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Do it yourself (DIY) spinal repair with Spinal Tape
Do it yourself (DIY) spinal repair with Spinal Tape. 
Sometimes you just have to laugh…
~~DISCUSSION~~
Material so black that we can't see it
99.96% Black Paint material so black that we can't see it.
“That,” he said, “that… is really bad for the eyes.”
It was a ship of classic, simple design, like a flattened salmon, twenty yards long, very clean, very sleek. There was just one remarkable thing about it.
“It's so… black!” said Ford Prefect. “You can hardly make out its shape… light just seems to fall into it!”
The blackness of it was so extreme that it was almost impossible to tell how close you were standing to it.
“Your eyes just slide off it…” said Ford in wonder.“ - Douglas Adams, “Restaurant at the End of the Universe” book two of five of the “Hitchhiker’s Guide to the Galaxy” trilogy.
BTW, Bob's Big Bang Burger Bar is at the other end of the Universe. See you at Millways!…
~~DISCUSSION~~
Added 2006 introduction to Trigger Points
Hubby originally wrote this in 2006, for FidoNet which was the precursor to the Internet we know today. Hubby ran a Bulletin Board System (BBS) for Matric where he worked at the time, which was a FidoNet node.
These messages where originally to Darlen Strand, about my wife, in the FidoNet Chronic_Pain Echo.
DS> My neck stays tense constantly. I am forever with a headache.
DS> It got better at times but as soon as I do work like cut the
DS> lawn or trim a tree or anything a little strenuous, it starts all
DS> over again.
When I meet Karen she walked around like she had a board strapped to her back and she would never turn her head, she turned her whole body.
This is one of the other things that we have found that did relieve some of Karen's pain, at least a little.
Some thing called Myotherapy or the treatment of “Trigger Points”:
Here is a quick introduction from The Trigger Point Manual, this is !!THE BOOK!! that Myotherapy is based on:
Myofascial Pain and Dysfunction: The Trigger Point Manual by Janet G. Travell, M.D. and David G. Simons, M.D., Illustrations by Barbara D. Cummings. Published by Williams & Wilkins 428 E. Perston Street, Baltimore, MD 21202, U.S.A. ISBN 0-683-083366-X.
Volume One covers The Upper Extremities (Waist and above), Volume Two covers The Lower Extremities (Waist and below). You must have the introductory information from Volume One to use Volume Two.
Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 1. The Upper Half of Body by Janet G. Travell, M.D. and David G. Simons, M.D., Illustrations by Barbara D. Cummings.
Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 2. The Lower Extremities by Janet G. Travell, M.D. and David G. Simons, M.D., Illustrations by Barbara D. Cummings.
Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual (2-Volume Set) by David G. Simons.
Office hours: day and night;: The autobiography of Janet Travell, M.D by Dr. Janet G Travell.
Travell and Simons' Trigger Point Flip Charts
Trigger Points of Pain: Wall Charts (Set of 2)
Pain Erasure by Boinnie Prudden.
Myotherapy: Bonnie Prudden's Complete Guide to Pain-Free Living by Boinnie Prudden.
Pain Erasure - The Bonnie Prudden Way - Discover The Wonders Of 'trigger Pont' Therapy by Boinnie Prudden.
From the Foreword of Myofascial Pain and Dysfunction: “At last a text is presented about the pain and dysfunction of myofascial tissues (Muscles), a condition that confronts the medical practitioner daily, but remains poorly understood and frequently overlooked by the medical profession. Yet, patients continue to present themselves with symptoms that are attributable to myofascial trigger-point pathophsiology. These patients often fail to receive proper evaluation and, therefore, appropriate treatment.
”'Trigger points' have been inadvertently discovered by patients, their spouses, therapists, non-medical practitioners; yet, many of their physicians who have examined them, have attributed their condition to various etiologies, and treated them with ineffectual methods. Failure to achieve success has resulted in the assumption [By the Doctors] that patients in their noncompliance are the cause of failure, rather than therapeutic misguidance [Doctor being wrong {Doctors are never, ever wrong, even if they are}].
“For decades, Janet Travell has labored to document the scientific basis of myofascial pain and dysfunction. Her clinical reports have been ridiculed and ignored by some, but believed and confirmed by many.”
