I would just give my Neuro the old MRI and let him compare them. He would be better at this than the radiologist I would think.
I think what would bother me the most about your MRI report is the volume loss. I think that would be the equivalent to a black hole or atrophy in the brain indicating permanent damage. With my C-spine MRI my Neuro showed me the place where my spinal column was 50% narrower (volume loss?) indicating permanent damage which account for both of my feet and lower legs being numb constantly.
Dennis
Thanks for picking up on that finding Dennis. I failed to mention that volume loss is indeed a concern for me. Given the location, it makes sense to me because of the persistent paresthesias and clumsiness of my hands especially on the left side, for the past six years. I'm resigned to living with this particular symptom of constant discomfort, but worried about what it might mean in the future re: profoundly affecting function. Right now I do okay albeit have had to replace glassware on a regular basis. I also worry about what it might mean for functioning anywhere lower than that level of the spinal cord.
OK not worry as in, keeps me up at night (though the sensations themselves often do). More like uneasy. I try to be realistic but to not to think too far ahead.
Note, above where the report said:
"small lesion ventrally with minimal volume loss" I omitted that this is at C1, a new area of demyelination for me.
Thanks for your comments Dennis.
I agree that it would be best if your neuro looks at the actual old MRI and does some comparisons. If you can get the new radiologist to do so as well, all the better, but the specifics are not as important as the overall picture. This is not a good report.
In your shoes I'd strongly consider another treatment, and that probably would be Tysabri. You may think of your overall condition as stable, even if you do have bothersome symptoms, but still, that could be a reasonable amount of luck, as in the new locations haven't involved anything dire. You don't want that to change.
I hope you don't find my thoughts too alarming, as they're not meant that way, yet I don't want to gloss over some pretty significant issues. Please keep us in the loop.
ess
The location of my 50% loss is the same location of moderate loss in your report. So at least to my thinking that could be why your having trouble with your leg.
Also the slapping down of your foot while walking is a classic sign of foot drop which most people would not notice. My foot drop in the right side actually varies between the slapping of the foot and dragging the toes( which is more noticeable to people). It really depend on how tired the leg is as to which form it takes. The more tired I am the more it becomes a dragging of the toes since I can't lift my foot as high.
I also have a lot of problems with my hands/arms and is also probably due to my volume loss. Lots of broken dishes, spilled food in my lab, and lost medications because they end up on the floor. My PC just notified the pharmacy that they are to provide me with whole pills in stead of having me cut them in half due to this.
Dennis
You could also consider Gilenya? Very good reports coming out on that DMD as more people use it.
Did you just get a copy of the radiologists report or have you seen the neurologist regarding this newest MRI?
I'm sorry your new MRI didn't bring you good news.
I had my first MRI on a 1 tesla machine & when I compared this to the 3 tesla MRI I thought there was a lot more new lesions. The radiologist put many of the new findings down to it just being different machines. It's amazing how much more these 3 tesla machines can pick up.
I would consider a change in DMD if your Neuro says there are a lot more new lesions.
Karry.
I am so sorry sweetie, but I ditto Dennis on this, my MRI'S are always compared to the one before, now, I dont know if they compare all of them, but sometimes the radiologist will give opinions on the report too, do they concur with what the Specialist said ???
I'm sorry that you are going through this, the did not find Copaxone worked for me. Now I am on Anonex, but to early to tell yet.
Good thoughts and gentle hugs coming your way
Candy
It sounds to me that you have encountered the clinical radiographic paradox - that mysterious point where clinical and MRI evidence don't jive. Usually I think of it as the symptoms are rather obvious but the MRI images don't give the necessary backup.
As depressing as it is, we know that MS is really not stopped by the DMDs, and the disease activity continues in the background. Now you and the neuros have to decide if the copaxone is not keeping the MS activity quiet enough or its time to consider something different. So sorry you are at this crossroad - don't let the doctor just dismiss your concerns.
I agree. Your neuro is better qualified to read your MRI anyway.
It does seem like more aggressive treatment would be a good idea.
Sorry about the bad report. Let us know what your neuro says, okay?
DV
I've not responded to you until now because I just didn't feel I had the experience to provide any useful feedback. But I do think your 'actions to take' assessment is sound. I'd also be a little thrown off if my MRI showed potential evidence of things I didn't feel were reflected in my day-to-day (even though we all know, in the abstract, that this can happen). So without offering advice, I'd just like to offer support. Let us know what he/she says.
Hi DV -
I think I'm with Laura on this one. For me the most important thing is the clinical side of things. "How do I feel?" The relapse/symptom timeline you gave seems to show that things are pretty stable.
