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Dear ,

First, a belated but very sincere welcome to our group of truly caring,

knowledgeable people. Since we now have three s on the list, may I

suggest that we add either a last initial or a state, so as not to

further confuse everyone? I am S., from Pennsylvania. I know one

of the other s is from Ohio.

Re your biopsy results. My results came in two batches, at two and three

months' time. That was back in 1999. To nail this even more, my neuro

wants me to have another biopsy, to which I have agreed.

Diagnosing mito, I believe, is still in its infancy. At present, it is

still an art as much as a science. A skilled and experienced clinician

must put all of the pieces together, much like a jigsaw puzzle. Please

listen to the logic of the excellent advice your husband gave you.

And---please try not to get discouraged. For most of us, , the

road to dx was at least ten years (mine was at least that), with some

dead ends. It was like being in a medical labyrinth, and not one of our

own choosing.

If you are thinking of going to the Cleveland Clinic, I would certainly

think that would be a very good idea, though you probably would not be

able to see Dr. Cohen himself. I personally think he is the premier mito

clinician in the US at the moment.

Get all of your bx resuts in writing, and try to know exactly what they

checked for.

It is SO hard to be patient, but that is what I would suggest now. You

know your own body far better than anyone else, , and you know

that there is something not quite right---probably many " somethings "

that are on the fritz. Each year brings some tiny increments in mito

knowledge, but I think there is great hope, since molecular biology is

probably the most exciting frontier in science today.

All of us here know what it is like to be very discouraged, and often in

pain, so please keep your postings coming.

Good luck, and take care.

Sincerely,

S.

Pennsylvania

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,

I can't recall whether or not your muscle biopsy was a fresh one. I

don't have any suggestions, other than to discuss with the doctor

about what tests were done. My biopsy was done over a month ago -

and I haven't learned the results, as the doctor wants to wait until

all the test results are in before putting it together. I know, of

course, that they already have the results from studying the fresh

muscle.

Is it possible to get results so quickly? I've heard of others say

that they got a tentative diagnosis of mito after a couple of weeks

(just haven't seen anyone mention the opposite happening by having

it ruled out) Has anyone else had that happen?

Hopefully after talking to your neuro you can trust whatever the

decision was - or at least feel confident that they DON'T know what

they're doing (whichever way it goes - it's nice to be able to have

enough information for you to make that decision).

Please let us know what the doctor says once you get through to him.

I hope you get a real answer soon.

Maggie

> hi everyone, hope your weekend was good. I just got a call from my

> neurologist office and they said the doctor said my muscle biopsy

was

> pretty much normal and they ruled out mito. Well I am actually

upset

> by this, I thought for sure the " mild non specific changes " on the

> report meant something. I only had my biopsy 2 weeks ago, can they

> rule out mito that fast. Should I go to the Ohio hospital I heard

so

> much about. How can they explain the purple toes, weakness the

> breathing problem, and also the aspiration of liquids that I have

and

> the balance issues and a whole bunch of stuff I have.

>

> I am just so frustrated right now, I called my husband up crying

and

> he said no way they couldn't of tested everything already. What

> should I do now. This is been going on for 1 1/2 years now and I

am

> just getting so tired of this, I want answers. Anyone have any

> advice. Thanks everyone for allowing me to vent, my neuro is

going

> to call me later. Maybe I can talk to him then.

>

> Thanks

>

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Dear ,

I'm sorry about the non results of your biopsy.....When DW had his in TX, it

took from January to July to get most of the results. I think a prelim came

back at 4 months and then the fibroblasts, etc...took much longer. I wish

there was something I could say to make the day better for you...just know

you are in many folks' hearts and prayers.

Love, Lynda R.

Re; Muscle biopsy

> hi everyone, hope your weekend was good. I just got a call from my

> neurologist office and they said the doctor said my muscle biopsy was

> pretty much normal and they ruled out mito. Well I am actually upset

> by this, I thought for sure the " mild non specific changes " on the

> report meant something. I only had my biopsy 2 weeks ago, can they

> rule out mito that fast. Should I go to the Ohio hospital I heard so

> much about. How can they explain the purple toes, weakness the

> breathing problem, and also the aspiration of liquids that I have and

> the balance issues and a whole bunch of stuff I have.

>

> I am just so frustrated right now, I called my husband up crying and

> he said no way they couldn't of tested everything already. What

> should I do now. This is been going on for 1 1/2 years now and I am

> just getting so tired of this, I want answers. Anyone have any

> advice. Thanks everyone for allowing me to vent, my neuro is going

> to call me later. Maybe I can talk to him then.

