As many people who read my blog will already be aware, I have a number of health conditions. A lot of my activism is dedicated to trying to find a voice for people with disabilities, chronic illness, and mental health problems, as a result I spend a lot of time speaking of my own experience of ill health, physical and mental. What some may not know is just how rare one these health conditions is, or even what it is. Given that I find myself having to explain it to doctors from time to time, it’s no real surprise that the general population doesn’t know of it. In this post I would like to introduce you to my syrinx, who I’ve named Dave, and my journey through onset of symptoms, diagnosis, and learning to accept him as a part of my life.
For some time I’ve been meaning to write up some things on this, namely explaining it in more depth and also my experience of diagnosis, which I’ve wanted to write for myself more than anyone else. Even years later, I find the memory of it quite frustrating and I’d like to get it down.
I have “idiopathic” syringomyelia, a cyst formed of spinal fluid in the centre of my spinal cord, blocking some of the nerves response my legs and left side of my abdomen..
When I was 18 years of age, in the October, I woke up at around 8am with pins and needles in my left foot. Thinking I just slept funny, and having suffered sensory and mobility problems in my legs in the past, I thought nothing of it and carried on with the day.
As time went on the pain got not only stronger, but began to present in my right foot and leg, and spread further up my left. By the evening a lot of the pins and needles and sharp pains had gone, and instead I was left with numbness, as though my legs had gone to sleep. In the space of a day I had lost all but a very dull sensation when touching my legs.
Having had similar (though nowhere near the same degree) in the past I didn’t think to go to A&E, it had been investigated thoroughly and the result was considered to be within normal parameters. I had not yet been diagnosed with Ehlers-Danlos Syndrome and a year previously had found, my spinal canal was “slightly enlarged”. Any and all neurological symptoms were, as many others with syringomyelia and EDS find themselves being told, ‘psychosomatic’.
I made an appointment to see my GP, a man I’d only recently begun to see. After skimming through my notes he announced that ‘unless you have broken your back, which is highly unlikely as you’re here, it’s probably all in your head’. He prescribed me tramadol and prozac and sent me home.
Upset and frustrated I left and didn’t go back until a few weeks later, when the sensation had deteriorated further and I could no longer stand, even with walking aids. I went to another GP and asked for the chance to see a neurologist; something was deeply wrong.
Months later I got my chance, seeing a well regarded neurologist at the nearby hospital. He told me not to pin my hopes on anything being found after previous investigations had come to nothing. I was told I’d have a full spine MRI as well as a visit to neurophysiology to check and see what signals were going through. Frustrated and far from hopeful of finding answers I went home and waited.
The first to come through was neurophysio. They use that blue tacky substance to stick electrodes to your head, a part of the process I’ve always found quite uncomfortable as they tend to push down quite hard. I’ve quite a fragile scalp and one caused a small laceration under the pressure that was applied. The doctor wired me up and had my lie down, he told me he’d send small shocks into my ankles, let me feel what it would be like on my hands. He told me he’d be able to have a look on screen to see what was ‘going on inside that thing in your head’. The shock to my hand was quite painful, and not having had such a thing tested on my range of feeling in my legs I expected it to be no different. I lied back and waited. 20 minutes later I was roused from the sleep I’d fallen into.
Next up, the MRI. It was the same machine in the hospital that I’d been in before. I’d gone through it all 3 times already so turned up prepared. I had my own blanket and some Winnie the Pooh PJs to change into. (Last time they couldn’t find a blanket and it was so cold my hands and legs were blue by the end of it. Apparently it was quite an odd thing to think of, but as anyone with EDS will tell you, the cold can really, really hurt.) I was slowly guided into the machine after going through the tick box questionnaire, making sure nothing would heat up or rip out of my body were it to go ahead. The same familiar mark, like a line of pencil, was there at the top of the tube, and as with every MRI I’ve had since, I stared at it while the whirs and bangs and zonks droned on around me. Done and over with, I went home.
