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first day of Physical Therapy
Craig had his first day of PT today. His therapist is actually a physiatrist who owns the PT center. He said that Craig only has about 20 percent of his leg function remaining, and he will be unable to walk soon if he and "Craig's wife" don't intervene and do something about it.
Craig explained that he has gone to several neurologists and has no diagnosis yet. So the physiatrist did an assessment and said that the backs of Craig's legs have alot of spasticity. He said that the reason he cannot run, jump, etc is because as the front of his legs lift, the back of his legs hold back the leg with all the spasticity.
The doc said that something is misfiring in the subcortical area of the brain making the constant spasticity. He asked Craig if the report of the brain MRI said "lesions" or "plaques". It said T2 hyperintense lesions, but of course Craig blanked out when the question was asked. He will bring the report with him next time.
Can someone tell me the difference between them and plaques??
One disappointment is that the center re-checked the insurance (Blue Cross) and Craig is only allowed 12 visits. Then the doctor has to come up with another diagnosis.
The physiatrist at the PT center said he no longer diagnoses patients. But he said it is definitely neurological.
At least when Craig left the center, his legs felt great. The muscles in the back of his legs were all stretched.
Elaine
Craig explained that he has gone to several neurologists and has no diagnosis yet. So the physiatrist did an assessment and said that the backs of Craig's legs have alot of spasticity. He said that the reason he cannot run, jump, etc is because as the front of his legs lift, the back of his legs hold back the leg with all the spasticity.
The doc said that something is misfiring in the subcortical area of the brain making the constant spasticity. He asked Craig if the report of the brain MRI said "lesions" or "plaques". It said T2 hyperintense lesions, but of course Craig blanked out when the question was asked. He will bring the report with him next time.
Can someone tell me the difference between them and plaques??
One disappointment is that the center re-checked the insurance (Blue Cross) and Craig is only allowed 12 visits. Then the doctor has to come up with another diagnosis.
The physiatrist at the PT center said he no longer diagnoses patients. But he said it is definitely neurological.
At least when Craig left the center, his legs felt great. The muscles in the back of his legs were all stretched.
Elaine
You sound so down, not like yourself at all. This has got to be so very frustrating for all of you. You've got to be getting closer, though. At least Morrow is actually using the term 'MS.' At least he is not like the fools at the NIH!
And the physiatrists are on the ball. Craig is on his way. You need to get out and smell the flowers. If we had any!
Take care of yourself.
Love,
Zilla*
And the physiatrists are on the ball. Craig is on his way. You need to get out and smell the flowers. If we had any!
Take care of yourself.
Love,
Zilla*
Hi ladies. Quix said that plaques are usually 4mm or greater and have a classic shape, seen only in MS. They are usually ovoid in shape and sit perpendicular to the ventricles.
Craig has 20 hyperintense lesions, only four are greater than 3mm. He also has whole brain atrophy. He has one hyperintense lesion that is in the left parietal region and sits perpendicular to the ventricles.
I think the physiatrist at the center was really trying to figure out what Craig has. Craig is going to take the MRI report next time. He kept saying that spasticity as severe as Craig's is not seen in early MS, so he was trying to figure out another disease it could be. But then again, he said the spasticity was from misfiring in the subcortical region, where most of Craig's hyperintense lesions are.
Even the physiatrist who has his own practice and who ordered the PT (there are two physiatrists in the loop now) said it looks like a neuropathy, he has had four normal EMG's in the last year, and that he would almost have no other option but to call it MS, though Craig's legs don't look like classic MS.
Then again, Morrow used the words "atypical MS' so I guess Craig is just a strange case.
Craig is in alot of pain today with back spasms. I think the therapy used muscles that did not want to move. His pain is paraspinal muscle spasms.
Thanks for your help.
Elaine
Craig has 20 hyperintense lesions, only four are greater than 3mm. He also has whole brain atrophy. He has one hyperintense lesion that is in the left parietal region and sits perpendicular to the ventricles.
I think the physiatrist at the center was really trying to figure out what Craig has. Craig is going to take the MRI report next time. He kept saying that spasticity as severe as Craig's is not seen in early MS, so he was trying to figure out another disease it could be. But then again, he said the spasticity was from misfiring in the subcortical region, where most of Craig's hyperintense lesions are.
