Dr Resnick was asked for a second opinion after my failed surgery by Dr Ali Baaj at Banner University Hospital, Phx, AZ. It seems Dr. Resnick and Dr. McCormick were at Milwaukee School of Medicine at the same time. Dr. Resnick has hesitation on another surgery and would rather wait until further symptoms arise . However he says if anyone were to do surgery on me he would recommend Dr. Paul C. McCormick in NY do it.
Below are his notes on consult with me. This was also before the 3D Fiesta MRI that showed the actual problem that the arachnoid web had regrown.
Health (Wisconsin), Access Community Health Centers (Madison), and Quartz Health
Solutions.
Progress Notes - Clinical Notes
Physician Daniel K Resnick at 10/28/22 0815
I spent 81 minutes with Mr. xxxxxx examining him, going over imaging studies, going over records and images, and counseling him regarding his thoracic arachnoid cyst. The dictation service is unavailable so this typed note will be a very poor proxy for our extensive conversation. In short he has had a very strange pain syndrome for years involving his thoracic and lumbar spine. He was found to have an arachnoid cyst centered at T5 and underwent surgery in Tucson in February, 2022. His symptoms recurred over the summer and f/u imaging in September revealed recurrent/residual cyst. He has seen several surgeons in the interim. Dr. Baaj in Tucson recommended waiting a bit longer and repeating MRI in February. He saw Dr. McCormick in NYC who recommended re-exploration and extension of the exploration to T4. He is here for my opinion as to whether or not surgery is a good idea. On examination, he has good strength in his lower extremities. Pinprick examination does reveal a relative sensory loss in the mid thoracic spine. His gait is ataxic and he is unable to perform tandem gait. His reflex examination is confusing- he is hyper-reflexic in the L patellar but normal in the R, he has absent achilles reflexes and his toes are downgoing with babinski testing. I reviewed his imaging studies and I agree with Dr. McCormick that the cyst does seem to extend rostral to the previous decompression. If surgery were contemplated then the procedure described by Dr. McCormick would be what I would recommend. The main issue is that I cannot establish a reasonable link between the radiographic findings and his pain syndrome. I think a decompression is reasonable given the relative sensory level and ataxia indicating a thoracic myelopathy. I suspect that with even a perfectly performed operation that there is a high likelihood of persistence of his symptoms. Furthermore, he is at increased risk for complications including spinal cord injury and in particular wound related problems given the redo nature of his surgery and his medical history which includes a chronically infected R shoulder prosthesis as well as recently diagnosed Vtach which is medically controlled. He and his wife had many questions for me and I did my best to answer them.
Certified-MA Michelle T at 10/11/22 0904
Images in PACS
Certified-MA Michelle I at 10/05/22 1426
Patient had surgery for arachnoid web about 7 months ago in AZ. Patient states that the arachnoid web has returned. Having mid/low back pain and bilateral leg weakness. Returning to AZ in December but hoping to get another opinion with Dr. Resnick prior to that. He did state that he did talk with Dr. Resnick about a year ago. Patient will mail CD.
Candelaria B at 10/04/22 1328
Request For Spine Evaluation
Spine Imaging Done: MRI; Where: Banner Hospital in Phoneix AZ - When: 09/12/22
Have clinic/radiology notes been faxed to HIM 608-203-4607 No - Terry has a disc with the imaging
Insurance:
Payor: MEDICARE / Plan: MEDICARE A & B / Product Type: Medicare /
What service is being requested : Surgical Evaluation
Which provider is being requested to see: Daniel Resnick, MD
Location preference: 1st available
~ign~L$y.rnptoms
Neck or Low Back Pain: Thoracic growth (spinal arachnoid web) and Lumbar pain, bilateral leg weakness
Cauda Equina ( Loss of sensation that they urinating or having bowel movement)? no (If yes send high priority)
Has patient seen a Rehab/Spine/Pain MD in the past?: No - he’s had previous surgery to have the growth removed and the growth has returned.
Referring Provider: self-referred - Provider phone: NA - Provider fax: NA
Patient was informed that it may take 7-10 days for triage review, yes
Ok to leave a detailed message? :yes