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February 2013
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May 2013

Call me "Tin Man"

“Right there,” says the neuroradiologist, poking her finger at the screen and sounding slightly exasperated.  “The enhancement is definitely worse there than on the March 25th scan.”  The neurologist leans in, looking back and forth between twin images of my spinal cord.  He shakes his head slightly. “I’m still not seeing it.” She enlarges the images. “Right there,” she says again. “It’s obvious.”

The neurosurgeon stands behind them, arms folded.  He says nothing. He doesn’t see it either, but he’s not the one who spends all day in a dark room looking at scans.  Maybe the enhancement is worse.  But he still doesn’t see anything he can cut.  And unless he’s sure what he’s going after he’s not going in.

At least, that’s how I imagine the scene a little while later as the neurosurgeon stands at the foot of my hospital bed explaining the current consensus (there are at least four world-class physicians working on my case).  I’ve been here since yesterday morning when my neurologist decided I needed another MRI.  I’ve been doing pretty well overall but the March 25th scan didn’t show the expected improvement in the spinal cord swelling.  And although two weeks ago I was walking all over Dublin after five days in Bournemouth, this past Saturday and Sunday I felt like I was struggling just to make it down to the end of my street.  So Dr. B. decided he wanted another image, and the fastest way to do that was to check me back into the hospital.  I’ve had nothing to eat since last night and no coffee yet today, on the off chance  that I’d need surgery.  I was as pleasant as I could be this morning to the three doctors and five medical students who crowded into my room to discuss my very interesting case, but now it’s going on 1:00 and I’m getting decidedly peckish.  So when Dr. O finishes explaining why he is not doing surgery, my only question is, “Does that mean I can have coffee now?”  He laughs.  “Yes, I’ll see that you get some coffee.”

That was Thursday.  Now I’m back home, waiting for the Home Health nurse to come by and infuse me with another gram of steroids.  Lynn has a list some twenty items long of diagnoses that have been considered.  Many have been discarded, but there are still a couple on the list.  (Think of what a waste of teaching materiel I'd be if I weren't in a big academic medical center!)  Without the exploratory surgery that Dr. O. definitely refuses to do they really can’t nail it down any further at this point.  So we’re treating it as an “autoimmune inflammatory process”.  Which simply means that my overeager white blood cells think there’s something wrong with the myelin that insulates the nerves in my spinal cord and are eating away at it, causing severe inflammation and swelling at the neck.  To put it simply, there’s a short circuit in my spinal cord.  When my brain tries to control my legs or hands, the signals get scrambled.  If I try to make a fist, the muscles on the backs of my hands start to contract as well, attempting to pull my fingers straight when I’m trying to clench them.  Makes forming chords on the guitar damned difficult.  Similarly, when I try to move a leg forward, some of my hip muscles are trying to pull it back, giving me what Lynn refers to as my “Tin Man” walk.  I can do most of what I want to do – it just requires some extra conscious effort.

The very cautious plan we’ve been on so far has been no treatment – let’s see what the body does on its own.  The latest MRI suggests that the body needs some help.  So we’re starting a regimen of steroids and a mild immunosuppressant.  That should help.

And in the meantime, of course, all the rest of life rumbles on and I remain a generally happy guy.

Work is good, and Lynn is ever her amazing strong magical self (she was with me the entire hospital stay and, seriously, we had a fine time).

The Bearded Pigs play Boston a week from tomorrow!

Josie came in 3rd on beam at the Regionals meet at Clemson on Friday morning!  Woo-hoo!

It’s a lazy Saturday in Birmingham.  I have no complaints.

 


Bournemouth

Look out the window one direction and there's the ocean at the end of St. Michael's street. Look the other way and half a block down is the Shamrock Bar where the footballers were gathered yesterday until late into the night. Through the alley across the way I can see another intriguing Terrace Bar similar to the one that fronts our own hotel. Right below us is the fancy Thai restaurant. Early this morning we were awakened by three spaghetti strap girls giggling and flirting with a couple of young men out front.

It's a breezy, partly sunny Sunday in the south of England. In an hour we'll meet Dr. Snowmoss for Sunday lunch and then go exploring.

We took the bus down from Heathrow yesterday afternoon after an easy flight across the Atlantic. I'd hoped for more scenery, but we were on the motorway most of the way and the sound bafflers blocked most of the view. We were, however, amused at the sheep industriously trimming the grass on the embankment as we left Heathrow.

As our cab took us from the bus station to Highcliff House, past the arcades on the waterfront, Lynn said -- "It's Atlantic City. Without Trump." And it certainly does have a bit of that feel.

After a walk around to get our bearings on the nearby neighborhood, we drank whisky on the hotel Terrace, letting the sunshine wash the jetlag away until the chill wind off the water pushed us into the warmth of the Lounge. And then, later, a superb dinner in the Highcliff Grill. I told my waiter it was some of the best lamb I'd ever had. He smiled indulgently, "The secret is simple -- fresh and local."

I drifted to sleep, thinking of all of the different cities that Lynn and I have spent time in over the past two decades. We are here now because someone thinks it's worth listening to me talk for 30 minutes on Wednesday to close the conference. I wonder what I'm going to say.