Brief Answer:
See below for HOMEWORK ASSIGNMENTS that are due

Detailed Answer:
Thanks for redirecting this question to my attention. And thank you for letting me know on this new request that you found my information helpful.

Let me start off by saying that for future reference I would be very happy to answer questions DIRECTLY from you. To that end, you can GUARANTEE that such questions will be routed to me by selecting the DIRECT QUERY option and finding my name. I wish I could tell you step by step how to do that but I really don't know what your desktop or platform looks like on your end to tell you which buttons to click or how to navigate. Perhaps, tech support can help you with that issue?

However, in the way you sent the question it could've legitimately been answered by ANYONE on the staff even though you PUT my name down on the request. Does that make sense? Plus, when patients send DIRECT QUERIES to specific doctors then, the network throws us an extra bag of peanuts to munch on...that's completely true. LOL!

So now here's the thing. I went back and looked at your pictures you put up to illustrate the curvature of your spine. It certainly seems as if the excess curvature to your spine is more in the upper thoracic region as opposed to the cervical portion, however, the only way of being absolutely sure (as far as I am able to tell from the presented information) were if you could show me an x-ray film obtained or at least a copy of a radiographic report. That would precisely localize the kyphotic areas of interest because you are correct...many people with even severe kyphotic thoracic spines can still turn their necks. HOWEVER, also be aware that many CANNOT and that's because the disease process which causes the kyphosis (different forms of arthritis such as spondylitis, rheumatoid arthritis, degenerative osteoarthritis) can and does often affect the entire skeletal structure...it's not that localized a process as one would believe (or hope). So while there are curvature issues that seem to predominate in one area of the spine....another area may be slowly becoming deteriorated and as a result fusing...as perhaps could be happening in your case. That could be an explanation to why you're not able to rotate or range your neck as you used to be able.

Again, I would like to recommend you obtain either a radiographic report of your cervical and thoracic spines or better yet, the pictures AND THE REPORT....greedy aren't I? You must understand I'm a neurologist and not a radiologist! Thank goodness. I enjoy looking at people AFTER they've been together...not their assembly line gadgets and widgets that made them up! HA!

Now, here is another possibility. I think you said you've had blood work? If so, can you get those results posted as well? Specifically, I'm looking for the following 2 tests: RHEUMATOID FACTOR and HLA-B27 serum antigen marker profile or however, they may term it in your neck of the woods. Simply, if you are positive at all for either of those arthritides then, that could be another very good explanation as to what's going on in the neck.

So, there's your homework lad....off to it and see what you can put together for the old doc! And no stopping at the candy store....you'll ruin your appetite!

As an aside, can I ask you a tremendous favor? Our last encounter was on Aug. 22 but you never formally closed that query nor did you rate the discussion. It's really of great import to everyone here at Healthcaremagic.com that we be rated by patients. Hey, it's the rage when it comes to internet transactions these days. I believe that for the non-medical folks who put these networks together it is actually more important we get rated well than the quality of the medical information that is put out there....sad but true...the world is different from whence I grew up.

Therefore, could I trouble you terribly to go back to our last conversation of Aug. 22, 2014 and give that exchange a brief write-up on how you felt about that conversation and also give it a STAR RATING? That would be fantastic!

And let me give you one more option which I think would be terrific for you to consider here....I am also LIVE on a webcam interface through another network and in fact, am on call right now as I am typing this response to you. If you wish to have a face to face by livestreaming internet technology (which gives me the added advantage of seeing you and watching you be able to actually do range of motion, and so on... so I can visually appreciate what's going on in the neck and back) then, please look me up at the following web address: www.healthtap.com/drsaghafi

You will find me online with tape and camera rolling Wed-Sundays. from 3a-6a (New York City Time Zone) and on Sundays 11p-3a as well. But by all means I am also available on this network as we've been chatting if that's simpler to do right now. Simply make sure that you directly route further questions to my attention as I detailed above.

If you do decide to use the webcam option then, again, could you please do the all important favors of written feedback on this last message with a STAR RATING as well as CLOSING THE QUERY so it doesn't remain pending.

By not closing your queries I'm told that the computers have asthmatic attacks and when they wheeze the oil they splatter...well, it's a mess! LOL

Looking forward to our next chat!

This query required 33 minutes of physician directed time reviewing, researching, and documenting for final draft and envoy.

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Brief Answer:
I was actually hoping you'd pick me up gobstopper

Detailed Answer:
You have to understand. I was trying to use reverse psychology by telling you not to stop at the candy store desperately hoping that since you are in that part of the world where XXXXXXX Wonka lives that you just might've gone by his place to pick me up one of his delicious gobstoppers!

Well then, back to medicine I guess it is and I understand that you actually have laboratory results that show negativity to ankylosing spondylitis. no, as you know I'm a neurologist and not a rheumatologist but I do believe that depending upon the initial phase of the condition and when you get that test done it could change over time. Do you think it might be worth repeating that test if your original was done let's say anymore then several years ago?

Well, at any rate I understand what you're saying in terms of the mechanism that you feel both caused as well as propagated your condition. As I said from my perspective as a neurologist that would be somewhat out of my realm of expertise but all in all I agree that what you are suffering from is certainly not a neurological phenomenon as much as it is a mechanical one but I can't tell you absolutely without looking at some films Whether that came about as a result of something like ankylosing spondylitis or another form of arthritis.

