Talk Cancer

Question:

My message was returned saying I had already sent it (which I hadn’t) so here it is again.  I apologize in advance if you received it twice. Hi!  I was just given my pre-diagnosis of MS last night after softball practice.  My doctor had left a message on my phone that he had the results of my MRI that I had taken for migraines.  Well, no tumor, but the radiologist thought I had MS.  So, I called my doctor and he gave me the news.  At first I was sad about it (which lasted about 20 seconds), and then I thought about how healthy I am – I’m not sick at all – but suddenly I have this dreadful disease.  I then went and got on the PC to find out what I could about the disease.  You can say I am in denial, because I think maybe the radiologist was wrong; and that I feel I won’t go through the depression because I am such an upbeat person – so it can’t happen to me.  But most of all, I feel like this:  at least if I got something, it’s not cancer. According to what I read, my life expectancy is cut by six years (thereabouts) – so that means I will only live to 94, not 100!  Today I looked up and printed tons of more info, and found your email list and thought I should join it and get info from "veterans" of the disease. I have my first appointment with a neurologist on April 19th.  My question to you all is this:  Does everyone get a spinal tap?  I had one once around 1985, and it is something I swore I would never go through again.  If I have to I will of course, but I hope if I have to have a spinal tap, that I only have to have it once.  Twice in a lifetime is certainly enough for one person. Tina Marie Lamb

Response:

Hello Tina, My Neurologist didn’t wan’t to do a CSF analysis until I suggested it. He said he didn’t want to because it was invasive. Although with my brain MRI showing several lesions it turned that the CSF testing wasn’t needed. (My original question was about a Myelogram.) But the tap itself is the same. Welcome to the group here. This list has been something of a "silver lining" to me. I hope you find the same. Jon ""Lamb, Tina"" <la…@HURCO.COM> wrote in message

news:C13341A2FCC9D311AC7800508B67064A246130@hurco_cse… – Hide quoted text — Show quoted text -> My message was returned saying I had already sent it (which I hadn’t) so > here it is again.  I apologize in advance if you received it twice. > Hi!  I was just given my pre-diagnosis of MS last night after softball > practice.  My doctor had left a message on my phone that he had the results > of my MRI that I had taken for migraines.  Well, no tumor, but the > radiologist thought I had MS.  So, I called my doctor and he gave me the > news.  At first I was sad about it (which lasted about 20 seconds), and then > I thought about how healthy I am – I’m not sick at all – but suddenly I have > this dreadful disease.  I then went and got on the PC to find out what I > could about the disease.  You can say I am in denial, because I think maybe > the radiologist was wrong; and that I feel I won’t go through the depression > because I am such an upbeat person – so it can’t happen to me.  But most of > all, I feel like this:  at least if I got something, it’s not cancer. > According to what I read, my life expectancy is cut by six years > (thereabouts) – so that means I will only live to 94, not 100!  Today I > looked up and printed tons of more info, and found your email list and > thought I should join it and get info from "veterans" of the disease. > I have my first appointment with a neurologist on April 19th.  My question > to you all is this:  Does everyone get a spinal tap?  I had one once around > 1985, and it is something I swore I would never go through again.  If I have > to I will of course, but I hope if I have to have a spinal tap, that I only > have to have it once.  Twice in a lifetime is certainly enough for one > person. > Tina Marie Lamb

Response:

