Areflexic

A

“I have lost my triceps jerk; I am areflexic.” I told my neurosurgeon. 

“So what?” he replied.”I know what is wrong with you” he said. 

I then went onto explain to him that it took me a week to find a patella hammer and to get someone to test my reflexes. In short, surgical wards and even neurosurgeons don’t really need a reflex hammer to practce their art. It was pretty clear from my original CT scan that I had a C7 radicuopathy. (pinched nerve)

Prof G’s fractured C7 vertebrae

Ironically, I am in the David Marsden ward at King’s College Hospital. David Marsden was the doyen of clinical neurology and considered by many to be the greatest British neurologist of the 20th century. Would David Marsden have expected my clinical team to have tested my reflexes?

I wrote a piece on “the art of medicine, and by inference neurology, being in terminal decline”. Do you agree or have I become a grumpy old fart?

Topor as a state is not black-and-white; I am in a brief grey patch with some lucidity. The hyena has not gone away; she is now on a leash and the white lightening now runs through the leash in more predictable patterns.  I am hoping to be transferred to a rehab unit for the next chapter.

Thank you so much for your continuing support of our Barts-MS Coronavirus antibody study. The surge in donations means we are halfway there.

Too painful to type much. I will keep you updated when I have enough energy.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

31 comments

  • I’m so sorry you’re in this position. Thank you for keeping in touch and I am very glad that you’re in such good hands . Take care and be kind to yourself.
    All the best

    A fan

  • “I wrote a piece on “the art of medicine, and by inference neurology, being in terminal decline”. Do you agree or have I become a grumpy old fart?”

    🙂 All I know is that no-one ever tests my reflexes. Maybe it happened in rehab – can’t remember – but never in regular appointments. Does that mean the art of medicine/neurology is in decline? As a completely non-medical and non-scientific person I would hazard a guess that it didn’t. As the doctor said, he knows what is wrong … presumably the ways of diagnosing certain things changes as new methods and technologies become available?

    Great to see you are well enough to engage with your treatment! It sounds as if you are slowly getting on the mend. All the best for the next stage.

    • Dear Professor Giovannoni. I am glad to hear you are having the best people around , helping you with your recovery. I am addicted to your blog!! 😊
      Wishing you more strength with each coming day.

  • Thanks for sharing Prof. Hope it’s helping you to do that, great to know things are moving forward. Rooting for you and hoping for good relationships with your rehab team for you. Another day done. 🙂

  • Oh, that Xray 😨
    Torpor is good. You need a Lot of rest to heal all your bumps, breaks and bruises.
    Old School Doctors are the Best. The Physical Exam should include Reflexes and not just rely on an X-ray Neurosurgeon or not. Plus, it can help the Patient focus on what’s not working right. Then Dr. Neurosurgeon can explain what Radiculopathy is (yes, even to You, Dr. Patient), patiently explaining the plan to correct or adapt to your new affliction. Also actions to promote healing and minimize post injury injury. Might get a voice to dictation box. Best wishes! Pt, OT, speech eval, physiatrist next 😎

  • Dr. G. Your Not an old fart, if you think your an old fart then you will be, and you will recover to the best you will allow to remover. Stay upbeat and positive as you are.

    After having cervical surgery things you’ll notice more, especially being now that your on the receiving end of medicine. This is going to make you more aware now than you were before.

    I can tell you from my own experience of being a nurse, and pursuing my PA and the diagnosis of MS. Just remember my friend your body and Spine already are I’m recovery, What has once moved smoothly is now looking for a temporary way to compensate until your full recovery. You are by the mentally strongest person I know. You can do it, and defy what you may think is against you.

    When I was diagnosed with MS my friend and Neurologist thought I would never walk again in 2005, I said to him no WHEEL CHAIR AS my team tbrougt I would and said just a single point Cain and PT will be fine for now. He agreed against his better judgement and gave me 3 months for re-evaluation . it took more than 3 months but wouldn’t you know it with a positive attitude I don’t need a wheelchair. Stay positive and I am looking forward to reading your post.

  • Thinking of you and your painful journey. I have found that medicine seems to have lost its “touch”- I used to work with docs who would never ever touch their patients, even to the point of not taking blood pressures on the hypertensive (or allowing the nurse to do it, oddly). I feel we are slipping into relying on the “machine that goes ping” technology and not looking with our senses.

