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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Got spinal injury. Diagnosed with type 1 diabetes and have swelling in arm pit. Are they related?

Answered by
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Dr. S K Mishra

Spine Surgeon

Practicing since :1998

Answered : 116 Questions

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Posted on Tue, 18 Dec 2012 in Diabetes
Question: I had a Car Accident in August, in which I suffered Spinal injuries to my neck and lower back. All the symptoms I got from the Spinal Injuries are on the Right hand side. i.e. Right Arm tingling and Numb, Right hand tingling and numb. Right Leg Painful with shooting pains and numbness to right leg and foot.
In October I have been diagnosed as Type One Diabetic I am Mid Forties and have to now take Insulin Four times a day.
I noticed a few weeks ago a swelling in my right Arm pit, it has now become painful to touch, Would I been to the Doctors he says it the Lymph Node swelling.
The question I ask is. Is this connected to my Spinal Injury?
doctor
Answered by Dr. S K Mishra 34 minutes later
Hi,
A tender lymph node swelling , commonly suggests infection. If it is so then reason must be poor sugar control. Check your glycated Hemoglobin and pre and post meal sugar thoroughly, consult diabetologist/physician.
Gone through the report. The armpit lymph not should not be related to spine.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S K Mishra 2 hours later
My Blood Sugar level is between 4.5 and 10.3 so I doubt that it is poor Sugar control. There is no Sugar in my diet and the Diabetic Clinic are very happy with the levels are am getting in readings from my meter.

So the possibility is infection, I do everything by the book so to speak, so I have no idea how I gained an infection.

So I ask this question.

Can A Spinal Injury bring on Type One Diabetes?

Thank you.
doctor
Answered by Dr. S K Mishra 1 hour later
Hi there,

Thanks again for writing back.

No, spinal injuries does not cause diabetes.

Lymph nodes are the primary gate way of defence and hence it commonly gets involved in any infection / inflammatory conditions. With a single lymph node swelling it is difficult to predict the infection involved. We rely on fine need aspiration biopsy (FNAC) to provide clues to detect the cause. Therefore if you persist to have tender lymph node, I suggest you to consult an internist and get examined. He/she can plan for FNAC to provide you the diagnosis.

Biopsy is final answer if all other investigations are normal.

Hope I have answered your query. Let me know if you have other concerns.

Regards

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. S K Mishra 49 minutes later
That now brings me to two questions.

1 Are these websites all wrong?

WWW.WWWW.WW 32. WWW.WWWW.WW 33. WWW.WWWW.WW 34. PDF from a top USA Hospital
WWW.WWWW.WW etesandSCI.pdf



& based on the MRI attached, Why does my right leg go numb and have a shooting pain down it?
doctor
Answered by Dr. S K Mishra 7 hours later
Hi,

Thanks for the follow up.

1.     I would not be able to comment on the findings given on the websites you have mentioned, as they are all research findings. In my experience, I have not come across any case of Diabetes Type 1 due to spinal injury.

2. Based on MRI:
L3/4: Broadbased right sided disc protrusion affecting the right lateral recess, foraminal and extra foraminal zones. This appears to be touching the right sided L3 nerve root. There is mild indentation of theca but no significant canal stenosis.
L4/5: Degenerative disc with mild circumferential disc herniation with more focal protrusion in the right foraminal and extra foraminal zone. Again, this appears to touch the exiting right L4 nerve root.

Yes, that explains right leg pain, but not the armpit swelling.

Hope I have been able to address your concerns.

Regards

Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. S K Mishra 4 hours later
Thank you very much for that,

Before I had the accident in August, I was not suffering any back at all, and certainly was not suffering from pain in the right thigh and numbness down the leg or right foot.
Looking at the MRI report, it mentions L4/L5 Degenerative disc issue.

But the L3/4 broadbased protrusion, affecting the right lateral recess, foraminal and extra foraminal zones. This appears to be touching the right sided L3 nerve root. There is mild indentation of theca but no significant canal stenosis.

Is this is what is new from the accident?

Unfortunately they don't write these reports in Laymans terms. Could you give me your interpretation in Laymans terms what the report means and what is old injury and what is new.

My Symptoms are as follows
a. Neck Pain
b. Numbness Right Arm
c. Tingling Right Arm
d. Pain in Right Arm
e. Numbness Right Hand
f. Tingling Right Hand
g. Pain in Right Hand
h. Pain in Lower Back
i. Pain in Thigh Right Leg
j. Burning Sensation in Lower Legs.
k. Intermittent Numbness In Lower Right Leg
l. Intermittent Numbness In Right Foot
m. Leaking Urine
n. Unable to gain an Erection at all.

