Re: Bone Infection ??? No - just facet disease

[Guest guest]

Well, the doc who ordered the Lumbar MRI and who (as I've learned

here) apparently used " osteomyelitis " as a possible diagnosis has not

sent me the report. In fact, we are parting ways completely which is

probably as well. He was a control man, insensitive and a few others

things I'll skip.

But, my pulmo DID send me the report!!! Yea! Take that and that,ex

pcp! The report just showed facet degeneration on the L5-S1 (if Im

remembering it right) and no reason for the radiculopathy even though

I sure do hurt!!! The weird part is that 2 years ago I had bulging

disks, slight stenosis plus the facet degeneration!!! Do you mean to

tell me that the last 2 + years of Advair and weight gain on my

chubby little body made my spine BETTER ??? Bizzaro!

I'm leaning more now towards what I've seen a couple others post

about the pain being more like a nerve inflammation and wonder if

that's happening to me? Someone else mentioned having an MRI and

coming out normal even though they had a lot of hip pain. Something

is going on! I don't think an MRI can show nerve inflammation.

I really do feel the pain has gotten worse since on Xolair. I talked

to the doctor's assistant (can't see the doc for a few more weeks)

and explained that I would like the best of both worlds - freedom

from allergies which hopefully someday Xolair will create, and

freedom from this exhausting and almost debilitating pain. My legs

ache too. The pulmo wants me to see a rheumy and I'm all for it -

just caught up in pcp changes and insurance hassles. Also, trouble

finding a good rheumy w/my insurance.

I also asked the doc if I could be " addicted " to Advair. She said

unequivocably NOT. What I really meant was rebound effect but was

too fogged in to think of the word. I really wondered if the 4 (?)

years on Advair might have leached into my body in general and

affected other systems. Before that I was on another inhaled

steroid. I'd like to hear more on this.

Tomorrow I'm supposed to self inject 375 mgs. again of Xolair. The

injections are pretty easy except for bending over to see the lower

part of my fat stomach to check for bruises, irritations, or blood

vessels before I inject. The last time, when I went up to 375 mgs

for the first time, I felt a little weird right afterward but no

breathing problems or swelling. I wrote it off to nervousness and

being " scrunched " briefly. I think I can tell it's doing something

to me but it's so odd I can't quite describe it and it seems to go

away fairly quickly.

--- In , " tiredofsteroids " <sitesee@...>

wrote:

>

> Anybody on frequent or chronic steroids should have periodic bone

> scans to check for osteoporosis. Adah, I think you said you had a

> bone scan with a worrisome result. It's important that you have a

> follow-up scan after a year to see where you stand. Treatment for

> osteoporosis or osteopenia (thinning bones that are not yet

> osteoporotic) should include daily 1200-1500 mg calcium with

vitamin

> D as well as Fosamax or Boniva. The latter meds slow down and can

> even reverse bone loss.

>

> I developed osteoporosis in my 30s after only 3months of 40mg daily

> prednisone. It definitely can happen even with just inhaled

steroids,

> although a lot of docs don't seem to realize that. If you're taking

> high-dose inhaled steroids, enough can be absorbed systemically to

> cause any or all of the common side effects of prednisone. For

> example, for 6 years I was on baseline doses of Advair 500/50 twice

> daily plus Flovent 220, 2 puffs twice daily. The amount of

> fluticasone (the steroid in both Advair and Flovent) absorbed by

the

> body (not just the lungs) at that dosing is equivalent to 25 mg

> prednisone daily. I'm extremely steroid-sensitive and that was

enough

> to worsen my osteoporosis, cause a 40-pound weight gain, worsen my

> high blood pressure, cause suppression of my adrenal glands and

> produce the bruising and susceptibility to skin tears that oral and

> IV steroids can produce. In children, inhaled steroids alone can

> cause suppression of growth.

>

> I don't say all this to frighten anyone, since there's no question

> that steroids are life-savers for many of us, but it's important to

> be aware that even inhaled steroids can cause serious side effects.

> A big one that should be checked for because it is treatable is

> osteoporosis - please, please get your bone scans!

>

> Fran

> So...bottom line is please get your bone scans!

>

[Guest guest]

I agree with you that the findings on your previous MRI are unlikely

to have disappeared since your weight is now higher. And the spinal

stenosis would be expected to be permanent regardless, although if

was reported as " slight " , it was probably borderline and simply

interpreted differently by the current radiologist as essentially

normal. Sometimes two radiologists will read films differently - like

much of medicine, it is mostly science and experience but is also

partly art, not always black and white.

