The nerve is officially firing***merged***

[FuzzyLumpkins]

Nice post, Asthma. Just a minor correction to this quote, "If he's moving his toes, that tells me that the nerve regeneration has already moved through the foot and is nearing the end of its journey (at the toes)."

The nerve regeneration for Jaylon doesn't actually end it's journey in the toes. It's furthest journey would be at the muscles which have their tendons attaching to the bones of the toes. The most distal of those would be muscles in the foot, but not toes. I wrote a longer explanation about it, but figured this would suffice. If you care to understand the neuroanatomy of this better, let me know and I'll post it.

I'd love to read that if you have the time.

 

[JoeKing]

Icey is in full swing I see today

It's like he is stuck in permanent contradiction mode with Fuzzy. Can't we all just get along?

 

[Idgit]

Normally I would be the last person to defend you Fuzz but on this topic you have been correct all along and even if no one else is man enough to admit this, I will be. I was wrong and have learned to give medical science more credit than I previously did. I look forward to our civilized discussions in the future Fuzz. Have a good day.

Wait. What just happened?!?

 

[waldoputty]

Normally I would be the last person to defend you Fuzz but on this topic you have been correct all along and even if no one else is man enough to admit this, I will be. I was wrong and have learned to give medical science more credit than I previously did. I look forward to our civilized discussions in the future Fuzz. Have a good day.

it takes a bigger man to be able to admit he is wrong.
great example!

 

[Tabascocat]

It's time for another nerve thread to be severed!

Dont worry guys, we can build another 30-pager in the near future.....

 

[FuzzyLumpkins]

I refer to it as the grainy photo, because, well... it was grainy.

As far as you and the other side going back and forth over whether or not the nerve was or is firing... that is a horse I don't have a race in. Maybe it slipped past you, but nowhere did I ever say his nerve was firing or wasn't firing. In fact, somewhere along the line, I believe my only comment on it was that I didn't know.... and I doubt the quasi doctors can state to any sort of medical certainty one way or another by looking at videos, grainy photos, and the grassy knoll.


My point of not caring is just that.... I did not care one way or another about the actual argument itself (was it firing, was it not)... but more about the tactics you utilized.

Then, of course, crying victim.

Dig through my posts. I'll wait.

Why would I need to dig through posts? I get that you are here because of me mostly. That still does not detract from the significance of what you choose to ridicule.

Maybe you do not think through what you are posting very well. You are after all just regurgitating Alex's take as it is.

So you just don't realize that ridiculing evidence would be an argument against said evidence?

At the very least you should be able to understand why someone would see that. After all is something is grainy and low-res it's hardly a stretch to think that would make is hard to discern detail.

After all that was what Alex was saying: my stills were like the JFK stills that conspiracy theorists like to post. Nevermind they are looking for a bullet and I am looking for a foot.

But hey if you want to grant that the stills in question are more than adequate to see foot orientation then that is okay with me.

Of course continually repeating it absent qualification belies that narrative. We both know you cannot say what you really feel without censure. It never seems to occur to your type that I have a schtick too.

And yeah victim. . . . My pointing out that you are coming after me is just an observation of fact. My coming back with this tone and trying to actually argue in the context of the thread ie the Jaylon stills in this case speaks a far different tune.

I do get that you desperately want me to feel the victim. All that does is make me think about the why of that. It's not pretty.

 

[waldoputty]

Direct in your face confrontation is my tactic, icetray. He comes nowhere near that. Nice baseless assertion though. See some things never change.

fuzzy it is all your fault with your direct confrontational ways.
you probably made several posters upset especially when they could not argue back due to lack of knowledge and /or will to read up.
when the MDs came in and agreed with you, the MDs got shelled because the angry posters were already entrenched in their position.
poor doc50 got called a non-MD because of fuzzy
fuzzy is the root of all problems on the board.

 

[FuzzyLumpkins]

fuzzy it is all your fault with your direct confrontation ways.
you probably made several posters upset especially when they could not argue back due to lack of knowledge and /or will to read up.
when the MDs came in and agreed with you, the MDs got shelled because the angry posters were already entrenched in their position.
poor doc50 got called a non-MD because of fuzzy
fuzzy is the root of all problems on the board.

If you read How to Win Friends and Influence People, it talks about how if you confront someone and point out they are wrong directly, they hate you for it. I find that is much more true for men than it is for women but they are not wrong.

For me it's a great way to discern those that are wrapped up in themselves; they tend to be selfish. I want to be friends with people that have gotten over themselves. The hate is strong though.