The Myotherapits that we have meet have made believers out of us. Remember I said Karen would not turn her head because of her tight muscles? Karen was setting on the therapy table with the therapies behind her. After the therapits treated her the first time, for about a hour, the therapits asked her a question. She turned her head to look behind her to answer him. She didn't even realize that she did it. I almost cried. After the first treatment she said she had noticeably less pain. Gone by no means, but that was the first thing that even made a dent in her neck tenseness.
From the Glossary: “Active Myofascial Trigger Point: A focus of hyperirritability in a muscle or its fascia [the bag like stuff that covers muscles] that is symptomatic with respect to pain; it refers a pattern of pain at rest and/or on motion that is specific for the muscle. An active trigger point is always tender, prevents full lengthening of the muscle, weakens the muscle, usually refers pain on direct compression, dediates a local twitch response of muscle fibers when adequately stimulated, and often produces specific referred autonomic phenomena, generally in its pain reference zone. [For example a trigger point below your ear will give you a headache behind your eyes.] TO BE DISTINGUISHED FROM A LATENT MYOFASCIAL TRIGGER POINT.
“Latent Myofascial Trigger Point: A focus of hyperirritability in muscle or its fascia that is clinically quiescent with respect to spontaneous point; it is painful only when palpated. A LATENT TRIGGER POINT MAY HAVE ALL THE OTHER CLINICAL CHARACTERISTICS OF AN ACTIVE TRIGGER POINT, FROM WHICH IT IS TO BE DISTINGUISHED.
“Referred (Trigger-Point) Pain: Pain that arises in a trigger point, but is felt at a distance, often entirely remote from its source. The pattern of referred pain is reproducibly related to its site of origin [You press on the Trigger-Point and it makes your pain feel worse, usually some placed remove from where you are pressing]. THE DISTRIBUTION OF REFERRED TRIGGER-POINT PAIN RARELY COINCIDES WITH THE ENTIRE DISTRIBUTION OF A PERIPHERAL NERVE OR DERMATOMAL SEGMENT.
“Referred (Trigger-Point) Phenomena: Sensory and motor phenomena, such as, pain, tenderness, increased motor until activity (spasm), vasoconstriction [Preventing proper blood flow; for example a trigger-point on the back of the neck can cut down blood flow to the eyes], vasodilation [To much blood flow], and hypersercretion caused by a trigger point, which usually occur at a distance from the trigger point.”
We got our copy of this book from B.Daltons Book store, each volume cost about $80. [I hope you didn't fall over, please stick with me for a bit.] Check your area libraries.
Ok so much for a basic introduction why are we telling you this?
DS> No pain at the time. Really, I can say I didn't feel any pain at all. I
DS> don't know if I mentioned to you about one morning waking up to my being
DS> stuck sideways in between my water bed mattress and the bed wood frame.
DS> I'm separated now, but at the time I do believe it was because being
DS> that my husband is a very big man and when he lays on the water bed my
DS> side goes up and I tend to roll. This time I guess being asleep I
DS> rolled the other way and fell in between the mattress and the frame. Well,
DS> when I woke up I was in the position of like doing a side stroke of
DS> swimming with my arm straight up over my head and my neck totally stiff
DS> and terribly sore. Well after that my neck has never been ok. It got
DS> better at times but as soon as I do work like cut the lawn or trim a
DS> tree or anything a little strenuous, it starts all over again.
Keep in mind I'm not a doctor and I can only speculate what has helped Karen might help you. This is my speculation:
Your accident gave you a Latent Trigger Point [everyone as a at least a few, but the may never become active, where they cause pain]. Then your sleeping wrong gave you a Active Trigger Point. When you get a bit better at time you end up doing some thing that irritates your Trigger Points again so you have a relapse.
What the book teaches is three techniques to get rid of trigger points, it also covers a exercise for each muscle to get each muscle in the body stretched out to its maximum length, with out over extending it. You do these exercises very slowly and gently. Over doing, by stretching to far, could damage your ligaments. You need to do them often and the should never make you feel any worse than when you started. They should make you feel just a bit better, maybe not much when looked at on a day by day basis, but looked at over a longer period of time they do help.