Thank you very much.
doctor
Answered by Dr. S K Mishra 52 minutes later
Hi there,


Thanks for providing the details of your symptoms. I shall try and group the symptoms as per your reports.

1. The symptoms of 'a,b,c,d e,f,g' is probably related to C5-C6: Broadbased disc osteophyte bar. This is causing significant narrowing on the right.

2. 'h,i,j,k,l' is probably due to right L3-L4 root compression. The right L3,4 roots are compressed giving rise to right leg pains. Besides this, the right lateral recess stenosis can produce significant symptoms even without canal stenosis.
It is rare to find a human spine without evidence of degeneration after age of 30. This is the price paid by human race for walking erect. Blood supply gets impaired with age and posture are factors responsible for degeneration. Possibly already existing mild degenerative changes which were aymptomatic became aggravated by trauma.

The spinal cord and bones return normal signal. This also signifies that your spinal injury was not severe.

3. 'm,n' are not explained by MRI.

Do you remember episode of weight loss prior to trauma / along with feeling of mild lethargy / anything unusual and was this cause of car accident. Such subtle symptoms can be of pre-existing diabetes.
Mild to rarely moderate hyperglycemia occurs after all severe injuries and is response to stress, but not severe diabetes, and in any case your injury was never severe.

In brief the symptoms 'a to l' can be explained by spine MRI changes. It can be possible that the injury just aggravated the damages. However 'm and n' cannot be related to the spine. It may be partly attributed to long duration of diabetes.

Had you checked your blood sugars before the trauma?

We can plan nerve conduction studies in consultation with a neurologist. This can provide clues to confirm my theory. I would also suggest serum creatinine levels to be checked too.

Hope this answers your query. Let me know if you have other concerns.

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. S K Mishra 7 hours later
Dear doctor thank you for that,
I am 5ft 11inches tall, and of a large frame and very muscular type body. The lowest body weight I have ever been was 210llbs (95.254 Kilos) I was doing and the work in the USA was physically demanding and enjoying outside activities like water skiing, boating and skiing in the Winter.

In 2007 this changed as work dried up so I moved from the USA to the UK, this was a large lifestyle change. I could no longer afford to do the outside activities I enjoyed and the job I got was a computer job, obviously there was a lot less activity.

I have always suffered with constipation and stomach issues like bloating and Acid Reflux.

In January this year my weight reached a peak at 300llbs (136.077 Kilos) so I decided to do something about it. I joined a gym and mainly did cardiovascular exercise on bikes, running and swimming. I started to lose weight albeit it slowly at around 2llb a month (0.907 Kilos) my body was at the same time putting on Muscle mass. But my waistline had gone down by about 3 inches. According to my excel spreadsheet my last weight measurement prior to the accident was on the 18th of August 2012 and I was 286llbs (129.273 Kilos)

The accident happened on the 23rd August 2012, thus stopping me going to the Gym to work out or swim due to pain etc. This is where I started to get the numbness in my leg etc. The shooting pain runs down the back of the right leg. And burning sensation started in legs as well as the Neck pain, shoulder pain and numbness in right hand etc.

At this point I noticed I started to lose weight. In-fact the weight loss which was previously low accelerated without doing any exercise; it was around 5llbs a week (2.267 Kilos) I put this down to losing muscle mass that I had gained over the last few months.

By the last week of September 2012 I was losing weight fast at around 2llb (0.907kilos) a day, I had become thirsty all the time, (drinking upwards of 8 litres of water per day). Had trouble staying awake, was peeing a lot and my vision started to get blurry. My weight had now dropped to 230llbs (104.326 Kilos)

I first thought that I had a stomach bug or something and was going to give it the weekend at the end of September to improve or go to the doctors. By the Sunday I was feeling worse, I searched on the Internet using the symptoms. Every website I came across, said the symptoms were Type One Diabetic.

On Monday the 1st of October I went to the doctors reporting these symptoms.

1.     Constantly Thirsty
2.     Dry Mouth
3.     Going To Toilet 30 times a day
4.     Fatigue
5.     Blurred Vision
6.     Headache

It was a new doctor I had never seen before, she was under GP training and the meeting was videoed. I told her I had done research on the Internet and came up with Type One Diabetes as the answer.

She asked me if I had any stomach issues, which I reported that I had all my life as I can remember Constipation and Acid Reflux.

She did an examination on the bed but found nothing wrong, after this she suggested to get an eye test for the blurred vision.

