Brief Answer:
No permanent damage expected from tingling

Detailed Answer:
Good morning Ms. XXXXXXX My name is Dr. XXXXXXX Saghafi. I am the Chief Neurologist at Parma Neurology and on the Neurology staff of the XXXXXXX Stokes VA Medical Center in XXXXXXX OH. I am the Director of the Headache Clinic and a subspecialist but am a General Adult neurologist in my private practice. I also deal and intervene with many cases of head trauma and its effects over time as well MS and other demyelinating diseases.

I spent nearly half the time in this query so far reading and examining other colleauges' notes, thoughts, responses, and your images. In brief I concur with everyone's opinion that your MRI is clean as a whistle. I wish mine was as good looking as yours! HA! At any rate, the the vein you see on the right side of the brain is entirely normal. The differences in contrasts between image sequences (FLAIR vs. T1 vs. T2 etc) are due to the way the slices are viewed by the scanner and then, reconstructed by the computer software so that in certain sequences we may see nice contrasting between the cortical ribbon of the brain vs. that which runs deep which is the white matter tracts which is frequently where lesions can be found and so forth. In other sequences the idea may be to see structures that have high water content as "bright" (T2 images) vs. the opposite where water may be dark (T1). And there are zillions more to talk about. Every time a graduate student in neuroradiology wants to get a school award or his/her name published they come up with some new funky software revision that nobody else has thought of.....pretty soon, the darn images are gonna' be polka dotted in order to distinguish PARTY ANIMALS from NERDS! ROFL!

Anyway, to get back to being a little more doctor'ish now and tell you that your MRI and apparently your neurological examination per the neurologist you are seeing out there in the Big 'ole State of XXXXXXX are normal.

Now, to be sure...and not to throw a wrench in the works. When I say your MRI is normal......it means that of the slices you've provided I don't see anything of importance. Remember, the entire sequence of slices comes on a disk....when you send a pic or 2 that's exactly what it is....a pic or 2......so unless you are going to try and load the whole thing (AND PLEASE LET'S NOT GET THAT DEEP INTO THINGS JUST YET) then, when I say I don't see anything in the scan....it's because I see nothing in the slices you've provided.

Having said that, if you've got a neurologist who you're confident about and you like their attention and thoroughness to your case then, I can almost assure you that he/she would've caught something in the rest of the scan if it existed. Not only that, but if you had a copy of the RADIOLOGY scan to upload then, that would be the whole Magilla in one page...right?

Now, what's causing the tingling you may ask? My answer is, "I dunno...." but it's not visible in the MRI slices you've provided and your neurologist doesn't find your examination parameters to be remarkable enough to make a neurological diagnosis. I'm sure he's also looked at bloodwork, correct? You know the routine I'm sure by now....thyroids, B12, Vit. D (which as a runner I'm sure you're awesome on)....., folate, and stuff like that, maybe an ANA, an ESR, CRP, sooooooo

Bottom line is this....you've got a neurologist down in the Heart of XXXXXXX that's giving you a thumbs up and that's huge cause as opposed to the rest of us poor guys..."we can only know you from afar!" HAHA! You've also got 3 colleagues, one of whom is a neurologist, a radiologist, and an orthopedic surgeon who BTW I think gave some excellent suggestions on how to implement interventions which may help you. I'm only able to vouch for the YOGA and I'm not very good at that one at all! Maybe I'll get better if I take stretching more seriously!

There is no nerve damage that has been identified to date that should cause you to worry about any permanent damage that will occur between now and the time you go back to see your neurologist.

One thing, I will mention is that in my patients when I am looking to rule out demyelinating processes in my patients I always throw in a cervical spine series of films as well so if that hasn't been done maybe I would add that to complement the head sequences.

I hope the information I've provided is of value to you and that you can rest more at ease knowing that no permanent damage in the limb (or any other part of your body) that you are feeling tingling in right now should occur based upon currently available information. I would recommend 3 things after taking all things into account:

1. Consider (as an option) a way of getting a hold of a copy of the MRI report and posting that for me to peruse.

2. Obtaining all your labs blood, urine, etc. which have been drawn and posting or collating those results for me to scout out a bit.