Certainly, in my experience and with the patients that I have treated over the years with kyphosis as well as cervical spine limitations and so forth I can't say that I've seen a case explained in the manner that you are stating but then again I can't give you any sound orthopedic rationale as to why it shouldn't be that way.

As far as the doctor in London that you are telling me about is he an orthopod or rheumatologist or physical medicine and rehab specialist? I also have several patients who are unable to extend their neck backward enough to comfortably lie on a table and we do have to prop them up on something more solid.

If you were in this area I would do my best to hook you up with the right team of folks that could try and make a go of getting your neck more functional. We really do need to look at those films to see what the potential is going to be for that sort of thing to happen down the road but if there is still any mobility left then, I believe modalities would be available to help loosen some of either the muscle rigidity (such as botulinum toxin injection) or the ligamentous and skeletal rigidity likely due to calcifications, osteophytes, and degenerative arthritic processes.

I did see some of your other consul questions having to do with a kidney stone so I understand that you need to take care of that business as well but I wish you the best of luck in getting some of these things straightened out and as I said before in my other messages I am ready to help if you would readdress any further questions and information such as lab results and imaging study reports directly to my attention.

As another quick reminder I would greatly appreciate your written feedback and comments as well as a star rating of this interaction and if you do not have any further questions or comments that you would like to direct at this time please close the quarry so that the network will properly process and credit these encounters.

I was also mistaken on the date of our last collection of notes that I asked you to follow up on and make a comment and rate. I had given you a date of August 22 but in fact your original request is dated August 19. If it were possible for you to find that original consult request and leave similar feedback as well as rating that would be once again heartily appreciated.

Again, don't forget that you can also find me live using WebCam consultation technology at the previously given website. I will be on at 3 AM this morning and once again on Sunday evening at 11 PM local time.

This query required 60 minutes of Physician specific directed time for review, research, and final draft documentation for envoy.

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Brief Answer:
I think it's possible to gain neck flexibility

Detailed Answer:
I think it's possible to get more neck flexibility in your type of situation because I've seen it happen in both my patients as well as others who were not my patients. However, the disclaimer is that in all those cases I was able to examine the patients, feel exactly how stiff things were and therefore, gain a better understanding of just how much or how little improvement I thought we could get and just how aggressive we could or should be without risking complications. So in your case, I stick with my first thought of there being a chance at gaining more flexibility. BUT, I can't really give you better than that since I can't "feel your neck" myself. Of course, if you wanted to hop the next 747 across the pond then, we'll see you in XXXXXXX in a mere 10 hrs. or so and I will look AND feel your neck more precisely for better predictions...otherwise, I must stand by that particular disclaimer!

Also, keep in mind that I do not believe your NECK problem will be amenable to maximum improvement in flexibility, range of motion, or rotational strength unless you also address the kyphosis. Most neck and cervical spine deformities from people with thoracic kyphosis are due to the thoracic problems to begin with. Doesn't mean you can't do SOME work with the neck but optimal correction can only come in the neck after fixing the thoracic spine.

My feeling in these sorts of cases is that nice and gentle does the trick as worked upon a good KINESIOLOGIST or person with a lot of therapy experience using tight cervical spines. Not only that but you need to perform the stretching maneuvers and apply the forces almost on a constant basis.....Once or twice a week is simply not going to make a hill of beans of difference to any situation where the neck is frozen or nearly frozen.

Some people advocate going on high dose Glucosamine Chondroitin Sulfate as a "lubricant" for the skeletal structure. Frankly, I've never found that medication very useful except in people who get a lot of mileage out of the placebo effect. I doubt you'd be one of those folks!

As I said, there are surgical corrective methods and perhaps you planned on discussing these with the person in London you found. Just research the surgeon or the procedure carefully and make sure you know exactly what procedure is going to be done before doing anything. I've seen really good results in some patients. I've seen some really BAD results.

Bottom line is this...I think it is definitely possible for anyone with your type of osteodegenerative problem to get better. With proper films, a good kinesiologist, and a lot of hard (and at times painful) work--- and potentially surgery when indicated-- disabling and debilitating kyphosis of the thoracic and cervical spines should be a thing of the past.

I would also redo your arthritis panels from the past as well as the HLA-B27 test just to humor the 'ole doc (and I'm not that ole mind you- no more than a few years your XXXXXXX to be sure!) HA!

Gobstopper spinal fusion osteotomy will remain your baby if you just promise me a Wonka Bar at your first opportune moment.....better yet....if you're headed to London....a Cadbury bar would be even more deliciously appreciated.

In closing, I have a link that I'd like you to read regarding at least one procedure that can be considered for your case aside from conservative treatment:

http://www.ncbi.nlm.nih.gov/pubmed/0000

Remember, gotta fix the thoracic kyphosis as much as possible before you can expect much in the neck. And finally, don't forget my invitation to join me on live webcam conferencing...in fact, I'm on tonight from 11p-3a (NEW YORK CITY time zone) and then, again on Wed-Sat nights from 3a-6a (what an ungodly time of the morning to be on a web-camera wouldn't you say?) Fortunately, they haven't figured out how to get a webcam to detect bad breath and pass that to the other side! LOL!

Cheers!

Please don't forget to rate the conversation we've had with a brief written redaction and then, put lots of STARS on top if you feel it was deserving....and at the same time please CLOSE THE QUERY if you have nothing further you'd like to question or add to this thread.

This query required 53 minutes of physician specific directed time to review, research, and compose in final draft format for envoy.

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