It All Started With Lower Back Pain and Sciatica

Transcription

1 Transformative Communication between Doctor and Patient It All Started With Lower Back Pain and Sciatica But There Was a Deeper Problem: Thoracic/Cervical Scoliosis of LS Spine PART ONE: THE SPINE 4/15/2011 2/28/2012 5/2/ /23/2014 Physical Exam: Cranial: Vagus compression R Lumbar: L3 RR, L4 L5 E, RL Sacrum: R/L, R SI joint dsfxn LE: Bil ankle stiffness GI: Fascial Restriction Spleen, Colon Aug 2014 Note 2D CT Scans Curvature At Calit2 Using GE Lunar Densitometer You will notice that there is a substantial scoliotic curvature of your upper mid-thoracic and lower cervical spine. -David Wing, Calit2 EPARC 8/18/2014 1

2 MRI Shows Central Canal Stenosis L4-L5: Circumferential disc bulge extends slightly inferiorly in an area of deficiency of the posterior aspect of the L5 superior endplate. Combined with moderate facet arthropathy and ligamentum flavum redundancy, there is severe central canal stenosis with near complete effacement of Cerebrospinal Fluid (CSF) and mass effect on the cauda equina. Severe bilateral foraminal stenosis, with compression of the exiting bilateral L4 nerve roots. T1 has contrast with fat bright (shows bone and alignment well) Advanced MRI: Adjusting T1/T2 to Bring Out Regions of Interest T2 with fat suppression: makes fat dark and fluid bright (emphasizes disc and fluid around spinal cord/roots) Validating My Osteopathic Findings with 3D MRI Virtual Reality MRI Images from Cynthia Santillan, MD, UCSD Radiology October 30, 2015 Images courtesy of Christine Chung MD, UCSD MSK Imaging Research Lab ( Visualizations from MRI by Jurgen Schulze, Calit2, UCSD 2

3 Mike Kurisu Examining Larry Smarr s Spine in the Calit2 Virtual Reality CAVE Visualizations from MRI by Jurgen Schulze, Calit2, UCSD Combining an Osteopathic Examination With 3D Visualization of the Patient Recreating the Anatomy Lesson Using 3D Visible Larry to Guide DO Manipulation March 29, 2016 Calit2 Then There Was Knee Pain PART TWO: THE KNEE Physical Exam: Cranial: Vagus compression R Lumbar: L4 L5 E, RL (still mobile) Sacrum: R/L, (more mobility) LE: Bil ankle stiffness Knee: Distal tracking on patella, swelling and MF strain inferior GI: Fascial Restriction Spleen, Colon 3

4 Using Enhanced MRI to Detect Regions of Inflammation in Joint Inflammation in Knee Treatment Finally, I Could Detect Abdominal Dysfunction 196 Slices, 512x512 Slice Resolution Inflammation in Bursa in Front of Patella Edema Behind Patella MRI and Annotation Christine Chung, MD, UCSD Visualization by Jurgen Schulze, Calit2, UCSD Dr. Chung Viewed the 3D Knee In the CAVE with Drs. Kurisu, Smarr, and Schulze Edema at Soft Tissue Attachment to Bone Decrease edema through myofascial release Lymphatic manual techniques Venous drainage techniques Decrease inflammation High dose Curcumin PART THREE: THE ABDOMEN Physical Exam: Cranial: Vagus compression bilaterally Lumbar: L5 compressed on R Sacrum: stabalized LE: Bil ankle stiffness R>L GI: Fascial Restriction Spleen, moderately distended descending colon, warmth, mass effect felt sigmoid junction with increasing density 4