3. Discovering whether or not you've had a cervical series and if not, perhaps asking your neurologist if he would consider getting one (with gadolinium preferably) before your next visit given the symptoms you have and their location below the neck.

With those things you could either then, discusse things with your neurologist again when you next see him/her or you can post to my attention....and believe it or not...I'm not sure of the exact address to use to get your question directly to me...nuts.....you can just come on the website and look me up... XXXXXXX SAGHAFI, MD from XXXXXXX OH (The Best Location in the Nation!). You can also try this web address and see what you get:

http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474

I can give you one other alternative which is to hook up with me on a live webcam network...sound cool, no? It is....this is rad man....live internet feed where we can hook up either by videocam, by straight real time messaging, or by audiostreaming...your choice. For instance, if you wanted to load up all your images on the disk on your computer and then, run through them on your screen and point the camera at the slices as their filing through I could see them that way?

You can find me at www.healthtap.com/drsaghafi on Wed-Sat's from 3a-6a and Sunday nights 11p-3a. So that's another option if you'd like to get another opinion.

If you've found anything I've said useful would you do me the grand favor of leaving a little written feedback and give me a STAR RATING? They'll leave an extra cookie on my tray this afternoon for lunch if I get just 1 more star! ROFLMAO! Also, another HUGE favor....my kids in college would appreciate this one!.....if you've no further questions or comments could you CLOSE THE QUERY so the network can process, archive, and CREDIT MOI...for this transaction and prepare it for future reference. That way other docs can look this over and say, "Huh???" HA!

And there you have it....shoot me a line if you think I can still help and good luck preparing for your next race....if you ever run in OH we may bump into each other although I'm sure you'll blow by me.....my most favorite part of any footrace is crossing the finish line! LOL! But somehow, my daughter who's big into crossfit keeps getting me to up my race miles....we last did a half together....she almost KILLED ME! Geezzz...... Anyways, best to you!

This query required 60 min. of physician directed time for review, research, and final draft documentation for envoy.

---

Brief Answer:
Get the gloves on....Round 2

Detailed Answer:
Ok....Missy, climb back in the ring here and let's have at it once more! ROFL!

So, tell me this....were you worried about the lack of a spine MRI BEFORE or AFTER I mentioned it? If you say AFTER then, I'm going to beat myself with my last pair of shoes I used in the Tough Mudder cuz that's like the last thing I wanted you to do was worry about that....but hey, I wanted to make sure it got put out there. It's my job man.....

But, I'm just going to take a helter skelter guess and say you were already wondering about that anyways since the hypochondriac side of you probably looked it up on the internet last week! HA! Seriously, though you want the truth so I have to be truthful. MS and any other demyelinating disease CAN present in any dog gone way it wants....one limb, 2 limbs, tingling, pain, headaches, funny smells, tastes, it's all in the placement of the lesions, the timing of whatever factors actually trigger the activation or actually the RESULT OF DEACTIVATING a certain tract of white matter, right?

What I'm saying is that the presentation of MS is in any way, shape or form you can imagine. Having said that, based upon a NEGATIVE set of MRI images you presented from the brain and based upon your report that the neurologist you're seeing gave you a clean XXXXXXX of health on your neurological examination....I think that those 2 things are HUGE (or as XXXXXXX Trump might say, "EUGE".....By all means let's not forget about getting those C-spine films and let's rifle through the slices in detail and see what's there. No fear...look we've gotta look in a case like this....so....

If NOTHING is present in the entire brain series and if the cervical spine films are also completely pristine then, nobody on the planet can give you a diagnosis of MS or SARCOIDOSIS, or any other form of demyelinating illness. There is no such thing as "phantom MS" where you get the diagnosis without lesions either in the brain or spinal cord. The diagnosis presumes...actually REQUIRES the presence of at least 1 lesion with a clinical history that is consistent with the diagnosis.

Now, hopefully this tingling/buzzing or what have you can be tracked down to be some kind of metabolic derangement which is correctable so that's what I'll say about that.

So, for the time being I think we need to get 3 things done:

1. Need the MRI report of the brain from radiology
2. Need to get a C-spine with gad contrast
3. Need to get solid serum testing done for any and all things that go BUMP in the NIGHT or what one normally gets in either a demyelinating or neuropathic workup in a female.

