RohanMemberSeptember 11, 2012 at 2:27 amPost count: 4
Dear Doctor Corenman,
I hope you can spare me a few moments of you time, Dr.
Following a very active childhood full of rugby and cricket, my activities were brought to a painful end at the age of 18. Herniation of discs at L3/4 and L4/5 was diagnosed in 1991; sequestration was muted at L4/5 but for some reason not confirmed. Due to rapidly increasing disability and pain chemonucleolysis at both levels was advised and undertaken in 1992 (following a 9 month wait for surgery in which time I was mostly bedridden!). Following surgery, no rehabilitation was prescribed or advised but the procedure alleviated the symptoms a little. The subsequent 20 years are a blur of disappointing follow-up consultations with various specialists and self-management. This included (and still does) physiotherapy, muscle reprogramming and neural mechanics, osteopathy, chiropractic assistance, pilates, yoga and general exercise. On two occasions I had a facet joint steroid injection but with no change in symptoms. Pain is present daily. I experience two to three severe episodes per year which normally involve 2-8 weeks of complete debilitating pain and on two occasions hospital admittance for intravenous analgaesics. Medications taken are anti-inflammatories, analgaesics and muscle relaxants. I have my most recent MRI results from May 2011 with consultant notes from the UK. My most recent episode of debilitating pain was July 2012, the condition taking approximately 9 weeks to reduce to normal levels of pain. I have encountered plenty of blank expressions in the UK medical field with various different opinions ranging from DDD to the latest postulation of spondyloarthropathy. An accurate diagnosis of my condition eludes me as does the subsequent treatment or indeed management. I manage the motion and pain by a combination of exercises learnt over the years in conjunction with regular medication. I attend a gym at least 3 times per week and participate in sport when able. The condition is obviously deterioating as I become older. The acute episodes increase in frequency and the recovery periods extend. I am 39 years old and given the above condition am in very good physical condition. I am 188cm and 178lbs with a very low body fat index. I have all the most recent scans and consultant notes archived electronically: these can be sent electronically immediately. Unfortunately the UK NHS no longer holds any records from the initial diagnostic process (X Ray, CT, notes etc.) and treatment regime in 1992, however, the consultant is still available for comment if needed.
I am currently fighting for a follow up set of scans for comparison to those undertaken in 2011, these may take the form of MRI or may also include CT, X Ray and blood work depending on what is advised. I intend to keep copies of all information myself to ensure an accurate timeline of events and consultations.
May I send you my most recent MRI results for your opinion, Dr? If you agree I will continue to fight for follow-up scans and when obtained, can also forward these onto you.
I am a UK national currently residing in Guatemala with my family. We are soon to relocate back to the UK, sometime in the next 9 months.
Please advise if you are able to assist in any way. I am researching as many institutions as I can and trying to keep abreast with reasearch and development in this area in hope that maybe one day I can live pain free.
My kindest regards and admiration for your work,
Mark.Donald Corenman, MD, DCModeratorSeptember 11, 2012 at 10:45 pmPost count: 8459
Your symptoms certainly deserve a thorough going-over to see if there is something that can be done to reduce your pain and flair-ups.
Chemonucleolysis is an old technique that has been subsequently abandoned as there were cases of paralysis associated in some patients. The technique requires removal of the nucleus of this disc space. This causes further stress on the disc and typically, the disc becomes very degenerative.
This lack of shock absorption will cause further damage to the endplates and more likely than not, this endplate injury is the cause of your major flair-ups.
You can contact my office to have your films delivered to me. I would be happy to let you know what I think of the films.
Dr. CorenmanRohanMemberSeptember 19, 2012 at 2:00 amPost count: 4
Dear Dr Corenman, Mrs Newman,
Cannot thank you both enough! All documents and scans sent today by courier…
My best to you both,
Mark.RohanMemberSeptember 27, 2012 at 2:56 amPost count: 4
Dear Dr. Corenman,
Dear Margaret, Dr Corenman,
I have a follow-up MRI booked at Tecniscan in Guatemala City for Friday 28th Septenber 2012 at 15:00hrs. I will make these scans available to you both by courier upon receipt.
I met with a nuerosurgeon by the name of Dr Oscar Anibal Pozuelos at Multimedica in Guatemala City. He examined me and reviewed my scans from May 2011. He was disappointed by the quality of the scans and the resulting interpretation in the UK. He was also disappointed to know that given the date, diagnosis and my overall condition at the time, chemonucleolysis was the chosen treatment in 1992.
He believes that there is one small anterior herniation to a disc in the lumbar region, areas of significant nerve compression with subsequent inflammation, and that the ligaments in the area are in a very poor condition. Based on the physical examination he also suspects one or more muscular hernias. My reflex responses at my knees was reduced by approx. 50%; my reflex responses at both ankles was non-existent.
I will be meeting with him again following the scans on Friday and will update you on his official diagnosis.
I hope my original documents reach you safely and you are both well.
My kindest regards,Donald Corenman, MD, DCModeratorSeptember 27, 2012 at 10:57 amPost count: 8459
Reflexes that are bilaterally diminished equally in the lower extremities may have no portend in your diagnosis. As people age, many individuals develop diminished reflexes. If it is symmetrically diminished and no significant compression to cause that- this finding may not be helpful in diagnosis.
I’m not clear what the doctor means by “muscular hernias”. Are these of the abdominal wall or the posterior lumbar spine? How does he think these are affecting you?
Anterior herniations in the lumbar spine do not typically yield specific symptoms. These go along with the diagnosis of degenerative disc disease.
I look forward to reviewing your films.
Dr. CorenmanRohanMemberSeptember 27, 2012 at 12:43 pmPost count: 4
Dear Dr. Corenman,
I can only surmise that the sooner I get my scans to you, the better!
I’m not sure if you are yet to receive those already sent, taken in May 2011; they were dispatched Tuesday 18th September. As soon as I have a copy of the latest set, due this Friday the 28th, I will do the same post-haste.
My kindest regards,
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