Aa
Back from new neuro appointment!!!!!!!
Thanks everyone for the thoughts and prayers today, they meant a lot to me!!!!!
So, now for the scoop on Dr.T, my new neuro!! Well, Dr. T came in and introduced himself and shook my hand and asked how I was!!!!!! Very nice man!!! I felt relaxed with him right away! He already had my two years worth of chart in his hand when he walked in. Quix, you were right, he asked me for my history right off the bat!!
So, I explained to him the onset ect......He asked about any possible things leading up to the onset, so I told him about the abrupt way in which my SSRI's were switched just six weeks before. He wrote down all meds involved. He basically asked a lot of questions about the time frame of the origional attack!
Then he starts going through my chart, looking at all test results so far. He talks to me about each one as he comes to it. I gave him the results of the VNG and the EMG that I had done recently! He made copies of these.
After we got through going over the test that had been done, I asked my questions, one of which was the location of the lesions, and he told me and gave me a copy of the last MRI report done. Next, he wanted to know if I had been having any new symptoms. I told him about the transient numbness/tingling in caves and forarms, the warm feeling running across my foot, because these are the ones that were not there from the origional attack.
He said how long does it last and how often does it come on. I said it only last for from 10 seconds to 5 min and only comes on occasionally!! He said, now how about any major numbness, loss of bladder/bowel or any return of the vision loss, or has it continually improved with no recurrances. I said no major dysfunction since the onset and my vision continues to improve and has never worsened even temporarily!
He said according to the evidence of all of the repeat scans showing nothing new, and your history of recent symptoms, I don't think this is MS!!! I said well, is it ADEM? He said your working dx is an immune response brought on by some kind of trigger, that is unknown, but most likely a virus. I said could the med change have caused this, or been the trigger, he said possibly but most likely a virus.
He repeated that he did not think this was MS, because with the severity of the onset that I had, he would have expected to see some activity in two years time! He said ADEM is severe at onset and is one time and heals from there, and this sounds more like my picture to him, but I want to study you a little bit longer! He ordered a new brain MRI with contrast, and also is having the VEP repeated to compare to the one done in 2006 to see if he can document the visual improvement that I am explaining!
He then said lets get you in the scanner and then we will see, and I need time to look it all over more completely!
He didn't do an exam at all, and this kind of puzzled me, but I thought maybe he may do one when the results of the MRI, and VEP come back!
I did get a copy of my last MRI report which was on 11/06/07 so this is what it said.
Exam
MRI Brain & Stem with& without contrast
Results:
Indication: Vision changes, questionable mass.
Technique: MS protocol contrast enhanced brain MRI utilizing Omniscan Interavenous contrast.
Reference exam: 11/14/06 and 5/31/07.
Findings:
Numerous white matter lesions demonstrating high T2/FLAIR signal intensity are again demonstrated, including anormal hyperintensity within the posterior body and splenium of the corpus and within the periventricular white matter of the bilateral frontal and parietal lobes. Large confluent regions of increased T2 signal intensity surround the periatrial regions of the lateral ventricles bilaterlaly, right greater than left, similar to the prior examination. The distribution of the white matter lesions has not significantly changed compared to prior studies. Post contrast images show no abnormal enhancement.
Diffusion weighted images are negative for acute ischemia. Ventricles and cisterns maintain size and configuration. Physiologic flow voids are maintained. The paranasal sinuses are clear. A single left mastoid air cell contains fluid.
Impression:
No apparent interval change in distribution of mutifocal white matter lesions consistent with multiple sclerosis. No abnormal enhancement is identified to suggest active demyelinating process.
Next MRI on August 12,2008
~Santana~
So, now for the scoop on Dr.T, my new neuro!! Well, Dr. T came in and introduced himself and shook my hand and asked how I was!!!!!! Very nice man!!! I felt relaxed with him right away! He already had my two years worth of chart in his hand when he walked in. Quix, you were right, he asked me for my history right off the bat!!
So, I explained to him the onset ect......He asked about any possible things leading up to the onset, so I told him about the abrupt way in which my SSRI's were switched just six weeks before. He wrote down all meds involved. He basically asked a lot of questions about the time frame of the origional attack!
Then he starts going through my chart, looking at all test results so far. He talks to me about each one as he comes to it. I gave him the results of the VNG and the EMG that I had done recently! He made copies of these.