 

[FuzzyLumpkins]

great.

which one had access to his medical records?

we can go by opinions in the injury sure. but how is this different than what i said - no one knows FOR SURE what is going on? at least in here.

far as i know his doc never stopped by to give a personal update and release private medical info. the entire argument was a "bet" more or less on if it would heal, based on speculation and guess we did by becoming a GOOGLE-PHD.

I have to say that this ad hominem because information is readily available, it somehow invalidates what is being said is hilarious. Your problem is that google turns up JAMA, NEJM, and research papers from Stanford. The rub is not all people can read that stuff and interpret it.

We aren't talking stochastics here but many people's eyes still glaze over trying to read through that stuff.

Just because you cannot have the most informed opinion does not mean that one cannot inform their opinion. And it should be noted that it is not the ones ridiculed as "experts" that are the ones who are disputing what the actual doctors are saying. That would be your ilk.

Nevermind what Jaylon's doctor and the Joneses, people who do have access to said information, are saying. Critical thinking is such a bugaboo.

As for your epistemological copout, you can infinitely regress any knowledge. Hume did it centuries ago complaining about the fallibility of the senses etc. My personal ethic is that at some point you have to rely on instinctive belief but that is neither here nor there. That someone can have a more informed opinion is inconsequential when you are not that person

Yours is just a generalized whine. You never apply it. You talk around the issue. I just listed over a dozen facts about Jaylon's situation that are readily verifiable. You ignore them to repeat yourself instead.

 

[waldoputty]

I have to say that this ad hominem because information is readily available, it somehow invalidates what is being said is hilarious. Your problem is that google turns up JAMA, NEJM, and research papers from Stanford. The rub is not all people can read that stuff and interpret it.

We aren't talking stochastics here but many people's eyes still glaze over trying to read through that stuff.

Just because you cannot have the most informed opinion does not mean that one cannot inform their opinion. And it should be noted that it is not the ones ridiculed as "experts" that are the ones who are disputing what the actual doctors are saying. That would be your ilk.

Nevermind what Jaylon's doctor and the Joneses, people who do have access to said information, are saying. Critical thinking is such a bugaboo.

As for your epistemological copout, you can infinitely regress any knowledge. Hume did it centuries ago complaining about the fallibility of the senses etc. My personal ethic is that at some point you have to rely on instinctive belief but that is neither here nor there. That someone can have a more informed opinion is inconsequential when you are not that person

Yours is just a generalized whine. You never apply it. You talk around the issue. I just listed over a dozen facts about Jaylon's situation that are readily verifiable. You ignore them to repeat yourself instead.

Most people dont know what JAMA and NEJM are.
You actually are involved in the medical field so you have an 'unfair' advantage, even though you come at it from the engineering side.
Most people dont understand that.

 

[iceberg]

nobody said for sure.

in the last 6 months, @Doc50 posted multiple explanations.
guess what, what has happened matched pretty much what he said.
these are based on years of education and experience, not something you get from google.

you can get some basic info from google, but these are real MDs and PhDs.
When it comes to medical matters, MDs and PhDs simply know more.
Most people accept that when they go see a doctor.

@danielofthesaints just gave asthma a medical explanation.
he is a medical student if I recall correctly.
he does not need Jaylon's medical records to give that opinion either as it is simply anatomy.

if you want to decide whether or not *HE* specifically has a chance to recover, sure you do.

otherwise you're just playing the odds and taking a side to take a side.

wheee. look at me now!

 

[danielofthesaints]

I'd love to read that if you have the time.

Sure thing.

Preface: A motor nerve will synapse with a muscle at a neuromuscular junction. This location signifies the end of the motor nerve and the beginning of the muscle fiber. A large enough action potential ending at the nerve terminal causes release of certain neurotransmitters that act on the muscle fiber, which after a few more steps later, can cause the muscle fiber to contract. In addition, a muscle is connected to bone via tendons. When the muscle contracts, it pulls on the tendon and, subsequently, causes movement of the bone.
----------
The most distal (furthest from the knee/closest to the toes) motor terminal synapse of the deep peroneal nerve is the deep peroneal nerve's innervation of 2 muscles in the foot (extensor hallucis brevis and extensor digitorum brevis). The former's role helps in dorsiflexing the big toe and the latter's role is dorsiflexing toes 2-4. (Note: other muscles in the lower leg which are innervated by the deep peroneal nerve have major roles in dorsiflexion of the foot and of the toe. I'm just using the most distal muscles as an example. Below is a diagram showing the branches of the deep peroneal nerve to the "other muscles" in the lower leg and the branch to the extensor digitorum brevis. The branch to extensor hallucis brevis is not shown. Disregard the branch to the dorsal digital cutaneous nerve; it is sensory, not motor.)

