Radiologist vs. neurologist

[FaithGirl]

So, I've been reading these forums since Wednesday when my MRI came back saying "t2 prolongnation" like a Gliosis. The radiologist report said "dymyelinating plaque cannot be totally excluded".

So, my hematologist said it was indicative of a possible MS diagnosis and sent me to the neuro.

However, he said tons of people have "spots", and if it were a ms lesion it was old. (I'm thinking you to that based on how it flared, right? But there's no where on the report that said how it did or didn't flare?)

When I specifically asked what the "demyelinating plaque cannot be totally excluded" meant, he said it was radiology mumbo jumbo, and basically they were just covering themselves.

But, after reading on these forums, it seems there's a lot of support for radiologists and what they say. I feel like the neuro completely brushed off the MRI, but he didn't give me a lot of evidence that made me feel like I could trust his reasonings in why the Gliosis wasn't a big deal.

Thoughts? I've really appreciated all your stories and advice...I'm hoping we get some answers soon(ish)!

[Tinkerbell65]

Faith- the first thing that comes to mind for me is whether or not your neuro specializes in MS or not. I truly believe it makes a difference. At least get another opinion since your obviously not confident in the one you've gotten. Trust your gut. When my neuro started condescending to me about nutrition and supplements (cuz he didn't know about these things) I fired him and got myself a neuro.

That being said, one of the most frustrating things with this disease is that it's usually more a matter of ruling other things out instead of diagnosing right away. If you haven't already done so, I would encourage you to start journaling your symptoms- when they're happening, what you've been eating, stress level etc. I know it helps me- I'm more than likely going to forget about a symptom when I'm in the office if I haven't written it down.

Continue to educate yourself and try to be patient with medical science- it's far from perfect

Not sure if I've helped at all, but I wish you the best. Please let us know how things unfold for you.

[Thinkimjob]

I don't know, obviously, but "cannot be totally excluded" is pretty much what people say when they're 99percent sure it can be totally excluded.

What we've got now, scientifically speaking, is as good as it has ever been.

Diagnostics will get even better, but it's never going to be perfect.

[kingrex]

So, I've been reading these forums since Wednesday when my MRI came back saying "t2 prolongnation" like a Gliosis. The radiologist report said "dymyelinating plaque cannot be totally excluded".

So, my hematologist said it was indicative of a possible MS diagnosis and sent me to the neuro.

However, he said tons of people have "spots", and if it were a ms lesion it was old. (I'm thinking you to that based on how it flared, right? But there's no where on the report that said how it did or didn't flare?)

When I specifically asked what the "demyelinating plaque cannot be totally excluded" meant, he said it was radiology mumbo jumbo, and basically they were just covering themselves.

But, after reading on these forums, it seems there's a lot of support for radiologists and what they say. I feel like the neuro completely brushed off the MRI, but he didn't give me a lot of evidence that made me feel like I could trust his reasonings in why the Gliosis wasn't a big deal.

Thoughts? I've really appreciated all your stories and advice...I'm hoping we get some answers soon(ish)!

By "flare" I assume you mean "enhanced" - lit up - after gadolinium was injected? If not, then I'm not sure what you mean.

The thing is, if you don't understand radiology terminology, you shouldn't pick out phrases and post them here - you should post the entire report as it was dictated. That would make it far easier to answer your questions.

BTW - whoever told you that the phrase "demyelinating plaque cannot be totally excluded" is mumbo-jumbo and used to "cover" the radiologist is dead wrong and way out of line. What it does mean is exactly what it says - that the possibility exists, so that your neurologist will consider that possibility when examining you clinically.


rex

[FaithGirl]

Rex, thank-you. I did mean enhance. I can post more of the report-I was basically just posting then 2 sentence conclusion.

I do appreciate your thoughts on the neurologist calling it mumbo-jumbo. That's what I was really confused about-how the radiologist could see a Gliosis, saying demyelinating plaque could not be totally excluded, but the neuro. say it was "mumbo-jumbo".

[FaithGirl]

i just found that the MRI was read by a neuroradiologist - that's good, right?

It's just confusing why the neurologist would so quickly brush off the radiologists' report?

and, what's the wording on the report that would show if the gliosis was enhanced or not after the contrast went in?

THANK you for your help! I have loved these forums over the past week - as I've been trying not to panic!

[Shiela]

IMHO-You should press your neuro for answers to your questions.

[kingrex]

i just found that the MRI was read by a neuroradiologist - that's good, right?

It's just confusing why the neurologist would so quickly brush off the radiologists' report?

and, what's the wording on the report that would show if the gliosis was enhanced or not after the contrast went in?

THANK you for your help! I have loved these forums over the past week - as I've been trying not to panic!

