New MRI results and now MORE questions.

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Retired Mom
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   Posted 8/17/2010 1:06 PM (GMT -7)   
Ok, so I had the x-rays a couple of weeks ago and they showed nothing.  So I went in for a full series of MRI's from the neck down.  The c-spine showed basically nothing, the T spine showed varying degrees of minimal bulging at T1-2, T2-3, T3-4, T7-8 and T8-9 with no thecal sac effacement.
 
The L-Spine (with and without contrast) showed degenerative disiccation of the L4-5 and L5-S1 disc space with a previous PLIF (note I had TLIF), but anyway, there was a special note of postop changes at L5-S1 and mild disc disiccation of the L4-L5 are.  Lastly, there was midl left paracentral Disc bulge/protrusion at L5-S1.
 
Ok, so I don't have an L5-S1 disc!!!!!!!!!!!!!  I have had a TLIF and my disc was completely removed at that time.  There was a sort of implant placed with a growth gel and powdered bone put in to the spot where the disc was and I had to wear a bone sitimulator for several months.  There was supposed to be a full fusion showing the last time the neurosurgeon did an x-ray.
 
I looked at the disc from the x-rays and the hardware is clearly still there and there is no disc space visable.  I also looked at the MRI disc, but couldn't tell anything from that.
 
Any idea what could be going on here?
Retired Mom

straydog
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Total Posts : 13473
   Posted 8/17/2010 2:15 PM (GMT -7)   
RM, thats strange from what you say they did at L5/S1 at the time of surgery, the report says you have a disc there, wow. Disc dessication means some fluid leaking from the disc which is part of our natural aging process. By chance do you have a copy of your old op records which shows what you are telling us they did? Those may be helpful to your dr. Really strange indeed. Let us know how this turns out and take care....Susie

Retired Mom
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   Posted 8/17/2010 2:58 PM (GMT -7)   
I do actually have the operative reports and the MRIs from both before and after the surgery.  So much of the information is different that it almost makes me wonder if they have been even reading the things at all.  I guess this is why my PCP referred me to a new ortho dr. 
 
I appreciate you mentioning these old reports because I can bring them with me to my appointment when it is set up.  I'm also waiting to see what the guy writing these reports has to say to my PCP.  She was pretty upset about the whole thing and is supposed to be calling me as soon as she talks to him.  She's a great person and I'm sure she will follow up. 
 
Thanks All!
 
 
Retired Mom

PAlady
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   Posted 8/17/2010 3:22 PM (GMT -7)   
RM,
Since I've had a PLIF double fusion, if I had these results on an MRI post-op I sure would be wondering, too. I had a post-op MRI a few months after surgery, and it wasn't until my neurosugeon himself looked at it that I got better info. on what was going on (scar tissue formation, basically, affecting the nerve root) but the MRI report described the fusion process pretty accurately.

I would definitely want to talk with a specialist - either the ortho, or maybe even the surgeon who did the procedure (not sure if you even still see him/her). Bringing old films/CD's, etc. especially those from closer to post op time I would definitely think would be helpful. I wonder if someone got something mixed up????

I wouldn't worry about it too much until you get a specialist's opinion because something sounds "off" to me, too.

PaLady

mrsm123
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Date Joined Dec 2007
Total Posts : 1228
   Posted 8/17/2010 3:23 PM (GMT -7)   
Disc dissection means that the disc is drying out, and this happens naturally as we age. It sounds like the bone growth protein they used ( bmp) may have overgrown some and that is what they are seeing.
All of our discs dry out as we age and this isn't usually a problem. BMP ( synthetic hormone/protein used to help bone growth when they remove the disc) is known at times to overgrow and that is why it is not allowed to be used in the cervical area.
Hope this helps,
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too

mrsm123
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Date Joined Dec 2007
Total Posts : 1228
   Posted 8/17/2010 3:26 PM (GMT -7)   
I also had PLIF and TLIF fusion done too and they usually refer to it in MRI or CT scan reports as PLIF since the entry was from the back. They really can't tell if it is from the side or not with those scans. I have to go have another CT scan since I haven't had one since the revision and I don't even know if I ever fused and I also had bmp added to my redo, so I might find myself in your same shoes here shortly. I have had nothing but problems since the revision so it wouldn't surprise me.
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too

Retired Mom
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Date Joined Feb 2010
Total Posts : 1753
   Posted 8/17/2010 3:35 PM (GMT -7)   
Hi guys,

I really appreciate the information and I will certainly be following up on this ASAP. The idea of the overgrowth of bone sounds more accurate than a disc that macigally appeared again.