As you mention, MRIs done on different equipment, read by different people can be difficult to correlate. As Laura mentioned, all available DMD's are aimed at slowing, not stopping, the progression of MS. I think we all like to pretend that our personal disease has stopped moving forward :-)
I would certainly make the images and radiology reports from past MRI's available to current Neuro. They may or may not do anything with them, but it can't hurt.
Kyle
Hi DV,
I tend to agree with you about having the radiologist read and compare your MRIs, especially a neuroradiologist as that is their expertise and could possibly shed some light on the lesions and whether the last MRI was truly that different and to what degree.
In my opinion, I think it's time for a new DMD given an increase in lesions despite little change in your overall symptoms. As Laura said, the disease continues to march on despite the lack of physical symptoms.
Tysabri has done well for me but I'm at dose #30 and at my recent neuro appt., I was again asked if I wanted to change treatments due to my current dose level. I declined since I am still JC negative, but he did like the success rate of Tecfidera and Gilyena. Just food for thought.
Sorry you've had this turn of events and I wish you the best in setting out to remedy this situation and prevent any further damage.
Hugs,
Ren
I think your idea of asking the radiologist to review your previous MRI images and compare them to the more recent ones sounds like a good plan.
I know my old neuro found lots more lesions than was noted by the radiologist when he reviewed my MRI.
Also, you have to think about your symptoms - progression, etc.
Good luck with everything.
Thanks All for your wise comments. Sorry for my tardy acknowledgement, I'm travelling on the East coast at the moment, just got in on a red eye and going to hit the sack. I will take some time to thoroughly reply to you over the next few days. Thanks!
Back from the East coast for a week now and finally getting around to updating.
I've spoken with a MS nurse about my concerns. Initially I was frustrated as it didn't sound d like much would happen to flag my concerns to my neuro. I was also dismayed to be told that his schedule is booked solid and he couldn't see me any time sooner than April or May (my annual appt) unless I was so bad off that I ended up in the ER, because he is so busy doing research and supervising interns and residents. This left me feeling like what's the point of being seen at a world class facility if patients aren't a priority, perhaps I'd be better off with a general neuro in private practice who has time to see me. Though it also made me wonder if she was hinting at how to get seen sooner, without outright encouraging me to use the ER.
She talked to one of the more experienced nurses, who spoke to my neuro, then the more experienced one called me back. Said neuro is not especially concerned since none of my lesions enhanced so I'm 'not having a relapse, and that's a good thing' (???). But that he agrees a comparison to the last one must be done and they would order it from the previous facility I attended, and ask their in-house radiologist (who isn't a neuro radiologist) to compare and issue a new report, then my doc would review them both himself and we can discuss.
The nurse was great, she asked me if I want to change meds regardless of what the new report said. This made me feel like the decision is mostly or at least partly mine and not just the doc's. She talked to me for quite a while about the options, offered to send me into, seemed to favour Gilenya over Tysabri (risk vs reward ratio). She talked to me about the risks of both. She encouraged me to call back in a week or two so that I don't fall through the cracks.
In the meantime I called the previous MRI facility to make sure they'd gotten the request for the CD from the MS clinic here. As of four days later, they had not. The records clerk was so great, she called me after hours last night to let me know that she'd gone ahead and copied it and it was packed and ready to go out, she just needed the mailing info and doc's name. She said she didn't want to leave me waiting and worrying about it so she wasn't going to sit on it and wait for them to ask. Geez some people are just really so nice and accommodating, it warms my heart. :)
So it's on its way, and hopefully I'll have some feedback within a week or two. Will keep you posted. In the meantime I'm immersing myself in Tysabri and Gilenya literature, and reading lots of old posts here which are really helpful.
Hi DV - Sometimes the (slightly) squeaky wheel gets the oil :-)
Sounds to me like you're getting pretty good care at the Major Mondo MS Clinic. I find that I can get as much accomplished, more efficiently, talking with the NP rather than trying to talk with the doc.
I can't speak to Gilenya, but I was a big Tysabri fan. I had no adverse reactions of any kind and I loved the once a month infusions, rather than daily/weekly injections. It just stopped working...
Kyle
DV ..
So much information.. I can't comment on it all but I will give my newbie advice :):)
My MRI had only one new lesion and possibly a start if another (6months) .. Only one of the many minions in there lit up .. The new one in my c spine lit up.
So my neuros take in the MRI was that I was probably ok to stick with Rebif ... BUT .. He wanted to go over what this meant in my symptoms .. What's new .. What's bothersome..
It was the symptoms effecting me that had him switch me to Gilenya not the MRI itself.
If you have any questions about the Gilenya let me know.. I am day 6 today :) I have to say taking a pill is grand instead of the injections!
As far as choice between Gilenya and tysabri I am with your ms nurse (the positive results bundled with less side effects..yahoo)
I also still have tysabri as a next step too if need be .. I am happy so far with choice but only time will tell
Well, at least it seems like things are working themselves out for you. It's good that you followed up with them. I'm not sure on either one of the other DMDs. I'm afraid of both of them.
