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17 hours ago · Herniated disc in Spine Health

@farmgirl57 Hi Carol. It sounds like you are doing great and handling this well and directing your path down the road. I was thinking last night that I should have mentioned the possibility of nerve entrapments that are not spine related, but have overlapping symptoms. For example, I have thoracic outlet syndrome which causes tight tissue that entraps nerves and vessels under the collar bone, in between scalene muscles (at side of neck), and under the pectoralis minor muscle on the front of the chest where it makes an attachment in the armpit. TOS prodices arm tingling, weakness and numbness. Ask the neurologist that you see at Mayo if you could have something like that. It's possible that your shoulder surgery is causing tightness from fascial scar tissue and causing nerve compression. Mayo can diagnose and treat TOS and that can be physical therapy with myofascial release. I had both of these problems at the same time (TOS and a ruptured spinal disc). I still do MFR with my physical therapist, and also doing it for a few years before spine surgery helped make it easier for my surgeon because the muscles were looser for retraction during surgery. There is surgery for TOS, but it can make a patient worse because of fascial scar tissue and I was advised that physical therapy long term was best for me. Here is our discussion about myofascial release. It can help you loosen surgical scar tissue after surgery, and you will have some also from your shoulder surgery. I didn't know you had prior treatment at Mayo, so you know how nice it is there. I'll be rooting for you and waiting to hear about your visit.



1 day ago · Herniated disc in Spine Health

@ktgirl Hi Carol. This is a long post. Let me know if you have further questions. Your responsibility is to look out for yourself, and your doctor should be supporting your decisions to get the best care that you can for yourself. As patients, sometimes we think a person is upset, but in reality they are not, and you won't be the first patient to get another opinion somewhere else. Getting other opinions is common and should be encouraged by your doctors for major surgery. There are a lot of referrals in house to try to keep a patient within a hospital system that is run for profit. That's different at Mayo too as everyone is an employee. They will refer you to other specialists as needed, but your physician doesn't profit from your care. They are paid a salary as an employee and are not an owner of a medical group. It's a big decision when you chose to have surgery and you'll get different opinions and different answers sometimes and biases because of possible profits. It's up to you to chose the path to the best possible care and outcome. If your doctors are not putting your needs first and assessing all the connected issues, they are not really focused on you. It will be different when you get to Mayo. I think you made a great choice to go there for an opinion.

I don't expect a new MRI to be done of the same area as was done a month ago as long as the images are good. When I came to Mayo with an MRI that was several months old, they didn't redo it, and I asked for MRIs on the rest of my spine to rule out other issues because I had pain all over my body caused by cord compression in my neck. For me, it helped me to understand how the procedures work and to visualize what is done during surgery. Some patients don't want to see the animated videos that explain things, but since I have a science background, it helped me understand how to fix the problem. By the time I got to Mayo, I was relieved and knew that I was finally going to get help after 2 years of being turned away elsewhere. It is stressful to have a medical problem when no one wants to help. Be prepared to explain the details of your symptoms and when it is at it's worst or best, etc.

When you get to Mayo, what you can expect is doctors who care about you. If you do have surgery on one level, it is possible to have a fusion without hardware and stay in a neck brace until bones fuse. That is what I chose and I don't have to worry about possible hardware complications. First, they need to evaluate the problem and create a treatment plan. If you are looking at surgery, here are questions from my list. You likely won't have time to ask everything, so pick and choose what is important to you and bring the list with you. The first question should be with your insurance company to ask if your treatment will be in network. Also ask your insurance company about MRI imaging. My insurance does not want to pay for MRIs at hospitals and wants to have them done at independent imaging centers because they are controlling costs.

My surgeon did the entire procedure except for closing the incision. That was done by doctors in the neurosurgery program (7 year program at Mayo) and they also visited me before and after the procedure, wrote precsriptions, and were on call for any issues post op. My surgery was and hour and a half with just a single level donor bone implant. I could have had an artificial disc, but I wasn't the best candidate for that because of 2 mm of backward slipping C5 over C6. I asked the surgeon's nurse to hold my hand, and she did in the operating room. I was actually curious about looking around in there and I saw my photo on a monitor with my information. I think you will get to Mayo and relax. There is a lot to ease your mind, great art work, piano music, and pretty places to hang out while you wait for appointments, and you'll be busy with the schedule of testing, etc. You can take a favorite photo with you, or a music player.. what ever will help. I consider Mayo to be my happy and safe place. They changed my life. I never felt that way at any of the other places with surgeons who saw me before Mayo; there were too many unknowns, unanswered questions, and attitudes, and I didn't feel welcome. All of that makes a huge difference in having a great recovery. You will be in great hands.

Here is my list of questions:

1. What type of surgery are you recommending? Why? What is the specific anatomic lesion being addressed? Have them show it to you on the imaging.

