--just thought I'd let you know I gave you two a shout-out to Dr. Goldfarb last time I was in Methodist Hosptial a few days back. First time she and I ever met (I know Dr. Salgado, another neuro there, quite well from Staten Island), but we had a lot to share over Drs. Chin, Latov, et. al.

While I was there, I actually got her opinion of the NCV/EMG Dr. Chin did on me for this right cervical radiculopathy/shoulder problem that's been going on for three-plus months now. She agreed with Dr. Salgado having me give the traction a try, but said we might want to repeat the test in six months if symptoms persist.

And she knew who you two were from the description I gave immediately--didn't even have to mention your names. Appaently you two are quite distinctive.

--not to forget you of course--I'm glad there's been at least some improvement, minimal though it may be in the larger scheme of things. I hope the minimizing of the immune modulating meds doesn't kick you back up a notch.

Me too Glenn, but he's really conscientious about my meds and my condition. He's from Russia, practiced over there in rheumatology and then did 7 years training here in order to be a family practice physcian. He's quite an unarthodox physcian. Doesn't mind telling us he's gonna replace his clerk if she doesn't get his on line filing caught up. (great we said) It was our records we were looking for and couldn't find. Luckily we had another copy with us. Then he mentioned a professor of medicine he worked with who would only use one medication and he found out that's the one that one of the drug reps was paying him to use. He Said "lost my respect for that fellow right then" Then he said to us, "did you know this happens?"
Had to tell him that it wasn't news to us.

He has me do bloodwork every two weeks and at any sign of inflammation he'll raise the meds back up. I do think the time away from some of the meds is great tho. My husband often says "Would you like some lunch/breakfast/dinner with your pills?" Yick!!

Billye

Oh my god, we're distinctive now!!!!!

I wonder what that means!!!!!!

lol Mel

Dear Melody:

You stand out in a crowd! You are memorable...

Shirley H.

In reading your post you mention you have cervical radiculopathy. Some time ago, I had shoulder problems, and I remember a report that was sent tomy doctor in 1999. Please read this and let me know what you think. I have recently been having the shoulder pain thing again (I did go back to the doctor who wants me to see a specialist and I soon will but I'm saving up money for that). Here's my report of 1991. Its from a Dr. Kulick, a neurosurgeon.

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Dear Dr. Goldbetter: The patient is a 51 year old woman with a history of degenerative joint disease and osteoarthritis in the past. She had an MRI of the lumbar spine previously which showed multiple bulging discs and degenerative disc disease, which I reviewed. Two months ago, she began developing electric socks shooting down her left arm (I no long have those Glenn). At that time she went for an MRI and it felt like one of her caps was being pulled out of her mouth and she could not tolerate that . She had a CT scan, which just showd multiple cervical spondylotic changes. She had a previously left Bell's Palsy ihn 1995. The patient also has had cervical spine x-rays which I have reviewed, which shows degenerative disc disease and cervical spondylotic changes. The patient also has a history of carpal tunnel syndrome and wore splints in the past.

NEUROLOGICAL EXMINATION. The mental status is normal. There is no evidence of aphasia or memory loss. Cranial nerves - the pupils are equal and active bilaterally. The visual fields are full Extraocular movements are normal. There is no nystagmus. Facial, cranial and bulbar muscles are normal, other than mild left facial asymmetry. There is a positive Adson's maneuver on the left and on the right there is a bruit over the infraclavicular region during the Adson's maneuver, the the pulse does not disappear (WHAT THE HECK IS THIS????)

Motor examination reveals normal tone, power and coordination in the upper and lower extremities. There is no dysdiadochokinesia. (??????)Finger to nose, and heel to knee tests are normal The deep tendon reflexes are equal and active. There are no pathologic reflexes. Sensory examination reveals normal pinpick, vibration and position. Cervical range of motion is normal.

IMPRESSION. The patient has left cervical radiculopathy. (See we both have this). Although a certical MRI would be preferable, if she is not able to tolerate that, she must hve an EMG to evaluate nerve root pathology extent and level and this was ordered. She gets relief with Soma and she also goes to the gym and does exercises, all of which are recommended she continue. I did suggest that she have physical therapy to include cervical traction. I will see her again in several weeks.
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Now Glen, I went to get the emg and when the nurse came at me with the cattle prod, I jumped off the table and threatened her life. She didn't do it again, saying "I know, I know, some people, find this uncomfortable". OH REALLY!!!!!

So for the past 5 years I have been exercising and my left side, well, I started to favor it and this past 6 months, the pain in my left shoulder and if I raised my arm, well, it was horrible. As I said my doctor said if I don't get an mri and see if I have a torn rotator cuff, I might wind up with a frozen shoulder. NOw is cervical radiculopathy, the same as a torn rotator cuff. After all, I do have degenerative joint disease. My arm does get better when I do the spider exercises up the wall with my left arm and when I do gentle stretching. The hard part is to do this several times a day. Also, when I take the magnasizer and put it (on low by the way), and press it into my left shoulder, boy does it ever hurt. Alan says that I either have adhesions and they need to be stretched or my muscles need to be worked on.

