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James Hamilton, M. D.

Mike McL.,

"Cauda equina" is Latin for "horse's tail".

Like most anatomic (and other medical things) Latin and Greek words have been prevalent since ancient times and were so named for their resemblance to things that were more familiar to people of that era.

The nerves at the end of the spinal cord in the sacral area splay out like a horse's tail. Those nerves control certain important functions including bowel and bladder activity in addition to some other functions. A "syndrome" is a group of different malfunctions that are caused by a common abnormality.

In a Cauda Equina syndrome that would entail (pun intended) pressure squeezing the nerves in an area near where part of that tail's nerves subserve these functions.

Jim

P.S.

Nina, 

Thanks for your prayers and concerns,!

I need all the prayers and support that I can get.

Jim

David Mitchell

"Volunteer Civilian Medical Tours" continued

A few months after Dad returned from that first trip to Viet Nam, he signd up for a second trip. This time he went much further north to the large U.S. Air Force base at Da Nang. If I recall correctly, it was a large Naval hospital on a large Air Force base. 

I got word to Dad that my life-time best buddy, Tom Litzinger, was a cook in the Air Force, serving somewhere on that Air Force base. Tom and I were almost family with a long-time freindship between our families at OLP church - and years after - he was in my wedding.

(* and recall those stories of the two of us 5 year-olds trying to burn down his garage - he had taught me how to play with matches)

Dad had to search several different mess halls to locate the kitchen that Tom worked in. When he found the right kitchen, he walked in on him - unanounced.

He told me later - "You should havr seen the look on Tommy's face when I walked into that kichen."

They were able to spend a little time together, as they were both there for several of the same weeks.

TBC

Airman Thomas Aquinas Litzinger

Sheila McCarthy (Gardner)

Dr. Jim: Count me in .... 

Michael McLeod

not to get too nerdy here but going way back to Latin classes at watterson and of course growing up and hearing latin in a formal, devotional setting I have this sense of it being an elegant, other worldly language.

but it was down to earth for those who spoke it day to day -- and used an earthy  barnyard image - a horse's sinuous tail - to vividly describe a pain in the butt everyday malady such as "cauda equina." it may sound fancy but trust me sports fan it's just an achy breaky lower back ache.

James Hamilton, M. D.

Mike McL.,

Ahhh, if only it were that simple!

The ancients were actually pretty sharp observers and were good at medical descriptions. They seemed to know their anatomy quite well, but maybe not yet their physiology.

The nervous system transfers many pain syndromes from their origens to distant anatomic parts which sometimes make diagnosis difficult. The spine and its cord and neurons are excellent at doing that. Thus the extremities - arms and legs in particular - frequently are targets of referred damage and pain.

Of course, some pain is certainly local, mainly or at least partly so. A good example of "butt" pain would be ischial bursitis which is very painful upon sitting. A bursa is like a little fluid filled pillow that cushions and protects bony prominences. If inflamed they are very tender to external pressure.

The spinal nerves have no such pillow protection and when there are abnormalities in the spine that pinches or squeezes the nerve roots which exit the spinal column through passages ("neural foraminae") between the vertebral bodies, or "squeeze" the spinal cord itself, pain is usually referred downstream to the tissues - muscles - that those nerves innervate. So, butt pain may be absent whereas leg and other pain may be present but not right where the pathology is occurring.

Of course the ancient doctors did not have MRI technology to diagnose their patients.

Jim

Michael McLeod

Thanks Jim for the explanation.

I'm way behind the ancients in my grasp of such matters. And i know it's not a simple thing you're going through and we are all pulling for you.

 I'm hiding from the florida heat which makes me feel ill the moment i step outside -- I cannot step barefoot on the lawn in my back yard cause it's damn near as hot as the sidewalk -- and when i get into the pool it feels more like a sauna.

yeah yeah first world problems but I gotta have something to gripe about. it's a requirement for retirees.

John Maxwell

Joseph Gentilini

Jim, since my back pain included S1, I did have some difficulty with bladder and bowel functions for about a week. Functioning finally worked as my body adapted and the nerves got working again. Hopefully, your surgeon will be very careful when he operates on you. You are in my prayers and thoughts.  

