What would you do?
Voltaire said in 1733 “Judge others by their questions rather than by their answers.” My French friend also said; “The art of medicine consists in amusing the patient while nature cures the disease.”
A few years ago I experienced a sharp pain that ran from my jaw, down my left arm while a huge vice was choking the life out of my chest. I was told it was a Heart Attack (MI) so a Cardiologist cared for me.
Several months ago I had the same kind of pain but this time it ran down my left leg and felt as if several knives were jabbing, cutting and twisting my calf muscle… my family doctor sent me to a specialist – a neurologist. Why, was something wrong with my Neurons?
A heart attack I can understand. My heart... my ONE heart is about the size of a clenched fist and centrally positioned so when that is the problem it is easily located. Fixing it is another problem but locating it is the easy part. Neurons are a whole other ball game. While there are roughly 100 billion neutrons in your body finding the one or two troublesome neutrons definitely requires a specialist. To put the number Billion into perspective think zeros; thousands = 3 zeros; million = 6 zeros; billion = 9 and trillion = 12. So 100 Billion looks like this 100,000,000,000. I sometimes get a nose bleed talking trillions but those with a need to know here it is. Does 100 million equal 1 billion? NO.. A billion (1,000,000,000) is one thousand million (1,000,000). And one trillion is one thousand billion. Don’t feel bad if that number scares the hell out of you because those in Washington do not yet realize the scope of just what they are doing. I worked in Washington for 24 years and during that time meet and was friends with many still in high elected office. Over lunch one day in the Pentagon cafeteria I asked one of my senator friend, “…did he ever consider what he did affected many families and lives for many generations?” His look and response surprised me when he said, “…What I do isn’t money and lives to me…it is just a way to keep score.”
The human nervous system is an intricate and complex network of fibers that impenetrate the entire body and functions in complicated and often mysterious ways. Sophisticated imaging and laboratory tests do not always provide sufficient information about how the nerves are functioning so enters the specialist. The neurological examination is a series of simple questions and tests that provide crucial information about the nervous system. It is an inexpensive, noninvasive way to determine what might be wrong.
One of these tests is a common needle. Using a sharp instrument (a sewing needle, an open safety-pin, etc.) The neurologist strokes or scratches, heel-to-toe, the outer side of the sole of the foot and in patients over the age of 2 the toes normally curl downward in response. If the toes fan upward, a brain or spinal cord injury is indicated. A simple test but a clue toward what could be a major problem. If there is no response whatsoever that is also an indicator of others problems.
Most of us take our ability to walk for granted. But as simple as it may seem, walking is a very intricate physiological process. How we walk - our gait - is influenced by a number of bodily mechanisms and nervous system reflexes. The body must be held erect; the limbs, head, and trunk must be held in the right position; the person must be oriented to the position of all body parts; parts of motor control involved with moving must be integrated; and so on. Kinda like a controlled fall but staying upright. Because walking depends on so many different parts of the nervous system, it can be affected by a variety of neurological disorders. Why am I telling you this? The first time a neurologist asked me to take my shoes off and walk across the room I thought he was a pervert. The next two trips across the room where he had me walking on my heels over and toes coming back reinforced that thinking. At the time I didn’t have a clue he was taking notes as to my neurological makeup AND my problem left leg.
If you watch any Crime and Punishment TV shows or old enough to remember Perry Mason you might relate to lawyer type questioning, if not, the first or next visit with your neurologist you will know how a witness feels when what you say, your words could mean additional pain to your already throbbing left leg.
Not all people are created equal – For example; others do not think the same as you and most importantly; others do not know data and information the same as you so when a question is asked of you, chances are the other person is trying to get information you know and he/p him know and understand you better..
The ONE question exception is; how are you?
How are you is a question in the English language and requires an answer. Listen to yourselves and others to include your elected officials and Radio, TV and Movies personalities this universal question is used as a greeting. Those that do answer the question have set or pat responses. “I’m well thank you; …fine, thank you… how are you?” Now… listen closely and you will hear those that launch directly into conversation as if the question was nothing more then a means to getting their mouth moving.
OK. That was my one pet-peeve of people and languages and I had to mention it so I could concentrate now on telling this story.
What would you do?
A number of years ago I ran into a few medical problems and as I was making repeated trips to the hospital and doctors offices I was being exposed to new or foreign (to me anyway) words, acronyms and aches and pains so I passed alone to you, those I could anyway in the form of a Short Story; I think one of them was titled; MRI or CAT. Worth your time reading when you have time.
Here I am again.
I am your basic normal male, long in tooth but with a military backbone and stance. I have a degree in Architecture but haven’t practiced in close to four decades. I am worlds different than my brilliant Neurosurgeon that has as a minimum, a medical degree, is Board Certified and 17 years practical experiences diagnosing and making well thousand of simpler folks with horrific pains running throughout their bodies. One beautiful summer morning a couple weeks ago I experienced in my 3 ½ hour waiting room others that I could only imagined experiencing the same pain like mine. All those that went before me were wearing overalls, cut-off jeans or trousers from the Thrift Shop, oversized blouses mostly without bras mainly because I’m not sure the garment industry produces 58DDDD sizes. I’m equally sure those men wearing trousers, long ago gave up wearing a belt and stayed exclusively with your stylist 2” colorful hand-me-down suspenders. When you haven’t seen your feet in years it’s best to go with practicality over style that wins in this neighborhood nine out of ten times.
