Sunday, June 1, 2008

Continuing the Confusion ...

So of course, by the time I saw my internist, by fever from last week was gone. We never did figure out what caused it. Her best guess is that it was related to my general illness. Apparently people with inflammation disorders, like rheumatoid arthritis or lupus, sometimes get unexplained fevers as part of their symptoms.

I've officially started on the once-a-week-for-a-month 50,000 IU of Vitamin D supplement. Hopefully, I'll remember to take the others on time. I wrote them on my calendar, but on really bad days, I don't always look at the calendar. The lab report indicates that my level of 14.4 ng/ml (?) is "insufficient" (as is anything under 32.3) but would have to be 9 or less to officially be "deficient."

I found it odd that she put me on the Vitamin D supplement, but didn't mention my iron levels, which were pretty low. Apparently I've moved up (down?) in the world from my "borderline anemic" label I've had since adolescence. My iron was 19, and the lab says anything under 50 ng/ml (?) "indicates iron deficiency likely." I'm going to try to dig out my iron supplements from when I was anemic after Ellie was born and see if they're still any good.

After hearing about my chicken pox vaccine experiences and reading the comments posted under my last post by SharonMV, my internist has recommended I go see a clinical immunologist to discuss my case and be checked out for an immune deficiency problem. I just love being a medical mystery. :)

Meanwhile, my internist also gave me copies of the MRI reports. As you may remember, I had a panic attack during my MRI of my lumbar region on May 13. I went back last weekend, armed with Xanax, and made it through my cervical MRI no problem. (Then promptly came home and fell asleep for 7 hours, rousing briefly a couple times when the phone rang.)

I'm pretty confused because this radiologist, even having my last round of MRIs, said he saw no evidence of tethered spinal cord. But my neurosurgeon didn't rely on the written report last time around; he looked at the images and circled exactly where he saw a very clear tethering of my spinal cord. I get to find out what he thinks about these new images and the reports next week (June 13, I believe).

But there was still some interesting detail, which I haven't seen or heard before.

My back problems center on the L5-S1 region, with some issues at L4-L5.

The lumbar MRI says: "L4-L5 shows a concentric broad-based disk bulge and mild thickening of the ligamentum flavum. L5-S1 shows a broad-based disk bulge and mild bilateral facet arthritis. There is a tear of the posterior annulus just ot the left of midline, measuring approximately 9 mm in length. Perineural sheaths (sic) cysts are noted incidentally in the sacrum. ... On the right, there is mild foraminal narrowing at L4-5 and L5-S1. On the left, ther eis mild foraminal narrowing of L4-5 and mild to moderate foraminal stenosis at L5-S1."

I find the bilateral facet arthritis interesting specifically because do not remember that being noted previously and I did undergo a number of injections into my facet joints as attempted therapy for my back problems (which stem from an August 2006 car accident). The IME had recommended additonal facet injections despite my lack of improvement from the previous three rounds, and I had been warned by friends online that the injections could cause new damage to my spine so I refused when the insurance company tried to force me to follow the IME's advice.

Meanwhile, from the cervical MRI, which I'd never had before:

"There are degenerative marrow endplate changes present at C5-C6. Mild to moderate endplate spurring is noted at multiple cervical levels. There is slight reversal of the normal cervical lordosis.Cervical cord is normal in caliber and signal intensity. Cerebellar tonsils are normally located."

I've also had neck problems since that 2006 car accident. When I was undergoing acute treatment for the accident, I kept getting asked which was worse (and which they should focus on), the back or the neck. The back was/is way worse, and somehow, my neck never really got much treatment or attention. The IME declared it completely healed, which was news to me since I still have trouble turning my head far enough when driving and trying to change lanes, not to mention pretty frequent neck pain. No, it's not severe when compared to my back or, now, my other joint problems, but it didn't hurt before the damn car accident and I continue to think that means the insurance company should offer a bigger settlement. Hopefully my lawyer will be able to use these reports to good benefit.


I went to physical therapy on Friday for my knee. I had been just once before, a week earlier, for intake and thought the therapist understood my overall health condition better than he apparently does.

The exercises he gave me to do at home were manageable, particularly broken up throughout the day. (Which he understood I was going to do and even recommended it.) But apparently he really didn't understand because on Friday's appointment, he expected me to do various exercises and stretches for 30 minutes straight. My pain levels were through the roof by the time I left, including severe chest pain (which I still don't understand since my heart is fine, they tell me). I've had to go back to the much higher levels of pain medication that I've been trying hard to cut back on just to get my pain to an almost-tolerable level. And it's not like I'm doing much but I'm so exhausted still from the experience. :(

We amicably agreed that he couldn't do much for me. He referred me to a place that has a therapy pool and classes for people with chronic illness and disabilities. So I'm going to check that out once I'm feeling recovered from Friday's PT session.


Sherril said...

One of my docs sells Vitimin D 5,000 IU from his office. I thought I noticed a marked improvement in my energy level while on it. Now I'm going to get some 700 IU from GNC (too much hassle to get to doc's office for them) and take more frequently.

Shari said...

Well, I just ran into an old friend this weekend that was recently diagnosed with lumbar spinal stenosis and described very similar issues of back pain and test results. I had never heard of it before. Maybe you could do some reading.