Brief Answer:
Trip to USA?

Detailed Answer:
Good morning to you once again Ms. XXXXX- Thank you very much for sending your question to me for a response.

Again, so sorry you're in the type of pain that is so very difficult to adequately treat no matter part of the world you are in. I understand why your doctor might say that getting studies to assess for osteopenia or possible osteoporosis would not be of sufficient value to order them (based on my knowledge of how socialized medicine operates), however, all I can say is that from a medical perspective it certainly makes sense to me to look for this type of problem if you've been suffering from disuse of the limb for any length of time. It is the equivalent of having an arm or leg in a cast for several months. Once it comes out of the cast, it will likely be smaller, weaker, and more fragile compared to the opposite side. Therefore, more care has to be taken to build it back up lest it fracture or become disrupted.

The same holds true for the paralyzed/paretic leg which has not been in use. You did not give me a time factor that this has been going on but I'm assuming it's been at least several months or longer since going from fully ambulatory and equally strong in both legs to either bedbound or wheelchair bound. Also, your statements suggest that you've not received very much if any therapy in order to get you to a weight bearing status again as soon as possible. Again, this can lead to demineralization of bone in the affected limb which can increase the risk of pathological fracture.

I believe that a study of calcium matrix integrity is of value, not so much from a complex regional pain perspective so much as from a rehab and RISK perspective of where you're currently at so that therapy could be done either more or less aggressively with respect to getting you ambulatory and weight bearing as soon as possible.

Increasing the dose of gabapentin is a possible move and perhaps one that most physicians may even pursue but it shouldn't take too long to gauge whether strategy worked or not....so if after a couple of weeks (depending on the time it takes you to get to the final full extra dose he wants you to be taking) if your pain is no better and you are not able to go further while taking steps or ambulating then, either the rehab program needs to get turned up a notch or two or medications need to be reconsidered.

Again, please understand that this is a really difficult type of pain to treat based upon the cause. Brown-Sequard patients commonly live with chronic pain, here, there, all over the world. So, for that reason alone there is some truth to what your doctor says in terms of what additional tests can add in terms of final outcome or value. But again, our approach is to try and search down each and every possible contributor to the total picture of pain and address that maximally before coming to the conclusion that the pain is going to be what it is and that no further testing would be helpful.

As far as coming to the USA for treatment I can tell you that in every metropolitan region there are excellent spinal treatment care programs that are available. That does not mean that there is a 100% cure rate for spinal cord injury patients because there is not. People continue to be paralyzed, bed-bound, and live in chronic pain, however, there is a lot of attention given to a variety of functions (GI, orthopedic, ambulatory rehab, neurological rehab and neuronal remodeling as possible) and there are a variety of approaches to controlling pain which at times help and other times really do not.

The large disadvantage of your coming all this way is simply the trip to begin with. Being on an airplane in a cramped position for the number of hours you will likely be flying I think may be extremely difficult. Of course, they are now advertising aircraft and flights where passengers can literally RECLINE and STRETCH out their seats....are you familiar with those airlines and flights? I don't know where in the world one has to fly to get some comforts offered but they do exist and I imagine they must cost quite a pretty XXXXXXX

Second disadvantage, once here to the states everything you do medically will be charged to you and collected on a cash basis only UNLESS you know of some way that you could obtain health care insurance. Perhaps, you have family here in the U.S. that can advise you on such a possibility. I know families actually are successful at getting certain types of insurance coverage for loved ones who come here specifically for medical treatments but usually in those instances patients will be actually living with their family members and may even have the intention of obtaining permanent visa status, etc. Again, things I'm not fully aware of in terms of procedure but things that I know occur.

But to answer your question directly regarding treatment options in the USA I can tell you that where I am from which is XXXXXXX Ohio we have one of the most recognized spinal cord rehab programs in the country at MetroHealth Medical Center and I do send most of my out patient spinal cord patients with similar types of problems of limb weakness or paralysis following chronic spinal cord injuries to the Chief of their spinal cord rehab unit, Dr. XXXXXXX Numanitis.

But once again, I remind you that the cost for a proposition like this is not cheap at all and I would imagine that the length of time they would recommend you be part of any program (based upon what you're telling me) is 3-4 weeks of intensive work with the goal of getting you ambulatory. For many patients, it could be as long as 2-3 months before they really start to experience some level of XXXXXXX or a sense of feeling a sense of finding a routine that they can handle on their own.

I am not aware of programs in Europe that are renowned for spinal cord rehabilitation, I'm sorry. But you are just as able to find such facilities probably as I am and I wouldn't doubt that even somewhere in your country there should be something that you can access...but getting someone to point you in that direction may be difficult.

As always I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.

I want to thank you as well for your last set of comments and rating. I'm honored you felt that way about my responses. I hope these were equally helpful though I personally wish I could do more but such is difficult when the distance is so great.

Don't forget that my webpage to keep me abreast as to how you're doing is:

bit.ly/drdariushsaghafi

All the Best

This query has required a total of 58 minutes of physician specific time to read, research, and compile the return envoy to the patient.

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Brief Answer:
Thank you for the update

Detailed Answer:
I wish I could help you understand your neurologist, however, I believe that can only come by you and he having a discussion so that he can explain his point of view to you. Every doctor is entitled to their own belief as to approach particular types of patients.

