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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 7814
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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WhY is a neuro inflammatory state mean?

Customer Question

WhY is a neuro inflammatory state mean?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Rick, MD replied 2 years ago.
This is a generalized term meaning the nerves are irritated and swollen. Usually when this occurs there is also a problem with the function of the nerves.

If you can give me more information about your specific issue I would be happy to go into detail.

Does this make sense to you?

It was a pleasure to assist you with your question. Please let me know if I can do anything else to help you in the future. Positive Feedback and/or Bonus is welcomed and appreciated.
Customer: replied 2 years ago.
It has been a year of going from specialist to another. Primary issues now are joint pain. AM & PM hands close and have to pull them open. It started with the right hand and only 2 fingers Now it is both hands@ all fingers (except thumb) Now it also happens randomly during the day. When I wake in the morning it us difficult to walk for about an hr or so. I "shuffle" not walk. then it gradually goes away and I can walk normally, but there is still often foot pain. My memory is getting worse, and sometimes blurry vision.
Other symptoms which may not be related, easy bruising , frequent headaches.
Which could I am sure be stress & anxiety Since as I stated this has been going on for 13 months seen more drs than I can begin to mention . One tried me on Methotrexate which did not help and ended up elevating
my LFT's. Lastly I ended up in the ER where the MRI WAS DONE , this is what the report said
Nonspecific subcortical  area of increased signal intensity.
Brain stemcell shows a normal outline. There is a partially empty sella
Prominent Perivascular spaces in each basal ganglia are seen on slice II. 
Brain Parenchyma is remarkable on T2 and FLAIR for small nodular  Hyperintensities   in both hemispheres consistent with small vessel ischemic changes
I was discharged and I was told to follow up with a Neurologist who' s consult letter summed my condition up as PHYSIOLOGIC NEURO INFLAMATORY STATE"
and his TX plan was the medititeranian diet as it is anti inflammatory... Still my symptoms persist & getting worse, not to mention the stress I now have 13 months later & no relief
S
Expert:  Dr. Rick, MD replied 2 years ago.
Ok. Well, it sounds like you have spent quite some time trying to get to the bottom of what is going on. I am sure that your previous doctors have thought of, and ruled out, all of the common and easily treatable conditions that could be causing your issues. Would you say this is a correct statement?


At this point I think the best thing you can do would be to gather up copies of all your medical records and travel to a large University Teaching hospital. At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.

The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.

If you could tell me what large city you live near and how far it would be possible for you to travel in seeking treatment I would be happy to give you some names. Of course, you could also ask friends and associates or check the internet yourself. Let me know what you would like to do.

Does this make sense to you?

It was a pleasure to assist you with your question. Please let me know if I can do anything else to help you in the future. Positive Feedback and/or Bonus is welcomed and appreciated.
Customer: replied 2 years ago.
I live in NY. I just don't understand. It seems as though if they can not ck off every symptom within the box of any of the many suspected diseases you are passed on to another specialist. I am not sure EVERYONE has every symptom in all cases. Given what you know & I have told you do you have any idea what it can be ? Also what would cause physiologic neuro inflammatory state? Yes the neurologist did suggest " my brain is not triggering" Comparing it to an expensive house alarm that does not go off when intruders enter. What would cause this? And is there any relation to the joint issues with my hands etc or is this both neuro & rheumatology? I M completely lost here and it's taking a huge toll on me emotionally,
mentally & affected almost everything. 13 months of this is too much. I have no issue with your suggestion but I don't know where to go & am not so sure how to go about it. I live alone & support myself so I am somewhat limited as to travel but welcome your suggestions of places. I actually thought of Mayo & John Hopkins but if there was something closer it would be easier. Wouldn't a Dr have to recommend me? I do have all my records actually dating back to 2006. I needed PST and had to see a hematologist because they said it looked like I had Lupus, which was ultimately ruled out & I was cleared for the surgery which went well thank god
Expert:  Dr. Rick, MD replied 2 years ago.
Those are all excellent questions and, as I'm sure you can understand, any meaningful answer to them would require and extensive history, physical exam and possibly specialized testing -- way beyond the ability of "chat" on the internet to solve....

The fact that your case doesn't have all the boxes checked for all the symptoms is another good reason to go to a University hospital. There specialists from many different specialties and schools of thought are working next to each other and down the hall.

You should not need a referral to be seen at these institutions...you can make the appointment yourself. Cornell University Hospital is top notch and are located in New York City. Here is their contact information:

http://nyp.org/volunteer/weillcornell.html

I firmly believe that you would have an excellent chance at getting to the bottom of your problem at this hospital.

Let me know if there is anything else you would like to discuss pertaining to this issue.