When the muscles are relaxed at their optimal length they tend to not to go into the very painful spasm. ie. Your tight neck muscles. You need to keep doing the exercises to keep the muscle lengthened out, to keep the spasms from coming back.
I wish I could figure out how to describe these exercises, as they are mostly pictures in the book.
The three techniques are:
1) Injection of a anesthetic by a doctor into the Trigger Point site, doing it wrong will just give you more Trigger Points. We can forget about this one in this context.
2) Number two is known as Stretch And Spray. As a Therapist stretches your muscles as they spray them with a very fast evaporating cooling agent [Fluori-Methane I think but I'm not sure.] that causes the muscle to lengthen.
3) Direct Trigger Point pressure. This is some thing you can learn to do your self with a bit of practice. [Karen did learn this and used a Thera Cane] All thou for some Trigger Points that are on your back it is easier to have help from some one else to press on them. When you, or some one finds a Trigger Point, you'll know it. It will make your pain much worse, and muscles tighter, and keep in mind that the Trigger Point may be far removed from where your pain is, thou it will always be within the same muscle as the pain. However you can get a overlapping effect because many muscles do overlap [A Trigger point might be on the muscle under the one that you are actually pressing on. A trained therapist knows how to deal with this, the book is a bit hard for me to follow in this area].
If you had the book you can look at the pictures and charts that say if it hurts here, press there. Don't start by pressing where it hurts, that is almost never the Trigger Point, thou there are exceptions. Without the book you just have to explore. The pressure that you apply should be a firm continuous pressure, no poking, no jabbing, no rubbing in circles, and never press so hard that it causes bruising. Since it makes the pain worse you have a tendency to try to wiggle away from the pressure, because of this it is more effect to have some one else press them; how ever you can learn to do it yourself.
Ok, now why would you want to press on a Trigger Point if it is going to make the pain worse?
With brief pressure the pain gets worse, but with sustained [Seconds to minuets, it just depends] pressure the muscle will relax. One of the theories (there are several) of what happens here is that the pressure on the Trigger Point causes some thing call 'no-knox-ia' (Not sure of the spelling that is how the word sounds to me), ie. The amount of oxygen going to the muscle is cut down, the muscle can't work with out oxygen so it relaxes. Some times they stay relaxed, some times they don't, it depends on what caused the Trigger Point in the first place, and what might keep them irritated. If you can keep the muscle relaxed, and the Trigger Point unirritated, the trigger point goes away after awhile, or at least not cause pain any more.
That's the best that I can do for a introduction to Trigger Points, I have not done the subject justice, but I hope that it at least points the way…”
Update:
The book ”Pain Erasure: The Bonnie Prudden Way” by Boinnie Prudden is a $12.95 Do It At Home Book on trigger point removal. I got mine at the local book store. ISBN 0-345-33102-8
End Update.
~~DISCUSSION~~
Molecule Could Lead to New Way to Repair Tendons?
If Karen had the patience to wait, would this new discovery been able to repair the damage of the Fluoroquinolones antibiotics that made it so she could not walk, and may have played a role in the failure of the CSF treatments?
It's an all-too familiar scenario for many people. You sprain your ankle or twist your knee. If you're an adult, the initial pain is followed by a long road of recovery, with no promise that the torn ligament or tendon will ever regain its full strength.
That's because tendon and ligament cells in adults produce little collagen, the fibrous protein that is used to build new tendon and ligament tissue. Physical therapy and surgery help, but for many people, there may always be a nagging reminder of the injury.
But what if doctors could coax an injured tendon to regenerate itself back to its original strength? A solution along these lines may come from an unlikely, feathered source. Berkeley Lab scientists have identified a molecule that guides the formation of tendons and ligaments. And they found it in chicken embryos.
The molecule binds to the outer lipid membrane of tendon cells, and allows tendon cells to signal their presence to other cells. The molecule’s job is to orchestrate growth and collagen production. In a chicken embryo, a dense growth plate of tendon cells work together to spin out collagen and weave new tendon, which is basically a collagen rope. The more cells signaling their presence to each other, the more collagen is produced.