I left the doctors thinking there was not a lot wrong and there was no big deal as whatever it was I was not dehydrating and I was drinking loads of water. I booked an eye test for the following Saturday

The next 3 days it got worse, where I started vomiting, drowsiness, abdominal pain and then started to find it difficult to breath, but by the Thursday I collapsed into a Coma and found by work colleagues who called an Ambulance. I was rushed to the Hospital. They said I was Ketoacidosis and Hyperglycaemic. My Sugar count was 63.70. The doctors at the hospital said I was lucky to be alive.

It took 6 days of being in hospital to get the sugar count down.

There is no sugar in my diet and never really has been, as I followed my mother using sweeteners in coffee rather than sugar and I have never really been a desert type of guy. And always eat three times a day. Although portions used to be on the rather large side these have been cut right down now.

I take Lantus Insulin, of a night (30 units) injection.
And Novarapid 3 times a day after meals (10 units per time) injection.

One thing I have noticed significantly I do not any longer get any constipation or Acid Reflux.

What are your thoughts on that?
Was the accident the key turning point?
Have I had this all my life without knowing?

Thank you kindly for your answers, they are appreciated. XXXXXXX XXXXXXX
doctor
Answered by Dr. S K Mishra 3 hours later
I know these symptoms of unexplained wt loss and lethargy by heart because I am also suffering from type 1 diabetes and take 80 unit insulin/day, which started in 4th decade of my life.

I like you searched too much literature but could not found any definite precipitating factor; I never had trauma or anything special to notice. Type 1 diabetes is commonly due to autoimmune destruction of beta cells of pancreas. All autoimmune diseases may be triggered by stress possibly. This is all I can say.

Some diabetologist or immunologist may better give exact answer of all such questions. We are in same boat but I am patient of diabetes and not a diabetologist. Hope I was able to explain ``a to l ``which is my specialty. m, n and your new questions, I shall not be able to comment much except what I shared already my experience.

Hope for best.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. S K Mishra 1 hour later
Dear Doctor XXXXXXX

Thank you kindly for your answer and your honesty. I sympathise with anyone who has Diabetes it certainly changes a lot of your perspective. I always thought I respected my body; I don’t drink Alcohol or Smoke. I have never used any drugs.

In relation to the accident, I was diagnosed with PTSD by a Consultant Clinical Psychologist, I find it particularly difficult getting back in a car. I close my eyes or look away if anyone comes to close and brake sharply for no real reason. I find it even worse if I have to go anywhere on my own and have to drive
.
With you saying that stress has a factor in Diabetes I can see where there is a possible connection and learn to understand how this came about. Understanding things always seems to help me and hopefully make my issues easier to deal with in the future. Your answers have been really helpful; I wish the doctors here would explain things like you do.

Going back to the Spinal Injuries, I am currently on Morphine Patches and Codeine based Painkillers.

The right leg issue are particularly disturbing, two weeks ago my right leg went numb when taking a shower and I fell in the shower this was not a good experience and something I would like to try and avoid in the future.

My GP has referred me for possible surgery.
People I know say you shouldn’t have surgery but they are not suffering the pain and numbness.


Do you think surgery is a good option to take?
What types of surgery are there?
Will they help make things better (Get rid of the pain and numbness)?
And finally what are the risks of surgery?

Kind Regards XXXXXXX XXXXXXX
doctor
Answered by Dr. S K Mishra 27 minutes later
Hi,

The side of pain correlates with MRI findings. I shall advice you NCV (Nerve conduction velocity) of all four limbs in addition. This may help (not definitely) in determining what nerves are more affected and some clue to diabetic component of neuropathy.

Surgery may be considered in your case preferably microdiscectomy at most affected level/more affected levels. Ultimate decision has to be taken by your spine surgeon. In diabetic patients outcome is little less favorable than non-diabetics, possibly due to diabetic component of neuropathy, extent of which is difficult to judge.

Hope I have been able to address your concerns.

Thank you.

Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. S K Mishra 3 hours later
Dear Doctor XXXXXXX
Thank you so much for answering all my questions, I have learnt a lot through you and appreciate the time you taken, not just with the areas of your expertise but also areas of your personal experience.

I will close the discussion now and rate you with best possible rating. I send this just to thank you.

Kindest Regards XXXXXXX XXXXXXX
doctor
Answered by Dr. S K Mishra 1 hour later
Dear Mr. XXXXXXX XXXXXXX

Thanks for consulting me. I am happy that I could be of help to you. I would be available if you require answers for any other medical queries.

Thank you.

