The Story of Andrew\'s Myelopathy

[FONT=Arial]Below is a copy of the email I sent out today, followed by a detailed account of what happened. I have posted it here, as I am getting tired of telling the story, and if people really want to know - everything is there. Enjoy![/FONT][B][FONT=Arial] ______________________________________________________[/FONT][/B][B][FONT=Arial]THE EMAIL[/FONT][/B] [FONT=Arial]Dear Friends,[/FONT] [FONT=Arial]I just wanted to drop you all a quick note to let you know what happened and how I am doing now.[/FONT] [FONT=Arial]I first wanted to thank you everyone who called / dropped by / sent things for Ange & I. I especially wanted to thank Bill & Dawn, who helped me get in touch with Chris Bailey, because as of Saturday night, I had lost all objectivity, and was waiting for a clinic appointment with Neurosurg “sometime next week” (I didn’t want to be a “bother”… idiot). Lastly, I wanted to thank all of you who picked up the shifts I am unable to work – I will be eternally grateful. I will admit I feel somewhat guilty about all of this, as many of you know, this is not the first time I have been sick and had to give up shifts on very short notice – I realize none of this is my fault, however I just thought I’d mention that (I know its ridiculous to be thinking that – but I sometimes have little control over what my brain decides to think).[/FONT] [FONT=Arial]As far as what happened… it was not an attack of acute fibromyalgia (as Derrick alleges), but an acute cervical myelopathy. I actually had fairly classic Brown-Sequard syndrome, and prior to my MRI, I was sure I had MS (more of my crazy brain syndrome). Chris Bailey did an anterior cervical discectomy/fusion on Saturday night, and I am doing well. I have not recovered all of the motor function in my left arm, and the sensory symptoms have not abated, but I am doing much better. I’ll leave the details to a post in the forum. I figured if people really want the details, they can read all about it there.[/FONT] [FONT=Arial]I am not sure exactly when I will be back to work, however Chris has told me it will be at least a month. I have to wear a c-collar 24/7 for 4 weeks (I am hoping to talk him out of that) and I cant lift more than 10 lbs – which means not only can I not intubate someone, but I cant drive! Bill had suggested doing some urgent shifts when I come back at first, and when Chris gives me clearance, I will start back with regular shifts. I plan to make up those shifts I had to give up, unless someone else has another plan.[/FONT] [FONT=Arial]Finally, speaking of intubation, I had mentioned to several people (other consultants, residents, RNs etc) around the time of my surgery, that I was worried about being able to intubate people (I was still - in my mind – working the next day) as the weakness had affected my “intubating” hand. Many, if not all of them responded with “oh… so you’re left handed?”. Thank goodness these people don’t have to intubate anyone.[/FONT] [FONT=Arial]Thanks again to everyone for their support.[B] ______________________________________________________[/B][B]THE FULL STORY[/B][/FONT] [FONT=Arial]OK people – so here’s the skinny. I have had trouble with my neck on and off for about a year (or so). A little bit of neck pain, and mostly radicular pain down my left arm and parathesiae into my left hand (mostly my thumb and index finger – quick… what dermatome is that?). I had sustained no trauma (that I recall) in the past, and had not had symptoms like this previously. At Angela’s insistence, I went to see my GP about it in August, as my symptoms had become more persistent, lasting hours at a time (nothing that a couple of Advil couldn’t fix however). He sent me to see John Kay (a neuron in town) who did an EMG (which was normal) and offered the obligatory MRI of my neck. I had no interest in surgery, and so he & I agreed that we would leave it and if it got worse, I could call him to arrange it. That was Sept 16th.[/FONT] [FONT=Arial]So last Thursday (Sept 28th) I got up and noted that my left hand felt “funny” – no longer a sensory complaint, but also not really weak – just different (I really couldn’t describe it). Friday AM I head to VIC for my weekend of early swings, and I head to keyboard to login, and I cant type my password with my left hand. I thought that was odd, but honestly wrote it off as fatigue or something equally as silly (you all know how much I love mornings). As the day went on, it was pretty clear to me that my hand was actually getting clumsy, and that unless I looked right at my hand, I had trouble controlling it. I spoke with Dawn at this point (~ 1600), who told me that I most certainly needed an MRI of my C-spine, and suggested I call neuroradiology. I subsequently spoke with Trevor Kotalak who agreed to do the scan first thing in the AM.[/FONT] [FONT=Arial]That evening, I am giving Adrian his bath, and as I get up, I note that I cannot really feel my [I]right[/I] leg against the tub. Hmmmm…. that’s odd I thought. It didn’t actually occur to me what was going on until ~ 2300 that night, when it occurred to me : “holy shit… I have Brown-Sequard syndrome!” So I went to the textbooks to try and figure out if there was something you had to have to Brown-Sequard to try and exclude the diagnosis. My case was actually fairly classic – as many of you know B-S is rarely seen in its pure form. So then I hit the DDx, and of course all the really good Dx are there – metastatic Ca, transverse myelitis, MS, and many other random demylinating conditions. I thought for sure I was done.[/FONT] [FONT=Arial]Off to work Saturday, and I had my MRI @ 1000. I had a brief look myself, and I could see that I had a huge disc @ C5-6 that was significantly impinging on the canal. I got the official report from Kotalak @ ~1200, who told me that not only was the disc impinging on the canal by ~ 75%, but that I had signal change in my cord – “You better have that looked at sooner rather than later”. At this point I agonized over whether to call NSx or Ortho. For the brief time I spent as a neurosurgeon, I was led to believe that the orthopods should never operate on a spine (because they were “like monkeys with tools” if I recall correctly). So after hours of debate & consultation with Dawn, I went against her advice and called NSx (~1730). Fawaz Siddiqi was on, who told me that Neil Duggal was not on call, but that’s who I would want to operate on my spine. He offered me a clinic appointment Monday/Tuesday. Sounded like a long time, but I figured he knew what he was talking about (I had told him about all my symptoms and the signal change).[/FONT] [FONT=Arial]By this point in the day, I had actually started dropping stuff from my left hand, and I was finding it a bit of an effort to get out of a chair. Over the last hour, I had also noticed I had been peeing quite frequently, and that there was some hesitation (it took me about 30-40s to start “going”). After a few more moments of thought, I became quite uneasy about waiting until Monday (or Tuesday) and went to go talk to Bill – who had just started the late swing. After telling him the story he asked me “What would you do if you had a patient with these symptoms? Would you be happy with clinic on Monday?” I told him or course not, and so he picked up the phone and called Chris Bailey, who was on call for Ortho. He happened to be in the hospital, and he actually came down in about 10 min. I gave him a brief history, and after looking at my MRI, he turned and said “when did you last eat anything?”. Yikes.[/FONT] [FONT=Arial]The rest is history. I went to the OR that night @ 2200 for my anterior cervical discectomy / fusion, after many failed IV starts by no less than 3 RNs (including Lu) and one consultant. I am doing better now with most of my neuro symptoms resolving. My lower extremity and bladder symptoms are gone, and while I still have some of that “clumsiness” with my left hand, I am finding it easier to type these days. My entire right side from the shoulder down is still “numb”, and Chris said this is the last thing to come back after cord compression (and may not return completely) – but I can live with that.[/FONT] [FONT=Arial]If anyone still had questions, they can be directed to[/FONT] [FONT=Arial]Cheers,[/FONT] [FONT=&quot][FONT=Arial]AEJ[/FONT] [/FONT]