After we got through going over the test that had been done, I asked my questions, one of which was the location of the lesions, and he told me and gave me a copy of the last MRI report done. Next, he wanted to know if I had been having any new symptoms. I told him about the transient numbness/tingling in caves and forarms, the warm feeling running across my foot, because these are the ones that were not there from the origional attack.
He said how long does it last and how often does it come on. I said it only last for from 10 seconds to 5 min and only comes on occasionally!! He said, now how about any major numbness, loss of bladder/bowel or any return of the vision loss, or has it continually improved with no recurrances. I said no major dysfunction since the onset and my vision continues to improve and has never worsened even temporarily!
He said according to the evidence of all of the repeat scans showing nothing new, and your history of recent symptoms, I don't think this is MS!!! I said well, is it ADEM? He said your working dx is an immune response brought on by some kind of trigger, that is unknown, but most likely a virus. I said could the med change have caused this, or been the trigger, he said possibly but most likely a virus.
He repeated that he did not think this was MS, because with the severity of the onset that I had, he would have expected to see some activity in two years time! He said ADEM is severe at onset and is one time and heals from there, and this sounds more like my picture to him, but I want to study you a little bit longer! He ordered a new brain MRI with contrast, and also is having the VEP repeated to compare to the one done in 2006 to see if he can document the visual improvement that I am explaining!
He then said lets get you in the scanner and then we will see, and I need time to look it all over more completely!
He didn't do an exam at all, and this kind of puzzled me, but I thought maybe he may do one when the results of the MRI, and VEP come back!
I did get a copy of my last MRI report which was on 11/06/07 so this is what it said.
Exam
MRI Brain & Stem with& without contrast
Results:
Indication: Vision changes, questionable mass.
Technique: MS protocol contrast enhanced brain MRI utilizing Omniscan Interavenous contrast.
Reference exam: 11/14/06 and 5/31/07.
Findings:
Numerous white matter lesions demonstrating high T2/FLAIR signal intensity are again demonstrated, including anormal hyperintensity within the posterior body and splenium of the corpus and within the periventricular white matter of the bilateral frontal and parietal lobes. Large confluent regions of increased T2 signal intensity surround the periatrial regions of the lateral ventricles bilaterlaly, right greater than left, similar to the prior examination. The distribution of the white matter lesions has not significantly changed compared to prior studies. Post contrast images show no abnormal enhancement.
Diffusion weighted images are negative for acute ischemia. Ventricles and cisterns maintain size and configuration. Physiologic flow voids are maintained. The paranasal sinuses are clear. A single left mastoid air cell contains fluid.
Impression:
No apparent interval change in distribution of mutifocal white matter lesions consistent with multiple sclerosis. No abnormal enhancement is identified to suggest active demyelinating process.
Next MRI on August 12,2008
~Santana~
The only thing I have ever heard or seen on my MRI reports say T2, but I will ask when I go back for this new scan on August 12th.
~Santana~
~Santana~
Hey -
T2 is not the strength of the machine, I believe it's related to the weighted imaging, the sequences. Various sequences will show different things in a different manner. And it's pretty technical what occurs in order for these images to even appear. That is why sometimes the report will mention something like, ". . .best appreciated or seen on FLAIR" etc.
What type machine does your old report reference? It's probably a 1.5
We should re-read Quix's write up on MRIs in the Health Pages before we go guessing...lol.... Should be right at the top of the list on the HPs.
ttys,
Shelly
ttys,
Shelly
T2 is not the strength of the machine, I believe it's related to the weighted imaging, the sequences. Various sequences will show different things in a different manner. And it's pretty technical what occurs in order for these images to even appear. That is why sometimes the report will mention something like, ". . .best appreciated or seen on FLAIR" etc.
What type machine does your old report reference? It's probably a 1.5
We should re-read Quix's write up on MRIs in the Health Pages before we go guessing...lol.... Should be right at the top of the list on the HPs.
ttys,
Shelly
ttys,
Shelly
So T2 is strong enough? I guess it is because it showed the 10 lesions, Right???
~Santana~
~Santana~
FLAIR would be the sequences. Machine should be a minimum of a 1.5 Tesla. They are still saying the 3T is not approved by the FDA, but who really cares, I say.
If he is looking into MS, then these sequences should be run by the techs at the facility.
