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    Old 01-23-2008, 10:09 AM   #1
    blueMach
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    Please help new guy

    Hi I'm new to posting but have been reading alot. This is long but there are lots of details.

    Orignally found out about all of this in 2002 with radiculopathy in right arm. Did steroids and no resolution. Referred to neuro and he said had stenosis and needed fusion next day. He called my primary care doc and primary care doc called me on cell phone on way home. They were convinced it was pressing cord bad enough that surgery should be done next day. They even intubated me awake sitting up. Surgery went fine and arm pain left immediately.

    Flares started about a year later so I got a copy of MRI for myself and looked to me it looked like 3-7 should have been opened up instead of fusion with laminectomy to begin with. I was 40 at surgery and am now 46 so maybe this is why they didn't go this route.

    I'm about 8mm from 3-7 even at the acdf level of c5-6. Flares have subsided each time they occur usually with round of steroids and muscle relaxers. Been to emergency room 2 times with breathing problem, no heart issues, cholestrol 160, weight 170 at 5'10".

    Went back to surgeon that did acdf in 2005 and he wanted to go another level in front and decompress laminectomy from 3-7 in back with rods and screws. He says I just don't have enough room. This scared me to death. I got another opinion that said if it is calming down to try and work with it to prevent multiple surgeries. This was Nashville Neurosugical group. Also got another opinion from Vanderbilt in Nashville and they said even though it is narrow that I have enough room. This was all in 2005-2006.

    Saw the Vanderbilt group again in 2007. Actually Dr. Cheng. This was June for last MRI including dye in cervical and thoracic area. Said that I could countinue working through it medically and that the symptoms I'm describing don't usually occur. Also said that I don't need anymore fusion but laminoplasty. I have read a ton about this and it sounds good except for the stability issues and he said he uses no hardware. Just cracks it open and leaves it.

    I'm currently halve way through pack of steroids and the thing that is scaring me with all this is that with the 2005 bout I started to feel pain across left breast and into stomach. This time it is more and seems to be affecting breathing muscle like a cramp mainly on left side.

    Went Vanderbilt emergency room on advice of Cheng's nurse yesterday but it was a zoo. Waited and they checked breathing said I was getting air and put me in line. My wife felt like they couldn't do anything and we have twin boys with Grandmother to pick up so we left. Called the Neuro again this morning and they said I should have stayed in emergency to get xrays. If I had done this the neuro could possibly have seen me today. Now I will need to wait until appointment on the 30th of this month and they are sorry. They also said notify my PCP and let them now what is going on. Left a message for them as told.

    Vanderbilt nurse also said since another surgeon did the original operation that maybe I should go back to him.

    This crap is driving me crazy and scaring me to death. Can someone offer any advice. I'm the only income for our faminly and my sons are 7 so I NEED to work.

    Am I overreacting? Or is this stuff ruining the nerve to my breathing muscle? Also should I stick with the Vanderbilt Dr.? He is supposed to be good even though it takes so long.

    Thanks for any help and patience.

     
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    Old 01-23-2008, 03:45 PM   #2
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    Re: Please help new guy

    Hi - and welcome I am trying to figure out how to give you some ideas to pursue in as short a space as possible. Do you have the text of your MRI study?

    1. What are your "flares" symptoms?
    2. Did your breathing problems begin when taking the steroids? If you noticed it has come on with the meds you might be having a reaction to steroids.
    3. Cervical issues can produce symptoms that mimick angina type attacks. Chest pain has been reported by many of us.
    6. C3, C4, and C5 innervate the phrenic nerve - phrenic nerve controls the diaphram. You could be irritated at those levels causing your breathing difficulties. (I had adult onset asthma that has since disappeared after my cervical surgeries)
    5. 9mm is kind of the cut-off for stenosis. You are on the border.
    6. There are other disease processes that stir up breathing problems, have you been checked out by your own primary care doctor?

    You are doing the right thing by researching and seeking multiple opinions. I would get at least 3 opinions before considering more surgery. If you post your MRI stuff the people here can compare it to their situation and give you ideas.

     
    Old 01-23-2008, 05:49 PM   #3
    blueMach
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    Re: Please help new guy

    Thanks for the reply neckpatient it means alot.

    Hi - and welcome I am trying to figure out how to give you some ideas to pursue in as short a space as possible. Do you have the text of your MRI study?

    Initial MRI that found this 7-23-2002

    FINDINGS: the cervicomedullary junction appears within normal limits. Visualized spinal cord is unremarkable except for moderate compression from approximately C3 through C6 without significant edema. No syrinx. The cervical vertebral bodies are normally aligned without fracture loss of height or focal lesions. Prevertebral soft tissues and posteriror elements are unremarkable.

    C1-2, C2-3: No significant abnormalities.

    C3-4: Evidence of congenitally narrow canal with moderate degenerative disc disease (DDD) with moderate broad posterior disc/osteophyte complex in addition to posterior longitudinal ligament (PLL) ligament hypertrophy. There is moderate central stenosis with AP thecal sac diameter 6 to 7 mm. There is mild facet and uncovertebral arthrosis and foraminal stenosis.

