SIOUX CITY | In case he needed a little divine intervention, Brandee Koedam, director of rehabilitation services, chose a church parking lot a half a mile down the road from CNOS Morningside Clinic as the place David Meisinger would attempt to ride a bike for the first time in nearly four years.
On a calm, sunny day in mid-October, the 23-year-old Morningside College senior donned a helmet and buckled his gait belt before mounting a black Trek bike with Koedam and physical therapist assistant Mary Anderson on both sides steadying him.
Meisinger was excited, but nervous as he tightly gripped the handle bars and pushed his feet downward against the peddles. As he circled the parking lot with Koedam and Anderson guiding him on the turns, he gradually built up his confidence.
Not before long, he was riding on his own, a seemingly insurmountable feat when he was first diagnosed with transverse myelitis, a rare inflammatory disease that causes injury to the spinal cord, his freshman year of college. The ability to be independent and athletic in that moment brought Meisinger, a soccer player since age 6, to the verge of tears.
"I was just really excited that I could do this," he recalled. "To be able to do something again that I had done before I got sick was really great and allowed me to make one more thing sort of get back to normal."
Meisinger, a psychology major from Papillion, Neb., was attending a biology lab on Morningside's campus on Feb. 17, 2011, when he felt tingling in his feet that gradually rose up his legs to his lower back.
A rush of pain followed. Then his entire body from his back to his toes went numb. This took place in a span of 15 minutes.
Frightened, Meisinger told his teacher something was wrong with him. She called 911; and paramedics rushed him by ambulance to Mercy Medical Center where doctors ordered a series of tests.
"If people pushed down on me or moved my legs I could feel that they were moved, but I couldn't really tell what type of pressure was being applied," he said.
Meisinger was initially diagnosed with Guillain-Barre Syndrome, an autoimmune disorder where the body's immune system attacks part of the peripheral nervous system.
For five days he had IVIG infusions, a plasma protein replacement therapy that restores antibodies and boosts the immune system. When he didn't respond to the treatments as expected, on the sixth day, a neurologist performed a nerve conduction test that ruled out Guillain-Barre Syndrome.
Subsequent MRIs revealed inflammation in Meisinger's spinal cord. He was then diagnosed with transverse myelitis.
According to the National Institute of Neurological Disorders and Stroke, about 1,400 new cases of transverse myelitis are diagnosed in the United States each year. An estimated 33,000 Americans suffer some type of disability from the disorder that leads to spinal cord scarring and interrupts communication between the nerves in the spinal cord and the rest of the body.
"It sort of impairs your ability to feel sensation as well as motor control," Meisinger said. "A third of the people typically make little to no recovery. They're pretty much wheelchair-bound. A third of the people end up where I'm at now, which is some recovery. And then a third of the people make 90 percent or better recovery."
TAKING SETBACKS IN STRIDE
Meisinger's neurologist prescribed steroids to reduce the inflammation in his spinal cord and physical therapy, which he did for three months in Sioux Falls, S.D., before coming to CNOS.
He progressed from walking with the aid of parallel bars to a walker and then forearm crutches. Two single-point canes followed. Today, Meisinger, who wears ankle-foot braces, only needs one of the canes.
Since Meisinger isn't the typical patient physical therapists at CNOS treat, Koedam knew it would be a challenge accommodating him and providing him with the care that he deserved.
"When David came to us, although he's an athlete, this was neurological, so what that means to us is you don't know what the prognosis is or exactly what the potential is," she said.
Koedam and her team set goals based on Meisinger's initial evaluation. When he met those goals, they raised the bar higher.
Physical therapists worked with Meisinger on walking and negotiating curves so he could once again navigate Morningside's campus. After taking the spring semester off, he returned to college in August 2011 using a power scooter.
The hardest part of his ordeal, Meisinger said, was having to be more reliant on others. A friend carried his tray at lunchtime. Professors moved his classes to rooms he could access more easily in the college's historic buildings.
Koedam said Meisinger accepted his new normal without complaint.
"It may not be fair, but he dealt with it with a level of class and dignity that inspired me on a daily basis," she said. "It gave all of our staff the strength to continue to push him."
While Meisinger said he never felt pain during physical therapy, he said the sessions that focused on core and lower extremity strengthening, balance and stability and cardiovascular endurance wore him out.
"You just get tired after and your muscles are sore. I'd go to physical therapy and then I'd pretty much rest the rest of the day," he said. "Now, I do physical therapy and just go about the rest of my day. I either do it before or after class depending on my schedule and then I just live my life."
While she worked with Meisinger, Anderson said they talked about everything from the TV shows they were watching to the things they did on weekends.
The extracurricular activities Meisinger enjoyed before he fell ill were often a topic of conversation.
One day Anderson pitched the idea of cycling to Meisinger.
"I would share with him places that I've gotten to go on my bike throughout the summer and where I've cycled," she said. "As those discussions progressed, I asked him, 'Do you think you'd like to try to ride a bike?'"
Meisinger said he would like to.
Anderson turned to the Internet, where she read about an avid cyclist who shared Meisinger's diagnosis. This man, unlike David, couldn't walk without assistance. If he could ride a bike, Anderson thought David could, too.
She brought one of her bikes to the Sunnybrook Community Church parking lot and was thrilled to see her patient eventually ride without assistance.
"I look forward to biking with him this summer," she said.
Meisinger, who will graduate from Morningside College this month, is applying to medical school, an aspiration he said his condition solidified. Although he can no longer play soccer, he is focused on the abilities he still has.
"You can do anything you set your mind to with hard work and determination," he said.