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My animals were being cute. 

Happy holidays to you and yours.

Routine Ultrasound Monitoring of Parotid Glands for Sjogren's Patients

Sjogren's Syndrome slowly destroys parotid glands, as an autoimmune reaction scars the delicate pathways that deliver saliva to the month. Over time, this process can create blockages/lumps that flare up and are quite painful. And sometimes, this process can lead to the development of a special kind of cancer called MALT lymphoma. 

To date, there have been few ways to either monitor the parotids for cancerous changes or prevent the cancer altogether. The gold standard is a fine needle aspiration/biopsy of any troubling areas in the parotids (as identified by an MRI and/or a doctor's physical exam). Pathologists examine the removed tissue to determine if any cancer cells are present. But let's face it, who wants to have needles stuck into multiple parts of their face more than once in a blue moon? Not I. Regular MRIs of the parotid glands have also been used to monitor the parotids for the development of cancer cells. But they are expensive, time-consuming, and uncomfortable (I had one done a year ago, and had to wear a claustrophobic head cage to hold my head still during the scan). Another option is to remove the parotid gland altogether, but this is radical - it can lead to nerve damage in the face, and the surgery might not even work, because it is very tricky to remove every last bit of the parotid glands. 

Recently, an ENT suggested that ultrasound might be a less expensive, less invasive way to monitor my parotid glands on a regular basis. I will certainly need a fine needle biopsy of my parotids up front (I have some serious lumps and bumps), but after that, routine ultrasound might be a good way to monitor my glands without going overboard. It allows you to keep an eye on things without needles or head cages. Using ultrasound in this manner is a relatively  new technique, and I've had challenges finding an ENT office that can do it. I finally found the JHU Head and Neck Surgery team at Greater Baltimore Medical Center, and they apparently offer the service. (I called to confirm today.) My appointment is later this month - I can't wait to see if ultrasound will really work in my situation. If you are looking for this kind of service in your area, try looking for head and neck surgeons - they seem best equipped to understand Sjogren's parotid issues and identify cancers when they develop.

Is Anterior Cervical Discectomy with Fusion (ACDF) Safe and Effective?

I received a comment from Carol recently that's worth addressing as its own post:
How successful are these surgeries (ACDFs) in relieving pain and maintaining function? 

The answer lies in research studies, which your surgeons should be familiar with and able to explain to you. As far as I can tell, the effectiveness of ACDF varies depending on the exact nature of your problem - is it stenosis? Kyphosis? Radiculopathy (nerve compression)? Myelopathy (cord compression)? Do you have ruptured discs? Osteophytes? Is the problem the result of a sudden injury, progressive wear and tear, or something like inflammatory arthritis? These key words help tell your physician whether an ACDF is a good idea. In general, it seems that ACDF is always a good idea when something is compressing the spinal cord... remove the something, and pain levels improve. The picture gets more complicated when there is a general diagnosis of disc degeneration. 

So, the basic answer is to ask your doctor to explain to you the exact nature of your problem and how ACDF will resolve it. Ask about pain improvements, too. I've heard (but can't find statistics to verify) that ACDF often reduces pain, but does not eliminate it altogether. 

Also ask about whether hardware will be used, and what kind. Sometimes, small (typically one-level) ACDFs can be done without surgical hardware being inserted. 

And don't forget to ask about postoperative treatments to enhance pain relief and/or encourage a strong spinal fusion. What kind of pain medications may you require, for how long? When can you start physical therapy, and how much may be necessary? Will the doctor provide you with a Cervical-Stim or something like it to encourage your spine to fuse? 

My Two Cents 

ACDFs are often considered "major surgery" (meaning, not something you want to do unless necessary). Long-term problems with swallowing and speaking may sometimes occur after ACDFs. And recovery times can vary wildly - someone may have a two-level ACDF and be 100% well after 3 weeks of recovery; someone else may have a similar operation and be bedridden for months or forever. 

My two surgeries have helped me a lot - before my first, C5 to C7 ACDF, I had tons of arm pain and numb fingertips, and I dropped things all the time. Within a few hours following surgery, my grip strength and sensation were back and my arm pain was gone. In about a month, I felt well and recovered, and did not require long-term pain relief. 

My second, C2 to T1 ACDF/PCDF surgery has been a much longer, tougher thing to recover from. I did notice immediate improvement in grip strength and finger sensation, but arm pain and neck and shoulder pain took nearly two years to taper off. I still have pain sometimes, but I am 100% off of pain medications and able to exercise regularly (with care). And I was in so much pain before the surgery (from terrible neck/shoulder muscle spasms) that I had to have the ACDF/PCDF. There was no other solution. I had been through physical therapy, taken every possible pain medication and muscle relaxer out there, and still was unable to do more than get out of bed, shower, and collapse on the couch for the day. I was so limited by pain that I laid in bed until I got a bedsore. It didn't help that my overall health and fitness had deteriorated before my combo surgery. Surgery is hard on anyone, and especially hard on people who have other health problems and/or are out of shape.

Additional Resources

I considered linking this post to various studies that reviewed the effectiveness of ACDF surgeries. But then I realized that wasn't the greatest idea. I'm not a doctor, you are probably not a doctor, and doctors are the only ones who really understand the unique set of circumstances in which an ACDF is desirable and appropriate. So, for additional information:

1. Ask your doctor. Repeatedly, if necessary, until you understand exactly what he or she is saying about your unique circumstances. 

2. Ask other patients. Spine-Health.com has extensive forums where people describe and discuss their spine surgeries and spine problems. SteadyHealth.com does also. 

3. Network to find real, live patients and discuss the surgery and recovery with them. I was surprised to find my neighbor three doors down was having spinal fusion surgery a few months after I did. He and I sat around in our cervical collars post-op and had a good time griping and sharing tips. You may find that your friend's boss or cousin's girlfriend, etc. may have had spinal surgery and be willing to discuss it with you. You may also find that people in your surgeon's waiting room are more than willing to discuss their surgeries. You can enjoy an impromptu support group while you wait for your next appointment.

And no matter what, make sure you understand exactly what will be done and why it is necessary before you sign up. ACDF can be wonderful, if done for the right reasons and with the right expectations.