    C5-6: Moderate DDD and PLL hypertrophy with evidence of additional central and right paracentral HNP measuring 2 to 3 mm. This results in moderate central stenosis and cord compression with AP thecal sac diameter approximately 5 mm. this is grater to the right. There is no significant foraminal stenosis.

    C6-7: Moderate DDD with mild to moderate posterior disc bulge with evidence of additional 2 to 3 mm right paracentral HNP with mild to moderate central stenosis and cord compression predominantly right sided. No significant foraminal stenosis.

    C7-T1: No significant abnormalities.

    IMPRESSION:
    1. Evidence of congenitally narrow central canal and diffuse posterior longitudinal ligament hypertrophy.
    2. C3-4 and C4-5 moderate central stenosis with mild to moderate cord compression and mild foraminal stenosis.
    3. C5-6 moderate central stenosis and cord compression with evidence of central and right paracentral HNP.
    4. C6-7 mild to moderate central stenosis and cord compression greater to the right secondary to an additional 2 to 3 mm HNP.

    RESULT was ACDF at C5-C6 August 2002.

    --------------------------------------------------
    MRI after flair in 12/09/2005

    FINDINGS: The cervicomedullary junction appears normal. The spinal canal is small on any congenital basis at the C3-C4 through C6-C7 levels.

    C2-C3: Normal

    C3-C4: There is a posteriror disc bulge. This compresses the anterior surface of the thecal sac and narrows the central canal to approximately 8mm. The canal on the right side is narrowed somewhat more so than the left. There is mild narrowing of the right foramen moderate bony narrowing of the left foramen.

    C4-C5: There is a diffuse posterior disc bulge in conjunction with marginal spurs. this compresses anterior surface of the thecal sac and norrows the central canal to approximately 7 mm. the cervical cord is compressed in AP dimension. There is marked bilateral bony neural foraminal stenosis.

    C5-C6: There is evidence of prior anteriror cervical discetomy and fusion at this level. Evaluation is somewhat limited due to ferromagnetic artifact. However there does appear to be anteriror compression of thecal sac as well as compression of cord. Cord is flattenened in AP dimension. On the sagittal images the central canal measures approximately 8mm in AP dimension. There is a mild-moderate bilateral bony narrowing of the foramina.

    C6-C7: There is a posterior disc bulge at this level. This compresses anterior surface of thecal sac and compresses the cervical cord. the central canal measures 6mm. there appears to be some bilateral bony neural foraminal narrowing although the images are degraded due to the ferromagnetic artifact from C5-C6 level.

    C7-T1: no evidence of disc herniation or significant disc bulge this level. No spinal or foraminal stenosis.

    Impression: Posterior disc bulges are seen at the C3-C4 through C6-C7 levels. the disc bulges are superimposed upon a canal which is small on a congenital basis. This results in even greater degree of canal narrowing with spinal canal stenosis and cord compression at C3-C4 through C6-C7. There are also foraminal stenoses at levels noted above. There is evidence of prior anteriror cervical discectomy fusion at C5-C6 level.

    --------------------------------------------------
    I don't have the one from Vanderbilt in June of last year but plan to get it the 30th of January appointment.

    --------------------------------------------------

    1. What are your "flares" symptoms?
    Left arm pain, left breast muscle pain weakness, cramping in diaphram area
    sometimes cramp in back of thigh.

    2. Did your breathing problems begin when taking the steroids? If you noticed it has come on with the meds you might be having a reaction to steroids.
    No.

    3. Cervical issues can produce symptoms that mimick angina type attacks. Chest pain has been reported by many of us.
    Me too.

    6. C3, C4, and C5 innervate the phrenic nerve - phrenic nerve controls the diaphram. You could be irritated at those levels causing your breathing difficulties. (I had adult onset asthma that has since disappeared after my cervical surgeries)
    My thought also.

    5. 9mm is kind of the cut-off for stenosis. You are on the border.
    See MRI

    6. There are other disease processes that stir up breathing problems, have you been checked out by your own primary care doctor?
    They gave me Albutoral in 99 when I first noticed this and went to ER.
    The did EKG etc. Looking back now I believe it was this.

    You are doing the right thing by researching and seeking multiple opinions. I would get at least 3 opinions before considering more surgery. If you post your MRI stuff the people here can compare it to their situation and give you ideas.

    Vanderbilt suggested either continuing to deal with it with meds or do Laminoplasty and advised against additional fusion.

    The first guy that did fusion wanted to fuse another level and do laminectomy on the back with rods and screws at the same time. (Scared the hell out of me).

    Third opinion suggested working through it if it calms down with meds.

    Sorry for long post. Advise appreciated.

     
    Old 01-23-2008, 09:46 PM   #4
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    Re: Please help new guy

    Hi - I logged back on to see if you posted results. There is a lot here to read. I forgot to ask if your flares are getting worse, or do they usually follow the same course?

    Dr. Cheng's credentials are good - sometimes surgeons won't take other surgeon's patients so you are lucky he took your case. It seems from your writing that you like Dr Cheng better?