Two days later, having stayed up late the night before with my now husband, talking about frustrations and expectations, I had a lie in. I was woken at just before 9 by my phone going off. It was the neurology department notifying me of a cancellation the very next morning, asking if it would be possible for me to come in for the results of my MRI. For some reason alarm bells didn’t go off, though I did think it was quite bizarre to have the MRIs ready so quickly, let alone them having been seen by the neurologist. Normally the wait is upwards of 6 weeks before you hear anything. But, it was a chance to get it all out of the way and the frustrations as over with as they could be. Nothing could have prepared me for that appointment.
I wheeled into the office of a grinning neurologist. He was incredibly excitable, speaking so quickly I could hardly keep up with him. He did a quick examination to re-check my reflexes and sensation before I moved back to the wheelie bin (my nickname for my chair, cue ‘i’m trash’ joke) to hear his verdict. “Very rare”, “very uncommon”, “quite remarkable” and then came “surgery”. He was beaming at his discovery and I just blanked out.
Surgery. Neurosurgeon. Spinal surgery. It didn’t properly hit until I got home, stuck between my relief and pure fear. Relief at feeling I finally had an answer (incomplete as it turned out to be), and some way to get better, but then was the idea of my flesh being cut open.
Much of the next few months was spent crying and worrying about what was to come, waiting for news from the neurosciences department in the Bristol hospital I would be going to, from the neurosurgeon who would be taking my case. A few months passed before it arrived and I spent the journey to see him distracted. I was going through a kind of high, manic phase and, now, I remember very little of it. I remember being told there were only four cases, if they counted mine, that they’d treated. I remember being told they would ‘fillet’ me, cutting ‘up here by your brain, right down to here by your bum, open you up and have a poke around to see what’s going on’.
Fortunately or unfortunately, depending on how you look at it, I wasn’t and still am not eligible for surgery. As much as anything it’s because I’m too much of an unknown. Other cases he was familiar with, he pointed out, with their ‘published articles’, all had a cause. They had tethering of the filum terminale, Chiari Malformation, cancer, arahnoid webbing. Mine has nothing. It’s just there and they don’t know why. A syrinx with no cause.
Syringomyelia is normally caused by some kind of blockage of the spinal fluid flow. The pressure spiking, or simply having nowhere to go, can cause it to leak into the centre of the spinal cord. A patch of the cord could be the path of least resistance in the face of a blockage, and so in it goes, forming into a syrinx in the usually pin-width central canal.
The images below are taken from some of my MRIs over the years (of which I lost count, I’ve had so many). If you look closely you will see in them a small, unchanging, unmoving circle. In the centre of it is a white dot which gets larger and smaller, and around it is a dark grey area. The white dot, that’s Dave, that’s the syrinx, the cause of some of my symptoms; not all, I should add. It’s complicated by the Ehlers Danlos Syndrome which can also have some neurological symptoms, and the suspicion of occult tethering; where the filum terminale, a little ligament at the base of the spinal cord which shouldn’t but does pull the cord taught for some and is not uncommon in EDS.. The dark grey area around that growing and shrinking circle that is Dave, is my spinal cord. Dave should not be there, that central canal is not supposed to be anywhere near as visible, if at all.
Turning it into a car analogy, Dave is the twat in a transit van who keeps breaking, swerving and switching lanes without looking on the M25, making you 3 hours late for work because he’s left a few crashes in his wake.
These are poor examples at showing his size, though I don’t have the better and more recent MRIs which show him clearer and larger. From it’s point in the centre of the cord, the syrinx puts pressure on all around it. Instead of being squeezed from the outside, it’s from within, stretching the fibres and sending out and receiving the wrong signals from around the body in relation to the area of the cord affected. It’s fucking up the nervous system from the very inside of it. And for me, no one’s certain why.
According to a study from 1966, before MRI, it was estimated that the prevalence of syringomyelia in the population is 8.4 out of every 100,000. Idiopathic syringomyelia makes up less than 1% of cases out of that 8.4.
For me, my syrinx, Dave (and speculatively symptoms from other EDS related complications, according to the doc) had left me an incomplete paraplegic. That is, I have no sensation from the hip down on my left side, and from around level with my breast on my right side. Between the two sides is very mixed, but I usually say it’s ‘waist down’ for ease.