I just pulled some old info from the summation for my initial SSD application for the info on my back. This is basically what the last MRI said before this one. I don't have copies of the ones done immediately after surgery, as the Neuro wasn't too pleased with releasing the copies. I'll have to check to see what I can find. I know I have everything else because I had to use the copies to get my retirement.

(((Large left paracentral L5-S1 HNP with marked thecal sac effacement. Mild central disc protrusion at L4-5 with with slight thecal sac efacement, Digenerative Disc Space Disease with vacuuming and disiccation at L5-S1 and L4-L5, Transverse lumbar interbody fusion with fixation L5-S1, LF-Disectomony performed on 03-26-009, lumbar radiculitis, lumbar radiculopathy, mechanical back pain, discogenic back pain, central disc protrusion at L4-5. Maximum medical improvement noted on 07-27-2009.)))

This makes me think it is even more fishy!!! I haven't seen the neurosurgeon since 7/27/2009, when he released me to pain management with the notation of maximum medical improvement. My PCP thinks the ortho will be a better match for me now since so many levels are involved, but I'm still on the lost side of it all. What happened to the other problems? Did they correct themselves? I also have mild scholeosis (sp?), but I don't see that either. It's quite clear in the x-rays and well noted on them.
Retired Mom

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 8/17/2010 4:11 PM (GMT -7)   
Sandi,
Thanks for the info. on the protein - of course, who else would know this stuff?! ;-) I have some of that in me, too. Oh, sometimes I don't want to know what may be in store for the future.

Sigh.

PaLady

mrsm123
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Date Joined Dec 2007
Total Posts : 1228
   Posted 8/17/2010 8:38 PM (GMT -7)   
Retired mom,
You can obtain copies of the reports from the post op MRI and or CT scan by writing to the hospital directly and requesting the copies of the reports. You may have to pay for them but they are part of your medical record and therefore you are entitled to them.
I had to write to the hospital post op for my nursing notes and reports so I know they can be obtained that way.
Sandi
You're welcome PA Lady. I seem to know the weird stuff, especially since I had to spend so much time researching to figure out what went wrong after my first surgery, I learned a lot more than I cared to know.
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 8/18/2010 6:24 AM (GMT -7)   
I just spoke with the nurse at the PCP who said she had talked to the radiologist. Apparently he told her that they don't remove the whole disc, so it is possible for me to still have a disc bulge. I tried to explain that I am absolutely certain that I have no disc because it is detailed in my post-op report and that the whole disc was removed, the area scraped, an implant put in with the gel and crushed bone and that it was a fusion of the bones. SHE DIDN'T GET IT!! I also told her that EVERYTHING had changed from the stenosis of earlier MRI's to even no notation of where they broke off some of the bone from a facet area to make the crushed bone powder for the new bone growth. She just said she would just set up the referral today and we can see what the other Dr says. Naturally there is no referral to the operating Dr. and I have to have one or insurance won't even consider letting me see him. This is nuts!
Retired Mom

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 8/18/2010 11:50 AM (GMT -7)   
RM,
You've got me curious about all this now, although I wonder if this nurse is thinking about a partial discectomy or some other surgical procedure? I had a double fusion and I am pretty sure reading my reports (although I sure didn't read all of the operative reports, but the surgeon's summary) that it says both discs were removed as the first part of the process (discectomy) and then the hardware and fusion materials are put in place. I'd make sure this new doc does a lot of fusions before I go there, because if he doesn't he and his whole staff may not be familiar with the different procedures and you sure want someone who is! Especially because I know they can use so many different materials for fusions. And I didn't know until Sandi's post about the possible overgrowth. I do know sometimes hardware gives people trouble and ends up having to be removed. I pray that doesn't happen to me (don't we all) as I dread the thought of any more cutting.

I'd try to find out all you can about this surgeon. Maybe see if his resume and background are somewhere, and anything else you can do. Checking medical organizations he may belong to. I'm not saying he's not a decent doc, just wondering what his specialties are.

PaLady
p.s. Oops. I just reread your post and see now you're talking about your PCP and the radiologist, although a radiologist writing a report should understand a fusion or they shouldn't be interpreting these tests, IMHO! Since your PCP's office is making the referral, and they don't seem to understand the whole procedure, I'd still check up on the doc they're referring you to. Just my 2 cents!