2. What is the natural course of my condition if it is not surgically addressed? What are my non-surgical options?

3. Why does the surgeon recommend this specific procedure? What are the potential results for this surgery? Why am I a good candidate for this surgery?

4. What is the source of the pain that is being addressed? How do you know this?

5. Please explain the procedure in great detail.

6. What products and implants are used? Is everything to be used FDA approved for this application?

7. What are the chances that the osteophytes will regrow? If so, what will minimize that chance?

9. What are the different surgical procedures that can address my problem? What are my choices?

11. What would you recommend if I was your friend, wife, sister, or daughter?

12. How long will the surgery take?

13. What are the possible side effects, potential risks, and potential complications? Please explain the risks and how they relate to me personally.

14. Do any of the materials used increase my chances of getting cancer? Are there common reactions to implants, metal sensitivities, plastic sensitivities, toxicities? Do I need to be tested for possible adverse reactions?

15. What happens to an artificial disk as it wears? How long would it last? Any not made of metals?
Are the metals used the same or different within the implant?

16. How great is risk of adjacent segment disk degeneration? Are there other discs that show degeneration now that could become problematic in the future? Do you think I will have a problem in the future on adjacent levels?

17. Do I have to have a metal plate on my spine? Is there another way to stabilize the spine?

18. What if, during my surgery, you encounter a different spine issue than you expected?

19. What is the risk/benefit ratio (the chance of a bad outcome as weighed against the chance of a good outcome)?

20. What are the standard safety and cross check procedures to insure my safety during the surgery?

21. Do you use neuromonitoring during surgery?

22. Are you using robotic assistance or free-handing?

23. Do I need to donate my own blood? If yes, why?

24. Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation? If yes, What are their background and qualifications?

25. What are the long-term consequences of the proposed procedure?

Questions about the surgeon

1. How many times have you done this procedure?

2. Are you fellowship trained in spine surgery? This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.

3 . If I want to get a second opinion, who would you recommend?

4. What is your personal success rate, and how many of this type of surgeries have you done?

5. How often will I see you after my surgery?

6. What expectations do you have for my recovery?

4 days ago · Gratitude Discussion Group in Just Want to Talk

@gingerw Do you have someone to accompany you? It seems that a long drive gets even longer when you don't feel well. We'll be here to support and encourage you. God bless.

4 days ago · Occipital Neuralgia in Brain & Nervous System

@jmb73 @bumble81 I also get occipital headaches that happen on the back of my head on one side. For me it is a physical problem that is caused by a slight misalignment of the upper cervical vertebrae, usually C1 & C2 that are caused by muscle spasms in my neck. Essentially, when the the skull doesn't sit correctly on top of the spine, it causes the muscles on the back of the head to complain. I had a whiplash 20 years ago, and had muscles spasms ever since that, and eventually spine surgery for a ruptured C5/C6, and now after surgery, the muscle spasms are infrequent and my neck is maintaining the correct curvature alignment. I had a lot of cervicogenic headaches prior to spine surgery.

A physical therapist who is knowledgeble with spine surgery rehab can probably help this type of issue. The best advice is to first evaluate with a specialist for any instability at the upper cervical vertebrae and skull. No one should attempt to realign anything in the spine if there is instability because it causes slippage of vertebrae past each other and can be very serious if that happens right under the skull and effects the spinal cord. If things are stable, then a physical therapist can work on the problem. A PT should always insist of imaging and an evaluation first before they do any work on a patient, or they can risk injuring the patient.

I can still trigger a slight issue that causes independent rotation of C1 and C2 if I sleep wrong or get a neck/shoulder spasm from overexertion. I am a lot more aware of this now from working with my physical therapist. I can also stop the spasm when it starts by bracing one arm and pushing my head back toward that side that hurts against resistance from my other arm. The reason that works is because there is a muscle that connects C1 and the spine and the other end connects to the shoulder blade. So when I brace my arm, I am stopping the shoulder blade from moving at that end of the muscle, so the muscle can pull against the resistance and move the other end which is attached to the side C1 which rotates C1 back in place. That is my body's pattern and yours may be different. Working with a physical therapist can really help.

4 days ago · Ideas for pain relief from Small Fiber Neuropathy (SFN) in Neuropathy