Andrew We are praying for a rapid and complete recovery. Yours would make an excellent autobiographical case report for the CJEM. It demonstrates an excellent first hand account of the natural history of a problem that has a subtle onset and confusing signs. It also demonstrates the difficulty we have as emergency physicians in advocating for our patients, even when the patient is ourself, and the trouble with objectivity we can have when our patient is a friend or family member, especially ourself. You did a better job than I might have done, and I am thankful for Dawn’s and Bill’s wisdom in guiding you. Roy

Andrew Just an astounding story. Thank you for sharing it. It is truly instructive and truly scary to see what you went through. My best wishes for your recovery. Amit

What an ordeal. I hope things have continued to improve for you post op. Let me know if there are any shifts you covered next month, I’d be happy to help out.

[B]UPDATE[/B]Things are moving along just fine, and I have been weaning myself out of that damn collar (finally). I see Chris (Bailey) again tomorrow and based on our original plan, I am hopeful he will give me the thumbs up for work this weekend!Thanks again to all who sent things, wished me well, and of course - covered my shifts. I am hoping to make up some ground before the year is out, so if anyone has any shifts they’s rather not work, I’ll have a look at them and see if I can fit them in. I will be doing urgent shifts for the first bit back, but after 7-10 days, I figure I should be as good as new.AEJ