If you could post the report, it would be easier to respond to your questions about it. And yes, a neuroradiologist is good.


rex

[0485c10]

IMHO-You should press your neuro for answers to your questions.

there was a period of time i was very frustrated with my neuro and the answers i did not have. i ended up writing my question and concerns down in some cases explaining my concerns what i wrote. i made a copy for my self and brought a copy of it with me. then in the appointment i gave her, her copy, kept my copy and used it as notes to do an overview of what i was looking for..what i feared and what concerns i had(the big one was money that i needed to manage through this whole situation)

it was like i had thrown a glass of water in her face. she quickly skimmed the copy i gave her as she listen to my overview of my concerns. she asked if she could keep the copy for my file. and i said yes of course you can that's what it is for.

she spent more time answering the specific question that i had..more than you can imagine...she just needed direction.

its been 3 years since i did that & i feel i remain an out of the ordinary patient to her because i did that. its like i became a person. i think she spends more quality time with me...she always asks if she has answered all my question before she leaves, waits and listens to my answer..quality time not more time, you still have to respect the time constraints they are under. not use it to weasel more appointment time, time that you don't want to pay for.

i think they(doc) really want to do well, they just need direction on what each individual patient is looking for...some patients don't want to know anything and some patients want to know everything. after they(the patient) have done their homework, as you are doing to understand the terms used in the answers.

they(docs) don't get paid to educate, they get paid to treat. at times the answer has be rather "brushed off" because they don't get paid to educate to a medical degree level...(i know that statement can be read wrong--they get paid to educate so the patient knows how to care for themself or select a treatment..but not to the level of a medical degree --that's the homework you are doing so you can ask and understand answers.

you have to respect their time if you do something like this, and i hope you do. they will respect you back equally.

you hired the doc for his interpretion of the information, thats what he is giving you. he might not even know the answers you were given were not what you were looking for. his next patient it might be enough and even more than that patient wanted to know?..how is the doc suppose to know which it is?

[0485c10]

When I specifically asked what the "demyelinating plaque cannot be totally excluded" meant, he said it was radiology mumbo jumbo, and basically they were just covering themselves.

just he didn't give me a lot of evidence that made me feel like I could trust his reasonings in why the Gliosis wasn't a big deal.

it sounds as if your question has less to do with the mri or ms and more to do with what the gliosis is? perhaps that is what your questions will be?

to the doc:
1. can you tell what is affected if anything? if affected why or why not?
2. can you tell when it occured?(which may be visible in serial mri's but not likely in a single mri. it may be in clinical observations. technology has a limit. some question have no answers. (for ms lesions at least)


MS lesions, stay active(enhance with dye while they are being formed) on average for 30 days. some more some less but on average 30 days. some can stay active for about a year...after that they show inactive and don't show age just older than when they were active.

older ms lesions mean older than 20+ days, could be 20, 30, 50 years or how ever old you are? actually in ms terms, which a gliosis is not, its easier to describe the lesions as active(enhancing) or inactive (hyperintense). i'm not certain if those are the terms of gliosis? which is what i think interest you the most?

btw: Tinkerbell65 has recently diagnosed ms with a past head injury?(which she only discuses generally--so i don't know much about it, except it complicated her ms diagnosis. you may gain much from her experience with 2 head/brain issues, one being ms )

[Tinkerbell65]

Hi 045c10 and everyone else-

I appreciate you bringing my tbi up- i guess I haven't gotten very specific about in the past, because I didn't want to bore anyone. When I was 19 I was hit head on by a drunk driver- came very close to losing my life so I consider myself very lucky. While I obviously had other injuries the most concerning was the closed head trauma. I had to be revived and they didn't know how long I'd been out. The hit I took also robbed me of my sense of smell- If you're going to lose a sense that's the one to lose- it made changing diapers so much easier

But I digress....they told me I might not be able to return to college but I did and graduated with good grades. After the MS was diagnosed, I lost a couple of jobs in relatively quick succession- not at all normal for me. That's when my neuro suggested a neurypsych eval. Once I had that it identified my cognitive difficulties and the neuropsych also mentioned that she was surprised no one had brought up the issue of the width of my corpus collosum (at least I think that's what it was). The part of your brain that transfers information back and forth. As a result of the head trauma, mine is thinner than "normal" people's. In college I was able to compensate for it by studying harder etc., but the MS has severely compromised my ability to do that anymore.

I can't retain new information quickly enough, am more easily confused, don't remember, can't multitask etc. Makes obtaining a job pretty difficult since employers can let you go within the first 90 days without having to explain. Although in both circumstances I knew why- I just thought that if I tried hard enough it would get better. So that's my story- I apologize if I've been too long winded.

Faith- if you or anyone else has more specific questions, please don't hesitate to let me know, I'm always happy to do whatever I can to help

BTW, I just want to mention that thankfully neither the tbi nor the MS has robbed me of my sense of humor