What? You're not having a relapse because there were no enhancing lesions??? This makes no sense at all. As if only new lesions can cause a relapse.
This neuro's credibility would be shot for me, based on that, because who knows what the next bizarre thing he says will be. Also, regardless of whether you're having a relapse, I didn't think that was the point of your inquiry. You have loads of new lesions, or so it seems, so it also seems that Copaxone is no longer doing its job. I'd be wondering what would have to happen for him to actually be concerned.
I agree--wait for radiological review before doing anything or drawing any conclusions. But meanwhile I'd be reviewing my options for future neuro care.
Just my $.02.
ess
Thanks for the Gilenya and Tysabri advice, folks. Ess, I agree, that comment made no sense, and I wanted to say "well if I'd had one last summer like I'd wanted, it would have lit up and so what difference would that have made.???" I would have argued the point were it not my greater concern and focus to get him to look at my last MRI and compare the two. Also to make sure they understood, it's not just my MRI that concerns me, it's also the weird leg thingy that troubles me, and the implications of both of these things, together. Also, when dealing with the neuro through the nurse I will give the latter the benefit of the doubt as I have no idea if that's precisely what he said or meant to say or whatever.
Now that I've been in this game for several years, I am actually more concerned with my GPs knowledge and attention than my neuro's. Sounds odd maybe, and I'm not saying I'd be happy to have an outright incompetent neuro. I say that because on average I have seen a neuro once a year, or a tad more often maybe. I see a GP far more frequently and have been lucky to have either really good ones, or okay ones who didn't mind, in fact who seemed to welcome major direction from me.....on testing, meds, paperwork for LTD, etc. I've dealt with so many neuro's, mostly short term, only one long term, and honestly it seemed to me they all talked in circles in one regard or another. The nurses too. I don't know if it's because there are still so many unknowns about MS or if that's the case in other specialties too. For sure I will look to this new guy (new to me - I have only seen him once) for his view on Gilenya and Tysabri, but I have a feeling I'll be more steered by my own research. I'm okay with that. I have always preferred to feel like I'm in the driver's seat, so as long as he doesn't say absolutely no to either med, then I'll live with the occasional (hopefully that's all it is) illogical statement. Perhaps I'd feel differently if I was in worse shape, I don't know. I'm totally prepared to move on from any doc who won't give me the care I think I need and who can't give me a good reason to explain why.
Hopefully soon I will have his feedback on the MRIs and a new plan. In my head I've already moved on from Copaxone, despite the fact that I'm still faithfully doing my needle every night.
DV... You know yourself best!!
Your choice to move forward to a new DMD can only be beneficial to you in my eyes
I am sure your doc will agree wearer it is by MRI or symptoms
Good luck with the research :)
There is a great group on Facebook for Gilenya as well you may want to join. I observe and have found many reassuring comments
Thanks Cann......I joined a few Gilenya & Tysabri groups on Facebook. Turned out the first couple I joined were not English but I didn't know it until I was accepted into those groups. Unfortunately I do not speak Danish or Dutch, lol.
UPDATE:
I heard from the MS nurse the other day who was just updating me that they'd received my previous MRI and it has been sent along with the latest MRI to one of their radiologists to review. She said it may take 3-4 weeks to hear back! I will be surprised if it takes so long but we'll see.
She also said that the neuro will not order the JC virus blood test at this time, at least until the MRI report is back, and that we'll cross that bridge when we come to it. This annoyed me, it's just a lousy blood test. I'd like to know my JC status now, as I am in the process of learning as much as I can about Tysabri, JC status, PML risk, as well as Gilenya - which apparently can also cause PML, I have read. ?
Anyway, I didn't argue it with her as I've learned to pick my battles and figure out more than one way to get something done. So I promptly called my GPs office and got an appt for today. He very willingly ordered the test for me, and I had it done immediately afterwards at the lab next door. We also discussed my MRI changes. He offered to have a friend of his unofficially review my last two MRIs and pass along his impressions. This appeals to me as the radiologist who the MS clinic is using is not a neuro radiologist, just a general one. So I need to go digging and try to fine that old MRI to drop off to my GP. I know I need to be careful and not blatantly step on the toes of my neuro & MS nurse, but if my GP is willing to go the extra mile for me, I'm certainly not going to refuse the offer. I've been so lucky with getting great GPs. I think this one is extra understanding as his wife has MS.
Fingers crossed I am JC neg................
Sorry, wasn't totally clear, I meant to say that the friend of my GP who would look at my MRIs is a neuro radiologist.
Oh, sounds like you have a great GP!! Anything to move things along... :-)