The gene that expresses the protein component of this signaling molecule is highly conserved among animals, meaning a similar molecule performs the same tendon-building job in developing humans.
“More research is needed, but our initial experiments suggest this protein-phospholipid molecule could be administered to adults who’ve had tendon injuries, to spark healthy tendon growth in the same way that happens during embryogenesis,” says Richard Schwarz of Berkeley Lab’s Life Sciences Division, a biologist who leads this research.
Schwarz studied chickens because they're stars when it comes to making tendons. Chicken embryos start developing tendons just eleven days before hatching, and they enter the world ready to skitter about for food.
“Their tendon-growth process is very fast,” says Schwarz.
The process isn't nearly as fast in humans, but the idea is the same. When we're growing, the tendon cells in growth plates are densely packed together, the perfect conditions for collagen production. In adults, however, the growth plates recede and the few remaining tendon cells are at low cell density. They produce enough collagen to maintain tendons, but not enough to repair an injured tendon.
“In adults, tendon repairs are more like darning a sock—adequate, but not like new,” says Schwarz.
Schwarz’s idea is to reignite the tendon-building capability that occurs during embryogenesis and throughout childhood.
“If we could add back this growth factor, then we could make tendon cells believe they are at high density again—and cause them to reform this growth plate,” says Schwarz.
Initial experiments on cell cultures have proved promising, but Schwarz says that more research is needed. For example, one big question that needs to tested in vivo is whether adult tendon can be driven to form a new growth plate—and heal the tendon or ligament in a stronger and faster manner—by injecting a tendon cell-density signal.
- See more at: http://newscenter.lbl.gov/2014/07/24/repair-tendons.
~~DISCUSSION~~
A blood test for suicide?
Johns Hopkins researchers say they have discovered a chemical alteration in a single human gene linked to stress reactions that, if confirmed in larger studies, could give doctors a simple blood test to reliably predict a person's risk of attempting suicide.
Identification and Replication of a Combined Epigenetic and Genetic Biomarker Predicting Suicide and Suicidal Behaviors – The American Journal of Psychiatry.
Would this have helped Karen? When would such test be done? What happens when the results are positive? What happens when the results are a false positive? What happens when the results are negative and there is a suicide? Paper is behind a paywall so a trip to the library is required to get those answers, if they are answered in the paper.
~~DISCUSSION~~
If you were the one left behind by a Suicide
A Handbook for Survivors of Suicide by Jeffrey Jackson from the American Association of Suicidology.
This is a book for people who have lost a loved one to suicide, written by someone who has suffered the same loss.
This book is not intended to be a complete guide for the suicide survivor—it only scratches the surface. There’s much more you can learn about coping with your unique grief than what is offered here.
This is also not a book about suicide prevention; there are many other publications that address that challenge.
Other helpful sites for the Survivors of Suicide:
No Time to Say Goodbye: Surviving The Suicide Of A Loved One.
Why Suicide?: Answers to 200 of the Most Frequently Asked Questions about Suicide, Attempted Suicide.
Healing After the Suicide of a Loved One.
After Suicide: A Ray Of Hope For Those Left Behind.
My Son . . . My Son . . .: A Guide to Healing After Death, Loss, or Suicide.
~~DISCUSSION~~
Helping Children Understand CSF Leaks
My Mommy Has A Leaky Brain (Volume)
My Mommy Has A Leaky Brain Version 2 (Volume)
Our friend Pam Tomlinson publishes books to help children understand issues, such as CSF Leaks, OCD, why daddy is in jail etc. Sadly Karen never got to read any of them. 
~~DISCUSSION~~
Switched main site to be the wiki
I've been working on this wiki for many months. Wanted to have Karen's main site switched over to the wiki by her one year anniversary that is less than two weeks away.
How can it be a year already?
I made the site be a wiki so that others can participate to share their own stories and information to help others. Also the wiki software lets me do updates quickly compared to what the past website took.
~~DISCUSSION~~
The Pain and Policy Studies Group issues Progress Report Card and Tom Corbett
The Pain & Policy Studies Group (PPSG) research program at the University of Wisconsin Carbone Cancer Center within the School of Medicine and Public Health, has issues a new report (based on 2013 data, old report was 2006):
Achieving Balance in State Pain Policy: A Progress Report Card (CY 2013)
This report contains a grade for each state and the District of Columbia, which represents the extent that state policies can support pain management and patient care. PPSG researchers evaluated the content of state laws and regulatory policies to determine the presence of language that could enhance or impede pain management.
