Babinsky's sign

Babinsky's sign:
A -- normal reflex
B -- pathological response

One of the "stupid pet tricks" my doctors have me perform, again and again, is the positive Babinsky reflex that proves I am brain damaged. It sounds vaguely pejorative, but is actually also known as "plantar reflex", and is commonly used as a diagnostic to indicate neurological compromise. Babinski is the name of the famed French neurologist from whom the technique takes its name.

One of the most amusing things about being tested for a positive Babinsky is that the doctor asks you to take off your shoes and socks -- to determine the status of your brain!

Then they scrape something along the bottom of the bare foot, and watch which way your toes curl. If something is wrong, the big toe and other toes flex upward and outward. The normal reflex is for the toes to curl downward, like the clenching fist.

Some doctors use a tongue depressor or some the blunt little hammer doctors use for testing reflexes. Dr. Brin, my neurologist at the U, preferred to use a key from her key ring.

I can perform this trick on request at any time. Any number of doctors have watched and nodded wisely at the uneducated and uncouth response of my big toe. It seems like a silly thing for learned doctors to be studying on, playing with their patients feet.

Miracles X: Unfolding

I have sought for a way to explain what took place that shares my amazement as effectively, and it continues to elude my grasp. So let me try to just chronicle the events as they took place, and you can draw your own conclusions.

After I thought the nurse was trying to start an autopsy on me, things are a bit blurry for a while. I saw a lot of ceiling tiles of hallways of the U Hospital as I was wheeled around form place to place, and I suppose someone told me what they were doing to me, but I don't recall much of it. One incident I recall fairly clearly in a sort of vignette memory was the performance of cerebral angiogram. They placed me on some sort of apparatus like a turntable that allowed them to rotate my body as needed to feed a catheter up from femoral insertion point, through my heart, and into my brain. From there, each separate vascular system of my brain could be singly injected with x-ray opaque dye timed with blood flow to outline the select vascular system on a fluoroscope and trace the brain's individual vascular flow very distinctly and very finely.

I listened as the techs and the neurologists chattered, as this procedure progressed, and they watched the pictures form. They talked to me occasionally, mostly by way of offering instruction and encouragement. They noted one major system after another was "slick", or "looks good". "Clean as a whistle" was an expression I kept hearing.

Then they steered the catheter into the basilar artery system, and everyone grew more quiet. They commented about obvious extensive development of atherosclerosis, saying that the vascular path of the basilar artery system is what they term "tortuous". Accumulation of extensive scar tissue and plaque build up are the obvious source of brain stem strokes. This was pretty grim news, because it pretty much confirms that the strokes are not much subject to any kind of medical intervention, and all they can do is let nature take its course, with some very good measures that can prolong my term but only effectively delay more inevitable brain stem damage. Even these good doctors cannot give me a new basilar artery system.

Somewhere about this time, Dr. Skalabrin, whom I presumptuously and affectionately started calling "Dr. Brin", literally adopted me as her cause. I was not aware at the time, and not until much later, but she became my private advocate in the neurology department, and worked tirelessly on my case. Indeed, she exhausted herself and her personal energy, and after they found the spinal tumors, her own colleagues insisted that she go home and not come back to work until she had rested sufficient.

The first I remember that I personally noted Dr. Brin was one day when she came in to my hospital room leading the teaching rounds. She lead the team through extensive neurological examination, which I have taken to referring to as "stupid pet tricks" after having performed these types of manipulations so many times. After Dr. Brin was satisfied, she summarized with a short speech of encouragement that I thought was part for MY benefit -- I don't remember anything of what she said, except that she iterated the neurological deficits they noted, and very emphatically asserted that they were NOT OKAY. This as an assurance that they would continue to try to find causes. And she was as good as her word.

After that, things slowed down again. I interject here that I met a nurse at this point who calls herself "Tina". She is really of Vietnamese ancestry, so that is not her real name. She was delightfully witty and kind, and I was absolutely enthralled with her cool offhanded comments observations about cultural anthropology. She was really intelligent, and could hold up her side of a discussion as a true peer without any need for me to tone down my rhetoric or make pretences about respectable argumentation. It has been so long since I was so impressed by such a woman that I fell in love with her, and resolved to propose. Like a stupid fool, I approached the whole thing far too aggressively, and of course, she declined. She said she had promised her parents she would never marry but to a Vietnamese man. I understand, but still maintain some hope of salvaging something. A strictly platonic affair is the only ideal I could manage under the circumstances.

