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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Hello! For the past five weeks I ve been experiencing

Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2417 Questions

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Posted on Tue, 5 Feb 2019 in Headache and Migraines
Question: Hello! For the past five weeks I've been experiencing random muscle twitches throughout my body, throughout the day, along with some "vibrating" sensations in my legs (although I am sure there's no connection, oddly enough, the twitches started right after I finished a course ofBactrim for a UTI). I have no other symptoms such as muscle weakness, etc. I've been under a great deal of stress lately and I do suffer from health anxiety and make the mistake of googling various conditions, which always makes me fear the worst case scenario. I can honestly say that on a scale of 1 to ten, my anxiety level is probably a 9 to 10 on every single day. I actually had an appointment with a neurologist yesterday, who performed a clinical exam; she said my muscles are strong and the only thing which came up was hyper-reflexia in my right knee jerk. She indicated she did not suspect any issues, but ordered a creatinine kinase blood test, an EMG of my right leg and arm, and a brain MRI. Quite honestly, I am on an anxiety forum and hearing other people's posts about their fears of ALS have made me worried that I may have it -- do you have any reassurances for me that based upon my clinical symptoms, ALS does not appear to be the case? My second question is this -- I have been diagnosed with fibromyalgia, and thoughout the years, when I have flare-ups I tend to get paresthesias, etc. Years ago, back in 2002, these paresthesias started shortly after giving birth to my son via c-section. I visited a neuro back then and had a brain MRI, which only showed one non-specific small lesion in my parietal lobe. The paresthesias, etc. continued, and in 2005 I visited another neuro, who did an EMG, brain MRI and cervical MRI. At that time,I apparently had the hyper-reflexia in my right knee reflex as well, and the EMG came back negative. The brain MRI showed no change from the brain MRI three years prior, and two non-specific small lesions showed on my cervical spine MRI. Based upon that, he could not definitively diagnose MS. Throughout the sixteen years since all of those tests, nothing further has happened to me physically, it's simply the occasional paresthesias I feel when I'm super anxious or run down, and of course, the muscle twitches which I've had for a few weeks now. Obviously I realize that nothing can be said with certainty, particularly until I have the current MRI of my brain, but would you venture to say that if I had MS there would be additional symptoms by now, over the course of the last sixteen years? Again, nothing physically has changed with me in term of strength, fatigue, weakness, vision or urinary changes, etc. over the past sixteen years, I just simply get the parenthesis when I have a flare-up of fibromyalgia or during periods of anxiety and stress. Thank you for any reassurances you can provide!
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Follow up: Dr. Dariush Saghafi 0 minute later
Hello! For the past five weeks I've been experiencing random muscle twitches throughout my body, throughout the day, along with some "vibrating" sensations in my legs (although I am sure there's no connection, oddly enough, the twitches started right after I finished a course ofBactrim for a UTI). I have no other symptoms such as muscle weakness, etc. I've been under a great deal of stress lately and I do suffer from health anxiety and make the mistake of googling various conditions, which always makes me fear the worst case scenario. I can honestly say that on a scale of 1 to ten, my anxiety level is probably a 9 to 10 on every single day. I actually had an appointment with a neurologist yesterday, who performed a clinical exam; she said my muscles are strong and the only thing which came up was hyper-reflexia in my right knee jerk. She indicated she did not suspect any issues, but ordered a creatinine kinase blood test, an EMG of my right leg and arm, and a brain MRI. Quite honestly, I am on an anxiety forum and hearing other people's posts about their fears of ALS have made me worried that I may have it -- do you have any reassurances for me that based upon my clinical symptoms, ALS does not appear to be the case? My second question is this -- I have been diagnosed with fibromyalgia, and thoughout the years, when I have flare-ups I tend to get paresthesias, etc. Years ago, back in 2002, these paresthesias started shortly after giving birth to my son via c-section. I visited a neuro back then and had a brain MRI, which only showed one non-specific small lesion in my parietal lobe. The paresthesias, etc. continued, and in 2005 I visited another neuro, who did an EMG, brain MRI and cervical MRI. At that time,I apparently had the hyper-reflexia in my right knee reflex as well, and the EMG came back negative. The brain MRI showed no change from the brain MRI three years prior, and two non-specific small lesions showed on my cervical spine MRI. Based upon that, he could not definitively diagnose MS. Throughout the sixteen years since all of those tests, nothing further has happened to me physically, it's simply the occasional paresthesias I feel when I'm super anxious or run down, and of course, the muscle twitches which I've had for a few weeks now. Obviously I realize that nothing can be said with certainty, particularly until I have the current MRI of my brain, but would you venture to say that if I had MS there would be additional symptoms by now, over the course of the last sixteen years? Again, nothing physically has changed with me in term of strength, fatigue, weakness, vision or urinary changes, etc. over the past sixteen years, I just simply get the parenthesis when I have a flare-up of fibromyalgia or during periods of anxiety and stress. Thank you for any reassurances you can provide!
doctor
Answered by Dr. Dariush Saghafi 1 hour later
Brief Answer:
ALS concerns