The extension/dorsiflexion of the toes via extensor hallucis brevis and extensor digitorum brevis happens like this:
1. Motor action potential gets sent down from the brain -> spinal cord -> spinal nerves L3-S4 leave spinal cord -> form sciatic nerve -> branches into common peroneal nerve -> branches into deep peroneal nerve -> synapses at the muscle fibers of both extensor hallucis brevis and extensor digitorum brevis, among others.
2. When the action potential reaches the end of the axon, it releases neurotransmitters into the synaptic cleft (junction between terminal axon and muscle fiber). The neurotransmitter in this case would be acetylcholine. Acetylcholine binds to receptors on the muscle fiber, and if it causes a strong enough end-plate potential, the muscle will end up contracting. (There is a lot more detail to this I won't bother going into.)
3. If you look for the extensor hallucis brevis (EHB) and extensor digitorum brevis (EDB) below, you will see that EHB's tendon attaches to the top of the proximal phalanx of the big toe and EDB's tendons attach to the top of the middle phalanges of toes 2-4. So, when the EHB and EDB contract, they tighten these tendons, causing the toes to point upwards (dorsiflexion).

In summary, the deep peroneal nerve only needs to reach and synapse with these two muscles for them to be able to have the motor control over dorsiflexing toes 1-4. It does not need to reach all the way to the toe itself.

Let me know if you have any questions, and Id be happy to answer.

 

[waldoputty]

if you want to decide whether or not *HE* specifically has a chance to recover, sure you do.

otherwise you're just playing the odds and taking a side to take a side.

wheee. look at me now!

for Jaylon's case, the MDs and PhDs opinions were based on data and stats.
if you are in a technical field, you would realize that there is rarely 100% certainty.
that is where expert opinions from MDs/PhDs come in as well as lots of learning and reading if one had the luxury of time.

before you look down at people like Fuzzy who worked hard to learn the info, this happens all the time in technical fields where people trained in one specialty learn another field.
the old school way of looking at a PhD is that the person has learned how to learn and should be able to pick up a new field by themselves, especially when experts are available for questions.

 

[FuzzyLumpkins]

Sure thing.

Preface: A motor nerve will synapse with a muscle at a neuromuscular junction. This location signifies the end of the motor nerve and the beginning of the muscle fiber. A large enough action potential ending at the nerve terminal causes release of certain neurotransmitters that act on the muscle fiber, which after a few more steps later, can cause the muscle fiber to contract. In addition, a muscle is connected to bone via tendons. When the muscle contracts, it pulls on the tendon and, subsequently, causes movement of the bone.
----------
The most distal (furthest from the knee/closest to the toes) motor terminal synapse of the deep peroneal nerve is the deep peroneal nerve's innervation of 2 muscles in the foot (extensor hallucis brevis and extensor digitorum brevis). The former's role helps in dorsiflexing the big toe and the latter's role is dorsiflexing toes 2-4. (Note: other muscles in the lower leg which are innervated by the deep peroneal nerve have major roles in dorsiflexion of the foot and of the toe. I'm just using the most distal muscles as an example. Below is a diagram showing the branches of the deep peroneal nerve to the "other muscles" in the lower leg and the branch to the extensor digitorum brevis. The branch to extensor hallucis brevis is not shown. Disregard the branch to the dorsal digital cutaneous nerve; it is sensory, not motor.)

The extension/dorsiflexion of the toes via extensor hallucis brevis and extensor digitorum brevis happens like this:
1. Motor action potential gets sent down from the brain -> spinal cord -> spinal nerves L3-S4 leave spinal cord -> form sciatic nerve -> branches into common peroneal nerve -> branches into deep peroneal nerve -> synapses at the muscle fibers of both extensor hallucis brevis and extensor digitorum brevis, among others.
2. When the action potential reaches the end of the axon, it releases neurotransmitters into the synaptic cleft (junction between terminal axon and muscle fiber). The neurotransmitter in this case would be acetylcholine. Acetylcholine binds to receptors on the muscle fiber, and if it causes a strong enough end-plate potential, the muscle will end up contracting. (There is a lot more detail to this I won't bother going into.)
3. If you look for the extensor hallucis brevis (EHB) and extensor digitorum brevis (EDB) below, you will see that EHB's tendon attaches to the top of the proximal phalanx of the big toe and EDB's tendons attach to the top of the middle phalanges of toes 2-4. So, when the EHB and EDB contract, they tighten these tendons, causing the toes to point upwards (dorsiflexion).