Keep us all posted with updates.  Joe

James Hamilton, M. D.

Joe G.,

Thanks for your prayers and support!

Yes, my surgical referral came through today and that office will contact me to set up an appointment prior to any incisions that will be done 👍.

When I was in college  I used to have an old dissection kit for certain biology classes in which I had placed a poem of Emily Dickinson (known for her brevity) to remind me of what awaited me in med school:

"Surgeons must be careful when 'ere' they take the knife,

For underneath their fine incisions stirrs the culprit:

Life."

Of course, I chose a non-surgical speciality but I always tried to approach patient care and treatment in a similar way: "Primum non nocere" ("First, do no harm").

Glad your surgeon did the same for you!

Jim

Michael McLeod

what a beautiful and comforting Dickensen couplet, Jim

as is the sentiment you drew out of it.

.And yes, Emily knew how to, well, cut to the chase.

David Mitchell

"Volunteer Civilian Medical Tours" 

While my dad was on that second "'tour" up in Da Nang, he was able to get a flight down to Kon Tum for a week to meet with that same Dick Pendell that he met at the Saigon airport - the insurance salesman from Columbus with the bumper sticker about Ohio State. Dad met his wife and six kids and also the young female Doctor that ran the misssion. She had become a bit of a legend for having run a clinic there for about ten years - young, single, and apparantly very attracive - named Patty Smith (if I recall Dad's description correctly). And as I mentioned, Dad and Dick became friends back home in Columbus thereafter. I had some photos of his time in Kon Tum but I have lost them.

An interesting detail about that clinic in Kon Tum was that they treated moslty "HMUNG" people ("mung" - the H is silent). The HMUNG were a seperate ehtnic group who, I think, were descenendents of Mongolian tribes who had migrated. They wore very bright tribal clothing and were skilled farmers. Though not well accepted by the Vietnamese they fought on our side - but mostly with bow and arrow and primitive blow guns. But apparantly the VC and NVA were terrified of them.

After returrning to the states, Dad befriended several families and worked to help them gain entrance to the United States. He also found a way to supply them with some money over a period of a year or so.

Sorry I cannot find any of those photos.

The name tag below is Dad's ID tag. The words Bac-Si ("bok she") mean Doctor. Other than the red A.M.A.(American Medical Association) I have no idea what the rest of it means.

TBC

Michael McLeod

ok this is going to make me sound like a poverty stricken senile old fart but whatever.

I am writing this on a hewllit packard laptop I've had for a zillion years, going back to my days as a marginally -functional member of society. The only sign of age - in the laptop, not me  - is that it takes forever, and by forever I mean about a minute or so, to become functional.  With plenty of time on my hands, depending on what you mean by "plenty of time on my hands" given our age group, that's a fleeting inconvenience. I just wondered if this thing is on its last days and should be put out of its misery and by that i mean the laptop not me, smartass.

Seriously: is that warmup period uncommon for a laptop? anybody? 

Michael McLeod

https://www.youtube.com/watch?v=4n7p9VUlr-k&list=RDEMHvukK9YrxxlGSGEtxCN0Ag&index=3

Joseph D. McCarthy

Mike.  In a roundabout answer here goes.

But first the quick background.  I packed the SUV the day before we were to leave on the trip to Columbus. One of the first items always packed was the trusty laptop.  Unfortunately, every Hampton we stayed at no longer has a business center, or area with a quest computer.  Even the Homewood Suites in Columbus has done away with their computer for quests.

Tuesday evening when we arrived in Columbus I unpacked my trusty, used only when traveling approximately 15 year old laptop and went through the gyrations to enable Wi-Fi.  Everything was the usual slower than molasses, but worked.  Wednesday morning I started it up.  Then "Attempted " to again utilize Email, everything else appeared to be working, but I was unable to open Emails.  The system was now set on "Airplane Mode" and I couldn't get it to change.

Luckily for me, Ohio was about to start a two week " No Sales Tax", that included computers, for items under $500.00.