So now that I have read that i was indeed diagnosed with cervical radiculopathy (I must look that one up), is this the same as having a torn rotator cuff. I haven't yet been to Dr. Fred about this.

That's my next appointment but with all of Alan's appointments with the podiatrists, Dr. Fred and Dr. Goldfarb, well, there isn't any money left for any more co-pays.

I just want your input on this report, (and anybody else who cares to chime in). I really do exercise every day, I've lost tons of weight, I can do my housecleaning, but this morning when the humidity was 100% I could barely stand up but after an hour, I was better. This arthritis stinks.

Be well,
Melody

. . .what I'm getting from that report is that the med professionals thought you had a degree of nerve root pressure--that is the definiton of radiculopathy: dysfunction of the nerve roots that are the first peripheral nerves outside the spinal cord proper.

Many things can cause radicular (from the Latin for "root") pressure in the cervical area, though the most common cause in people our age are either bulging or herniated discs that deform (or even rupture) and put pressure on the nerve roots, or arthritic changes in the cervical spinal bones themselves that pressure the roots, often by narrowing the space (the foramen) through which the nerve travels on its way away from the spine. In my case, there is MRI evidence on the right side, at the C6/C7 level, of foraminal narrowing due to arthritic bony buildup there; this dovetails nicely with the symptoms I've been experiencing, as certain positions close the space just enough to pressure the nerve root and produce my sensory dysethesia, apparently. The effect is exacerbated if the nerve root becomes inflamed, as that expands its size and makes it easier to pressure. Part of the reason, I'm sure, that traction was recommended for me was to try and widen that foraminal opening enough to stop pressuring the root, and allow inflammation to subside. (I've had only two sessions as of Sundya the 14th, so it's hard to tell if it's working yet.)

Radiculopathy can be caused by trauma as well, and my neural symptoms started after the muscle tear in my right shoulder area. Many neuros will say that a cervical radiculopathy itself might cause referred muscular shoulder pain, but mine was abrupt and absolutely connected with my weightlifting; the neural symptoms came after, and I'm going for a shoulder MRI this Tuesday to check out if I'm getting additional pressure on the nerves farther down, past the cervical area, in the brachial plexus where the nerves pass form the body into the arm and shoulder. It certainly FEELS like my right shoulder muscles are tight and that the scapula (shoulder blade) has been pulled out of position.

Dr. Salgado ordered the MRI; he noticed the shoulder/back tightness, which has persisted despite physical therpay (mostly TENS and ultrasound), and he was concerned that the pulse in my right wrist varied a bit in intensity when my arm was held in different positions. He was wondering about some degree of Thoracic Outlet Syndrome (or variant)--that's what your doc was looking for with the Adson's maneuver. (Thoracic outlet syndrome occurs when the area through which blood vessels and nerves pass from body to shoulder to arm--the area, basically, between the shoulder blade and armpit--is constricted to a point that one experiences vascular or neurological symptoms, or both. This can be caused by a trauma to the area narrowing an already congentially small outlet, or by arthritic calcium additions to the bones in the area.) A bruit is an unusual sound in an artery made when blood that is constricted by some obstruction then rushes past it; if this was heard near your clavicle region it would be logical to suspect the doctor would want to look closely at your rotator cuff--injury there usually involves a displacement and inflammation of the muscles or tendons in the area, and that may well pressure arteries. But a torn rotator cuff is not the same as a cervical radiculopathy, though it's certainly feasible that the former might displace enough structures to pressure nerves in the area, especially if one is already prone to pressure effects on nerves (and diabetics are especially prone to compressive nerve effects). AND--trauma to that area might result in BOTH rotator cuff and cervical spine injury.

The problem is that the weakness caused by rotator cuff injury, which is muscular in origin, can be mimicked by weakness that originates from nerve compression, although the latter will usually be accompanied by other neural symptoms. This is one reason a savvy neuro will want to EMG/NCV the whole shoulder/arm/paraspinal muscles up the neck, to see if there is any nerve signal disruption to the muscle, and if so, where.

I'm glad you no longer get that nerve tingling down the arm--apparently, your inflammation/nerve root pressure reduced to the point where these subsided (and I hope it stays that way).

BTW, "dysdiadochokinesia" is a very long word that means inability to perform rapid, alternating movements, such as the fingertip to nose touching that neuros and cops testing for inebriated drives are fond of. I'm glad you showed no signs of that; while one can have trouble doing such things with muscle injury, it's far more likely to result from cerebellar lesioning (it's characteristic of ataxia, and seems to result from the inability to switch on and off antagonizing muscle groups).

You probably have chronic muscle tightness in the rotator area, and the area does tend to get even less resilient with age. And you may have torn part of the rotator cuff, which is the sort of thing which doesn't tend to get better by itself--and repetitive motion can make it worse (think baseball pitchers). I certainly think you should get an MRI of that area if at all possible (maybe at a stand-up MRI center?), as that is the modality that can look at soft tissue as well as bone.