In summary, the deep peroneal nerve only needs to reach and synapse with these two muscles for them to be able to have the motor control over dorsiflexing toes 1-4. It does not need to reach all the way to the toe itself.

Let me know if you have any questions, and Id be happy to answer.

Great info, mang.

So that explains why it is two different "thoughts" in lifting your pinky toe and the rest of your toes. It also explains why there is a lot less articulation in the feet as opposed to the hands beyond structural issues.

The anatomy seems pretty straightforward. Where my confusion is is in how the muscle innervates.

The mechanics seem simple enough. The dendrites try to follow the old pathways to make a new bundle and extend into the muscle but when it cannot it starts getting confusing. The stuff I was reading talks about amino content and the like and I just am too ignorant regarding biochemistry to make sense of it.

 

[FuzzyLumpkins]

if you want to decide whether or not *HE* specifically has a chance to recover, sure you do.

otherwise you're just playing the odds and taking a side to take a side.

wheee. look at me now!

That ship has sailed. He has been recovering. Time to move on.

 

[iceberg]

for Jaylon's case, the MDs and PhDs opinions were based on data and stats.
if you are in a technical field, you would realize that there is rarely 100% certainty.
that is where expert opinions from MDs/PhDs come in as well as lots of learning and reading if one had the luxury of time.

before you look down at people like Fuzzy who worked hard to learn the info, this happens all the time in technical fields where people trained in one specialty learn another field.
the old school way of looking at a PhD is that the person has learned how to learn and should be able to pick up a new field by themselves, especially when experts are available for questions.

not even talking about fuzzy. i got enough reasons to disagree with him before any of this hit.

it all has to do with people sitting in here getting mad cause their opinions have been proven incorrect in the course of time. maybe next time don't get so emotionally inundated with how you "feel" to let that make you want to shape life to your views, not your views to life.

now - i would also say - you can speculate away all you want but why do people then get mad when they speculate incorrectly? that's all.

wow. i was wrong and the dude is recovering. guess i got more research to do or wait for more info before i make my decisions...

now that would be a valid response to being wrong.

all this butt-hurt is amazing to me when NO ONE HERE had his medical records to go by and were just...speculating. i 100% agree it's fun and why we gather and talk about such things. but to get upset and take it personal?

some people need to let go of their insecurities and grow up.

 

[waldoputty]

Sure thing.

Preface: A motor nerve will synapse with a muscle at a neuromuscular junction. This location signifies the end of the motor nerve and the beginning of the muscle fiber. A large enough action potential ending at the nerve terminal causes release of certain neurotransmitters that act on the muscle fiber, which after a few more steps later, can cause the muscle fiber to contract. In addition, a muscle is connected to bone via tendons. When the muscle contracts, it pulls on the tendon and, subsequently, causes movement of the bone.
----------
The most distal (furthest from the knee/closest to the toes) motor terminal synapse of the deep peroneal nerve is the deep peroneal nerve's innervation of 2 muscles in the foot (extensor hallucis brevis and extensor digitorum brevis). The former's role helps in dorsiflexing the big toe and the latter's role is dorsiflexing toes 2-4. (Note: other muscles in the lower leg which are innervated by the deep peroneal nerve have major roles in dorsiflexion of the foot and of the toe. I'm just using the most distal muscles as an example. Below is a diagram showing the branches of the deep peroneal nerve to the "other muscles" in the lower leg and the branch to the extensor digitorum brevis. The branch to extensor hallucis brevis is not shown. Disregard the branch to the dorsal digital cutaneous nerve; it is sensory, not motor.)