Detailed Answer:
I have read your comments and can tell you that although you are showing a great deal of concern over symptoms and their meaning....you are joined by many, many people who feel the same levels of anxiety. It's probably a combination of media hype combined with peoples' already baseline nervousness over their health issues that is contributing to your worrying about ALS. I see this sort of thing quite often both online as well as in my clinical practice. Every patient is approached as an individual which means that nothing is considered impossible or out of the realm of possibility UNTIL we've looked at the data.

Therefore, it is a very good sign that you've seen a neurologist already and had a neurological examination because that is very important when trying to determine whether or not muscle twitches are likely significant or not. First of all, a woman of 51 years is not in the most common category or demographic for ALS which is typically and most frequently found in men who are in the 65+ age category. However, be that as it may, if someone wanted to make an argument that the 50's (though less likely) are still a decade where people with ALS can appear...they would not be wrong.

But in your particular case you are experiencing twitches of the upper extremities in the face of NO NEUROLOGICAL MUSCLE WEAKNESS detected on examination, no loss of muscle mass, and no other problems of a neurological nature that could suggest the possibility of motor neuron disease. In ALS (or any other type of motor neuron disease), TWITCHING of muscles occurs BECAUSE there is nerve damage to a point where muscles are not able to sustain themselves because there's no nerve signal coming in which also means that the muscles are already feeling debilitated, exhibiting loss of power, and have started atrophying (loss of muscle mass). It is at that point they begin twitching.....not before. Make sense?

Therefore, muscle twitching in the absence of muscle weakness is never reasonably interpreted as a heradling or suggestive sign of motor neuron disease. It's the equivalent of putting the cart before the horse and we both know that carts in front of horses result in horses remaining still....(i.e. nothing can happen).

BOTTOM LINE #1: No ALS in the differential diagnosis of a patient with the above presentation and history.

The 2nd point of contention in your case that makes ALS less possible is the fact, that the natural course of the disease almost always starts in the legs and ascends...not the reverse. Is that true 100% of the time? Of course not, but it's true the vast majority of the time so it bears notice. Patients at risk for developing ALS or who HAve ALS generally present with a history of stumbling, even falling, weakness in the legs and heaviness with eventual weight loss and loss of MUSCLE mass followed by twitching in the affected muscles. THEN, after weakness in the legs has already been announced....things typically are seen in the upper extremities.

Bottom line is that twitching of muscles (after taking BACTRIM...known side effect of medication) in the face of a normal neurological examination and especially normal strength and absence of muscle atrophy as well as absence of any loss of muscle mass, in a less than typical age group and gender makes ALS a very, very, very unlikely explanation for your symptoms to the point that it should not be on yours or any doctor's radar in terms of differential diagnosis.

With respect to your second issue of paresthesias-

I am intentionally not copying out all of the other information you noted as being your rationale to not having MS and keying in on your questions BECAUSE, as far as I am concerned....there is nothing I can say to you as an explanation as to why you should not worry about MS that you haven't already said very correctly and very eloquently....

SOOOO--- in the spirit of answering your question with the most direct and to the point response I can give you, I list your question, ""would you venture to say that if I had MS there would be additional symptoms by now, over the course of the last sixteen years?"

Followed by MY ANSWER: "Yes..." using all of your reasoning and logic.

I will add 1 point to the compiled discussion you presented in support of NO MS...which is that your paresthesias (by history) are and have been entirely TIME LOCKED (i.e. synchronized) to periods of anxiety, stress, or your FM....whereas MS would not be able to so coincidentally cause such phenomenon to occur in such brief spurts of time exactly during times of stress or FM attacks.

BOTTOM LINE #2- NO MS to worry about based upon your history, current symptoms, and diagnostic data.

If I've provided useful information and provided some reassurances of what your symptoms DON'T MEAN.... could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive feedback?

52 minutes total time spent reviewing, researching, and analyzing the present query.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
ALS concerns

Detailed Answer:
I have read your comments and can tell you that although you are showing a great deal of concern over symptoms and their meaning....you are joined by many, many people who feel the same levels of anxiety. It's probably a combination of media hype combined with peoples' already baseline nervousness over their health issues that is contributing to your worrying about ALS. I see this sort of thing quite often both online as well as in my clinical practice. Every patient is approached as an individual which means that nothing is considered impossible or out of the realm of possibility UNTIL we've looked at the data.