Unrequited love, so sad.

Anyway, more about me and Dr. Brin, my favorite of the neurology team.

My next study of ceiling tiles was a trip across the ward to a room where they conduct EEG studies. With the help of some very capable EEG techs, I donned a not-so-fashionable hat crafted of dozens of electrodes pasted on to various places on my scalp and around my head, with a tail of many colored wires trailing back to a mysterious black box that fed signals into a polygraph trace machine. I could not blink my eye or wrinkle my nose without the machine tracing lots of squiggly lines down the paper to record the event.

The neurology team was disappointed in the EEG results in one respect. I was definitely not having anything like epileptic seizures. After a multitude of "Shark Attacks" under close medical scrutiny, there was no conclusive brain signature that would be indicative of any kind of seizure activity. I started hearing groups of doctors gathering outside the door conducting whispered conferences of concern, using words like "psychotic" and "somatoform".

(You gotta see what these terms really mean to truly appreciate what all these guys were thinking about me at this time. They were pretty sure I was a genuine fruit cake, and I wasn't about to argue.)

At this point, I really did not care what diagnoses they presented me with, as long as it could help me understand better, and hopefully stop me from hurting.

While I was in the EEG study, there was a visit from the psychiatric team that I cannot recall the details of clearly. I will ask for some assistance from others to recall. One thing I do recall very vividly was a question directed from the head of the team, delivered in rather a tone of amazement. "Then, you have hope?", he asked. I answered him most emphatically and in the affirmative, that I have the most firm of convictions that the course and purpose of my life is firmly sealed, and that I place utmost faith and confidence in that. That is all I remember of the incident.

Along about this time, my son Jim and his wife Jen showed up one day, along with their two children Katelynn and Christopher. I have not seen Jim for over a decade, and was almost ready to get up out of bed and walk, I was so inspired by their visit.

My darling sweet grandchildren played by my bed, and were intrigued by my strange looking multicolored hat. Katelynn, a precocious 7-year-old, was curious enough to climb up on the bed and take a closer look, but Christopher, the young two-year-old son, was happier with his great-grandmothers lap and views of the fire engines and life flight helicopters operations visible from the fifth-floor window view. He was having nothing to do with the old guy in the bed wearing the weird-looking hat, and I can't say that I blame him.

On other occasions, all four of my sons, visited at the same time, and we exchanged hugs. My sons gave honest pledges and unmistakable tokens of their love, and I believed them. It had been so many years since I had even seen my sons. Even to see one of them was beyond my greatest dream. Imagine all of them gathering together.

If I had to die right then, I was ready for heaven. Fortunately, heaven did not ask me yet. Not just yet. In fact, sacred promises were made and sealed upon this occasion that I would live years to survive and I believe long enough time to fulfil my mission here upon the earth. I look forward to that with eager anticipation, and am hoping it involves spending time with my sons and their families. That will be almost as blissful as heaven itself.

For the next act, Dr. Brin summoned me once again to the imaging lab, this time for an MRI scan of my spinal column. All of the scans heretofore had focussed on the brain, but Dr. Brin apparently deduced that they were missing something significant from the neurological deficit picture. So, scanning for abnormalities of the spinal column.

It turned out to be a very inspired action. They detected an abnormality - a tumor mass on the  lumbar spinal column.  Of the type known as a Schwannoma, the tumor was judged to be significant, and the neurosurgeon, Dr. Kenneth Yonemura was summoned to operate at 1:00 in the morning. He responded with every haste, and the procedure was performed.

Post-surgery.

Hallelujah! I could feel my feet moving as they should feel! There was an immediate and gratifying sense of proprioception in my lower body that was completely and totally absent before the surgery.

Success!

Next instalment:  Home Sweet Home II

Miracles VI: Friends, Doctors, and Sharks

Rehab in Provo was fairly routine. It is the exceptional things that are worth mentioning.

