Doctor Bell,

I do not believe apologies are necessary. I appreciate the time you choose to spend on my case. I am aware you have hundreds if not thousands of patients for which you are their primary physician. I hope to do my part as well as I can so that sooner you will have more time to devote to all of your other patients and yourself.

Although I have not reviewed the images, only the reports, I agree that my syrinx does not require surgery at this time even if it were responsible for all my symptoms. If that was found to be the case, I would want it monitored for at least an additional year to find other alternatives to surgery on my spinal cord. At this time, for the syrinx, I hope to have another T-spine MRI in July of 2024, which we can schedule next year through my regular checkups.

Yes, I am looking forward to seeing Dr. Yuki (Neurology.) I agree insight will be gained from a repeat of the same test, just over a year after the first. To see whether the specific test results will increase or decrease in the size of the affected area or the intensity of the deficits. I feel the test will show the same results, possibly worse in effect and area, as I have noted no improvement in the muscular function in the areas covered. Gladly, I have substantially less pain than the last time I was seen and this may enable better results.

I will look forward to the discussion with Dr. Lamarca (Neurosurgery,) regarding my syrinx and S1 area and feel this is the likely result: it will be to be monitored as well, with another L-spine MRI in July of 2024. I do feel that the S1 is the most likely direct cause of the muscular issues in my lower left leg and ankle. Those symptoms are beyond the commonalities caused by left-sided hemiparesis (initially hemiplegia, as noted immediately after my injury.) I am yet unaware of the surgical options. I do recall an ‘ESI’ option you previously mentioned as well as the Botox treatments mentioned by Dr. Yuki and I would like to discuss all of the available options with Dr. Lamarca in the totality of all we will learn by then.

Is Dr. Lamarca (Neurosurgery,) the proper person/department that will remove my spinal cage when that is my next best step?

Please send the PT referral to 1 Jackson Square. At this point, I think that is the best option to ensure current progress. Once I have completed my surgeries and have recovered from those as well, I would eventually like to follow up with a more intensive PT (which, athletically would be my OT,) possibly with the U of M Sports Medicine department, to be determined among available options later.

I have not heard from Doctor Moore, however, this is likely a prudent choice.

My current ankle issues are most likely sequela of the S1 issues, hence not best addressed by him. Since we last spoke, I did try a left shoe insert for perhaps a week or two, it did help me learn more about how to trigger my spasticity to aid in walking and helped muscle growth in my left leg, however, I remain incapable of properly using my ankle while walking. My current ankle swelling that I could present to him is most likely the simple result of too much impact that is not being properly absorbed. In the last several weeks I have stopped my daily mile walks and the swelling has nearly disappeared. However, this is not a long-term solution as already feel the muscle tightness in the back of my legs pulling more taut. I feel and think I need to protect my ankle while not limiting my leg, health, or recovery. I am not able to meet this objective on my own.

After the PT evaluation (which this time was thorough on my ankle if nothing else,) Mr. Doll assured me that my ankle has full and normal passive movement capabilities per his manipulation and observation. We also discussed several prosthetic/brace options that he was aware of (in a general sense,) that might help me trigger my ankle to properly catch my body weight, allowing me to increase the work output of my leg without overstressing (and possibly causing long term damage,) to my ankle. If this is the case, I think my next best step for my ankle is to be seen by an “AFO” (quoted from memory of Mr. Doll,) specialist (once found and briefed by you,) that is familiar with my hemiparesis, syrinx, S1, and spasticity issues so that an integrated best long term solution can be found.

In the realm of possible issues that may affect my functional objectives, at this time there may be nothing we can do about the hemiparesis, syrinx or S1 issues, all of which affect my left leg, however, I believe there is also a physical impediment that may be removed to allow a proper range of motion of my left hip. As it is currently limited, I cannot fully rotate my left leg outward when my knee is held up. This impediment directly contributes to my difficulty walking combined with the other causes.

I understand Dr. Faulker does not feel my hip bolts need to be removed. He is correct in his feeling. My bolts were designed and intended with permanent installation as an available option. However, during that installation, an error was made and a broken drill bit was left inside my pelvis, causing the left bolt to be put into a non-symmetric location. For most people, this alone would perhaps be surmountable and their case not worth the risk of surgery.

However, I am still having difficulty walking, as my physically non-symmetric left leg is also impaired by three other issues (hemiparesis, syrinx and S1, as noted above,) with no current resolutions. Walking is a necessary part of my ADLs, and especially important to the long-term health of my leg muscles (and even longer-term, cardiovascularly as I still have decades of life ahead and need to be able to exercise to avoid heart attacks in the future, for which I am prone.)

Occupationally, my physical symmetry is key in my ability to skydive- I need to be an ‘even keel’ especially if I am already impaired with the inability to muscularly correct the currently in-build skeletal impediment. I will try to fly again and it is possible that I will have another severe impact again and may break my pelvis again while jumping locally.

If my bolts were to remain inside of me during another impact, they could be bent and be unable to be removed at that time, which could limit the attempts of the pelvis surgeon who would then be called in to rebuild me a second time.

I understand that my feeling of necessity is different than Dr. Faulkner’s feelings on the matter. I think that having my bolts removed will best enable my current recovery, best enable my long-term health, best enable my return to work, and best enable my future medical team in case I am involved in another injury. With my thoughts, I believe we should proceed to expedite a local surgery with Dr. Faulkner to remove my bolts. I am not sure if Dr. Faulkner may agree with my thoughts and in his mind my surgery may remain “elective”.

In such case, I again feel it is only proper for me to offer a full blanket waiver to Dr. Faulkner, his department, and all others required to facilitate my desire, to effectuate my desire. I think this is best also as my embedded broken drill bit alone may be an impediment to Dr. Faulkner’s acceptance and eventual success in pursuit of my desire, in this case, I believe offering a waiver to him and the hospital and all others involved is in my own best interest to secure an opportunity to achieve my next best step forward.

My desire is simple: to have my hip bolts removed locally and placed into my hands as soon as reasonably possible, prioritized behind Dr. Faulkner’s more urgent surgeries.

Please discuss my case in full with all doctors mentioned and with the Regional Director of Orthopedics for Henry Ford, as going forward I hope to continue to experience a streamlined approach to achieving my best possible health outcomes and I fully appreciate your diligence and the efforts of everyone involved at Henry Ford, most especially this week, as I process all of the recent MRI findings.

Thank you.

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