Therefore, it is a very good sign that you've seen a neurologist already and had a neurological examination because that is very important when trying to determine whether or not muscle twitches are likely significant or not. First of all, a woman of 51 years is not in the most common category or demographic for ALS which is typically and most frequently found in men who are in the 65+ age category. However, be that as it may, if someone wanted to make an argument that the 50's (though less likely) are still a decade where people with ALS can appear...they would not be wrong.

But in your particular case you are experiencing twitches of the upper extremities in the face of NO NEUROLOGICAL MUSCLE WEAKNESS detected on examination, no loss of muscle mass, and no other problems of a neurological nature that could suggest the possibility of motor neuron disease. In ALS (or any other type of motor neuron disease), TWITCHING of muscles occurs BECAUSE there is nerve damage to a point where muscles are not able to sustain themselves because there's no nerve signal coming in which also means that the muscles are already feeling debilitated, exhibiting loss of power, and have started atrophying (loss of muscle mass). It is at that point they begin twitching.....not before. Make sense?

Therefore, muscle twitching in the absence of muscle weakness is never reasonably interpreted as a heradling or suggestive sign of motor neuron disease. It's the equivalent of putting the cart before the horse and we both know that carts in front of horses result in horses remaining still....(i.e. nothing can happen).

BOTTOM LINE #1: No ALS in the differential diagnosis of a patient with the above presentation and history.

The 2nd point of contention in your case that makes ALS less possible is the fact, that the natural course of the disease almost always starts in the legs and ascends...not the reverse. Is that true 100% of the time? Of course not, but it's true the vast majority of the time so it bears notice. Patients at risk for developing ALS or who HAve ALS generally present with a history of stumbling, even falling, weakness in the legs and heaviness with eventual weight loss and loss of MUSCLE mass followed by twitching in the affected muscles. THEN, after weakness in the legs has already been announced....things typically are seen in the upper extremities.

Bottom line is that twitching of muscles (after taking BACTRIM...known side effect of medication) in the face of a normal neurological examination and especially normal strength and absence of muscle atrophy as well as absence of any loss of muscle mass, in a less than typical age group and gender makes ALS a very, very, very unlikely explanation for your symptoms to the point that it should not be on yours or any doctor's radar in terms of differential diagnosis.

With respect to your second issue of paresthesias-

I am intentionally not copying out all of the other information you noted as being your rationale to not having MS and keying in on your questions BECAUSE, as far as I am concerned....there is nothing I can say to you as an explanation as to why you should not worry about MS that you haven't already said very correctly and very eloquently....

SOOOO--- in the spirit of answering your question with the most direct and to the point response I can give you, I list your question, ""would you venture to say that if I had MS there would be additional symptoms by now, over the course of the last sixteen years?"

Followed by MY ANSWER: "Yes..." using all of your reasoning and logic.

I will add 1 point to the compiled discussion you presented in support of NO MS...which is that your paresthesias (by history) are and have been entirely TIME LOCKED (i.e. synchronized) to periods of anxiety, stress, or your FM....whereas MS would not be able to so coincidentally cause such phenomenon to occur in such brief spurts of time exactly during times of stress or FM attacks.

BOTTOM LINE #2- NO MS to worry about based upon your history, current symptoms, and diagnostic data.

If I've provided useful information and provided some reassurances of what your symptoms DON'T MEAN.... could you do me the favor of CLOSING THIS QUERY with a 5 STAR rating and positive feedback?

52 minutes total time spent reviewing, researching, and analyzing the present query.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 21 minutes later
Oh Dr. Saghafi -- I am giving you a BIG virtual hug! Please know that your detailed, informative and reassuring response has truly meant the world to me! Health anxiety is quite a beast to battle with, and with the ability to "research" these things online, it invariably leads to disaster for the mental state!!

You have answered my questions so wonderfully, and I just have two follow-up questions for you:

1) As i indicated, the neuro I visited yesterday noted hyper-reflexia in my right knee reflex, and the neuro I saw back in 2005 noted the same at that time. the EMG done in 2005 was normal. Is it possible for hyper-reflexia to simply be idiopathic and benign?

2) This is somewhat of a crazy question (that may make you chuckle!). I am scheduled to have the EMG of my right arm and right leg in four days. I am also scheduled to have surgery under general anesthesia nine days after the EMG -- are there any issues with having the EMG nine days prior to general anesthesia (I presume the answer is no)? You may find this interesting -- the surgery which I am having is for my ENT surgeon to remove what is called a "Schneiderian papilloma" from my left nasal vestible, which he will do endoscopically. Apparently these types of papillomas are quite rare, and if left unchecked (mine is literally the size of a grain of rice), they have unlimited growth potential and can invade the sinuses; there is also a risk of malignant transformation (can you tell I googled all about these growths). I think knowing that I have developed such a rare growth has led me to believe anything is possible, hence my current state of extreme anxiety!!

