A Narrow Escape From Paralysis
Maston relates how her story unfolded.
“It was busy at our club in March,” she says, referring to The Springs in Rancho Mirage. “I was in charge of décor for our ladies’ invitational golf tournament and trying to get everything done. I’m a very healthy and active person, but I just wasn’t feeling right.
“I thought it was the beginning of a pinched nerve due to everything I was trying to do,” the 57-year-old continues. “I was having what I called spells, feeling numb all over, like the sensation when your hands fall asleep. It was happening more and more. I felt slow in my movements and I was getting tired every day.”
Maston called her Eisenhower primary care physician, Gloria Engel, MD, Board Certified in Internal Medicine, explaining that if this was a pinched nerve, she wanted to get a corticosteroid shot because she had yet another golf tournament coming up. Dr. Engel referred Maston for an MRI exam to help determine what was causing her symptoms.
“It took all my strength to hit the ball”
“My MRI was scheduled for the afternoon of the first day of the tournament I was playing in,” Maston recalls. “It took all my strength to hit the ball, and I just fell apart off the course, which isn’t like me.”
After her MRI, Maston went to her car and started crying again. “And I’m not much of a crier,” she says. She called her doctor’s office from the car and asked to have the doctor review her scan as soon as possible.
“I just didn’t know what was happening to my body,” she says.
When she got home, Maston received the call from Dr. Engel.
“I asked her if I needed to come in for a shot and she said that she’d scheduled an appointment for me with a neurosurgeon for the next day,” Maston recalls, referring to Farhad Limonadi, MD, Board Certified in Neurological Surgery. “I told her I couldn’t do that because I had a golf tournament the next day.
“Then she told me, ‘You don’t understand,’” Maston continues. “‘You are broken right now and need to get fixed. And a shot won’t do it.’”
Troubling MRI findings
Dr. Engel had discovered troubling findings on Maston’s MRI. The exam showed severe narrowing of Maston’s cervical spine that was resulting in a potentially paralyzing injury.
“I knew we needed to act quickly, because when Yolanda told me she could not feel the golf club in her hand, I knew that was not a run-of-the-mill numbness,” says Dr. Engel.
Maston admits that she didn’t believe her doctor at first.
“I was more concerned about letting my golf partner down,” she says. “And I just kept thinking, ‘They’re wrong, I’m healthy.’ And maybe I should get a second opinion.”
So the next morning, Maston and her sister headed to Dr. Engel’s office with the intention of getting a copy of her medical records. Dr. Engel called Maston on her cell phone and urged her to keep her appointment with Dr. Limonadi.
“I have such respect for Dr. Limonadi who has always been accessible, extremely kind and more than willing to help in any situation,” says Dr. Engel. “He epitomizes what every doctor should do — take care of the patient first.”
“I looked at my sister and said Dr. Engel is adamant that I see the neurosurgeon,” Maston recalls. “So I went to Dr. Limonadi’s office, arriving a little late for my appointment. As my sister was filling out my paperwork, they called my name. I got up and could barely walk; I couldn’t feel my feet. I was already getting paralyzed from the waist down.”
Maston remembers Dr. Limonadi coming into the exam room carrying her imaging results.
“He proceeded to show me how I had spinal stenosis in my neck,” she relates. Stenosis is a narrowing of the open spaces within the spine, which can put pressure on the spinal cord and the nerves that travel through the spine. “He told me that I could walk out and get a second opinion, but there’s no guarantee that I would have five minutes, a day or a week before becoming paralyzed.
“I was dumbfounded,” Maston says. “I kept looking at my sister, trying to comprehend what Dr. Limonadi was telling me. Then I said, ‘Okay, what do you want me to do?’ And he told me I should go to the Emergency Department at Eisenhower immediately.”
Dr. Engel, Maston’s primary care physician, made the arrangements to have her patient admitted to Eisenhower Medical Center. “I wasn’t in my room more than five minutes when Dr. Limonadi, Dr. Engel and Dr. Shen [Neurosurgeon, Alfred Shen, MD] were there checking on me,” Maston recalls. “And I was in the ICU within an hour.
“I was blown away by Dr. Engel’s efficiency and determination to get me the best care possible,” Maston says. “She was magnificent and wasn’t going to risk my life.”
A serious situation
“Mrs. Maston’s situation was quite serious,” Dr. Limonadi relates. “And credit goes to her primary care physician for diagnosing this problem early and addressing it properly. Dr. Engel had pulled me out of a meeting and asked me to look at her patient’s films. Her impression of spinal cord injury was quite accurate.
“When I saw Mrs. Maston that first time, she had a profound weakness, notably dysfunction of her upper and lower extremities,” he continues. “She had what’s called a robotic gait — a very difficult time with walking.
“She complained of how her symptoms had worsened from just that morning,” he continues. “It was a fast-moving process, and she was having numbness, heaviness of her arms and legs, and progressive loss of manual dexterity. The numbness was painful, with an electric shock-like sensation.”
