This Is MS Multiple Sclerosis Knowledge & Support Community

Hi there! First post here.

Need to vent a little bit, if no one minds. Waiting for some answers, and having a hard time not freaking out in the meantime. Input or advice, or anything, really, would be appreciated.

I’m a thirty-year old female lawyer. About 3.5 months ago, I started having left-sided low back discomfort, and noticed numbness in an L5 distribution down my left leg, including a sensation of numbness in my shin and the top of my foot. I had experienced identical symptoms in the past on two occasions over the last two years, but they lasted for a couple days and then went away without further problem.

After a week, the numbness down my shin and top of my left foot was still there, and the low back pain was severe. I’m not much on doctoring, so I don’t have a primary physician. I ended up making a Friday evening trip to an urgent care clinic because the low back pain was simply too much to tolerate. I was told I have “sciatica,” given a prednisone taper, and instructed to follow up with another physician if my symptoms didn’t resolve within a week.

Of course they didn’t resolve, although I will say the low back pain was improved. There was, however, no improvement of the symptoms in the L5 distribution of my left leg, and increasingly severe burning pain in that distribution, especially at night. Because of the line of work I’m in, I strongly suspected a lumbar disc herniation compressing the left L5 nerve root, so I scheduled an appointment at a spine specialty practice that I’m familiar with. Since I had no prior scans, I had to doctor through a P.A. to begin with. Very brief muscle testing revealed some weakness in the hallux extensor (big toe) muscle, normal or slightly depressed reflexes, and no other pathological signs. Due to the muscle weakness, my P.A. decided to get me in for a lumbar MRI right away, and gave me another prednisone taper.

During this time, I also started noticing similar burning pain wrapping around from the left low back around my left hip, and radiating from belly button to groin. At first, I would notice it when I was driving, and I thought maybe my seatbelt was just pinching or something, but then it became pretty much constant, and severe.

My lumbar MRI was negative at the suspicious lower levels, other than some mild degenerative bulging at L5-S1. Except, I had a 3 mm right and central extruded disc at L1-2, migrated up behind the L1 lumbar vertebrae. It did not appear to be compressing any nerve roots, and the spinal canal was not being compromised. I also had 4 mm left and central extruded disc at T11-12, migrated up behind the T11 vertebrae. Again, that did not appear to be compressing any nerve roots or the spinal cord. The MRI was also read as evidencing moderate degeneration throughout the thoracolumbar junction, consistent with underlying Scheuermann’s (juvenile disc disease). My P.A. didn’t think that these two disc herniations were causing me problems. He also gave me a prescription for 200 m.g. of Neurontin 2(x) per day after I specifically asked if there was something I could do to help control my pain. By this time, the pain in my legs at night was causing me serious sleep difficulties.

I also decided at this time, to mention the mild-to-occasionally-moderate mid-back pain (a couple inches below my bra) that I’d had for the last few years, ever since a horse-riding accident. I had never sought out medical treatment for that issue, because everyone has occasional back pain, right? Due to my profession, I know a lot more about anatomy of the spine than the average Josephine, which is both a blessing and a curse. I didn’t mention the mid-back pain at first, because based on my assumption as to what my problem was (an L4-5 herniated disc), I didn’t think it was relevant.
By this time, I was also starting to get muscle twitches in both legs, particularly in the hamstrings. They weren’t constant, and I figured it was just because I was sore.

Since my lumbar MRI didn’t show anything in the obvious areas, I was referred for an EMG. The EMG of my left leg was normal, of course. The test itself was not a big deal pain-wise, but the pain in my upper thigh, groin area, and hip was severe for about a day after that.

I also started PT with a wonderful physical therapist, who did believe that the two disc herniations could very well be causing my problems. She told me that the type of herniations I have are extremely rare, and she had never seen a case like mine. We started traction which did provide some temporary reduction in my pain levels in both my wrap around hip pain, and my leg pain. My left-sided low back pain was gone by this time.

I then underwent bilateral epidural injections at L5-S1 to see if that gave me any relief and/or provided a diagnostic response. My left leg felt numb for about an hour, but provided zero relief after that. My P.A., however, decided that this was, in fact, a diagnostic response, and recommended that I try another round of injections. He also referred me for a positional MRI of my lumbar spine, basically to see if I had lower lumbar herniation that was related to position. Thankfully, my insurance covers positional MRI’s in some cases, including mine.

