A letter from Sister Lazarus
Hi, Doc. I wanted to thank you for putting your site together. It is very helpful to have plain English explanations of neurological terminology. I have been referred to a neurologist because I have foot-drop in my right foot and am beginning to have episodes of foot-drop in my left foot. All of my doctors have been unable to elicit any reflexes from my upper or lower body. They hit me and nothing happens then they hit me again and nothing happens. Then they ask me to clench my jaw as they hit me and nothing happens. Then they make me sit in odd positions and hit me. And, yup, nothing happens. What on earth are they looking for? I think they think I am a bit mad because after a while I just can’t help laughing at them. Whacking people with hammers is like being in the Stone Age or something. In my imagination I can see a dinosaur sitting in a hospital gown on an examination couch and a doctor has just come out from behind a curtain weighing an enormous stone club in his hands and he’s saying, ‘if this doesn’t get a response nothing will…’ and the dinosaur’s eyebrows are up off his forehead — like a Far Side Cartoon. I don’t know, it just strikes me as very, very funny, especially when the same doctors then send me off for space age scans in MRI machines. It is so weird – blunt instruments and quantum mechanics all in the same day. Neurologists are a breed apart. I don’t know if you know how strange you are…? I mean that in the nicest possible way
Anyway, would you please put a page together for your website explaining what the doctors are looking for when they whack their patients with hammers and what it means when they get or don’t get a reaction? I would appreciate it (and I think other patients would too).
With many thanks,
All best wishes,
Dear Sister Lazarus,
thank you for your kind email. It brought a smile to my face. I shall certainly put up your post on my website (with your permission I hope) and shall help explain the mystery behind eliciting deep tendon reflexes with the use of a reflex hammer. May I tell you something. I have noticed that even my most serious/ tough patient shall break into a smile or a giggle when I tap on their reflexes. Maybe for that reason itself I shall keep the mystery of the reflex hammer a mystery.
Nitin Sethi, MD
My Father is an aolcoholic and last Sept he was admitted to hospital after a fall when drunk – whilst in hospital he had a fit – understandable he was cold turkey whilst there. He was treated and sent home. Since Dec he has reduced his drinking and now generally consistantly drinks 1 bottle red wine a day – yes this is still too much but about 50% what he used to drink – he reduced gradually and has maintained this intake for a few months now.
What I find strange is that all i can find about these alcohol withdrawl fits relates to 2-3 days without alcohol – Dad had a fit a few mornings ago after a normal day and normal alcohol consumption levels. The hospital saw alcohol in his notes and packed him off home again with some Vitamin B tablets.
How many alcoholics normally get fits whilst they are still drinking? How normal is this? He is eating better these days than he was but still could do with eating more. He borderline underweight and 74 years old – he has been dependant for more years than I can imagine but probably the last 12 years have been the worst. He does not drink in the morning but the first drink in the day is normally 3/4pm and last drink 6/7pm before bed. This one bottle of wine is often enough for him to fall when on his way to bed or even a few hours later I have had to carry him back to bed if he falls in the bathroom. His body just doesnt seem to be able to cope with alcohol any more – less alcohol to get drunk – is this why he is having the fits?
My apologies for long winded questions but the question needed some context to make sense I think. Any I am not delusional about his alcohol intake – I monitor it and he has no other way or place to stash any.
Thank you so much in advance
P.S. the fit was 6.30 am Thursday and now Sat pm he is still very unsteady and his memory is worse than before. What is the normal recovery from these fits?
thank you for writing in to me about your father. There is no one set limit above which alcohol can induce a seizure. The limit varies from person to person. Rum fits (seizures which occur at the height of binging) of course occur when one consumes too much alcohol in too short time. Alcohol withdrawal seizures classically occur 24-48 hours after the last drink (they occur in people who are chronic alcoholics/ people who consume heavy alcohol on a daily basis and who then suddenly stop drinking). Again not every chronic heavy drinker gets alcohol withdrawal seizure if he/she stops drinking suddenly. Usually it is the person who is chronically malnourished and dehydrated who is more predisposed to an alcohol withdrawal seizure in the setting of sudden cessation of drinking. These people as you can well imagine are deficient in multiple vitamins and minerals (commonly the B group of vitamins such as Vitamin B1, B2, B6, folic acid and B12). Their electrolytes are also more likely to be off (meaning they serum sodium, potassium, magnesium is low). They may also have alcoholic liver disease (alcoholic steatosis or fatty liver, alcoholic hepatitis and finally cirrhosis). During their prolonged drinking years they may also fallen down and struck their head. So it is a combination of factors (meaning the overall health status) and not just the sudden cessation of drinking which predisposes some alcoholics to alcohol withdrawal seizures.
Finally over the course of years of heavy drinking, some alcoholics develop epilepsy. The reason for this may be any of the above I have listed. My personal feeling is that these patients likely have underlying epilepsy and alcohol (in excess or sudden cessation after years of drinking) just helps to unmask it.
Now let me answer your last question about time frame of recovery. Again if his pre-existing neurological status is compromised (his memory is already bad after years of drinking, his general medical condition is poor or if he has coexisting medical problems such as chronic lung or liver disease, diabetes or congestive heart failure) his recovery from a convulsion shall be slow as compared to a young person with no pre-existing medical problems.
I hope I have addressed some of your concerns. I wish you both my very best.
Nitin Sethi, MD