    If I were in your shoes I would slow down a bit - don't rush the surgery this time! Dr. Cheng has just started seeing you, maybe it would be a good course to have him manage your current flare. You already waited this long and unless he feels it is urgent, it might be good for him to have time to get to know your case better than the first meeting. This will allow you some time to research the procedures more.

    You could also try to get Dr. Henry H. Bohlman at Case Western to review your MRIs - he teaches lamnioplasty. Or Dr. Russel C Huang in NYC

    I am not a doc but with my personal experience w/stenosis I would avoid more fusion - looks like that could set you up for more problems if ridges grow. If they do the lami they could always fuse it in the future vs. once it's fused you are stuck.

    Look at ROY15 posts - he is going through same decisions.

     
    Old 01-24-2008, 06:03 AM   #5
    blueMach
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    Re: Please help new guy

    Hi - I logged back on to see if you posted results. There is a lot here to read. I forgot to ask if your flares are getting worse, or do they usually follow the same course?
    This one seems to be the worst as far as the breathing issues but you know
    it is hard to tell in the middle of it. I have 6 days left on steroids and am
    sure some of anxiety is from them?

    Dr. Cheng's credentials are good - sometimes surgeons won't take other surgeon's patients so you are lucky he took your case. It seems from your writing that you like Dr Cheng better?
    There seems to be a hesitation here also. I saw them first time in middle of
    2006 then actually met him after MRI at end of last flair in June of 2007.
    I have an appointment for January 30th at 9:15 so hopefully something
    can be decided.

    If I were in your shoes I would slow down a bit - don't rush the surgery this time! Dr. Cheng has just started seeing you, maybe it would be a good course to have him manage your current flare. You already waited this long and unless he feels it is urgent, it might be good for him to have time to get to know your case better than the first meeting. This will allow you some time to research the procedures more.
    I stayed home from work today. I write software for over 20 years, I think
    part of the problem is being at a machine for so many hours a day.
    I don't know when this is deemed urgent. It scares me so much. I'm trying
    to wait and think this is the third flair since I started seeing Dr. Cheng.
    Maybe I am too impatient and worry too much? I am for sure type A
    personality. I feel guilty when I stay home but the stress does make this
    worse.

    You could also try to get Dr. Henry H. Bohlman at Case Western to review your MRIs - he teaches lamnioplasty. Or Dr. Russel C Huang in NYC


    Dr. Cheng said he does not use hardware. Don't know
    how I could get Dr. Bohlman to review them.

    I am not a doc but with my personal experience w/stenosis I would avoid more fusion - looks like that could set you up for more problems if ridges grow. If they do the lami they could always fuse it in the future vs. once it's fused you are stuck.
    My feelings also and this is what Dr. Cheng also advised. I did not
    understand anything about this in 2002 and felt rushed to have this done by
    the first guy. As I said he deemed it emergency and even intubated me
    awake before procedure. Now I feel this was the wrong type of surgery for
    me to have. I had lami at L5 in 1995 and knock on wood no problems since.
    My Dad and both of his brothers have all had either neck, back, or both.

    Look at ROY15 posts - he is going through same decisions.
    Will do.

    Sorry for the long post but there is so much detail and most people I talk to
    about this make me feel like they either don't understand or that I am overreacting. Am I?

    Thanks for your help and God bless you.

    Last edited by moderator2; 01-24-2008 at 07:03 AM. Reason: disallowed website

     
    Old 01-24-2008, 07:13 AM   #6
    monarog
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    Re: Please help new guy

    Hi BlueMach...

    Welcome to the board. You will find so much support and so many with knowledge (Neckpatient) - it's a fabulous resource.
    I just wanted to give input and support on your last question. You are WAY NOT overreacting. When you feel you are struggling for air, you definitely have some major decisions and C-spine issues going on....no, you're being wise, cautious and who wouldn't have anxiety over all of this? You're only human. Like Neckpatient said, I think taking a deep breath (sorry...no pun intended), seeing if things do calm down...finding the right NS who will spend lots of time, help you weigh options etc. is really great advice. Please keep us posted and am sorry you're going through all of this right now. Remember....it's only 6 more days until the 30th. Believe me, I understand how that can seem forever sometimes...let us know how it goes. God Bless. Mona

     
    Old 01-24-2008, 07:30 AM   #7
    blueMach
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    Re: Please help new guy

    Thank you for the support Mona it does seem to help. I have reading this forum on and off for a couple of years and it really does seem to help me to get through these attacks.

    I think this time may be to the point of needing to do something more. The waiting is the most terrible part when you don't know what is happening or if it is going to get worse. And as I said in another post, I don't think the emergency rooms are equipped or know enough about this stuff to really help.

    Two years ago about this time I had a similar episode with face numbness and breathing problems. I went to local ER, about 6 miles from house but 45 miles out of Nashville to East, and they actually told me the neck could NOT cause my symptoms. They did x-ray and I finally went home. Fortunately it subsided. This time seems to be waaaay longer. This is what scares me to death. And as I posted before the big hospitals in Nashville are overwhelmed so I guess I must just wait and try to make sure they understand what this flareup has been like Wednesday.

    God bless and thanks for your concern.
    Randall

     
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