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From: MARTHA ARNOLD
To: Rodney Quinn MD - FD-Neurology (FD-Neurology - Nurse/Back Office)
Sent: 02/01/2019 09:12 a.m. CST
Subject: Forgot to ask....
Thank you for your message. It has been successfully sent to the appropriate care team.
I knew this would happen even with my list of questions. Sorry.
I meant to ask about any possible meds to help with falling asleep. I still have just a few Clonazepams that I have been cutting in half and they work very well. But I know you don’t like to offer them anymore. I’ve never had any reactions to them. But you might have a better idea.
About the supratentorial leukoariosis.... Carol wanted me to ask about the possibility of tiny strokes. You didn’t mention that so I assumed that is not what is going on. I have not had any stroke-like symptoms except maybe all this lightheadedness and the numbness around my face. But I’ve had all that for many years and those things are what brought me to the diagnosis of MS. By the way.... if you had been the first doctor to see me way back, would you have dx MS? I always thought Dr. Sreepada had it right, but now I wonder. Maybe I’m just a very lucky person to have this minor case.
And about the damage that has already been done... do I understand that right? The lesions you showed me on the MRI actually are most likely MS lesions?? Sorry for the confusion on my part.
My primary believes I also have TMJ since I grind my teeth at night. Could explain the pain in my jaw. And I get sporadic events of Trigeminal Neuralgia... ouch. The ringing in my ears is constant.. on the right. But it has started in the left too occasionally. We started to talk about that. And I have been choking like crazy... could be sinus/allergy or Gerd I think. I don’t imagine this is some new MS thing.
I do wonder about the dizziness when I eat. I’ve had a few times when I thought I would black out, but never did. Scary stuff. Sorry to bring up so many questions. I don’t mind so much being "sick", but I am OCD about wanting to know what is happening. Speaking of OCD.. I am still pacing around, constantly moving things around, back and forth.. lots of action. Started before Sam died. Still have some anxiety.. especially around people.. even my kids. I love them, but I just get so antsy around people at times. Probably why I forgot to talk to you about a few things.
Well, I think that’s it. Will get on those tests by next week. Thank you so much for taking the time to show me my MRI in detail. And for checking my shoulder. I know you didn’t have to do that.
Marti
These are my neuro's answers to my questions that I sent him AFTER our visit. I always forget things, even with my notes.
1. Latest evidence shows that combining short and long acting melatonin at the hour of sleep is effective in many individualls.
The melatonin immediate release induces sleep quickly.
The melatonin extended release has longer duration of action to promote sleep after the immediate release has worn off.
Common adverse effects of melatonin include hypothermia, sedation, somnolence, and fatigue.
2. MRI scan and all radiologic tests give images based on the physical proprerties of the brain matter (subatomic particle density, density of tissue, water content, etc.) It is always important to remember that radiologic images do not make pathologic diagnoses (diagnoses based on the appearance of tissue appearance under a microscope, for which biopsy or autopsy must be done (this is often not practicle in daily medical practice).
3. The leukoareiosis lesions are not strokes. Medical research from correlative studies between MRI brain scans and brain neuropathology slides from autopsy has shown that where these MRI lesions are located, sometimes nothing at all can be found in the pathology of the brain at autopsy.
4. Evidently many conditions cause nonspecific white matter abnormality.
5. The nonspecific white matter changes are abnormal, but could be seen in a variety of disorders including consequences of birth related complications, immune responses to viral infections or immunizations in the past, traumatic brain injuries, autoimmune vasculitis, antiphospholipid antibody syndrome, neuroborelliosis, migraine, arteriosclerosis and a variety of other conditions as well.
6. We will never know whether MS caused these lesions and has now gone into remission, or whether they were ever due to MS in the first place.
7. The radiologist says that not all of the strict criteria for a radioligic diagnosis of MS have been met, and that the lesions are nonspecific.
8. We can say that the scan was very encouraging because no definite evidence of any new disease activity is identified.
9. The TMJ diagnosis is interesting and important, since proper treatment of that could help you to feel better.
10. It is correct that the pacing, and other symptoms described are likely to be symptoms of anxiety.
11. After we get results of the recent tests, we can consider treating anxiety.
R. Quinn, M.D.
From: MARTHA ARNOLD
To: Rodney Quinn MD - FD-Neurology (FD-Neurology - Nurse/Back Office)
Sent: 02/01/2019 09:12 a.m. CST
Subject: Forgot to ask....