Thank you again for your kindness -- you are truly a godsend!!
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Follow up: Dr. Dariush Saghafi 0 minute later
Oh Dr. Saghafi -- I am giving you a BIG virtual hug! Please know that your detailed, informative and reassuring response has truly meant the world to me! Health anxiety is quite a beast to battle with, and with the ability to "research" these things online, it invariably leads to disaster for the mental state!!

You have answered my questions so wonderfully, and I just have two follow-up questions for you:

1) As i indicated, the neuro I visited yesterday noted hyper-reflexia in my right knee reflex, and the neuro I saw back in 2005 noted the same at that time. the EMG done in 2005 was normal. Is it possible for hyper-reflexia to simply be idiopathic and benign?

2) This is somewhat of a crazy question (that may make you chuckle!). I am scheduled to have the EMG of my right arm and right leg in four days. I am also scheduled to have surgery under general anesthesia nine days after the EMG -- are there any issues with having the EMG nine days prior to general anesthesia (I presume the answer is no)? You may find this interesting -- the surgery which I am having is for my ENT surgeon to remove what is called a "Schneiderian papilloma" from my left nasal vestible, which he will do endoscopically. Apparently these types of papillomas are quite rare, and if left unchecked (mine is literally the size of a grain of rice), they have unlimited growth potential and can invade the sinuses; there is also a risk of malignant transformation (can you tell I googled all about these growths). I think knowing that I have developed such a rare growth has led me to believe anything is possible, hence my current state of extreme anxiety!!

Thank you again for your kindness -- you are truly a godsend!!
doctor
Answered by Dr. Dariush Saghafi 20 hours later
Brief Answer:
The VIRTUAL HUG Payment Voucher.....I LIKE that concept

Detailed Answer:
You are so very nice and complimentary and I'm glad I had some things to say that you feel were of value and helped.....I also am sorry you've gotten stuck in this anxiety spiral about things but understand how that happened with your discovery of the Schneider papilloma....I did some research on that myself last evening and a bit more today. You are likely more the expert than I on the topic since I'd really never heard of that type of mass lesion.

However, give yourself a round of applause since now, as a result of reading more of these lesions....and being the Director of the Headache Clinic here in XXXXXXX at the VA Medical Center, I am going to keep my antennae up for patients who complain of facial pains, epistaxis, or other things that could suggest the presence of an obstructive entity...and look for them in suspicious headache/facial pain cases. In all the years I've been in medicine and running this clinic I've never had a patient come out to have this sort of ENT problem. On the other hand, I've never LOOKED!

So, KUDOS MISSY for having drawn my attention to your problem enough to peak my interest to find out more...you've likely helped others in the process! :0

I did read a good review article this morning stating that more recent patient series studies looking at questions of epidemiology, and things such as conversion rates from benign to malignant forms etc. are showing a MUCH LOWER incidence rate for these lesions than had previously been thought? Maybe you've already read that study. But, I completely understand why you want to take that lesion out surgically and wish you all the best on the appointed Day.

Hyperreflexia is more often times benign and just shows you've got hopping muscles attached to a healthy skeleton...I'll also bet you credits to navy beans that if your HYPER on the right then, I could get the same response on the left....it depends on how one is tapping the joints but more than not, asymmetry of reflexes is more an operator dependent phenomenon more than it is a physiological or PATHOphysiological one. If there's been no change since the last time someone banged on your joints a long time ago then, nothing to worry about in my opinion.

Is there anything I can do or say to help you feel good about NOT putting yourself through the unnecessary uncomfortable/torture of an EMG given the lack of salient data at hand for any pathology having to do with the twitchings......doesn't mean that you couldn't be worked up to find a cause....it's just that it wouldn't necessarily require an EMG/NCV study??? I guess you just sound like too nice a person to be used as a pin cushion. HAHA! And I'll bet my bottom dollar the neurologist won't be unhappy you made that decision....just think about it a minute before answering....Remember that when talking about motor neuron disease, ELECTRODIAGNOSTIC criteria are LESS sensitive in making the diagnosis of something like ALS compared to the clinical criteria based upon the NEUROLOGICAL EXAMINATION Plus HISTORY of evolution of problem.

ANSWER TO YOUR QUESTION though regarding the EMG proximity to surgery....NO PROBLEM to do one just before another You presume correctly young lady.....

