Surgery Explanations

I didn't do a very good job at explaining the Alcohol Block (nerve block) in my previous update, so here is a better explanation of how it works. The most impactful statement below is that: "Children can't learn what does what when no mater what they do - everything happens. Much of the motor learning delay that we see is from kids trying to figure out what to suppress in order to just get the one thing they want. They learn oddball secondary acts which seem to inhibit the unwanted actions."

This sums up what was happening in Lucas every time he'd try to make a movement (even just to play with a toy in his hands)... EVERYTHING would happen. See the analogy below about the light switch. The alcohol block that we had done last week eliminated this over-firing by slowing the transmission down.

PS, for fellow preemie parents that follow our blog, here is the link to Dr. Nuzzo's site, which will explain SPML and Alcohol Block in much better detail. The SPML procedure stands for "Selective Percutaneous Myofascial Lengthening"... this is not to be confused with the more traditional surgery of "Percutaneous Lengthinging". The SPML procedure we had done is very, very different, as explained on the website. Lucas' incisions are the size of a small needle in about 6 places (as opposed to "zipper" scars all the way down the leg that comes with the traditional invasive perc lengthening surgery).

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Alcohol Block:

Alcohol is a good chemical defatting agent. Rub it on your hands and see how chafed they get. That last feature is what we use alcohol for. Fat removal. It is used in window cleaning agents for that chemical trait.

Nerves come in two main sorts, those with fat envelopes and those without. The fat insulation speeds up the nerve transmission chemistry by insulating it from the general circulating milieu, the part with chloride and sodium and potassium and calcium ions just itching to pour through neural pores. Fat covered nerves conduct faster by controlling that conduction specific milieu and focusing the ion current to receptive nodes.

If there is a nerve that, innocent as it may be, is carrying way too much data as inappropriate bursts of spastic overly repetitive pulses, then placing a speed bump on that nerve can reduce the ill of that overactivity.

Alcohol injected right on the nerve directly, strips off the fat from that location and slows conduction there. Multiple speeding impulses pile up and come through as one single impulse. So a stream of impulses such as :

gogogogogogogogog-----gogogogogogo-----

comes through the block area as:

go-----go-----go-----go----- Engineers call this a low pass filter.

When a muscle gets hit with a single "go" it responds. When it gets hit with a barrage of gogogogogogogogog it gets thrown into tetany, a rigid hard to undo contractile state. Worse, it screams for help over feed back circuits which (in spasticity) are mistakenly linked into the motor circuits by reflex spinal pathways.

Slowing certain nerves in the loop can drop the recruitment of the reflex mechanisms which get drawn into the fray from further and further away in the spinal pathways as the recruitment gets worse.

The result of aborting that run away reflex recruitment of far away muscles is not just less overactivity of the muscles supplied by the nerve but more precision. Precision? Yes. Often a child cannot just activate a single muscle without getting a smorgasbord of other stuff at the same time. Indeed, the youngster may not even know that there is such a thing as just that muscle.

Imagine if you flip a switch in your house and every single time the toilet flushes, the TV goes on, the garbage disposal comes alive and a light goes on. Do you call that a light switch? Only if you can peel off the unwanted stuff, then yes.

This has impact on learning. Children can't learn what does what when no matter what they do - everything happens. Much of the motor learning delay that we see is from kids trying to figure what to suppress in order to just get the one thing they want. They learn oddball secondary acts which seem to inhibit the unwanted actions.