The following was sent to me in an email from a PFSer who no longer posts here. They asked that I share this with you guys.
I saw Dr. Aaron Filler. I short, he was familiar with the symptoms, had heard it all before and attribute most of them to a problem with the autonomic nervous system. More specifically with HYPOACTIVITY because of a problem with the impar ganglion, which is part of the sympathetic (fight or flight) nervous system. This would explain loss of emotional response, loss of sexual response, numbness, digestive problems, lack of excretions (sweating, earwax etc.). The MRN confirms impar ganglion involvement but also significant bilateral pudendal nerve inflammation.
I had injections done which ruled out that surgery will help. He said that it is unlikely that surgery will help if I did not respond to the injections, which I did not. He was very upfront and did not try to sell me anything.
List of symptoms:
Sexual:
100% sexual dysfunction
No sexual arousal/response
Not able to get erect
Numb genitals
No sexual fantasies
No longing for sex
Emotional
Lack of emotional response
No longing for emotional intimacy
No longing for a hug
Can’t feel love
I don’t feel any emotional response to a hug
I feel no emotional connection to people when I talk to them
I don’t respond emotionally to any events
No emotional response to music
Cannot feel joy or thrill
No fight or flight response
No passion
Fatigue/malaise:
Extreme fatigue, both mental and physical
Extreme malaise, I feel as if I am dying slowly from an illness
Excretions:
Do not sweat/no body odor
Skin does not produce oil/sebum
No earwax
No nose boogers
No eye boogers
Dry eyes
Dry hair, used to be very oily
Cognitive:
Severe brain fog
Unable to visualize the immediate future, time is at a standstill
No executive function
Memory problems
Focusing problems
No mental stamina
Sleep:
No dreams
Completely unrefreshing sleep
No circadian rhythm
No yawning
Digestion:
Severe fatigue after eating
Carbs and sugars make all symptoms worse
Unable to digest vegetables – they come out undigested
Others:
Cannot relax pelvic floor
Choking throat sensation
Sagging facial structure
Lack of face color - no vasodilation
No goose bumps in response to cold or emotions
No ambition – I just exist
Numb sculp
Numb urethra (can’t feel excreting urine)
Numb anus (can’t feel defecating)
From Filler’s MRN exam:
MR NEUROGRAPHY STUDY OF THE PELVIS with Dr. Aaron Filler
Open Systems Imaging, Pasadena, CA GE 1.5T
Findings:
The S2 and S3 spinal nerves traverse the piriformis muscle with some irritative change proximally particularly on the right. At the level of the sacrospinous ligament there is a SIGNIFICANT increase in caliber and image intensity affecting the pudendal nerves. Also a SIGNIFICANT VEIN DILATATION on the proximal portion of the course of the pudendal nerve along the medial aspect of the obturator internus muscle. This resolves as the elements progress more distally. The coccyx demonstrates some anteroversion and on the anterior aspect of the sacrococcygeal joint there is an area of hyperintensity in the vicinity of the impar ganglion, which could represent local inflammation. The pelvic floor muscles are symmetric in size and shape.
IMPRESSION: Irritative changes in pudendal nerve bilaterally at the spinal nerves at the level of the ischial spine also to a lesser extent affecting the S3 spinal nerves at the level of the piriformis muscle. Evidence of vein dilatation and nerve irritation on the proximal superior portion of the course of the pudendal nerve along the pudendal canal in the medial aspect of the obturator internus muscle. The degree of abnormality at the level of the ischial spine and proximal portion of the course on the medial aspect of the obturator internus muscle is SIGNIFICANTLY ABNORMAL to suggest a CLINICALLY SIGNIFICANT ABNORMALITY.
HYPERINTENSITY ANTERIOR TO THE SACROCOCCYGEAL JOINT MAY DEMONSTRATE IMPAR GANGLION IRRITATION; ALTHOUGH, CAREFUL CLINICAL CORRELATION IS WARRANTED TO ASSESS THE CLINICAL SIGNIFICANCE OF THIS FINDING.
MULTIPLANAR RECONSTRUCTION AND ANALYSIS:
STUDY: Soft-Tissue MRI Neurography, multiplanar reconstruction and analysis.
TECHNICAL: Multiplanar reformats were carried out on an eFilm Workstation.
Findings: These images demonstrate the course and caliber of the lumbosacral plexus and the pudendal nerves using multiplanar reformat techniques to provide an overview.
The general course, caliber and contour of the pudendal nerve is abnormal bilaterally due to increased caliber and image intensity at the level of the sacrospinous ligament as well as increased caliber and image intensity affecting the portion of the pudendal nerve in the proximal segment of its course along the pudendal canal where THE DEGREE OF ABNORMALITY IS STRONGLY SUGGESTIVE OF A CLINICALLY SIGNIFICANT PUDENDAL ENTRAPMENT BILATERALLY AT THE LEVEL OF THE ISCHIAL SPINE.
IMPRESSION: CHANGES IN COURSE, CONTOUR AND CALIBER OF THE PUDENDAL NERVES, BILATERALLY AT ITS PROXIMAL COURSE AND AT THE LEVEL OF THE SACROSPINOUS. THIS IS CONSISTENT WITH PUDENDAL NERVE ENTRAPMENT AT THE LEVEL OF THE ISCHIAL SPINE.
Signed:
Aaron Filler, MD, PhD, FRCS
Chief of Clinical Services Institute for Nerve Medicine
Center for Advanced Spinal Neurosurgery
IMPRESSION AND PLAN:
Based on this patient’s history, exam, data and findings, this seems most likely to be primarily an impar ganglion syndrome in that the patient has a complex sense of numbness, which often is experienced by patients with autonomic nervous system dysfunction, that is, there is present sensation but it feels normal. Also, the urethral sensation is dominated by autonomic fibers.
This may also explain the low general abnormalities with regard to emotional and sexual response and activity levels. I would most strongly suspect a problem with the impar ganglion.
When there is hyperactivity in the impar ganglion so that there is autonomic type pain it is relatively straightforward to test for because anesthetizing the ganglion will relieve the pain. When there is hypo-function such as this, with some numbness, the anesthetic block may only confirm location.
Signed:
Aaron Filler, MD, PhD, FRCS
Chief of Clinical Services Institute for Nerve Medicine
Center for Advanced Spinal Neurosurgery