Ramblings on healthcare, medical education, and life with a spinal cord injury
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I like to kick people

Really.  It’s probably my favorite thing to do these days.  When therapists come near me, I kick them and they just smile.  When visitors come, I kick them and they either break into tears or start excitedly shouting.  Then they ask me to kick them again.  You see, I’m not being mean – I’m showing them for the first time that one of my legs has started to wake up.

In my last post, I shared my understated excitement at having movement in my big toe.  The post was intentionally succinct, as I wanted to share with you just how speechless I felt when I first saw movement.

Every morning since arriving three months ago, I would try to move my legs and my toes while sitting in the shower.  And every morning, nothing would happen.  Once in a while I would think I saw small movement, but it always turned out to be my mind playing tricks on me.  This time, there was no mistaking the more gross movement.  In a state of shock, I tried again.  It moved again.  Right when I told it to.  I tried about twenty times before I let myself even consider the possibility that it was real.  Then I prayed that this was the beginning of the next stage of my recovery.

I felt exhilarated and scared at the same time.  Scared that my exhilaration would be consumed by the realization that the toe movement was just a spasm I was somehow able to influence.  Several times before, I’d had my hopes dashed by reality.  I would see something change and think it was a sign: spasticity disappeared when I had a fever, feeling became more acute during injections below the injury level, even positive changes to my mood with no direct cause.  But time and time again, nothing big happened.  I kept telling people, “I’m seeing positive changes, staying positive, but nothing major yet.”

This was major.

Unfortunately, it was Monday at the start of a week when Dr. Stein was on vacation.  The attending covering for him was a more than capable physician, but I had wanted to allow some time to ensure the changes were repeatable before discussing them with a doctor.  But I did share my observation with my physical therapist.  Her face attested to her shock and disbelief, but she did promise later that day during our session to check things out.

Her confirmation that the tendon pulling on the big toe was actually moving was the first thing that allowed me to believe that it might be real.  The following Monday when Dr. Stein returned, he also confirmed what I suspected: I was able to control the toe.

ASIA Levels

That changed everything.  My therapy now focused on the legs and getting additional movement that was just starting to appear.   It also changed the classification of my injury from ASIA B to ASIA C.  This was also major.  The image on the right describes the different levels used to classify SCI, and although my reclassification as ASIA C by Dr. Stein did nothing to change the movement that I’d regained, it further made the changes to my body real.  They were now on paper, not just a supposition of my own, but a medical fact.  I was now making major progress, one toe at a time.

The days after that brought further return.  First I noticed I could swing my leg out just a bit.  Then I could contract the leg medially.  At the start of this past week, my therapists did an eval of what functionality had returned so far.  My left leg was bending at the knee (allowing me to kick), and was even able to resist some basic resistance provided to it.  This garnered a score of 2+ on the ASIA muscle grades (again, see the chart just on the right of this block of text).  I could also bend the toes upward and flex the leg up at the hip.  But only in the left leg, nothing in the right.

Some time had passed since my left toe started moving, but the right still wasn’t waking.  I often watching other patients walking in the gym and it always seemed that one of their legs was dragging.  This, I reasoned, was due to one leg returning sooner and stronger than the other.  Dr. Stein confirmed this to be the case, which temporarily assuaged my concerns that the right leg might not wake.  And while he had previously seen instances where one side would wake up and the other not at all, this was much less often the case.

But still, the right wouldn’t wake.

As recently as the past few days, muscles in the right leg are starting to move.  I can move the big toe just like a could the left at first, the hip adductors are also under my controlled contraction, and I have some ankle plantarflexion as well.  It seems as though the right is waking up in a similar manner as the left, but it’s just a couple weeks behind.

So what does this all mean?  Yes, the legs appear to be slowly waking up.  But make no mistake, they are nowhere near as strong as they were pre-injury.  Many movements I can only do when not fighting gravity or friction, and it can take significant effort to evoke even the slightest movement.  But it is definitely big progress in the right direction.

There is no guarantee as to what functionality my legs will be able to regain.  They may plateau at a certain point, leaving me functionally in a wheelchair.  They may reach a point where I can walk, but not without assistance or for too lengthy a distance.  They may continue to wake up until I am walking as I was pre-injury.  There is no way to know.

But the one thing I do know for sure is that I am going to fight for every muscle that I can get back.  I am going to fight harder than I’ve fought for anything in my life.  I  couldn’t imagine doing anything less.

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