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 IIX: Doctors Let Me In The Door!

After Ruth's wild ride, I was ready for almost anything but what really happened at the ER.

It was almost a major anticlimax. Turns out, the attending who saw me almost immediately was one of the staff neurologists. That was great, I thought. She bundled me up quick and sent me down right away for an MRI. I thought, we're off to a so much better start than at either UVRMC or Mountainview, this has just got to turn out so much better!

Things went downhill pretty quick, and were looking like combat for a few touchy minutes. The neurologist took a quick look at the MRI scan and declared that she could find no evidence of brain stem stroke since November. She turned to interogative, demanding why we had not sought a clinic appointment, since there was obviously no stroke or neurological problem that constituted emergency in her estimation. Some other emergency patient was threatening immediate demise without her quick attention, so she ducked out to take care of that situation, after exchanging a few terse words with my mom, who defended her bring me to the ER, saying that the telephone assistance had instructed her to bring me right in. Ruth had her fight reflexes fully aroused, and was ready to pounce with all her fury, but was throwing verbal jabs too fast to make any comprehensible impression. When the doctor left, we reigned in her leash a bit, but I was resigned, and ready to get my clothes on and go home. My dad was trying to help get Ruth to settle down -- I'm not sure what else he was thinking at that moment. I'm sure, saying a prayer of desperation in his heart.

When the doctor came back, we all unloaded. Ruth reasoned that there were obvious neurological deficits that could not be ignored, and they were getting worse by the minute. Mom said the guys on the hot line told her to bring me, not schedule a clinic appointment, and we lived hours travel away. I said I did not care what the diagnosis was -- I just knew something serious was wrong, and I NEED HELP! Every other place we have gone said there was nothing wrong, or gave me SSRIs. Please HELP! Dad tried to inject at logical quiet tone of reason, saying we came there for help, and trusted the doctors to do their best.

The doctor finally listened, I think most convincing to her was Ruth's argument about neurological deficits. She started to administer what I have come to refer to fondly as "stupid pet tricks" because I have now performed them or variations of them so many times. They are as familiar and tiresome and tedious to me now as doing household chores. At the time, some of the tests were very frightening, because I was suddenly confronted with the stark truth -- I failed. I was failing to perform some of the simplest cognitive and physical tests, things I have know how to do without effort since I was a grade school age child. I could not memorize a series of words, and the effort to remember caused a cold sweat to break out. How could I forget something so easy? She gave me easy reminders, and still, I failed!

She finally conceded that something more serious must wrong, and I thing against her better judgement, decided that further inquiry was needed before they let me go home. As a last test, she asked me to show how well I could stand with my eyes closed, and I tried to plead that I couldn't do it at all, but she thought I was just stressing out or something, so urged me to try anyway.

Well, I shut my eyes, and I'm pretty sure I toppled like a felled tree. I couldn't stand up for hardly a second without my eyes opened or else some other support. I fell over against the gurney, and that pretty well concluded the "stupid pet tricks" for that session.

At that point, there was continuing argument about the need for immediate admission, or whether I should come back for clinic exam by her referral in the next day or two. Of course, Ruth was arguing for immediate admission, but the doctor was sceptical. In an inspired idea, Ruth suggested that they ought to perform an immediate lumbar puncture, to examine cerebrospinal fluid pressure and content for abnormalities. In order to defend her great professional skill and proficiency, this neurologist agreed that it was an easy procedure, and that she could just go ahead and do it right there, as if she performs dozens of spinal taps every day. Anyway, whatever Ruth said somehow stroked her professional ego in just the right way to get her to go along. She arranged to perform the LP right away.

That is where complications started. I don't know what. It hurt me more than LP normally does, according to what I understand. It is normally a painful procedure, but this was PAIN to the MAX. I felt like I was having electricity connected to my body directly through my back. And supposedly this was while I was heavily sedated, and supposed to be aware of almost nothing. It was hurting me badly, and it went on for and inordinate length. Apparently, the neurologist had difficulty tapping a spot with enough pressure to provide sufficient flow to fill the test vials. And when she did finally settle upon a spot, the vials filled excruciatingly slowly. I surmise that the doctor was used to tapping patients with high cerebrospinal pressure, from whom the fluid literally squirts generously. Mine was a miserly sluggish slow drip, by comparison. I know not why, nor can I explain why mine would be different than any other. But I remember the pain.

After the LP, I understand I was admitted to the neurology ward at the U hospital. Ruth stayed in the room with me and slept on the foldout bed, while mom and dad went to camp out at Aaron and Michelle's place. I don't remember, but Ruth says one of the nurses was changing my gown or something, and I woke up enough to be convinced that it was the coroner, preparing me for the autopsy. I think she was doing something like shaving my chest, to place electrodes for the remote sensors of the cardiac telemetering device. Anyway, Ruth says I was trying to convince the nice hispanic-looking woman that I was not dead yet.

Thus started an interesting few weeks at the neurology ward.

Next instalment:  Friends, Doctors, and Sharks

Continung Migraines

I like this diagram from Ruths's blog.

When I started taking Zonegran, the background migraine seemed to go away when I titrated up to 100mg dose. The headache was gone for a while, but came back while I was at the University of Utah Hospital. Since then, even though they resumed the Zonegran at the therapeutic level of 300mg, and started titrating Topamax, along with a confusing cocktail mix of other drugs supposed to be prophylactic for migraine, the headache has continued. This morning, I noted that the intensity has doubled again, so I would now rate he background continual headache pain as hovering around between 4 and 5 on a scale of 10. By that I mean some times it is obtrusive to the point that the pain interrupts otherwise lucid thoughts.

Nothing that I know of relieves this headache. When it mounts full-scale, there is nothing else. It ranges up to 10 and beyond, meaning it dominates my thinking, and interrupt clear thoughts with pangs of headache pain. The only relief I have found then is sleep, sometimes induced by narcotic drugs. They don't seem to relive the pain, but they make me sleep while the headache runs its course. These headaches are different -- they are more chronic in nature, and unremitting, so I have wished at times for something that would afford a permanent sleep. Of course, more sensible minds have prevailed, but I still reserve that solution as the last resort.