Saturday, September 26, 2015

Blog #62: What Your Doctor's Exam Tells About Your Nervous System.

The following blog is an excerpt from Chapter 26 of my novel, DINGS. DINGS is described on my website: It follows the family of a precocious 8-year-old boy whose non-convulsive epilepsy has not been recognized. DINGS is available in audio-book, softcover and  eBook formats at popular internet stores. 

Okay, Conner, let’s see you just walk back and forth, normally.”

Conner stepped out. “Like this?”
The neurologist nodded. He watched Conner’s arm swings, balance and how he walked. “Perfect. Now, walk on your tiptoes. Like this.” Dr. O’Rourke rose onto the balls of his feet and demonstrated what he wanted Conner to do.
“Good. Now, walk on your heels like this.” The doctor rocked back onto his heels as he leaned forward and elevated the toes of his shiny, black shoes to take a few awkward steps. Once again, our boy mimicked him. I covered my mouth with both hands to conceal my smirk at their awkward postures.
“Fine! Your legs are equally strong. Now, I want you to walk as if you are on a tightrope. Put one foot in front of the other and touch the heel in front with the toes on the other foot. Keep the feet real close together.”
Conner took five perfect in-line steps.
“You’ve got great balance.”
“This is easy, Dr. O’Rourke!” Conner beamed.
The neurologist returned Conner’s broad, toothy grin. “I knew you’d like this part of our visit. Now, hop up and down on your right leg like this.” Dr. O’Rourke put his hands over the side pockets of his white coat to prevent papers and tools from popping out as he hopped a couple of times. Conner imitated him. “Now switch legs. Excellent!”
“Okay, now put your feet together like this so that they touch ankle to ankle, side by side.” The doctor stood with the side of each of his shoes touching the other. “Yes, just like that! Now, stand like that and don’t move.”
“This is so easy!” Conner exclaimed. Sam smiled at him and then looked at me.
The neurologist nodded. “Now, stay just like that and close your eyes. Don’t move.”
Conner stood ramrod straight and exaggeratedly buried his eyelids extra tight as little kids do. A few seconds later the doctor said, “That’s great, Conner. Your balance centers could not be better. Now, turn around so I can check your back.”
He lifted Conner’s gown and bunched it up around his shoulders. “I don’t see any spinal curvatures or birthmarks that sometimes accompany degenerative nervous system diseases that are associated with epilepsy.”
That was good to hear. This was really the way all doctors should interact with patients and their families: educate us, for crying out loud! Dr. Choy was good like that, too.
“Okay, now climb onto the exam table, young man.” He felt Conner’s wrist pulses and then inspected Conner’s hands and fingernails. “There can be telltale clues of diseases here, too.”
Then he picked up a thin, cloth measuring tape and wrapped it around Conner’s head. “Your head circumference is fifty-three centimeters.” He looked at a chart and declared, “Normal head size.”
“Oh, that’s good!” I felt my heart thump and then, just as suddenly, a sharp gloom settled over me. I had gotten so distracted and their interactions that for a precious few moments I had actually forgotten why we were here.
Conner looked at us and giggled. He seemed to be enjoying himself.
The doctor smiled and began to wrap a pediatric-size blood-pressure cuff around Conner’s left upper arm.
“No! That gets too tight!” Conner yanked his arm away.
“This is a very important part of the evaluation, Conner. It’s a small cuff made for children. I don’t think I’ll have to make it too tight, and the pressure will only last for a few seconds. I promise.”
“Let the doctor do it, Conner,” Sam commanded.
Conner cast a sober glance at his father and extended his arm—slowly. He grimaced as Dr. O’Rourke rhythmically squeezed the large black bulb that slowly tightened the cuff around Conner’s arm.
The doctor placed his stethoscope in his ears: “Seventy-eight over fifty. That’s fine!”
Dr. O’Rourke moved the stethoscope to the boy’s chest. After a moment, he declared, “No heart murmurs.” Then he moved the stethoscope over both sides of the boy’s neck. “No abnormal ‘whooshing’ sounds there, either. That suggests no blockages in the arteries leading to the brain. But I wouldn’t expect to hear any in a child.”
Conner nodded and looked into the neurologist’s eyes. Dr. O’Rourke smiled at him.
“I appreciate how you’re explaining what you’re doing, Dr. O’Rourke. It’s like we’re all in medical school.” I laughed and gave Sam’s hand a gentle squeeze.
Finally, the neurologist placed the end of the stethoscope on top of Conner’s head and closed his eyes.
What the doctor was doing? Sam asked, “I’ve never seen a doctor do that before—listen over the top of the head, I mean. Do you hear something up there?”
“I’m just being thorough, Mr. Golden. If there’s an abnormal blood vessel or increased pressure inside the skull, sometimes we can hear a telltale sound.”
“Well, did you hear anything?” Sam and I exchanged a worried glance.
“No, and that’s normal. I shouldn’t hear anything.”
This examination was turning out to be a performance. My doctor never did any of these things.
He told Conner to lie down on his back. Then, he quickly moved his hands over Conner’s belly as Dr. Choy had done, stopping here and there, pressing softly and moving his hands again. Conner looked uncomfortable once or twice, then erupted into giggles. “That tickles!”
“If an abdominal organ is enlarged that could be a clue of a neurological-associated disease. Conner is normal,” Dr. O’Rourke reassured us. He pulled out the waistband on Conner’s undershorts and took a quick look at his privates. “No evidence of a developmental or genetic disturbance here. Okay, you can go ahead and sit up now, Conner.”

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.