Dave limited my mobility which is incredibly tiring both physically and mentally. In order to move my legs I have to consciously think about what it is I’m doing. Am I having to move my right or my left? How do I make my foot go there, or move like that? The easiest way to move my legs is, aptly, also one of the most taxing. I tense all the muscles during the movement, for some reason it helps focus and then I am less likely to fall. To walk in a way that looks ‘normal’ I think ‘hip, raise knee, lift foot, place foot while moving from hip and knee, hyperextend knee, push weight forward, raise from hip…’ and so on.
You know the line from Kill Bill? “Wiggle your big toe”? That’s been quite an influence in my life because goddamn you would not believe how hard it it. Not just moving toes, but moving them in a particular way. To wiggle one toe, or even all of them, without them just spreading out or curling up and not releasing. I’ve had hours of fun just sat on the bed trying to work out what I have to do to move them how I want.
Anyone who’s ever thought about how nerves work probably knows this isn’t the extent of it. When the spinal cord itself is affected, any number of things could happen. For me, those things include incontinence, feeling like I’m being burned (imagine touching a red hot ember, that pain within the first moments of touching it), aching, stabbing, the feeling of bugs crawling around under the skin that’s so vivid you find yourself looking for them. Electric shocks, tremors, muscles tensing and cramping, feelings of cold or heat. There’s very little that it can’t make you feel. One of the hardest realisations I’ve had to get to grips with is that this may not be the worst of it.
Syringomyelia, as mentioned above, often has a cause. Treating the cause is what usually brings about an improvement (if any) with the size of a syrinx. It’s not something they can go into and just suck out, its right in the centre of the cord. There are options such as putting in a shunt to prevent pressure from rising in the cerebral spinal fluif, but even that does not have great success rates. What is considered ‘success’ with a shunt varies widely, too. For a lot of people who have had shunts installed and their syrinx reduced in size as a result, many have suffered a change in symptoms that they wouldn’t exactly describe as an improvement. Increased pain is among the top problems which I see a startling number of people among syringomyelia/CM noting, yet they are considered a success because the syrinx itself has reduced.
Dave, my syrinx, he is presently (and has been for a number of years now) around 30cm long and 4.6-4.7mm wide at his widest point. One thing that doctors do not like pointing out, and so have skirted it almost every time I’ve asked – almost – is what the future is likely to hold. The reality is that it’s not necessarily going to be bright. Because of the nature of an idiopathic syrinx, it being so hard to treat and the reality of ‘success’ rates, it really is an unknown. In American literature it’s largely considered to be a progressive problem, wherein the syrinx grows in length or width, or in some cases another syrinx appears somewhere else along the cord (in some of my MRIs you can see an enlargement in the canal in my c-spine about 3cm long), and mobility and sensation are further decreased as a result.
For me it’s a balance of what I’m able to do now and my quality of life, vs the risks of a shunt and the potential for success. This decision is out of my hands at present, though given the balance as it is right now I wouldn’t consider surgery an option anyway, particularly after the surgeon’s ideas of an expedition of sorts. It’s always going to be difficult, and the future will most likely be more so.
What I cling to with dear life is the comfort that I am human. While I do suffer from quite severe depressive phases which may give me incredibly negative thoughts about it, I often find comfort in knowing that we are very adaptive creatures, we are creatures who find ways around things.
I have learned to walk again. I can wiggle my big toe if I try really hard. Despite the problems I developed with the EDS I can just about hold a pen, or a cup of tea. These are things that, thinking back to the times where I tried so hard to relearn or adapt and they seemed impossible, I managed.
I’ve often found myself asking the question ‘why did this happen?’, but the answer is as simple as the question, and given what I write above, is also quite a positive thing if looked at in the right light. It’s because I’m human. Bodies are incredible things; they can perform incredible feats and possess remarkable strength. They can also be so incredibly fragile and have the power to mess you up quite royally.
Initially written for Rare Disease Day (28/02/2014) revise 13/02/2016