Yesterday I purchased a new laptop with Windows 11 at Best Buy.  I am having them do the setup, transfer some info, apps, etc. from my older laptop.  They are also going to fix the old laptop.

So my response, you can't take it with you so purchase a newer and faster laptop.  Oh, and then you can be quicker in things like correcting my very poot English.

Michael McLeod

well if you were trying to test my editing eyes you caught my attention joe d: Your spelling  is ka-"poot" (see last line of your message) but your heart is in the right place I am sure.

thanks.

ps sorry as a longtime journalist and writing teacher I'm a compulsive fixer. seriously: I was so embarrassed when I made any little mistake in print that I am savagely devoted to pointing them out no matter how harmless they may be.

I made my living as a full time journalist but somehow i managed to teach part time mostly in evenings over the years at various junior colleges and universities.

I don't know how I had the energy but I do remember really enjoying teaching. I hope I was as good at it as I tried to be. 

David Mitchell

Personally, I can't understand why anyone would buy anything but an Apple laptop.

James Hamilton, M. D.

Mike McL.,

From  the articles that you have written in you career and shared with us here on the Forum, I think that your ability to have taught the next generation of journalists and writers is very evident. In fact, just reading those that you have posted here has taught - and inspired - me  to be more cognizant and careful in writing anything that I do for any purpose including this venue!

Your formal teaching career may be retired but the subtle effect on those who read your musings is certainly not lost on us who log on to this website. 

Jim

Michael McLeod

It just occurred to me: we should have called ourselves "watt bulbs"! No:  make that '66 watt bulbs!

And Jim: I wish I were a good enough writer to put the feeling that compliment engenders in me into words.

If there was one thing I was utterly devoted to besides my family and rooting for the ohio state football team it was doing the best job I could of making the written word come alive on the page. And it was a challenge start to finish. Never got easy.

I was always jealous of performers because if they do well they get immediate and tactile feedback in the form of applause. I got compliments from editors and occasionally from readers and it meant a lot to me but for the most part I just wrote and taught and did my best and was proud now and then as I saw evidence from my students that they were engaged, or if I read over something I had written and realized that it came out as well as I wanted it to (which wasn't always the case.)

Making words come alive. Engaging readers I'll never meet. Helping students navigate sentences of their own. I admit I was always at some level unsettled, unsure. but dedicated throughout.

so thanks again for the thumbs up. We are living in a time of info wars. Distorting information is a dark art and people will look back at these next few years as being a real turning-point battlefield for the heart and soul of this country. That may sound like fancy and exagerrated writing. But it's just the truth.Which is what's at stake right now.

Pay attention. Some people would prefer that you didn't.

Michael McLeod

Our brief personal health discussion stirred a memory in me that relates to a Latin phrase I remember hearing as a child that it is good advice whether or not you are a doctor. 

Actually I think rather than hearing it I saw it on my grandfather's notebook or prescription pad or perhaps up on a wall of his office:

 "Primum non nocere"

it means "First, do no harm" 

I assume it is a traditional slogan for healers and likely would appear on the walls of places of healing though I don't know if that tradition has extended into the modern era.

I don't remember if I have already shared this so forgive me if I have, but my grandfather on my mother's side was a general practitioner. His name was Ernest Victor Reutinger. He lived in a three story brick mansion on east main street that was right next to a catholic church and school (holy rosary, I seem to recall) and straight across from an old school movie theater with those fuzzy seats and the old-school marquis. (hope i spelling that right). I remember as a child having been given one of his stethescopes and an old black leather carrying case which was about the size of a small loaf of bread. 

I could see the kids on the holy rosary playground from his backyard, which had grape arbors and a small fish pond. 

He would do this trick of palming a small object and waving his hand past the side of my head and then showing me the object and telling me he'd just done me the kindness of plucking it out of my ear.

I thought, damn, that didn't hurt - this guy's either a great doctor or a splendid magician. I think I'll start coming here for all my shots.