Hi Tina, Welcome to the group. Your positive attitude will help you but be prepared for a few months coming to terms with the idea. My take on spinal taps is that they aren’t worth it. Between 5% and 10% of people with definite MS do not have positive IgG oligoclonal banding (one of the things the test results gives) nor Myelin Basic Protein in the cerebrospinal fluid (CSF – the stuff got out from the tap) nor any other indicators in their CSF. A whole load of other conditions also show positive IgG bands in the electrophoresis as well. Basically if you’re positive for the test it doesn’t mean that you have MS and if you’re negative it doesn’t mean that you don’t. I can’t find any studies where anyone has looked at the effects on MS of sticking a metal tube through your meninges. This MS thing is an autoimmune disease, it strikes me that the last thing you want to be doing is puncturing the shield between the brain and the rest of your body, or in this case the rest of the world. On top of that, in a small number of cases spinal taps can cause irreversible damage and can be fatal, particularly with people running high CSF pressures. Even the normal side-effects, up to a week lying in bed with a monster headache, are bad enough. And it is only done to support a diagnosis that is already made. People forget all the time that MS is primarily a clinical diagnosis and all the high tech tests merely support the clinical evidence. Of all this high tech stuff, MRI is far far far and away the most useful. Now if spinal taps were a treatment or even a precursor to a treatment, then I’d think again, but they are not. They should be removed from the arsenal of MS testing except in special cases. I think too many neuros just do them because that’s how they learned MD diagnosis. Just my 2-bits. Take care, Paul http://www.btinternet.com/~ms_pages/ – Hide quoted text — Show quoted text -"Lamb, Tina" wrote: > My message was returned saying I had already sent it (which I hadn’t) so > here it is again.  I apologize in advance if you received it twice. > Hi!  I was just given my pre-diagnosis of MS last night after softball > practice.  My doctor had left a message on my phone that he had the results > of my MRI that I had taken for migraines.  Well, no tumor, but the > radiologist thought I had MS.  So, I called my doctor and he gave me the > news.  At first I was sad about it (which lasted about 20 seconds), and then > I thought about how healthy I am – I’m not sick at all – but suddenly I have > this dreadful disease.  I then went and got on the PC to find out what I > could about the disease.  You can say I am in denial, because I think maybe > the radiologist was wrong; and that I feel I won’t go through the depression > because I am such an upbeat person – so it can’t happen to me.  But most of > all, I feel like this:  at least if I got something, it’s not cancer. > According to what I read, my life expectancy is cut by six years > (thereabouts) – so that means I will only live to 94, not 100!  Today I > looked up and printed tons of more info, and found your email list and > thought I should join it and get info from "veterans" of the disease. > I have my first appointment with a neurologist on April 19th.  My question > to you all is this:  Does everyone get a spinal tap?  I had one once around > 1985, and it is something I swore I would never go through again.  If I have > to I will of course, but I hope if I have to have a spinal tap, that I only > have to have it once.  Twice in a lifetime is certainly enough for one > person. > Tina Marie Lamb

Response:

