A Rancher’s MS Was Blamed on an Old Back Injury for Six Years

The notebook began with a gate.

In January 2018, Tom caught his left toe while stepping over the low bar at a cattle pen on the New Mexico ranch where he had worked most of his adult life. He did not fall. His wife, Elena, saw him grab the post and wrote the date in a notebook they kept near the kitchen phone.

“Left foot hung up at gate,” she wrote. “Says he is fine.”

Tom was 55. He had injured his lower back in 1999 after coming off a horse, and the explanation was ready before anyone asked for one. His back had hurt on and off ever since. Some mornings it took longer to straighten.

Certain jobs left a dull ache across his beltline.

The old injury had become part of the family record, as established as the dry years and the pasture that flooded first. When his leg dragged, the back was responsible. When he stumbled on uneven ground, he needed to watch his footing. Aging accounted for the rest.

The old explanation

By September 2018, the notebook held nine entries. Most were brief: a boot catching on a step, an unexplained loss of balance beside the truck, a morning when both legs felt too stiff to climb over a fence. Tom did not describe these as symptoms. They were incidents, each one small enough to excuse once it was over.

At a primary care visit that fall, he mentioned the back injury and the left foot. An X-ray showed changes that were presented as common for his age. The primary care doctor said, “The old injury explains a lot of this,” and referred him for physical therapy.

The therapy cost him $35 a visit. He drove 58 miles each way and completed eight appointments over ten weeks, missing the days when livestock or weather made the trip impractical. Stretching helped the familiar lower-back pain. It did not stop the toe from catching.

That distinction mattered later. At the time, improvement in one problem was treated as evidence about the other.

During 2019, Elena started adding details Tom would have omitted. His right leg had become stiff too. He could still lift feed sacks, repair wire, and spend hours in a truck, but turning quickly was harder, especially when the ground shifted beneath him. Urinary urgency had also begun to shape his work.

He chose tasks near the house and stopped drinking coffee before longer drives.

A clinician suggested that age or a prostate problem could explain the urgency. The evaluation that followed did not find a clear cause requiring treatment, but the absence of that cause did not send anyone back to the balance problem. The bladder issue stayed in one chart. The back and legs stayed in another.

In February 2020, Tom fell while carrying a mineral tub. He landed on one knee and let go before the tub pinned his hand. Elena wrote two lines in the notebook, then underlined the part he had told her in the truck: “Couldn’t get left leg where he wanted it.”

Appointments became harder to arrange that spring. The next visit happened remotely, and without a walking examination the discussion returned to pain, prior injury, and whether Tom had kept up with the exercises. He had. The exercises still helped his back.

For another year, the notebook did most of the continuity work that the healthcare system did not. It placed the urinary urgency beside the falls and showed that both legs were changing, even though no single appointment had gathered those facts into one account.

What the notebook showed

The fall that changed the tone came in June 2021. Tom was checking a water line alone when his left foot failed to clear a shallow rut. He went down hard enough to crack the screen of the phone in his shirt pocket. Nothing was broken.

He sat in the dirt until his legs settled, then drove home.

Elena wrote that he had been about two miles from the house. Underneath, she added, “No one knew where he was.”

Tom disliked that sentence. He crossed out “No one” but left the rest.

A new primary care doctor examined him in August 2021 and paid attention to the stiffness rather than the pain. Tom’s reflexes were brisk, and his walking looked different after several passes down the hallway. The doctor requested a lumbar MRI and a neurology referral.

The scan showed degenerative changes, but not enough, the doctor later explained, to account for the progression in both legs. The neurology office was 170 miles away. The first available appointment was five months out, then was moved back another seven weeks.

During the wait, Tom kept working. He stopped riding alone but continued checking distant water tanks in the truck, partly because there was no employee waiting to replace him and partly because he still thought of the falls as interruptions rather than evidence. Elena began asking which pasture he meant to visit. Sometimes he answered.

