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You are welcome to apply any part of this article to your own personal use. Please do NOT publish any part of the article or apply any part of it to any non-personal use without the express written concent of the author.
Hi all,
Well, we saw the doctor this afternoon (Tuesday), and it was pretty much the same as we heard last Friday. To rehash, just below the back of my left knee at the top of the calf and just under the skin is a lump. I've been noticing it for about a year now. It's growing and becoming bothersome.
It's 99% likely to be benign. The permanent solution is to remove the section of nerve involved with the growth. If the nerve is sensory, I'll just loose a bit of feeling somewhere below the knee and I can live with that. If it's a motor nerve, I would loose the ability to control muscles controlled by that nerve. As a consequence I might loose my ability to walk using that foot.
We spent some time in the library over the weekend, checking out Gray's Anatomy, etc., looking for whatever we could find on neurofibroma. It wasn't much. One of you asked if it was something like ganglion; no, that's a cyst and this is a growth of nerve cells.
Now, here's new stuff we learned today. Sometimes such growths can be shaved off the nerve using lasers, with little or no adverse impact on the nerve. However mine is involved so much that shaving the growth is not a permanent solution; whatever is left in the nerve will keep growing and the problem will just resurface. If the nerve controls motor functions the most likely muscle to be impacted would be the calf, given its location. Since the calf impacts the ability to press down with the foot, walking (or even standing) would become a non-trivial event. There is the possibility of grafting a new nerve segment to replace the exorcised one, but that takes a looooong time to get any results, if ever. There's a neurosurgeon in Gainsville, FL, just a few hours drive away. If the nerve turns out to be motor, I'll most likely be referred that other guy as he's the best in dealing with this kind of situation.
Just for grins I tried an experiment -- walking and just standing without out contracting my calf muscle. Pretty difficult, but not impossible on flat ground. But working on a boat trying to muscle down the spinnaker...
I'm not so sure it's doable safely.
Okay, here's the plan as it stands right now. Thursday afternoon of this week I will see another neurosurgeon. He will do a preliminary test to see what kind of nerve is involved. The results will be immediately known, so then we can discuss our options. If it's a sensory nerve, we'll schedule a quick surgery to do the exorcism. If the preliminary results indicate it's a motor nerve, again we'll do the surgery confirming the preliminary results; but this time we'll just shave the lump to reduce the impact and give us time to get other opinions and make the hard choices. Of course we'll confirm the preliminary results directly on the nerve in surgery before actually doing anything on the nerve, whether cutting or shaving. The follow-up surgery should be done soon before scaring builds up, so that it'll be much easier to do whatever has to be done.
My thoughts... Having the preliminary tests is not rigorously required, as the surgery will have to confirm those results with special test equipment anyway. On the other hand, the fellow doing the preliminaries has been quite accurate. So we will have a good sense of what's ahead of us before the actual surgery. Also two heads are better than one, so with a consulting neurosurgeon more options can be explored.
All for now. More Thursday...
Fair winds,
Capt. Edmund "Bear" Downing
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