Update on PCP appointment

[tot_teacher]

Hey all -

Thought you  might want to know how my appointment with my PCP went yesterday.  After a failed attempt to appease me with an MRI w/OUT contrast ( which had thick slices through the brain ), and a laughable appointment with a resident neurologist at UNC Hospital, I saw my PCP yesterday and was again amazed at how fast she pulled out her "Drug Reference Manual" and started to look up migraine meds that surely would "fix everything".

I insisted that my visual disturbances were far from normal and that ON has not been ruled out.  After some well-thought-out statements, I have convinced her that a MRI of the brain w/ thin slices through the orbits, and CONTRAST would be helpful at this point.  I DID IT !!  She did however decline my request to be referred to the local Diagnostic Center for the MRI ( which could do the MRI w/in 2 days ) vs. waiting for the "traveling MRI machine that comes only once a week.  Hopefully, my eyes are still symptomatic in the 14 days I'll be waiting.

If I'm experiencing ON ... will an MRI show damage to the optic nerve if I'm no longer symptomatic?

Should I try to push for a n earlier MRI ?

Thanks guys !  
- Alisa

[Deb61]

I have ON, but the MRI didn't show it.  The opthamologist discovered it when looking at my optic nerves in my eyes.  Reds are most definitely faded, like Jen said.  

Deb

[JonM]

I complained of eye pain behind my left eye and a little blurry vision.  I was referred to a Neuro Opthomologist who after examing me and asking questions concluded that it was more likely Trimyngial Nueralgia that was causing this.

He said since I also had ringing and itching in my ears and he discoverd a patch of skin on my jaw thats numb that it was more likely TN.

Jon

[jensequitur]

The only way I have of describing the color loss is to compare it to a bad print - as if the printer is running out of magenta toner.  Or like the printer's running out of all the color inks.  It started with a slight red loss, and at its worst I was seeing things with almost no red out of the left eye.  Good luck!

[tot_teacher]

I've noticed changes in shades of color/lights but not missing colors all together.  I can not be 100% sure that ON is what's causing my eye pain/sensitivity, but I do want it ruled out.  I guess I'm gonna wait for my repeat MRI in a couple of weeks and see what that shows.  If it's negative, its probably a good idea to insist on VEP.  With a negative VEP, I'd be appeased enough to sit back and just wait for the next episode of MS-type symptoms ... however, I want this episode documented in my medical notes.

Thanks!

[jensequitur]

Good site -

http://www.mult-sclerosis.org/opticneuritis.html

[jensequitur]

That should be plenty strong enough to pick up lesion activity.  

Alisa, are you seeing colors differently in each eye?  That's a sure sign of optic neuritis - colors in one eye will be washed out, or you might be missing the reds in one eye.  I always know when I'm having problems, because one eye will see everything in REALLY intense colors, and the other one looks like it's faded.

[tot_teacher]

Thanks Guys -

I know that the treaveling MRI machine is a 1.5.  My visual disturbances have been present for years, the pain behind them and when I move them up/down left/right, only a few weeks.  Your thoughts on pushing for a VEP makes alot of sense.  I'm going to contact my ophthalmologist and see if he'll refer me to a local neuro for the test.

Thanks again -

- Alisa

[Quixotic1]

I don't understand how it is that a doctor can dictate which machines you can use.  And I have to agree with Jon about the preference of the VEP for documenting the damage of ON.  The VEP is more likely to show the problem than an MRI using thin cuts.

On the traveling MRI.  Many imaging centers do send out good, newer machines in their mobile units.  I don't think that you can definitely say that it will be older and/or weaker.  When I worked in a rural town 90 miles from the nearest city our traveling MRI was state of the art.  It travels in a huge semi-trailer which would easily transport a 3T unit.

If you are having ON, your best chance to document it is while it would enhance, thus there would be some urgency.  But, any visible underlying lesion will still be there in 2 weeks.  The VEP is still the test of choice per my reading.

Quix

[JonM]

As far as the MRI goes, waiting a couple of weeks won't make a big difference.  The damage MS causes would still be visible.  I do have a concern about a "traveling MRI" unit.  That strikes me as likely being a weak machine, which means (if thats the case) that if you do have MS its going to have to be pretty much full-blown had it for years for the machine to detect it.  I would try to find out how stong it is.  The machines are rated by the strength of their magnet.  The newest, most powerful machines today have a 3.0 Tesla rating.  Good older units are in the 1.0 - 1.5 range.  Some really old units and maybe this traveling one can be down below .5 which I doubt is going to help a whole lot for MS DXing.  Also with a taveling unit, does it come with a experienced radiologist to read it?  That would concern me too.  Often times to get a good reading the radiologist needs to work on the same machine all the time. Be familar with its quirks and format , etc. Kinda like a carpenter and his tools.

Jon

[JonM]

I'm not a MD, but have MS, and have had ON,  The MRI shows lesions and inflamation that MS could cause, adding the contrast will show "active" lesions.  For me the ON was DXd with a VEP (Visual Evoke Potential) test.  I believe that is the standard for ON diagnosis.

Also ON damage can still be detected months or years later with the VEP, so it doesn't have to be active.  Hope this helps.

Jon

[Wobbly]

that's a good question?  I'm not yet Dx and that is something I can't answer... my guess is that it would show if you had a lesion or ON?  But that me guessing... did you check out the "Health Pages" and see what it says on there?  

hopefully someone with more knowledge will come on and give you so info...
I'm from Canada... I've never heard of a travelling MRI?  Here we have to wait for months on end to get a MRI... sometimes up to 6 months...and I can't get it any faster ...they say??  

so two weeks would be so nice...but I understand when you are having symptoms...it would be nice to have it done then?  not sure if it would change the Dx though..
take care
wobbly
undx