In an extract from his new book, Just One More Question: Stories from a Life in Neurology, Professor of Clinical Medicine at University College Dublin, NIALL TUBRIDY tells the story of one patient – a bride-to-be with a nervous issue far more serious than cold feet …
Janine had not been sleeping well. She would wake in her West London flat at three, four and five am, as if an alarm clock was going off on the hour. Her recurring dream was of a small elephant walking slowly in front of her family and friends, a forlorn look on their faces, as the sounds of a Durban school band echoed in her ears. Her wedding was in three months’ time and she was worried. Not about her decision to get married – Giles was definitely The One. Nor was she concerned about having the ceremony in her native South Africa, the ongoing long-distance rows with the wedding planner notwithstanding.
What was really causing her sleeplessness was the fact that she was three stone heavier now than when she and Giles had met two years earlier. Domino’s pizzas and nightly video rentals had turned her into what she referred to as ‘the blob’. She had been so sure she would lose weight she had persuaded the bridal shop to order a dress two sizes smaller than she then was. They told her that of course she would lose the weight; every bride did. Now they were making noises about letting out the seams and sewing in extra panels.
She had tried various diets, each one more extreme than the last. Her net weight loss: a miserly four pounds. In desperation she joined a local gym and signed up with a prohibitively expensive personal trainer. Finally, the weight started to shift. She ate hardly anything, walked to work instead of taking the Tube, and gave up alcohol. Life was miserable but at least she was getting thinner. Four weeks into this desperation regime and she had shed a stone. She decided to up her game by taking laxatives. In two weeks she had lost another half-stone.
She felt tired and wretched, but at least everyone was telling her she looked great and it looked like she’d get into her wedding dress after all. On her way to her next punishing gym session, she tripped over her gym bag as she tried to haul it out of the car. Both of her legs suddenly felt numb and, as she made her way inside, she tripped again, this time falling flat on to the tarmac. She picked herself up hurriedly, took two further steps and realised that her feet were not doing what they should. To propel herself forward she had to lift her legs high off the ground. Her walk reminded her of the images of astronauts walking on the moon; she knew that if she did not imitate their high-stepping movements her feet would remain stuck to the earth and she would go over once again.
Janine came to visit the Central London hospital where I was working about six weeks before the big day. The loud slapping of her feet on the hospital linoleum made the diagnosis more acoustic than visual. She just could not lift her feet off the ground. When she walked it was with great effort from her upper thigh muscles. The noisy slapping of her feet accentuated her embarrassment and prompted a torrent of anxious tears.
Although it was clear she had foot drop, I did not know why and thus could not adequately comfort her. It did not take long to explain how this had happened – she had damaged both of the nerves that controlled her ability to lift her feet off the ground. It took longer, however, to find out why. I asked the usual questions about changes in medication, family history and whether she had had any previous medical problems, but to no avail. It was the trip over the gym bag that was key. And so I got the whole story of her mad bid to lose over two stone in three months.
As a result of dieting and exercising like a woman possessed Janine had lost the fat protecting the nerves near her knee joints so they had been inadvertently exposed. These nerves run down to our feet and control dorsiflexion of the foot – the movement we produce when we walk on our heels. Being more exposed, the nerves were easily compressed; for example, by crossing her legs when sitting at meetings at work. Eventually, the nerves controlling the muscles of her ankles and feet were damaged to the point where they could no longer transmit the electric current required and ceased working altogether, leading to Janine’s pre-nuptial ‘dropped’ feet. It is a common problem in people who lose weight precipitously either by design or through illness. It is a fairly common sight in patients with cancer or in some who have spent prolonged periods in intensive care.
The nerves would recover slowly over the next month or two, and Janine’s fears of a wheelchair-bound future were put to rest. But the wedding had to be postponed. I later learned that she recovered full function of her legs and went on to marry Giles later that year. She walked up the aisle the same size she was before the nightmares of elephants had started.
Younger doctors, who lack experience in medicine and in life, can sometimes seize upon the vices of their patients to chastise them. Contrary to their deserved reputation for prolific drinking, young doctors may seem very mean, lecturing already anxious patients many years their seniors. Over time I realised this was a small defence mechanism to manage their own (my own, in my early years) ignorance. After all, it is easier to blame a patient for their illness, and thus exacerbate their shame and misery, than think through the problem in depth and admit how little you actually know.
Just One More Question: Stories from a Life in Neurology by Niall Tubridy is published by Penguin Ireland.
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