Ask A Doctor - Neurology/Pain Management

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Q.
I have pain in my pelvic area radiating into both groins and vagina. I had many tests by primary doctor and gynecologist and all of them were normal. What can be done?
A.
There are many different structures in the pelvic area and genitalia which can be affected and produce pain. The painful conditions may include inflammation or impingement of a nerve or a muscle, chronic inflammation in the uterus or bladder, endometriosis and others to name a few. Unfortunately, diagnosing those conditions may be very difficult at times. Pain killers and pain modulating medications may be helpful. Those patients who do not get significant pain relief may benefit from the nerve injections in affected areas. There is no general advice for treatment of pelvic pain and different conditions are treated in different ways.

Q.
My 82 year old husband recently developed Parkinson’s disease, which is progressing rapidly with shaking hands, lightheadedness, etc. He is taking medications and has seen several doctors, but none are able to help. Can you suggest any other treatment?
A.
Shaking hands, lightheadedness and other symptoms may be a part of many disorders, not only Parkinson’s Disease. Treatment options depend on the patient’s diagnosis. Movement disorders, stroke, seizures, degenerative brain conditions and other neurological problems may present like this as well. There is no universal medication which can be used to treat all of these conditions. Diagnostic tests may be very helpful in making the diagnosis and may include brain imaging (MRI or CAT Scan), recording of the brain electrical activity (EEG - electroencephalography), studying of the brain blood flow (carotid ultrasound and transcranial Doppler), blood work and others. The quality of shaking, coexistence of other symptoms, the order of the symptoms onset, the speed of progression and other pertinent information is as helpful in making the diagnosis as a thorough physical exam or specific tests. This is why it is very important to bring a written history of the disease development and other data to the appointment.