Suggest Treatment For Severe Pain In The Buttocks

Brief Answer:
Baffled Docs

Detailed Answer:
Thank you for your question on this network.

I've read your description of the problem and how your pain in the buttocks seemed to begin following taking 1000mg of levaquin for a dental procedure that occurred subsequent to the taking of the medication.

My assumption is that x-rays did not show any significant arthritic degenerative disease in the hips or legs though this would be ONE of the possibilities for anyone who were 83 years old and complaining of pain while while walking. I wouldn't necessarily think this pain to be related to vascular claudication pointing to insufficient blood supply to the muscles of the legs which is often related to reduced pumping action of the heart but it seems that they considered that possibility as well.

The pain as induced by levaquin itself is a very unlikely answer to this question since a review of the literature reveals that while levaquin has been implicated in the process of what we call RHABDOMYOLYSIS....which refers to damage to muscles....the main symptoms include pain, weakness, and swelling. The diagnosis is fairly straight forward through blood work and acquiring tests such as renal function tests, myoglobin, aldolase, and CPK values in both the blood as well as urine. An isolated symptom of PAIN which is intermittent upon walking really doesn't raise this as a high possibility in the differential list.

I wouldn't do more unnecessary X-rays or ultrasounds because the symptoms are not changing therefore, one would not expect to find the same tests giving different results.

What may be worthwhile doing is an EMG/NCV study to see whether there may be an entrapped nerve root in the lumbosacral region of the back or a twiglet of a nerve root supply the gluteal muscles and thereby causing the pain. I would endorse this as a possible useful test.

I would also look at the possibility of ordering of AQUATHERAPY for your condition which may help ease the pain compared to land therapy.

---

Brief Answer:
You are very welcome and I wish you the very best

Detailed Answer:
Let me make 1 more recommenation for a diagnostic study that I would strongly consider given your symptoms....which may have been performed already. But with the pain you describe I would also get an imaging study of the lower lumbosacral spine (though I think it's unlikely that it would show anything definite or related to the exact pain that seems to be very local). Nonetheless, I would order an MRI of the LS spine and correlate that with the EMG/NCV study just to cover all bases.

If the neurological examination also suggested an S1 or S2 radiculopathy I might even consider what is called a CT MYELOGRAM which can sometimes be more sensitive than an MRI scan since the myelogram actually outlines nerve roots...even as small as they get in the lumbosacral region making it easier for most radiologists to "see" them and make the call of some type of entrapment as opposed to MRI which often times can either not really see the abnormality or be misread by a non-neuroradiologist.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 45 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---