Paul, I agree with all the data he cites, but disagree most strongly on his message that spinal taps should be routinely given. He doesn’t know, nor does anyone, it seems to me, what the effects of the spinal tap are. Some risks are known (http://netwellness.org/std/top/003428.htm): "What the risks are:      Risks of lumbar puncture include:      *     hypersensitivity (allergic) reaction to the anesthetic      *     discomfort during the test      *     headache after the test      *     bleeding into the spinal canal      *     brain herniation (if performed on a person with increased intracranial pressure), and resulting in brain damage and/or death      *     damage to the spinal cord (particularly if the person moves during the test)      *     Cisternal puncture or ventricular puncture carry additional risk of damage to the brainstem or brain tissue and risk of bleeding within the brain; resulting in incapacitation or death." Read those again. "bleeding into the spinal canal", "damage to spinal cord", "brain herniation", "brain damage", "death". And these are just the severe known ones. Mild symptoms include severe vomiting and headaches for up to a week is not fun. This is neurosurgery for heavens sake. This is a dangerous procedure with severe known and possibly unknown risks. And it is only diagnostic and not very hot at that. I got a definite dx even though I refused a spinal tap. I know many other people have as well. Neurologists should leave well clear until someone has done some proper double blind studies on their effects like they do with drugs. Trouble is, of course, who would volunteer for a double blind study where they is no possibility of ameliorating their MS. Cheers, Paul http://www.btinternet.com/~ms_pages/ – Hide quoted text — Show quoted text -Chanteline wrote: > >From: la…@HURCO.COM  ("Lamb, Tina") > >Does everyone get a spinal tap?  I had one once around > >1985, and it is something I swore I would never go through again.  If I have > >to I will of course, but I hope if I have to have a spinal tap, that I only > >have to have it once.  Twice in a lifetime is certainly enough for one > >person. > Keep Lumbar Puncture on Tap When You Suspect MS > [Dr. David Squillacote, Senior Medical Advisor, Multiple Sclerosis Foundation > (MSF)] > Under what circumstances is lumbar puncture indicated in a patient with > multiple sclerosis? > Lumbar puncture should certainly be done in all patients in whom Clinically > Definite (CDMS) or Laboratory-Definite MS (LDMS) cannot be diagnosed on the > basis of the history, neurologic examination, and MRI. > In many patients, possible MS is diagnosed on the basis of the clinical > presentation and negative MRI scans. Since the MRI scan of the brain may be > negative in 5% of patients with early MS (and may remain so for several years > in some cases, despite microscopic demyelinating changes in the white matter), > using all available diagnostic modalities to detect MS is important. It is > surprising how many of these patients have not had a lumbar puncture to help > clarify the diagnosis. In such patients, the lumbar puncture and MRI should be > seen as complementary, not competitive, paraclinical examinations. > Lumbar puncture findings in MS include a normal opening cerebrospinal fluid > (CSF) pressure, fewer than 20 mononuclear cells, a normal or slightly elevated > protein level, a negative CSF VDRL test, and negative tests for bacteria and > fungi. These findings rule out many infections that can mimic acute MS. > The myelin basic protein level is elevated during acute exacerbations of MS. > Oligoclonal bands (OCBs) are found in 83% to 95% of patients in whom definite > MS is eventually diagnosed. > OCBs are also seen in 25% to 50% of patients with other inflammatory diseases > of the > nervous system, including viral, bacterial, and fungal infections and CNS > vasculitis. In addition, they can be found in patients with cancers of the > nervous system, CNS syphilis, other demyelinating diseases, and some parasitic > diseases. OCBs generally disappear in patients who are recovering from brain > infections, but the unique pattern seen in MS patients does not change over > time. It is important to perform simultaneous measurement of OCBs in the blood. > The CSF IgG index gives invaluable information about abnormal immunoglobulin > synthesis in the brain. An abnormal index can be found in about 90% of patients > with MS, but it is not disease specific and may also occur in more than 50% of > patients with inflammatory and infectious disease of the CSF. > Many patients refuse a lumbar puncture because of fear of paralysis or severe > head-aches or other unjustified fears. Patient education materials, such as the > accompanying guide to lumbar puncture, may help allay such fears. > Often, the more convenient MRI scan is performed instead of the lumbar > puncture. While MRI has become the most commonly used surrogate marker for MS, > it is neither 100% sensitive nor 100% specific. The lumbar puncture remains a > simple examination that yields valuable information. Together, a negative MRI > scan of the brain with contrast, a negative lumbar puncture with OCB and CSF > index, and a negative evoked potentials study form a very powerful argument > against a diagnosis of MS. >  16 > Spinal Tap (Lumbar Puncture) Preparation and Restrictions: > A Guide for Patients > A spinal tap is usually a very safe procedure. It is easier in persons who are > not obese, but a skilled neurologist should be able to insert the needle on the > first pass or in several passes in most patients. The spinal tap is not > normally a painful procedure. There is about 15 seconds of mild burning as the > skin anesthetic sets in. Most neurologists also inject some anesthetic over the > spinal bones, between which the needle will pass. If the covering of the bone > is hit as the needle enters, some pain will be felt. Finally (and rarely) the > needle may touch a nerve root floating normally in the spinal fluid. This will > give an electric pain into the legs, which stops as soon as the needle is > moved. There is no pain as the fluid is withdrawn. > Avoid aspirin and nonsteroidal anti-inflammatory drugs like ibuprofen (Motrin, > Advil) for a couple days before the procedure unless your doctor advises you to > take them. They inhibit blood clotting. > Eat lightly on the morning of the procedure. Be sure to drink plenty of fluids > to keep yourself well hydrated. > Ask your neurologist to use a 21-gauge (pediatric) spinal tap needle if one is > available. Otherwise, the 20-gauge needle is fine. > There is no way to predict who will have a headache after the spinal tap. > However, the fear is worse than the actuality: most patients do not have > headaches after a spinal tap. They are slightly more common in thin females for > some unknown reason. > Ask your doctor in advance what to use to treat a headache, in case you get > one. > Lie down on the back seat of the car during the ride home. Do not drive > yourself home. > Most headaches that occur after the spinal tap are relieved by rest and > disappear after 24 hours. Avoid all exertion greater than walking to the > bathroom in the first 24 hours after the spinal tap. Drink plenty of fluids. > A few patients have headaches with repeated vomiting after a spinal tap. If you > have such a headache, ask your doctor to arrange as soon as possible > (preferably within 24 hours) to have an anesthesiologist perform a "blood > patch." In this situation, the very small hole produced by the spinal tap has > not closed up and the spinal fluid persistently leaks. This causes very bad > headaches sometimes with severe vomiting. The anesthesiologist will take some > blood from your arm and inject it over the spinal tap site. The blood will > clot, sealing the leak, and the headache should instantly go away. >                                          -17- > 1999 – Multiple Sclerosis Foundation., Inc.