He'd better do an exam on you next time, durrnit!
-Shelly
If he is looking into MS, then these sequences should be run by the techs at the facility.
He'd better do an exam on you next time, durrnit!
-Shelly
Ray,
I have been to Vanderbilt but only to a neuro-opthomologist! It was about a four hour drive from Knoxville, and add another 30 min from Sevierville to Knoxville! Your neuro is in Knoxville too isn't she?
I wasn't impressed with the neuro- optho there, but I am not familar with the neuro's there! Vanderbilt has a very good reputation here in Tennessee!!!! I wish you luck in your up coming trip there!! Let me know what they do and how it goes with this, OK?
Hugs,
~Santana~
Shelly,
I thought it was a pretty good visit over all. He seemed to be a straight shooter and I felt he was confident in what he does. He said that he needs more time to study it some, and let's get you in the scanner and then we will see!! This gave me the impression that He was just getting the information from me to familar himself with my case and was really waiting for the new MRI results to decide which way to proceed!! This will be my fifth MRI since this all started in April 2006. None of the previous repeat scans showed any change. No new lesions, No enhancement! I am assuming this fifth MRI will be done on T2 FLAIR just like the rest have been done on. Is this strong enough? He also ordered it with contrast!! I will ask about the exam if he does not do one next time!!
Hugs,
~Santana~
kristin,
I was kind of worried about the no exam thing too, but I will ask if he doesn't do one next time. The first VEP done in Sept. 2006 was possitive for slowing. I have seen improvement in the blind quadrant and in my overall vision since this test and he wants to repeat the VEP now to see if the new VEP reflects this change that I am seeing!
I did have an LP a year and a half ago and it was negative and showed no O banding. I have also had a VNG and EMG, both were negative. I have not had a SEP yet nor has anyone suggested one yet! I had the Sjogren's antibodies test, and both of them were negative and the ANA was negative also. I think the next thing that needs to be done is the lip biopsy for Sjogren's!
Hugs,
~Santana~
I have been to Vanderbilt but only to a neuro-opthomologist! It was about a four hour drive from Knoxville, and add another 30 min from Sevierville to Knoxville! Your neuro is in Knoxville too isn't she?
I wasn't impressed with the neuro- optho there, but I am not familar with the neuro's there! Vanderbilt has a very good reputation here in Tennessee!!!! I wish you luck in your up coming trip there!! Let me know what they do and how it goes with this, OK?
Hugs,
~Santana~
Shelly,
I thought it was a pretty good visit over all. He seemed to be a straight shooter and I felt he was confident in what he does. He said that he needs more time to study it some, and let's get you in the scanner and then we will see!! This gave me the impression that He was just getting the information from me to familar himself with my case and was really waiting for the new MRI results to decide which way to proceed!! This will be my fifth MRI since this all started in April 2006. None of the previous repeat scans showed any change. No new lesions, No enhancement! I am assuming this fifth MRI will be done on T2 FLAIR just like the rest have been done on. Is this strong enough? He also ordered it with contrast!! I will ask about the exam if he does not do one next time!!
Hugs,
~Santana~
kristin,
I was kind of worried about the no exam thing too, but I will ask if he doesn't do one next time. The first VEP done in Sept. 2006 was possitive for slowing. I have seen improvement in the blind quadrant and in my overall vision since this test and he wants to repeat the VEP now to see if the new VEP reflects this change that I am seeing!
I did have an LP a year and a half ago and it was negative and showed no O banding. I have also had a VNG and EMG, both were negative. I have not had a SEP yet nor has anyone suggested one yet! I had the Sjogren's antibodies test, and both of them were negative and the ANA was negative also. I think the next thing that needs to be done is the lip biopsy for Sjogren's!
Hugs,
~Santana~
Hi there!
He does sound like he is giving you the attention you need but I am really perplexed by the no exam thing.
What were the results of your initial VEP? Have you had SEP or LP done yet?
The Sjogrens with CNS involvement might be documented as rare but we have one case here on our forum and there are only a couple hundred of us here.
If he does not start to do the exam at next visit I would ask him why he is not interested in that. My first neuro (also a MS Specialist) did not repeat my exam after first one yet he continued to document that he was on the following visit reports. It would not hurt to get a copy of his initial visit report - you can say you like to keep good records.
