Doctor's Notes

Impression: I agree with Dr. Glenn that the patient’s 4-5 month course of slow progression of primarily demyelinating sensory motor neuropathy, confirmed by EMG/NCS, is most consistent with CIDP. Lumbar puncture with CSF analysis is needed for the diagnosis. She has minimal motor involvement but is very uncomfortable from sensory involvement. As she has diabetes mellitus, obesity and hypertension, high dose steroids are probably a second line choice, although overall a little more effective than other immunotherapy. I recommend IV ig, should CSF prove consistent with the diagnosis (very high CSF protein with minimal WBC increase). I would give 2gm/kg in 3-4 days, then 0.5 gm/kg IV q.2 weeks x 3 months, then taper if possible. Discontinue Neurontin due to weight gain, although it probably has helped (she can now wiggle her toes comfortably), consider Trileptal.

Plan: The patient is interested in proceeding with LP. This is scheduled under fluoroscopy at Rex next week. She will taper Neurontin and start Trileptal, gradually increase up to 450 mg b.i.d. if needed, then check a level and sodium. Follow-up 2 weeks, she will probably have had her initial Iv ig.

I met Dr. Nancy Schecter in April of 2005. It was during our first office visit I could tell that I would enjoy working with this woman. Not only did she take the time to review the doctors notes I’d brought with me; she did another nerve conduction study right then and there in her office that same day! Floored me. One of the questions she asked was whether or not Dr. Susan Glenn did a Lumbar Puncture (Spinal Tap) before coming to a final conclusion of CIDP. I told her no, she did not. Dr. Schecter did state that Dr. Glenn was not incorrect in her decision to treat my CIDP with steroids, but given the fact that I am a diabetic, it would not be her first choice either.

The Lumbar Puncture (Spinal Tap) was done and diagnoses of CIDP confirmed. I was admitted to Rex Hospital for initial round of IVIG treatments. We found out that all IVIG is not created equal and that I’m allergic to a brand called Octagam.