need some advice

[Udaysk]

I am a 25y old male, Asian. I was dx'd with urinary retention about a year back and need to cath 4 times a day to empty my bladder. After about 6 months noticed sensory changes in sexual function, then two months later faced constipation. I have recently started to feel my left leg toes fan out whenever I lift up my feet + tremor in the shin/tibial muscle, can still heel walk though. Both my arms and legs are hyper reflexive 2+ symmetrically. Sometimes I get mild spasms in both my hands (simultaneously), pain behind both eyes on and off without any visual disturbances. I have no cognitive and gait problems.

I have undergone plain T1 and T2W FLAIR MRI of brain and spine at 1.5T multiple times and 3T plain sagittal screening of spine once with no detectable lesions. Had nerve conduction test done for PNS, CSF checked for various common pathogens/STD -all negative. My neurologist says that I don't show any clinical signs of MS as I don't have any upper motor problems and suggests that I undergo neuromodulation/LDDM to correct urine retention and protect kidneys.

I plan to approach a different neuro again. Would Gd contrast make a diff. at 3T for MS lesion visibility? Is it possible to have gross neurological deficts due to MS/infections without showing any lesions on MRI?

[Margaretx]

Perhaps you're not familiar with the idea that on the internet we're all dogs.  No one who uses a fake or incomplete name should be considered a "retired neurologist" or "seminarian" or "PhD candidate" or anything else for that matter.  The danger--and real physicians know this--is that an unsophisticated person reading here will rely to his detriment on advice from a somewhat knowledgeable person who is acting on very incomplete information (i.e., he hasn't examined the "patient") or a charlatan who purports to have knowledge that he really doesn't have.  IMO, any laypersons who claim to be physicians should be banned from commenting for the same reason that people who tell the judge during voir dire that they are lawyers are thrown off juries.  Laymen will assign the opinions of those people weight out of line with any provable expertise.  We've seen it again and again.

If you want evidence of Hilton's lousy advice, just compare his comment to the real neurlogist's in this thread.

And I have never figured out why some people like to write 500 words when 50 will more efficiently convey the very same thought.

[Annie62]

Margaret:  Oh, for Pete's sake. My post clearly states that it is a response to Hilton's stupid "materialistic world" post.

Me: I know your "Duh!" post was clearly a response to Hilton's "materialistic world" post.  And so was your earlier post where you said "Huh"? (which you later turned to "Duh!") regarding his "materialistic world" post.  

Margaret: Were you imagining some sort of time travel on one of our parts so that my later post could have actually inspired his original one?

Me: No, but whatever you want to write, go ahead and write it.

Margaret:  And I am amused by your implication that my use of the word "duh" so discombobulated you that you became unable to process simple English. Hope you had a fainting couch or smelling salts at the ready.

Me:  Margaret, I tried to be as clear as I could be that your words could be construed in two different ways, but you have a real knack for ignoring whatever I write which you choose not to acknowlege and try to capitalize on the rest.  I'm not sure what your agenda is or if you just like to argue.

You can believe what you want about BobbHilton.  You are free to insult his English language skills (even though I told you he posted that English was his third language) and ridicule his knowledge of neurology.  I really don't care whether you believe he is a retired neurologist or a kid on spring break or a nurse's aid for that matter.  What really bothers me most are your unkind words towards an older man--and it probably bothers me even more so because he is foreign.  I think it is pretty generous of someone (whom I believe to be a physician) who is not American and whose first language is not English to come on an American neurology forum to share his time and knowledge trying to be helpful to others.  And as far as the smelling salts and fainting couch, well there was a word that came to mind when I read that, but I can't seem to recall it now.  I won't even say what it rhymes with.  

[Annie62]

Margaret:

I wrote:  The 'materialistic world" posting on the other forum by BobbHilton clearly was a reference to exactly that-your (and perhaps others') questioning/incredulity that any doctor would choose to donate his time for free when he could be out making money. Why is that so hard for you to believe that a doctor (especially a retired one who has more free time) would choose to do this??