Joseph D. McCarthy

First chance to do something.  Had lunch today at the TAT restaurant with Tom Fitzpatrick and some fifty plus gentlemen, including two Dominican priests.  The monthly luncheon for Any and all Aquinas alumni.  
By the time I was finished I couldn't pick up my computers.  So tomorrow I am free for an hour.  Can hardly wait to have a computer again.

John Jackson

The latest example of Trump’s unending war on science/facts is his firing of the head of the Bureau of Labor Statistics last Friday after a very bad jobs report for the past three months.  No better place than the Borowitz Report to provide needed perspective:

WASHINGTON (The Borowitz Report)—In one of the most stunning political comebacks in American history, on Monday Donald J. Trump picked the disgraced former congressman George Santos to lead the Department of Labor Statistics.

"This is such an honor," Santos told reporters. "I really didn't think I'd get pardoned before Ghislaine."

The new DLS chief hit the ground running, revising upward the job figures from every month of Trump’s presidency. “The American economy added a million new jobs in May and a billion new jobs in June,” Santos declared. “President Trump is creating jobs like crazy—he even gave one to Pete Hegseth.”

The unprecedented job growth has boosted Trump’s approval rating, which Santos said currently stands at 140 percent.

Michael McLeod

Trump makes Richard Nixon look like Winston Churchill.

David Mitchell

"Volunteer Civilian Medical Tours"   conclusion

Note: I include this last part of this chapter because I seem to recall someone  in our class (maybe one of our "Lurkers") is related to the guy I am going to mention.   

                                                                 *

While in that Naval Hospital at Da Nang, Dad had another familiar encounter - one of those wonderful “small-world” stories.

When I was about eleven or twelve years old, my two older sisters attended a Catholic girls academy high school (St. Mary’s of the Springs) and hung out with the same eight or ten classmates. These girls in turn dated the same eight or ten guys, all students at a Catholic boy’s seminary prep high school (St. Charles). Both schools were on the east side of Columbus and shared a lot of functions. This group was often at our house, before or after dances, plays, or even sports games. My parents loved having them around, and I did too. I thought the guys were cool and wanted to be a part of their group. My two sisters would just as soon I get lost, but I managed to hang out with them anyway. I wanted to be one of those cool guys. 

One of the guys was sort of the “golden boy” of the bunch. He was handsome, polite, straight “A” student - and most important to me - the star quarterback of the St. Charles football team. His name was Dave Nardone. Everybody - the girls, the guys, and the parents loved Dave. 

Dave went on to graduate from Notre Dame, and then on to Georgetown Medical school. My dad even tried to recruit Dave into his practice during one summer break. Dave spent a few weeks in Dad’s office, but after thanking Dad, went on to some other specialty. 

Fast forward several years and Dad is at the Da Nang Naval hospital. He gets called into the ER one morning and sees the patient - an older local Vietnamese farmer who has stepped on a land mine, and his one leg is a shredded mess. Later, Dad described the scene to us.

He was standing along one side of the gurney, gripping the railing on one side of the bed, looking intently down at the man’s leg. He did not see a young Naval Doctor, in a white physician’s coat approaching from the opposite side of the gurney. As he gets close, the doctor calls out loudly, “Doctor Mitchell!”

It was Navy Doctor Dave Nardone.

James Hamilton, M. D.

There is an old saying among doctors that goes "When you hear hoof steps behind you, think of horses, not zebras." 

Basically that means if a patient presents with common symptoms, consider common diagnoses first and not some rare malady.

Yesterday, as I opened the front porch door to retrieve the morning paper, I heard soft but galloping hoof beats. Since there are no zebras known to inhabit our Rockrimmon neighborhood, I surmised that a fawn had nested on our porch while momma was out foraging for food.

Looking up I saw the little fawn under our Mugu pine tree and watched as the little one lay down in the shade.

You know me - PHOTO OP!! Cell phone camera will do, and besides, it's right beside me.

Soon I saw it's twin near a bush beside the small porch. But to get that shot I would have to shuffle around and that would spook them both, so I decided to let them nest.

And, oh yes, I waited till later to get the newspaper.

Jim

Michael McLeod

Thanks Jim.

Puts a smile on my face.