A beautifully engraved wooden sign gracefully attached to the wall behind Frank’s chair read, “Whether medicine is an art based on science; or, the art of medicine will be answered before leaving this office.”
Pain does not know pedigree, gender, and age or ethic group.
While touring sunny Vietnam in 1969 I was a bit too close to an incoming mortar round and experienced what, at the time, I thought was the worse possible pain that left me with a 19” jagged scar across my mid-section, commonly called ‘gut’ but I was wrong about the measure of agony something as simple as a nerve can cause.. You don’t necessarily need be a combat casualty or a mother giving birth to know the pain I mean. If you have a sciatic (sahy-at-ik] nerve chances are you have already experienced the pain or will as your body, like mine, falls apart.
Now that you are thinking alone medical lines and medical terms I would like to pass alone a bit more on and about the medical field and profession of my now most favorite medical discipline; Neurology. Mother Nature being the lady she is and will undoubtedly continues doing things her way so whether we like it or want her to or not sit back and enjoy the next few minutes.
Neurologist – one who sticks needles in various part of your body to ascertain if you feel the prick? No pun intended. I apologize to those neurologists reading this story but before I did research for this story I thought your playing with the needles was just something you did to justify being in a higher income bracket from say, the gynecologist. I was wrong.
My protagonist character in this story I will call; Frank.
My antagonistic neurologist character will be CB Bonaparte (That’s the one – the little general from France that lived, loved, battled and moved around a lot between 1769 – 1821). In conversational dialog in this story I will refer to him simply as CB. I lived in Paris France for four years during my middle twenties and learned much about life plus I spend many long hours studying and standing next to his tomb in the Musée de L'Armée. My choose of character names will become apparent as the story progresses - promise. Maybe because I liked Napoleon or I was just jealous of the times he lived or the wars he fought or maybe it was because I had the honor of working in his old living quarters in his château in Fontainebleau. I could look out over the manicured gardens with its meandering stone walkways and the one meter deep water ways. My one lasting memory is of his cupola accessible only by a pole powered dingy where he took female guests. His private world was accessible to me through the heavy green painted latched windows where I pictured myself standing next to the little general as he viewed his personal guillotine during week-end entertainment punishment beheadings or simple walking his Rose garden paths and stepping on the same small round pebbles he and his first wife Josephine walked. I will not mention Josephine was older and much richer then Napoleon. But at that time in his life and as history records that period it said he needed to gain as much respect as possible and as soon as possible and marriage was a good way to do it. Josephine was no beauty queen as you see on today’s movie screen but a normal woman not born into royalty but there was old-money in the family. According to Green-back soft cover novels written and published on in French, Josephine had more bedroom experiences then Napoleon and actually had two children by a man that lost his head, not to love but to Madame Guillotine on a beautiful spring week-end in Fontainebleau.
My French friend was always chatting about people, places and things and the one lesson I liked most is when he said, “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing. Francois Marie Arouet Voltaire (1760)
The mid-Eighteens century was not a fun place to live if you intended to die from old-age.
My character CB also loved, battled and moved around a lot but with differences. Other then the time difference my CB is taller, not as combative, is a lot smarter and is a Medical Doctor (MD) that is board certified to work on your brain and your nervous system.
Picture the following scene in a typical doctor’s office 109 miles from the patient’s (Frank) home. Frank had followed Map Quest directions and had only made three wrong turns but did arrive 2 ½ hours early for a 1040 appointment. If you did the math here you know Frank left home before the chickens and the sun were up.
CB’s waiting room was similar to the bedrooms of Fontainebleau. Picture this; It was not until Josephine married Napoleon did she introduce the young General and the general populace of Paris to bathing and perfumes. If you ever walk the Rue De Pigalle or the Boulevard Voltaire you will instantly smell what I mean. French ladies do not wash or shave their legs or under arms and all other private parts were powered rather then washed.
Once you get use to the smell it actually isn’t too bad.
CB – “Good morning” (CBs thinking of frank; He’s old but at least he isn’t wearing overalls)
Frank – “Good morning sir.”
CB – “What can I do for you this morning? What problems are you having?” (Thinking; Hope he can articulate his symptoms and not just tells me something hurts). CB doesn’t know Frank’s symptoms as all had been detailed in a three page questionnaire Frank filled out last week and mailed it to CB’s office.
Frank – “My left leg hurts.”
CB – “Where?” (This looks to be fun)
Frank – Pointed to the outer side of his left calf and left hip as he said, “…started several months ago but recently gotten really bad.”
CB – “How bad?” (Hope he doesn’t say ‘excruciating’)
Frank – “Pain is now excruciating.”
