Brief Answer:
Both? You mention 3 drugs that you are taking

Detailed Answer:
Good morning. I notice that you mention 3 drugs in your current regimen but then, in your statement you ask about the risks "of taking BOTH of them together." I'm confused...which 2 combined out of the 3 might you be referring to or did you mean to say all 3?

Your question of risks in taking CIALIS and PROPRANOLOL revolve around side effect profiles. These are detailed in accompanying package inserts that you can read that pharmacies include with all prescription medication. Potential side effects are numerous since ALL side effects are required to be reported by the FDA when testing and dispensing drugs to a patient.

Now, to be clear....my assumption is that CIALIS is being prescribed to you for erectile dysfunction, correct? The Percocet is for pain. Why are they prescribing the propranolol? Typically, this is used to treat blood pressure or cardiac problems. Do you have either? Propranolol can also be used to improve autonomic function in cases where patients may be experiencing symptoms or have a diagnosis of DYSAUTONOMIA or in other situations where there is a primary diagnosis of POSTURAL ORTHOSTATIC TACHYCARDIC SYNDROME. It also just happens to be a pretty good medication for stage fright! No kidding....Plenty of XXXXXXX stars can't get in front of cameras or stand up and sing unless they've taken their fix of propranolol.....at any rate, in most cases it's used to treat high blood pressure and symptoms heart rhythm problems.

You are asking which medication is "better" to take between CIALIS and PROPRANOLOL. However, this is not a clear question to me since both medications are used for different purposes. There is no comparative information for them on those grounds. Propranolol is a beta blocker which is implicated in causing erectile DYSFUNCTION (ED) in some men while CIALIS is used for improving ED...make sense? In other words, those 2 drugs actually work against each other and so I'm not sure what you are trying to say when asking for an opinion on which is "better" than the other?

If you're being prescribed BOTH for the same medical reason then, the question makes sense but I can't really think of a diagnosis for which those 2 drugs could possibly be used as alternatives.

Let's look at the medication interactions you asked about:

Cialis + Propranolol can cause an interaction of increasing the lowering of blood pressure and/or heart-rate which can cause problems with staying alert and even passing out. The reaction potential is listed as SIGNIFICANT. It is recommended that patients be monitored closely if taking together.

Percocet is not known to have any significant reactions with either of the other 2 medications you are taking.

I looked at your MRI and please keep in mind that I am a neurologist and not an orthopedist. However, I do look at and read many MRI's of lumbar spines. I'm not sure why at the age of 24 you're having spinal surgery unless you suffer from scoliosis or have had a major back injury from severe trauma or chronic sports injuries, etc.

But frankly I see no significant degenerative types of problems in the disks, the vertebral bodies, or the column itself. If I had to make a call at all on this film I would say that the intervertebral space between L5 and S1 appears to be slightly smaller than the other disk spaces but I wouldn't categorize that as so severe that surgery were necessary for any reason.

You'll need to supply me with your actual diagnosis and symptoms or upload the radiology report so that I can correlate what the radiologist read out with the film in order for me to have a better chance of understanding what's "wrong" with this film.

And one more point to make is that when reading MRI's just looking at 1 slice of a sequence can be problematic. Usually we like to look at multiple images including the axial images (you've uploaded a sagittal view). It is difficult to look at one image and make a fully informed diagnosis. Also, we like to look at different sequences (changes in contrast) such as T1, T2, Gradient Echo, etc. You've only presented what appears to be a T2 sequence. Looking at different sequences can sometimes bring out things otherwise not seen in other views and contrast series.

I hope these suggestions satisfactorily address your questions and give some additional information you can discuss with your doctor regarding the concerns you have. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other comments, may I ask you not forget to CLOSE THE QUERY on your end so the question can be transacted and archived for further reference by colleagues as necessary?

You are invited to direct more comments or inquiries to me in the future by going to my web address at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 45 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
The document you've uploaded is for the cervical spine reading BUT

Detailed Answer:
....the film you've uploaded is of the lumbar spine.

So the report doesn't match the film you've put up for me to look at. Also, part of the report got cut off on its right margin. I'd like to know what that last little bit says since it could say there IS a problem or it may say there isn't much going on....DEPENDING ON THE WORDS! HAHA! Also, remember, what I said before,,,one slice from an MRI is really not entirely adequate to say whether something is wrong or not....you usually need a minimum of several cuts from different orientations when dealing with the spinal cord in order to get the entire 3D picture of what's wrong.

