27/02/22 Healthy diet...

Nice day yesterday, bright and sunny if not too warm, so Sue bundled me and the wheelchair into the car and drove us off to Promenade Park in Maldon. Bacon and cheese croissants with cappuccino for a very pleasant lunch.

Nice to see the first crocuses and daffodils of the year putting in an appearance. Lifts the spirits no end.

The morning's post included a letter with a follow-up appointment with the neurologist Dr.Da on March 22nd. Seems rather a long way away for "urgent" but there'll be the recall MRI scan and presumably at least one appointment with the neurosurgeon before then. I'm just impatient to get on with it.

26/02/22 Blood results

Good again - first set of bloods completely under the new no-treatment regime. Paraproteins still undetectable, one of the FLCs little out of normal range but nothing we haven't seen before. That's a relief because I was half-expecting the PPs to grab the opportunity and shoot up again.

Otherwise, a very slow day yesterday. In the morning I made it from stairlift to riser/recliner chair and had to sit down for a rest before making it through to the kitchen. Did a couple of small bits of washing up and exhausted by both of them. On the other hand did the evening meal without any help except at what we now have to call the "plating" stage. Hoping for a ittle more energy and vitality today!

24/02/22 MRI report

 It's arrived.And I have to go back for a more detailed scan of my cervical (neck) spine on Wednesday.

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Thank you for referring this patient.

EXAMINATION DATE: 22/02/2022 Examination: MRI Spine Whole
EXAMINATION: MRI Spine Whole
CLINICAL INDICATION:
Multiple myeloma. Left leg weakness. Exclude myelopathy
TECHNIQUE
Routine imaging protocol
FINDINGS:
There is an old fracture of the odontoid peg with posterior displacement of the odontoid peg in relation to the C2
vertebral body. There is narrowing of the cervico-medullary junction. Although axial images have not obtained
through this level, the cervico-medullary junction appears to be atrophic with high T2 and STIR signal here in
keeping with myelomalacia.
There is minimal grade 1 anterolisthesis of C6 on C7. The C5-6 and C6-7 intervertebral discs are degenerate
and of reduced height. The other cervical intervertebral discs are dehydrated.
At C2-3 the left C2-3 facet joint is degenerate. No significant neural compression seen.
At C3-4 there are degenerative changes in the right C3-4 facet joint and uncovertebral joint with narrowing of the
right C4 neural exit foramen.
At C4-5 No significant neural compression seen and there are some degenerative changes in the right C4-5
facet joint.
At C5-6 there are degenerative changes in the uncovertebral joints and disc/osteophyte bars cause narrowing of
both C6 neural exit foramina.
At C6-7 there are degenerative changes in the facet joints and uncovertebral joints with some narrowing of the
right C7 neural exit foramen.

RAMSAY SPRINGFIELD HOSPITAL, Private & Confidential
Crisp, Ian, ID: 2328367, DoB: 10/11/1948,
Description: MRI Spine Whole, Study Date: 22/02/2022, Page 2 of 2
The rest of the cervical cord returns normal signal with no evidence of cord compression.
There is a scoliosis of the thoracic spine, convex to the right. Some of the mid and lower thoracic intervertebral
discs are degenerate.
There are minor posterior disc bulges in the lower thoracic spine but no significant neural compression or
foraminal narrowing is seen in the thoracic spine. The thoracic spinal cord returns normal signal with no
evidence of cord compression. Although there is a small far right dorsolateral disc bulge at T11/T12, this is not
causing compression of the right T11 nerve root.
There is a scoliosis of the lumbar spine, convex to the left. Minimal retrolisthesis of L5 on S1 is noted. The L2-3,
L4-5 and L5-S1 intervertebral discs are degenerate and of reduced height with associated endplate spondylotic
changes. The other lumbar intervertebral discs are dehydrated.
At L1-2, there is no neural compression. At L2-3 and L3-4, there are minor annular disc bulges. No neural
compression seen. At L4-5 there is a small annular disc bulge with a left lateral and far left lateral component.
This is causing left lateral recess stenosis and there is some impingement upon the left L5 nerve root in its
lateral recess. There is narrowing of the left L4 neural exit foramen but the exiting left L4 nerve root is not overtly
compressed. At L5-S1 No neural compression seen.
The lumbar thecal sac is adequate throughout. The conus is normal.
There is abnormal low T1 and high STIR signal in the mid and superior aspect of the L4 vertebral body. The
appearances may be due to degenerative change but myeloma involvement here cannot entirely be excluded.
No infiltrative bone marrow disease is seen elsewhere in the spinal column.
CONCLUSION:
There appears to be an old fracture of the odontoid peg with posterior displacement of the odontoid peg in
relation to the C2 vertebral body. This is causing narrowing of the cervico-medullary junction. Appearances
suggest that this is longstanding and there is myelomalacia and atrophy of the cervico-medullary junction with
high STIR signal. A neurosurgical opinion suggested for further evaluation.
There is abnormal signal in the L4 vertebral body which I suspect is due to degenerative change but myeloma
involvement here cannot entirely be excluded. No spinal cord compression seen elsewhere in the spinal column
and the lumbar thecal sac is adequate throughout.
I am recalling the patient for dedicated axial imaging of the cervico-medullary junction.
Reported by: Dr Sanjiv Chawda GMC: 3329005
Consultant Neuroradiologist
Reported by: Consultant Neuroradiologist 

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Interesting reading, isn't it?