>

> Thanks

>

>

>

>

>

> Medical advice, information, opinions, data and statements contained

herein are not necessarily those of the list moderators. The author of this

e mail is entirely responsible for its content. List members are reminded of

their responsibility to evaluate the content of the postings and consult

with their physicians regarding changes in their own treatment.

>

> Personal attacks are not permitted on the list and anyone who sends one is

automatically moderated or removed depending on the severity of the attack.

>

>

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-dear , Just wanted to offer my sympathy about the inconclusive

muscle biopsy. In my 15 year(and counting) adventure with this disease

I have had a load of inconclusive tests, so I can understand just how

frustrated you must be. And the interpretation of tests seem to vary

so much from doctor to doctor. It's not that we want to have a serious

diagnosis made, just that we want to know what is the matter with us.

Anyway, I hope you have a good talk with your neuro and that he comes

up with some good suggestions for you, Celia--

In , " " wrote:

> hi everyone, hope your weekend was good. I just got a call from my

> neurologist office and they said the doctor said my muscle biopsy was

> pretty much normal and they ruled out mito. Well I am actually upset

> by this, I thought for sure the " mild non specific changes " on the

> report meant something. I only had my biopsy 2 weeks ago, can they

> rule out mito that fast. Should I go to the Ohio hospital I heard so

> much about. How can they explain the purple toes, weakness the

> breathing problem, and also the aspiration of liquids that I have and

> the balance issues and a whole bunch of stuff I have.

>

> I am just so frustrated right now, I called my husband up crying and

> he said no way they couldn't of tested everything already. What

> should I do now. This is been going on for 1 1/2 years now and I am

> just getting so tired of this, I want answers. Anyone have any

> advice. Thanks everyone for allowing me to vent, my neuro is going

> to call me later. Maybe I can talk to him then.

>

> Thanks

>

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> hi everyone, hope your weekend was good. I just got a call from my

> neurologist office and they said the doctor said my muscle biopsy

was

> pretty much normal and they ruled out mito. Well I am actually

upset

> by this, I thought for sure the " mild non specific changes " on the

> report meant something. I only had my biopsy 2 weeks ago, can they

> rule out mito that fast.

Can they rule out mito that fast? Depends on what tests were done.

The histopathology, electron microscopy and actual biochemical

assays to measure the activity of the mito enzymes can be done in

this time, but most labs take weeks to months because they have a

backlog. I would suggest that you get a copy of the report and ask

your doctor to explain exactly what tests were performed.

Below I am pasting a summary of a research study on typical muscle

biopsy yield in mito patients. This is technical information, but

does list the kinds of findings in a muscle biopsy that indicate

mito. If you compare this list with your report, it will give you

some idea of how thorough the testing was.

Hope this helps. I know the waiting in hard! I waited 19 years for

the first mito diagnosis and an additional 15 years for the second

mito diagnosis. At this point I've had active disease for 40 years.

Take care,

Barbara

Am J Clin Pathol. 2001 Sep;116(3):326-30.

Diagnostic yield muscle biopsy in patients with clinical evidence of

mitochondrial cytopathy.

Rollins S, Prayson RA, McMahon JT, Cohen BH.

Ohio State University College of Medicine and Public Health,

Cleveland, USA.

We retrospectively reviewed 118 muscle biopsy specimens from 113

patients with clinical and/or biochemical evidence of mitochondrial

cytopathy. Light microscopic evaluation revealed histologic

abnormalities in 65 specimens. The most common histologic findings

included angular atrophic esterase-positive muscle fibers, type II

muscle atrophy, regenerating muscle fibers, and scattered cytochrome-

oxidase deficient fibers. Ragged red fibers were noted in 3

specimens on a Gomori trichrome stain. Electron microscopic

evaluation was performed in 113 muscle specimens, and in 34, no

abnormalities were identified. Increased numbers of mitochondria,

particularly in the subsarcolemmal region, were identified in 54

specimens. Increased mitochondrial size was seen in 8 specimens and

paracrystalline mitochondrial inclusions in 3. Other ultrastructural

findings included focally increased glycogen deposition, focal Z-

band streaming, and focally increased lipid accumulation. For 39

cases, concomitant skin biopsy specimens were available;

abnormalities were identified by electron microscopy in 12. The

majority of biopsy specimens demonstrated some light or electron

microscopic abnormality. Specific histologic findings suggestive of

mitochondrial abnormalities (partial cytochrome oxidase deficiency,

ragged red fibers) were noted in a minority of cases.

