Gerda’s temporary inability to walk diagnosed—”A glass key: be sure it doesn’t break in your hand”

Featured image: The Glass Key, René Magritte, 1959. It portrays a cracked (bottom left edge) boulder “floating” just above where the stone balances on the mountain ridge. There is no glass in the painting. I the painting’s title, Magritte intended for “glass” to be symbolic for “fragility,” the boulder for “key.” The artist thought about the painting’s name for three years, dismissing 50 titles before finally calling it after the novel by Dashiell Hammett. In the way the hardboiled detective unravels an enigma, the phrase “the glass key” suggests a paradox—something meant to “unlock” a secret, but rendered inherently fragile or impossible to actually use.

Title: Quote from Dashiell Hammett’s novel The Glass Key

Seeking a diagnosis for the short-lived immobility of my legs

I posted my last blog on May 11th, the day on which I had an appointment with my spine surgeon to discuss the incident when I was in the bath tub and both my legs went lame. Why Dr. Spiker? Why not go directly go the emergency room as the internet adamantly suggests?  The basis of our choice was the research my family had done for possible causes that matched my symptoms. The first finding, 1), was that they could have been caused by a mini stroke (transient ischemic attack or TIA) at the site from where leg movements are controlled in the brain. We soon ruled this out: since both my legs were involved, it would have required 2 simultaneous  mini-strokes, one in the left- and one in the right brain. My left-brained family considered it a statistical impossibility. The second, 2), was that I might have had a pinched nerve in my spinal cord. The injury’s location in the spine led us to decide on Dr. Spiker, who knows at least 6 inches of my vertebral column inside out.

I have caudal equina syndrome in my what?

Peter and I spoke to Dr. Spiker and one of his team nurses, Victoria. It is not an exaggeration that they each in turn looked thunderstruck while we were explaining the incident. However, Dr. Spiker was not fazed.  He was familiar with patients who’d had both legs paralyzed with similar symptoms: the blood flow to the nerves that control the legs had been temporarily interrupted, thereby lowering the nerves‘ oxygen levels “to the point where they could not match the metabolic demands of the lower extremity musculature.” Translating the med-speak, Dr. Spiker said I’d had a mini-stroke in my spinal cord, right where the nerve bundles controlling the legs were  located. For medical turf purposes, neither vascular- nor nerve issues fall within the specialty of a spinal surgeon. Accordingly, Dr. Spiker referred me to a  neurologist for MRIs, CAT scans, and neuropsychological testing to pin down the specific origins of my temporarily paralyzed legs. At his mention of these diagnostic methods, I balked: I’d had enough MRIs, CAT scans, and neuropsychological tests for one lifetime.

“Here, take this pencil. We taped some sudokus to the ceiling in there to help you pass the time.”

I was extremely lucky

The nerves that enable standing and walking are in the lumbar area of the spinal cord. I was extremely lucky that my mini-stroke was just a small transient blockage of which the worst effect, temporary paralysis, was over in about 20 minutes. Had it been a large clot, my legs could have been permanently incapacitated. The higher up the spinal cord a stroke/injury occurs, (whether mini or maxi), the bigger the damage to the torso and/or limbs.  Since my injury apparently happened in lumbar area of the spinal cord, “only” my legs and feet went lame. The diagram below shows that the extent of paralysis depends on the height of the injury site along the  spine. The higher up the injury, the greater the part of the body between-injury-and-feet will be paralyzed.

But there are unlucky facts too

The fact that my dementia is caused by micro-clots in my brain indicates that clots of any size—micro, mini, or maxi—can form anywhere in my vascular system. Anytime. And to people who’ve never been aware of a clot. Dr. Spiker said that a “mini stroke” is a warning sign that additional strokes—micro, mini, or maxi—and possibly more disabling strokes might occur within five years after the mini. When he told us to see a neurologist for more brain imaging and neuropsychological testing, I said I was not up for more diagnoses for my brain and/or spine. Besides, I was already taking a handful of anti-clotting etc. medications for my vascular dementia. Dr. Spiker and Victoria said they could understand our decision in light of our philosophy that every person should determine their criteria for what a worthwhile life looks like for themselves. If their life situation drops (or might likely drop) below their acceptable level, it is perfectly understandable if they refuse treatment.

While eying me covetously, Zeus stocks up on lightning bolts (adapted from Michaël Renard’s Post)

Should YOU have a “mini-stroke,” immediately go to the Emergency Room

Mini-strokes or TIAs aren’t called mini because they aren’t serious. They should be treated like a medical emergency because they can act as red flags that warn of the possibility of future full-blown strokes. Neurologists will investigate your brain and vascular system via history, imaging, and neuropsychological testing. If the doctors find lesions that indicated a former blockage, they will warn you that future strokes might occur in future; they will prescribe a daily regimen of medications and/or lifestyle changes tailored to your specific needs. These might include antiplatelet drugs (aspirin), anticoagulants (blood thinners like warfarin), blood pressure medications, and cholesterol-lowering drugs (statins).  Mayo Clinic

Detail of Francisco de Goya’s Self-Portrait with Dr. Arrieta (1820), in which the artist portrays himself as a frail patient clinging to his bedsheets, slumped backward while being gently supported and urged to take medicine by Dr. Arrieta. The bottom of the canvas features a moving text: “Goya gives thanks to his friend Arrieta: for the expert care with which he saved his life from an acute and dangerous illness which he suffered at the close of the year 1819 when he was seventy-three years old. He painted it in 1820.”  Goya would live for 8 more years. He died of a cerebral stroke in 1828

“there are good times yet to be lived”

In six of my most recent blog posts, I have belabored my back pain, my anxieties about more surgery, and my here-today-gone-tomorrow recovery. I have naturally (for me, at least, it’s natural!) thought of my overall health and whether I still regard my life as “worthwhile” despite the roadblocks Peter and I face. I also spoke about my fear of missing the window when I can still do everything it needs to take my own life when I decide my time has come. From responses to my blog and the reaction of people to whom I talk in person, I’ve become aware that my written examination of this usually-not-talked-about-topic can be interpreted as an announcement that I no longer want to live. That is not the case. While I have motivation-less, black dog days, at other times my life is still rich in kindness and love. Awe of our own “pale blue dot” still melds my Self with the earth, the sky, the universe. Most of all, my Being is uplifted by “the Holiness of the Heart’s affections,” as John Keats wrote to a friend.  I, too, am lucky enough to have friends who say just the right thing in relation to my recent dark days. To end, here is a most loving statement my friend Kimarie, wrote: “Only you can know when enough is enough, or if there are good times yet to be lived.” Yes, Kimarie, there are good times yet to be lived…

Marc Chagall, Birthday, 1915. Chagall said that the primary color of his paintings was “love”