@jager5210 You're welcome. I don't eat out very often myself, and always have a discussion with the staff. There are enzymes available now and I saw them at a CVS pharmacy that digest the gluten. I think people with gluten issues are deficient in the ability to produce this enzyme for digestion, so if you are eating out and are not sure, that is an option to reduce exposure. I had to give up nightshades for the most part, and I developed a reaction to tomatoes, but I found that I could tolerate them cooked in sauces if I don't do it too often. I can get joint pain in my fingers if I have too much. I also have asthma, and foods that trigger that are ones I avoid. I have been gluten free for 20 years and recently accidentaly ate a couple bites of Mac and cheese that wasn't gluten free and was real dairy. I thought it was the leftovers from my own gluten free/dairy free version. I did get pain in my stomach and intestines, but after a day, I was OK. My reaction to a mistake like that used to be worse like getting the stomach flu, and would also involve my asthma, and I think that because it had been years since my immune system was constantly fighting the gluten war, the soldiers were on leave. You can just start with basic foods without seasoning; plain meat and vegetables like your paleo diet. It gets tricky when you have to test individual ingredients and when labels don't tell you anything. That is true of a lot of seasonings and when a restaurant buys a large container of it, there isn't any guarantee, and they just don't know. That's why I avoid seasonings and spices unless I'm at home and know what is safe. I know for myself, any kind of pepper causes a problem. I've read that Bananas are related to ragweed, and I have breathing issues if I eat a tiny bite. Sometimes a person can tolerate a food if it is not eaten during the allergy season for a related plant. I can eat an egg yolk, but not the white and the only way to completely separate that well is hard boiling it first. I use the unsweetened coconut milk instead of dairy. I also treat my inhaled allergies for mold spores, grasses, ragweed, dust, etc. I do allergy shots. According to my functional medicine doctor, that reduces inflammation in the body for everything when you treat allergies that contribute to it. Just keep track of what is different about foods you ate if you don't feel well after. I give it a few tries to make sure I get the same results each time before I eliminate it altogether. Another suggestion may be digestive enzymes. I think as we age, we are less efficient at digestion, so adding some digestive enzymes may help. I have taken those before. The name of the game is really to try to reduce inflammation everywhere in your body as it is the root cause of a lot of disease. Eating foods that reduce inflammation helps a lot.

6 days ago · Waiting on diagnosis in Brain & Nervous System

@jl1 A lot of hemangiomas are benign. I have a couple of them in my thoracic spine and I wouldn't know about them without an MRI as there are no symptoms. They are an area of blood supply within the vertebrae, and there is less bone there because of the hemangioma. If they cause weakness in the bone or if the lesion grows into the spinal canal, that could be an issue. I asked my spine surgeon about mine and he told me it was nothing to be concerned about. Essentially it is like a birthmark which is a lesion caused by a clump of blood vessels and those can occur on internal organs.

Here is a link that explains. https://www.ncbi.nlm.nih.gov/books/NBK532997/

This is a case report of a symptomatic hemangioma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088736/

6 days ago · Ideas for pain relief from Small Fiber Neuropathy (SFN) in Neuropathy

@jager5210 Hi Barry. You might be able to work some things out for yourself. You can explore the possibility of food allergies or sensitivities that can cause inflammation that leads to leaky gut. That happened to me when I developed a gluten problem, and before I figured this out, a lot of food allergies followed because the leaky gut let incompletely digested food enter the blood stream. You can test this yourself with an elimination diet and see if you can improve. Diet can have a huge impact on health or disease and you probably already have knowledge about healthy foods, but you can still be allergic to healthy food. Avoiding foods like sugar and highly processed carbs that cause inflammation helps a lot too. You can add a good pro-biotic to start colonizing the gut with good beneficial bacteria which can over time replace the bad bacteria. There are also some medical foods from Metagenics or Orthomolecular for detoxing and reducing inflammation, and they also have some supplements to kill off bad bacteria before you start a detox. These products are expensive and sold by doctors offices and specialty pharmacies and you can find them online.

You could just start with foods in your diet to see if that is a cause of your gut issues. You start by eating one thing for a few days until you feel better. If that goes well, add one other thing. Keep track, and when you add something that makes you feel bad, write that down on your list to avoid. It will take awhile to figure things out. This is what I did long ago when my doctor would not listen to me about gluten and back then even the existence of celiac disease was controversial. I developed these issues suddenly after the stress of going through surgery years ago. Initially I thought I had a wheat allergy, so I was baking bread with spelt and that was fine for awhile, but then I started reacting to that, and I tested through diet to figure it out, and everything with gluten made me react and a few times I ate things with gluten (a rice milk product) unknowingly and still reacted. I have been gluten free for 20 years. I also had sharp pain in my hands that ended when I took dairy out of my diet. It is usually the specific proteins in foods that cause the allergies, and I can use butter without issues because it is the fat from milk. FYI- with all the gluten free foods available today, junk food is still just that with or without the gluten. Gluten can be in so many things and you can find information online about that. Humans did not evolve eating grains, but during biblical times, the cultivation of grain in agriculture allowed the population to grow and survive with the additional food sources.

Here is some information about gluten and celiac disease. Even if you are not gluten sensitive, you might feel better without it.



Sun, Sep 8 8:40pm · Acupuncture helpful for PN? in Neuropathy

@palmorejs Have you tried myofascial release? It can help. I do this myself for a different nerve entrapment issue and it helps me a lot. It is listed as being able to help pundental nerve issues. Here is our discussion where you can find lots of information. https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/