VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Discussion of magnetic resonance imaging and magnetic resonance neurography

Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby A's Mommy » Mon Jan 24, 2011 5:02 pm

Ms Wise wrote: For me, the alaternative of going to see Dr. Hillis Potter, a radiologist, would mean that she would only be qualified to interpret the scan and not provide clinical diagnosis of a problem that would not come up on the scan and I also couldn't risk having contrast dye injected again owing to the anaphylactic reaction last year.


First off, just so you know, during my 3Tesla scan, the injection of contrast dye only provided mild enhancement, as stated by Potter's report. Sometimes, it does nothing. Just because you have an allergic reaction to the dye does not mean you have to rule out having a 3Tesla MRI. She will do them w/out the dye. Also, Dr. Potter stated to me that she interprets the scans, as is her job. She does not order the scans herself. She is a radiologist. Your ordering physician would be the one to provide a clinical diagnosis, primarily based on the symptoms, and then backed up by evidence found on the MRI, if they are taking that into consideration. I contacted her regarding the scar entrapment on the right side of my Alcock's canal, which is minor compared to what was found on the MRI on the left side, which Dr. Hibner then operated on. She commented to me that "the basis for surgery should be on clinical symptoms, not on MRI results." I tend to agree.

The best surgeon to evaluate a peripheral nerve problem is 1. A Neurosurgeon; 2. A Plastic Surgeon and 3. an Orthopaedic Surgeon depending on their specialty and geographical location/ experience.


In general, one would think a neurosurgeon would be the best person to evaluate a peripheral nerve problem. But we are not talking about the "usual" peripheral nerves here. We are talking about the pudendal nerve, a nerve that hardly any neurosurgeons care to think about or base their practices on. Please don't discount Dr. Hibner or Dr. Antolak's knowledge of the pudendal nerve. They are, a gynecologist and urologist, respectively, but have devoted time, education, and practice to their study of the pudendal nerve. I may be leaving out another doctor or two as well who aren't neurosurgeons. I do believe, and correct me if I am wrong, that Dr. Bautrant in Aix is a gynecologist as well.

I am not belonging to Dr. Filler's office at all nor am I asscoiated with Dr. Filler, other than I saw him for my problem. Yes he is expensive but when I enquired re my problem with a plastic surgeon, his prices were comparable.... On my visit to Dr. Filler, I had a little fall and ended up in the ER of Cedar Sinai for which the bill was in excess of €4,000. In the US you pay dearly for medical services. Also I understand that Dr. Hillis Potter charges $2,800 and I paid $3,000 for my MRN, so the costs are comparable and you have a Neurosurgeon evaluate your spine for other neurological problems. I just hate to see biased and uneven analysis of Doctors when the comparison is not the same. Insurance coverage would appear to be the issue with Dr. Filler's office... he has written extensively about this in his newsletters and in his book, "Do you really need back surgery", which I found excellent. My pain physician also praised it.


It depends on whether or not you hold credence to the 1.5 Tesla MRN and Dr. Potter's 3 Tesla MRI that she developed the software for. It is a personal opinion, and in my case, I am glad that I went and had Potter's scan. My MRI results were confirmed surgically by Dr. Hibner.



Good luck to you all as I have found myself to have been on a personal Odyssey the last 8 years and for which I feel that for every patient who gets help there are at least the same amount who don't because they may not have the energy or the health to research themselves or a Dr. who will listen to them and help them figure it out......

Ms. Wise


I hope you find the right direction to go in, Ms. Wise. I know how difficult it is to get a Dr. to pay attention to you and help you with confusing neuropathic pain. Best of luck to you and please keep us updated.