My muscle twitches were becoming more constant by this time, in both hamstrings, and in my calves. I was also getting full-on cramps in my calf and hamstring in the morning in my right leg. My hip, abdominal and groin pain was severe.
Seated MRI again revealed nothing in the lower levels of the lumbar spine, but the extruded disc at T11-12 in the seated position was contacting and flattening my spinal cord. Based on that finding, my P.A. recommended I try an epidural injection at T11-12. He also upped my Neurontin to 600 mg per day since the prior dose was giving me no pain control.

The injection at T11-12 was horribly, horribly painful compared with the injections at L5-S1. My paraspinal muscles went into severe spasms when I was being injected. I will say, however, that I got almost 12 hours of complete pain relief following this injection. I didn’t feel normal, but I was pain free for about half a day. Post-injection, I developed a new symptom, unfortunately. I was trying to put my hair in a pony tail the day after my injection, and when I put my head down, I had the most excruciating searing pain in the center of my spine, exactly where my injection took place, that almost brought me to my knees. That lasted for about a week. Any forward bending of my head, or flexion of my upper back caused severe pain in my mid-spine, exactly where my T11-12 disc herniation is at.

When I told my physical therapist about this stabbing back pain she grew concerned about possible spinal cord compression. She tested for Babinski and Hoffman’s, and I had no response. I had also started to develop burning pain in my upper inner thigh, groin, and perianal area on the left. My physical therapist basically told me that I needed to insist on seeing a surgeon, and that the type of the traction didn’t seem to be doing me any significant good. I’d get a day or two of a reduction in my pain after traction, but overall my condition was worsening. I am absolutely grateful for her advice and care.

I asked to be seen by an orthopedic surgeon, and was scheduled for about two weeks later. By the time I was seen, the burning pain wrapping from my hip to my belly button and groin had almost completely resolved. The surgeon thought that maybe the T11-12 injection had taken care of that problem. After looking at my scans, he thought the T11-12 disc was probably responsible for my problems and that my L1-2 disc was in bad shape, too. He said he could do a three-level fusion, but may be able to avoid fusing me because of my lack of significant back pain. Thoracic fusions are a major, major surgery. He referred me to his colleague, who is a neurosurgeon for a consult about possibly doing a discectomy at T11-12. Before sending me on my way, he had me do some maneuvers, and definitively ruled out SI joint dysfunction. He also decided to test my reflexes, just using his fingers. To his (and my) surprise, my left patellar and Achilles’ reflexes were hyperactive on the left compared to the right. The last time my Achilles’ reflex had been tested, they were barely able to get a response. He also ordered a thoracic MRI (if you are keeping track, this is MRI number three).

My neurosurgeon was a lovely person. She tested my patellar and Achilles’ reflexes, which were hyperactive on both legs, more so on the left. In fact, just touching me near my left knee would trigger a response. She also tested my reflexes in my upper extremity, which also appeared to be hyperactive. My neurosurgeon said that you can have hyperactive reflexes in the upper extremity if you are thin….She was also able to feel the muscle twitches (fasciculations) in my right calf while testing my reflexes. By this time, I was having nearly constant muscle twitches throughout both legs, and in my abdominal area – more or less from the waist down. I had also started to have an occasional twitch in my left triceps, and in my eye. I’d had those from time-to-time in the past, and chalked it up to tiredness or stress, which was usually when I’d experience twitches like those in the past. She also tested my muscle strength of my lower extremities. It was obvious that my strength was significantly reduced in all of the muscles in my lower extremities. I hadn’t even realized it. By that time, I was also having a sensation of difficulty starting urine flow, even when I had to go really, really bad.

Based on my physical exam, she dropped a bomb on me. I needed to have surgery, and I needed it yesterday. I was in a gray area in terms of permanent damage. She felt the T11-12 disc extrusion, although it wasn’t massive, was responsible for causing spinal cord compression. The thoracic MRI revealed some other small herniations or bulges, but nothing as obvious as the T11-12 extrusion. This consultation was on a Thursday, and she wanted me in surgery by Monday or Tuesday. She was going to do laminectomies and discectomies at both T11-12 and L1-2 and also do a non-instrumented fusion at L1-2 with artificial bone graft. To rule out any possible compressive lesion in any higher levels of the spine, and just to be on the safe side to rule out MS or ALS, she also referred me for urgent cervical spine and brain MRI’s. She gave me her cell phone number to call me when I had completed the scans. After she had reviewed them, just to make sure nothing else was going on, we would schedule surgery early the following week.