Even the physiatrist who has his own practice and who ordered the PT (there are two physiatrists in the loop now) said it looks like a neuropathy, he has had four normal EMG's in the last year, and that he would almost have no other option but to call it MS, though Craig's legs don't look like classic MS.
Then again, Morrow used the words "atypical MS' so I guess Craig is just a strange case.
Craig is in alot of pain today with back spasms. I think the therapy used muscles that did not want to move. His pain is paraspinal muscle spasms.
Thanks for your help.
Elaine
Can this be concluded from Quix's write-up?
All plaques are lesions, but not all lesions are plaques.
ess
All plaques are lesions, but not all lesions are plaques.
ess
This is what Quix says about plaques and lesions in her write-up:
f the nerves do not re-myelinate and the damage continues, for a long time the lesions sit as scars. These scarred areas contain damaged and dying cells, their blood supply shrinks, and they become dense--more dense than the normal brain around them. These are the classic MS "plaques" and are considered old lesions. They show up as the bright areas, also called "hyperintense," most of us have seen in pictures and on our films. If the attack on the myelin sheath is too strong for the immune system to repair, more and more myelin disappears and the area of nerves eventually dies. Then it completely scars and contracts. The blood flow is decreased to that area and the body tries to reabsorb it. The area then becomes "less dense" than the surrounding normal nerve tissue. After a longer time the scar can reabsorb completely and the area becomes "empty." It's called a black hole.
What I was wondering about is why the physiatrist would consider this distinction significant in treating Craig.
ess
f the nerves do not re-myelinate and the damage continues, for a long time the lesions sit as scars. These scarred areas contain damaged and dying cells, their blood supply shrinks, and they become dense--more dense than the normal brain around them. These are the classic MS "plaques" and are considered old lesions. They show up as the bright areas, also called "hyperintense," most of us have seen in pictures and on our films. If the attack on the myelin sheath is too strong for the immune system to repair, more and more myelin disappears and the area of nerves eventually dies. Then it completely scars and contracts. The blood flow is decreased to that area and the body tries to reabsorb it. The area then becomes "less dense" than the surrounding normal nerve tissue. After a longer time the scar can reabsorb completely and the area becomes "empty." It's called a black hole.
What I was wondering about is why the physiatrist would consider this distinction significant in treating Craig.
ess
Hi Elaine,
I just checked, and he definition of "lesions" and "plaques" IS included in the New Health Pages - It's Quix's - "How MRI's show Lesions"
Definetly describes the difference between the two you are looking for.
SL
I just checked, and he definition of "lesions" and "plaques" IS included in the New Health Pages - It's Quix's - "How MRI's show Lesions"
Definetly describes the difference between the two you are looking for.
SL
Hey, guys! I'm glad to know Craig is in capable hands (and mind!). This guy sounds sharp. The 12 visits thing is just plain dumb. We know this. But, the doc I work for will often get around by using different diagnoses. We have fun with it!
Our cancer patients will sometimes need PT after getting contracture following radiation therapy, so for a while we say "effects of radiation"; next, "pain" -- it can be as simple as that. Or, we can ask for another group of muscles to be treated (like lower arm instead of upper) and the PT will just use his good judgment.
This is not fraudulent. We use diagnoses that the patient actually has, and we are not PTs, so we can only suggest a treatment plan.....We always say "evaluate and treat."
We are not asking for full body massages for people who do not want to go to the spa for one. These are patients who do not have full range of motion because of cancer treatment. Or they're in pain. Not fraud. We're working within the system. You can, too!
As to the lesion/plaque question--I do know that 'lesion' seems to be a catch-all phrase for 'abnormality.' In other words, the scarring left by demyelination, or the atrophy Craig has would both be considered 'lesions,' as I understand it. It is a very general term. A plaque, I am not sure of, but I think it could be either vascular, like in TIAs, or perhaps it could represent scarring like in demyelination. Not sure. That's probably what the doc wants to know...exactly what kind of problem does Craig have? Don't we all?
Hope you and your family are all doing well and looking forward to the spring blossoms. Keep us updated. Be well,
Zilla*
Our cancer patients will sometimes need PT after getting contracture following radiation therapy, so for a while we say "effects of radiation"; next, "pain" -- it can be as simple as that. Or, we can ask for another group of muscles to be treated (like lower arm instead of upper) and the PT will just use his good judgment.
