side. It fades after a few moments and I’m good for the next 24 to 48 hours.
As I described this to the good doctor, he immediately began asking relevant questions: Had I recently started a new exercise program? Yes. Did the pain happen when my leg would be rolling inward? Yes. The pain was more superficial than deep? Yes. Decreased sensation on the skin in that area? Yes.
He had me lie down, flat on my back, and let my feet relax and splay to the sides. “Yup,” he said after barely a second had passed. “I know what’s going on.” He did some stretches and manipulations on me, and then we talked about the underlying cause.
“I think you’ve got two things here,” he began. “First, since you’ve been doing more physical activity, you’re probably getting adhesions in your iliotibial band.” He explained this is one of the fascia of the outer thigh, and when we exercise, sometimes it thickens and develops adhesions. The pain you’re feeling could be the result of them breaking apart.” Given the location and shape of the iliotibial band, this seems pretty stinking likely. But not the sole cause of the problem.
The second thing is something called, Piriformis Syndrome. Oh yay, another Syndrome. Essentially, my sciatic nerve is being compressed, very likely by the piriformis muscle, located deep within the pelvic structure.
In a small percentage of the population, the sciatic nerve passes through this muscle, rather than adjacent to it. This can lead to the nerve getting pinched or bound more easily than it otherwise would, resulting in pain anywhere along the nerve’s path.
The reason mine is flaring up? Driving.
The doctor said we see this more frequently now amongst commuters, because as we drive, we externally rotate our right leg – we flop the leg outward (toes pointed out) in a most unnatural position. Given the extremely narrow driver’s side foot well in my car, and given the accelerator pedal is jammed up against the wall of that well, flopping my knee out to the side is pretty much the only comfortable position in which I can drive. Part of how he determined this to be the problem was how much farther my right toes lay laterally than my left in a relaxed position.
The good doctor showed me a series of stretches, and advised me to be more mindful of the positioning of my leg when I drive. I’ve had to raise the steering wheel up quite a bit to get the positioning I need due to my long legs, but I’m working on reconditioning myself to drive in a better posture.
After the office visit, I realized the pain only began again after I started driving 80 minutes per day – after getting this new job. Previously, Mike drove me to work 4 days out of 5. Bingeaux! When it flared up 15 years ago, it was the same outward rotation of the leg that likely induced the pain. Aha. Mystery solved.
I sent him a note today that began, “You, sir, are a damned genius.” I then went on to talk about my “piliform syndrome,” which would be something to do with hair, rather than my “piriformis syndrome.” Oh well. I hope he’ll forget that by the time I next see him in three months.
Here’s the basic stretch:
There is a whole slew of stretches here: Sciatic Pain Relief Exercises
Good information here: Piriformis Syndrome Stretches
I’m also certain yoga will help in this area, given many of the twisting stretches and poses we do.
The important thing here, for me, is that he did not take “I’m fine” as an answer. I’d imagine he sees a lot of reticence from some patients talking about the little things, the stuff they don’t want to bother him with. He kept asking, and now I have a potential solution for a very painful daily problem.
The other take-away (for me, perhaps for others,) is to bother our doctors with the little things, especially if we’re right there in the office already.
It is, after all, what we pay them to do, what they want to do.
If any of you are in the Lansing/Williamston area, and are looking for a new, awesome doctor, I’ll be more than happy to provide his name and contact information. The practice has an in-house lab, and has taken each of the three insurance providers I’ve had in my two years there.