My TBPI injury in Thailand: treatment/prognosis

[siamerican]

Hi BPI community. I've been reading here the past few months and finally got the guts to post as to share my story and pose some questions I have.

I'm Steven, Thai American originally from the states--born and raised, though living in Thailand for all my legal adult life. I'm 25 now.

Jan 21, 2009, had a midnight plea with a quiet roadside tree on a 130 cc motobike-- after 17540 kilometers of a clean spill record all around the hectic roads/traffic here, it was my own vulnerability that became my biggest danger.

= LTBPI here in Bangkok assumed to stem from trauma of whiplash. The helmet I was wearing spared my skull/brain from injury.

Despite zero blood loss or any bone injury, just some bruises on my knees. From the moment of accident, I was on my feet and instantly noticed the limp, powerless arm hanging. Then I was convinced it would be amputated.

Xrays ultimately showed nothing broken. MRI showed spine contusion at neck and there was too much inflammation to confirm extent of nerve injury, though docs expect/suspect avulsion at C7 or C8, with less severe injury at C5-C6 and T1.

Will finally do an EMG in several days to be sure and know whether surgical intervention can be expected to be of use for me. Kind of nervous, hopeful and worried at the same time.

On Fri 13 of February, the neuro surgeon I met at an expensive private hospital told me it wasnt looking good, that I'm lucky to have survived such a spinal contusion, (pointing out all the apparent blood/inflammation in the MRI taken 4 days after my accident)

Went on to say I'll never have fine hand use again, and maybe lucky to regain 30 to 40 percent of my arm in the long run.

Considering he made such premises before thoroughly examining my hand & arm, referring mostly to the MRI before finally sticking a toothpick several spots to test sensations, it was only certain that an EMG would be needed. On my inquiry with that doc, likely the surgery would be aprox. 10,000 USD ++.

Others have suggested that sometimes private docs here will over-downplay the prognosis if it means justifying ever expensive surgery for folks without insurance like me. It could be the case with that doc considering after two full months since the accident, I can already grip my fingers into fist and flex my wrist, from nothing at time of accident, so I don't want to accept such grim prognosis just yet.

Though I dont want to have overly wishful thinking and want to be realistic and ready for the worst case, and anyway, due to my financial situation, switched to a famous government hospital for EMG, further prognosis-second opinion for a surgery that certainly wouldn't be as expensive as quoted by that doc.


tbpi cases are quite common in Thailand, not surprisingly. in fact I met one tbpi guy randomly the other day which you can read abt on my blog below.

anyway, so being uninsured, feel content with my odds at the government hospital, of who's docs have dealt with many tbpi over the years, though will say again my decisions/options after my EMG prognosis come next week.

On my initial meeting with an examiner at the government hospital a few weeks ago, before referring/scheduling the EMG, he did a thorough motor exam of my arm but his hand writing is unclear and I forgot to clarify. Hoping others here might be able to help make sense what the question marks might be, maybe transcribed by me wrong...

Deltoid = 0
Biceps = 0
Triceps = 0
Infra? = 0
WE? or LIE??? = 0
EIP?? = 0
supination = 0
pronation = 3
FCll?? or FCH??= 4
APB? = 4
FDS? + FDP? = 4

Well, that's all for now, if anyone might know more about this, please do share. Other comments and questions are welcome. Also, you can read my blog for full details about my accident/recovery/life. www.siamerican.com

Looking forward to reading your replies/comments. hv so much more to ask/share on this forum coming soon.

Steven

[AngelaW]

Wow. Except for the bpi injury you sound very lucky to have avoided other major injury. I was in a motorcycle accident and was pretty much crushed.
If I read right it also sounds like you've had some spontaneous nerve recovery which is great. I never got so much as a finger twitch I think you are doing the right thing by getting different opinions from different doctors. Just so you know (in case you don't) if you do need nerve surgery you must get it within about 6 months from the accident to get the best results. Good luck! (And by the way, thai food rocks!)