This is not fraudulent. We use diagnoses that the patient actually has, and we are not PTs, so we can only suggest a treatment plan.....We always say "evaluate and treat."
We are not asking for full body massages for people who do not want to go to the spa for one. These are patients who do not have full range of motion because of cancer treatment. Or they're in pain. Not fraud. We're working within the system. You can, too!
As to the lesion/plaque question--I do know that 'lesion' seems to be a catch-all phrase for 'abnormality.' In other words, the scarring left by demyelination, or the atrophy Craig has would both be considered 'lesions,' as I understand it. It is a very general term. A plaque, I am not sure of, but I think it could be either vascular, like in TIAs, or perhaps it could represent scarring like in demyelination. Not sure. That's probably what the doc wants to know...exactly what kind of problem does Craig have? Don't we all?
Hope you and your family are all doing well and looking forward to the spring blossoms. Keep us updated. Be well,
Zilla*
Hi Elaine,
This is good news. Yes, these Drs can get past the insurance, but it's important for Craig, that they hit them head on, up front, and early.
The eval of Craig (letter) should be sent in to the insurance Co. right away, or at least maintained on file until the 12 visits are up. The progress should be updated as well. This way, there is a clear history of what is going on.
After his 12th visit, they will have some Ins. Dr write up something that "claims" why Craig should not continue and doesn't need the PT any longer. This you know will be "bunk" and nothing but protocol, and totally arguable.
I'm glad this PT Dr is on the ball. I tried to look up the difference between plaques and lesions early last year. I cannot recall the end result of my search. I'm sure Doc Q can educate us on this matter. I will read throught the lesions thread as well to see if she already covered it in the past.
Even though it's hard to hear of the %'s of what he has left, I'm glad for you both that someone has identified it, and will work to keep what he has left. They may be able to restore some additional as well.
Well wishes to Craig, and peace and stamina to you,
SL
This is good news. Yes, these Drs can get past the insurance, but it's important for Craig, that they hit them head on, up front, and early.
The eval of Craig (letter) should be sent in to the insurance Co. right away, or at least maintained on file until the 12 visits are up. The progress should be updated as well. This way, there is a clear history of what is going on.
After his 12th visit, they will have some Ins. Dr write up something that "claims" why Craig should not continue and doesn't need the PT any longer. This you know will be "bunk" and nothing but protocol, and totally arguable.
I'm glad this PT Dr is on the ball. I tried to look up the difference between plaques and lesions early last year. I cannot recall the end result of my search. I'm sure Doc Q can educate us on this matter. I will read throught the lesions thread as well to see if she already covered it in the past.
Even though it's hard to hear of the %'s of what he has left, I'm glad for you both that someone has identified it, and will work to keep what he has left. They may be able to restore some additional as well.
Well wishes to Craig, and peace and stamina to you,
SL
Hi Carol, Thanks for your prayers. Craig will work very hard to get his legs stronger. He gets the same feelings in his feet as you...feels like walking on cut glass or tacks..same words you used. I am optimistic that if it helped you, it will help him.
Sally, Craig went to Dr. M last month and will be returning in April. Thanks for your note.
Elaine
Sally, Craig went to Dr. M last month and will be returning in April. Thanks for your note.
Elaine
Hi Elaine and Craig,
I'm so glad that he is in PT. It helped me so much. Since I'm just now coming out of this latest flare I'm thinking about asking my doctor if another round of PT would help me get back on my feet a little faster.
I'm working out at home and doing all the exercises I did at therapy but I would like to have the benefit of a couple of machines I used while in PT. I'm coming along pretty well right now. I can't walk for very long at a time but at least I'm up and going again.
I just know that Craig will see a huge improvement with PT. The majority of my problems are in my legs like his is but my therapist always started me out by having me lay on my stomach while he worked on my lower back. He would push a lot and it did hurt some but he said that by stretching out my lower back muscles it would help with my legs. He was right. I'm hoping that they will do that with Craig.
You both know that I'm praying for you every day and I also pray that Craig will get a diagnosis very soon. I know how frustrating it is not knowing. Please Craig, work hard, it will pay off.