Suggest you check the report to see of the recent films were compared

to the previous ones. If it's not noted, it wasn't done (but should

have been if they were taken at the same facility). If they were

taken at the same facility, you could just go to the radiology desk

and tell them that your recent MRI was apparently not compared to the

previous one and you would appreciate a rereading of the new one

alongside the old one, focusing on the previous findings. If the

MRIs were done at different facilities, pick up the films from the

first one and take them to the recent one for comparison. If they

give you any grief about needing the doc to order the re-reads, then

just ask your supportive pulmo to write the order.

When you finally get to a rheumatologist, be sure to take both sets

of actual MRI films, not just the reports, so the rheumy can see them

for her/himself. An MRI may or may not be able to detect inflammation

of a smallish nerve but if it doesn't, that doesn't mean the

inflammation is not there. There just are limits to how much

information MRIs can provide. Also, the technical aspects of the MRI

method used to look for info about nerves are different than for

seeking info about bones and joints. Your doc can speak with the

radiologist if the MRI was adequate to evaluate both bones/joints and

nerve tissue. I'm guessing it was, but it may not have been.

Also, ifyou haven't been seen by and taken both sets of MRIs to a

neurologist, you should do so. Can't remember - have you already seen

a neurologist? You could, as you're considering, have nerve pain

unrelated to the " hardware " (bones and joints)and have neuro review

the films could help sort that all.

I'm sure it seems strange for me to suggest taking the MRIs to

different specialists in addition to the radiologist but each

specialty has its own take on interpreting films. A rheumatologist

looks at bones and joints all day every day, seeking often subtle

clues relevant to his specialty that might be overlooked by a

radiologist who looks at many, many different types of films every

day without focusing on just one specialty. Similary for a

neurologist.

About the " addiction " to Advair, you are right in realizing that you

asked the doc a question that was different from what you were really

trying to find out Addiction has a very specific biological meaning

in medicine (but not so in the general population of folks not in the

health field). It applies to the way narcotics and other substances

affect the brain at the biochemical and cellular level, and Advair

does not fit that definition.

The phrases you might use to explain your question include whether

reducing steroid dosing while on Xolair could be resulting in pain

symptoms that might have developed for whatever reason while you were

on steroids but were masked by systemic (whole body) absorption of

the steroid in Advair. I've mentioned in the past day or two on this

board that inhaled steroids definitely get absorbed by the body

outside the lungs and so can produce systemic effects, especially in

patients who are especially sensitive to steroids and/or are on high-

dose inhaled steroids, and in children in whom growth can be slowed

when they're on inhaled steroids alone.

Well, I think my brain is on empty for the moment...it's too late and

I gotta go to bed! I hope this helps and doesn't read like gobbledy-

gook. Don't hesitate to ask me to explain something better if you

don't get any of what I've said here. Sweet dreams!

Fran

> >

> > Anybody on frequent or chronic steroids should have periodic bone

> > scans to check for osteoporosis. Adah, I think you said you had a

> > bone scan with a worrisome result. It's important that you have a

> > follow-up scan after a year to see where you stand. Treatment for

> > osteoporosis or osteopenia (thinning bones that are not yet

> > osteoporotic) should include daily 1200-1500 mg calcium with

> vitamin

> > D as well as Fosamax or Boniva. The latter meds slow down and can

> > even reverse bone loss.

> >

> > I developed osteoporosis in my 30s after only 3months of 40mg

daily

> > prednisone. It definitely can happen even with just inhaled

> steroids,

> > although a lot of docs don't seem to realize that. If you're

taking

> > high-dose inhaled steroids, enough can be absorbed systemically

to

> > cause any or all of the common side effects of prednisone. For

> > example, for 6 years I was on baseline doses of Advair 500/50

twice

> > daily plus Flovent 220, 2 puffs twice daily. The amount of

> > fluticasone (the steroid in both Advair and Flovent) absorbed by

> the

> > body (not just the lungs) at that dosing is equivalent to 25 mg

> > prednisone daily. I'm extremely steroid-sensitive and that was

> enough

> > to worsen my osteoporosis, cause a 40-pound weight gain, worsen

my

> > high blood pressure, cause suppression of my adrenal glands and

> > produce the bruising and susceptibility to skin tears that oral

and

> > IV steroids can produce. In children, inhaled steroids alone can

> > cause suppression of growth.

> >

> > I don't say all this to frighten anyone, since there's no

question

> > that steroids are life-savers for many of us, but it's important

to

> > be aware that even inhaled steroids can cause serious side

effects.

> > A big one that should be checked for because it is treatable is

> > osteoporosis - please, please get your bone scans!

> >

> > Fran

> > So...bottom line is please get your bone scans!

> >

>