CB – “How so, please describe?” (I think he just ruined my lunch)
By this time Frank realized CB was taking the questionnaire he had completed and was trying to get first hand and more thorough personal information. Frank had hand-carried the latest MRI images but he was finding out pictures are not necessarily worth a thousand words. CB wanted to hear those thousand words. As luck will sometimes have its day in the sun CB excused himself and disappeared around a corner. He had taken the CD with Frank’s latest MRI to a computer two doors down to see if he could come up with words and symptoms for Frank’s problem.
When CB came back into the patients room were Frank was waiting he had a light spring in his step and a friendlier disposition, “Come with me please.”
“Gladly.” Frank was on his heels while the last part of please was still hanging in the sterile air of a hospital.
The computer room was dark but that was good. Dr. CB was standing next to a bright screen that look initially to be black and white but was Dr. CB pointed to the different shades of grays, “…this is a nerve… the view is from the bottom so this side is your left…”
Frank was looking at his MRI images.
Frank’s years in the Pentagon and as a photographer and mapping instructor for the Army fit perfectly into what Dr. CB was saying and pointing out. Frank knew exactly what and where he was looking and what he was seeing. Looking at the MRI did seem a bit strange however looking at vein, muscle, nerves, bone and know the images are of you.
Finally… Relax Frank you are now on TV.
As Dr. CB pointed to the vertebra of the back he said, “…there it is. I believe that is your problem… a cyst.” Dr. CB’s finger was touching what looked to be a bubble on L5. Where was the bubble? Left side of the spine of course and touching the sciatic nerve.
Frank subconsciously reached toward the screen with an index finger and actually felt a twinge in his back were his finger was touching.
Frank was glad when they finally left the computer room and his MRI images but now in some way saddened.
You know what a cyst really is?
Are you interested in numbers about the human body? Try these on for size.
1. Our heart beats around 100,000 times every day.
2. Our blood is on a 60,000-mile journey.
3. Our eyes can distinguish up to one million color surfaces and take in more information than the largest telescope known to man.
4. Our lungs inhale over two million liters of air every day, without even thinking. They are large enough to cover a tennis court.
5. Our hearing is so sensitive it can distinguish between hundreds of thousands of different sounds.
6. Our sense of touch is more refined than any device ever created.
7. Our brain is more complex than the most powerful computer and has over 100 billion (remember 9 zeros) nerve cells. Normal people use but less then 10% of their brain’s power.
8. We give birth to 100 billion red cells every day.
9. When we touch something, we send a message to our brain at 124 mph.
10. We have over 600 muscles.
11. We exercise at least 30 muscles when we smile.
12. We are about 70 percent water.
13. We make one liter of saliva a day.
14. Our nose is our personal air-conditioning system: it warms cold air, cools hot air and filters impurities.
15. In one square inch of our hand we have nine feet of blood vessels, 600 pain sensors, 9000 nerve endings, 36 heat sensors and 75 pressure sensors.
One in twenty people have an extra rib, one in ten are left handed, one in three was born in China, one in eight was born in Africa, and one in four 'get mad' at least three times a month.
Getting back to what a cyst really is - A cyst is a closed sac having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery. (…these are not my words but Google’s and CBs.)
Back in CB’s exam room he explained what they were looking at and the consequences of leaving the cyst in place or an operation. The operation part blurred Frank’s thinking so Dr. CB repeated his instructions… and waited. Waiting was not CB’s strong suit and even being the noon-hour the waiting room was filling up again with more cover-alls and more huge people.
Frank knew his time was up but he needed to make sure he knew the next step because we are talking pain now and every word, every noun, adverb, constant not understood meant more pain.
CB – “Ok I’ll say it again” (the instructions, the problem, the next step, the operation, etc…) The next step was to be Frank’s call and would be an easy one IF he were pregnant. An Epidural anesthesia… but CB kept talking saying, “…that may or may-not help (meaning ease the pain), may help for a week or so or longer or may not help at all. THE Operation was even IFFIER but CB laid it all on the line. Damn.
According to CB THE operation was no-big-deal. A small snip here, a forceps grab there, a couple staples here and I am home free. What is my problem? I have seen too many folks that have had back problem operations that now have wheels for legs and no feeling below their belt buckles.
Do I hear any ED moans in the background?
What would you do?
The two hour drive home was not uneventful. Frank’s head was full of “What-ifs” and there just did not seem to have any clean-cut, black-white, yes-no answers.
Frank can control the majority of pain with drugs and he knows a few folks in the same boat. They tell him about ‘controlling the pain, the excruciating pain, drug addiction, about operations they have had, the fused or degenerated disc, etc... Actually all the bad stuff.
Frank has had his share of bad stuff is extremely gun-shy when it comes to his being cut on. Frank lost a kidney to cancer and other organs for an assortment of reasons but the bottom line he now does not have any spare parts. All remaining organs are necessary for life.
Side affects or by-product of drugs are many, such as; Legal Consequences, Health Consequences, Social Consequences and the one we just can’t get away from are the Financial Consequences. Some minor points to consider; constipation, organ-failure, can cause guys to grow breasts and girls to grow beards, can cause confusion, depression, sleep problems, intense fear and anxiety that can last for days or weeks, HIV, AIDS just to mention a few of the not-so-fun stuff.
Remember the one reaction few folks do not like to mention – Death.
It is decision time….
What would you do?