BTW, are you taking any new medications let's say within the last few weeks or months before all this came down the pike? Anything homeopathic, herbal, or whatever that you were taking to improve your running, your stamina, conditioning, something you thought you'd buy from the jungles of the XXXXXXX because other runners said it was the XXXXXXX ....???? Birth control pills, birth control shots, I dunno....anything? Gluten allergy? Plain old food allergy of some sort???
Did you just buy a big fat Persian Cat that's shedding on you? Crazy sounding....but it happens....

See these would be the sorts of things that your PRIMARY doc would want to investigate...in other words non-neurological issues that could possibly be related to your symptoms and do a parallel workup along with the neurologist. Then, we bring the Ying together with the XXXXXXX and Voila....Party Time! HAHA!

So we straight on all that?

Let's break it down once more......

1. MS can present in a variety of ways....there is no absolutely CLASSIC or NONCLASSIC way.....oh....and by the way, just IN CASE your mind decided to run away with itself because I've answered like a million questions on this over the past 3 months......NO! THIS IS NOT ALS! LOL! So let's just put a stake in that vampire's heart right now.

2. We need the radiology report of the brain. We need a cervical set of films done with gadolinium and the REPORT

3. We need full labs to have been run by both your primary doc as well as your neurologist looking for neuropathy or demyelinating types of issues and then, on the medical (i.e. NON-NEUROLOGICAL side of things) labs that would be done in case all the neuro labs are clean.

4. Seems like I'm forgetting something....Oh...yeah...I know what I wanted to ask about....can you start keeping a log of things that are going on that are funky in your body, numbness, tingling, vague other sensations, headaches, sensations of weirdness.......for example, do you have any type of ZINGING sensations that go down your spine when you flex your head forward or the other direction? Any headaches that you've never had before in your life? How's your sleep going? Nightmares? Weird stuff going on there? Are you accidentally leaking urine or bowel without wanting to? How's your Love Life? And then, the sometimes UNRELATED QUESTION by today's NOW generation... XXXXXXX XXXXXXX Fanatics!)....How's your Sex life? Any trouble with your husband, lover, partner, stressful issues that are like making you scream inside at work, with the family....got an axe to grind with your neighbor, friend, or the geese that keep walking across your yard making you have to take your shoes off when you go in the house????

I think that coves it.....

So, if you wanna answer any of these questions that's fine or if you just want to ponder them and discuss them with your Neurologist that's fine too.....it's your call. But if you've gotten a few more ideas out of this and would be so inclined I'd very much appreciate your written feedback and a STAR RATING.....i think I've got 84 decent ones so far.....I've got a trophy case......collecting more so I can turn them in for a Cherry Popsicle! True Story---HAHA!

And if you'd also do me the favor of CLOSING THE QUERY if you're not going to shoot that last bullet! HAHA! But if you are...then, Bring it on lady....and let's see what I haven't answered for you yet....I dare you to find something more to ask that isn't somewhere in here! HA!

This query took 45 min. of physician specific time to review, research, and document in final draft form for envoy.

---

Brief Answer:
If we did webcam conference you could roll them

Detailed Answer:
Hi again. Thanks for more information.

So, stress is an important thing in your life right now? And aside from that you've got this going on? So what came first? Is it possible the stress precipitated your symptoms? Vice versa? Or perhaps stress is just making things worse? As far as the labs are concerned can you get everything that was done and post them? I'd like to see everything that was done to make sure it's the entire complement of what I might've gotten given your circumstances. Again, if the neurologist ordered the sets to be done then, we probably think similarly....but then, again.....I've already had 3 questions extra to think about this compared to him/her! HA!

If you want to do a webcam conference (I'm on duty tonight and tomorrow night at 3a and then, Sunday night at 11p) and you could pull the images up on the computer screen....or maybe on a separate laptop since we'll probably need the computer with the webcam undisturbed so we can maintain the connection then, I can review the images slice by slice as you scroll through them.

You could also read through your labs if you wanted.....

Well, consider it.....you'll know where to find me....either here or there...

