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3/6. Medical Reports - X-Ray & MRI & Ultrasound Scans

July 18, 2016
The amount of times rheumatologists sent me to the X-Ray, Ultra sound and MRI departments to photograph / scan my bones.   Years later after having so many, I wonder how much of my physical problems known or unknown are / were the direct result from having these intrusive and unnecessary X-Rays and MRI scans.  After researching the side effect of X-Rays, I discovered X-Rays can cause the body more problems than already existed, and MRI scans also had potential health problems.

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I have no idea what the following reports say. I know I "was" in pain when the following tests were done.   Now, I have no pain in the hips, knees, or shoulders. I have cancelled all doctors and hospital appointments. 
 Your medical reports may be similar to mine.
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1. My X-Ray Report - AP Pelvis and Left Hip - 2011.

Clinical Notes: Ankylosing Spondylitis. HLA B27 Positive. Severe Left Hip Pain.

Report: There is enthesopathy the involving the ischia, greater tuberosities and lesser tuberosities bilaterally.  There is anklosis of the inferior sacroliac joints and L4 and L5. These findings would be consistent with Ankylosing Spondylitis.
No fractures seen within the left hip. The alignment of the hip joint is normal. Minimal osteoarthritic disease is seen within both hip joints.
Gas and faecal materiel is noted within the bowel. No abnormal soft tissue shadowing.
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2. MRI Scan - Sacroiliac Joints - 2011

Clinical Notes: Standard Sequences Were Performed


Report: As noted on the pain radiographs, there is ankylosis of the sacroiliac joints, particularly inferiority. No other feature of note.

MRI Lumber Spine:  Standard sequences were performed and axial images were obtained through the levels of L1/2. L3/4, L4/5 and L5/S1.
There is ankylosis of several of the lower thoracic and lumber vertebrae. On MR appearances it is not possible to ascertain whether this is partial or complete. At the L5/S1 level however there is marked irregularity of the end-plates and some widening of the intervertabral disc with associated oedema in the adjacent vertebral bodies. These appearances are suggestive of a pseudoarthrosis at this level. There is also some oedema in the posterior elements at this level and this is keeping with bone marrow oedema due to a stress response.
At the L one two level there is oedema in the anterior aspects of the adjacent L1 AND L2 vertabrel bodies in keeping with inflammation/a stress response at this site. In addition there is oedema related to the facet joints bilaterally at this level and again these appearances are in keeping with inflammation/a stress response. There is no evidence of significant impingement on the theca or nerve roots at any level in the lumber spine.
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3. X-Rays - AP Pelvis and Both Hips - 2011

Report: Lumber spine ankylosis, and fusion of sacroiliac joints is noted, consistent with the clinical information of ankylosing spondylitis. There is also some whiskering of the inferior pubic rami bilaterally, in keeping with an enthesopathy.

Right Shoulder AP and Axial View:  There are degenerative changes at the shoulder and AC joint. There is an unusual appearance to the cortex of the posterior acromion on the axial view, where there appears to be a defect within the cortex. This is a change from the earlier shoulder radiograph of 28/10/2003. Some calcific densities are projected over the soft tissues adjacent to this and is uncertain if these are extrinsic to the patient or whether they lie within the overlaying soft tissue. It is unclear from this single image whether there is a progressive process here. Correlation with clinical symptoms - is there a lump here or tenderness or pain? In addition further evaluation with either ultrasound of the posterior aspect of the acromion or MRI would clarify.

Left Shoulder - Degenerative changes in the shoulder and acromioclavicular joint. There is some whiskering of the scapula inferior to the glenoid. Given the underlying history of ankylosing spondylitis, the appearances are probably acceptable, consistent with further enthesopathy.
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4. Letter Sent From Consultant Rheumatologist - 2012

Thank you for asking me to see this gentleman who came to see me today at St Georges Hospital. He has had Ankylosing Spondylitis for 25 years which is now quite advanced. He has been encouraged to take anti-TNF drug. He is convinced that the side effects of the drug outweigh any benefit. He clearly has active disease and is only taking Celebrex 100 mg BD, Tramadol or Dihydrocodeine PRN and Omeprazole. He is not working at present because of his arthritis. He does not drink much and smoke very rarely. His BASDAI was 9. His pain visual Analogue Scale, VAS was 9.

On examination, he had no movement of his lumber spine. He had marked decreased movement of his thoracic and cervical spine and very reduced shoulder movement. He also has very irritable hips. The results of some Radiology that he has had included an MRI scan of his right shoulder showing erosive arthropathy affecting the acromioclavicular joint and marked arthropathy in right glenohumeral joint with erosive change. He has got ankylosis of the sacroliac joints and minimal degenerative change in both hips. An MRI scan of his lumber spine performed about a year ago showed marked irregularity of the end plates with associated oedema suggesting some inflammatory change.