Sadly this report was issued before PA governor Tom Corbett issued his attack on pain doctors:
Pennsylvania Releases Guidelines for Physicians on Use of Prescription Opioids
This is their recommendation:
The guidelines recommend that chronic pain is best treated using an interdisciplinary, multi-model approach. This may include physical therapy, cognitive-behavioral therapy, electronic stimulation therapy, and careful use of medications as needed.
People like Karen long ago went thought all of the physical therapy, mental therapies et.al. and found them to be ineffective at treating Chronic Pain.
They cite the “current heroin epidemic” for the reason to crack down on pain medication. This is typical Government Orwellian Doublespeak. The 'heroin epidemic' was created because it was cheaper than the medication that doctors are so fearful of prescribing that they won't prescribe it any longer to those that need it.
Yes, drug abuse is a problem. Lets not solve that problem at the expense of those that truly need pain medication.
The Pennsylvania Opioid Prescription Guidelines
~~DISCUSSION~~
Use the Charge Master find hospital costs
Use the Charge Master find hospital costs
When Karen and I were in California for her Dural Reduction Surgery I discovered that California had something called the "AB 1045 and the Payers′ Bill of Rights" and Charge Master, or Chargemaster as it appears both ways, program that lists hospital costs.
For example searching for “cedar sinai” brings up a downloadable spreadsheet of their procedure costs. The highest thing listed is:
“02781367 HB TOTAL ARTIFICIAL HEART $510,125.75”
“03400011 HB NM CSF LEAK SCAN 78650 $1,476.66 $1,919.65 ”
That easy to get a price, at least if you know what it is called. I could not figure out the what Dural Reduction Surgery was called in the CM.
Now why don't all states have this so we can shop for medical procedures just as we would do for anything else we buy in our lives?
In a different tho related matter I got a bill in March of 2014 for thousands of dollars from the hospital in LA, seven months after Karen died.
Karen once got a bill seven years after the date of service.
I keep thinking I should contact my representatives in Congress to get them to enact a law that says if the hospital and doctors can't get the bill sent out in 120 days, then the bill can not be sent. What excuse if there to take seven months to send a bill?
~~DISCUSSION~~
Documentary The Revenge of the Nerds
The movieThe Revenge of the Nerds was a documentary of my life. Us Nerds won, or you'd not be using your computer right now would you?
Karen and I were attracted to each other because of our Nerd like traits.
I've never had much regard for the opinions of those I do not know well and don't call 'friend'.
Karen proved life is to short, don't waste your life worrying about the views of others. We all are given the same number of minutes each day, don't waste one of them on those that do not matter.
~~DISCUSSION~~
Karen how do you program the scanner?
Sadly we we do not appreciate the Little Things our wife's do for us. I just ran into yet another thing that Karen always took care of doing for us.
Karen liked to listen to the Police Scanner. I liked listening too, however she always took care of finding and putting the frequencies into the scanner, so I never had to worry about it.
This week Garth accidentally unplugged the scanner., and it lost all of its frequencies, all 200 of them.
This scanner predates computer interfaces. The frequencies need to be entered by the keypad.
Karen was an accomplished programmer when she wanted to be. She programmed the local Amateur (Ham) Radio Repeater system for years, having her Ham license as KD3ZU.
It is not the Big Things what we miss when someone dies, it is these Little Things of life that were overlooked when they were with us. Learn from my mistake and tell your Wife/Girlfriend/Significant Other 'Thank You!“.
Now off to find a manual for this scanner…
“I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful” – Albert Einstein.
“When we first got married, we made a pact. It was this: In our life together, it was decided I would make all of the big decisions and my wife would make all of the little decisions. For fifty years, we have held true to that agreement. I believe that is the reason for the success in our marriage. However, the strange thing is that in fifty years, there hasn’t been one big decision.” – Albert Einstein.
