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Old 09-05-2012, 06:25 PM   #1
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Neurologist won't look at MRI film

I had my first Neuro appointment and I don't think it went very well. I'm not sure if this Dr. specializes in MS but I asked and he said he has over 100 patients who have MS.

So when I originally called for my appt. they said to bring the disk of MRI images and he would look at it. I brought it and all my paperwork, including the MRI report. When I got there he said he would look at the disk. We went through all my symptoms, history, etc, he said he "was originally thinking MS" but based on all the balance tests he did in the office (which were normal) he said he thinks it's chronic fatigue. At the end of the appt. he said he would not look at the MRI disk! What the hell??? He said he would call the MRI lab and have the tech take a 2nd look at the scans. I don't get this at all. Don't most neurologists look at the actual MRI images??

So he's ordering a ton of other tests -- and on the orders he wrote "rule out MS." I have a c-spine MRI with and w/o contrast, SSEP, AER, VER (auditory and visual evoked response tests?) and a lot of bloodwork. He is testing for Lyme, Lupus, Sjögren's, and other inflammatory diseases.

Why is he testing for all this if he doesn't think it could be MS?

I'm really frustrated and angry. Let's face it, chronic fatigue is a ******** diagnosis that they tell you when they don't know what it is. It just is. It's like "oh you're female and you're tired? CFS." I have dealt with this before, when I went to the Dr. to get tested for Anemia, she tried to tell me I was just depressed. Well no, it turns out I have an iron deficiency.

I am so tired of Drs. thinking they know everything! Every single dr. I have seen has been 100% wrong about every diagnosis I have received in my entire life. From my Lidocaine allergy ("that's so rare! you can't have that!") to c-diff, to my iron deficiency. Every single Dr. was wrong.

So now this idiot is testing me for West Nile, b/c so many people in the state have it. I'm pretty sure it's not West Nile. What a ##$%! moron. Do I need a new Dr? I already waited 3 weeks for this appt!

The other thing is, I was referred to him based on my abnormal MRI of the brain. This is what the report says:

"A few non-specific T2 bright foci within the subcortical white matter have non-specific appearance. Migraines or other causes of demyelination could be considered.

"There is a dot-like abnormal enhancement within the right side of the pons. Enhancement compatible with occult vascular malformation."

The neuro dr. said "oh that's normal, that's just a vein." So the MRI tech thinks it's abnormal but it's really "normal"??? What the hell is going on?!

I have had it, I am completely fed up and at the end of my rope.

Do most Neuros look at the actual MRI images? Why won't this Dr. look at it? Should I find another Dr?

 
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Old 09-05-2012, 06:46 PM   #2
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Re: Neurologist won't look at MRI film

100 MS patients does not an MS Specialist make. Added to this that he did not bother to look at your MRI would raise doubts about his specialty. I would recommend finding another neuro who only does MS.

CFS is difficult to diagnose. I have a nephew who spent 10 years to get from CFS back to a normal life. With your abnormal MRI result, I would doubt CFS. You might read the other boards, but I think yours is more in the direction of MS. Your local MS Society or Association can help you locate a qualified MS Specialist.
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Old 09-06-2012, 10:08 AM   #3
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Re: Neurologist won't look at MRI film

Although he did not look at your MRIs, which to me would also be a deal breaker, he did follow up with the radiology department.

The reason you are getting more extensive testing is because your white matter lesions are nonspecific. MS lesions have a specific look and location that the tend to be located.

When a person has an MRI and white matter lesions show up that are nonspecific, demyelination has to be a consideration.

The evoked potentials will provide a sensitive look at your CNS function in terms of delayed nerve responses from the CNS to the PNS. Also, the VEP is a sensitive measure for any damage to your optic nerve (a favorite place for MS plaques.)

The C-spine MRI will also give a larger picture about any lesions in that area.

The physical exam in neurology can be very localizing, meaning that neurologists can often see things in your exam without needing an MRI.

It may feel like you were being blown off, but you are getting further testing. It will pay off in the long run.

 
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Old 09-07-2012, 07:08 AM   #4
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Re: Neurologist won't look at MRI film

I agree. There is nothing in your brain MRI which suggests you have MS; and the mcDonald criteria says he cant give you a dx based on what he DID see. Ordering more tests, will give a clearer picture of what he didnt see. THey are important tests.

Neurologists are NOT radiologists. They do not all know how to read MRIs. And the fact that he has 100 patients with MS isnt a bad thing- he may only see 40 patients a day, making his practice 50% MSers. I have a neurologist in a busy city practice who is a general neuro- he sees 25+ MS patients a day- and sees about 60 patients a day total. He also has a fellowship in MS.....and i trust him more than my MS specialist -who has no bedside manner.