You wrote:  "What in the world are you talking about?  I have never, ever, ever said a word about a doctor "donating his time for free when he could be out making money." Did you read my previous post? I pointed out that that's a straw man--one that both you and Hilton keep repeating. My issue with Hilton has absolutely nothing to do with some perceived belief that doctors won't donate their time to help people (in fact, I know many docs who do just that)."

Yes, I did read your previous post and you asked why no one questioned why a doctor would want to give his time to this group instead of make money.  Your exact words were:  "My "duh" comment referred to the fact that no one here has questioned why a doctor would want to give his time to this group rather than make money.  He's set up a rather weak straw man and not bothered to adddress the true issues."  I don't know how it gets any clearer than that, Margaret.  You DID question his motive in choosing to give his time to this group instead of make money.  Perhaps you think he is bringing up the materialistic world subject as a "straw man" to divert attention from what you see as his handing out of "incorrect diagnoses/cavalier advice," but you DID question why no one on this board questioned his motives in choosing to donate his time on this board instead of make money.  

And I have to say this as well.  Your continued insistence that his interchange of the words neurology and urology (clearly he simply misspoke!) is evidence of his pulling a fast one on us (his not being a retired neurologist-who he says he is) and evidence of his lack of knowledge is quite ridiculous if not disingenous as well.  He had even made mention immediately preceding his misspeaking of cholinergic failure and a neurogenic bladder-which attests to the fact that he thinks the cause is neurologic in nature.  You do acknowledge later that he might be a PA or foreign medical student (at most).  Are you going to tell me that a PA or medical student wouldn't know the difference between a urologist and a neurologist?!  Even an LPN would know the difference!  Yet you will not admit that which is patent--that he simply misspoke.   People misspeak all the time.  *I* do it all the time--and it has nothing to do with what I do or I do not know or "bad language skills" as you mentioned.  Considering this is his third language, I'd say he speaks English pretty damn well; quite frankly, he writes better than many Americans who have English as their first language!

You wrote:  Hilton made it up and you're running with it and it's beginning to tick me off.

What did he "make up?"  He is allowed to say what he thinks-that he finds it sad that the world is such a suspicious/disillusioned place that some in it can't bring themselves to believe that a retired physician would choose to donate his time to helping others without having some ulterior motive or without being an outright fraud and not a physician at all.  I couldn't agree with him more.  

[Annie62]

I don't claim that my reading and comprehension skills of the English language are perfect, but then neither are your writing skills.  I just went back and re-read several times what you wrote, and I now see that what you said can be taken two different ways (not only the way I took it but another way-the way you apparently intended).  Ok, Margaret, I get what you meant and I'm sorry I misunderstood you, but "duh" is a word that I don't use and it passed right over me.  (I assume when you said "duh" that you meant it is a "given" that nobody questions his choosing to volunteer his time, but you actually didn't say "Duh" in your original comment but "Huh?" regarding his reference to a material world and incredulity re: a doctor volunteering his time.)   Your words below could also be seen as an "indictment"; in other words, people SHOULD be questioning why a doctor would want to give his time to this group rather than make money--and that is the way I originally took it.  

{Your words were:  My "duh" comment referred to the fact that no one here has questioned why a doctor would want to give his time to this group rather than make money.}

[Margaretx]

I now understand why you support Hilton.  Your skills at reading and understanding the English language are as poor as his.

Just for the record, I've never questioned why a doc would post here instead of trying to make money.  It's Hilton and Annie's argument and it's a stupid one.

[Annie62]

BobbHilton,

Thank you for the articles you posted above for Udaysk with regards to immune-mediated autonomic neuropathy.  I also intend to check them out, though it's possible I've read them already if they are the Mayo ones regarding experimental AAN induced in rabbits/mice injected with the antibody (the Vernino/Sandroni (sp?) ones).  I was just diagnosed with autonimmune autonomic neuropathy and have been reading everything I can find on it on the internet, but the suggestion about a medical library is a good one which I hadn't thought of, especially since many of the articles I really want to read can't be accessed unless one has subscribed to the neurology journals they're in.