First is that I came there with a renewed sense of purpose. I met repeatedly with my son Robert and his wife Stacy. I was obsessed, perhaps, with a sense of urgency that my life had been spared for a purpose. A short mission, so to speak, to serve so cause for good. I was not aware of the mission yet, Robert and I discussed some possible actions we might take toward directing the lives of his brothers, because I expressed some remorse as an absent father of so many years that I had failed my family and not trained my sons well. Anyway, we discussed many subjects with tentative feelers along those lines.

I also met my friend Michael Golden, several times. In fact, he came with me the one Sunday to the abbreviated Sacrament meeting they held in the little chapel at the hospital. It was a special, spiritual moment for me, and kind of ministering of a special friend that I will try to always remember in my heart. I can never repay Michael for his kindness, but I hope to try to do things half as thoughtful for others, and am hoping to try to instil in my own sons such a sense of selfless charity and friendship. I hope the seed is already there, and it is not too late for them. I hope...

Another thing that happened while I was in the Provo Rehab was that I had a series of "shark attacks" under clinical observation. This is important because the incident was documented by trained medical observers. First at Mountainview, then in the Provo Rehab ward, and finally at the U Neurology Unit, doctors and nurses have seen these attacks, and know that I am not making up the stories. In fact, one man of the psychiatric practice at the U hospital witnessed a "shark attack" while there was quite a crowd of onlookers. I was somewhat absent myself for most of the incident, since they tend to affect me that way, but my dad told me later in rather a bemused demeanor that the doctor seemed rather horrified by the incident. I hope he was not permanently traumatized. When we find some understanding, I want to share it with him personally, just to offer my personal reassurance.

Again, this clinical observation is notable because my doctors stand outside the room and whisper and shake their heads, "somatoform", "deeply psychotic!", "borderline shizofrenic behavior!", and other two- dollar words from the DSM, I've heard them all before. But the blood pressures continue to go higher than ever, and the nurses were alarmed to the point that they were going to call a "code blue", because they had seen nothing like this before, and my respirations were down to almost nil, and blood pressure levels were so too high to be even believed. Later, I heard the nurse describing the incident to the next on duty, in the handing-off briefing. He used the term "freaky!" emphatic and numerous times. I say this not to his discredit, because I think he responded well to the incident. We have found subsequently that the "shark attacks", although alarming, do not seem to produce any serious life-threatening effects beyond the extreme pain. Best to just stand back, and maybe don't watch, if that is your preference, and wait until it passes.

My point is, these attacks are very real, to me. They are happening to me. I don't give a damn if the doctors call the "psychotic complexes" or "somatoform" or "silly putty"! I want to know reasons and explanation this is happening to me, because IT IS! It has happened before, and I know it will happen again! It cannot just go away for no reason. The first attack was obviously associated with the first stroke incident in July. They started then. Why? Why are they continuing? I want to know, even more than reasons for how to stop them from happening, but UNDERSTANDING what is happening to me!   If I had better understanding, even if I could not stop or control these things, at least I could know WHY they are happening to me. As it is, one of the best explanations seems to be to simply shrug your shoulders and turn away and mutter, "he's obviously mad as a hatter!", and dismiss the whole affair.

That might resolve the issue just fine for a doctor who gets to move on to the next disease. But I live inside myself.

I remember Dr. Brin, standing in the circle of doctors in neurology rounds, at the foot of my bed one day, pronouncing, "That's NOT OKAY! -- That's NOT OKAY!" And true to her words, she worked until she found something that was NOT okay. I owe her such a debt of gratitude for that! Finally, a doctor who lived up to the IDEAL of HEALING!

But I get ahead of myself..

I went home from Provo Rehab fully prepared to start over again from the July point.

Little did I know what was in the works, and would so shortly come to pass. The biggest series of miracles in all...

Next instalment:  Interacte

Strabismus questions

Ruth,

I thought you could ask Dr. Warner and friends because this is a puzzler for me.

The consensus of neurology staff ala Dr. Brin was "don't worry about seeing double. It will probably go away in a few days." It hasn't.

When should I get worried?

I feel like there must be a little adjustment screw I don't know about for my left eye. Just a tiny tweak is all it would take to move it back into agreement with the dominant right eye.

Right now, everything I see is double. When I look casually, it isn't bad, but focusing makes me feel sick. Partly the problem with loss of appetite...