And again, many thanks for the opportunity to help you with your case. If you ever feel you want to take a jaunt a few hrs to your southwest (Cleveland, OH) then, you'll find me here at my office either seeing patients or answering questions on Healthcare Magic! LOL! Be well, and hopefully, all goes well for you.....

Please do keep me in the loop if anything changes down the road and I'll be happy to give you some more ideas to chew/Google on! HA!

Cheers young lady!

110 minutes total time spent reviewing, researching, and analyzing the present query.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
The VIRTUAL HUG Payment Voucher.....I LIKE that concept

Detailed Answer:
You are so very nice and complimentary and I'm glad I had some things to say that you feel were of value and helped.....I also am sorry you've gotten stuck in this anxiety spiral about things but understand how that happened with your discovery of the Schneider papilloma....I did some research on that myself last evening and a bit more today. You are likely more the expert than I on the topic since I'd really never heard of that type of mass lesion.

However, give yourself a round of applause since now, as a result of reading more of these lesions....and being the Director of the Headache Clinic here in XXXXXXX at the VA Medical Center, I am going to keep my antennae up for patients who complain of facial pains, epistaxis, or other things that could suggest the presence of an obstructive entity...and look for them in suspicious headache/facial pain cases. In all the years I've been in medicine and running this clinic I've never had a patient come out to have this sort of ENT problem. On the other hand, I've never LOOKED!

So, KUDOS MISSY for having drawn my attention to your problem enough to peak my interest to find out more...you've likely helped others in the process! :0

I did read a good review article this morning stating that more recent patient series studies looking at questions of epidemiology, and things such as conversion rates from benign to malignant forms etc. are showing a MUCH LOWER incidence rate for these lesions than had previously been thought? Maybe you've already read that study. But, I completely understand why you want to take that lesion out surgically and wish you all the best on the appointed Day.

Hyperreflexia is more often times benign and just shows you've got hopping muscles attached to a healthy skeleton...I'll also bet you credits to navy beans that if your HYPER on the right then, I could get the same response on the left....it depends on how one is tapping the joints but more than not, asymmetry of reflexes is more an operator dependent phenomenon more than it is a physiological or PATHOphysiological one. If there's been no change since the last time someone banged on your joints a long time ago then, nothing to worry about in my opinion.

Is there anything I can do or say to help you feel good about NOT putting yourself through the unnecessary uncomfortable/torture of an EMG given the lack of salient data at hand for any pathology having to do with the twitchings......doesn't mean that you couldn't be worked up to find a cause....it's just that it wouldn't necessarily require an EMG/NCV study??? I guess you just sound like too nice a person to be used as a pin cushion. HAHA! And I'll bet my bottom dollar the neurologist won't be unhappy you made that decision....just think about it a minute before answering....Remember that when talking about motor neuron disease, ELECTRODIAGNOSTIC criteria are LESS sensitive in making the diagnosis of something like ALS compared to the clinical criteria based upon the NEUROLOGICAL EXAMINATION Plus HISTORY of evolution of problem.

ANSWER TO YOUR QUESTION though regarding the EMG proximity to surgery....NO PROBLEM to do one just before another You presume correctly young lady.....

And again, many thanks for the opportunity to help you with your case. If you ever feel you want to take a jaunt a few hrs to your southwest (Cleveland, OH) then, you'll find me here at my office either seeing patients or answering questions on Healthcare Magic! LOL! Be well, and hopefully, all goes well for you.....

Please do keep me in the loop if anything changes down the road and I'll be happy to give you some more ideas to chew/Google on! HA!

Cheers young lady!

110 minutes total time spent reviewing, researching, and analyzing the present query.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 34 minutes later
Dr. Saghafi -- you've earned another virtual hug from me!! I cannot tell you how much I have thoroughly enjoyed reading your reassuring responses and I love your personality! This is quite ironic -- you referred to me as "Missy", and that is actually my nickname which all of my family and friends call me! And yes, maybe sometime I will stop and visit you, given the fact that we "share" one of the great lakes and are so relatively close by!

You are so wonderful and I wish I had you on speed dial lol, but you can bet your bottom dollar that any future neuro questions which I pose here will be directed to you!

