The Stethoscope

Road blocks causing paralysis

I met this fine gentleman accompanied by his equally fine wife. She was walking behind the nurse, giving instructions related to the care of her husband. The said man was seated in a wheelchair looking seriously disconcerted.
Pray, what is the matter?

Mr Man would not talk to me directly preferring for his wife to narrate the story. A shocking story of headaches and dizziness treated for weeks without relief. Then slowly and additionally, he added on numbness of the hands and feet. Incrementally, he had also gradually lost power in his hands and legs. So, now he could no longer stand without support. In a short period of a few days, he could no longer raise his legs off the bed and was unable to walk.
Hence the wheel chair.

A previously fit and fine man rendered dis-abled in a short 6 weeks. He suffers from diabetes and hypertension so had ended up with the cardiologist, Dr Achilihu. The good cardio man evaluated him in depth and cleared his heart, of course. He also requested for an MRI scan of his neck. This is the gold standard in evaluating a patient with weakness of all 4 limbs.
Pray, what is the matter?

This is arthritis in the neck and we call it cervical spondylosis. Or in this case, with its severity, we call it cervical myelopathy. Don’t worry about the big words. I will break it down for you!

A patient complaining of pain in the neck, weakness of an arm or a leg and difficulty walking may have arthritis in the neck. This can put pressure on the spinal cord. The spinal cord send signal to the skin and muscles. If there is no signal then, paralysis of the muscles and numbness in the skin ensue.

normal spine

This is like someone being sent on an errand and getting stuck in traffic due to a road block. Similar to one of our Police checkpoints. As you know, this could lead to serious traffic jam and a long tailback. The message therefore arrives late, if at all. You know as well that the message can only arrive if the checkpoint is cleared or removed. Then, the traffic will flow easily and the errand can be delivered.

The MRI scan

MRI scan machine

The MRI scan revealed an obstruction in the neck in my chap. The bones in the neck had worn away the shock absorber and this was now causing pressure on the spinal cord. This is the reason for the weakness in the arms and legs. It is also the cause of the numbness which he describes as ‘cold as ice’.

MRI scan showing pressure areas

An urgent operation was required. We needed to clear away the police checkpoint and remove the obstruction. This would relieve the pressure on the spinal cord so it can wake up and continue doing its job of moving the arms, legs, and enabling us to urinate easily. Pressure on the spinal cord can cause all sorts of problems. Some people have sharp lancinating pains, shock-like sensations and wicked feelings of ants crawling all over the body. Weird and horrible sensations of heat in the body like one is being fried with pepper like kilishi can also happen.
Anyway, who is talking about food?

The last thing you would be interested in is food. Many of my patients cannot do their buttons let alone feed themselves. just imagine someone else helping to clean your bottom. And you are not even a king. The thought stops some people from eating!
Good news though.

This is an x-ray showing clearance in theatre.

The operation can be easily accomplished and the results are good in the majority. It is better if the operation is done early before the spinal cord is permanently damaged. Left alone, this condition can kill and I have had some bad experiences with patients who refused surgery. In one case, the family wanted local treatment at the herbalist.
Oh well!

But now you know and you will avoid going to the pastor, traditional bonesetter or herbalist with this type of problem. Remember, this like a road block and it often needs to be dismantled to restore order!

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