I called my husband in tears. I called my boss and talked out how we were going to manage with me being out and then on reduced speed for at least several weeks. My law firm is two attorneys and four staff. Me being gone, for even a day or two, puts a huge strain on the office. I went into the office and sat the staff down and informed them there was a strong likelihood that I was going in for surgery next week, and we discussed how we were going to proceed.

I had the MRI’s that Friday afternoon. Cervical spine MRI, and MRI of the brain with and without contrast. They had to stick me three times to get an IV in for the contrast. This was MRI number four and five within a three month period. My prior MRI’s were no big deal, but these MRI’s, which took about an hour and forty-five minutes, were almost intolerable. It seems like the vibrations of the machine were triggering my muscle twitches. My legs were on fire and twitching for the whole time, and I couldn’t move. I called my neurosurgeon as soon as I was done and she told me she was trying to get access to my scans over the weekend and to expect a call from her on Sunday or Monday.

I was at work Monday morning, when I got her call. She told me my cervical spine looked great, but that my brain MRI was abnormal. Abnormal. Abnormal.

For the rest of the conversation, my head was spinning. She told me that there was an abnormality. Both she and the radiologist felt that it didn’t look like MS, but that it couldn’t be ruled out. She said it could be an old injury, etc., but they just didn’t know for sure. She also told me that “it,” whatever “it” is, is in an area that would not necessarily correlate with my symptoms. Being in a state of shock, the types of questions I should have asked did not come to me. I did manage to ask her if she could tell whether “it” was old or new, and she said she couldn’t tell.

She wanted me to be seen by a neurologist for a full work up, since I had not undergone a full neurological work up, prior to surgery. But, she also was worried about waiting too long to proceed with surgery due to the increasing risk of permanent damage. She told me she was going to call around and try to get me in to a neurologist on an urgent basis. If she could get me in quickly, she would recommend holding off on proceeding with surgery. If not, she would recommend proceed with surgery. She said she was basically leaving the decision up to me. She told me that if it was her, she would proceed with the surgery, because of the potential risk of permanent spinal cord damage. I sat in my office, stunned, and in tears, with my head spinning. If I had had my wits about me, I would have told her that she’s literally the brain surgeon in this conversation—she should be telling me what to do.

I got a call back from her shortly thereafter. She said she had talked to three different neurologists who thought it prudent to do the workup prior to surgery. They could get me in within 10 days.

I received a call from the neurologist’s office the next day scheduling me for nine days out, which was the soonest they could get me in. I about blew a gasket when they called me the next day and tried to cancel my appointment, which, after I spoke with a nurse, was rescheduled to the same day, with the same doctor, fifteen minutes later. Working at a law firm, this set of circumstances can mean only one thing…the neurologist wanted to golf in the afternoon, and instructed his staff to cancel his afternoon appointments. When one of his patients called up screaming, he agreed to post-pone his tee time. Already I’m not feeling great about this situation.

In the interim, my neurologist texted me (which I think is kind of cool and strange at the same time), to confirm I had an appointment. She said he should have all of my records, and the goal of the exam is to get the neurologist’s opinion as to whether my symptoms are stemming from my thoracic disc herniation, or as to whether the evidence points in another direction, warranting further work-up.

My neurology appointment is next Wednesday. I’m trying to keep functioning in the meantime, but the stress of first being told I need to undergo an immediate surgery on two levels of my spine, trying to prepare for that mentally, and trying to sort that out at work, and then being told that I have a brain abnormality of some sort…this has been a really, really rough week. I’m trying to avoid the temptation of trying to read my own brain scan and trying to keep my online research to a minimum. I’m trying to avoid the temptation to over-analyze ever little sensation that I experience. I’m trying to avoid texting my neurosurgeon with a million and one questions. I’m trying not to be afraid for my future.