Wishing you good health.
Dr. S.K. Mishra
Above answer was peer-reviewed by : Dr. Mohammed Kappan
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Recent questions on  Broadbased disc osteophyte

doctor1 MD

I have neck pain that occasionally goes into the right shoulder. It is very severe when it goes to the right shoulder...No tingling or numbness . I had an MRI recently (1 week ago) that said: There is severe disc space narrowing C5-6 C6-7...

doctor1 MD

MRI results - language. I have right side weakness for years and recently had a severe case of adhesive capsulitis . after that time I was receiving physical therapy and the weakness in the right arm became greater and numbness in lower three fingers as well as arm. MRI was suggested. Shoulder is doing better but still have right side weakness. To complicate this I have POEMS disease but I don't know how much of the symptoms are related to the disease - or not at all. So frustrated. I deal with chronic pain and muscle problems all the time. Now I am having problems in the lower left rib area with extreme pain. Ultrasound didn't reveal much - I have had an enlarged spleen for years but it showed no changes.
Anyway. Here are the results of the MRI of neck as related to the shoulder/arm problems.
Thank You,
Stephania
AGE: 52 years DOB: 7/23/1960 GENDER: Female      

PROCEDURE: MRI CERVICAL SPINE WO CONTRAST, 3/20/2013 6:45 PM      
ACCESSION NUMBER(S): RIM0000      
LOCATION: SSPLDIMA      

COMPARISON: MRI from 11/4/2010      

CLINICAL INDICATION: neck pain with radicular symtoms on the      
right arm..      

TECHNIQUE: Sagittal T1-weighted, sagittal T2-weighted, sagittal      
STIR, axial T2-weighted, axial gradient echo.      

FINDINGS:      

Mild degenerative changes are present at C1-2.      

Vertebral bodies are normal in height, signal, and alignment.      

There is diffuse desiccation of the cervical discs.      

Ligaments are within normal limits.      

The spinal cord is normal in signal and size. Contour the spinal      
cord is abnormal at C5-6 and C6-7 due to central spinal stenosis      
from disc osteophyte complexes. These will be further described      
on the axial images.      

Axial images:      

C2-3: No significant abnormality      

C3-4: Broad-based disc osteophyte complex with resultant mild      
central spinal stenosis. There is right uncovertebral hypertrophy      
producing moderate right neural foraminal stenosis. There is left      
uncovertebral hypertrophy producing mild left neural foraminal      
stenosis.      

C4-5: Broad-based disc osteophyte complex with resultant mild      
central spinal stenosis. There is mild left neural foraminal      
stenosis. Right neural foramen is normal.      

C5-6: Broad-based disc osteophyte complex with resultant severe      
central spinal stenosis and flattening of the spinal cord. There      
is severe bilateral neural foraminal stenosis due to      
uncovertebral hypertrophy. No definite cord signal abnormality.      

C6-7: Broad-based disc osteophyte complex. In addition, there is      
a small superimposed left paracentral protrusion that contacts      
the left hemicord but does not significantly efface it. There is      
resultant severe left neural foraminal stenosis as the lesser      
paracentral protrusion extends into the proximal aspect of the      
left neural foramen. There is moderate left hemi-canal stenosis.      
Right neural foramen is normal.      

C7-T1: No significant abnormality      

Paraspinal soft tissues are within normal limits.      

Flow-voids are present within the imaged aspects of the vertebral      
arteries, common carotid arteries, and internal carotid arteries.      



Impression:

Impression:      
1. Multilevel degenerative changes as detailed above. No      
significant interval change from previous exam on 11/4/2010.      
2. At C5-6, there is a broad-based disc osteophyte complex      
producing severe central spinal stenosis and cord effacement.      
There is severe bilateral neural foraminal stenosis. There are no      
abnormal cord signal changes.      
3. At C6-7, there is a broad-based disc osteophyte complex and a      
small superimposed left paracentral protrusion extends into the      
proximal aspect of the left neural foramen. There is moderate      
left hemi-canal stenosis and severe left neural foraminal      
stenosis.      
     
Electronically Signed by Arun Krishnan, MD, Sutter Medical Group      
3/20/2013 8: 13 PM      

doctor1 MD

Can you please explain these MRI results:
1. C5-C6: Broad based disc osteophyte complex most prominent in the right subarticular with slight compression of the cervical spinal cord. Bilateral uncovertebral joint hypertrophy. Bilateral facet joint hpyertrophy. Mild central stenosis. Severe right and moderate left neural foraminal stenosis.
2. Multilevel cervical spondylosis.

Thank you!

doctor1 MD

Hello, I just received a report for my MRI C Spine and I would like help reading it before I go to my specialist. I would also like some advise as to what steps I should take. My Primary Doc wants me to go to a pain clinic. But I was wondering if...