Response:

>Paul Jones Paul_Jo…@btinternet.com writes: >Paul, >I agree with all the data he cites, but disagree most strongly on his message >that >spinal taps should be routinely given. He doesn’t know, nor does anyone, it >seems >to me, what the effects of the spinal tap are. >Some risks are known

   <snip snip> OMG, I’m sure glad I didn’t know all this before my lumbar puncture (only because mine went OK).   Of course, the doctors didn’t tell me.   All I heard was "don’t move" while the needle was going in. Mine was done in a lab with a fluoroscope to show that the needle was going to the right spot, but many of these are done in ER with *nothing to guide the needle.   Those are just stick and hunt!!! I’ll never allow another one unless it is a matter of life or death.   Thanks for the info that the doctors don’t tell us. Take care, Paul. Conni

Response:

> This MS thing is an autoimmune > disease,… > Just my 2-bits.

Remember the caveat not necessarily the premise. MS is THEORIZED to be an autoimmune disorder. That is not yet proven.

Response:

An excellent bit of scientific thought. Is there any data that doesn’t fit the auto-immune model? >>>>>>>>>>>>>>>>>> Original Message <<<<<<<<<<<<<<<<<<

On 3/31/00, 6:25:10 PM, Paul Flavell <flav…@sfsu.edu> wrote regarding Re: does everyone get a spinal tap?: – Hide quoted text — Show quoted text -> > This MS thing is an autoimmune > > disease,… > > Just my 2-bits. > Remember the caveat not necessarily the premise. MS is THEORIZED to be an > autoimmune disorder. That is not yet proven.

Response:

Paul Flavell wrote: > Remember the caveat not necessarily the premise. MS is THEORIZED to be an > autoimmune disorder. That is not yet proven.

Hi Paul, B****y Netscape just crashed and wiped out my reply to this so I’ll type it all in again. Yep, MS is not necessarily autoimmune, but this is not the central tennet of my argument. Whatever the aetiology of MS is, it doesn’t affect the risk/reward equation of spinal taps, and, IMO, it is heavily weighted to the risk side. MS might not be autoimmune, but the evidence is fairly strong. It is almost beyond doubt that cell-mediated acquired immunity is involved in the destruction of myelin, though whether the trigger for this is autoimmune or not, is far from clear. It clear, however, that T-cells that are auto-active to myelin are present in the CSF of PwMS. This doesn’t necessarily imply autoimmunity and there is evidence that, under the right conditions, everybody’s acquired immune system can be persuaded to attack MBP. But what are these cells doing there and why are they so frequently found at the site of active lesions? Remember that T-cells are monoclonal for specific antigens and these are specific for the proteins in myelin. It is true that HHV-6 antibody titers are frequently found in the CSF of PwMS but not so very often at the site of active lesions (though they have been). Of course, it is possible that the immune system has put paid to the HHV-6 by the time the pathologist gets to work but it is also possible that the HHV-6 is an opportunist invader of a damaged CNS and, as far as the demyelination goes, is innocent. If it is true that the auto-MBP T-cells are there to destroy the HHV-6 then why are they so unspecific? Why specifically go for MBP when it is not the enemy? Malfunction? What is autoimmunity anyway? Are any autoimmune diseases autoimmune? Perhaps an auto-response to a particular self-protein can zap an enemy that also goes for that same protein and is therefore somehow reinforced. Of course, this is just a run of "just so stories" and we must wait and see. Let’s hope the waiting is not too long. Cheers, Paul http://www.btinternet.com/~ms_pages/

