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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Hi again. I am 68 years old male with Sciatica

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2429 Questions

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Posted on Sun, 24 Mar 2019 in General Health
Question: Hi again. I am 68 years old male with Sciatica. I am having EMG/NCS test tomorrow. For my Sciatica, I use daily lidocaine patch on the butt and lidocaine cream plus voltaren gel on the hamstring and calf. My test is at 3 pm tomorrow. Is it ok to do the lidocaine/voltaren stuff tomorrow morning ? If not, can I take 1 Aleve in the morning. If it is best not to take anything, let me know. Thanks for your prompt response.
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Follow up: Dr. Dariush Saghafi 0 minute later
Hi again. I am 68 years old male with Sciatica. I am having EMG/NCS test tomorrow. For my Sciatica, I use daily lidocaine patch on the butt and lidocaine cream plus voltaren gel on the hamstring and calf. My test is at 3 pm tomorrow. Is it ok to do the lidocaine/voltaren stuff tomorrow morning ? If not, can I take 1 Aleve in the morning. If it is best not to take anything, let me know. Thanks for your prompt response.
doctor
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Typically the Doctor's Office gives its patients PREP instructions

Detailed Answer:
Good evening and many thanks for stopping back to my VIRTUAL OFFICE for another visit. Hope you've been well since our last meeting.....let's take a look at what's going on today and get you on the right track.

Typically, in our office we have prep sheets for all the procedures and when a patient is scheduled for something we always make sure they leave the office with the sheet in hand. Sounds like this office left you wondering about what to do. I am happy to give you my opinion but I will say that if your procedure is not until 3p why not call to the doctor's office first thing when they open (8 or 9a?) and let them know you're having this procedure but that you weren't instructed on what to do with your lidocaine cocktail.

Then, you can hear it directly from the horse's mouth and there'll be no doubt as to whether you can use the cream or not. Generally, speaking I really never care what the patient uses on their skin or ingests ahead of time UNLESS...it can somehow interfere with nerve conduction properties of the nerves or blocks muscle activity, or the neuromuscular function....things like that.....lidocaine/voltaren cream which is given for pain management in a patch form (relatively small area of coverage) should be fine when it comes to the conductivity of the sciatic nerve.

Technically speaking the lidocaine can alter electrical activity locally of the nerve in the area just underneath the patch IF your fat pad is reduced for any reason or if your anatomy of the nerve as it runs through the buttock ends up running a little less shallow than usual. And so, there could be a theoretical affectation of the nerve conduction velocity on the side where the patch exists.

You should definitely bathe on the morning of the test in order to wash off excess oils, dried skin, and other debris on the extremities to be tested. You should not put any type of moisturizing creams or lotions on before the test. No smoking and avoid caffeinated foods and beverages starting...well, probably NOW! HA! This will avoid causing changes to blood flow and blood pressure that could materially interfere with how the nerves and muscle respond to the stimulation that will be provided by the machine. Also, don't forget to tell the neurologist (if he doesn't know already) any drugs you may be on that thin the blood (aspirin included) and anything you may taking that can affect the activity of the central nervous system such as transquilizers like Ativan or Valium.

But again, your neurologist may have a different perspective and he may prefer to have an absolutely clean and unblemished milieu for the nerve to operate in while being tested. The lidocaine patch may affect this more than the operator likes....so a phone call to their office is best to avoid any misunderstandings.

And so, if I've provided useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I would be interested in getting updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.

This query required 60 minutes of professional time to research, assimilate, and respond in complete form.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Typically the Doctor's Office gives its patients PREP instructions

Detailed Answer:
Good evening and many thanks for stopping back to my VIRTUAL OFFICE for another visit. Hope you've been well since our last meeting.....let's take a look at what's going on today and get you on the right track.