Yes, I had a feeling you may find the uncommon "Schneiderian papilloma" to be interesting! And yes, I've learned more about sinonasal papillomas than I ever wanted to know in my lifetime! Thankfully, mine was discovered fortuitously via the CT scan of my sinuses, is benign and doesn't show any evidence of erosion. Had the scan not been done, the little stinker would have kept growing until problems presented themselves. At the time of discovery, it was literally about the size of two grains of rice, and now is less than one grain (per my ENT), following the biopsy and my immune system perhaps wiping out more of it. Nevertheless, because of its unlimited growth potential, I certainly want the darned thing out, and I presume my surgeon will have to remove much more to get clean margins. Thank you so much for sharing that updated info on the cancer transformation risk -- you have made me feel so much better in that regard as well!! As these papillomas can recur, my ENT will keep me under surveillance regularly. That makes me feel so happy to know that the sharing of my crazy papilloma issue has brought such a growth to light for you! I'm still wrapping my mind around the fact that I developed a quite rare growth and i understand the etiology of them is still unknown -- perhaps viral in origin or due to chronic allergic rhinitis. Nevertheless, I suppose rare things do happen to people (why couldn't it have been winning the lottery lol?) and that this issue was caught early and can be successfully removed. I certainly don't want to take up more of your valuable time, and the papilloma issue isn't related to my initial query, but I'm going to attach a copy of the pathology report, simply for your perusing pleasure lol! I hope you have a wonderful day -- we here in Western New York are gearing up for a Lake Effect snow storm heading this way over the weekend -- I'm going to treat it as an opportunity to take some naps to maybe sleep away some of this anxiety lol (I'll let my husband do the shoveling). You're the best, Dr. Saghafi!
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Follow up: Dr. Dariush Saghafi 0 minute later
Dr. Saghafi -- you've earned another virtual hug from me!! I cannot tell you how much I have thoroughly enjoyed reading your reassuring responses and I love your personality! This is quite ironic -- you referred to me as "Missy", and that is actually my nickname which all of my family and friends call me! And yes, maybe sometime I will stop and visit you, given the fact that we "share" one of the great lakes and are so relatively close by!

You are so wonderful and I wish I had you on speed dial lol, but you can bet your bottom dollar that any future neuro questions which I pose here will be directed to you!

Yes, I had a feeling you may find the uncommon "Schneiderian papilloma" to be interesting! And yes, I've learned more about sinonasal papillomas than I ever wanted to know in my lifetime! Thankfully, mine was discovered fortuitously via the CT scan of my sinuses, is benign and doesn't show any evidence of erosion. Had the scan not been done, the little stinker would have kept growing until problems presented themselves. At the time of discovery, it was literally about the size of two grains of rice, and now is less than one grain (per my ENT), following the biopsy and my immune system perhaps wiping out more of it. Nevertheless, because of its unlimited growth potential, I certainly want the darned thing out, and I presume my surgeon will have to remove much more to get clean margins. Thank you so much for sharing that updated info on the cancer transformation risk -- you have made me feel so much better in that regard as well!! As these papillomas can recur, my ENT will keep me under surveillance regularly. That makes me feel so happy to know that the sharing of my crazy papilloma issue has brought such a growth to light for you! I'm still wrapping my mind around the fact that I developed a quite rare growth and i understand the etiology of them is still unknown -- perhaps viral in origin or due to chronic allergic rhinitis. Nevertheless, I suppose rare things do happen to people (why couldn't it have been winning the lottery lol?) and that this issue was caught early and can be successfully removed. I certainly don't want to take up more of your valuable time, and the papilloma issue isn't related to my initial query, but I'm going to attach a copy of the pathology report, simply for your perusing pleasure lol! I hope you have a wonderful day -- we here in Western New York are gearing up for a Lake Effect snow storm heading this way over the weekend -- I'm going to treat it as an opportunity to take some naps to maybe sleep away some of this anxiety lol (I'll let my husband do the shoveling). You're the best, Dr. Saghafi!
doctor
Answered by Dr. Dariush Saghafi 22 hours later
Brief Answer:
Gotta love the form of payment you use....BETTER THAN BITCOINS EVEN!

Detailed Answer:
Again, your comments are far too generous but I very much appreciate that they've been helpful...and perhaps slightly amusing....(we're in the same generation so we know what "BORING" people were like whilst going through school....didn't we vow NEVER to be like them?)....HAHA!

And it would be a huge pleasure to see you around the middle of our shared Lake over yonder if you ever felt the need....but somehow Missy....I think you're going to do just fine...in fact, more than fine. You are bright, intellectual, well informed, and present yourself very well. The Anxiety part of it is quite UNDERSTANDABLE...though I dearly wish I had the magic pill for that one....if I could help you with anything it would be to somehow train you as to "turn the brain off" to unnecessary noise.

Those who do not exhibit signs of such anxiousness related to medical issues fail to appreciate just how well buffered our brains are when they are processing all the gazillions of bits of information second by second in the correct way so as to cause us to be appropriately concerned vs. appropriately apathetic when it comes to our personal health. We tend to not "get" how anybody could possibly be doubting or over the top when the "facts are clearly before them." But at the same time we also fail to see or simply don't comprehend how situations can and do TRIGGER states of mind (which never existed heretofore) can impact our brains in a way that goes beyond our control. And I can give a plethora of examples of that sort of behavior outside the medical field...so can you.