Response:

Tina: I haven’t read the other responses yet but I was diagnosed in ‘91 WITHOUT a spinal tap — I was diagnosed with the MRI and my history.  3 years ago when I was in the hospital a new intern there wanted to do a spinal on me and I said "NO WAY"  I was diagnosed 6 years ago, why on earth do you want to do a spinal….  I called my neuro and said "no way" and he agreed that it was uncessary…. Anyway, keep up the good outlook and attitude.  I have never been in denial yet I have always refused to believe I’d let this thing "get" the best of me.  I was dx’d 9 years ago and each attack still scares the hell out of me like is this going to be the one, etc., but then I get through it and life goes on. I’ve made some modifications in my life and my husband andd I have made plans for "what ifs" but we have not let MS get a hold too deeply on us yet… Take care and good luck!  Jackie

Response:

Me too.  I was diagnosed in 1990 without a spinal tap….but then again, the MRI was so wickedly positive that they didn’t wanna waste my time! "JKS127" <jks…@aol.com> wrote in message

news:20000401173753.05425.00000532@ng-fj1.aol.com… – Hide quoted text — Show quoted text -> Tina: > I haven’t read the other responses yet but I was diagnosed in ‘91 WITHOUT a > spinal tap — I was diagnosed with the MRI and my history.  3 years ago when I > was in the hospital a new intern there wanted to do a spinal on me and I said > "NO WAY"  I was diagnosed 6 years ago, why on earth do you want to do a > spinal….  I called my neuro and said "no way" and he agreed that it was > uncessary…. > Anyway, keep up the good outlook and attitude.  I have never been in denial yet > I have always refused to believe I’d let this thing "get" the best of me. I > was dx’d 9 years ago and each attack still scares the hell out of me like is > this going to be the one, etc., but then I get through it and life goes on. > I’ve made some modifications in my life and my husband andd I have made plans > for "what ifs" but we have not let MS get a hold too deeply on us yet… > Take care and good luck!  Jackie

Response:

>"jos croeze" j.c.cro…@hccnet.nl writes:

   <snip snip> >Welcome to the group just as I welcome myself >hereby. >Pleasant greetings, Jos Croeze >j.c.cro…@hccnet.nl

Jos I welcome you, too.   And you, too, Tina, if I failed to welcome you earlier.   Please stay around and comment anytime you want. I wish you didn’t have to be here for the obvious reason, but I am glad you found us and hope you stay.   ) Conni

Response:

No. I fired my neuro when he wanted to give me a tap after he had already diagnosed my MS with an MRI. – Hide quoted text — Show quoted text -"Lamb, Tina" wrote: > My message was returned saying I had already sent it (which I hadn’t) so > here it is again.  I apologize in advance if you received it twice. > Hi!  I was just given my pre-diagnosis of MS last night after softball > practice.  My doctor had left a message on my phone that he had the results > of my MRI that I had taken for migraines.  Well, no tumor, but the > radiologist thought I had MS.  So, I called my doctor and he gave me the > news.  At first I was sad about it (which lasted about 20 seconds), and then > I thought about how healthy I am – I’m not sick at all – but suddenly I have > this dreadful disease.  I then went and got on the PC to find out what I > could about the disease.  You can say I am in denial, because I think maybe > the radiologist was wrong; and that I feel I won’t go through the depression > because I am such an upbeat person – so it can’t happen to me.  But most of > all, I feel like this:  at least if I got something, it’s not cancer. > According to what I read, my life expectancy is cut by six years > (thereabouts) – so that means I will only live to 94, not 100!  Today I > looked up and printed tons of more info, and found your email list and > thought I should join it and get info from "veterans" of the disease. > I have my first appointment with a neurologist on April 19th.  My question > to you all is this:  Does everyone get a spinal tap?  I had one once around > 1985, and it is something I swore I would never go through again.  If I have > to I will of course, but I hope if I have to have a spinal tap, that I only > have to have it once.  Twice in a lifetime is certainly enough for one > person. > Tina Marie Lamb

Response:

Hello Tina, "Lamb, Tina" wrote in mail > I have my first appointment with a neurologist on April 19th.  My question > to you all is this:  Does everyone get a spinal tap?  I had one once > around 1985, and it is something I swore I would never go through again. >  If I have to I will of course, but I hope if I have to have a spinal tap, > that I only have to have it once.  Twice in a lifetime is certainly enough > for one person.