  • You got this! Your COVID19 prehabiliation will serve you well for a speedy recovery. Sending well wishes and prayers your way.

  • Prof G,

    I feel sorry for the neurosurgeons having you as a patient. Remember you are a patient and need to act as one. Neurosurgeons are the good guys / gals of neurology – many of their patients get better.

    You need to stop feeling sorry for yourself. You are in good hands at King’s. In a relatively short period of time the pain will subside, you will start to heal and you’ll get your old life back (not something that can be said for progressive MSers). I wish you a speedy full recovery.

      • I don’t want anyone to suffer. I’m saying that Prof G is now a patient and must follow the advice of his doctors / nurses. It must be tempting for Prof G to review all his x-rays / go through his medical notes with a fine tooth comb etc. but he needs to rest and let his doctors use their skills / experience to get him better. I suspect that giving up this control is difficult for Prof G.

        • I completely disagree! Dr. G is laid up but I have no doubt his brain is Fully Engaged. He is Capable and Should review every aspect of his care and Assert his Authority like Any Human has the Right to. Him Giving feedback to Doctors isn’t wrong, it is Essential! Participating in the plan? I expect no less.

  • I am afraid you are now on the receiving end of the NHS and will probably find out first hand what the rest of us already know. The NHS is not what it was . All my newly retired GP and consultant friends are now seeing what their old practice / hospital has become by being a patient for the first time . Salutary and dispiriting for them….but the writing has been on the wall for years ..and yes they would say they have becoming miserable old farts …but the scales have dropped from their eyes .
    I have been miserable about it for years . And you won’t be an easy patient but you are right .

  • Any of us with nerve pain curtesy of MS really can sympathise with you!
    Gabapentin helps keeps the worst of mine at bay and I hope all your meds do the same whilst you wait on/undergo rehab.

    … maybe use of terms such as ‘jerk’ isn’t recommended, even if it’s via your facial expression or tone of voice.
    You’ve all got rather sensitive images of self as clinicians – best keep em sweet as the one who’s currently at their mercy😉

    Glad you’re keeping in touch with the Blog as it’s nice to hear from you – hopefully with ever increasingly progress reports!

  • Happy to hear you’re on the mend albeit slowly!
    I totally agree with you that the Neuro Team should be checking out other things like reflexes etc.

    Personally I had a massive MS T6 Spinal Relapse in September 2019 that left me with all sorts of problems; neurogenic bowel & bladder, balance, mobility as in unable to stand or walk unaided, loss of feeling in my abdomen and legs, severe abdominal distension and pain and back pain. (I should just mention that I had been pretty stable for 23 years, with no major relapses) all this started with an MS Hug! For some time I had been telling my Neuro & MS Team there’s more going off here not just MS only to be told it’s your MS. Well 15 months on I’m still suffering with severe pain etc., together with new symptoms a bpm that can spike up to 133 and within seconds drop to 39, my blood oxygen levels keep dropping also and has fallen as little as 78 (all this can happen whilst resting in a chair within a matter of seconds) investigation is now underway with the spinal injuries unit to see if I have Autonomic Dysreflexia, or it would if it wasn’t for covid-19 and the fact we’re in the middle of a global pandemic.
    So all that being said I definitely agree that not everything should be put under one label and everything should be investigated, as no body knows their body like the patient.
    SO YES I TOTALLY AGREE WITH YOU!!

    Hope you get well soon.
    Gill 🙂

  • I’m sure they do know what’s wrong. So do you, but you’re not an old fart, just a grumpy in pain neurologist. You’ll soon get your old joie de vivre back again. My husband was 31 when the school bus whacked into him crossing a Cornish granite bridge (the bus was. He was leaning over it minding his own business). He was told he was lucky because he had youth on his side, but still it took a year. The Western Morning News kept his job for him, but as he lived on his 32′ boat, he had to find somewhere ashore when they discharged him on a zimmer. He was cycling to work after that year though. I’m sure that things have moved on since his RTA in 1981. After all, there were no MRIs. He’s almost unaffected by the accident according to the orthopaedic surgeon he saw last year. Everyone is different, but with the best diagnostics and treatment I really hope your recovery will be full and fast. It’s quite surreal sharing your scans, but it does show another side (or is that another layer) of you. Seriously Prof G, get well and at YOUR pace. Do what the team, your wife and the nurses tell you, even if it’s frustrating. I’m raising a glass to you tonight; not a premier cru, but a respectable merlot!