Sincerely,

AM
Daughter grew completely on left side of pelvis
Multiple uterine surgeries to fix uterine adhesions, septum, and endo
Had all the conservative workups done, 3Tesla (Potter), recovering from L sided TG (Hibner) 11/10, Botox 6/11 failed, bilateral anterior PNE decompression (distal Alcock's/perineal branch), Aszmann, Vienna, 10/11; dx'd with CRPS Type 2, 12/11, Ketamine @ CCF 2/12, doing 75% better PRAISE JESUS!
http://fighting-pne.blogspot.com
http://www.thepelvicmessenger.org
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby Charlie » Sun Mar 13, 2011 4:13 am

After consulting other Dr's I have to say I am very unsure about the MRN. Dr Filler appears to have an appalling reputation. The MRN certainly does not seem to be highly regarded. I have to say I am skeptical of both scans discussed. The general consensus seems to be on the MRN that it is a gimmick and not at all helpful for a diagnosis. There are certainly no independent studies that can prove the efficacy of the MRN. If it could really scan nerves so effectively why does n't every hospital have one?
Last edited by Charlie on Sat May 28, 2011 10:30 am, edited 1 time in total.
Tried numerous medications as well as a long period of myofascial physical therapy combined with meditation/relaxation. My pelvic floor muscles are now normal and relaxed on exam ( confirmed by many Pelvic floor PTs) yet my pain remains the same. Also have intense leg pain. Deciding on next treatment.
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby shawnmellis » Sat May 28, 2011 2:38 am

Hi Griff522
Hi, I saw you had a Dr. Potter MRI and they could not find anything and you were considering getting an MRN. I was wondering if you ever got a MRN? I am considering which one to get done now.
Thanks
Shawn
Bringing Help Awareness Education to Patients & Doctors about PNE through Videos at http://www.YouTube.com/PudendalNerve & PudendalHope.com Please tell Dr. Oz to cover topic of PNE by going to http://www.doctoroz.com/contact Started 1/2010. Initial urinary tract infection in 1/2010. Medication: Diazepam, Tramadol. 4 nerve blocks. physical reinjury 8/2010. 7/2011 Potter MRI Varices dorsal branch 8/23/11 Diagnosis Entrapment of Dorsal Branch Dr. Lee Dellon There's Always Hope!
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby Karyn » Sat May 28, 2011 1:16 pm

Hi Shawn,
Please find below Griffs MRI Report:


Griff522 MRI Results from Dr Potter
MRI Of the pelvis

MRI of the pelvis was performed utilizing coronal and oblique axial inversion recovery followed by coronal , sagittal, axial and oblique axial fast spin echo techniques. Clinical concern is bilateral pudendal nerve entrapment.

Per request, images were obtained from the sacrospinous ligaments through Alcock's canal to evaluate the dorsal nerves to the clitoris, bilaterally. The patient reports pain that is slightly worse on the right side.

The sacrospinous ligaments appear symmetric. Similarly the sacrotuberous ligaments appear unremarkable. No scar entrapment of the nerve is seen at this point. The pudendal nerves at the posterior margin of Alcock's canal appear unremarkable and there is no scar encasement of the branch of the pudendal nerves to the rectum. The coccyx is slightly deviated to the right as well as anteriorly.

At the far inferior margin of the pelvis, there is a linear scar in the anteroinferior margin of Alcock's canal and this is present bilaterally. This extends to the proximal margin of the dorsal nerves to the clitoris. The scar tethers from the perivaginal fat planes towards the anteroinferior margin of Alcock's canal.

Minimal prominence of the pericervical venous plexus is seen but there is no MR evidence of pelvic venous congestion syndrome. The obturator nerves appear unremarkable without scar encasement. The obturator intern us muscles appear symmetric.

There is some bilateral adductor tendinosis without acute tear. The genital branches of the genitofemoral nerves appear unremarkable and no scar encasement of the ilioinguinal nerves is seen. The hamstring origins are minimally degenerated but not acutely torn and there is no ischial bursitis.

