Rate My Neurologist

[Fed Up]

Yesterday my neurologist(not my M.S. doc) told me that "O" bands vary and come and go with infections, simple virus's and inflammation. According to him, they come and go, even with exposure to someone else coughing.

I asked him " if a flaw in the blood-brain barrier cause's "O" bands to get into the spinal fluid..How do they get out?" Needless to say we had a "spirited discussion" and he left smiling and laughing at me; Never really answering the question! fed

[jreagan70]

O-bands is a complex discussion, and without actually hearing both sides of your conversation, it's impossible for anyone to rate your neurologist based on one discussion and your perception of it.

It could be that your neurologist did answer your questions, but if it wasn't in a way you were expecting, you might not realize that he did answer them. If he was talking about O-bands in general and your understanding is based only on O-bands in MS, it's possible that his answers didn't fit in with the limited scope of MS and you didn't know how to interpret what he said out of that context.

I asked him " if a flaw in the blood-brain barrier cause's "O" bands to get into the spinal fluid..How do they get out?"

O-band proteins cross the blood-brain barrier in both directions by an active protein transport mechanism that allows the transport of some proteins, but they seem to pass out of serum and into cerebrospinal fluid more readily than they cross out of CSF and into serum. (I haven't researched that enough to know the details of the direction of transport.) Which direction they go and where the greater concentration is -- or equal in both CSF and serum -- is a determining factor in diagnosing MS vs. some other condition.

Therein might have been the failure of communication between you and your neuro on this topic. Without knowing the context of the discussion, and without knowing exactly what was said by both sides, it isn't possible to rate your neurologist.

[Fed Up]

We are talking about a "general practice neurologist." Not my M.S. doc.

O-band proteins cross the blood-brain barrier in both directions by an active protein transport mechanism that allows the transport of some proteins, but they seem to pass out of serum and into cerebrospinal fluid more readily than they cross out of CSF and into serum. (I haven't researched that enough to know the details of the direction of transport.) Which direction they go and where the greater concentration is -- or equal in both CSF and serum -- is a determining factor in diagnosing MS vs. some other condition.

This makes more sense than anything he said.

Therein might have been the failure of communication between you and your neuro on this topic. Without knowing the context of the discussion, and without knowing exactly what was said by both sides, it isn't possible to rate your neurologist.

He was in an extreme hurry and when his aide called me into the Dr. patient area she said, "I'll take your Vital Signs and quickly slip you in a room!"
She was very rushed as if the Dr. was late coming back from lunch or took too long to do an "in office" procedure -- Lumbar Puncture.

The automatic B/P machine wouldn't take a reading on my Blood Pressure; I had a serious concern that it was either way too high OR way too Low. 2 weeks prior I was asymptomatic hypotensive with a B/P of "low 60's over 30's in Rheumotologists office!"

I felt just fine, absolutely fine, and I NEEDED that visit with Rheumie. As the office aide and then a nurse tried to sweep me to ER and Rheumotologist wouldn't see me, as a result. With all that, my b/p was finally normal and I stopped blood pressure medication with normal b/p's since--for now anyway.

My neurologists aide was less interested in what my B/P, as she was trying to scurry to her job.

The Neurologist came into the exam room with a sense of urgency and wanting to say a couple words and exit--he had a Resident with him, about to do a lumbar puncture-as soon as I left.

Since I am not able to recall verbatim what he said..."Cognitive Issues"--which have been severely decreased with a low dose of Wellbutrin. It started working within 20 hours (first improvement of cognitive issues in over a decade or more). I sounded a bit more intelligible than any previous visit and my speech wasn't even slurred. Essentially, he said that O bands can come and go across the blood brain barrier at will, by just being around a virus or infection..even if it is someone else. We were specifically discussing M.S. and "O" bands.

I am extremely curious; pretty new to MS in past 3 years and I have questions. Again; he was in an extreme hurry, I wasn't.

It was the first time I was able to actually communicate with him, due to my cognitive issues being reduced. He left the room smiling/laughing while shaking my hand...he has never done that before. And even said that it was a successful appointment--mostly because, I think it is the first time he knew the 'lights were on and I was finally at home" in my head.

Oh, I had a T.I.A. (trans Ischemic Accident-precursor to a stroke) and had paramedics at my home until the event passed and stayed at home; my little dog had been injured and I wasn't going anywhere without her. The numbness in my Right Upper lip was resolving and I requested no further assistance. This I explained to the same Neurologist.

He told me that was syncope. Gave a really good explanation, almost. However, I told him it was a hypotensive event I tend to get frequently, it was only caught in the Rheumie's office--as stated above. I had no fainting, light-headedness or even falling feeling--definitely was not syncope, unless the medical definition has changed.

He definitely gave a good explanation of syncope except, that was not what happened and he clearly didn't hear me when I said, "I did not go to the ER because of the expense and it was resolving. There wasn't any point in spending hundreds and hundreds of dollars to be stuck there looking for a ride home.

He also told me my insurance company refused on the Brain MRI's. Ultimately, I let him know the name of my HMO is an Insurance Company and he was being a "Claims Adjuster." IDK why, being in the medical field watching it from the early '70's from a very busy group of Orthopeadists with insurance billing,

I am in an HMO that happens to have some of the most excellent doctor's in the world to the worst non-compassionate docs in medicine for the money and making it to their golf "T" time or mid life issues, etc. Doctors use to ALL be excellent and seldom wrong, especially without all the fine lab testing that keeps getting invented.

Changing HMO's and losing Docs that I've had for 15 or more years, is not acceptable; MS has taken enough from my life, at least I do have excellent docs, for the most part. Just watching medicine from the inside over decades makes me sick, everything is always about money and productivity.

Still curious what others have to add on the subject. Thanks for a response and I sure hope we have some more discussion of this issue and maybe 'links' to any previous threads of this nature; or a good source of "trusted information." thanks again...Fed

[Marco]

O-bands can and do change over time. That is why you must have a blood test in close time proximity to your lumbar puncture. If your neuro is getting the main stuff right then I would extend a little grace on some of the finer details. It would be awesome to all have perfect doctors and even better if they had patients with perfect health. Interesting conversation though.