The neurologist's accompanying letter says

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Dear Ian

 

I have now received the results of your MRI scan of the whole spine which was done on 22/02/22 at Springfield Hospital.

 

This does show severe multi level degenerative changes (wear and tear) some of which are old. There is a fracture at the vertebral level of C2 (high neck) causing some damage to the spinal cord - myelomalacia and a doubtful change on the L4 vertebrae (lumbar) raising a suspicion for myeloma involvement.

 

These findings require review by a neurosurgeon and if you give your consent, I can refer you URGENTLY to my colleague, Mr XXXXX. Please find attached a copy of the MRI report. I also note that the Consultant Rdiologist, Dr  XXXXX is bringing you back for more imaging of your neck and I will contact you once again with this result.

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I have of course agreed to see the neurosurgeon.

More later, including translation of some unfamliar medical terms

24/02/22 Waiting...

Nothing much today, just waiting for blood test and MRI results.

Did Pill Organisation yesterday andwith my left hand barely working and the right one heading in the same direction it took an age even with the new pill popper. And eating is now largely single-handed, which doesn't help!

23/02/22 Anniversary

Quite a day, yesterday. It started with my (computer) mouse disappearing. Somehow it jumped off the computer desk and found a new home in the two-inch gap between the bottom of the desk. I used to  be be flexible enough to get down there with a torch and look for missing items but no more, so had to get a neighbour in to help. It took a while but eventually we found the mouse and returned it to its mat.

I took one of my four Diazapams last thing at night, and when I got up my balance and walking were probably the worst ever, but that was short-lived. I took #2 half an hour later, #3 after breakfast, and #r4 just a few ninutes before the scan. I don't know i0f the diazapam helped - certainly there was no obvious effect of sleepiness or woozly light-headidness - but I got through the scan with no great difficulty at all. 

What I think did make a difference was that instead of being in a separate control room on the other side of a window, the technicians were in the room with me throughout. Even better, Sue was allowed to stay in as well. So there was a lot of support instead of the sense of complete isolation that I've had before.

CORRECTION: Sue tells me that all the techies were in their control room behind a glass window, so she was on her own in the MRI room (apart from me). Being inside the machine I couldn't see but I had the clear impression there were two, perhaps three, people giving encouragement and physical contact. Obviously not. Perhaps I can blame the Diazapam...)

Anyway, profound sense of relief for both of us now that the MRI thing is finally put to rest.

Otherwise, our 40th anniversay included a surprise afternoon tea that wasn't a surprise, and one of our cats getting into a fight with a neighbour's cat that ended up with her dripping bood all over the floor. She had to be taken to the vet to get stitches in a nasty wound in her inside thigh and at least seven days confined to quarters while it heals.

I prefer the Devon way but Sue goees for the Cornish method. Vive la difference!

We've also been having some fun - and not a little frustration - with our new Ring Video Doorbell - nothing like as easy to set up as they say! Here's a frame from a video it shot of a deliver man ringing the bell and failing to deliver. I was upstairs taking part in the Great Mouse Hunt so could't get to my phone in time to deal with him. Here's a frame from the video:

I like the late afternoon sky in that image!

21/02/22 MRI postponed

Ever since my aborted MRI back in 2019 when my myeloma was diagnosed, whenever a doctor has raised the subject of MRI I've told the story and said that I'll need heavy sedation, preferably to the point of unconsciousness, to be able to get through it. "Yes," they've all said (including the recent neurologist who ordered the scan), "no problem, just tell the radiologists when  you arrive and they'll sort you out." Someone from Radiology phoned up a few days ago to run through a list of questions about whether I have any metal objects on or inside my body, and etc. Sue took the opportunity - yet again - to talk about sedation and got much the same response.

So we arrived this rather early morning and were rapidly and efficiently whisked into Radiology where we asked the question."No, no way, we don't do that and even if we did it needs a prescription from your GP..."

To cut the story short, they agreed another appoinment  10:00 tomorrow, and we shot off to arrange a prescription from our GP - Sue did all that, I'm just too slow over the ground these days. And she had to go back in the afternoon to collect what the doctors in their wisdom had decided on - four 2mg diazepam tablets to be taken between last thing tonight and the time of the scan. That's barely enough to knock a mouse over and I doubt it'll have much effect on me. I have considered washing them down with a bottle of Shiraz for greater effect...

(Sidenote: since the stay in hospital my desire for a glass or three of red in the evening has faded completely away - it's well over a week since I had one)

And one mort thing - tomorrow, the day of the rescheduled scan, just happens to be our Ruby (40th) wedding anniversary and we had shunted all sorts of other things around to keep the diary clear. You can imagine how we feel about that!

20/02/22 (2) The dreaded MRI...

 ... is at 08:20 in the morning. Better to get it over with, the sooner the better, and all that. I am more than a little apprehensive after having to abort the one a couple of years ago. At least this time they're all cued up for heavy sedation, and one way or another it has to be done.

Alarms set for 05:30 and we plan to leave at 07:30. I'm so slow at getting dressed etc. these days that I'll need all of an hour and quarter to be ready for breakfast. In he meantime, wish me luck!

Not an entirely accurate image, as there's no way the radiologist would be in the same room as a scanner with a computer and a metal-framed chair. Not with those magnetic fields...