  • Seems you are a do-er and this must be hard to endure being in the patient mode. If you want to be “active” without pushing it too far, check out qi gong and yoga breathing exercises for healing. Roger Jahnke wrote a book a long time ago about qi gong and healing that you can get used for about 2$. There are lots of movements you can do lying down or in a chair. Don´t let the fascia get ya. May your pain med-free day be coming soon.

  • Gavin, You’re partially correct. I read your piece; big data is only a threat if we use it inappropriately. And guess what—we’re using it inappropriately. A lot of our clinical ‘gestalt’ was simply wrong; but the term “data-driven” is more wrong still. I disagree with your contention that “In the current era technology and big data trump clinical skills and human knowledge.”
    Clinical reasoning is still more important than ‘big data’ because good clinical reasoning is based on good science—hypothesis generation, testing, and provisional acceptance as ‘true’, where appropriate. Current tools used for manipulating big data do not accommodate causality, and thus can’t trump good science. These tools need to accommodate Judea Pearl’s second and third layers (causal inference and counterfactuals) and they simply don’t.
    Get well soon., and go easy on the gabapentin ( https://pubs.asahq.org/anesthesiology/article/133/2/265/109137/Perioperative-Use-of-Gabapentinoids-for-the )
    Regards Jo van Schalkwyk.

    • Thanks Johan. Hope all is well. I wrote the piece more than 2 years ago. I agree the price is issues are as always more nuanced. I have noticed that since we were trainees, when we spent more time with patients and less time on the patient record. This has now been reversed let’s hope we use the encoded data more intelligently.

  • Relevant only to lifting your spirit and refreshing your strength as only music can, Prof G…

    “Soulshine” performed by Allman Brothers



    When you can’t find the light
    That guides you through a cloudy day
    When the stars ain’t shining bright
    You feel like you’ve lost you’re way
    When the candle light of home
    Burns so very far away
    Well, you got to let your soul shine
    Just like my daddy used to say

    He used to say soulshine
    It’s better than sunshine
    It’s better than moonshine
    Damn sure better than rain
    Hey now people, don’t mind
    We all get this way sometime
    Got to let your soul shine, shine till the break of day

    I grew up thinking that I had it made
    Gonna make it on my own
    Life can take the strongest man
    Make him feel so alone
    Now sometimes I feel a cold wind
    Blowing through my aching bones
    I think back to what my daddy said
    He said, “Boy, there is darkness before the dawn”

    Let your soul shine
    It’s better than sunshine
    It’s better than moonshine
    Damn sure better than rain
    Yeah, now people don’t mind
    We all get this way sometimes
    Gotta let your soul shine, shine till the break of day…

  • Oh Prof G, I am pained to hear your experience. I’m sure most can understand that the experience of being a doctor turned patient adds another layer of mental anguish to the situation. I was a professional accustomed to scheduling and facilitating meetings of some import when MS decided to take over my scheduling, indefinitely. I found Advocating for myself is very important and has been important to meeting my quality of life needs. If you don’t advocate for yourself then who will? Two books that have given me solace and confidence to continue to be my own advocate are: “my stroke of insight” by dr. Jill bolt Taylor and “rowing without oars” by uilla-carin lindquist. Dr. Taylor, a neuroanatomist, doesn’t sugar coat what’s it like to suffer a stroke and the challenges a dr encounters on the long road to recovery. Dr. Taylor is a fighter and her book is inspiring. Ms. Lindquist is a famous news person , who succumbs to ALS. Tuesday’s with Morrie, it isn’t. But it is a daily journal of sorts detailing her daily struggles for dignity and achievement of small joys on her journey. Both are relatively short if you have someone to read to you, or may be available by audio. Regardless, hearing these or other similar stories of illness and persistence should help make feel less alone. Because you are not alone and we are all rooting for you. 🥰

  • I have a recurring injury at C5/6, the result of trying to turn over during the night without leg/abdominals to help the manoeuvre (incomplete relapse recoveries). It is excruciating at times and causes pain and weakness in my left arm and shoulder. Obviously nothing like your injuries, so I can’t imagine the pain you must be in! Glad you’ve been patched up and screwed back together. I hope your concerns are being taken seriously and that you get good rehab opportunities.

  • “Do you agree or have I become a grumpy old fart?”

    False dichotomy – it’s perfectly possibly that we agree you’re correct and also that you’re becoming a grumpy old fart…

By Prof G

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