So, I do think I understand a bit what you're going through with the discovery of this papilloma and then, why that could trigger a cascade of vigilant sorts of behaviors on your part that could get you thinking in all sorts of directions when you discover other things going awry...twitching muscles or other things....if you ever come to XXXXXXX I can give you all sorts of other examples that I see almost continuously.....which I don't want to tell you about right now since I can't control your reactions as well as if you were in front of me....ROFL.....at any rate, I know you understand what I'm talking about.

There are very good people who can help you deal with this sort of blip on your radar screen and help you to REBUILD your brain buffers which seem to be a bit down right now.....kind of like the Shields on the Enterprise that need to recharge before XXXXXXX waps them with another photon torpedo! Don't know if you were ever an ORIGINAL TREKKIE as I was...I wasn't terribly over the top like some of my friends....but I still remember episodes and marvel at their significance to social and political problems of the Day! HA! Please let me know what you've done to try and overcome these issues...maybe they're really NOT to the level of Health Anxiety on a pathological scale? People use the term a lot...but sometimes when there's justification and people don't go to unreasonable extremes....it may not be that at all. If you'd agree NOT to do the EMG...then, maybe that would be a sign in support of the "maybe not" diagnosis? HAHA! I'd love to try and help you get on track with this if you've not addressed it formally so, just let me know how you've been fairing and how much it's really interfering with your day to day life (at home, at work, socially, etc.). I don't have anybody off the top of my head in the XXXXXXX area for this sort of problem but I'm not opposed to doing some networking. After all, what helps you helps others in the long run....I once had a private patient who taught in the XXXXXXX School System. Plus, every year we take our wrestling team from JCU to the RIT Open...that's in your neck of the woods, isn't it?

True Story--I ran across a patient yesterday in my Headache clinic who seems to have terrible migraines (in part due to his wife smoking like a chimney....boy did she get irritated when I mentioned a "Come to Jesus moment" that her smoking was likely contributing to a good portion of her poor husband's headache picture!)...but I digress...anyways, he has now more recently been complaining of some nonspecific pain and throbbing/pressure symptoms in the middle of his face, unlike his migraine symptoms, but just annoying....Thinking about you, I asked if he'd ever been CT scanned for his sinuses? He said it's been about 5 years....bottom line, I snooped around for some symptoms to suggest the presence of a papilloma hanging out maybe in HIS NASAL VESTIBULE....but couldn't get much so decided to hold off on the scan in favor of continuing to treat his headaches more aggressively. But don't worry, his CT scan from 5 years ago was clean....and I'll be doing like Sting says, "Watching Him..."....I don't like to CT scans on people if I can avoid it since they emit about 200x the X-radiation compared to plain X-rays....just a thought to keep in mind.....sometimes they're necessary but I always want a bit more justification to them.....but again, thanks to you....I will be watching him for consideration of an imaging study of the face and nasal regions if he isn't adequately responding to treatments.

So ends my rambling.....I think you're going to do marvelously well my dear and again, don't forget about visiting XXXXXXX ...our rivers don't burn anymore, we've got a football team that seems to have come out of the Doldrums, and RUGBY SEASON is just around the corner....(yep, I love to get my big nose dirty and risk concussions!! Go figure!).....

We are only hours away from what some people have dubbed the Winter Blast of 19....which means you guys are going to see it likely in about 6-8 hrs. (maybe sooner because of the Lake Effect). Be well, stay warm if you can (allow your husband to come in once in awhile for something hot to drink)....I'm trying to convince my kids to stay in tonight....but of course, they feel they can conquer XXXXXXX in Toyotas, Hondas, and Ford Fusions! LOL.....what can one do??

P.S. Can you really shovel snow in Buffalo? I've heard that these kinds of dumps can be so incredible that some people have found it easier to just let everything freeze and then, simply conduct their living activities at home on mounds of ice and snow 4 feet higher than usual until Spring arrives....ROFL!

Be well, dear Missy.....

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Gotta love the form of payment you use....BETTER THAN BITCOINS EVEN!

Detailed Answer:
Again, your comments are far too generous but I very much appreciate that they've been helpful...and perhaps slightly amusing....(we're in the same generation so we know what "BORING" people were like whilst going through school....didn't we vow NEVER to be like them?)....HAHA!

And it would be a huge pleasure to see you around the middle of our shared Lake over yonder if you ever felt the need....but somehow Missy....I think you're going to do just fine...in fact, more than fine. You are bright, intellectual, well informed, and present yourself very well. The Anxiety part of it is quite UNDERSTANDABLE...though I dearly wish I had the magic pill for that one....if I could help you with anything it would be to somehow train you as to "turn the brain off" to unnecessary noise.