I have requested x-rays of his chest, lumber spine, sacroiliac joints and hips today and a blood test to ascertain his inflammatory markers and he would certainly qualify for TNF alpha-blocking drug. I understand he has been screened for TB exposure. He would obviously need to have this repeated here before proceeding to a TNF alpha-blocker and would have to be reviewed in three months with repeat disease activity scores performed at this time. I have tried to convince him that the risk of having untreated ankylosing spondylitis includes experiencing increasing disability and deformity and over the years there is also the associated risk of extra-articular manifestations of disease such as aortic regurgitation and drug fibrosis, not to mention the risk of kidney failure due to secondary amyloidosis. The risks of TNF alpha-blockers which have been in clinical use for more than 15 years are relatively minimal. There is no link with cancer which he is worried about. There is a small risk of serious infection and he is also concerned about this. I will see him again at my next available clinic appointment.

Unfortunately, I feel that if he does not want to be treated with the TNF alpha-blocking drug, there is very little more that I can offer him as a Rheumatologist. We will discuss this further when he comes to see me again.
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5. Ultrasound Right Shoulder - 2012.

Report:  Irregular calcification is noted in the region of a markedly  degenerate acromioclavicular joint and adjacent to the lateral acromion. Distal acoustic shadowing makes it difficult to access the underlying bony cortex. An MRI examination is being arranged to evaluate more fully.
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6. MRI Right Shoulder - 2012

The history of ankylosing spondylitis is noted. There is evidence of a marked arthropathy in the right shoulder. A joint effusion is present and extensive synovial thickening is noted throughout the joint in addition to widespread erosive change (most pronounced in the humeral head, adjacent to the insertion of the supraspinatus tendon)
There is also evidence of an erosive arthropy affecting the acromioclavicular joint and there are super-added degenerative changes in the joint with some marked bony prominence superiorly and a probable loose body adjacent to the superior aspect of the lateral clavicale.
The rotator cuff tendons appear somewhat thinned distally but remain in tact. The biceps tendon is normal in appearance but there is an effusion in the biceps tendon sheath and synovial thickening within the tendon sheath. No other features note.
------------------------------------------------------------------------------------------------------------------- 7. Right Knee X-Ray - 2013.

Report: There is an old healed fracture of the lateral tibial plateau which appears to extend into the tibial tuberosity. There is soft tissue swelling over the tibial tuberosity. There is chondrocalcinosis within the right knee.

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8. Left Hip Ultra Sound Scan  - 2016

Report: There severe insertional gluteous minimus and medius tendinopathy and paratendinitis associated with linear mature calcification within the distal tendons.
I note that the prior plain x-rays of the pelvis, the appearances are suggestive of widespread enthesitis around the pelvis and there is minor symmeetrical loss of joint space at the hips bilaterally.
The appearances raise the possibility of an underlying seronegative arthropathy - clinical correlation advised.

As requested, following informed verbal consent, 40 mg triamcinolone together with 0.25% Marcaine and 3 ml 1% lidocaine was injected into the left trochanteric bursa under ultrasound guidance. 2 ml 1% lidocaine to the tract. There were no immediate complications. Clear aftercare instructions were given to the patient.
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9. Sent From Orthopaedic Consultant - 2016.

I reviewed this patient today in clinic for problems 1 Bilateral Hip Pain. 2. Ankylosing Spondylitis: Plan: Review in 6 months, consider for hip injections.

Since we last saw this patient for his hip problems, the left side was more symptomatic than the right. As expected, he went on to have a hip injection and tells me that did give him some relief but, at this point, the symptoms are on the left side, but now his symptoms have returned and he is complaining of severe left hip pain. A referral letter says his right hip is more symptomatic. Patient is very clear that his left hip is more symptomatic than the right.

Clinically, there is reasonable range of movement in the right side with full flexion and up to 90 to 110° flexion and full rotation of movement with some discomfort. Left side hip flexion is up to 90° and there is some irritation, especially on external rotation of the hip joint.

At this point, the patient is under very self-directed exercises and has a positive outlook about things as he feels he can heal himself with a positive mental attitude and exercises. He is not sure whether his hip problems are due to worsening problem or the fact that the side effects of the initial steroid injections have worn out and he would like to hold off and see whether this is the case.

The last examination, and letter I received is posted at the testimonials.
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http://theonlywayproductions.blogspot.co.uk/

1. Introduction. Reversing My Ankylosing Spondylitis, Arthritis & Other Joint Symptoms.

2. Story / History & All Symptoms. How long I have been suffering for. How it changed my life for the worse, and why I made the decision to fight back.

3. Medical Reports, and results of my X-rays, Ultra sound and MRI scans. 

4. The First Year - Beginning Of Exercise Routine - Painful, Progressive & Positive.

4A Detailed Training Program. Dozens of exercise routines, thousands of repetitions for hours each day, and the best places to do them for maximum results.

5. Nutrition Information. Diet and important supplementary products I now take daily. 

6. Testimonials from medical professionals who knew how much pain and stiffness I was in.

7. One Year On. How I am winning my fight against Ankylosing Spondylitis.

http://theonlywayproductions.blogspot.co.uk/


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