MRI - Second Set?

[sllowe]

Hi All,

Wondering if anyone had an idea why a second order of MRI's would exclude the Thoracic when you are already dx'd?  I haven't had any since my initial ones last year.  

I've received a script from my Dr for Brain and C-Spine w/and w/out contrast, but was wondering why the T-spine wasn't ordered.  I have some really weird sensations in that area, right smack in the middle of my spine, and have had this for the past few months.  So, of couse I'd prefer that area to be looked at too.

Any thoughts on why?  You think I should call the Office and ask?

Any input will be greatly appreciated,
Thanks,
-SL

[sllowe]

Hey All!

Thank you so very much!
I make a short list and call my office tomorrow! I feel better now, knowing what to say, and I can't thank you enough.

db - I can't remember how discussing the MRI's all transpired.  I think I mentioned it, and he said if I wait a month that the office had a new machine at a different office and could get set up there.  He said they would be doing "some neat new thing" w/the machine.  I asked if it was the T3, and he said no.  I don't know what types of imaging they will be doing, but I hope it's something new, and also that they compare my old ones with it since it's been since last year.

So, if I've got this right, I will be practical, mention my back issues, the spasms, and the jimmy legs probs, and I think it will work!

Thank you, thank you, thank you!
-SL

[doublevision1]

Hi SL!

Can you tell us what the purpose of this second MRI is?  I understand that typically, follow up MRI's (after clear MS diagnosis) are not necessarily ordered, unless there is unexpected disease progression, or as a baseline to determine disease burden prior to starting DMD.  Do either of these scenarios apply to you?  Or is there another reason for the 2nd MRI?

When my GP ordered my follow up MRI (I had one in March and I'm going back in mid-May b/c of something suspicious in c-spine), she asked for brain and c-spine.  I said why not T-spine?  She said it's often not involved in MS (what???).  I reminded her that in my neuro's first report, he said that my last flare was partly thoracic based on my symptoms (MS hug).  I also advised my GP that my T-spine has yet to be imaged, and that I would like to know what might be happening there based on my symptoms.  She said OK, no prob, and included it in the requisition.   So I am glad I spoke up.

BTW, my GP ordered the MRI at my request as a pre-treatment baseline.  From talking to my neuro afterwards, he is inclined not to order follow up MRIs very often.  (this is when he made his "I treat patients, not MRI's" comment, just like Ess's neuro).  But it sounds like he is willing to do so, at patient request.  Since he is now describing my disease as 'very active,' and I'm having the problems with Rebif, I'm glad I'm having another MRI soon.  

I would go with Jen's suggestions re: bringing up any symptoms you are having or had, that may be T-spine related.  I would push for it and say it would give you peace of mind to know the test was totally thorough, rather than be left wondering.  Having your T-spine imaged can't hurt, and certainly may help, in terms of monitoring your progression down the road.

Having said all of that, I read recently that the spine is much more difficult to image than the brain, so neuro's don't necessarily put too much stock in them, after a MS diagnosis has been confirmed.  Has anyone else heard this?

Is insurance an issue?  ie: would your insurance company be reluctant to cover this part of the test?  Does your doctor have to somehow prove it is critical that you have it done? I'm not sure how it works in the US.  In Canada, MRI is covered by provincial health insurance, and I don't mind pushing for it if ever I need to.  I figure I pay my taxes and I am entitled to the service.  So far I haven't had a problem, but I have learned that I do need to be proactive and know what to ask for and why.  The docs won't necessarily think of everything, and SHOULD be open to their patients being proactive in managing their own health.  I understand that this is exactly what you are wanting to do too.  I hope your doc is supportive of that.

db

[jensequitur]

Hmm... Symptoms?  MS hug?  (Chest pains, especially around the sternum and reaching back to the spine)  Are you having any lower leg problems?  Leg weakness, proprioperception problems, spasticity?  How about your knee-jerk reflex?  And... drum roll... bladder problems?  

All of those are signs of a potential lesion in the spinal cord.  If you've already been diagnosed, then the doctor is checking for progression.  

[sllowe]

If you's can, beef me up with some good info (why you think the T spine should be ordered as well) before I call the Dr back next week and ask for it. . ..

thanks,
SL

[CtResident]

Hm, in Practical Mode here. (Aw, who am I kidding, I have a big P on my cape for Practicality!)

In terms of Time and Efficiency and Money, isn't it better for them to do it all at once, to get a complete picture?

No harm in asking, really. This MS stuff is very serious. You have a right to ask questions, to communicate with your dr. If he is going to get all annoyed at you, that's an awkward predicament for you to be in. I hope he treats you with respect and will listen to your input, as your input is valuable too!

Suzanne

[sllowe]

Hi there,

Well, I feel like I'm being a pain if I call.  I don't know what to do.  I guess it's because of my history w/ the dx.  I've questioned things on my visits, had to have the dx beat into my head originally, and recently declined changing to Copax at this time on my last visit, etc.  Maybe he won't remember ...LOL

I know I need to call, but want to have a strong argument prior to the call.  Incase the Dr ends up saying that it's not necessary or something like that.  Just anticipating it and wanting to be prepared and have my response ready.

I don't have a date yet.  Just the script in the mail.  My Dr's office just got a new machine, and I'm waiting for them to call me for the appt date and time.  It's only a 1.5, and I wish it were the stronger one.  My original was on the 1.5, so I shouldn't be fretting about it, but I am.

So, send any and all ammo my way - k?
thanks,
-SL

[CtResident]

Can you expand upon your statement that your dr. didn't find everything? What did he omit and what should it have shown?

I had a t-spine ordered with and without contrast, whereupon the techs decided (according to the protocol the supervisor sets up, they told  me) that I did NOT need contrast.

Thanks,
Suzanne

[cjacks]

SL

Definitely call and find out why ..  Also tell them your concerns .

My first neuro only did brain and c-spine, saying,  " I'll find out everything I need to know with them".  No  need for t-spine ..  Well he didn't find out everything .

I can't figure these guys out .  It does seem strange that being dx.d he wouldn't want to get the full picture of want your system is up to ???  

Good luck with all of this .  When is the MRI ordered for ?

Jo

[CtResident]

The curiosity is known to drive an adult insane.

Call! Ask!

Suzanne