If you've got a c-spine report then, that means you also have c-spine films. Upload some of those bad boys as well so we can correlate the right report data with the scan it goes with....

Now, please also acknowledge the fact that I am not an orthopedic surgeon but a neurologist. Therefore, since your questions now have gone outside my area of expertise I just need you to understand that any opinions I might have are not necessarily going to be the same as an orthopod looking at the same film and same report.

Having said that there is information lacking from your end in order for ANYONE to make an intelligent opinion on whether or not the guy with the laser is legit or just trying to pay the equipment off! As I said originally in my other message it surprises me that a 24 year old with a back film that looks pretty OK to my UNTRAINED NEUROLOGY EYES....would have to get services of a LASER SPINAL WHATEVER CONTRAPTION it is this doctor is trying to use.

I see no evidence in that film of anything major or nasty such as a herniated disk, not even a bulging disk. I see no ligament tears. The only thing I MIGHT admit to is a narrowing of the space between L5 and S1 but that shouldn't cause such horrific pain or disability that you need to go atomic on it to fix the darn thing!

So, what you need to supply for more information in this case would be the EXACT SYMPTOMS you went to the doctor who either offered the laser or the doctor that sent you to the guy with the blowtorch....what were your symptoms? How long have you had the symptoms and how disabled have you been because of the symptoms. I'm assuming that pain is involved since you're on Percocet. Was it an industrial accident or you just doing some dirtbiking or levitation skateboarding and bomb on a rail or flight of stairs?? ROFL!!

Also, what type of laser device are we talking about....in other words, what is this guy trying to FIX using laser that he can't fix using conventional methods of cut, stitch, and sew...maybe through an endoscope which is a very routine and safe procedure, can be done as an outpatient, and has excellent results....ASSUMING THERE IS REALLY SOMETHING THERE THAT NEEDS TO BE FIXED that way.....

When you say LASER surgery all of a sudden the price of the procedure skyrockets...both for patients as well as insurance companies. Are you paying for this out of pocket? I've had a number of patients go for these procedures with all sorts of promises and hype that they would be cured....the only thing they got cured of was not having to carry around $17,000 or up to $35,000 in their pockets/bank accounts anymore! One office practice even got a patient's approval to do automatic withdrawals from their payroll and social security checks in order to pay for this procedure. The patient thought that was a great deal since he didn't have to worry about budgeting the money anymore and said he didn't "even see it leaving his bank account" so it was as if he got the procedure for free! Can you believe such brainwashing?

Now, don't get me wrong....I'm not suggesting that this doctor is trying to pull one over on you....but the information you've provided doesn't really allow me to clearly see what it is you have and what it is that this doctor is going to do for you.

I tell my patients who go for these procedures and who are cajoled into paying all up front costs before even stepping foot into the office of the surgeon that the only way you should go for such a procedure is if the surgeon is willing to give you a full 100% money back guarantee on your procedure if you don't get the result you're looking for within 4-6 weeks of recovering from the procedure NO STRINGS ATTACHED....that means forever and ever, Amen....you gotta be pain free, tingly and numbness free, and be able to work at your old job like you did before you started having problems. You get a guarantee like that in writing, written by YOUR ATTORNEY, and signed by the doctor (whose practice should've been present in that location for more than 5 years as well) then, I would say, "Be my Guest....." LASERIZE that spinal cord/column or whatever you need to do and make me good as new again doc!"

Anything short of that and I'd tell the doc...."See 'ya!" And then, I'd look for someone interested in helping you go through the conservative modalities of treatment which I don't even know that you've had yet aside from Percocet. Have you done, Physical therapy, Aquatherapy, Exercise Therapy, Acupuncture, Accupressure, other medication regimens aside from narcotics, TENS units, SOOTHEAWAY device? These would be the conservative forms of therapy to be tried ahead of ANY TYPE of surgery....laser or otherwise.....

Ok...we'll leave it here.....

I hope these suggestions satisfactorily address your questions and give some additional information you can discuss with your doctor regarding the concerns you have. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other comments, may I ask you not forget to CLOSE THE QUERY on your end so the question can be transacted and archived for further reference by colleagues as necessary?

You are invited to direct more comments or inquiries to me in the future by going to my web address at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 68 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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