My Bird’s Nest
Another strange incident occurred when Joshua was around two and Colby was just a baby. The discovery of a small but firm jelly like ball behind my right ear caused some concern. It seemed to create pressure in my head especially when I wore sunglasses as the arm would rest directly on this mass. It was a firm ball of jelly that did not move.
I mentioned this to Duncan and Helen one night while we were over for dinner, wondering what it could be but not thinking much of it. Duncan seemed to think it might be something to be concerned about but didn’t want me to go to my regular doctor. Instead, he made an appointment for me with a specialist, without a referral. This was very strange because this was not the normal procedure for seeing a specialist.
At the time, not having any of the information regarding my past and still accepting these people were my birth parents, I felt sort of honoured he was paying attention to me, taking charge of the situation. It was not normal behaviour for them to show any interest in my health or be concerned about my well being, so I was a bit surprised and let him take the lead. It did not really occur to me until many years later, although I did think about it on occasion, how out of character this offer was. When all the other information began to come out it made more sense, much like when Helen offered to have Duncan be my abuse counsellor.
This made me wonder just what that lump was and what happened to it. I suppose this must sound strange but other than telling me it was called a ‘Bird’s Nest’ and explaining what that meant, there was no procedure to remove it, nor was I given anything to alleviate it. Within a few weeks it just wasn’t there anymore, but I have no idea how that happened. It was never again discussed after I had explained what it was and so I chose to ignore my concerns….let sleeping dogs lie.
It was explained to me a bird’s nest is a bundle of nerve ends all tangled together and forming a ball. I have tried to find out more information on this term, but there is nothing to be found other than the actual nest of a bird. I am left wondering if this was also a lie, after all when one is a bit scared and you don’t know the first thing about a subject, it is quite easy to be deceived.
Back then we did not have internet or electronic devices to quickly look up something of interest, so if you didn’t have the proper term and the book in which to find it, you had to trust the ‘expert,’ in this case a doctor provided by Duncan.
Author’s Note; While finishing this book here in Ecuador, I once again did a search for my “Bird’s Nest” and after a many tries found this article which came the closest to describing the phenomenon. One point made regarding the initiation of the tumor is being struck with a sharp or even blunt object. I have no memory of this other than what occurred when I fell back on the folding door (See “Memeory Dream”; Chapter 5). However, it is the closest description of what I remember being told at that time.
Pathogenesis of the Neuroma
Neuromas may form after any nerve injury. Nerve injury can occur through sharp trauma, blunt trauma, or traction injury. In injuries where the nerve is partially injured, a neuroma-in-continuity forms. Neuromas result from the abnormal regeneration of sprouting axons. A nerve swelling is formed at the proximal end of the injured nerve. It consists of random proliferating proximal axonal sprouts and scar tissue deposited by fibroblasts. The most widely held theory behind neuroma formation is that axon fascicles escape out of a damaged perineurium. An intact perineurium is hypothesized to be an impenetrable barrier to axons. However, when the perineurium is damaged, either through sharp laceration or stretch, sprouting axons escape into the extraendoneurial environment. The unorganized proliferation of axons into the extraendoneurial environment in conjunction with scar tissue deposition by fibroblasts results in neuromaformation (Yuksel, Kislaoglu, Durak, Ucar, & Karacaoglu, 1997). Macroscopically, the neuroma is a well-circumscribed, firm, and rubbery mass. The size of the neuroma depends on the amount of axoplasmic flow, the amount of fibroblasts and Schwann cells present, and the nutritional status of the peripheral nerve (Nath & Mackinnon, 1996). The neuroma may be adherent to the surrounding structures such as bone, muscle, or subcutaneous tissue. Microscopically, the neuroma consists of bundles of disorganized nerve fibers and fascicles in various stages of maturation. Fibroblasts, collagen, macrophages, capillaries, and myofibroblasts are present. Compared to uninjured nerves, there is a higher content of glycosaminoglycan in neuromas.
The majority of neuromas are asymptomatic. Painful neuroma can develop if the neuroma is chronically irritated or if the axons within the neuroma are constantly stimulated. Spontaneous activity of neurons within the neuroma or from neurons more proximal to the neuroma, either in the dorsal root ganglion or central nervous system, can cause severe and spontaneous pain. However, the exact mechanism of how a neuroma causes pain is poorly understood. Histological studies of painful neuromasshow an abundance of small, unmylienated fibers and unorganized minifascicles. Myofibroblasts have been consistently identified in painful neuromas(Badalamente, Hurst, Ellstein, & McDevitt, 1985). Recently, the expression of alpha smooth muscle actin (α-SMA) has been noted as a phenotypical marker for myofibroblasts and painful neuromas. The intensity of expression of α-SMA is directly correlated with the intensity of pain (Yan, Gao, Pan, Zhang, & Fan, 2012).
The website to visit for this information: https://www.sciencedirect.com/topics/medicine-and-dentistry/neuroma
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