Second Opinions for TBPI diagnosis prognosis

 

Last Friday, April 3, I decided it was in my best interest to follow through on my initially scheduled appointment with a private hospital (Bangrungrad) neurosurgeon, to get his recommendation for comparative purposes in Saturday’s consultancy with the neurosurgeon at the government hospital (Chulalongkorn), for two opinions are certainly better than one.

Having met with both now, I report that while both opinions seem to clash as far as the exacts of the diagnosis, there is consistency in that there seems to be no urgency to rush me to an operation table, yet…

Despite the EMG evidence, or lack thereof, the private hospital doc still loyally believes/insists on the initial 3-4 day post accident MRI radiology study that C8 is avulsed—C5, C6, C7 anatomically intact, and perhaps pointing to the spine contusion rooting C5, C6, C7 inactivity in EMG—i.e. possibly dead neuron (Walerian degeneration I think) inside spine root—which I can only hope to be wrong.

Yet on the other hand, EMG review and physical Nerve conduction study at the government hospital place the prime legion(s) somewhere at C5, C6 and perhaps C7 roots, trunks, and/or branches. Though the initial EMG impression suggest that it is most likely (hopefully) post ganglionic, permanent (un-fixable) pre ganglionic damage can’t be written out yet, particularly due to the knowledge of spinal contusion-blood clot.

The public hospital doc still hasn’t written out the possibility of root avulsion and/or rupture, believing that C5 and/or C6 may likely be avulsed or ruptured, while C7, C8 and T1 more likely firing at least something based on motor/sensory physical responses, indicating only time waiting for those lower roots to naturally do what they can.

While these tests/reviews seem to be contradicting one another, the relief is that both docs aren’t anxious to put me on the exploratory surgery bed just yet, as the window for spontaneous recovery is still open.

Private Hospital Prognosis: wait six more months and hope/try for supposed avulsed C8 function to be replaced by C7/T1 regeneration/compensation naturally. As for the upper extremities, it’s also a wait & see strategy. For being a neuro surgeon who I learned specializes in Brain Tumors, he was hesitant for any further spinal tests to confirm avulsion, let alone exploratory surgery stating the risk doesn’t outweigh the potential yet. Other than me not waking up from surgery, or the surgery not working, I’m not sure exactly which risks were being weighed. His opinion was that scapel exploring now wouldn’t be any more promising now than in six months—that in six months, at least there is still chance for more natural recovery.

Either way, his absolute faith in MRI seems to contradict EMG/NCS findings re. C8, and besides, I’ve read that MRI studies of plexus root alone often are contradictory and such was confirmed by the government hospital doc who refused to even look at the MRI film based on his personal experience of inaccurate/contradictory MRI findings in these type of injuries all to often.

Also from what I can gather, if surgery does need to be done at the roots or even trunks or branches of the brachial plexus, nine months may be too risky, considering, nerves still need times to catch up and reconnect with muscles, which are at risk of dying for good as time goes by.

Government Hospital prognosis: meet next month to assess whether any/how much recovery/regeneration has occurred. And if radial nerve/musculotaneous muscles still show no positive activity/signs, than to schedule a spinal/cervical meylogram dye injection + X-ray test to determine if/what nerves are actually avulsed.

Supposing that avulsed/ruptured roots are confirmed from the dye–whether at C5 or C8, I’m anxious to confirm—either way, it would indicate immediate reconstructive operation to take advantage of the optimal six month time window in which natural regeneration is deemed impossible (split nerves can’t find their way to intact nerves which would aim to compensate function) for regenerated nerves to reconnect with atrophied muscles.

All this to be revealed beyond May. In the meantime, must continue to harness my energy and efforts to a healthy and positive lifestyle full of optimal rehabilitation stretches & exercises—still pumping atrophying muscle fibers with electric pulse daily, for what it’s worth, also hitting the pool a few times a week, if not to exercise what is possible, than to cool off as this raging central Thai summer peaks toward the Thai new year next week. Stay tuned…