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Old 12-19-2011, 04:37 PM   #1
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Question Need Help Understanding MRI, Pain Management, What Specialist to see next??? Please.

After an MRI, I was diagnosed with a left C6-7 Cervical Radiculopathy (pinched nerve) in 2003. Physical Therapy, Preddnisone taper, NSAIDS (Relafen) and Darvocet 100 were prescribed and taken as ordered. Darvocet was pulled by the FDA and I went to take Ryzolt 200 mg 24hr tab 1 daily(Tramadol), had three (3) epindural injections, etc. Eventually numbness of my left index, middle, and thumb areas just became life, my strength generally came back to my left hand (my dominant hand)... and life went on.

Now 2011, December 17. New MRI, new issues. pinky finger and ring finger started going number about three weeks ago... left elbow EXTREME PAIN, and I don't understand the MRI report to save myself. If anyone can help I would greatly appreciate.

Here is the MRI report, word for word:

HISTORY: 45 year old male with pain over left arm and hand with a new numbness in the ulnar aspect of fourth and fifth digits, and weakness to the wrist extension.

TECHNIQUE: Using a 1.5 Tesla magnet, following sequences of the cervical MRI were performed; Sagittal T1, STIR, and T2 weighted images, and axial T1 and T2 weighted images.

FINDINGS: There is straightening of the normal lordortic curvature of the cervical spine. The bone marrow signal intensity is within normal limits except presumed hemangioma at the anterior aspect of T3 vertebral body. Degenerative endplate changes are seen at C4-C5. There is no signal abnormality throughout the spinal cord.

C2-C3 disc is unremarkable.

C3-C4 shows disc osteophyte complex resulting in mild central stenosis, moderate to severe left neural foraminal stenosis and mild to moderate right neural foraminal stenosis.

C4-C5 demonstrates mild central stenosis, severe rright neural foraminal and moderate to severe left neural foraminal stenosis due to disc osteophyte complex.

C5-C6 demonstrates mild right paracentral disc protrusion abutting the right ventral thecal sac. Mild central stenosis is noted at this level. No significant neural foraminal stenosis is identified.

C6-C7 shows broad-based disc buldge with mid central stenosis. No significant neural foraminal stenosis is noted.

C7-T1 shows far left lateral disc protrusion (4:3). Immediate left lateral aspect of the disc protrusion, there is soft tissue signal replacing the lft neural foreamen (4:2, 7:64, 6:24) resulting in severe left neural foraminal stenosis. This demonstrates relatively dark signal intensity on the GRE.

IMPRESSION:

1. C7-T1: Abnormal soft tissue signal replacing the left neural foramen. Adjacent far left lateral disc protrusion at this level and signal intensity of this lesion are likely suggstive of extruded disc material. Unlikely to represent a neoplasm, such as nerve sheath tumor.

2. Central stenosis and neural foraminal stenosis from C3-C4 through C6-C7, as above.

---

What does this all mean? Primary Care Physician (PCP) took me off Ryzolt 200 mg. in August 2011, diagnosing me with "Opioid Abuse." No foundation, highly subjective, undocumented, etc. I have never drank alchohol, done any illicit drug, and have never taken medication for what it was not intended, or more of what I am suppose to. Just the opposite. When I was prescribed to take 1 Darvocet 100 every four hours, nor more than 6 in a 24 hour period. I was taking 1/2 to 1 pill in the AM and 1 pill in the PM. If I had been taking 6 I would not have been able to work, stand up, or even think. Ryzolt was one pill 200 mg, taken in AM. Never abused, never had a dog ate my meds, always took one, never more, and wala... she came off with this "Opioid Abuse" diagnosis. In process of getting new PCP, because frankly, I think she's nuts. I am such a tight-wad straight-laced guy... I wouldn't abuse a prescription drug or any thing, no matter what it is. I am just floored and shocked at the whole thing.

Currently prescribed 5mg Prednisone taper (5 day) and Tramadol 50 mg oral tab take 1 tab orally every 6 hours as needed for pain. Short three day's of tramadol and the Prednisone taper I am on my 3rd day of 5. Prescribed NSAIDS Motrin 600mg 3x daily when needed for pain (take usually 1-2 a day)and Naproxen 500 mg 2x daily (take 2x a day).

Any suggestions for what kind of specialist I should see, or specialist(s)? What should I do now, while I wait until a new PCP is assigned to me? I want an M.D. not a D.O., so going through the Kaiser Permanente list. Belong to HMO in CA through health insurance from work. 14 years same job, stable family, married, stable life, until this "stab in the back" with the "opioid abuse" allegation from my PCP D.O. threw me off big-time. Although, in the Kaiser ER the physician didn't seem to be bothered by the "diagnosis of opiod abuse" given he gave me Dilaudid IV for pain, and Toradol IV for NSAID. I HATED the Dilaudid, it made me ill and made my head swim, and it was NOT a good feeling. Made me dizzy and nausea bigtime. Then they gave me a anti-nausea medication IV, which helped a lot. OK... there you have it. Don't know what to do next, where to go next, who to talk to next, and what I should and shouldn't do. Can I get some good advise please? Thanks a lot in advance.