Sometimes he said he had been doing this work since before they were married.

At the neurology appointment in March 2022, Elena set the notebook on the desk and opened it to January 2018. The specialist read several pages, then asked about changes that had not seemed connected: bladder urgency, numb patches, heat, vision, and fatigue. Tom had not noticed a clear attack followed by recovery. He described a slow narrowing instead.

Tasks remained possible until they took too long or became unsafe.

The neurologist said, “This is not coming from one spot in your lower back.”

MRI scans of the brain and spinal cord were requested. Insurance approved part of the imaging first, and the rest required additional review. The delay was eleven weeks. Tom and Elena paid $487 in combined patient costs after coverage, in addition to fuel and a night away from the ranch.

The images showed lesions in the brain and cervical spinal cord. Blood tests were used to examine other possible explanations. A spinal tap later added another piece of evidence. No single result arrived with a tidy announcement; the findings accumulated across visits, separated by travel, authorization, and the work that had to be done at home.

In the notebook, Elena copied the dates. She did not copy the technical language.

A name, then another calculation

In May 2023, six years after the first changes they could place with confidence, the neurologist diagnosed primary progressive multiple sclerosis. Tom was 61.

The term described the pattern that had made the case easy to misread. Unlike forms of MS marked by distinct relapses and recoveries, his course had been gradual from the beginning, with worsening walking and stiffness spread across years. His age and the old injury had supplied more familiar explanations, while rural distance and divided appointments kept the evidence apart.

The diagnosis ended the search for a name. It did not establish which stumble had been MS, when the disease had begun, or how much capacity Tom would retain. The neurologist discussed treatment intended to slow progression and the limits of predicting an individual course. Tom listened most closely when the conversation reached falls.

On the drive home, Elena held the notebook in her lap. She turned back to the crossed-out sentence from June 2021: “No one knew where he was.” Neither of them said that the ranch was finished. They had livestock, debt, and work tied to seasons rather than a clinic calendar.

They changed two things first. Tom wrote where he was going before leaving the house, and he no longer checked the farthest water lines alone. A neighbor helped when available. Elena took over some driving across rough ground, although Tom still objected when she reached for the keys without discussing it.

The notebook changed too. Earlier pages had tried to prove something was happening. The newer entries recorded what the diagnosis could not settle: whether his right leg cleared the truck step, which jobs required another person nearby, and how often urgency forced him back toward the house.

In October 2023, Tom repaired a stretch of fence near the main road while Elena worked within sight of him. He rested twice and finished before the weather turned. The next morning, he fed cattle from the truck and came home with mud on his boots.

Elena opened the notebook. Beside the pasture name, she wrote, “Back before lunch.”

Questions people ask

Can an old back injury delay an MS diagnosis?

In Tom’s case, the injury gave each new walking problem a familiar explanation, especially while back pain improved with therapy. The delay grew because his balance, bladder, and leg problems were considered in separate visits. The notebook showed that the pattern extended beyond pain from one old injury.

What made the doctors reconsider the back explanation?

The change involved both legs, continued over years, and was accompanied by urinary urgency. A later examination also identified findings that did not fit the lumbar imaging. The neurologist reviewed the dated notebook, examined Tom, and requested brain and spinal cord imaging rather than treating each fall as an isolated event.

Why was primary progressive

MS considered after years without attacks?

Tom described steady decline rather than distinct episodes followed by recovery. The diagnosis was based on that long progression together with examination findings, MRI evidence, and additional testing used to assess competing explanations. For him, the absence of a dramatic attack had helped the earlier explanations remain in place.

How did the diagnosis change his work on the ranch?

It did not produce an immediate retirement date. Tom and Elena focused first on the consequence they had already recorded: a fall could leave him out of sight with nobody expecting him back. On ordinary mornings, the notebook stayed near the kitchen phone with the pasture name and expected return written on the next line.