Right now, I continue to have burning and numbness in an L5 distribution in my left leg, including an extension into the bottom of my foot. I have burning pains in my upper inner thighs. I have numbness in my perianal area which comes and goes. My hamstrings constantly feel like I just finished running a sprint. I’m having difficulty standing up from a seated position, and this seems to be getting a little worse every day. I’m not sleeping worth a darn due to pain and stress, which of course compounds things. I’m exhausted, probably in part, due to the lack of sleep. I have near constant fasciculations in my legs, my abdomen, and a few here and there, primary in my left upper extremity, and in my eye, and once in a while, my lip.

Thanks for reading my rant. Any comments, questions, insight are definitely appreciated.

Sincerely, Jen

Hey Jen,
Sorry to hear you are having so many symptoms and that you face the daunting prospect of surgery:(

I was originally told my brain lesions didn't look like MS so not sure if that actually counts for anything.

The fact that you have had a riding accident and have issues with your spine could be the trigger for MS or it could just purely be a spinal issue.

Even with brain lesions it may or may not be MS as brain lesions can be caused by many things.....

I can't really advise you much but please keep us posted after your appointment Wednesday.

L x

Welcome to ThisIsMS, Jen. Since you asked for any "input or advice, or anything," I offer you my standard action plan recommendation:

First, take a deep breath. You may not have MS at all; it is a differential diagnosis – made by ruling out other possibilities. It seems to me that, from the first, when you visited the urgent care clinic and were diagnosed with sciatica, your problem was pigeonholed as "neurological." Obviously, you are very knowledgeable about the spine and know your own body best, but since the cause of MS is unknown, I wonder if a wider search would have been helpful from the start. My first three MRIs, EMG, and evoked response tests were normal, and it was the fourth neurologist I saw before I got my MS diagnosis. Sometimes it is just a matter of finding the right doctor – my husband has had TERRIBLE back pain on two occasions, and his doctor of osteopathy (D.O.) has diagnosed a muscle problem and resolved it within a few days. IF you do have MS, you have found many supportive friends at this site. We come from diverse experiences and hold diverse ideas. We do not agree necessarily in our thoughts on MS; you will probably not agree with some of us either; we only ask for tolerance when we express unconventional ideas.

Second, I suggest that you find a GP or internist, or even a D.O., with whom you are comfortable, who is compassionate and who enjoys being a "disease detective." He can order the tests necessary to rule out some possibilities. Start again at the beginning with a thorough physical, baseline examination including blood tests for your cortisol level (elevated with stress), glucose AND insulin levels (these are two DIFFERENT tests), thyroid hormone levels (TSH, Free T4, Free T3, Reserve T3, and antithyroid antibodies), even a liver profile, CRP (C-reactive protein) test (indicating inflammation), – our member jimmylegs will recommend others for nutrition levels, such as vitamin D3. Ask for a copy of all your test results for your own file. You will benefit greatly with "a wonderful physical therapist" on your team. Since I suspect insulin involvement and insulin resistance in skeletal muscles, an endocrinologist or even someone with expertise in muscles could also be helpful.

Third, if you do have MS, start your reading with two books: "Multiple Sclerosis: The History of a Disease" by T. Jock Murray, OC, MD, and I think "The Multiple Sclerosis Diet Book" by Roy Swank, MD, PhD and Barbara Dugan is a good second book to read or even have. You may be able to get these through your local library.

Fourth, from this day forward, I encourage you to eat a healthy diet (a good idea whether or not you have MS). Many people find that diet can influence the symptoms of MS. In my opinion, this means a low-carb diet -- removing all sugar (including beer, wine, etc. which have sugar), all artificial sweeteners, including sugar alcohols like sorbitol, xylitol, etc. (These promote insulin production, too.), all trans fats (These also increase insulin.), and white flour, white bread, white potatoes, white rice (in fact, all carbs so far as possible) from your diet. Personally, I think that excess insulin plays a great part in MS. I think that Fatty Liver Disease is also involved, since visceral fat secretes cytokines, which lead to increased insulin, which leads to inflammation which leads to more visceral fat… And the cycle goes round and round. Diet is important; in fact. You may find the account of Dr. Terry Wahls and her dramatic improvement interesting (http://www.TerryWahls.com).