Typically, in our office we have prep sheets for all the procedures and when a patient is scheduled for something we always make sure they leave the office with the sheet in hand. Sounds like this office left you wondering about what to do. I am happy to give you my opinion but I will say that if your procedure is not until 3p why not call to the doctor's office first thing when they open (8 or 9a?) and let them know you're having this procedure but that you weren't instructed on what to do with your lidocaine cocktail.

Then, you can hear it directly from the horse's mouth and there'll be no doubt as to whether you can use the cream or not. Generally, speaking I really never care what the patient uses on their skin or ingests ahead of time UNLESS...it can somehow interfere with nerve conduction properties of the nerves or blocks muscle activity, or the neuromuscular function....things like that.....lidocaine/voltaren cream which is given for pain management in a patch form (relatively small area of coverage) should be fine when it comes to the conductivity of the sciatic nerve.

Technically speaking the lidocaine can alter electrical activity locally of the nerve in the area just underneath the patch IF your fat pad is reduced for any reason or if your anatomy of the nerve as it runs through the buttock ends up running a little less shallow than usual. And so, there could be a theoretical affectation of the nerve conduction velocity on the side where the patch exists.

You should definitely bathe on the morning of the test in order to wash off excess oils, dried skin, and other debris on the extremities to be tested. You should not put any type of moisturizing creams or lotions on before the test. No smoking and avoid caffeinated foods and beverages starting...well, probably NOW! HA! This will avoid causing changes to blood flow and blood pressure that could materially interfere with how the nerves and muscle respond to the stimulation that will be provided by the machine. Also, don't forget to tell the neurologist (if he doesn't know already) any drugs you may be on that thin the blood (aspirin included) and anything you may taking that can affect the activity of the central nervous system such as transquilizers like Ativan or Valium.

But again, your neurologist may have a different perspective and he may prefer to have an absolutely clean and unblemished milieu for the nerve to operate in while being tested. The lidocaine patch may affect this more than the operator likes....so a phone call to their office is best to avoid any misunderstandings.

And so, if I've provided useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I would be interested in getting updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.

This query required 60 minutes of professional time to research, assimilate, and respond in complete form.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 19 hours later
Thank you for your prompt reply.

I had the EMG/NCV test and it was done by the neurologist himself. He said that my Sciatica comes from nerve exiting at L5 and has recommended going back to my pain management doctor for a nerve block at L5. Full report will be sent to my doctors by friday.

1) I would like to have your thoughts. Should I do it etc.

2)How long can nerve blocks provide pain relief. Is 1 year possible?

3)Is it any more risky compared to Epidural injections.

Thank you.
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Follow up: Dr. Dariush Saghafi 0 minute later
Thank you for your prompt reply.

I had the EMG/NCV test and it was done by the neurologist himself. He said that my Sciatica comes from nerve exiting at L5 and has recommended going back to my pain management doctor for a nerve block at L5. Full report will be sent to my doctors by friday.

1) I would like to have your thoughts. Should I do it etc.

2)How long can nerve blocks provide pain relief. Is 1 year possible?

3)Is it any more risky compared to Epidural injections.

Thank you.
doctor
Answered by Dr. Dariush Saghafi 6 hours later
Brief Answer:
Nerve block recommendation

Detailed Answer:
Good morning.... (12:08 AM)....Glad your EMG testing went well. I hope the information I gave you last time helped a little with preparing for the test.

My opinions on nerve blocks is not terribly positive since it is very easy to develop an expectation that the shots WILL do much more than they have the ability to do. And it is very easy to feel that if it doesn't work very well the 1st or 2nd time that the 3rd time will be the charm. Also, it is very easy to became fully reliant on the shots as the definitive treatment when in fact, they are the LEAST important or helpful intervention in my opinion (as far as long range results are concerned).

The very best therapeutic interventions for L5 radiculopathies (PINCHED NERVES) due to compression include:

1. Watchful waiting since according to Green et al, over 50% of compressive radiculopathies will resolve SPONTANEOUSLY OVER A PERIOD OF 3 YEARS OR LESS and will not need any type of surgical or other invasive procedure (no vagal stimulator, no shots).