P.S. You need a little stress relief....how about a yoga class? Tai Chi? A dog? Not a little kid..right??? LOL!

Lemme know if you wanna come on the other network and I'll be watching for you....you've got the web address in one of my previous messages.

This query required 12 minutes of physician directed time to review, research, and compile the final draft with envoy.

---

Brief Answer:
Which way is your bloodwork?

Detailed Answer:
Hey kiddo....no can find uploaded blood work....did you upload maybe up to the Healthtap website? We gonna do a chat maybe? That way I can talk to you a little bit as well.....you can audition for me....practice up, now....cuz you asked if stress could cause these symptoms....So after a conversation by live webcam maybe I can put my detective hat on and let you know whether I think you're just driving yourself nuts over stress...or are we just looking in the wrong haystack for the needle?

I mean, for sure, and you've already said it yourself, if that many doctors have cleared you on the MRI then, I'd say, we should be good to go....BUTTTTT....remember that's just a head. I still think it would be awesome to get the c-spine because I think you're symptoms are possibly localizable within the spinal cord somewhere around like C5-C7, maybe even C8/T1? Heck....truth is, it could be anywhere but definitely if the head is clean and we're still looking for something organic then, it's gotta be farther South..make sense?

And so did I answer your last question about whether your symptoms could be due to stress? The answer is YES....could be....but if you were acting like this ever before (or were you???)....haha! And if all these symptoms coincide more or less with the onset of a lot of stress and anxiety in your life..then, I think it's got to be considered, don't you?

So, if you were meaning to upload your labs for me to see on THIS network....try again....because I don't see them. If you mean to say that you've uploaded them to HealthTap.com in anticipation of our webcam encounter then, tell me when you were planning on calling.....I'm gonna' make sure I look like I'm just getting ready to STEP OUT AND CAUSE A RIOOOOTTT! LOL!....yeah right, @ 3A? Really?

Now, if we're done here....don't forget to give me your honest injun opinion of how you've felt with what we've done today. Don't forget the STARS! They like the words....but they LOVE the stars! LOL!

And then, CLOSE THE QUERY if that's what you wanna do and then, I'll see you either tonight, tomorrow night, or Sunday?

P.S. If you go out asking a bunch more doctors on this network....what they think of all this....well, now, you'll be spending a lot of money that you COULD be donating either to the ALS bucket challenge or to buying that Big Fat Persian Cat! LOL!

R-E-L-A-X and just think very soothing and refreshing thoughts, sound good?

---

Brief Answer:
Reviewed labs

Detailed Answer:
Hello. I reviewed your labs. Not all were necessarily there such as B12, folate, Vit. D which I may have included (and perhaps a couple more) but on the other hand with everything else being unremarkable I'm not sure that any of those extra labs would've been either DEAL MAKERS OR DEAL BREAKERS if you know what I mean.

I'd really love to see YOU on webcam and any parts that could be twitching as well as films that you can upload of the brain.

Sunday night perhaps? I'm online from 11p-3a (ET) if you'd like or you may also choose to upload the other material simply to this network's site.

Be well and I look forward to talking (or seeing?) you soon.

Also, please don't forget to leave some written feedback if you can find a few moments to describe our transactions and discussions to this point with a STAR RATING....always very helpful...and if there are no further comments or questions on this query please close it on your end so the network knows that I'm satisfactorily addressed your concerns and will archive, process, and credit the interactions.

Be well and warm.....seasons are starting to change in XXXXXXX ....I don't like that at all! HA!

---

Brief Answer:
Absolutely

Detailed Answer:
You know where to find me either HERE or THERE.

If here please use the DIRECT QUERY function so that I am directed the question. I get even a BIGGER bag of peanuts because they think you must really LIKE ME to ask me for name....I mean, honestly, whose name can you pronounce on this network! LOL!

Would love to see you on the other network as well because otherwise I feel like the Maytag Repairman at 3am--- no action! HA! So ring me and we'll have a party!

Please don't forget to close out our encounter with a little honest feedback...I can take it.....and a STAR RATING and also by CLOSING THE QUERY down so the network will process, archive, and credit the thread appropriately for future reference.

Cheers!

---