By the way, when my local GP diagnosed me with Thoracic Outlet Syndrome and had scheduled a surgeon to remove my first rib, I was terrified at the prospect and I went to the Mayo Clinic in Rochester, Minnesota, for a second opinion (Do NOT be in a hurry for surgery; doctors CAN be wrong! They usually consider only the options in their own specialty – a surgeon will recommend surgery.). In the first meeting with my Mayo Clinic doctor, he told me that he didn't know what it was, but it WASN'T Thoracic Outlet Syndrome! I was optimistic; but mistakes are made even at the Mayo Clinic. They missed on my MS diagnosis, thought the problem was a herniated disc – I unnecessarily had a cervical laminectomy (Of course, it did not improve anything.); but MS is often VERY difficult to identify.

We are here to listen… to rantings, to questions, to everything.
All the best to you.

Thank you so much for your thoughtful and kind replies. Taking a deep breath this weekend, and recognizing that I can't do anything until I know more. Will update status after Neuro exam on Wednesday.

Sincerely,
Jen

hi jen and welcome. sorry to hear about your tough time. chiming in with the nutrition angle. regardless of your diagnosis or lack thereof, here's some info i sent to my brother recently regarding his spine issues:

email 1:

http://www.chirogeek.com/000_disc_anatomy.htm#nu

The intervertebral disc is the largest avascular structure in the human body. The reason for this is because it has no direct blood supply like most other body tissue. Nutrients (food) for the disc are found within tiny capillary beds (black arrows) [open the link for the diagram..] that are in the subchondral bone, just above the vertebral end-plates . This subchondral vascular network 'feeds' the disc cells of the all important nucleus and inner annulus through the diffusion process. The Figure on the left shows the 'disc feeding setup' for disc. Note that the outer annulus has its oven blood supply that is embedded within the very outer annulus. This is a much more efficient system and nutrients don't have to diffuse very far to find their hungry disc cells. The 'more direct' blood supply of the outer annulus is why tears of the outer 1/3 of the annulus will heal/scar shut with the passage of time, which unfortunately is not true of the rest of the disc. Research has indicated that disc tears will not heal in the inner zones of the disc - probably because of the avascular nature of the inner two thirds of the disc. Note the nutrients (pink balls) diffuse directly into the tissue of the outer annulus, where as the nucleus and inner annulus has a much longer diffusion route that is block by the vertebral end-plates. Note how the nutrients (pink balls) are released from the blood vessels (red) in the subchondral bone just under the vertebral end-plates. These nutrients must 'diffuse' or soak their way through the vertebral end-plates and into the disc. This 'diffusion method' is how the cells of the disc get the nutrients oxygen, glucose, and amino acids which are required for normal disc function and repair. This poor blood/nutrient supply to the disc is one of the main reasons that the disc ages and degenerates so early in life.

The 'diffusion feeding process' is enhanced somewhat by a phenomena called 'Diurnal Change'. Our discs have the ability to expand and compress over the course of a day. As we start the day our discs, like squeezing out a sponge, will compress and dehydrate because of the gravity and physical activity which place axial loads upon the discs. In fact a healthy disc will shrink down some 20% (104), which in turn decreases our height by 15 to 25mm (194,441,815). As we sleep and decompress our spines, our discs swell with water plus nutrients and expand back to their fully hydrated state. This tide-like movement of fluids in and out of the disc will help with the movement of nutrients into the avascular center of the disc. (Click here to learn more on Diurnal Change).

http://www.chirogeek.com/001_Degenerati ... isease.htm

Degenerative Disc Disease

Unlike other tissues of the body, the intervertebral disc under goes an early and often severe form of aging and degeneration (6 ,8,14,151,152 ). In most humans, this aging/degeneration process is slow and steady, but in some the process rapidly accelerates and may lead to catastrophic failure of the disc; which in turn may lead to chronic pain and disability. This 'accelerated' form of aging/degeneration may be called Degenerative Disc Disease (DDD), although the term is commonly and erroneously used to describe any form of disc degeneration.