Holy Mother of Whatever:

And this morning, Alan and I were doing yoga in bed. Stretching our bodies, this way and that. bringing our knees up to our chests. Dr. Theirl said that Alan has to be more flexible and since I do some yoga I showed him some moves. Dr. Theirl said Alan should learn Hatha Yoga.

I asked Alan if he could sit in a lotus position and showed him what it means (not that I could do this, I just showed him what it looked like). He looked at me like I lost my marbles. He said "are you for real?" I could never put my body in that position." I responded "Before you went to Dr. Theirl, you couldn't put your body in ANY position". He said "yeah, you got me there".

When I do the spider thing going up the wall, and when I stand up strait and put my arms in big circles round and round for a few minutes, and I do this several times a day, I get more ability to move my left arm. Does this mean anything? Alan said "if you had a torn rotator cuff, you couldn't put your arm in any circles the way you are doing it. It hurt real bad at first but as I move it, it does get a bit easier. The bad thing is when the weather is like today (again it feels like 100 degrees humidity), well, everything hurts, but then again, I am almost 60 and no longer Gina Lolabrigida. But at least I do try and move. I walk every day with my ipod (thank god for my ipod). When the weather is right, and the sun is warm, nothing hurts (why the heck is that?).

I remember going to rehab on my left arm (when I wouldn't let that terrorist nurse kill me with the cattle prod), I went to rehab, and they used the tens unit on my shoulder, and they massaged me, and they put these electrodes on my upper back shoulder area with a hot pack over it. Felt great.

I have always had muscle spasms all my life. I've never been what you consider a cool, quiet person. I'm getting there as I get older, but in my youth I was a bundle of nerves (having a young son with problems will make anybody nervous believe me). But as I age, (too bad that arthritis has to come along with aging), but as I age, and I move, and I exercise, honestly, I do feel better (I certainly am thinner, thats for sure).

I mean, I look at photos of me at 300 lbs and say "what happened to my brain, was I out of my mind?". Thank god, I came to my senses and it took most of my adult life to do this, but I'm getting there.

This Friday I go to Cornell and I shall blow them away when I get on the scale. You should see all these skinny little nursing people (they must weight 90 lbs), and every time I come, they weigh me backwards and they go, "Oh, she lost more, weight, oh my". I say how much and they go "wow, you lost 2 lbs". That's when I want to crack them but I keep my mouth shut. Last visit I lost 10. I'm not doing anything special to do this. Just eating my healthy eating but I am moving more.

I'm going to put on my blond wig this friday. They won't know what hit them. I might even dress like Madonna. Now WOULDN'T THAT BE SOMETHING???".
This friday is my two year annual physical at Cornell, with all the blood work, the blood pressure, the eye thing, the heart thing. I broke their protocol and while that's not good for them, they laughed and said "it's certainly not what we expected for you to accomplish but it's great for you".

This year I turn 60. I want to be a healthy fit 60, not some bent over full of degenerative joint disease, scoliosis, diabetic, full of aches and pains 60 year old.

Oh, you'll love this. I was in Radio Shack discussing how to fix my Directv system by buying a new 100 foot coaxial cable and installing it myself. The guys who work there were maybe 24 years old. They looked at me and said "you know how to fix a satellite system?, and I said "I even know about dish pointing, signal meter strength and barrels and connectors, AND I EVEN HAVE AN IPOD". They burst out laughing and said "Did you know that Microsoft came out with an IPOD thing called Zune? I said No, how is it different from my Apple Ipod?" and the guy goes "well, it comes with video".

I responded "Son, when you are almost 60, all you need is music, not the video". and he said "who's 60"? and I said "well, I will be 60 this year". and he says, and I kid you not, he said this "You can sell someone the brooklyn bridge, but don't tell me you will be 60 this year". I whipped out my non-drivers license and he started to laugh. I never laughed so hard. I mean, what do they think 60 is supposed to look like? Like Grandma Moses? I mean, look at Sophia Loren at 72, and Goldie Hawn. She's almost 60.

We gals are the new 30!!!!! Thats all I can say. That is if I can get up out of my chair and walk to the kitchen.

lol

Melody

Dear Melody:

I think you will be forever young! Remember, they are only numbers - and in our heads we are forever youthful. At least that has been my experience with the passing of years.

I am bothered by weather changes and feel sort of achey when the barometer is low and when precipitation is on the way. Many of us are weather sensitive like this.

Guess we all feel better when the sun is shining.

By the way, thanks for shining YOUR sun on all of us. Your posts give me a daily lift. Thanks, Melody.

Shirley H.

Thank you Shirley:

I do have a question relating to this radiculapathy thing.

Many many years ago, I was in a relationship with an abusive man. ONe time, he forced my arm behind my back and tried to put my head down the toilet bowl. Of course, I have put that episode behind me as it happened when I was 24 years old.

My question is this: Could his forcing my left arm behind my back have initiated this radiculapathy thing? I mean, could he have injured a tendon or something, that took all these years and now because I have arthritis, could it have made it worse.

Just a thought. It came to my mind last night and I said "oh, I wonder if my shoulder got damaged by what that guy did to me".

thanks, Melody