2. Exercises for the back and legs are highly recommended although they HURT a bit....yes, they do hurt but the funny thing is if you can acclimate to the movements slowly in a stepwise fashion you will find that little by little you can start gaining mobility and there will be less tension in the tendons, ligaments, etc. which will reduce mechanical pain. AQUATHERAPY and especially WATER JOGGING are my 2 favorite water exercises for lumbar radiculopathies. Leave your ego at the door of the swimming pool....no worries of anything, except getting in the pool and feeling how incredibly buoyant your body is making it so unbelievably EASY to move your hips, your back, your legs, and your knees. You will truly be amazed. It is said that 20 minutes of pool therapy has more physiological value than 5 days of hard demanding land therapy.

3. THERMAL INTERVENTIONS (Hot or Cold....you'll have to try each to see which works best). However, aside from the standard ice or heat compresses that you would wrap around or lay upon there is a rather ingenious device that was developed by a NEUROSURGEON for migraine headaches (THERMAZONE DEVICE). Not only does it help people with all sorts of headache types but it has now been retrofitted with special pads that can be used to treat other parts of the body such as the back, neck, elbows, and knees. It's a pretty nifty device...but it does cost a pretty XXXXXXX as well. But the reviews from my patients have been nothing short of extremely satisfied....especially since you can wear the pads virtually as long as you long...can't hurt yourself with it and you can wear the device AT NIGHT!

4. Nerve blocks will never last 1 year....not even close......Most injectors will tell you 2-3 months. The truth is that if you are LUCKY....you will see 8 weeks consistently, however, I've had patients tell me that their injections have only last from a few days to a few weeks at best. If you are like most people I see who get shots from pain management I'd say the success rate is <50% improvement. And probably less than 20% who would SWEAR BY THEM. The rest of my patients would probably say that it's "Ok"...and perhaps it is slightly better than taking pills....but the frequency of injections on average is going to be about 8 weeks. With a lot of luck you could get out to 12-14 weeks......I did have 1 patient in the past 15 years get out to 16 weeks......but one year? Wow! Not sure where you got that number. I hope it wasn't a doctor telling you he could get that sort of relief because I'd really like to see the rest of the snake oil he's trying to sell from his carpet bag....I mean medical bag! LOL!

5. Risky? Not any more risky than epidural injections as far as I am concerned but perhaps a little more technically involved than epidurals since with blocks you really have to do a good job with the anatomy and place the injection strategically in the best place for the medicine to be absorbed by the tissue and then, work to deaden the nerves. The problem is it is not always possible to "GUESS" correctly where exactly the nerves are located when you depot the shot and even with fluoroscopic guidance, remember the X-rays monitor is only in 2 dimensions while the injector is working in 3! That makes the guesswork even more challenging in terms of getting the injection located.

Bottom line, if it were me....it would take me a minimum of 4-6 months to do injections if I've tried all the other available modalities (including things such as acupuncture, biofeedback, and maybe even a few more good medications for neuropathic pains before agreeing to shots....and even then, I would feel (personally) that I would only want to do a shot if the pain were so excruciating that the only way I could get relieve would be from being immobilized. THEN, I would agree to shots......otherwise, I am not a fan of shots that are injected into depot areas, etc. I simply wouldn't do them on myself nor recommend to any family member that they get them done either.

And so, if I've provided more useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I would be interested in getting updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.

This query required 100 minutes of professional time to research, assimilate, and respond in complete form.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Nerve block recommendation

Detailed Answer:
Good morning.... (12:08 AM)....Glad your EMG testing went well. I hope the information I gave you last time helped a little with preparing for the test.

My opinions on nerve blocks is not terribly positive since it is very easy to develop an expectation that the shots WILL do much more than they have the ability to do. And it is very easy to feel that if it doesn't work very well the 1st or 2nd time that the 3rd time will be the charm. Also, it is very easy to became fully reliant on the shots as the definitive treatment when in fact, they are the LEAST important or helpful intervention in my opinion (as far as long range results are concerned).