What I've suggested is only how I and colleagues that I work with would suggest things be done for a case such as yours...but that is also not taking into consideration the environment of restrictions which do not YET exist here as they do in many other countries of the world who practice one form or another of socialized medicine. When costs are brought into play on large scales then, physicians become pressured to abide by the rules or they are pushed out of the system. In the U.S. that may mean simply being asked to leave a particular hospital or clinic if you fail to meet their productivity requirements, etc. However, if you are a doctor practicing in a COUNTRY where you are expected to keep costs of tests down and to practice CLINICAL MEDICINE as much as possible.....then, if you buck that system too hard....they will push you out of your profession. And so to some extent I sympathize with doctors who are in such situations. Remember, many European physicians (and indeed many other countries) train here and are definitely exposed to the greater tendencies we have compared to other countries to order tests and offer services (physical therapy, devices for comfort, transplantation procedures, etc). We like to think that such practice of medicine is "better" or more advanced.....the truth is that a lot of testing and such has its drawbacks and can also be detrimental to patients. Sometimes it sends the wrong message to people. Sometimes patients will expect that there MUST BE some test to detect what's wrong, or some device that will FIX my problem....etc. etc.

Therefore, it's not necessarily that physicians don't know or have knowledge of what potentially can be done....but when they are placed in working environments with little resources and are told specifically to NOT ORDER tests or studies or additional services beyond something basic such as a few sessions of physical therapy,etc.....well, then, things appear to be less rigorous, and patient satisfaction tends to go down.

As far as a prognosis is concerned. I believe my first set of notes would've implied that Brown-Sequard syndrome patients can have a variable prognosis depending upon the severity of their spinal cord transection and the intensity with which therapy and other ancillary measures are taken and under what time frame. Obviously, the sooner things get started in order to mobilize and get patients ambulatory the better and more robust one should expect to see outcomes. On the other hand, severity of the injury is also very important and some times no matter how aggressive one is with ancillary measures...the outcomes cannot be changed or changed very little because the problem was simply beyond our capability to handle.

In your case, I've not had the advantage of physically laying hands on you therefore, I cannot accurately tell you what to expect or not to expect from your condition by engaging in any of the things I mentioned in my first set of notes.

What I would say is that if any of the measures I mentioned have not been tried yet that I would not dismiss the possibility of trying them IF THEY WERE AVAILABLE TO ME...and seeing what happened. If too much time has passed for anything to be effective then, I think you will know this within several weeks but you'll never know until you try....that's my motto!

I think it's safe to say prognostically that if you DON'T BECOME MORE AMBULATORY and independent in terms of getting about either by walking or other means that as time goes on and you age the likelihood of you being able to perform those types of activities will diminish with time, muscle atrophy or disuse atrophy could set in to the muscles of the paralyzed leg and then, trying to get responses from such affected limbs in the future will be difficult if not impossible.

As always I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.

Don't forget that my webpage to keep me abreast as to how you're doing is:

bit.ly/drdariushsaghafi

I wish you the best in speaking with your physician. I'm sure he would be happy to engage you in a discussion as to his reasons as to why he believes what I've recommended will not make sufficient difference to implement anything...but just know that what I've suggested simply follows what we consider to be the standard of care in such patients...but this is not the only way to do things.

This query has required a total of 20 minutes of physician specific time to read, research, and compile the return envoy to the patient.

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Brief Answer:
I'm not expert in complementary medicine options

Detailed Answer:
Good afternoon. Since I'm not really trained in any of those complementary modalities of treatment I don't think my opinion should be taken on an expert's level so I must defer giving any formal statement.

I think that a person is always at their XXXXXXX to try any type of treatment modality they are willing to spend money on with the understanding that the results could be improvement, worsening, or no change. The science behind many complementary medical procedures is lacking therefore, it becomes more of an individual patient's thresh hold for risk vs. financial resources.

I have sent patients for acupuncture in the past with some examples of success but never for a condition such as yours. Nevertheless, pain (no matter what the cause) is one of the fields that acupuncturists delve into quite extensively. You may wish to contact someone local to you who is an expert and ask them if they've treated spinal cord injury patients.

I recently had an acupuncturist (Dr. Chester Dickerson) as a guest on my radio show (THE OHIO PHYSICIANS EDUCATIONAL NETWORK) which airs on the 3rd Saturday of each month on radio station WHK 1420 AM.

https://soundcloud.com/am-1420-the-answer/the-ohio-physicians-educational-network-acupuncture

You may wish to listen to this podcast as Dr. Dickerson discusses some of the basics having to do with acupuncture and its application in different types of medical problems. Dr. Dickerson will be back to XXXXXXX in the near future to be a guest again on the radio show.

As always I'd appreciate your commitment in providing a STAR RATING and positive brief written feedback if your questions have been satisfactorily answered. In addition, your cooperation in CLOSING THE QUERY at this point would be greatly appreciated. You may reopen this thread if you'd like with a different theme or recharge this question for another set of responses.

Don't forget that my webpage to keep me abreast as to how you're doing is:

bit.ly/drdariushsaghafi

I'd also appreciate your visit to Parma Neurology's Facebook page at

This query has required a total of 138 minutes of physician specific time to read, research, and compile the return envoy to the patient.

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