I had to do a spinal tap and evoked potentials in July ‘94, because those were much less expensive than MRI. Both didn’t indicate anything, till the MRI showed several percussions. I was dxd in January ‘95 because symptoms held on for half a year. AFAICS it isn’t very useful. Welcome to the group just as I welcome myself hereby. Pleasant greetings, Jos Croeze j.c.cro…@hccnet.nl

Response:

"CarniGurl" <carnig…@aol.com> wrote in message

news:20000331181809.20214.00000256@ng-fz1.aol.com… – Hide quoted text — Show quoted text -> OMG, I’m sure glad I didn’t know all this before my lumbar puncture (only > because mine went OK).   Of course, the doctors didn’t tell me.   All I heard > was "don’t move" while the needle was going in. > Mine was done in a lab with a fluoroscope to show that the needle was going to > the right spot, but many of these are done in ER with *nothing to guide the > needle.   Those are just stick and hunt!!! > I’ll never allow another one unless it is a matter of life or death. Thanks > for the info that the doctors don’t tell us. > Take care, Paul. > Conni

Hi, Conni. My spinal tap was "stick and hunt". The doc stuck me in the nerve that goes down the left leg. It felt like a "buzzing jolt" down the length of my leg. Before I could even say "WRONG!!" he backed the needle out. After the tap I told the doc I was no fool. When the novacaine wears off, that left leg is going to hurt like hell, isn’t it? He just kinda mumbled "Sorry." Copious amounts of Tylenol got me through it. Other than wanting my left leg amputated, the tap was a piece of cake.  :/ Karen

Response:

actually, i theorize we are all inhabited my little alien beings that eat myelin to survive.  We are the "chosen" ones so to speak.  Really….i saw it on x files : ) Yours in abduction JD Paul Flavell <flav…@sfsu.edu> wrote in message

news:Pine.GSO.3.96.1000331152233.4975A-100000@apollo.sfsu.edu… – Hide quoted text — Show quoted text -> > This MS thing is an autoimmune > > disease,… > > Just my 2-bits. > Remember the caveat not necessarily the premise. MS is THEORIZED to be an > autoimmune disorder. That is not yet proven.

Response:

>I have my first appointment with a neurologist on April 19th.  My question to

you all is this:  Does everyone get a spinal tap?  I had one once around 1985, and it is something I swore I would never go through again. No, I never have had one. I was dx in 96 with just my MRI and the symptoms I had at the time and had in the past but couldn’t get answers for.   Welcome to the group. Micky

Response:

>From: la…@HURCO.COM  ("Lamb, Tina") >Does everyone get a spinal tap?  I had one once around >1985, and it is something I swore I would never go through again.  If I have >to I will of course, but I hope if I have to have a spinal tap, that I only >have to have it once.  Twice in a lifetime is certainly enough for one >person.

