43f 190 lbs 5’6” Canadian
•Asthma •Anxiety •Celiac •Depression •Gastroparesis • irritable Bowel •Chronic Migraines •Psoriatic Arthritis (loads of joints affected)
•amitriptyline-migraine prevention •celexa - depression •domperidone-gastroparesis -haven’t began yet •folic acid - pSa •methotrexate: sub q. -Psa •naproxen - psa enthesitis •vitamin d - deficiency
( I’m off to work, I’m giving lots of information, sorry if it’s too much, I just won’t have time to respond to questions)
High level of pain between shoulders above bra line in spine. Pressure like sensation in spine which is new. This seems to be causing low grade migraine for weeks, can’t shake it, refuse to go to er for meds due to covid outbreak in my city. Pain in spine below rib cage but above hip. Tender to touch right side of spine in this area ( associated with one to 2 vertebra), sends electric fire like sensation to right hip.
I’ve finally after 7 years of me pushing and approximately 10+ years of symptoms have a team of doctors taking my concerns seriously. Was diagnosed with chronic daily migraines a year ago, psoriatic arthritis in July, and gastroparesis 2 weeks ago.
At this point concerned at the level of pain in my Spine. Feels like it’s causing new migraines, and spasms in my abdominal area between and just below my rib cage. I spent the past two days completely drained from pain in my upper spine sleeping on my heat pad.
I want pain resolution, and symptom resolution this isn’t a way to live. I’m not sure if I should touch base with my neurologist or my rheumatologist about the low grade migraine, or if I should even suggest looking into the gastroparesis as a problem from my spine?
I plan on discussing the pain in my spine again with my rheumatologist mid December appointment.
I’ve attached my imaging below.
What is your takeaway from my imaging? in regard to the pain I have in my spine, would the low level of degeneration cause these levels of pain in my spine? Is this just my stupid body over reacting? Could the issues in my spine be associated/ a contributing factor with my gastroparesis or am I just hoping that I don’t have a multitude of individual issues going on at once?
What is my best approach moving forward? I already see a therapist to help me cope with the emotional aspects of living with day to day pain.
I’m tired of living life with massive amounts of pain. Once covid is over I plan to get back into physiotherapy and exercise.
Due to my long time in receiving diagnosis, I have troubled relationships and mistrust with physicians. I tend to let my pain get to crisis level before dealing with it. Many physicians in my past have tried to downplay my symptoms, saying they were due to my mental health problems, I’m aware that my mental health makes it more difficult for me to cope, but my symptoms are very real. My anxiety and depression are as a result of my ptsd from being stalked by two separate people, sexually victimized and raped.
My apologies if I’ve given too much information, I don’t want to leave anything out in the I can’t quickly respond.
Attached are the results of my mri- my rheumatologist performed it to look at Spine and si joints.
CLINICAL INDICATION: 43 yo F w/ inflammatory back pain, psoriasis, elevated CRP, strong family hx of psoriasis.
TECHNIQUE: Multisequence/multiplanar images of the spine and SI joints were obtained without contrast on a 3.0 T magnet.
COMPARISON: Lumbar spine radiographs from the same day and SI joint radiographs from July 29, 2020 and CT abdomen from July 18, 2020.
FINDINGS:
COMPLETE SPINE:
There are 7 cervical, 12 rib-bearing thoracic and 5 non-rib-bearing lumbar vertebral bodies. No fusion or segmentation anomaly is identified.
Bone marrow signal is within normal limits. No bone marrow edema/inflammatory bone marrow lesion is identified. Specifically, no acute or chronic Andersson or Romanus lesions nor costotransverse or costovertebral joint inflammation. A few small intraosseous hemangiomas in the spine and sacrum are noted, including at C5, T6, T7, T10, L2 and S2.
Alignment of the spine is maintained. The vertebral body heights are maintained. There is mild loss of disc height and mild disc desiccation at L4-5. The remaining disc spaces are maintained. There are very small posterior disc bulges at the C4-5, C5-6, C6-7, T5-6 and L4-5 levels that result in very mild spinal canal narrowing, with mild effacement of the anterior thecal sac but no mass effect on the cord. There is no significant spinal canal narrowing identified in the remainder of the spine. No significant neural foraminal narrowing is identified.
The visualized brainstem and cerebellum are unremarkable. The spinal cord and cauda equina are normal in signal and morphology. The conus terminates posterior to L1. No obvious spinal cord lesion is identified on sagittal screening. Incidental note is made of multiple small Tarlov cysts.
SI JOINTS AND PELVIS:
Mild subchondral sclerosis of the bilateral anteroinferior SI joints and more extensively involving the bilateral posteroinferior SI joints, with partial ankylosis on the left side. This corresponds to mild degenerative changes with marginal osteophyte formation visualized on the previous CTs from July 18, 2020 and March 29, 2019. The SI joints are otherwise unremarkable. No bone marrow edema, capsulitis, erosions or bone fat depositions.
The bone marrow signal in the pelvis and proximal femurs is normal. No enthesitis is identified. Imaged muscles are normal in signal and bulk. No hip joint effusion or trochanteric bursitis.
Imaged pelvis is unremarkable.
IMPRESSION:
- No active or chronic inflammatory lesions within the spine, pelvis or SI joints to suggest the presence of a spondyloarthropathy.
- Mild degenerative changes of the SI joints as described above.
- Very mild multilevel degenerative changes of the spine as described above. ***** FINAL REPORT *****