Im not so sure you arent on to a good doctor here..
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Old 09-07-2012, 10:39 AM   #5
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Re: Neurologist won't look at MRI film

Well I'm just confused. I don't understand why what he told me contradicted all the tests he ordered. If he doesn't know what it is and feels he has to rule out MS, that's fine, but why say it's chronic fatigue. He was extremely off-putting, and kept interrupting me. I hate that, because I know it means they're not listening. I also don't understand how he can completely contradict the MRI report when he won't even look at the images, and then say he would have the radiologist read it again. What would be the point of that.

I have the other tests lined up in the next 2 weeks, and I made an appt. with an MS Specialist at an MS clinic that is in a month. So I guess I'll see what the tests say and go from there.

Meanwhile, I am still having symptoms.

 
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Old 09-07-2012, 11:24 AM   #6
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Re: Neurologist won't look at MRI film

The best thing to alleviate symptoms is to reduce your triggers and find a way to rest yourself. Any doctor, no matter how brilliant, if their bedside manner does not mesh with their patients, there will always be a bad feeling and a sense of distrust, I think.

I think that long term you need a doctor who will be an interactive member of your team. I am on my second neuro and the same clinic which I have been using since 1982. If you find something or someplace that works for you, consider it a blessing.
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Old 09-07-2012, 12:33 PM   #7
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Re: Neurologist won't look at MRI film

Quote:
Originally Posted by thepalestgirl View Post
Well I'm just confused. I don't understand why what he told me contradicted all the tests he ordered. If he doesn't know what it is and feels he has to rule out MS, that's fine, but why say it's chronic fatigue. He was extremely off-putting, and kept interrupting me. I hate that, because I know it means they're not listening. I also don't understand how he can completely contradict the MRI report when he won't even look at the images, and then say he would have the radiologist read it again. What would be the point of that.

I have the other tests lined up in the next 2 weeks, and I made an appt. with an MS Specialist at an MS clinic that is in a month. So I guess I'll see what the tests say and go from there.

Meanwhile, I am still having symptoms.
Neurologists, like all specialists, can be tough. They are usually to the point, and not that much into bedside manner, at least the many I have seen. My MS specialist is a well known researcher, and that is about what she is good for, but she is an excellent doctor.

The good thing is, he is following up on the MRI. Obviously when he talked to the radiologist he decided to order further testing. A good thing for you. You wouldn't believe how many people think the have MS based on 1 or 2 symptoms and a simple search on the internet, so you can understand why the neurologist can sometimes be skeptical.

Again, he is following up with further testing so you will have that info and can then see your new doc who may or may not be better. Like the others said...if you don't like them, move on, but try not to take it too personally.

 
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Old 09-08-2012, 11:11 AM   #8
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Re: Neurologist won't look at MRI film

I agree with what has been said here, too. Not every doctor and patient mesh....in my opinion, most general Neurologists have better bedside manner than most MS specialists; however in a MS specialist office I have often found the nurse (who is strictly a MS nurse or nurse practioner) to be the strength of the office.

As the other poster said, I have a MS specialist who is also well documented in the MS community and is reknowned for his clinical research and writings....but I cant stand him. Hes a jerk to deal with, I do not get my questions answered to my liking and I feel he is always pushing me towards clinical trials. SO, I see a general neuro, allow him to regulate my meds and order my MRIs, take the whole kit and caboodle to the MS specailist once a year and allow him to review everything- and to this day, still havent had the two of them disagree. (eight years now). It just so happens my general neuro, has a fellowship in MS and is highly interested in MS and staying on top of what is happening. Not all general neuros are like he is. (he also happens to be warm and fuzzy, which works for me).

You keep brining up CFS- this is actually a virus. Are you aware that chronic fatigue starts from a viral infection and is fairly easily ruled out? Not always easy to dx, it is much easier to rule out. Why hasnt anyone tested you for the antibodies for this? Or have they?

You desperately need the further testing...and the fact that you have an appointment at a MS specialist is smart. Make sure between now and that appointment, you get copies of EVERYTHING. Films, Cds, reports, blood work, any other tests you have had....if you can, drop them off before you get there for review. If you cant, take them with you. BUT MAKE COPIES OF EVERYTHING. Have a master folder of all your tests and results at home at all times, keep copies to give out to the doctors. You will need these things down the road whether you get a dx or not. I find that I sometimes am asked to bring the last 3 MRIs ( a year and a half for me, as I do them every 6 months) to my specialists office, as he is not part of the same health system as my regular Neuro and cant view them online.
Ive also had some unusual neck pain, which is more than likely from an old car accident and whip lash, however I have seen a doctor several times for trigger point injections, she also looks at my cervical MRIs to see if there are changes.

Keep everything ....no one said getting a dx is easy. Only for about 3% of us do we get quick answers. For me, symptoms, and MRI lesions, along with my History and Physical resulted in an instant diagnosis, but I do realize im the exception to the rule.

Hang tough..answers are coming!
Nikki
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