 
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Old 12-19-2011, 06:10 PM   #2
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Re: Need Help Understanding MRI, Pain Management, What Specialist to see next??? Plea

Welcome to the board. Let me begin by saying that you may also want to post this on another board that you will find further down the list, "Spinal Cord Disorders." This board pertains more to cervical issues, and people will lumbar problems tend to post here.

However, I can provide some information to you, even though I personally do not have cervical issues. From the MRI, it looks like you are suffering from a more intensive form of what you had back in 2003 when you had the first MRI. I don't know who was treating you at that point, but I would suggest you make an appointment with a spinal specialist. You will want to look for a fellowship-trained orthopedic spine surgeon or a neurosurgeon who limit their practice to issues of the neck and back. This does not mean you necessarily will need surgery, but these are the two specialties that have the most specific training in issues pertaining to the neck and back. They will begin with conservative treatments and never consider surgery until it is deemed necessary, and conservative modes have failed.

Stenosis refers to a narrowing. In this case, your MRI refers to [B]Central stenosis and neural foraminal stenosis from C3-C4 through C6-C7[/B]. The foramina are a series of openings located at each pairing of vertebrae through which the nerve roots exit. Central stenosis is a narrowing of the spinal canal. Generally, stenosis is caused by a degenerative process in the spine.

When there is stenosis, it often results in one or more of the spinal nerves becoming compressed or "pinched." This often causes the pain a patient feels radiating to a particular part of the body, such as your symptoms in your fingers, etc.

You will note that you have stenosis at each segment, beginning at C3 and continuing on to the T1 vertebra, for a couple reasons. "Disc osteophyte complex" is mentioned in the C3-C4 vertebrae. An osteophyte is a type of bone spur and can also result in stenosis as it can take up space that is otherwise needed for the nerve to pass freely. It, too is caused by a degenerative process in the spine.

Stenosis can be painful and when in the cervical area, needs to be evaluated by a spine surgeon, as it can impact the spinal canal.

Hope this helps a little bit.

 
Old 12-20-2011, 10:22 AM   #3
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Re: Need Help Understanding MRI, Pain Management, What Specialist to see next??? Plea

Hi Teri...and welcome Chipeerob...I'm Jenny from the Spinal Cord Disorders board where us "cervies" hang out.

I agree with Teri completely that you NEED a spine surgeon, either ortho or neurosurgeon but you need a spine surgeon and you need one NOW.

Your big problem is at C7-T1 where it looks like the disk has pushed out so much of it's interior that it has almost completely blocked the hole in the bone where the nerves to your left arm exists. This is why you have so much elbow pain and why your fingers are numb. To put it plainly, you are in danger of losing the use of that arm if not dealt with pretty quickly. You are only the 3rd person I've met here who had a blockage listed as "very severe"...that is about the worst you can get.

Your primary is an idiot because 1) she put down a diagnosis that can follow you for life and is totally unwarranted; and 2) she didn't recognize how dire the consequences were for your arm if not treated promptly. Once you find a spine doc to help you, then go and report her....she is incompetent and Kaiser needs to know who is incompetent as they have a problem with this issue.

If you don't really push to see someone, you are in danger of developing paralysis of your left arm that may not be reversible(mine was....I was 1 of the 3 people I knew who had that same diagnosis).Make noise and get some treatment....please!

Come on down and join us.

Jenny(fused C3 to T1)

 
Old 12-20-2011, 11:52 AM   #4
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Re: Need Help Understanding MRI, Pain Management, What Specialist to see next??? Plea

Thanks, Jenny. Lumbar problems tend not to have dramatic consequences unless there is a cauda equina issue...so thanks for pointing out the urgency of needing to be treated soon.

I forgot to comment on the doctor's comments. It is so hard to remove an irresponsible comment like that, and you are right. Once in writing, it does tend to follow the patient around.

 
Old 12-20-2011, 03:02 PM   #5
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Re: Need Help Understanding MRI, Pain Management, What Specialist to see next??? Plea

That is why we with cervical problems hang out where we do....it is different and sometimes, very different. Did you know that the foraminal opening in the lumbar is twice the size of the openings in the neck? And the canal is so much larger in the lumbar than in the neck too. Not much room so things go bad quickly in the neck. Maybe the idiot doc forgot her anatomy lesson.

Even cord issues are different. The lumbar gets cauda equina but in the neck, if the cord compression gets bad enough and is high enough(above C5) it can result not just in paralysis but in the person stopping breathing(yup...death). Why they tend to operate earlier in necks than backs.

I did get my MRI and am now waiting for the doc to decide what to do. Can only feel gas pedal with lightweight or no shoes on. So now that winter is here, I will have to take off my winter boots or "snow sneakers" to drive. Can't feel the pedal at all with them on. Confirmed L5 on left and bi-lateral on S1. Just waiting.

But thanks for helping....sorry I didn't jump in earlier but I was off helping someone who was getting out of rehab from a hip replacement yesterday.

many hugs.............Jenny

 
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cervical radiculopathy, medical advice, opiod abuse, pinched nerve, specialists



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