The following blog comes directly from Chapter 26 of my novel, DINGS. It, along with Blogs # 62 and 63, detail what the neurologist’s examination entails in the exam room and what each test of the body’s nervous system tells about the function. DINGS is described on my website: LanceFogan.com. It follows a family and their 8 year-old whose non-convulsive epilepsy had not been recognized. DINGS is available as an audiobook, softcover and an eBook at popular internet stores.
(Continued): “Now, young man, open your eyes but keep holding your arms up. Let’s see how strong you are.” The doctor pressed down on Conner’s outstretched arms. They both grunted, “Grrrrrrr.” Conner’s grin contorted into a grimace.
“You’re a very strong boy!”
Sam smiled and gave Conner a thumbs-up.
“Now, I want you to relax your arms and make them go limp like a noodle.” Dr. O’Rourke rapidly twisted, bent and straightened Conner arms, one at a time, in several directions. It looked like they were shaking hands. Then, he knelt and slid his palm under Conner’s sole and thrust Conner’s foot upward. He repeated the maneuver on Conner’s other foot. “I’m searching for tightness and involuntary jerking of his foot,” he told us. “All of these maneuvers tell me that his motor functions are working well. There is no tightness or involuntary jerking of these muscles. That’s normal.”
He stood and removed a rubber-edged, round-wheeled hammer with a long handle from the waist pocket of his white coat. “Now, I’m just going to test your reflexes, Conner.” When the corners of Conner’s mouth started to turn down, Dr. O’Rourke added, “This won’t hurt.”
He tapped the tendons on Conner’s elbows, wrists, knees and ankles. Conner’s eyes widened. His foot and entire leg jerked way up when the doctor tapped his knee, and Conner burst out in a full-throated laugh. Sam and I laughed, too. That reflex trick never ceased to amaze me. We had done that to each other as kids.
The doctor squatted again; his white coat tented on the floor around him. “This will tickle, so try not to move.” He slid the pointed end of the reflex instrument’s handle along the side then across the ball of Conner’s sole. I remembered Dr. Choy doing that in the emergency room, too.
“That tickles!” Conner’s big toe curled down. Sam and I laughed again.
“That’s great. A normal reaction.”
He grabbed a two-pronged metal fork from the shelf. When he struck it with his palm I heard a low hum. Then he placed the vibrating thing on Conner’s left knuckle.
“Okay, Conner, let me know if you feel any vibration or buzzing.”
“I feel it. Ooh!” Our startled boy snatched his hand back. “That feels funny!”
The doctor struck the instrument again and placed it on his patient’s toes. “I can feel that, too!”
“Now, do you see what I’m doing?” He took hold of one of Conner’s fingers and wiggled it up and down. “Do you feel that?”
“Good. Now, shut your eyes and keep them closed tight. I want you to tell me which way your finger moves. Keep your eyes closed! Are you ready?”
Conner nodded and squeezed his eyes closed again. He looked so cute; he was trying so hard.
The neurologist held Conner’s index finger and moved its tip upward. “Which way is it going? Up or down?”
“Down. I mean, up.” Conner opened his eyes.
“Yes. But keep your eyes closed.” Dr. O’Rourke moved the finger again. He repeated the test with a finger on Conner’s other hand. Then, the doctor knelt and performed the test on his patient’s toes.
“You’re doing magnificently. You gave the correct answer every time.”
Conner tilted his head to the side. I wiggled my fingers at him.
Dr. O’Rourke broke off a wooden stick from a cotton swab and gently touched Conner’s feet and hands with the sharp end. “Does that feel the same all over?”
“Good. We’re almost done. Now, point your index finger and touch my fingertip with your finger. Good. And, touch the tip of your nose with that same finger. Great!” Conner repeated the exercise several times.
“Your coordination and balance centers are fine. Okay. We’re all done. Go ahead and get dressed. I am going to talk with your folks in my office. Just hang out here for a few minutes, and then I will come back to get you. There are books and some models and toys you’ll like to keep you busy.” He nodded at Sam and me, and held the door open for us. The corners of Conner’s mouth dropped again.
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.