~~DISCUSSION~~
Questions about Prenatal Ultrasound and the Alarming Increase in Autism
When you see the ultrasound of a young boy still in the womb shielding his eyes with his barely developed hand and fingers, as tho in pain, it makes you wonder. Was the article, Questions about Prenatal Ultrasound and the Alarming Increase in Autism in the 2006 issue, of Midwifery Today, was really on to something about the alarming increase in Autism?
There does seem to be empirical correlation between the increase of Autism and the increase of the use of Ultrasound. Is it as simple as they are getting their developing brains scrambled?
Seems the answer today in 2019 is Yes:
FDA Warning
… Ultrasound waves can heat the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues (cavitation). The long-term consequences of these effects are still unknown. Because of the particular concern for effects on the fetus, organizations such as the American Institute of Ultrasound have advocated prudent use of ultrasound imaging in pregnancy. Furthermore, the use of ultrasound solely for non-medical purposes such as obtaining fetal ‘keepsake’ videos has been discouraged. Keepsake images or videos are reasonable if they are produced during a medically-indicated exam, and if no additional exposure is required. … – https://www.fda.gov/radiation-emitting-products/medical-imaging/ultrasound-imaging#benefitsrisks
Kelly Brogan, MD warning
Human Studies Condemn Ultrasound By Kelly Brogan, MD
I wrote this in 2014 and have been attacked and ridiculed for it. Now I win…
“First they ignore you, then they laugh at you, then they fight you, then you win.” – paraphrasing of union leader Nicholas Klein in 1914, frequently misattributed to Mahatma Gandhi.
While there may be doctors and links to medical information on this site, a lot of the information here has come from a persons own hard won self education due to lack of support of the Medical Establishment. Independently validate for yourself any information from this site with authoritative sources, as you should do with any information found on Internet.
How did Diamond sense Dad's Heart Attack?
Years ago our dog Diamond sensed my father was going to have a heart attack from sixty miles away. How did she do it?
~~DISCUSSION~~
Companion Arts National non-profit organization providing Caregivers resources, programs and products..
You and I are not the first person in the world to take care of a loved one. Seek guidance from those that are going down the same road that you are on to help your loved one.
Wish I'd know about this organization a long time ago. I'd sat next to the COO of this organization many times, being the brother of a friend of mine, and never knew this was one of his passions until this past Saturday. There are no coincidences in the world…
Companion Arts enhances the quality of life of family and professional caregivers by providing innovative and evidence-based services, products, and resources. Our work with caregivers is based on our values:
Companion Arts, a 501 ©(3) nonprofit organization, was co-founded in 2002 by Michael Stillwater and Gary Malkin, creators of the acclaimed audio resource, Graceful Passages: A Companion for Living and Dying.
~~DISCUSSION~~
Trepanation Putting Hole in Skull
Trepanation is the practice of making a hole in the skull in order to improve the brain pulsations and hence the overall well being, Trepanning: Trepanning, also known as trephination, trephining or making a burr hole.
I wrote about this in 1996 in trepann2,asc for Keelynet not understanding the importance of the Dura back then.
It covers the work of Sutherland and the late Dr. John E. Upledger, D.O., F.A.A.O.. See Karen's reading list for Upledgers books.
Did any Trepanner's get CSF Headaches???
~~DISCUSSION~~
Epigenetics Why Women Are Stripey
Epigenetics means women have different active x-chromosomes in different cells.
When a female embryo is four days old it consists of just 100 cells. At this point the x-chromosome from Mom and the one from Dad are both active. But in order for proper development to occur, one of the x chromosomes must be switched off.
Through a tiny molecular battle within each cell, one of the x-chromosomes wins and remains active while the loser is deactivated.
This is done by wrapping the DNA tighter around proteins, modifying histone tails, and DNA methylation - molecular markers to indicate this DNA should not be read.
What's surprising is that it's pretty random which x chromosome wins - sometimes it's Mom's and sometimes it's Dad's. So when a female is just 100 cells big, her cells have a mix of active x-chromosomes, some from Mom and some from Dad.
~~DISCUSSION~~
The Facts About Flatulence
I added the page The Facts About Flatulence. New research leads one to believe that breathing small amounts of such gas may have health benefits. Who knew Farts where so healthy? 