The very best therapeutic interventions for L5 radiculopathies (PINCHED NERVES) due to compression include:

1. Watchful waiting since according to Green et al, over 50% of compressive radiculopathies will resolve SPONTANEOUSLY OVER A PERIOD OF 3 YEARS OR LESS and will not need any type of surgical or other invasive procedure (no vagal stimulator, no shots).

2. Exercises for the back and legs are highly recommended although they HURT a bit....yes, they do hurt but the funny thing is if you can acclimate to the movements slowly in a stepwise fashion you will find that little by little you can start gaining mobility and there will be less tension in the tendons, ligaments, etc. which will reduce mechanical pain. AQUATHERAPY and especially WATER JOGGING are my 2 favorite water exercises for lumbar radiculopathies. Leave your ego at the door of the swimming pool....no worries of anything, except getting in the pool and feeling how incredibly buoyant your body is making it so unbelievably EASY to move your hips, your back, your legs, and your knees. You will truly be amazed. It is said that 20 minutes of pool therapy has more physiological value than 5 days of hard demanding land therapy.

3. THERMAL INTERVENTIONS (Hot or Cold....you'll have to try each to see which works best). However, aside from the standard ice or heat compresses that you would wrap around or lay upon there is a rather ingenious device that was developed by a NEUROSURGEON for migraine headaches (THERMAZONE DEVICE). Not only does it help people with all sorts of headache types but it has now been retrofitted with special pads that can be used to treat other parts of the body such as the back, neck, elbows, and knees. It's a pretty nifty device...but it does cost a pretty XXXXXXX as well. But the reviews from my patients have been nothing short of extremely satisfied....especially since you can wear the pads virtually as long as you long...can't hurt yourself with it and you can wear the device AT NIGHT!

4. Nerve blocks will never last 1 year....not even close......Most injectors will tell you 2-3 months. The truth is that if you are LUCKY....you will see 8 weeks consistently, however, I've had patients tell me that their injections have only last from a few days to a few weeks at best. If you are like most people I see who get shots from pain management I'd say the success rate is <50% improvement. And probably less than 20% who would SWEAR BY THEM. The rest of my patients would probably say that it's "Ok"...and perhaps it is slightly better than taking pills....but the frequency of injections on average is going to be about 8 weeks. With a lot of luck you could get out to 12-14 weeks......I did have 1 patient in the past 15 years get out to 16 weeks......but one year? Wow! Not sure where you got that number. I hope it wasn't a doctor telling you he could get that sort of relief because I'd really like to see the rest of the snake oil he's trying to sell from his carpet bag....I mean medical bag! LOL!

5. Risky? Not any more risky than epidural injections as far as I am concerned but perhaps a little more technically involved than epidurals since with blocks you really have to do a good job with the anatomy and place the injection strategically in the best place for the medicine to be absorbed by the tissue and then, work to deaden the nerves. The problem is it is not always possible to "GUESS" correctly where exactly the nerves are located when you depot the shot and even with fluoroscopic guidance, remember the X-rays monitor is only in 2 dimensions while the injector is working in 3! That makes the guesswork even more challenging in terms of getting the injection located.

Bottom line, if it were me....it would take me a minimum of 4-6 months to do injections if I've tried all the other available modalities (including things such as acupuncture, biofeedback, and maybe even a few more good medications for neuropathic pains before agreeing to shots....and even then, I would feel (personally) that I would only want to do a shot if the pain were so excruciating that the only way I could get relieve would be from being immobilized. THEN, I would agree to shots......otherwise, I am not a fan of shots that are injected into depot areas, etc. I simply wouldn't do them on myself nor recommend to any family member that they get them done either.

And so, if I've provided more useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I would be interested in getting updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.

This query required 100 minutes of professional time to research, assimilate, and respond in complete form.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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