Thank you for your message. It has been successfully sent to the appropriate care team.
I knew this would happen even with my list of questions. Sorry.
I meant to ask about any possible meds to help with falling asleep. I still have just a few Clonazepams that I have been cutting in half and they work very well. But I know you don’t like to offer them anymore. I’ve never had any reactions to them. But you might have a better idea.
About the supratentorial leukoariosis.... Carol wanted me to ask about the possibility of tiny strokes. You didn’t mention that so I assumed that is not what is going on. I have not had any stroke-like symptoms except maybe all this lightheadedness and the numbness around my face. But I’ve had all that for many years and those things are what brought me to the diagnosis of MS. By the way.... if you had been the first doctor to see me way back, would you have dx MS? I always thought Dr. Sreepada had it right, but now I wonder. Maybe I’m just a very lucky person to have this minor case.
And about the damage that has already been done... do I understand that right? The lesions you showed me on the MRI actually are most likely MS lesions?? Sorry for the confusion on my part.
My primary believes I also have TMJ since I grind my teeth at night. Could explain the pain in my jaw. And I get sporadic events of Trigeminal Neuralgia... ouch. The ringing in my ears is constant.. on the right. But it has started in the left too occasionally. We started to talk about that. And I have been choking like crazy... could be sinus/allergy or Gerd I think. I don’t imagine this is some new MS thing.
I do wonder about the dizziness when I eat. I’ve had a few times when I thought I would black out, but never did. Scary stuff. Sorry to bring up so many questions. I don’t mind so much being "sick", but I am OCD about wanting to know what is happening. Speaking of OCD.. I am still pacing around, constantly moving things around, back and forth.. lots of action. Started before Sam died. Still have some anxiety.. especially around people.. even my kids. I love them, but I just get so antsy around people at times. Probably why I forgot to talk to you about a few things.
Well, I think that’s it. Will get on those tests by next week. Thank you so much for taking the time to show me my MRI in detail. And for checking my shoulder. I know you didn’t have to do that.
Marti
These are my neuro's answers to my questions that I sent him AFTER our visit. I always forget things, even with my notes.
1. Latest evidence shows that combining short and long acting melatonin at the hour of sleep is effective in many individualls.
The melatonin immediate release induces sleep quickly.
The melatonin extended release has longer duration of action to promote sleep after the immediate release has worn off.
Common adverse effects of melatonin include hypothermia, sedation, somnolence, and fatigue.
2. MRI scan and all radiologic tests give images based on the physical proprerties of the brain matter (subatomic particle density, density of tissue, water content, etc.) It is always important to remember that radiologic images do not make pathologic diagnoses (diagnoses based on the appearance of tissue appearance under a microscope, for which biopsy or autopsy must be done (this is often not practicle in daily medical practice).
3. The leukoareiosis lesions are not strokes. Medical research from correlative studies between MRI brain scans and brain neuropathology slides from autopsy has shown that where these MRI lesions are located, sometimes nothing at all can be found in the pathology of the brain at autopsy.
4. Evidently many conditions cause nonspecific white matter abnormality.
5. The nonspecific white matter changes are abnormal, but could be seen in a variety of disorders including consequences of birth related complications, immune responses to viral infections or immunizations in the past, traumatic brain injuries, autoimmune vasculitis, antiphospholipid antibody syndrome, neuroborelliosis, migraine, arteriosclerosis and a variety of other conditions as well.
6. We will never know whether MS caused these lesions and has now gone into remission, or whether they were ever due to MS in the first place.
7. The radiologist says that not all of the strict criteria for a radioligic diagnosis of MS have been met, and that the lesions are nonspecific.
8. We can say that the scan was very encouraging because no definite evidence of any new disease activity is identified.
9. The TMJ diagnosis is interesting and important, since proper treatment of that could help you to feel better.
10. It is correct that the pacing, and other symptoms described are likely to be symptoms of anxiety.
11. After we get results of the recent tests, we can consider treating anxiety.
R. Quinn, M.D.
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