Intrapelvically there is no adenopathy. Adnexal cysts are not individually enlarged by size criteria

Impression:

MRI of the pelvis demonstrates focal scarring at the anteroinferior margin of the pelvis, at the inferior aspect of Alcock's canal, tethering to the perivaginal fat planes and abutting the inferior margin of the pudendal nerves bilaterally, right slightly greater than left, as well as the proximal margin of the dorsal nerves to the clitoris. The pudendal nerves more posteriorly at the level of the sacrospinous and sacrotuberous ligaments are intact. There is minimal prominence of the pericervical venous plexus but no MR evidence of pelvic venous congestion syndrome. Coccyx is deviated but there is no direct impingement on the branch of the pudendal nerve to the rectum.
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby agent0 » Sun Jul 24, 2011 1:53 am

so what do you guys think what the better test is to take to see small peripheral dorsal nerves inside the penis, the mrn or the 3t mri?
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby HerMajesty » Thu Jul 28, 2011 7:08 pm

agent0, just based on my own personal observations on this board, Dr. Potter makes note of abnormalities in small peripheral nerves and i have not seen a Dr. Filler MRN report that goes into the same detail. I can't say Dr. Filler never finds that kind of thing, but I can say for sure that Dr. Potter does. Just on that subjective basis i would say do the 3T, although I am open to be contradicted.
pelvic pain started 1985 age 14 interstitial cystitis. Refused medical care from age 17, did GREAT with self care for years.
2004 PN started gradually, disabled by 2009. Underlying cause SIJD & Tarlov cysts
improved with PT & meds: neurontin, valium, nortriptyline, propanolol. (off nortriptyline & propanolol now, yay!)
Tarlov cyst surgery with Dr. Frank Feigenbaum March 20, 2012.
Results have been excellent so far; but I won't know my final functional level for a couple of years.
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby pn_person » Sat Jul 30, 2011 9:25 pm

Filler's report had significant detail.

Characterized the PN along its entire course from S3..at least in my report.

Also reported on vein dilation.

Can't speak to Potter's reports.
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby HerMajesty » Mon Aug 01, 2011 3:02 am

Filler's report had significant detail.

Characterized the PN along its entire course from S3..at least in my report.

Also reported on vein dilation.

Can't speak to Potter's reports.


My MRN report, which is attached earlier in this thread, was much spottier than most of the Potter reports I have read...I wonder if there is a competition factor causing more recent Filler reports to be more detailed (??) Not sure, just an idea. I got my MRN in the spring of 2010 pn_person, and I have seen much more "buzz" about Dr. Potter since that time which is why i wonder about the competition factor. When did you get your MRN done?
pelvic pain started 1985 age 14 interstitial cystitis. Refused medical care from age 17, did GREAT with self care for years.
2004 PN started gradually, disabled by 2009. Underlying cause SIJD & Tarlov cysts
improved with PT & meds: neurontin, valium, nortriptyline, propanolol. (off nortriptyline & propanolol now, yay!)
Tarlov cyst surgery with Dr. Frank Feigenbaum March 20, 2012.
Results have been excellent so far; but I won't know my final functional level for a couple of years.
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby pn_person » Mon Aug 01, 2011 3:21 am

done in NYC, but read by Filler in CA.
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Re: VERY INTERESTING - DR. FILLER'S OFFICE ON MRN VS. 3T

Postby sunshine » Tue Aug 16, 2011 9:33 pm

Hello!
I hope you are having a very good day! I have been suffering for over seven years from pain when sitting, standing and walking. My MRI, the most recent a 3T, did not show any scar tissue. This MRI, was not read correctly because the radiologist did not care to mention that my hamstring, piriformis, and obturator internus are 50% smaller than normal due to many botox injections I had had for pain. Also, many of my doctors think that I have scar tissue but it never showed on the MRI.

I am very excited to hear about Dr. Potter, as she seems to be truly extraordinary. If I only knew where the scar tissue is in my sciatic nerve, then I am sure I would get a lot better.

Should I make a appointment to see Dr. Potter to show her the 3T MRI I had? Or should I try to just get another RX for a brand new 3T with her and then see her? Do you know if she can/likes to re-read outside scans? I really don't want her to look at a bad scan and then discard the possibility of scar tissue simply because my scan is not good, or because it was not done using the proper setting (they didn't use dye on me for example). I really wish I had had it done with her from the start, but oh well, I didn't know about her until recently.

Any info would be so very much appreciated it!! I thank you for reading my post and for your reply!

Thanks :D
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