Ultrastructural evidence of mitochondrial abnormalities was noted in

the majority of cases.

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I'll say, don't get discouraged, but I know hard that is. It took me 15

years of frustration and anger and a self diagnosis before I had any

answers. When I didn't get what I thought was appropriate, I looked some

more. Once you have the reports, we might be able to help a bit more. Mito

cannot be entirely ruled out to my knowledge. Even with a fresh biopsy, they

may take a piece that isn't affected. All the pieces, of which the biopsy

and blood tests are only a part, have to be put together. Please be sure to

ask what makes him think that you don't have mito and then ask all the

questions you have. That is what he is getting paid for.

Hugs,

laurie

>

> Reply-To:

> Date: Mon, 30 Aug 2004 14:59:29 -0000

> To:

> Subject: Re; Muscle biopsy

>

> hi everyone, hope your weekend was good. I just got a call from my

> neurologist office and they said the doctor said my muscle biopsy was

> pretty much normal and they ruled out mito. Well I am actually upset

> by this, I thought for sure the " mild non specific changes " on the

> report meant something. I only had my biopsy 2 weeks ago, can they

> rule out mito that fast. Should I go to the Ohio hospital I heard so

> much about. How can they explain the purple toes, weakness the

> breathing problem, and also the aspiration of liquids that I have and

> the balance issues and a whole bunch of stuff I have.

>

> I am just so frustrated right now, I called my husband up crying and

> he said no way they couldn't of tested everything already. What

> should I do now. This is been going on for 1 1/2 years now and I am

> just getting so tired of this, I want answers. Anyone have any

> advice. Thanks everyone for allowing me to vent, my neuro is going

> to call me later. Maybe I can talk to him then.

>

> Thanks

>

>

>

>

> Medical advice, information, opinions, data and statements contained herein

> are not necessarily those of the list moderators. The author of this e mail is

> entirely responsible for its content. List members are reminded of their

> responsibility to evaluate the content of the postings and consult with their

> physicians regarding changes in their own treatment.

>

> Personal attacks are not permitted on the list and anyone who sends one is

> automatically moderated or removed depending on the severity of the attack.

>

>

>

>

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--- My heart goes out to you. You have received a lot of good

advice. I beleive that mito can not be ruled out by a muscle biopsy.

So many factors that can go wrong.

I just had my and will be getting the results, just like you, two

weeks after the biopsy. I am so nervous. A PA performed the biopsy.

The muscle that was taken was one of my stongest muscles. I am very

anxious thta I will receive the same answer as you.

Don't give up. Mito is still in it's infancy. It seems like there

are very few Drs who really know much about this. They are all just

learning. Hang in there! I know it must be hard.

Big hugs, dawn a

In , Laureta Fitzgerald

wrote:

>

>

> I'll say, don't get discouraged, but I know hard that is. It took

me 15

> years of frustration and anger and a self diagnosis before I had

any

> answers. When I didn't get what I thought was appropriate, I

looked some

> more. Once you have the reports, we might be able to help a bit

more. Mito

> cannot be entirely ruled out to my knowledge. Even with a fresh

biopsy, they

> may take a piece that isn't affected. All the pieces, of which the

biopsy

> and blood tests are only a part, have to be put together. Please

be sure to

> ask what makes him think that you don't have mito and then ask all

the

> questions you have. That is what he is getting paid for.

>

> Hugs,

> laurie

>

> > From: " "

> > Reply-To:

> > Date: Mon, 30 Aug 2004 14:59:29 -0000

> > To:

> > Subject: Re; Muscle biopsy

> >

> > hi everyone, hope your weekend was good. I just got a call from

my

> > neurologist office and they said the doctor said my muscle

biopsy was

> > pretty much normal and they ruled out mito. Well I am actually

upset

> > by this, I thought for sure the " mild non specific changes " on

the

> > report meant something. I only had my biopsy 2 weeks ago, can

they

> > rule out mito that fast. Should I go to the Ohio hospital I

heard so

> > much about. How can they explain the purple toes, weakness the

> > breathing problem, and also the aspiration of liquids that I

have and

> > the balance issues and a whole bunch of stuff I have.