I wish you the best of luck
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 7814
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
Dr. Rick, MD and 3 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
Hi, sorry It took me awhile, but I am going through alot right now. I did take your advice and made an appt at Cornell here in NY. I do have another question/s regarding a recent C spine MRI I'm not sure of all the terminology & what it means & am hoping you can explain it and if perhaps this can actuLly be a cause for my symptoms. Also What part of the brain/body does C5 root nerve go to & have an affect on
Thanks So Much
Rosanne
Here is the report :

At C4-5 there is a mini
Al posterior subluxation and a broad based central and right foraminal disc herniation with right foraminal encroachment and suspected right C5 nerve root impingement

C3-4 a small right sided disc ridge complex with minimal right foraminal encroachment

IMPRESSION:
Central Right foraminal disc herniation with flattening of the ventral thecal sac, Right foraminal encroachment and suspected right C5 nerve root impingement


Expert:  Dr. Rick, MD replied 2 years ago.
The C5 nerve root is part of the brachial plexus and as such is involved in the skin and muscle innervation of the entire upper limb, with some small exceptions....

In any event the C5 serves the skin sensation over the deltoid muscle and the outer (lateral) side of the arm. There is also some parts of this nerve root that serve the diaphragm muscle so you could have some problems breathing if this root is damaged.

The xray report says that there seems to be pressure on the C5 root and, while there are some abnormalities at C4 the nerves don't seem to be affected.

I hope this information is helpful. Let me know how things turn out.
Customer: replied 2 years ago.
What does this mean:
" flattening of the ventral thecal sac"
& what are the possible affects from it?
Expert:  Dr. Rick, MD replied 2 years ago.
The thecal sac is a fluid filled space made of dura mater (the lining of the nervous system/brain) that surrounds and protects the actual nerves.

When they say it is flattened it means that something if pushing on it --much like pressing your thumb into a water balloon -- and distorting it. In your case it is kinda flat.

The effects from this depends on how much, if any, actual pressure is being placed on the nerves themselves. This can cause no problems at all or it can cause complete loss of nerve function/paralysis/loss of sensation.

Here is a website that explains the anatomy pretty well. If you scroll down there is a artists drawing of the thecal sac and its relationship to the nerves:

http://www.chirogeek.com/000_disc_anatomy.htm

Let me know if there is anything else you would like to ask me.
Customer: replied 2 years ago.
Ok I am now more confused than ever and ready to give up hope. I went to Cornell they had me do an EMG to test for what the dr suspected was poss Myotonia / or perifrial neuropathy. Well he prescribed Phenytoin and said if his suspicion is right (myotoni) it should help. Thi med is a seizure med. So I looked n got a copy of my EMG SO THIS IS WHAT IT SAID: essentiay normal. EMG of Bilateral first Dorsal interosseous and flexor carpi ulnaris muscles at rest was normal. Following brief activationagainst resistance, there was some brief runs of Fibrillation Potentials and scattered fasciculations in these muscles.
Study of RT arm & Leg essentially normal
The brief increased spontaneous activity (post-activation) in bilateral First Dorsal interosseous and flexor carpi ulnaris muscles is of unclear clinical significance. No Myotonic discharges were detected!
Soooo what does this mean? And how does this med fit in the picture if there's no diagnosis. I m so confused an ready to give up I'm so tired an feel defeated. I tht the MRI of my C spine was more telling and a poss cause but docs say no??? HELP
Expert:  Dr. Rick, MD replied 2 years ago.
Well, it sounds like you got excellent care at Cornell. The good news? The test results show that everything is basically normal -- no significant nerve damage was found.

EMG is very dependent on operator skill and you can be assured that at Cornell you had a very good test done.

What the doctor is saying by starting you on Phenytoin is that he believes what you are saying but his tests don't show anything terribly wrong. The drug should, in his opinion, help.

Give it some time and see how things go.
Customer: replied 2 years ago.
I know he believes me certain things are obvious but I just don't get it. This med is not one used for Myotonia which he says is wat it's being used for. I tht the MRI OF the C spine & MRI of the brain were far moe significant? I rely feel defeated. I appreciate your help and in the end will of course accept the Ans.
Expert:  Dr. Rick, MD replied 2 years ago.
Doctors use medicines all the time "off label" for things that they are not designed or FDA approved for. In my field I inject avastin, which is a chemotherapeutic cancer agent, into peoples eyeballs to treat abnormal blood vessel growth. You'll never find that use listed on the label! In this light, don't get all caught up about what you read on the internet, PDR, package insert about the drug...I'm sure your doc knows what she is doing when prescribing it to you.


The MRI showed anatomical changes but can't give any data about actual function or loss thereof. The EMG shows that, no matter what the MRI shows, the nerves are just fine. I believe that the EMG is the "more accurate" of the two tests.

Try not to feel defeated. You may not have a perfect answer of what is going but a ton of bad things have been ruled out. Give the medicine a chance, try to relax and know that you are in good hands...

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