5 I Have Been Tracking My Internal Biomarkers For A Decade To Understand My Body s Dynamics Longitudinal Stool Tests Suggested Inflammatory Bowel Disease Confirming the IBD (Colonic Crohn s) Hypothesis: Finding the Smoking Gun with MRI Imaging Typical Lactoferrin Value for Active Inflammatory Bowel Disease (IBD) 124x Upper Limit for Healthy MRI Ordered By Dr. Bill Sandborn; MRI Read by Dr. Cynthia Santillan UCSD Liver Small Intestine Transverse Colon I Obtained the MRI Slices From UCSD Medical Services and Converted to Interactive 3D Working With Calit2 Staff Descending Colon MRI Jan 2012 Cross Section Diseased Sigmoid Colon Calit2 64 Megapixel VROOM My Quarterly Blood Draw Normal Range <7.3 µg/ml Severe Colon Wall Swelling Major Kink Calit2 64 Megapixel VROOM Lactoferrin is a Protein Shed from Neutrophils - An Antibacterial that Sequesters Iron Sigmoid Colon Threading Iliac Arteries 5

6 MRI 2D DICOM Slices Converted to 3D Volumetric Imaging and Sigmoid Colon 3D Printed 3D Volumetric Visualization From MRI In Calit2 Virtual Reality StarCAVE 2012 MRI Video Reveals Diseased Sigmoid Colon Sigmoid Colon Descending Colon Sigmoid Colon 3D Volumetric Visualization Created by Calit2 s Jurgen Schulze from January 2012 MRI Possible Fistula 3D software: Jurgen Schulze, Calit2, UCSD 3D printing: Philip Weber, Calit2, UCSD Source: Cynthia Santillan, MD Radiologist, UCSD 6

7 2016 MRI Slice Through Sigmoid Colon Reveals Thick Walls and Very Narrow Lumen Source: Smarr MRI Oct. 25, 2016 Reading by Cynthia Santillan, MD Radiologist, UCSD MRI in 2D and 3D Revealed That The Diseased Sigmoid Colon is Sitting on Top of Bladder From Quantified Self to Quantified Surgery: Converting MRI Slices to 3D Organ Segmentation for Surgical Pre-Planning Images of Dr. Smarr s Abdomen To Support Sigmoid Colon Resection Surgery 4.2mm 13.3mm 16.4mm Normal opening (bright yellow) is 40mm, so mine is 1/10 the diameter it should be. Normal wall thickness (dark yellow) is 3mm, so wall thickness is 4-5 times as thick as it should be. Region to Investigate Possible Fistula Between Sigmoid colon and Bladder Sigmoid colon Bladder MRI Reading by Cynthia Santillan, MD Radiologist, UCSD; Volumetric Visualization by Dr. Jurgen Schulze, Calit2, UCSD MRI Slice from Dr. Cynthia Santillan 3D Organ Segmentation Made by Dr. Jurgen Schulze from Dr. Santillan s 150-Slice MRI 7

8 Pre-Surgical Planning in QI Virtual Reality: Using Virtual Reality As Input for Positioning The Two Resection Cuts Key Outcomes From 2D and 3D MRI Analysis Which Guided Presurgical Planning Pre-Surgical Team Meeting With Surgeon and Patient Plus Radiologists and GI MDs, DO, Bioengineering, Design, VR, & Robotics November 4, 2016 Three Specific Problem Areas Discovered: Sigmoid Has Kinks at Both Ends Sigmoid Colon is Sitting on Bladder Splenic Flexure Colon Has Folds and is Attached to Spleen Led to Decisions About Surgical Procedures: Location of Ports Was Changed on Body Sigmoid Colon Resection End Points Were Determined Extra Time Will Be Needed Near Spleen Surgeon Sonia Ramamoorthy, MD in QI Virtual Reality CAVE Friday November 25, 2016 Colon visualization by Jurgen Schulze, Calit2; Photo credit Tom DeFanti, Calit2 Photos by Dr. Sonia Ramamoorthy 8

9 Calit2 Collaboration with Radiology, GI, and Surgery to Support Sigmoid Colon Resection Colon Before and After Surgery From Digitally-Enabled Future Patient to Digitally-Enabled Future Doctor UC San Diego Health Communications Press Release 9

10 Transformative Communication Radiologist to Clinician to Patient A Picture is worth a thousand words Use of Images as a tool for COMMUNICATION Use of Images as a tool for TEACHING 10