FLYING IN:Typically for patients who fly into New Jersey for
coccydynia treatment here in my office, usually they fly into Newark Airport
(which is only about 15 minutes from my office, $16 by cab). We try to
coordinate everything to accomplish as much as possible during the visit here.
Thus, we will often perform the office evaluation and the seated x-rays on the
same day (coned-down x-rays taken in the seated position, since that is when
coccyx pain is often worse). (It seems that very few radiology centers in this
country are familiar with taking those x-rays, but I have trained the radiology
technicians here, and I have found a multiple cases where these seated x-rays
reveal dislocations that did NOT appear on the non-seated x-rays.)
NON-SURGICAL TREATMENTS: Before
coming to see me, most patients have already tried medications taken by mouth
(ibuprofen, etc.), donut cushions or wedge cushions, etc. Many patients have
considered having the coccyx surgically removed, but are looking for
non-surgical options that can give relief without the invasiveness and
prolonged recovery time often associated with the surgery. I am not a surgeon,
so I focus specifically on non-surgical treatments, and fortunately these are
usually effective at providing relief. The injections that I find most commonly
helpful for patients with coccydynia are “ganglion Impar nerve blocks” (perhaps
occasionally combined with focal injection of a corticosteroid [similar to cortisone]
at any joint that seems to be dislocating on the seated x-rays, or that shows
substantial arthritis). Note that these injections are very different than “epidural”
steroid injections that some of my patients have had done elsewhere in the past
[usually without relief], and they are also different than local
"blind" cortisone/steroid injections. "Blind" injections
means that that the physician sticks the needle in without using fluoroscopy. Fluoroscopy
is like being able to see x-rays up on a video screen during the procedure, so
that the physician can see exactly where the tip of the needle is, and thus can
make sure that the medication gets to the right spot. As you can tell from my
tone here, I am NOT a fan of blind injections, and I do not think that they are
very safe at that body region (certainly not for ganglion Impar injections).
Essentially all of the injections that I perform for coccyx pain are performed
under fluoroscopic guidance. Further information about ganglion Impar
injections can be found at the following web site:
making an appointment, patients should keep in mind that the radiology department
closes by 4 or 5pm. Thus, although some of my appointment times include late
afternoons, it would be difficult to get x-rays done on the same day, after
seeing me, if the appointment with me is too late in the day. But one
alternative way to work around this would be to have you show up about an hour
earlier than your appointment, so that you could go down to radiology and have
the x-rays taken before the actual office visit with me. This would need to be
coordinated with me and my office staff. Also, patients with flights in/out of
NJ should let the staff know this in advance, so that the staff can help make
sure the office visits work around the flight times.
INSURANCE: Dr. Foye's office accepts most insurance plans, but please call the office (973-972-2802) to check before your visit. Also, please click here to see our webpage on Insurance, or use the link labeled "Insurance Accepted" on the left side of your screen, for further details.
RECORDS:Perhaps the easiest place
to start would be for you to send me copies of your medical records, including
the official radiology reports from any X ray, MRI, bone scan, CT scan, etc.,
that you have had of the lower back, pelvis, sacrum or coccyx. Generally, the
easiest thing is to have all of your medical providers send copies of your records
directly to YOU (not me), so that you can personally make sure that everything
has arrived in your own hands. The best way for you to do this is to make a
list of all of the relevant doctors and tests, request that they send your
records to you, and then check off the items as they come in. Then you should make
a copy of all of it, keeping one entire set for yourself and mailing the other
set (copy) to me in a single package. My mailing address is noted below.
IMAGES:Also, please send to me (or
else bring with you) any actual radiology images (especially x-ray, CT scans or
MRI of the lumbosacral spine, sacrum, pelvis, or coccyx). I would certainly be interested in seeing the
images for myself.Many radiology
centers nowadays have their images in electronic/digital format, in which case
they could simply put them onto a CD for you and then you could mail it to me,
or bring it with you to your evaluation here. By the way, I find that often
doctors and radiology centers will have a typical “lumbosacral” spine MRI
performed (which is helpful for “lumbosacral” causes of low back pain, but
typically does NOT include any images of the coccyx!). You should obtain and
read for yourself the radiology reports, and see whether or not they
specifically comment on the actual appearance of the coccyx. I have had MANY
patients travel from out of state, arriving here to see me with their radiology
films and reports, only to find that the films did NOT include the coccyx at
all! For patients with coccyx pain who have NOT undergone an MRI that includes
visualization of the coccyx, an MRI should probably be done. For patients who
are flying in to see me, it is logistically NOT possible to have the office
visit, seated x-rays, MRI, and injection all performed on the same day. Thus, we
sometimes try to have those patients get the MRI done in their home state,
prior to coming for the office visit here. (And for patients who have access to
having the MRI performed in the seated position, that may be ideal.)
INJECTIONS:Please make a specific list of any injections you have
already had. Specifically note whether these were performed using fluoroscopy (i.e.,
with a big radiology machine and what looks like x-rays up on the video screen,
guiding the placement of the needle). I find that unfortunately many places
still do the injections "blind" (without fluoroscopic guidance).
Also, please document what your response was, if any, to these injections. The best way to know for sure what type of injection was done is for you to obtain copies of the actual procedure notes and then I can review those with your during your office visit here.
SENDING ME YOUR INFORMATION (medical
records and radiology images and a list of prior injections):
My mailing address is as follows:
Patrick M. Foye, M.D.
Director, Coccyx Pain Service, PM&R
90 Bergen St, DOC-3100,
Newark, NJ 07103
(If the records are less than 10-15 pages total, you can
just fax them to my attention at Fax # 973-972-2825.)
I look forward to hearing from you, and hopefully meeting
you and providing you with relief.
Meanwhile, you may be interested in further information on
tailbone pain at the following web site:
Disclaimer: This web site is for general informational purposes only.
The information should not be considered as medical advice.
The information is not a substitute for appropriate in-person care by a physician with expertise in evaluating and treating tailbone pain. This website is not meant to represent official views of any university, medical school, hospital, etc.
Effective July 2013:
New Jersey Medical School is part of Rutgers, The State University of New Jersey.