I'll be praying,
Carol
I'm so glad that he is in PT. It helped me so much. Since I'm just now coming out of this latest flare I'm thinking about asking my doctor if another round of PT would help me get back on my feet a little faster.
I'm working out at home and doing all the exercises I did at therapy but I would like to have the benefit of a couple of machines I used while in PT. I'm coming along pretty well right now. I can't walk for very long at a time but at least I'm up and going again.
I just know that Craig will see a huge improvement with PT. The majority of my problems are in my legs like his is but my therapist always started me out by having me lay on my stomach while he worked on my lower back. He would push a lot and it did hurt some but he said that by stretching out my lower back muscles it would help with my legs. He was right. I'm hoping that they will do that with Craig.
You both know that I'm praying for you every day and I also pray that Craig will get a diagnosis very soon. I know how frustrating it is not knowing. Please Craig, work hard, it will pay off.
I'll be praying,
Carol
Great news that the PT really helped. usually doctors can find ways to get around insurance. If it is really limited or in any case, they can teach you both techniques that can be used to reduce the spasticity and make Craig more comfortable and mobile.
Craig was going to see Quix's Doctor? When is that?
Best wishes to you both.
Sally
Craig was going to see Quix's Doctor? When is that?
Best wishes to you both.
Sally
ess: The PT was ordered by a physiatrist in DE that I had Craig go to for an appt. He sent him to a (different) physiatrist owned PT center. I think the physiatrist that ordered the PT will hopefully know how to get around the insurance and write different versions of the diagnosis. Right now it is parapesis.
I have to try and find out the difference in plaques vs lesions. The PT person said it can influence the diagnosis.
The PT center physiatrist said he is optimistic he can get some leg function back by lessening the spasticity, but ultimately he will need treatment for whatever neurological disease he has. But when he said that something is misfiring in the subcortical area of the brain to cause this problem, what else besides MS could it be??
Ada: thanks for your support. I don't like insurance companies either. Sounds like your doctor has learned how to get around them!!
Elaine
I have to try and find out the difference in plaques vs lesions. The PT person said it can influence the diagnosis.
The PT center physiatrist said he is optimistic he can get some leg function back by lessening the spasticity, but ultimately he will need treatment for whatever neurological disease he has. But when he said that something is misfiring in the subcortical area of the brain to cause this problem, what else besides MS could it be??
Ada: thanks for your support. I don't like insurance companies either. Sounds like your doctor has learned how to get around them!!
Elaine
This sounds like a good news-bad news situation for sure. At least you have a sound medical explanation for Craig's walking difficulty, the mechanical part anyway. How often will he see the physiatrist? Is there a way that this doc can refer Craig to someone he knows and trusts? And how specific does a diagnosis have to be? Does it have to say MS, or can it be something that has a more general definition, like a percentage debility of some sort? Even that 20% figure is something tangible that you could work with to try and surmount the insurance hurdles. I know Dr. M. is Craig's doctor, but I'm being pragmatic here in view of the circumstances.
Could you find out what language the insurer needs to see so their criteria are met? Lots of doctors will 'play this game' to help their patients if it's just a matter of semantics.
Finally, did you get an idea of why lesions vs. plaques might be important? I sure am full of questions, I know, but I'm just trying to brainstorm here to see if there's a way around this immediate difficulty until the obvious MS diagnosis ultimately gets made.
Keep your chin up, Elaine. We're pulling for you and Craig.
ess
Could you find out what language the insurer needs to see so their criteria are met? Lots of doctors will 'play this game' to help their patients if it's just a matter of semantics.
Finally, did you get an idea of why lesions vs. plaques might be important? I sure am full of questions, I know, but I'm just trying to brainstorm here to see if there's a way around this immediate difficulty until the obvious MS diagnosis ultimately gets made.
Keep your chin up, Elaine. We're pulling for you and Craig.
ess
I am so glad to hear Craig is in PT, I wish insurance companies would understand that it takes some people longer in PT, I have my dr change the dx's to like low back syndrome, one time he said something like dorsal strain or something like that. Im glad to hear a physiatrist is working with him, that's great. I am so sick of insurance companies..... I really hope things will get better for the two of you......
Sending All my Love
Ada
Sending All my Love
Ada
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