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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Neurology
Satisfied Customers: 11267
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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Bob this isPhyllis again Here are my EMG/NCS, MRI c-spine,

Customer Question

Hi Dr Bob this isPhyllis again Here are my EMG/NCS, MRI c-spine, brain and neurosurgeon visit notes. I had talked with you before about my issues can you offer any guidance? I see my GP Monday any lab test requests I should have done? Thanks again for your guidance
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Rick, MD replied 1 year ago.

Hi. My name is***** and I am online and available to help you today. Thank you for your patience.

Question and answer is just one of the services I offer. I can also provide you with premium services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.

Why was the EMG/NCS and other tests done?

How long have you been experiencing these sorts of problem?

Do you have any other medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

Customer: replied 1 year ago.
I have a list of responses under my name I had previously spoken with Dr Bob the neurologist and was trying to get this info back to him or another neurologist since I had already went through all that before,
Can you link to my previous threads?
Customer: replied 1 year ago.
Here is part of the previous thread.I have several issues. My name is Phyllis.
JA: Thanks. Can you give me any more details about your issue?
Customer: I had TT removal in oct for papillary cancer stage pT1b, pNX then shoulder surgery in dec but before the surgery i had right hand and leg weakness. since surgery I have lost fine motor skills in right hand and can't lift right arm and have spastic gait in right leg. I had mri of brain, c&t-spine it shows 6mm likely meningioma right lateral frontal convexity. C-spine shows c-2thru c-7 disc bulge with central protusion indents on thecal sac and slightly deforms ventral contour of cervical cord hypertrophy contributes to mild bilateral foraminal stenosis. c5-6 ap is 7mm and ap at c-6/7 is 8mm06 March 2016 10:42
Dr. Bob Dr. Bob
Neurologist
While I don't have the benefit of your complete record or a physical exam, what you have posted so far would suggest that the denervation is due to either the NF stenosis or a combination of the NF stenosis and the spinal stenosis. The meningioma is relatively narrow and on the wrong side (i.e. a right sided meningioma in that location would be expected to cause symptoms on the left side of the body). In addition, the thyrotoxicosis would not normally cause focal denervation like this. If the surgery worsened your symptoms, perhaps the manipulation of your neck during the process resulted in worsening of the stenosis that was already there. (?)06 March 2016 10:46
Dr. Bob Dr. Bob
Neurologist
As for permanent damage, the neck is not likely to improve much on its own...although some stenoses do improve somewhat over time with careful neck care and physical therapy. The nerve damage may or may not be permanent, depending on its severity and duration. Nerves that have not been totally damaged do retain the capacity for repair and regeneration, especially if the pressure on them is relieved. An updated EMG/NCV test would help your doctors determine the location and severity of the nerve damage and how likely you are to regain function and reduced pain from any type of intervention.Now I have the new testing but have a months wait to see a neurologist and I was needing guidance as to weather I should get GP to push appt or something else
Customer: replied 1 year ago.
Please let me know this has been received thank you
Expert:  Dr. Rick, MD replied 1 year ago.

got it :)

Expert:  Dr. Rick, MD replied 1 year ago.

When you say that you have to wait "months" to see the neurologist, how long exactly do you have to wait?

Are you having any new symptoms?

Did the new testing show anything that is worse/of concern?

Customer: replied 1 year ago.
I have another month till my appt. My NCS and EMG were worse then the previous done last Aug
Customer: replied 1 year ago.
I had rotator cuff, labrum repair, bicep fix and nerve decompression in shoulder in Dec and was in sling for 2 months and then faced all of this after that surgery. That is when all the testing started. Did you get my testing results?
Customer: replied 1 year ago.
I hate to overwhelm you but my hand has curling of index and little finger and middle finger is very weak I also have clonus(I think is the term) in my right foot. I keep that foot close to the ground for balance.
Please let me know if you are reviewing my test results.
Thank u once again
Customer: replied 1 year ago.
I should say my foot doesn't pulse when pushed it is turning inward but I do have hyper reflects in legEMG and NCS just showed 1-2+ fibrillations and positive waves right inifraspinatus muscle. Consistant with active denervation in that muscle which serves the suprascapular nerve whice emerges from the upper trunk of brachial plexus which carries the c5-6 myotomes. Needle sampling unremarkable. NCS didn't show any demyelination or axxon loss in the right median, ulna nerves on motor or sensory measurements. This was 9/3/15I am a bit detailed I think. Sorry again for the many messages but trying to give all info. If u are looking at my results I hope this helps
Customer: replied 1 year ago.
If I am too detailed please let me know this waiting to get into a neurologist is hard with all the unknowing.
Any response would be helpful?
Customer: replied 1 year ago.
Dr rick are you there or reviewing my info?
Customer: replied 1 year ago.
I sent a lot of my medical testing and have wondered since last night if they had been reviewed as of yet? Thanks again.
Expert:  Dr. Rick, MD replied 1 year ago.

Sorry for the delay.....Had the entire herd of grandkids over for Easter ;)

I have reviewed your data and, I must say, I agree with Dr. Bob

About the best advice I can offer is for you to seek out another opinion and possible more specialized testing at a University Medical Center.

Why a Medical center? Because 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.

I know that it is going to take significant effort on your part, but I believe that going to one of the "Medical Mecca's" is your best chance to – finally -- get to the bottom of what is going on.

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned the top rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Customer: replied 1 year ago.
I have given that much thought.
Can u offer any info from the test results I shared with you?
I hope u have a blessed Easter and sorry I interrupted you time with family
Expert:  Dr. Rick, MD replied 1 year ago.

You did not interrupt my family time, but thank you for your concern.

In my opinion, Dr. Bob hit it right on the head when he gave his opinion on your test results. I agree 110% with him.

Does this make sense to you?

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick MD FACS

Have a Happy Easter :)

Customer: replied 1 year ago.
It would suggest that the denervation is due to either the NF stenosis or a combination of the NF stenosis and the spinal stenos. This was from Dr Bobs answer.
That is why I sent the updated EMG/ncs results to show where the denervation was connected to.
After seeing that new testing I was asking if that shows consistentcy with the cervical neck area affected. And can a laying MRI miss trapped nerves in that area?
Also my other question was I see my GP tomorrow and wanted to know if there are any specific labs I should have done?
Thank you once again and I want bother again I just needed those specific questions addressed if possible.
Please have a blessed Easter
Expert:  Dr. Rick, MD replied 1 year ago.

At this time you do not need any specific or special tests done from my point of view.

Your GP will be able to figure out what to do after she examines you since she knows you best.

Please don't forget to rate :)

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick MD FACS