Second opinion

New diagnosis and before diagnosis
1

Hi all

After a letter from neuro saying head and c-spine MRI normal so he doesn’t need to see me again, (he saw me once for about 5mins) my GP has been fantastic. Had a phone call from him on Sat to say he thought I should have a second opinion. Yesterday, he rang to ask if I would mind seeing another GP in same practice first.

Saw another GP this morning who was as thorough as my normal GP. His findings agree with my GP, (although my symptoms have eased dramaticallyly since first visit) except he seemed to do a few extra things. One thing of interest was that when I hold my arms up in front of me with my eyes closed, he says my right hand turns and curls up. He also thinks I have a degree of foot drop. My right side reflexes remain brisk.

He also said that my MRI should have been done with contrast as I have only had symptoms since August. He says that without this lesions may not be visible and that the MRI should have been done following the “MS protocol” which it wasn’t. Does anyone know what this is? I didn’t like to ask him as I had already taken up 50 mins of his time.

Would just like to say thankyou for all the support given on here, your encouragement has given me the strength to accept the offer of a second opinion. My GP is sending me to one of the larger teaching hospitals as he feels so agrieved by the treatment from the local neuro. I think I am very lucky to have such a supportive GP especially as he has done all this since the end of September when I first saw him with the symptoms. He described the first neuro as “very genius” or “very bad” if he could say that he agreed with GP assessment but that there was nothing wrong!

Thankyou again everyone x

2

An “MS protocol” is basically a set of scans designed to explore whether or not a patient has MS.

Different scans show up different things, for example, the fluid in MS lesions shows up in T2 scans can’t be seen in T1 scans, but “black holes” (where a part of the brain has atrophied / died) show up best in T1 scans.

To properly check for MS, there needs to be a range of type of scans and each of them needs to be taken from different directions / orientations. The resolution of the images also needs to be quite good because MS lesions are only 7mm on average.

It sounds like your GPs know way more about neurology than the average GP - hang onto them!!!

Karen x

3

Contrast actually shows up where the blood brain barrier is currently breached and, therefore, where lesions are beginning to form as well as currently forming. Lesions that are just forming can be too small to be seen on MRI. So if a patient is having new symptoms, then it is sensible for them to have contrast or new lesions could be missed.

There is always a chance that your symptoms are because of CIS (clinically isolated syndrome) and that it never happens again, but there is also a chance that it isn’t and that an early diagnosis will be for the best in the long run. After all, early diagnosis often leads to early treatment - and that has got to be a good thing!

Trust your GPs; they really do seem to know what they’re doing.

Karen x