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June 9, 2013
Good news, bad news, and no news
I got the results of my brain MRI two days later, on January 7, 2013, about 30 minutes before I was to board a flight from Dulles to San Francisco. I was having a delicious Potbelly pizza sandwich near terminal C2 and preparing myself for 5 hours of tedium and poor customer service.
My neurologist explained that the brain MRI order itself was drawn up by one of her colleagues since she happened to be unavailable that day. She also explained that the term "demyelinating disease" probably should have been preceded by "examine for" and that it was a guideline for the radiologist, not a diagnosis. She said that she is usually more verbose than her colleague, and apologized if the order had caused me any panic or distress. "You're damn right it caused me distress! I thought I had MS!" She apologized again for the terse verbiage and said that testing hypotheses was part of the diagnostic process, and that there would likely be more twists and turns along the way.
The good news was that the MRI did not show any of the brain lesions characteristic of MS, and that we could safely conclude that it was not causing my condition. The report focused more on my sinus cavities than my brain, which was a good thing. I had suffered fractures to my nose and facial bones playing soccer the previous fall, so this was not a revelation.
The bad news was that we still didn't know what was wrong with me.
My symptoms were still roughly the same, though they tended to fluctuate in intensity from day to day. I continued to have a lack of sensation in my feet and shooting paresthesia in my back, shoulders, and arms. This caused general clumsiness and prevented me from pursuing my normal active life. There was something wrong with me, likely related to the enhancement on my spinal cord between my C4 and C6 vertebrae.
The neurologist ordered further tests. I was signed up for a third MRI, this time of my thoracic spine (back), as well as a full metabolic workup (blood tests) and a lumbar puncture examination (spinal tap).
I had the thoracic spine MRI on the morning of January 17th, 2013. By this point, the administrative and technical staff at the radiology center were starting to recognize me and chat even more courteously with me. I'm not sure it's good to be a regular at places like that, but at least the customer service was pleasant. The MRI was taken with and without contrast, just like the previous two. The results came back the same day and showed no abnormalities. No enhancements, no lesions, no bulging discs, no nothing. Whatever was causing my condition was not coming from or affecting my thoracic spine.
The following day, January 18, 2013, I went into the hospital for a full metabolic panel (more blood drawn). The results were uneventful and actually showed increases in my B12 and D3 levels. This however hadn't improved my condition, confirming our belief that it was unlikely to be the cause.
Following the vampirism, I went through a lumbar puncture (spinal tap). This involved lying prone on an operating table while technicians extracted cerebrospinal fluid (CSF) from my spinal cord. They used a local anesthetic (lidocaine) to numb the area between my L3 and L4 vertebrae, then used fluoroscopic (real-time, continuous) x-rays to guide a needle between these vertebrae and associated tissue and into my spinal cord. They withdrew a small amount (13cc) of CSF. This procedure took about 20 minutes, after which they then wheeled me into a recovery room. Spinal taps historically have a bad reputation, but for me it was relatively quick and painless if not pleasant.
The recovery was where the real boredom began. Because of the risks of headaches due to CSF leakage, bleeding, and back pain, I had to lie still while supine for 4 hours afterwards. I read my book, screwed around on the internet, and generally daydreamed for the duration. I suffered no actual complications from the procedure and was happy to go home as soon as I was cleared to leave.
The results for these two procedures came back a few days later. The lumbar puncture report came back on January 22, 2013. It showed no abnormalities or surprises. The one important subject going in, oligoclonal bands (MS indicators), came back negative (in a good way). There were also no signs of tumor cells such as lymphocytes. My test results were unable to show anything specifically wrong with me or help in diagnosing my symptoms.
Similarly, the metabolic panel results were uneventful. A few hormones were slightly above or below normal ranges, but none of these were deemed likely to be related to my symptoms either.
We were no closer to diagnosing the root cause of my lack of sensation, though we were able to eliminate a wide range of possibilities.
Posted by jon at June 9, 2013 3:58 PM