[siamerican]

I finally go for my EMG today, and will meet with the actual doc to prognosis me on Thursday...I'm so excited to hopefully learn something more concrete! Prepared for worst, hoping for best...

[AngelaW]

Good luck!:) I'm not fond of the emg's but they are essential. It can be nerve wracking but it is better to know what you are dealing with.

[AngelaW]

Just checked out your my space page and I liked how you wrote you are not half thai, half american but one whole person from two countries. I was born in south korea, abandoned by my mother, and then adopted by norwiegans in minnesota so I know how people try to label you a certain way. I feel I'm culturally minnesotan, but my heart is very korean

[siamerican]

I posted the EMG results on my blog. www.siamerican.com

Looks like I have ruptures at C5, 6, and 7, suggested by the lack of spontaneous response at my paraspinal muscles.

anyone, please correct me if I'm wrong, but if there were any full root avulsions, there should have been IIA--PSW and FIB at the cervical paraspinal muscles, which thankfully lacked spontaneous activity to at least say its post ganglionic injury...

albeit obviously severe being most the rest of my arm having plenty of IIA suggesting denervation w/o motor unit action potential = pain, numbness and atrophy.

Have yet to consult with a surgeon to see if nerve graft/transfer at the roots is likely card, and/or whatever else possible reconstruction along the PNS I might consider.

Not the best, Not the worst...???

[siamerican]

ergh...no solid diagnosis or prognosis yet...

MRI & EMG don't seem to agree, so probably will have to do meyogram-x ray next month...from what I read here, not looking forward to that...

see my blog for specifics.

[siamerican]

Now eight months into this TBPI club, I finally received a callback from the government hospital doc... Last time I was at the hospital was about the five month mark right after the Meylogram which only further suggested what was/is expected of avulsed rootlets, though still didn't confirm anything for sure.

Then it was said I'd be queued up for primary surgery on normal state--out of pocket & affordable basis--which to make an even long story shorter (if you care to indulge in the longer version, see my dot com URL of my user name) has come up only now on delayed yet sudden notice.

It looks like this expectoration of the plexus and beyond with expected nerve transplant to see if can salvage the reawakening of shoulder to elbow function.

Part hard work-part fortune or whatever has been seeing partial return of my wrist and hand on its own these hard eight months, enough to retake up the ukulele and typing some (when I can position my arm right as it can't support itself let alone lift up)

I worry that the compensation I have achieved in my wrist and arm will be jeopardized when I’m opened up. Surely, it is normal concern as who wants to take four steps back after only making this first step out of the dreaded pit of agony. As is with any worthy gain, there must always exist associated risks, so be it—I can only hope going under the knife is in my best interests at this stage. I want to regain whatever upper arm is possible but don't feel easy gambling lower arm-hand.

Has anyone else had the primary surgery, later--post six month mark as me in which hand and wrist had returned on own prior to surgery? What were the results? What kind of risk are we talking--particularly to lose what was previously regained (wrist and hand) once nerves for upper arm get rewired, am I going to have to start from square one with twitching fingers or should my arm/hand be where they were as they are now before any nerve transfer/rewiring?

Okay, well I amagine I may be already be in lala land by the time some of you get a chance to respond if at all. Still hoping top hear from others in similar boats:)

[siamerican]

so basically, i'm talkin to myself here...

well my operation revealed perhaps better situation than expected with just one c5 rupture at trunk, grafted with 5cm of sural nerve... as it is not gurunteed to work with the timing of my fix bein 8 months and expected another 8 more months time for nerve to grow and reach my shoulder/bicep (knocking on wood that the graft works these next several months), oberlin procedure was also done (part of healthy ulnar nerve transferred to musculotaneous in bicep)to aim for earlier compensated function return. hopefully, both will work.

please see my blog for more specific, description of my operation, particular if you want to be shocked about how much I ended up paying out of pocket for it all...making your supposed American saints (we all know who everyone brags hear about) look more like profit pumping peripheral pimps.

[siamerican]

btw,my hand/arm appear to be unaffected by the operation, though my wrist extension does seem stronger a tid bit, maybe related to clearing of scar tissue