He Was Getting Weaker and More Confused. Could It Be His Drinking?

New York Times

6 days ago

The woman struggled to get her 53-year-old husband out of the car and into the just-borrowed wheelchair. She rolled him through the crisp February air to the Emergency Department at Lawrence and Memorial Hospital in New London, Conn. They had driven straight from the neurosurgeon's office, where the physician assistant was shocked by how weak the man had become, how much worse he was than six weeks earlier when he last saw the patient.
In the E.R., the man lay moaning quietly on the stretcher. His blood pressure was low, his heart rate was high. He could barely move his legs on his own, and when the E.R. doctor lifted each leg and let go, he couldn't hold them up. The doctors were worried something was compressing the man's spinal cord. The patient needed an M.R.I. right away.
After the test, the man was given fluids. He hadn't been eating or drinking much for the past few weeks, his wife told the nurse. The M.R.I. showed wear and tear in his neck and some narrowing of the spinal column in his lower back, but it didn't seem enough to cause this profound weakness. Even so, the neurosurgeon who reviewed the results thought they should start him on intravenous steroids to bring down any swelling that might not have been seen on the M.R.I.
That night, after his wife went home, the patient, tired and a little confused, could only provide the admitting doctor with a very basic story. His legs had started hurting a few months earlier. It began with a pins-and-needles feeling in his feet that over time moved upward. And he had terrible leg cramps. He couldn't sleep. He couldn't work. Then he couldn't walk. And now he was here.
The doctor found the rest of the history in his chart. Back in September, his primary-care doctor sent him for an M.R.I. and tested him for B12 deficiency and, because this was Connecticut, for Lyme disease. His B12 was low, so she started him on a supplement. He didn't have Lyme disease. And that M.R.I. showed some osteoarthritis and mild compression, so she sent him to a neurosurgeon. He was given oral steroids and referred for physical therapy. Neither helped.
By December, he was unable to leave the house. He fell several times. By January he was having problems with his memory. He missed appointments; didn't get ordered lab work. The patient had a long history of drinking, the doctor noted. The previous year, he was found guilty of driving under the influence and had to go to a court-ordered alcohol program. He was drinking less, he told the doctor. But still drinking. He had a drink earlier that day, he admitted. But only one.
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