Good luck on the next MRI and I hope there are more clues to help you and the new neuro figure this out.
Hugs!
Kristin
He does sound like he is giving you the attention you need but I am really perplexed by the no exam thing.
What were the results of your initial VEP? Have you had SEP or LP done yet?
The Sjogrens with CNS involvement might be documented as rare but we have one case here on our forum and there are only a couple hundred of us here.
If he does not start to do the exam at next visit I would ask him why he is not interested in that. My first neuro (also a MS Specialist) did not repeat my exam after first one yet he continued to document that he was on the following visit reports. It would not hurt to get a copy of his initial visit report - you can say you like to keep good records.
Good luck on the next MRI and I hope there are more clues to help you and the new neuro figure this out.
Hugs!
Kristin
WOW!!!!!!!!!!!!!!!!!
Excellent appt. descript! Great guy! I wish he would of examined you though. I'm surprised, but maybe it's a good tactic! He got the history, made notes, has and knows about the reports and labs. THEN I bet you get one heck of an exam on your next visit!
He'll have more thoughts, he'll have put more together by then.
This is awesome news.
So glad you are getting new MRIs too. Anyway to find out what type of machine?
-Shelly
Excellent appt. descript! Great guy! I wish he would of examined you though. I'm surprised, but maybe it's a good tactic! He got the history, made notes, has and knows about the reports and labs. THEN I bet you get one heck of an exam on your next visit!
He'll have more thoughts, he'll have put more together by then.
This is awesome news.
So glad you are getting new MRIs too. Anyway to find out what type of machine?
-Shelly
AWWWWWWWWWWWW
I'm soooooooooooo glad for you that your New Doctor seems to really care and it seems to me he wants to get down to the bottom of all this and give you the answers you deserve!!!!!
Please know i'm thinking of you and that you are in my Prayers.
Seems like we have somewhat of the same things going on at this time.
my last MRI showed "several cortical lesions"
went from 3 subcortical lesions to several,,,, and now mine is sending me to Vanderbilt?????? Go figure???????
Love and HUGS
Ray
I'm soooooooooooo glad for you that your New Doctor seems to really care and it seems to me he wants to get down to the bottom of all this and give you the answers you deserve!!!!!
Please know i'm thinking of you and that you are in my Prayers.
Seems like we have somewhat of the same things going on at this time.
my last MRI showed "several cortical lesions"
went from 3 subcortical lesions to several,,,, and now mine is sending me to Vanderbilt?????? Go figure???????
Love and HUGS
Ray
This being my first visit and so much prior test results to sort through, might be the reason he didn't do an exam this time! He kind of gave the impression that he wanted to get me in the scanner and then we will know which way to proceed!
I have had four MRI's in all:
First one- 9/26/06 without contrast, showed about 10 lesions
Second one- 11/14/06 with and without contrast, showed no change
Third one- 5/31/07 Included C- spine and brain stem, showed no change in brain lesions and no lesions in C- spine or brain stem.
Fourth one- 11/6/07 Showed no change
The next one is on 7/12/08
I am suposed to call for an appointment after the MRI on 7/12/08 is done!!
~Santana~
I have had four MRI's in all:
First one- 9/26/06 without contrast, showed about 10 lesions
Second one- 11/14/06 with and without contrast, showed no change
Third one- 5/31/07 Included C- spine and brain stem, showed no change in brain lesions and no lesions in C- spine or brain stem.
Fourth one- 11/6/07 Showed no change
The next one is on 7/12/08
I am suposed to call for an appointment after the MRI on 7/12/08 is done!!
~Santana~
well, I'm glad your appt went alright.... I'm not sure if I would feel better or not about it though..
he sounds like he wants to find out what is wrong with you and I hope he does just that.
don't know why he didn't exam you? maybe next visit? When was your last MRI done? I wonder if there will be changes with this one?
do you have a date to go back to see this Dr?
take care and keep us updated OK..
andie
he sounds like he wants to find out what is wrong with you and I hope he does just that.
don't know why he didn't exam you? maybe next visit? When was your last MRI done? I wonder if there will be changes with this one?
do you have a date to go back to see this Dr?
take care and keep us updated OK..
andie
We went over so much information to get on the same page that I didn't even realize that he didn't do an exam! When I go back in about three weeks I will ask him about an exam if he doesn't do one this time! I think it actually takes a few times with any new doctor to really see if they are going to do the right things! But over all I think he seemed to be very confident in his opinion, I guess time will tell!!
