Walking is Nice

CP is getting now to where she just can't walk. She is 89 years old. Mostly she is in a wheelchair, but can get up and walk a little way (ten or fifteen feet) if someone is there to help her. She has been slowly getting worse over the years. She was diagnosed with neuropathy, before seeing me. I confirmed that diagnosis. It does caues trouble walking, and her examination is consistent with that. Recently, her walking got significantly worse. In just a couple of months she went from pretty good walking with a walker to mostly wheelchair. The type of neuropathy that she has isn't usually like that. She has a form of neuropathy that is very slowly progressive. When I first met her, I hadn't done a nerve study. I wish I had, because then I could repeat it now, and see if the Neuropathy has changed. I was trying to save doing too many tests and trying to decrease the cost of medical care. No good deed goes unpunished. I could do that test now, but it wouldn't help much, since I can't compare it to what it was before. But I thought that this might be more of a spinal cord problem. That's an odd thought, because the examination doesn't really support that. I've had some cases where patients clearly looked like they have neuropathy, but they have myelopathy (spinal cord injury) PLUS neuropathy. It's a terrible conundrum. You can't see the myelopathy because the signs are mostly covered up by the neuropathy, and it's very hard to know which problem is causing what. It's hard to justify surgery for the myelopathy since it likely won't help. So several times I've had patients with this and we've done the surgery for the spine. The rationale is this: It probably won't help. Surgery could make things even worse than they are now. However, the patient is currently getting worse. If we do nothing, then the future is continued worsening. So if the patient really wants to take the risk, then fixing the spine is the only possible option. It's a high risk, low yield option. But some people want that. This is something I've done less than ten times. It's helped on some of the occasions. And it hasn't on others. And it hasn't hurt any of them so far.
Anyway, for some reason I thought about that with CP. Mostly because of the nature of her rapid deterioration and also a little bit of clumsiness in the hands that I didn't think was exactly like the arthritis clumsiness that I'd expect or the neuropathy clumsiness I'd expect. She has some bladder issues, but that's a very vague thing that could indicate spinal cord issues, but almost always doesn't. She has pretty severe spinal cord compression with evidence of changes in the cord itself that indicate damage on her MRI. Since I got the MRI of the spine, I don't actually have to do the nerves again, so I got out of that mistake. Today I had to go in to tell her that she has this spinal cord problem. It's probably going to get worse, and there's probably nothing we can do to make her better. I wasn't looking forward to this.
You try putting on your somewhat happy face to go in and tell it how it is, in plain English and look into her eyes. It's the only way to go.
Well, she said that she pretty much knew this. She doesn't care about surgery, "I'm too old for that." And she said that she's happy to understand what's going on. "I'm lucky because I'm not blind. I can read. There are good people to help me get up and go to the bathroom. I have an electric scooter, so I get around pretty well. There's a man where I live who's blind. A lot of people are going blind at my age. And I can even hear OK." That's what she has to say about losing her spinal cord function.
I think walking is nice. I'm glad I can walk. I'm glad I'm not blind, too. But I sure am glad I can walk.