> >

> > I am just so frustrated right now, I called my husband up crying

and

> > he said no way they couldn't of tested everything already. What

> > should I do now. This is been going on for 1 1/2 years now and

I am

> > just getting so tired of this, I want answers. Anyone have any

> > advice. Thanks everyone for allowing me to vent, my neuro is

going

> > to call me later. Maybe I can talk to him then.

> >

> > Thanks

> >

> >

> >

> >

> > Medical advice, information, opinions, data and statements

contained herein

> > are not necessarily those of the list moderators. The author of

this e mail is

> > entirely responsible for its content. List members are reminded

of their

> > responsibility to evaluate the content of the postings and

consult with their

> > physicians regarding changes in their own treatment.

> >

> > Personal attacks are not permitted on the list and anyone who

sends one is

> > automatically moderated or removed depending on the severity of

the attack.

> >

> >

> >

> >

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> ,

Can they see if there is enough of a sample to send to Cleveland?

I know it won't be fresh but they have more testing to do. They say

that they have to do EM (electron microscopy?). 's muscle and

skin were negative but it showed up in her liver. Don't give up

hope. Push for more answers. Tell them you need answers!!!

Good luck.

Dawn

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The testing is not done at Cleveland Clinic. Dr. Hoppel is at the VA

hospital and another hospital and does the testing. Frozen muscle is sent to

Atlanta to Dr. Shoffner if DNA testing is done.

laurie

>

> Reply-To:

> Date: Tue, 31 Aug 2004 01:41:58 -0000

> To:

> Subject: Re: Re; Muscle biopsy

>

>> ,

>

> Can they see if there is enough of a sample to send to Cleveland?

> I know it won't be fresh but they have more testing to do. They say

> that they have to do EM (electron microscopy?). 's muscle and

> skin were negative but it showed up in her liver. Don't give up

> hope. Push for more answers. Tell them you need answers!!!

> Good luck.

> Dawn

>

>

>

> Medical advice, information, opinions, data and statements contained herein

> are not necessarily those of the list moderators. The author of this e mail is

> entirely responsible for its content. List members are reminded of their

> responsibility to evaluate the content of the postings and consult with their

> physicians regarding changes in their own treatment.

>

> Personal attacks are not permitted on the list and anyone who sends one is

> automatically moderated or removed depending on the severity of the attack.

>

>

>

>

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Thanks, I will print this out and compare it to my report when I get

it

C

> > hi everyone, hope your weekend was good. I just got a call from

my

> > neurologist office and they said the doctor said my muscle biopsy

> was

> > pretty much normal and they ruled out mito. Well I am actually

> upset

> > by this, I thought for sure the " mild non specific changes " on

the

> > report meant something. I only had my biopsy 2 weeks ago, can

they

> > rule out mito that fast.

>

> Can they rule out mito that fast? Depends on what tests were done.

> The histopathology, electron microscopy and actual biochemical

> assays to measure the activity of the mito enzymes can be done in

> this time, but most labs take weeks to months because they have a

> backlog. I would suggest that you get a copy of the report and ask

> your doctor to explain exactly what tests were performed.

>

> Below I am pasting a summary of a research study on typical muscle

> biopsy yield in mito patients. This is technical information, but

> does list the kinds of findings in a muscle biopsy that indicate

> mito. If you compare this list with your report, it will give you

> some idea of how thorough the testing was.

>

> Hope this helps. I know the waiting in hard! I waited 19 years for

> the first mito diagnosis and an additional 15 years for the second

> mito diagnosis. At this point I've had active disease for 40 years.

>

> Take care,

> Barbara

>

>

>

> Am J Clin Pathol. 2001 Sep;116(3):326-30.

> Diagnostic yield muscle biopsy in patients with clinical evidence

of

> mitochondrial cytopathy.

>

> Rollins S, Prayson RA, McMahon JT, Cohen BH.

> Ohio State University College of Medicine and Public Health,

> Cleveland, USA.

>

> We retrospectively reviewed 118 muscle biopsy specimens from 113

> patients with clinical and/or biochemical evidence of mitochondrial

> cytopathy. Light microscopic evaluation revealed histologic

> abnormalities in 65 specimens. The most common histologic findings

> included angular atrophic esterase-positive muscle fibers, type II

> muscle atrophy, regenerating muscle fibers, and scattered

cytochrome-

> oxidase deficient fibers. Ragged red fibers were noted in 3

> specimens on a Gomori trichrome stain. Electron microscopic

> evaluation was performed in 113 muscle specimens, and in 34, no

> abnormalities were identified. Increased numbers of mitochondria,

> particularly in the subsarcolemmal region, were identified in 54

> specimens. Increased mitochondrial size was seen in 8 specimens and

> paracrystalline mitochondrial inclusions in 3. Other

ultrastructural

> findings included focally increased glycogen deposition, focal Z-

> band streaming, and focally increased lipid accumulation. For 39

> cases, concomitant skin biopsy specimens were available;

> abnormalities were identified by electron microscopy in 12. The

> majority of biopsy specimens demonstrated some light or electron

> microscopic abnormality. Specific histologic findings suggestive of

> mitochondrial abnormalities (partial cytochrome oxidase deficiency,

> ragged red fibers) were noted in a minority of cases.