Post Edited (PAlady) : 8/18/2010 12:55:01 PM (GMT-6)


Retired Mom
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Date Joined Feb 2010
Total Posts : 1753
   Posted 8/18/2010 1:20 PM (GMT -7)   
Thanks again PALady!  I still can't understand why they are sending me to this person instead of the one who actually did the surgery, but the new office called today and I'll be seeing them on the 25th.  The referral was so vague that it only said mid and low back pain.....see last MRI.  I was able to tell the person who called that I had copies of the last MRI and X-ray discs and reports and that I had copies of the post-op and follow-up summaries from my Neurosurgeon.  She was positive that this Dr would want everything before he would consider what to do.  I'll sign any releases to get whatever they need, but I'm thinking this is what Sandy suggested and is an excess growth as a result of the procedure.  I am (like you) positive that the first part of the surgery involved removal of the disc.  It is written clearly in the operative report and even tells which tools were used for what and what was done with the materials that were removed.
 
I am honestly NOT interested in any more surgery at this time.  I just wanted to know what to do to help the pain be better.  I was thinking that the MRI's would tell me if I had infection or perhaps help the PM to decide what to do about additional nerve ablations.  They worked well for me in the past and I'm leaning toward that....who knows now!!!  I was also looking for additional documentation for when I go before the Administrative Law Judge for my SSD hearing.  I never expected this strange situation!!!
 
I'll keep you guys updated on what the Ortho has to say.  It just seems nuts to begin with a whole new Dr. this far in to the process.  I did some research and he graduated from Princeton and then from Emory.  He's fairly young for an Ortho and my PCP says she would go see him before anybody else if she had back problems.  I don't even know where else to start now.
Retired Mom

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 8/18/2010 2:09 PM (GMT -7)   
RM,
What if you said you preferred to return to the doctor who did the surgery, since he knows what he did, what materials he used, etc.? If you were satisfied with your surgeon, that's what I'd do. And you have a right to make that choice. However, if you weren't satisfied with him, that's a different story.

Gosh, these things take over our lives!

PaLady

Screaming Eagle
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Date Joined Sep 2009
Total Posts : 5005
   Posted 8/18/2010 2:29 PM (GMT -7)   
I too have to agree with mrsm123. I had read this before as I had done quite a bit of research prior to my surgery. Good call, but we will of course have to wait and see what the Dr says.

SE
"Respect your fellow human being, treat them fairly, disagree with them honestly, enjoy their friendship, explore your thoughts about one another candidly, work together for a common goal and help one another achieve it."

Mrs. Dani
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Date Joined Jun 2009
Total Posts : 2787
   Posted 8/18/2010 9:01 PM (GMT -7)   

 

  Dear Retired,

     Hey there! I am so sorry for my late response to your thread! Back to school is always such a busy time here. I hope you are doing okay *hugg* You sound pretty stressed out. Oh boy oh boy if I were in your shoes I would be stressed out to no end!

     I do not know anything about the surgery you had performed. But I know a LOT about scoliosis. I dont want to stress you out... but you said you had fusion of some sort of your bottom vertebre? Is the "scoliosis" probably right above it. I dont want to scare you but I think its important that you know why scoliosis is a big deal, even "mild".

     To be calssified as scoliosis you have to meet two basic critera. First and for most is rotation on the verticle axis. It means that there is enough degeneration to allow vertebre to "rotate". The second classification is if your curve is over 10 degree cobb. Even though you do not "see" what they are talking about just from viewing the x rays, it is still pretty improtant. Once scoliosis starts, even if it is what is terms as "age related  / degenerative" scoliosis, it can cause a whole heck of alot of problems. If it is "mild".. to the naked eye it might just look like a slight tilt. But ,in all reality, by the time it is termed "degenerative scoliosis" it has done a number on the bottom vertebre in the "curvature". Are you sure that the "stenosis" isnt caused from your curvature? I have areas of narrowing, both at my major curve points. Here is some info you might find useful.

~~~> http://www.eorthopod.com/content/adult-degenerative-scoliosis

~~~> http://www.scoliosis.org/resources/medicalupdates/degenerative.php

     I sure am sorry you are going through so much right now. I do hope you can get to the bottom of things quickly. Try to rest as much as your body will let you. You are in our hearts and prayers.