Research has strongly linked DDD to back pain, and sciatica (201,206,219,227), although not in every case, for it is well known that DDD, disc protrusion, and stenosis do occur in completely asymptomatic people (100-106), but for about 10% of the population, DDD will result in permanent chronic pain and disability (250-253). Technically it's not the actual process of DDD that results in pain; it's the evil 'end-phases' of the disease that have the potential to generate back pain. These end-phases include anular tears (aka: Internal Disc Disruption or IDD) (203,209,216,231); disc protrusions (227); nerve in-growth (900,904,905,906); and the ultimate end-phase, stenosis.

The diagnosis of DDD is best made on T2-weighted MRI imaging (27), although some of the late appearances of DDD (disc collapse, osteophytosis, and sclerosis) may also be seen on CT scan and X-ray. The MRI appearance of DDD is easy to spot, even for the layperson, and is characterized by a loss of 'signal intensity' (loss of whiteness) of discal tissue, which makes the disc appear black instead of bright white. Technically, this 'Blackening' of the disc occurs because the disc has greatly lost its water content and become dehydrated. This 'blackening' is called disc 'Desiccation'. Since the MRI signal intensity (whiteness) is directly related the disc's water content (215,226), any loss of discal water will proportionally decrease the 'whiteness' of that disc on T2-weighted MRI. So, in layman's terms, the dryer the disc, the blacker and more degenerated it will look on MRI"

email 2:

http://www.livestrong.com/article/36091 ... c-disease/

Hydration
Proper hydration plays a role in the relationship between degenerative disc disease and nutrition. Once of the causes of disc degeneration is the drying-out of the discs that cushion your neck and spine. Discs are made primarily of water and can lose height when they become too dry. Discs that have lost some of their height can press on your nerves, causing tingling, numbness and pain. Drinking plenty of water throughout the day hydrates your body and replenishes the parched discs with the water they need to stay healthy. Avoid alcoholic beverages, as well as coffee, tea and soft drinks that contain caffeine, because these substances can contribute to dehydration.

Iron
Healthy discs require oxygen. One of the nutritional goals to meet to help prevent or ease the discomfort of degenerative disc disease can be to increase the oxygenation in your bloodstream. Eating iron-rich foods increases the number of red blood cells your body makes; these are the cells that carry oxygen throughout your body, the MedlinePlus online medical encyclopedia explains. Beef, dark-meat poultry, beans, raisins and other dried fruits, several types of fish and seafood and spinach are all examples of foods that are high in iron.

email 3:

http://www.livestrong.com/article/41117 ... nal-discs/

Your spine contains several bones, or vertebrae, connected by spinal discs made of cartilage. Both the vertebrae and spinal discs surround and protect the spinal cord, a part of the nervous system that allows communication between your brain and the rest of your body. Spinal disc injuries can lead to pain and discomfort, and might potentially lead to permanent spinal cord nerve damage if left untreated. While nutrition alone might not prove sufficient to heal an injured spinal disc, nutrients in the foods you eat might contribute to spinal disc healing.

Vitamin C
One nutrient important for healing spinal discs is vitamin C. The tissues that make up your spinal discs -- cartilage and other connective tissues -- all contain the protein collagen. As a result, your body must make new collagen as part of the process of healing your spinal disc tissue. To synthesize collagen, your cells require vitamin C, according to the Linus Pauling Institute at Oregon State University. Many fruits provide a source of this nutrient, so consuming a balanced diet rich in fruits might help promote spinal disc healing.

Vitamin A
Vitamin A -- an essential vitamin -- might also help promote spinal disc healing. After a spinal disc injury, your body must generate new cartilage cells -- called chondrocytes -- for healthy cartilage tissue. Vitamin A helps promote proper cartilage cell development by promoting the development of mature chondrocytes, according to the New York University Langone Medical Center. Consume pumpkin, spinach, kelp and potatoes to increase your vitamin A intake and help promote spinal disc healing.

Omega-3 Fatty Acids
Another nutrient that might help ease the discomfort of spinal disc injuries is omega-3 fatty acids. Often, disc injuries such as herniated discs lead to discomfort due to increased inflammation around the injury site. The displaced spinal disc tissues irritate the surrounding tissue, leading to the release of inflammatory factors, as well as swelling and pain. Omega-3 fatty acids help control the levels of inflammation in the body, according to the University of Maryland Medical Center, and might therefore help ease some discomfort associated with a herniated disc. If you suffer from spinal inflammation, consult your doctor about the potential benefits of taking omega-3 fatty acid supplements, or include fish and flaxseed in your diet.

