SPMLs & EtOH

stand, let alone walk. On the 12 th we see two adductor emg bars go full height as someone tries to pry her knees apart. No go. Next day, she had ethanol focal dysmyelination (we didn’t call it that back then) and three days later she could abduct & adduct with supple ease & walk once again. Key points: SPMLs are NOT “an operation”. It is a way to gauge and alter interactive function and reaction in a reactive patient. “GOOD” relaxed anesthesia and well supported padded positioning makes this impossible. We do what we do using local anesthetics and putting the parts in motion while we fix checking resistance and reaction. Light anesthesia is used to do the electrical nerve stimulation first, which can be nasty, and to then put local anesthetic in the various locations we map out by reactivity for SPML ‘portals’. The preoperative list of what is thought will be done is not a preop list of what will be done. It is a guess of what we will probably find which needs addressing. We sometimes add and very often remove things from that [required to book cases] list. Consent is as informed as we are knowing that we are reacting to what actually happens as we go stepwise.. Commonly what we do in one spot causes a different location to change its reaction to our testing manipulations. These reactions cross sides very commonly. A troubled left hip may be found reacting very strongly in a bad way to stimulus to the opposite leg. So, treating the “BAD” side means what? See? It is more like electronics than like carpentry. Circuits matter. Because of compensatory function, actual defects may be well hidden.