Nothing new on the myeloma front, just waiting for the next neuro-appointments on Saturday and Tuesday. Which reminds me that I haven't posted the neurosurgeon's clinic letter yet. Here it is:
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Diagnoses:
Recent C2 fracture with slowly progressive myelopathy
Previous myeloma - recently stopped lenolidamide and
dexamethasone
Old C2 fracture
DH: Cotrimoxazole, acyclovir, rivaroxaban, omeprazole,
amitriptyline
AH: NKDA
Operations: Umbilical hernia repair, R Achilles repair
I assessed this 73-year-old right-handed gentleman who
was accompanied by his wife. His myeloma has been in remission for two years.
He presented to Broomfield on 12th January with some left leg weakness. He had
brain MRI and he was discharged with stroke refuted. When he returned home, he
had a fall in the kitchen when bending for a tablet and needed help to get up
he has had a further fall in the shower, needing help to get up and a partial
fall onto the bed. His weakness predates these three falls but on closer
scrutiny, he had a fall in the summer of 2021 whilst playing bowls, when he
landed flat on his face. Since then, he has noticed a slow progressive
worsening of walking. Until January, he was able to walk outside with a stick
slowly or with a walker. He now uses a wheelchair outside but can mobilise with
a stick or two sticks at home. He has a stair lift. His right leg is the best
limb. He can dress himself but cannot fasten buttons or laces. He feeds with
his right hand and his left hand cannot really manage cutlery. He has urinary
urgency. He has no real neck pain but on certain motions, feels a minor twinge
intermittently. L'Hermitte's is negative. He reports altered temperature sensation
in the right hand.
He did not have cervical tenderness. He had restricted
rotation but reasonable flexion and extension. Shoulder power was grade 5,
right arm normal, left elbow and wrist and grip all grade 4. Left arm reflexes
were brisk. Hoffman's was negative. He had normal sensation in the upper limbs
including proprioception in the index finger. He had normal power in the legs
but walked slowly. Knee reflexes were brisk ankle reflexes absent, plantars
flexor. Proprioception was preserved in the big toes.
MRI shows an old C2 fracture with posterior
displacement of the odontoid process with some signal change in the spinal cord.
I have arranged a hard collar, CT of the cervical
spine and dynamic x-rays. I have suggested we are working towards a posterior
stabilisation, perhaps with decompression in order to stabilise his neurology
and allow some improvement.
Yours sincerely,
Checked electronically but not signed to avoid delay
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Yesterday was a beautiful day so we took the scooter down the garden to soak up the sun and inspect the job done by the pond professionals we had in the morning to do the yearly (approximately) clean-up.
Here's the small pond:
and the big one - still being topped up, hence the hose:
Me getting some sunshine:
and Belle failing to grasp that "beep beep" means "Get out of my way!"
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