Considerations
Eating healthy and consuming a range of nutrients can have a beneficial effect on spinal healing. Compounds naturally found in healthy foods can help your body in recovering from a spinal disc injury, but a healthy diet alone might not prove effective in treating a spinal injury. Any health condition affecting your spinal discs requires the attention of a medical professional, who might suggest a number of treatments, including prescription medication. If you're interested in nutritional supplements to help heal an injured spinal disc, consult your doctor regarding the safety of the supplements, and their potential benefit in helping to heal your injury.

email 4:

academic research those other two sites failed to include (because apparently they don't care what the disc is actually MADE of):

Effect of Zinc Deficiency on Bone Collagenase and Collagen Turnover
http://jn.nutrition.org/content/110/10/2095.full.pdf
"Half-turnover time for tibia collagen was 13 days in the control and 35 days in the zinc-deficient chicks."

not suggesting you're a chick but still. zinc-dependent enzymes are zinc-dependent enzymes, and collagenase is one of them:

Zinc Deficiency and Clinical Practice
http://www.med.or.jp/english/pdf/2004_08/359_364.pdf

- for the zinc-collagenase connection, see table 1, pdf page 2 (p. 360 of the original hard copy)

zinc has a structural role as well as an enzymatic role when it comes to healthy collagen formation. if you've heard anything on cbc radio lately, about 'protein folding' issues as a common denominator to a variety of chronic diseases, they failed to describe published research to the effect that proper protein folding is also zinc-dependent:

Zinc-dependent protein folding
http://www.ncbi.nlm.nih.gov/pubmed/10742185

ah, here's the kicker (of specific interest, "The Zn level and Zn/Mg ratio showed a decline in patients with IDH"):

Correlation of serum trace elements and melatonin levels to radiological, biochemical, and histological assessment of degeneration in patients with intervertebral disc herniation.
http://www.ncbi.nlm.nih.gov/pubmed/16444002
"The aim of our study was to assess the blood concentrations of some trace elements and melatonin (MLT) in patients with intervertebral disc herniation (IDH) and to investigate the interaction of histological and biochemical degeneration findings with aging. The present study was carried out on 13 subjects (8 women and 5 men) diagnosed with IDH. They were divided into three groups according to their ages. Nighttime serum MLT, zinc (Zn), and magnesium (Mg) levels were determined in all patients. In addition, computed tomography (CT) scan of the brain and magnetic resonance imaging examination of the lumbar spine were obtained in this study. *The Zn level and Zn/Mg ratio showed a decline in patients with IDH* with aging, whereas the serum Mg level and tissue hydroxyproline content increased. A positive correlation between serum Zn and MLT concentrations was found (r=0.104, p=0.734). In addition, there was a positive correlation between serum Zn level and Zn/Mg ratio (r=0.835 and p<0.01), and a negative correlation between serum Mg level and Zn/Mg ratio (r=-0.571, p<0.05). On CT study, both volume percentage of calcified pineal gland and density of calcification were found to increase progressively with advancing age. The results of semiquantitative evaluation of disc tissues of patients with IDH for histological degeneration findings showed that 66.7% of discs treated had slight degeneration in younger age group, but 75.0% and 100% of discs had moderate or marked degeneration in older age groups. Our data indicated that there is a close relationship between MLT and Zn or Mg levels in the serum samples of patients with IDH, and the levels of these elements might be affected by the presence of degeneration process and serum MLT level, or vice versa."

anecdotal support for the above: have i had a bulging disc? yes. was i zinc deficient at the time? also yes.

interesting aside: zinc for preventing cavities?

Zinc reduces collagen degradation in demineralized human dentin explants
http://www.ncbi.nlm.nih.gov/pubmed/21108986

email 5 (he had commented that no coffee would be tough):

Rules of thumb, two glasses of water makes up for one coffee, and if you're thirsty you're already dehydrated.

The good news is, how water improves energy - I get so dehydrated at work, I'll come in so tired out, chug some water, and pretty soon feel like I had a nap.

Get a good b-complex in you and that will help with energy levels too.