Those who do not exhibit signs of such anxiousness related to medical issues fail to appreciate just how well buffered our brains are when they are processing all the gazillions of bits of information second by second in the correct way so as to cause us to be appropriately concerned vs. appropriately apathetic when it comes to our personal health. We tend to not "get" how anybody could possibly be doubting or over the top when the "facts are clearly before them." But at the same time we also fail to see or simply don't comprehend how situations can and do TRIGGER states of mind (which never existed heretofore) can impact our brains in a way that goes beyond our control. And I can give a plethora of examples of that sort of behavior outside the medical field...so can you.

So, I do think I understand a bit what you're going through with the discovery of this papilloma and then, why that could trigger a cascade of vigilant sorts of behaviors on your part that could get you thinking in all sorts of directions when you discover other things going awry...twitching muscles or other things....if you ever come to XXXXXXX I can give you all sorts of other examples that I see almost continuously.....which I don't want to tell you about right now since I can't control your reactions as well as if you were in front of me....ROFL.....at any rate, I know you understand what I'm talking about.

There are very good people who can help you deal with this sort of blip on your radar screen and help you to REBUILD your brain buffers which seem to be a bit down right now.....kind of like the Shields on the Enterprise that need to recharge before XXXXXXX waps them with another photon torpedo! Don't know if you were ever an ORIGINAL TREKKIE as I was...I wasn't terribly over the top like some of my friends....but I still remember episodes and marvel at their significance to social and political problems of the Day! HA! Please let me know what you've done to try and overcome these issues...maybe they're really NOT to the level of Health Anxiety on a pathological scale? People use the term a lot...but sometimes when there's justification and people don't go to unreasonable extremes....it may not be that at all. If you'd agree NOT to do the EMG...then, maybe that would be a sign in support of the "maybe not" diagnosis? HAHA! I'd love to try and help you get on track with this if you've not addressed it formally so, just let me know how you've been fairing and how much it's really interfering with your day to day life (at home, at work, socially, etc.). I don't have anybody off the top of my head in the XXXXXXX area for this sort of problem but I'm not opposed to doing some networking. After all, what helps you helps others in the long run....I once had a private patient who taught in the XXXXXXX School System. Plus, every year we take our wrestling team from JCU to the RIT Open...that's in your neck of the woods, isn't it?

True Story--I ran across a patient yesterday in my Headache clinic who seems to have terrible migraines (in part due to his wife smoking like a chimney....boy did she get irritated when I mentioned a "Come to Jesus moment" that her smoking was likely contributing to a good portion of her poor husband's headache picture!)...but I digress...anyways, he has now more recently been complaining of some nonspecific pain and throbbing/pressure symptoms in the middle of his face, unlike his migraine symptoms, but just annoying....Thinking about you, I asked if he'd ever been CT scanned for his sinuses? He said it's been about 5 years....bottom line, I snooped around for some symptoms to suggest the presence of a papilloma hanging out maybe in HIS NASAL VESTIBULE....but couldn't get much so decided to hold off on the scan in favor of continuing to treat his headaches more aggressively. But don't worry, his CT scan from 5 years ago was clean....and I'll be doing like Sting says, "Watching Him..."....I don't like to CT scans on people if I can avoid it since they emit about 200x the X-radiation compared to plain X-rays....just a thought to keep in mind.....sometimes they're necessary but I always want a bit more justification to them.....but again, thanks to you....I will be watching him for consideration of an imaging study of the face and nasal regions if he isn't adequately responding to treatments.

So ends my rambling.....I think you're going to do marvelously well my dear and again, don't forget about visiting XXXXXXX ...our rivers don't burn anymore, we've got a football team that seems to have come out of the Doldrums, and RUGBY SEASON is just around the corner....(yep, I love to get my big nose dirty and risk concussions!! Go figure!).....

We are only hours away from what some people have dubbed the Winter Blast of 19....which means you guys are going to see it likely in about 6-8 hrs. (maybe sooner because of the Lake Effect). Be well, stay warm if you can (allow your husband to come in once in awhile for something hot to drink)....I'm trying to convince my kids to stay in tonight....but of course, they feel they can conquer XXXXXXX in Toyotas, Hondas, and Ford Fusions! LOL.....what can one do??

P.S. Can you really shovel snow in Buffalo? I've heard that these kinds of dumps can be so incredible that some people have found it easier to just let everything freeze and then, simply conduct their living activities at home on mounds of ice and snow 4 feet higher than usual until Spring arrives....ROFL!

Be well, dear Missy.....

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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