~~DISCUSSION~~
IRS Topic 502 - Medical and Dental Expenses
What the IRS has to say about Medical and Dental Expenses.
~~DISCUSSION~~
How useful is glucose detection in diagnosing cerebrospinal fluid leak?
http://www.ncbi.nlm.nih.gov/m/pubmed/14719513 :
Abstract
BACKGROUND: This report describes the sensitivity and specificity of glucose detection using Glucostix test strips and computed tomography (CT) of the skull base for confirming cerebrospinal fluid (CSF) fistulae in patients with persistent rhinorrhoea or otorrhoea, and comparing them with the beta-2 transferrin assay as the gold standard for CSF detection.
METHODS: Fluid samples from the nose were collected from 18 patients with suspected CSF fistulae. The samples were assayed for beta-2 transferrin using the Western blotting and immunostaining technique. CT (5mm axial slice) of the skull base was performed for evidence of skull base fracture. The glucose levels and Glucostix results were compared.
RESULTS: Out of the 18 samples, 15 were positive for beta-2 transferrin and the leaks were validated surgically in 10 patients. Give leaks healed spontaneously with conservative management. Glucostix tests produced three false positive results from blood and nasal mucus contaminated fluid. Glucostix failed to detect another three CSF leaks resulting from false negative tests because of low CSF glucose levels. The Glucostix glucose test was nonspecific and insensitive compared with the beta-2 transferrin assay. CT failed to detect three of the 15 beta-2 transferrin-positive leaks but there were no false positive results. CT produced six negative results, of which three were false negatives.
CONCLUSIONS: Glucose detection using Glucostix test strips is not recommended as a confirmatory test due to its lack of specificity and sensitivity. In the presence of a skull bas fracture on CT and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity.
New insights into the glucose oxidase stick test for cerebrospinal fluid rhinorrhoea:
Abstract
Rhinorrhoea is a clinical sign of cerebrospinal fluid (CSF) leakage in patients with skull fracture, but can also be attributable to respiratory secretions or tears. Laboratory tests confirming the presence of CSF are not sufficiently rapid to support clinical decision making in the emergency department and may not be universally available.
Detection of glucose in nasal discharge was traditionally used to diagnose CSF leak at the bedside, but has fallen into disuse as it has poor positive predictive value. We propose an algorithm to improve the diagnostic value of this test taking into consideration factors we have found to affect the glucose concentration of respiratory secretions. In patients at risk of CSF leak, nasal discharge is likely to contain CSF if glucose is present in the absence of visible blood, if blood glucose is <6 mmol.L−1, and if there are no symptoms of upper respiratory tract infection.
Cerebrospinal fluid (CSF) leakage from dural tears complicates around 20% of basilar skull fractures and 25% of facial fractures.1,2 As CSF leakage is commonly complicated by intracranial infection in 3–31% cases,1,3,4 it is important not to miss the diagnosis. Clinical suspicion of CSF leak should be raised by the presence of rhinorrhoea; however, differentiating CSF from other causes of nasal discharge (respiratory secretions, tears, and blood) presents a diagnostic challenge. Immunofixation electrophoresis of nasal secretions in the laboratory can be used to detect β-2-transferrin—a protein produced by neuraminidase activity in the brain and uniquely found in CSF and perilymph.5 This test is not sufficiently rapid to provide support for clinical decision making in emergency departments and may not be available in all hospitals, particularly in developing countries.
Measurement of the glucose concentration of nasal discharge is a traditional bedside test for the detection of CSF leaks. Glucose oxidase sticks are wetted with nasal secretions and colour change is compared with a calibrated scale to determine glucose concentration. The presence of glucose is taken to indicate that secretions contain CSF. This test is easy to perform, cheap, and widely available, but has poor positive predictive value for CSF leakage. Glucose was detected in nasal discharge from 15/17 normal children6 and in 44% of clear nasal and lacrimal secretions from people without any risk factor for CSF leak.7 False negative results, where glucose oxidase sticks have failed to detect CSF, have also been reported.5,8 We propose that if factors determining the appearance of glucose in respiratory secretions can be explained, this old test could still have a role in identification of CSF leaks.
~~DISCUSSION~~