The extension/dorsiflexion of the toes via extensor hallucis brevis and extensor digitorum brevis happens like this:
1. Motor action potential gets sent down from the brain -> spinal cord -> spinal nerves L3-S4 leave spinal cord -> form sciatic nerve -> branches into common peroneal nerve -> branches into deep peroneal nerve -> synapses at the muscle fibers of both extensor hallucis brevis and extensor digitorum brevis, among others.
2. When the action potential reaches the end of the axon, it releases neurotransmitters into the synaptic cleft (junction between terminal axon and muscle fiber). The neurotransmitter in this case would be acetylcholine. Acetylcholine binds to receptors on the muscle fiber, and if it causes a strong enough end-plate potential, the muscle will end up contracting. (There is a lot more detail to this I won't bother going into.)
3. If you look for the extensor hallucis brevis (EHB) and extensor digitorum brevis (EDB) below, you will see that EHB's tendon attaches to the top of the proximal phalanx of the big toe and EDB's tendons attach to the top of the middle phalanges of toes 2-4. So, when the EHB and EDB contract, they tighten these tendons, causing the toes to point upwards (dorsiflexion).

In summary, the deep peroneal nerve only needs to reach and synapse with these two muscles for them to be able to have the motor control over dorsiflexing toes 1-4. It does not need to reach all the way to the toe itself.

Let me know if you have any questions, and Id be happy to answer.

Nice info.
So the nerve needs to reach roughly where the ankle is?
I have been wondering about the time difference between reach the muscles responsible for dorsiflexion and the muscules responsible for lifting the toes?
Does it look like about 6 inches - 12 inches to you?
If so, how long would you think Jaylon started to have some motor neuron connection with the muscles responsbiel for dorsiflexion?

lol I just want to verify if it appears Jaylon started to have some motor neuron connection ~Oct or so - matching his magical tweets.

 

[danielofthesaints]

Great info, mang.

So that explains why it is two different "thoughts" in lifting your pinky toe and the rest of your toes. It also explains why there is a lot less articulation in the feet as opposed to the hands beyond structural issues.

The anatomy seems pretty straightforward. Where my confusion is is in how the muscle innervates.

The mechanics seem simple enough. The dendrites try to follow the old pathways to make a new bundle and extend into the muscle but when it cannot it starts getting confusing. The stuff I was reading talks about amino content and the like and I just am too ignorant regarding biochemistry to make sense of it.

Is your confusion on the basic innervation of nerve to muscle, or something else?

 

[waldoputty]

not even talking about fuzzy. i got enough reasons to disagree with him before any of this hit.

it all has to do with people sitting in here getting mad cause their opinions have been proven incorrect in the course of time. maybe next time don't get so emotionally inundated with how you "feel" to let that make you want to shape life to your views, not your views to life.

now - i would also say - you can speculate away all you want but why do people then get mad when they speculate incorrectly? that's all.

wow. i was wrong and the dude is recovering. guess i got more research to do or wait for more info before i make my decisions...

now that would be a valid response to being wrong.

all this butt-hurt is amazing to me when NO ONE HERE had his medical records to go by and were just...speculating. i 100% agree it's fun and why we gather and talk about such things. but to get upset and take it personal?

some people need to let go of their insecurities and grow up.

I have been trying to say - doc50, other MDs, danielofthesaints (and fuzzy) all made analysis that did not require Jaylon's medical records.
Anatomy is anatomy, unless you are saying Jaylon's muscles and nerves connect differently than a normal human being. Jaylon is a super athlete, but I have not heard he is martian.
Also doc50 and other MDs made projections based on data and stats.

To give you an example, I just finished going through a family member's medical issues with a MD friend from college.
My family member just had a 'borderline' tumor removed.
Fortunately, it was caught early at stage 1.
Without medical records or even any checking, my MD friend immediately said stage 1 tumors of the particular borderline type generally do not have a recurrence within 5 years with a >95% certainty (knock on wood).
My friend who is in a different area of oncology was just able to tell me that without even reading any medical books.
If I ran through 20 medical journal articles, I probably would have found the same information.
Of course, given the gravity of the situation, I would still have consulted the MD friends.

Trained MDs would know when they need more info, and would state as such.
When I asked him why those tumor cells did not seem to spread (knock on wood), he then said he need to see the medical records to see which exact type of cells we are talking about.
A lot of things can be figured out without all the medical details.

 

[FuzzyLumpkins]

Is your confusion on the basic innervation of nerve to muscle, or something else?

The process how the muscle innervates in particular when the old pathways breakdown.

In short I was looking for potential complications that might lead to a partial recovery or worse for him.

I found two things. 1 was when scar tissue formed in the axonal canal or whatever it is called. I was not worried about that because Cooper said the exterior was intact and how young Jaylon is.

The other had to do with the muscle not innervating properly and that came down to old pathways not being viable and new pathway formation being problematic. That did concern me because the regeneration was going to take half a year or more with atrophy being what ti is. What exactly the problem was was confusing though.