TTFN!

one thing i think you can/should try right away, while you're figuring things out, is a simple epsom salts bath. stress and certain common dietary factors lead to magnesium depletion. epsom (magnesium) salts can help restore your electrolyte balance. if you decide to try it, follow package directions carefully. some is good, more is not necessarily better. you can take dietary and supplemental steps too. i mention magnesium specifically as the first action item because of the pain and twitching you describe.

Hi all! I'm back

Here's the latest. I was seen by the neurologist for a work-up per the recommendation of the neurosurgeon to try to ascertain if there was any evidence suggestive of anything OTHER than spinal cord dysfunction. He was a complete jerk-bag. He hadn't looked at my records or the notes from my neurosurgeon ahead of time, and spent the first 10 minutes of my 30 minute appointment looking at my MRI scans. He then ran some quick tests, and concluded that my exam was normal except for what he thought seemed to be a tremor. I should add was extraordinarily nervous for this exam, and felt my hands were shaky due to nervousness. He then asked what my symptoms were, which as I noted above, are numerous, and he interrupted me mid-sentence to say "well, your symptoms don't really matter." Errm....ok. He didn't think I needed surgery, and he also didn't think I had MS. He thought I was hyperthyroid due to the "tremor."

Had blood tests to check the thyroid function, which were well within normal limits. [thyroxine, free 1.31] [normal: 0.70 - 1.85]; [TSH 0.48] [normal: 0.4 - 5.0], so both he and my neurosurgeon felt that was not the problem.

I then spoke with my neurosurgeon who had consulted with another surgeon within her practice, the neurosurgeon, and two other neurologists, who all said that they should "just wait and see" with me.

After that, I did undergo another injection which did give me some temporary symptomatic relief, but flared up the sharp central back pain again. By this time, I started having burning pain in my arms now too.

I saw my neurosurgeon again in September who said she recommended proceeding with the surgery, but that she was only about 60% confident that the disc herniation was responsible for the problem. I'm not liking those odds. I decided to get a 2nd opinion with another neurologist.

Saw the new neurologist about a week ago. He was awesome. Listened very attentively to my history and my symptoms, did a thorough exam, and had actually reviewed all of my records before my appointment (!). He thought maybe it was best to start over from scratch. We discussed the fact that every test seems to reveal some other issue, so I don't know what to report as a symptom anymore, versus what is not a symptom. He suggested we try another injection specifically focused on symptom relief of the low back and left leg pain which is most problematic. After that, we would likely proceed with a spinal tap and a repeat brain MRI to see if there are changes. BTW, there are four hyperintensities, but none enhancing. He also sent me for blood tests to check my B12, D, and folate levels.

Now this is interesting: my 25 OH Vit. D was "<13". It didn't even give a number--just below 13 (normal 30-75). My B12 was "borderline" at 270 (normal 247-911). The neurologist remarked that most of his MS patients are Vit. D deficient, and reading up on the connection between MS and Vit. D deficiency has been really interesting. Met with a family physician today to get started on treating the deficiencies. Unfortunately, I don't have regular PCP, so I had to re-iterate the whole saga with her. She seemed not as concerned about either the D or B12 deficiency as my neurologist did (and possibly not as knowledgeable?).

She gave me a prescription for 50,000 Vit. D2, and told me to pick up OTC sublingual B12, which I got 1500 mcg per dose. I know many on here supplement. Does this seem in the range of an adequate supplementation?

Thanks!!
Jen

Glad to see you back, Jen. You have been busy the last few months! I agree about your first neurologist – a real jerk! I am quite sure your hands were shaky during his exam – nervousness is to be expected – and I suspect it was the source for the "tremor." In my opinion (remember my focus on insulin), your nervousness (a.k.a. stress) caused an increase in your cortisol, the "stress" hormone, which caused an increase in your blood sugar. Increased blood sugar results in increased INSULIN!

I think you were wise to seek a second opinion from another neurologist. It sounds like you have found the right one – good listener, thorough exam, prepared in advance of your appointment! Give him ALL your symptoms, let him decide which are important. A low vitamin D level for MS is VERY often in the news these days – you can find MANY mentions of this here at ThisIsMS. Jimmylegs can direct you to them; she can give you advice on D3 supplementation (preferable to the vitamin D2 prescribed by the family physician you saw today). All the best.