Hugs,
~Santana~
Hugs,
~Santana~
Yay!! While it may have not been exactly what you were expecting, it does sound like he was VERY thorough, even if you didn't have a exam-Wonder why?
Awesome, I'm so happy for ya' that you found a doc. who will listen and actively work on your case! As Wanna said, we are here for you always!
~Sunnytody~
Awesome, I'm so happy for ya' that you found a doc. who will listen and actively work on your case! As Wanna said, we are here for you always!
~Sunnytody~
Thanks you guys for the support! This guy is heading up the MS clinic at this hospital, and I could tell that he was a little more sure of his self when it comes to MS than my other neuro. He didn't seem hesitant to state his first impresion of my case!!
Now don't get me wrong, he did not promise or say for sure that it wasn't MS, he didn't say anything until he was done looking at the tests and my history in the chart and then when I explained the new symptoms and he found out the nature of them, that is when he immediately burst out his oppionion! I don't think this is MS! But he did say at the end that lets just wait and see the MRI results this time!
I asked him about CNS Sjogren's too and told him of the severety of my dry eyes condition and also that I have dry mouth and a dry non productive cough. He said, well, what has the Rheumatologist tested for with that. I told him about the antibodies that she tested me for and that they were negative, but that I still needed to have the lip biopsy done! He said good. I said Sjogren's can have CNS involvement can't it? He said yes, but it is rarer than hair on a dogs belly, but we will see when all the results are in on that!
Hey, You all that might have Mercury dental fillings, like I do, Yes I asked about this too! He said don't have your fillings removed, because that is bull****. That is not crediable! Just thought someone else might be wondering about that too!
I feel pretty good about staying with him at this point, but I will have to see him a few more times to know for sure what he is going to do!
I am a little worried about the new MRI, but I realize that it is what it is, and at this point I just need to know what I am dealing with!
Thanks for being such good friends to me!!
~Santana~
Now don't get me wrong, he did not promise or say for sure that it wasn't MS, he didn't say anything until he was done looking at the tests and my history in the chart and then when I explained the new symptoms and he found out the nature of them, that is when he immediately burst out his oppionion! I don't think this is MS! But he did say at the end that lets just wait and see the MRI results this time!
I asked him about CNS Sjogren's too and told him of the severety of my dry eyes condition and also that I have dry mouth and a dry non productive cough. He said, well, what has the Rheumatologist tested for with that. I told him about the antibodies that she tested me for and that they were negative, but that I still needed to have the lip biopsy done! He said good. I said Sjogren's can have CNS involvement can't it? He said yes, but it is rarer than hair on a dogs belly, but we will see when all the results are in on that!
Hey, You all that might have Mercury dental fillings, like I do, Yes I asked about this too! He said don't have your fillings removed, because that is bull****. That is not crediable! Just thought someone else might be wondering about that too!
I feel pretty good about staying with him at this point, but I will have to see him a few more times to know for sure what he is going to do!
I am a little worried about the new MRI, but I realize that it is what it is, and at this point I just need to know what I am dealing with!
Thanks for being such good friends to me!!
~Santana~
SOOOO happy this guy seems to be really listening and has helped you understand some of this. Sounds like he is going to be your ticket outta Limboland!
You sound upbeat as well, and that means you have hope, and you needed a boost in your hope factor. I am also glad you do not have along wait for the MRI. Hold on to your friends and family until then. We are all here for you.
(((HUGS)))
Wanna:o)
You sound upbeat as well, and that means you have hope, and you needed a boost in your hope factor. I am also glad you do not have along wait for the MRI. Hold on to your friends and family until then. We are all here for you.
(((HUGS)))
Wanna:o)
Whoa....sounds like he is interested in your case and is going to look into things further for you which sounds very promising! I am very happy for you my dear and will be waiting impatiently to hear the results from the MRI on August 12th!
Congrats honey....seems like a neuro visit worth waiting for and that is a rare thing in this land of limbo isn't it?!
Lots of Hugs,
Rena
Congrats honey....seems like a neuro visit worth waiting for and that is a rare thing in this land of limbo isn't it?!
Lots of Hugs,
Rena
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