[mmglobal]

I'm back from Germany and struggling to catch up. Something very interesting happened there. After the week in Berlin for SAS, I spent last week in Straubing with 2 cervical patients. Both are recovering nicely after relatively good experiences... I hope they'll come and post.

When I left Berlin, instead of arriving at Munich Airport and driving east to Straubing, we head west to Munich to see Baumbach. Yes, he came in on Sunday to see 2 clients. We spent from 10am till 10pm with 2 clients.

When going to Germany, if my clients have significant neuro involvement, I always try to get a Baumbach exam because it is more comprehensive than anything I've seen. His insight is remarkable and he frequently adds to the process in a very meaningful way. Even if there is nothing discovered that has an impact on the upcoming surgery and related decisions, having a comprehensive "baseline neuro status" may be very important in the future. (If neuro deficits are discovered after surgery, we often don't know if they existed before.)

(Posting with his permission) One client has a difficult constellation of symptoms, both lumbar and cervical. He's here for cervical surgery because he has significant myelopathy that is affecting his grip strength and dexterity in his hand. This made his c-spine a priority, even though the pain associated with his cervical issues is relatively minor. His chief complaint is severe testicle pain that has been with him since 2000. In 2003, he had a lumbar fusion in an effort to relieve that pain.... no change. In the year that followed, he had 2 more procedures in an effort to relieve that pain... again... no change.

Dr. Baumbach wanted to do more electrophysiologic testing... EMG, NCV, and SSEP. I questioned this because the patient had recent testing that identified a delay in his arm and called it carpal tunnel. Dr. Baumbach explained that the delay may be carpal tunnel, but may also be part of something else and not ruling other issues out would be a mistake. OK... I get it... he's not repeating the testing; he's doing a more comprehensive battery of tests.

Other neuro deficits were discovered in his legs, making a diagnosis of polyneuropathy more appropriate than a diagnosis of carpal tunnel syndrome. Note that Polyneuropathy does describes the symptoms, but not an illness or the cause of the symptoms. Knowing that this exists, it will be necessary to rule-out common causes... lyme disease, diabetes (could be latent diabetes that is not caught by normal screening... glucose tolerance test indicated), B-12 metabolism, thyroid, heavy metal exposure, etc… This is VERY important; however, it is not the amazing diagnosis!

We were at the end of almost 6 hours with Dr. Baumbach for this one patient. We were done and reviewing the results. I asked a question about the testicle pain. The expression on Dr. Baumbach’s face changed and we could see the wheels turning in his head. He asked the patient to get back on the table and proceeded to apply pressure to the lower abdomen/groin area, trying to provoke the pain. Amazingly, Dr. Baumbach was able to provoke the testicle pain by applying pressure. Presumably there is some nerve entrapment / irritation, UNRELATED| to the patient’s spine, which may be involved in this pain syndrome. A few minutes later, the patient remarked that this pressure point that provoked his pain was on a scar for a surgery that he’d had when he was 5 years-old.

Again, this patient was in Germany for cervical surgery, but his most severe pain has gone undiagnosed for the last 7 years and remains severe in spite of a fusion and 2 other procedures. Now he has a chance at getting a proper diagnosis and hopefully, will have a chance at getting it resolved.

As we were wrapping up, I made a comment about his willingness to spend ½ a day with a patient… ending Sunday night at 10pm. He replied, "What's 1/2 a day, when he's been in such pain for so many years?" Dr. Baumbach is incredible. I’m proud and honored to be involved in this process.

More later… all the best….

Mark