As a result of the narrowing and compression of two discs in her cervical spine (the neck), there were changes in Maston’s spinal cord itself, evidence that the tissues had been damaged.
“The spinal cord is supplied by the anterior spinal artery,” Dr. Limonadi explains. “In Mrs. Maston’s case, this artery was compressed along with the spinal cord itself, limiting blood flow to the spinal cord, just like a stroke cuts off blood flow to the brain.
“With spinal cord injury, the disease process may be a one-way street and symptoms can be irreversible,” he continues. “That’s why it is important to remove the offending material, reinstitute blood flow and disrupt the disease progression process as soon as possible.”
In Maston’s case, this meant surgical intervention.
What surgery entailed
Dr. Limonadi performed what’s called an anterior cervical discectomy and instrumented fusion on Mrs. Maston. This is a form of surgical decompression that enables the offending discs to be surgically removed. At the same time, he performed fusion surgery to stabilize the segment of the cervical spine where the discs were removed.
“We monitored the electrical activity of her upper and lower extremities throughout the operation to ensure that her spinal cord function remained intact,” he notes. A surgical microscopealso provided exceptionally precise visualization for this delicate operation.
The anterior approach means that the surgery is done through the front of the neck, which generally provides better access to the spine. Patients also tend to have less incisional pain from this approach than from a posterior (back of the neck) operation. The operation took about four hours.
Remarkable improvement
“The procedure went extremely well,” Dr. Limonadi says. “Almost immediately afterward she had remarkable improvement in her symptoms; she was able to walk with a better gait and move her arms and legs with strength and control. We were quite satisfied that the outcome was what we hoped for and expected.”
Maston had to wear a cervical collar for the first three months after her surgery, and was prohibited from driving — both a car and on the golf course.
“The collar was to immobilize the neck to make sure that the fusion ‘takes,’” Dr. Limonadi explains, noting that Maston could have removed the collar to drive a car in an emergency, if necessary.
As for golf, he told Maston she could putt right after the collar came off, but he advised her to wait a full six months before returning to “aggressive golf” to ensure complete healing.
To aid in healing, Maston also used an electronic device called a bone stimulator. She likened it to a “yoke” she wore over her neck for four hours a day.
“Studies suggest that patients who use this device have more success with their bones healing after surgery,” Dr. Limonadi says. “We do everything we can to optimize our patients’ recoveries.”
A few weeks after surgery, Maston had a bit of residual numbness or tingling in the tips of her fingers, but that is resolving, she says. She is expected to make a full recovery, with no restrictions on her activities.
“Life could have turned out very differently for me,” Maston acknowledges. “I couldn’t believe how fast my condition deteriorated; I’d never fallen or had any kind of injury.” “Had Mrs. Maston not been brought to proper care immediately, without a doubt she’d be paralyzed now,” Dr. Limonadi states. “I have been very blessed and fortunate,” Maston says. “It’s a miracle, and I’m still wrapping my head around the seriousness of it all.
“Dr. Engel’s persistence,” she continues, “and Dr. Limonadi catching it in time…he saved my life as far as what it would have been like otherwise.
“I will rave about these doctors for the rest of my life,” she adds.
What causes degenerative disc disease?
“Unfortunately, as we get older, we undergo age-related degeneration of all our joints, including the spine,” explains Eisenhower Neurosurgeon Farhad Limonadi, MD.
In the neck, this process sometimes can evolve faster than the rest of the body, resulting in compression of the spinal cord (myelopathy) or the nerve roots that come from it (radiculopathy) — both of which Mrs. Maston was experiencing (see main story).
When to see a doctor
Dr. Limonadi advises anyone who experiences the following symptoms to see a doctor right away:
• Neck pain that radiates to the arms
• Back pain that radiates to the legs
• Weakness of the arms and/or legs
• Numbness and/or tingling of the arms or legs
• Gait (walking) instability
• Impaired manual dexterity
“While pain is a sufficient reason to see your doctor, weakness is a major alarm, and you should see your doctor immediately,” he stresses.
How to help prevent degenerative disc disease
Dr. Limonadi gives this advice to help slow the degenerative process:
• Avoid smoking
• Eat a proper diet and practice modification in consuming foods containing ingredients that contribute to inflammation, including trans fats, sugar, white bread, saturated fats (animal fats), alcohol, omega 6 fatty acids, full-fat dairy, MSG and gluten
• Maintain good bone health by getting enough vitamin D
• Avoid activities and sports that cause repetitive injury to the spine
• Maintain proper posture at all times to avoid what’s called “tech neck” (“Modern technology, like the computer, cell phone and tablet, causes us to hold our body in poor posture,” Dr. Limonadi cautions.)
To find a primary care physician, neurologist or neurosurgeon, visit emc.org/physician or call 760-568-1234.
