Question Title: PLEASE PLEASE PLEASE respond Neurogenic Bladder/Possible MS

1. Should I have been recommended to a Neurologist by now? My Primary Physician is wonderful, but from what I read here, I feel it necessary to see a Neurologist, do you agree?

2. The first response that you gave me said that a Clinical Neurologist would be able to prioritize diagnostic testng, because i don't have insurance. I was under the impression that the MRI was the last test needed. What other tests are available and/or adviseable?

3. I am exhausted physically and emotionally from all this, and like everyone else, I am wishing for a speedy diagnosis. f I do, indeed, have MS will it definately show on the MRI?

Thank you, Thank you, Thank you in advance. This site is wonderful and you are doing a great job!

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If you have symptoms which could possibly stem from the nervous system, then it never hurts to see a neurologist (of course I'll say that, I'm a neurologist!). Self-serving comments aside, I often see patients who should have been referred before they were.

Without insurance, you are in an unusual position. For one thing, of course, it is quite expensive to visit the doctor. But on the other hand, you are NOT subject to any insurance company or HMO rules. So there is no limit on who you can see, no limit on what the network is, which hospital of affiliation, requirement for primary doctor referral, etc. If you can afford it, you stand a chance of getting a good evaluation. Of course, you can also come up with an inconclusive result.

Stick with the neurologists with the best reputations. Ask around in your community. Ask your doctor(s) who they'd send their mother to, or visit themselves. If you are near an academic medical center, inquire if they have a large neurology department. If you are close to CCF, check us out. Each year, US News and World Report (in July or August) publishes top 10 lists - go to your library and find out which of the top 10 neurology places is nearest you. You'd do well to see any of the top 20 or 30 neurology departments in the nation.

It's hard to say what test should be done first, and whether an MRI is either necessary or in what order one should be done.

For neurogenic bladder, MS is a possibility. But there are also other structural problems in the spinal cord which can impair bladder function. A careful, systematic history and physical exam can direct a good doctor to prioritize a list of possible suspects, and thus prioritize tests (as Dr NT pointed out in the prior message).

For MS, we usually look at an MRI (brain, plus/minus cervical spinal cord, plus/minus thoracic spinal cord). We also look at the results from a spinal tap to detect signs of inflammation. Also, sometimes evoked potential studies are done to pick up any evidence of demyelination and therefore conduction block along long tracts in the central nervous system. These include somatosensory evoked potentials in the arm and leg, visual evoked potentials, and auditory evoked potentials.

Bear in mind: THERE IS NO DEFINITIVE TEST FOR MS. If you have it, all tests can be negative. There can be false positive or ambiguous test results. Just watch out and don't hang your hat on a single test result. The information is in the PATTERN. An excellent neurologist knows that.

I hope this helps. CCF MD mdf.