Biowham - looking for diagnosis

[CtResident]

Hi, I saw your wonderfully helpful post to Mr. Wiggles and I didn't want to hijack his information by butting in with my own stuff.

In that thread, you suggested a list of things a good MS neuro would do on the diagnostic tests. So here is where I ask for your input:

I went to an MS specialist this week. He did some of the neuro tests in your list, but did NOT do pinprick or brush testing. I don't think he did vibrational testing (is that with the tuning fork thing?) He also didn't do the foot down the shin thing which my pcp had done (sorry to sound so amateurish in use of the terminology).

However, he did order brain and cervical MRI, with and without contrast (done the same day as my first appt. with him).

Next week I will have an EEG, and he ordered VEP and BAER.

Although some things were left out (T-spine?), he seems to be okay - - I am just scared that the one thing he leaves out will be the clincher to diagnosing me!

Is it terrible to leave out the T-spine, is that going to be the one stone left unturned and have me walk away from a diagnosis? As you can tell, I'm starting to fret. But is it needless fretting, or valid fretting?

The parting words he had were that I don't seem to have MS on the face of it, so that should give me peace of mind.

Um. No. It doesn't. Why do I feel depressed as he gave me such words of _ahem_ comfort?

Thanks,
Suzanne

[biowham]

So, with my cross-eyed vision, I completely misread your sentence about the vibrational testing, reading it to say that he DID do it. I think he should have done that. Again, I'm not an MD, but loss of vibrational sensation can be significant. I forgot to mention also positional testing; i.e., he lightly grabs your big toe between the thumb and index finger and very slightly alters its position up or down. Most people will feel the slightest change and know whether it was up or down. I, on the other hand, thought she had grabbed my second toe instead of my big toe; she hadn't, I just couldn't feel her thumb.

The test your PCP did was the Romberg's. If you can't even stand with feet together and hands stretched out flat and together with your eyes OPEN, that's a cerebellar problem. If you sway in this position with your eyes closed or fall, that's a "positive Romberg's" (some purists would say you HAVE to fall for a positive, but my neuro says swaying is enough). That's a sign of proprioceptive (your position in space) or vestibular (ear) problems. I sway, but don't know I'm swaying. I feel like I'm standing completely still. It's very weird.

The lying down is so that you're less subject to the downward pull of gravity. Some docs even have their patients do it sitting in a chair. I'd fall over if I did it standing up.

E

[CtResident]

Thank you so much for the detailed reply!

No, Dr. S did not use the tuning forks, they stayed over there on the counter.

I had my son (age 15, reasonably reliable, LOL) watch me do the shin-knee test. We think I did fine. Interesting that you said to lie down, as my pcp had me standing up! The pcp also had me do a test where I stood with my feet together and close my eyes; I started to wobble and he said don't worry, he'd catch me. My eyes had popped open, so I don't know how long I was supposed to do this. At any rate, the new dr. (MS spec) didn't have me do that one.

I was just hoping to get an MS specialist that would have me do every single thorough test and the pcp did one batch o' things, whereupon Dr. C did another batch. Kind of confusing.

And yes, your point is valid, I do have to have patience. Nothing much else to do but see it through one day at a time. :-)

Thanks again!
Suzanne

[biowham]

I think that the vibration testing is very important, so it's good that he did that. That is the tuning fork thing. How did you do on that? I know that I have lost my sense of vibration in my feet, more so on the right.

If I were an MD (I'm not), I'd get the whole thing done in one fell swoop: T-spine, C-spine, and brain. It's just efficient. That said, given a choice of two, I'd go for C-spine and brain. So that's OK, in my book. The other tests he ordered are right on, getting the data he needs to make a determination. If your MRI for brain and C-spine come back with nothing informative, ask for the T-spine. He's got it with and w/o contrast, and that's great, too.

You can test yourself on the heel-shin test. Just lie down flat on your back (eliminates effects of gravity). Put the heel of the opposite foot on your knee cap and slide it down your shin to the ankle. Now slide it back. Do this on the other side. DON'T READ FURTHER UNTIL YOU'VE DONE THIS TO AVOID BIASING YOUR RESULTS....

I know that many people on here have had a hard time with docs...it's probably a self-selected audience for that because when you don't get answers from your physician, you turn to places like this. But in general, the neuros are probably doing what yours is, ordering the appropriate tests. Otherwise, there'd be about 3000 people posting on this board. It's a pain to wait on these things, but...you have to.


OK....Now for the heel-shin test info:
Then, ask yourself these questions. Did your heel land where you thought when you tried to place it on your bent kneecap? Or did it over- or undershoot either up or down or laterally (sideways)? When you slid your heel down your shin, did it stay on the shin up and down, or wobble around, sliding off the mark?

For the over- or undershooting, that's a manifestation of dysmetria. You don't know where that side is in space--your proprioception is off. Whether or not you slide off track is a function of cerebellar issues, I believe (ataxia). For myself, I exhibit dysmetria when I try to place my left heel on my right knee, overshooting to mid-thigh. This fits with my other neuro exam results. I don't think my body knows where my lower right leg is in space.

Hope this is helpful in some way. Mostly, it sounds like patience is in order until all the test results can come in. The only thing that would slightly concern me is the ready conclusion he's made that it's not MS. Not because I want it to be or you want it to be, but because he doesn't have much in the way of data AT ALL to make that determination.

E

[CtResident]

bumping this; doesn't have to be specifically answered by biowham, just was a note in response to what biowham posted on another thread

Thanks,
Suzanne