> Ultrastructural evidence of mitochondrial abnormalities was noted

in

> the majority of cases.

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I remember Rainbow Children's being in Cleveland.

Alice

I think Rainbow Babies is where Shoffner is.

Okerlund wrote:

>The part of my muscle biopsy that was sent out form U of M was sent to Dr

Hoppel in Clevland and rainbow babies children hospital. susan

>

>Laureta Fitzgerald

lfitzger@...lfitzger@...>> wrote:The testing is

not done at Cleveland Clinic. Dr. Hoppel is at the VA

>hospital and another hospital and does the testing. Frozen muscle is sent to

>Atlanta to Dr. Shoffner if DNA testing is done.

>

>laurie

>

>

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I remember Rainbow Children's being in Cleveland.

Alice

I think Rainbow Babies is where Shoffner is.

Okerlund wrote:

>The part of my muscle biopsy that was sent out form U of M was sent to Dr

Hoppel in Clevland and rainbow babies children hospital. susan

>

>Laureta Fitzgerald

lfitzger@...lfitzger@...>> wrote:The testing is

not done at Cleveland Clinic. Dr. Hoppel is at the VA

>hospital and another hospital and does the testing. Frozen muscle is sent to

>Atlanta to Dr. Shoffner if DNA testing is done.

>

>laurie

>

>

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Alice,

You are right. Horizon Molecular Medicine, in Atlanta, is where

Shoffner is.

A ADAMS wrote:

>I remember Rainbow Children's being in Cleveland.

>

>Alice

>

>

>

>

> I think Rainbow Babies is where Shoffner is.

>

>

>

> Okerlund wrote:

>

> >The part of my muscle biopsy that was sent out form U of M was sent to Dr

Hoppel in Clevland and rainbow babies children hospital. susan

> >

> >Laureta Fitzgerald

lfitzger@...lfitzger@...>> wrote:The testing is

not done at Cleveland Clinic. Dr. Hoppel is at the VA

> >hospital and another hospital and does the testing. Frozen muscle is sent to

> >Atlanta to Dr. Shoffner if DNA testing is done.

> >

> >laurie

> >

> >

>

>

>

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Alice,

You are right. Horizon Molecular Medicine, in Atlanta, is where

Shoffner is.

A ADAMS wrote:

>I remember Rainbow Children's being in Cleveland.

>

>Alice

>

>

>

>

> I think Rainbow Babies is where Shoffner is.

>

>

>

> Okerlund wrote:

>

> >The part of my muscle biopsy that was sent out form U of M was sent to Dr

Hoppel in Clevland and rainbow babies children hospital. susan

> >

> >Laureta Fitzgerald

lfitzger@...lfitzger@...>> wrote:The testing is

not done at Cleveland Clinic. Dr. Hoppel is at the VA

> >hospital and another hospital and does the testing. Frozen muscle is sent to

> >Atlanta to Dr. Shoffner if DNA testing is done.

> >

> >laurie

> >

> >

>

>

>

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Alice,

You are right. Horizon Molecular Medicine, in Atlanta, is where

Shoffner is.

A ADAMS wrote:

>I remember Rainbow Children's being in Cleveland.

>

>Alice

>

>

>

>

> I think Rainbow Babies is where Shoffner is.

>

>

>

> Okerlund wrote:

>

> >The part of my muscle biopsy that was sent out form U of M was sent to Dr

Hoppel in Clevland and rainbow babies children hospital. susan

> >

> >Laureta Fitzgerald

lfitzger@...lfitzger@...>> wrote:The testing is

not done at Cleveland Clinic. Dr. Hoppel is at the VA

> >hospital and another hospital and does the testing. Frozen muscle is sent to

> >Atlanta to Dr. Shoffner if DNA testing is done.

> >

> >laurie

> >

> >

>

>

>

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