This Is MS Multiple Sclerosis Community: Knowledge & Support

Nigel,
I always did thorough standard orthopedic and neurological exams on all my patients. I also did basic and advanced manual muscle testing and examination of origins and insertions as well as trigger points. I checked posture and gait on every visit. They tell you a great deal. I would check out patient's posture and gait if I met them in town. I have x-ray vision. Physical testing is one of the best ways to determine if you have achieved what you intend to accomplish, as well as for ongoing monitoring. The other tests are MRI, MRA cine MR and US. NUCCA has an exceptional posture monitoring device called the Anatometer and there is digital thermography.

The link below is to an article on an increase in ricketts in the UK due to lack of exposure to sunlight and sunshine vitamen D. The bones are one of the first tissues to suffer from lack of vitamen D.

http://www.dailymail.co.uk/health/article-2072377/Keeping-sun-bringing-rickets-cases-increase-fivefold-14-years.html

As I mention in my book, Eskimos don't get MS. They also have very little skin exposure to sunlight because, except for their faces they are covered up most of the year. They also are exposed to long dark nights and winters. But they do eat a lot of fish which are loaded with vitamen D.

For landlubbers and fussy or non-fish eaters, the yolks of free range chickens are a good source of vitamen D. Conveyer belt chickens aren't nearly as good.

http://www.motherearthnews.com/eggs.aspx

Be careful what you read in the Daily Mail, consider it the newspaper version of Fox News.

dr. flanagan,

i wish you were treating me but i have to go with what i have here. i need a game plan.

what i was asking was do you think first remove the spurs and correct the stenosis endroscopic then correct the jaws or vice versa. i just need reassurance i guess i don't wanna mess up.

i think i know the answer but reassurre me.

thanks as always

Hi, Dr seems we are all putting pressure on you to help us.

I have just had a productive appointment with my GP who is sadly leaving at the end of the month to go on an overseas mission to PNG as a GP and trainer.
So I have a window of time where we are trying an approach to get the help of a Radiologist that Tim has a report with. At the clinic where the Radiologist works they have a new MRI of quality, what ever that means.
So GP Tim has asked my to ask you if you know if there is a specific MRI technoque sequence or methodology for the dx of Chiari?

What Tim will do is ask the Radiologist who on his bio says that his interests are in head and neck radiology and CSF flows amongst other things. What Tim needs to know is whether there is anything that we need to ask for to get the best images for dx of Chiari.
If this guy says I will be best to travel to Australia for Upright MRI, then that is what I am happy to hear, we will ask his best advice from the people who are locally doing what we need to know with what we can give him as info on our quest, if that makes sense. To say to him that this is what we believe we need, has he any insight or input.
The challenge is I have only a very short time frame for Tim's help before I have to educate a new GP!

*So the question is;
Is there a specific technique (eg, slice spacing's, sagital etc) for MRI to dx Chiari and can normal horizontal MRI detect Chiari zero or One malformations, so that we can ask this Radiologist or an Upright MRI Radiologist to take the films I need to have done for dx on Chiari?

Thanks Dr, sorry to butt in Blossom,
Regards all,
Nigel

You can find the story in several news sources in the UK. All you have to do is do a google search for "rickets in the UK." There is an article in the BMJ as well. Personally, I think the BBC is as bad as NOW and Faux News.

http://www.bbc.co.uk/news/uk-england-hampshire-11741262

Blossom,
If I thought working on your TMJ would straighten out your problems or improve your condition in any significant way I would drive out there and fix it myself. Your TMJ is a minor concern. The spondylosis is the problem. The spondylosis causes deformation of the cervical spine which affects the upper cervical spine and TMJ. The upper cervical spine and TMJ did not cause the spodylosis. It was most likely caused by trauma.

If the surgeons stick to endoscopic surgery there is very little chance they will mess you up and make thing worse. You don't want open surgery (laminectomy). You want a laminotomy. In a laminectomy they remove the posterior arch of the vertebra to gain access to the site. It's open surgery and requires general anesthesia. In a laminotomy they go through a small tube inserted between neighboring bones. Nothing is cut and general anesthesia in not required. The downside is you may not get the desired result. The upside is it will definitely improve blood and CSF flow as well as the health of the cord.

Nigel,
I will get back to you.

Thanks Dr,

Nigel,

Chiari malformations can be checked in the standard supine position but upright MRI is much better for Chiari 1 for obvious reasons. Flexion and extension cervical MRI views also make a lot of sense in your case.

I would suggest you or your GP contact Dr. Gaillard in Australia for any particular recommendations he has for taking scans to check for a possible Chiari 1. Dr. Gaillard is a radiologist familiar with Chiari malformations and could provide you with any specific information you need.

I used one of his scans with permission on my webite. I may be contacting him soon to use a rare scan he has of a Dandy-Walker syndrome. His link is below. Let me know what he suggests.

http://radiopaedia.org/users/frank

Thanks Dr.,
Tim and I will get onto this asap,
Thanks,
Nigel

thank you dr. flanagan, i pretty much thought you'd tell me that. i guess all these yrs. of trying to get the spurs etc. addressed and couldn't and now it can be happening has me excited and cautious.

but, like you said endroscopic surgery has come a long way-i'm sure fine tuned more than 20 yrs. ago.

so far none of the places i've talked to have an upright mri. i would think they should. do you feel that will catch everything they should with a reg. mri?

when i get this done i don't want those suckers growing back. got any suggestions to help prevent that or restenosis?

i know you said and i know that the results may not be everything i want. but, onetime you mentioned that my problems there is where the arms and legs can be effected. if i understood right. so, we know no guarantees.

i aways appreciate your knowledge and kindness you extend to me and others here. thanks

Nigel,

I just recieved the following reply from Dr. David Harshfield. Harshfield is the radiologist and specializes in upright MRIs. His reports are also the best I have seen.

"We can make the diagnosis of CTE on recumbent MRI’s, although not as easily as on upright MRI’s, and there are additional secondary findings that are indirect evidence of increased intracranial pressure, such as dural ectasia of the optic nerve sheaths, prominence of the Meckel cave regions of the CSF space adjacent to the cavernous sinuses, prominent perivascular spaces of Virchow Robin, prominent posterior cerebral veins, pacchionian granulations along the transverse and sigmoid sinuses and other subtle findings. I would be happy to talk with your colleague" if you want to give him my cell number,,,thanx,,d"

Let me know what you hear from Dr. Gaillard and if your GP Dr. Tim would like to speak with Dr. Harshfield. If so I will give him Harshfield's cell phone number.

Blossom,

Endoscopic surgery has come a very long way and it is a perfect solution for cases like yours. It's similar to arthroscopic surgery of the knee to shave down spurs and repair a torn meniscus (cartilage/disc) in the knee.

The spurs don't actually grow. They are calcium deposits in the ligament called traction spurs. They are the result of chronic strain on the segment. It will take decades for the spurs to come back if at all and the surgical solution will be even better. The disc between the spurs breaks down and bulges out. It can't grow back. The other thing you need to consider is that the spurs can continue to enlarge and eventually they will contact the cord. As it is they are just about there now, especially when you flex your chin to your chest. It's better to get it done before it gets there.

The long motor (muscle) tracts traveling from the motor cortex in the brain down to the spine are located on the front side of the cord. They are the first to feel the effects of the traction spurs. That's why you get weaker with neck flexion.

Thanks Dr,
Have forwarded to Tim and we are in process. Appreciate you efforts, far and wide.
Thanks, Nigel