*hugg*
  dani


 
TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood
 
Chronic Pain Moderator

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1228
   Posted 8/18/2010 10:34 PM (GMT -7)   
Hello Retired Mom,
I read about the confusion regarding the complete removal of the disc and the reports. They usually do leave the front outer part of the disc in place, even when they add the cage and bmp, along with the hardware. I had the same questions when I saw the same thing in my post op reports. There are basically two reasons they leave part of the disc in place, first, it helps keep the upper vertebrae from tipping forward, and secondly because in order to  remove all of the disc, they would need to go in from the front and the back , and they don't like to go in from the front for the L3-S1 levels because they are too close to the major arteries and veins going through that area and scar tissue or moving them can cause the vessels to bleed, and risk death so a part of the disc is left in place.
I know that these reports can cause far more confusion than they clear up and make us worry more. I also have some thoracic scoliosis but it is not enough to warrant surgery, thankfully, so for now, we don't do anything about it. You don't say where yours is located but one of my surgeons said that most kids have some but not enough to be "treatable". He said if the curve ever got greater then we would have to deal with it but for now, not to let it worry me. They have to list whatever problems they see, even if they are not treatable.
Hope this helps ease your mind some,
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 8/19/2010 2:38 AM (GMT -7)   
Thank you Sandi! That was very informative. I appreciate all the information and the suggestions from all of you!

My scholosis is in the T-spine (to the right) and my buldges are indicated all over the T spine and L4-5, L-5-S1. All the bulges in the T-spine are "new". The MRI doesn't show the scholosis, but the last (several) x-rays do very clearly.

I'm looking forward to the clarification by the new Dr. To answer PALady's question, I did honestly ask to go back to the surgeon that did my procedure, but the PCP said she could not justify a referral to a neurosurgeon since the MRI only showed bulges and not nerve impingement. Sometimes she seems to miss the mark, but she's great for basics and she does do alot of testing and will refer you anytime you need one.

Sorry, but I have to run....my hands are giving me fits today!
Retired Mom

Mrs. Dani
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Date Joined Jun 2009
Total Posts : 2787
   Posted 8/19/2010 6:42 AM (GMT -7)   

 

   Dear Retired,

     Having rotation in your thoracic vertebre is hard. I developed a secondary dextroscoliosis from T4 to T9 and it is having a feild day. Not a very good area at all. Hopefully just the individual vertabre with the degeneration damage can be repaired and/or treated. If not the advances in scoliosis correction have come a long way. "espine" has alot of informaiton on scoliosis correction surgeries. Not sure why your MRI didnt pick up on the scoliosis? Did anyone mention what your Cobb Angle was?

     I hope the appointment with the Ortho goes well. I know you have alot on yoru plate right now, but try to find a few moments for some much needed rest. You are in our hearts here

*hugg*
  dani

     


 
TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood
 
Chronic Pain Moderator

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 8/19/2010 10:37 AM (GMT -7)   
Thank you all again for everything!!!!

I'm so overwelmed with this that I think I have gotten brain burnout. It's like my mind is saying to just forget it until I hear what the new Dr. says. I don't even know where to begin thinking, so I'm shutting down and just taking my meds as directed until I can get an answer.

For those who suggested the med sheet in my earlier thread and calling the PM to tell them about the med changes I have had.....it has been a Godsend! I have been keeping up quite well with my meds and am starting to figure out what to take exactly when. I still have times I feel a little too medicated, but those are fewer and farther between. I guess it just takes time to get used to everything. Now when I get all the answers and take the med sheets, the updated MRI reports, and whatever else I can get to my PM, he will be able to make an informed decision on how to handle my case.

You guys are the greatest!!!
Retired Mom

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 8/19/2010 10:46 AM (GMT -7)   
RM,
This thread has really yielded some great info for me, too. (thanks, Sandi!!!) I know you're understandably overwhelmed with this right now. Maybe you need to take a day or two off from even thinking about it!

But I'm going to add one more idea. So that YOU have 100% understanding of just what the surgeon did to you, you could try calling and ask for a good time to talk to his nurse or PA (a lot of surgeons have their own team that handle a lot of the outpatient stuff) and ask nicely if they might be able to tell you what procedure what done on you, etc. You can explain a little of what happened with the MRI report, and say you want to know just what was done to your body. Fact is, this has got me thinking about calling my NS's nurse and asking her about disc being left in, etc. Sometimes they don't want to admit to things that might go wrong (like the overgrowth issue), but the likely would tell you the type(s) of procedures your NS does - and they all may work a bit differently.

Glad things are smoothing out with the PM!

Try to go relax a bit somewhere!

PaLady

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1228
   Posted 8/19/2010 6:57 PM (GMT -7)   
 You're welcome. I'm glad that I could offer some help. I was just as confused and overwhelmed after I got multiple reports back, all saying different things with only a matter of a few days between them and I was determined to learn as much as I could before I went into surgery , and after when things were not going like they should have.
If there is anything that I can help with, just ask. I'm no doctor, but am full of sometimes useful and not so useful information.....LOL
Hope you all are having a low pain day.
We all deserve one for a change.
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too
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