Keep Lumbar Puncture on Tap When You Suspect MS [Dr. David Squillacote, Senior Medical Advisor, Multiple Sclerosis Foundation (MSF)] Under what circumstances is lumbar puncture indicated in a patient with multiple sclerosis? Lumbar puncture should certainly be done in all patients in whom Clinically Definite (CDMS) or Laboratory-Definite MS (LDMS) cannot be diagnosed on the basis of the history, neurologic examination, and MRI. In many patients, possible MS is diagnosed on the basis of the clinical presentation and negative MRI scans. Since the MRI scan of the brain may be negative in 5% of patients with early MS (and may remain so for several years in some cases, despite microscopic demyelinating changes in the white matter), using all available diagnostic modalities to detect MS is important. It is surprising how many of these patients have not had a lumbar puncture to help clarify the diagnosis. In such patients, the lumbar puncture and MRI should be seen as complementary, not competitive, paraclinical examinations. Lumbar puncture findings in MS include a normal opening cerebrospinal fluid (CSF) pressure, fewer than 20 mononuclear cells, a normal or slightly elevated protein level, a negative CSF VDRL test, and negative tests for bacteria and fungi. These findings rule out many infections that can mimic acute MS. The myelin basic protein level is elevated during acute exacerbations of MS. Oligoclonal bands (OCBs) are found in 83% to 95% of patients in whom definite MS is eventually diagnosed. OCBs are also seen in 25% to 50% of patients with other inflammatory diseases of the nervous system, including viral, bacterial, and fungal infections and CNS vasculitis. In addition, they can be found in patients with cancers of the nervous system, CNS syphilis, other demyelinating diseases, and some parasitic diseases. OCBs generally disappear in patients who are recovering from brain infections, but the unique pattern seen in MS patients does not change over time. It is important to perform simultaneous measurement of OCBs in the blood. The CSF IgG index gives invaluable information about abnormal immunoglobulin synthesis in the brain. An abnormal index can be found in about 90% of patients with MS, but it is not disease specific and may also occur in more than 50% of patients with inflammatory and infectious disease of the CSF. Many patients refuse a lumbar puncture because of fear of paralysis or severe head-aches or other unjustified fears. Patient education materials, such as the accompanying guide to lumbar puncture, may help allay such fears. Often, the more convenient MRI scan is performed instead of the lumbar puncture. While MRI has become the most commonly used surrogate marker for MS, it is neither 100% sensitive nor 100% specific. The lumbar puncture remains a simple examination that yields valuable information. Together, a negative MRI scan of the brain with contrast, a negative lumbar puncture with OCB and CSF index, and a negative evoked potentials study form a very powerful argument against a diagnosis of MS.  16 Spinal Tap (Lumbar Puncture) Preparation and Restrictions: A Guide for Patients A spinal tap is usually a very safe procedure. It is easier in persons who are not obese, but a skilled neurologist should be able to insert the needle on the first pass or in several passes in most patients. The spinal tap is not normally a painful procedure. There is about 15 seconds of mild burning as the skin anesthetic sets in. Most neurologists also inject some anesthetic over the spinal bones, between which the needle will pass. If the covering of the bone is hit as the needle enters, some pain will be felt. Finally (and rarely) the needle may touch a nerve root floating normally in the spinal fluid. This will give an electric pain into the legs, which stops as soon as the needle is moved. There is no pain as the fluid is withdrawn. Avoid aspirin and nonsteroidal anti-inflammatory drugs like ibuprofen (Motrin, Advil) for a couple days before the procedure unless your doctor advises you to take them. They inhibit blood clotting. Eat lightly on the morning of the procedure. Be sure to drink plenty of fluids to keep yourself well hydrated. Ask your neurologist to use a 21-gauge (pediatric) spinal tap needle if one is available. Otherwise, the 20-gauge needle is fine. There is no way to predict who will have a headache after the spinal tap. However, the fear is worse than the actuality: most patients do not have headaches after a spinal tap. They are slightly more common in thin females for some unknown reason. Ask your doctor in advance what to use to treat a headache, in case you get one. Lie down on the back seat of the car during the ride home. Do not drive yourself home. Most headaches that occur after the spinal tap are relieved by rest and disappear after 24 hours. Avoid all exertion greater than walking to the bathroom in the first 24 hours after the spinal tap. Drink plenty of fluids. A few patients have headaches with repeated vomiting after a spinal tap. If you have such a headache, ask your doctor to arrange as soon as possible (preferably within 24 hours) to have an anesthesiologist perform a "blood patch." In this situation, the very small hole produced by the spinal tap has not closed up and the spinal fluid persistently leaks. This causes very bad headaches sometimes with severe vomiting. The anesthesiologist will take some blood from your arm and inject it over the spinal tap site. The blood will clot, sealing the leak, and the headache should instantly go away.                                          -17- 1999 – Multiple Sclerosis Foundation., Inc.

Response: