Dr. H's Blog

Case Study #9: "Doctor, I just lost some of my eyesight! Can You help me? "

Kim is a 54 year old woman is tip-top shape who called me in a panic this past weekend. She was already a patient so we had a professional relationship established. Kim told me on the phone that she was sitting at home watching a movie when she noticed a dark spot in the middle of her vision field. She thought she might be having a stroke. I went to see the patient on a Sunday night. I took her blood pressure, performed reflexes, postural appreciation, light touch and basic range of motion of her neck and low back. All was normal. I next performed a simple set of Cranial Nerve checks with emphasis on Cranial I, II, III, IV, VI. All of these inventories were normal as well.

What Kim was describing was a "scotoma." A scotoma is a darkend area in your field of vision. It often looks like a black spot. See Picture: 

Scotomas are defined as temporary (sometimes permanent) blind spots in a person's field of vision. The usual culprits for this are optic lesions such as optis neuritis, macular degeneration, glaucoma, clorioretinitis. Migraine headaches can also cause this as well as diabetes. Stroke maybe but very rarely.

In lieu of an opthalmological exam which I can't do, I opted to chiropractically adjust Kim's mid back. We are all familiar with the so-called "autonomic" nervous system. That's the system of nerves that controls blood flow, adrenaline, heart rate, respiratory rate and adjusts your body according to your needs. It is "sympathetic" to your needs at any given moment. We should also be familiar with some of the miraculous cures that have been affected by chiropractic adjustments to the spine that, in effect, re-calibrate the sympathetic nervous system. The legend of Harvey Lillard is a good example: This is how chiropractic got its modern name of expression when bonesetter DD Palmer adjusted Harvey's neck when Mr. Lillard claimed he had gone deaf years before when he heard a crack in his neck. The adjustment restored Harvey's hearing. In 1990, in the Journal of Opthamology, a man who had gone blind after a fall had his vision restored after chiropractic adjustments to his neck. This after all conventional treatment failed.

The common problem in all these scenarios including Kim is this; blood flow was interupted to the various organs in question. The organs themselves were normal. Chiropractic adjustments that affected the sympathetic nervous system restored normal blood flow and special senses were restored. It is an old story. Kim's scotoma was irradicated instantaneously with one adjustment to the mid back. Case Closed.

Case Study #8: "My low back is constantly aching!" 

In our case study today, we have a 37 year old African American man named Jon who came to us with a history of low back pain, bilateral sciatica and occasional headaches. Interestingly, he also mentioned that through an MRI when he was 22, an incidental finding of Arnold-Chiari Malformation 1 was noticed. This is a semi-rare conditiion where part of the Cerebellum slides through the foramen magnum (big hole in the bottom of the skull where the brain stem and spinal cord exits from the brain) and lodges in the upper cervical area. He was otherwise in good physical condition. His low back X-Rays were largely unremarkable: alignment was good, disc spacing, the lordotic curve in the lateral view was maintained. There didn't seem to be a reason for his continual LBP. Incidentally, Jon has sought and received chiropractic care for years with other doctors and quite enjoyed the relief he got. BUT, no chiropractor would touch his neck or even X-Ray the area because of the Arnold-Chiari 1 issue. Here now, Jon's cervical films:

Note total loss of normal lordosis in this lateral view of Jon's cervical spine.

Jon's open mouth view revealed pinching of the C1-C2 interspace but the region was otherwise intact.

We've seen Jon a few times already and I am adjusting his cervical spine, below the C1-C2 complex with excellent results already. He has responded well and I am confident we can irradicate the troublesome sciatic and LB issues by working on the entire spine in this case.

Moral to the story: barring absolute contraindications, the entire spine should be evaluated and treated by a chiropractor as needed. With AC-1 malformations, the literature is admittedly split on whether or not chiropractic manipulation should or should not be performed. In Jon's case, the manipulative reductions are very gentle and below the upper cervical area. The results have been astounding.

Dr. Haberstroh is a Boston and Somerville Chiropractor.

June: Sally presented as a 33 year old executive who, while having had a recent broken foot and a terrible whiplash accident many years ago, was in great shape. She trains actively and regularly, is fairly young and had no recent precipitating accidents that would explain the debilitating neck pain she was feeling. After an exam, we took 2 radiographs of her neck. This is what we found in the lateral view: 

Notable is the neck tilting forward. To look at this young woman visually, you would never have guessed that her cervical spine was this far tilted. Note too a total lack of the normal lordosis, or half-moon arc curve that we should see in the neck. That curve bends forward normally. Here, upon closer inspection, the neck curves very slightly backwards.

Moral to the story: Long term faulty posture can lead to problems later in life. Often, it comes down to one day, one hour when your body finally says, "Enough, I can't take it anymore."  

The Good News: Sally has had three treatments thus far and her pain has been reduced by 80%.  She is modifying her habits such as elevating her computer screens at home and work. Elevating books she reads all so she can stop continuously looking down which breeds this kind of aberrant posture. She is sleeping on her back now with an orthopedic pillow which will help to slowly rehab her neck and over the course of years, start to put the normal curve back in. 

Where do we go from here?  Sally will probably be pain free in another week. Case closed? Hardly. If we were to re-take this same radiograph next week, would she look any different? No. Understand that people experience pain when the body gets to a specific tipping point and the nociceptors (pain receptors) in the back or wherever, are finally activated. We humans can undergo much deformation before we start to feel pain. I am going to recommend that Sally continue with us 1X/week for the next several months, long after her pain has gone; in an effort to help rehabilitate her spinal posture. Along with the ergonomic changes she is making, this should add up to the most full-filling health experience possible. 

Case Study #6: Alex has been researching, under secret clearance with the U.S. Government for three decades, Laser Engineering which means he has been huddled over a computer and/or laser equipment nearly night and day.

Picture of a laser engineer, not Alex.

He's seen chiropractors in the past and PT but never stuck with it because he "didn't have time." Now Alex hobbles into my clinic with unrelenting low back pain that is worse than ever. Oddly, no one over the years thought to X-Ray him either. We did. Here is what we found:

In this film, we are looking at Alex's back from behind. The left is clearly marked and as you can further see, he has a frank scoliosis of the low back.

Adjustments have already made him feel better. You're asking; "Can chiropractic care straighten out his back??" The answer is probably not. However, a wholistic approach to this man's activities may help reduc the scoliosis issue along with chiropractic adjustments. Since he likes to swim, we leave that alone. He also likes to jog. I begged him to stop running on concrete and use a softer surface since he refuses to quit running too. So, we split the difference and he is using his treadmill instead of running on the street. I asked him to sit in his car when getting in, rather than step into the car like most people do. The twisting motion of stepping into your car mimick's a gold swing. Interestingly, he already has a cross bar installed in his basement so I told him to start doing pullups and chinups religeously to help build up the Latissimus muscles and utilize gravity to traction out his spine.

With these factors all working, I am confident we can reduce this scoliosis in the coming year.

Dr. Haberstroh is a chiropractor in Boston and Somerville.

This typical case came in not long ago. We'll keep the details succinct so the blog can stay at a reasonable length. Nancy was 27 years old. She was a secretary and sat such that she had to look to her right for materials to type data from. As well, the phone was to her right and she often cradled it in her right shoulder/neck area while working. She slept on her stomach, enjoyed red wine and entire pots of coffee each day as well as chocolate. Finally, she didn't exercise much. Her neck X-Ray show a reverse curve in the neck. Taken altogether, we had a classic example of a case that required a WHOLISTIC Care approach. Make a long story short: Nancy re-arranged her work station materials, got a head-set to use with the phone, stopped sleeping on her stomach, drastically reduced her red wine and coffee intake, stopped eating chocolate altogether, used an ortho pillow for her neck, joined a gym and began working out and finally; came in for regular chiropractic adjustments to her entire spine, with an emphasis on her C spine.

Moral to the story: Chiropractic care alone probably wouldn't have solved Nancy's Headache issue. But a thorough WHOLISTIC APPROACH worked wonderfully. Think about it.

May 5, 2011: Ana came to us yesterday complaining of blistering pain in her neck. She is Brazilian and has worked as a house cleaner for over 20 years. She told us that her pain actually began 8 years ago and has gotten progessively worse. She saw a Chiropractor 2 years ago but he didn't take X-Rays and his adjustments offered only slight relief. After our careful case history with Isabel translating for us and 2 X-Rays of the neck, her problem became clear. The X-Rays told the story: she had lost her normal curvature of the cervical (neck) spine. Her neck, from a side view was straight. Normally, there is a curvilinear appearance like a half moon arc. Remember, the human spine is a suspension system and a loss of the normal front to back curves disrupts the entire spinal/musculo system. This was causing undue muscle spasm and the subsequent pain.  After just one treatment, Ana felt much better. But this is just the start; she will need to rehab her neck to regain the normal curvature she should have. To help this along, Ana bought from us an ortho pillow designed to restore the normal curvature to her neck. She'll need around 4-6 more treatments to get out of her pain. After that, it is up to her to continue to rehab her neck with postural changes and the use of that pillow nightly for the rest of her life. *Note in the patient's actual X-Ray seen below, how straight the curve is when seen from the side. She is only 39 years old.

4/20/11: Several years ago, a patient approached me for help with chronic diarrhea, chronic back pain, chronic headaches and occaisional pain down both legs. His case history was fascinating: he had been stationed in Saudi Arabia with the U.S. Army in a forward missle battery when an Iraqi Scud missle came whistling overhead.

The Scud was intercepted by an American Patriot missle and there was an explosion. A fine mist fell upon this man's entire unit. It was Sarin Nerve Gas. Over the course of time, those symptoms I spoke of manifested and one by one, the men of "Bill's" missle battery started dying off. Make a long story short. "Bill" (*Not his real name) came to me in utter desperation. Chiropractic "Diversified" adjustments to him helped keep his symptoms at bay, albeit temporarily. He couldn't afford chiropractic and didn't have insurance so we did a trade: since he was an IT guy, he got his chiropractic at no charge and fixed my computers when they glitched up. The end result is that chiropractic care has been the ONLY thing that has helped this War Vet since he was Gassed.

Scud missles in Iraq.

It doesn't cure, but temporarily relieves the bulk of his symptoms for days and sometimes weeks at a time. EPILOGUE: The US Government is notorious for not treating its Veterans very well, especially the wounded. My Forensic Report on his condition together with multiple citations and articles pasted right into my report helped convince the US Government and the Army that Bill actually did have a serious problem; a problem the Government had long denied. His case settled recently and Bill is getting 20 years tax free back pay and additional funds for pain and suffering for a now recognized injury; that of Sarin Nerve Gas poisoning.

Abstract: In this interesting case, the patient suffered injuries to the back and neck as a result of a MVC (motor vehicle crash). During routine radiological imaging, we noticed a number of pre-existsing issues including frank thoraco-lumbar scoliosis. The X-Rays tell the story. Note also the damage to the vehicle itself.

1/10/08: Mr. T presented to us seeking treatment for injuries received in a MVC (motor vehicle crash) on or about 1/1/08. He stated that he was the restrained driver in a 1990 Nissan Pick-up that was stopped at a stop sign when a mini-van slammed into the rear of his vehicle. The offending van was apparently going at a high rate of speed because the entire rear window of the Nissan exploded upon impact. Mr. T indicated that prior to impact he was facing forward, his head rest was set and the crash came as a surprise to him. He stated that the impact thrust him forward and backwards in his car seat and he furthermore slammed his chest against his own steering wheel. He denied any loss of consciousness, but did mention that he was dazed from the impact. He stated that there were no police or EMS called to the scene and that after exchanging papers, he opted to go home. Mr. T added that the pain became worse by the next day and that his wife drove him to Somerville hospital. He stated further that when he arrived at Somerville Hospital, he was attended by an ER doctor. He stated further than he was examined, received no X-Rays, was scripted for meds and told to go home and to rest. He stated that the reason he presented to our office (BSCs-Somerville) was because of continued chest, neck and back pain. He described the primary locus of pain as being in his L spine that was of a constant achy/sore pain in nature in which most activities such as bending, lifting, getting up aggravated his condition and was temporarily relieved with rest. He stated further that his neck and chest were not quite as painful as the LB but still extremely sensitive and sore. Mr. T stated that the entire region of his neck (like the entire region of his LB) was achy/sore/constant in nature where lifting and movement aggravated and rest offered slight relief. The same was true of his chest pain. All areas were sensitive and painful to touch. He stated that he did not smoke or drink. He informed us he did get yearly physical exams and that he was in otherwise in good condition. He added that he was feeling fine prior to the MVC without the abovementioned pain. Mr. T reminded us that he was a patient here in 2004 for injuries resulting from a MVC at that time. He was discharged at the time with few residuals. Upon further questioning, he could not recall any other significant past personal or family medical history including traumatic accidents. He further stated that the crash disrupted his ADLs; this included activities such as walking, going up/down stairs, getting in/out of the car, job activities, carrying groceries, lifting things, turning door knobs, getting dressed. *The patient was asked to obtain all of his relevant hospital records. He stated that he would attempt to do so.  

JOB DESCRIPTION:  Steward at the FOUR SEASONS Hotel in Boston. A Steward assists in the kitchen cleaning, washing, lifting etc.

VEHICLE PICTURE(S):  

Note tape holding right rear light assembly in place. Noted also here is the exploded rear window as well as the bumper damage.

GENERAL PHYSICAL EXAMINATION:
Mr. T presented as an alert, cooperative, right handed, 61 year old, WDWNHaitianM standing 5’8” and weighing 131.6 lbs.

HEAD-RESTRAINT GEOMETRY: An inquiry with the Insurance Institute for Highway Safety (www.iihs.com) on the efficacy or lack thereof on the patient’s particular vehicle tells us that a) the truck hasn’t been made by Nissan in years, b) the only year it was rated was 1997 and it received a mixed rating of A-M-P (acceptable, marginal, poor).  As one can see from the picture below, Mr. T’s back set is sizeable. As well, the head-restraint is situated low on his truck, at the “marginal” to “poor” zone. 

>Head restraint geometry explained: The necessary first attribute of an effective head restraint is good geometry. If a head restraint isn't behind and close to the back of an occupant's head, it can't prevent a "whiplash" injury in a rear-end collision. Institute researchers regularly evaluate the geometry of head restraints in passenger vehicles based on the height and backset relative to an average-size male. A restraint should be at least as high as the head's center of gravity, or about 9 centimeters (3.5 inches) below the top of the head. The backset, or distance behind the head, should be as small as possible. Backsets of more than 10 centimeters (about 4 inches) have been associated with increased symptoms of neck injury in crashes.

>Geometric ratings: Geometric ratings are good predictors of how well people will be protected in rear-end crashes — drivers with restraints rated good are less likely than those with poor restraints to claim neck injuries. Head restraint geometric ratings for hundreds of passenger vehicles are listed by vehicle make and series. Various head/seat combinations are rated (not every available seat option in every series has been measured). The restraints are measured with the angle of the torso at about 25 degrees, a typical seatback angle. Each restraint is classified according to its height and backset into one of four geometric zones — good, acceptable, marginal, or poor.

Note Back set of head restraint.

RADIOLOGICAL EXAMINATION:
A clinical decision was made to take the necessary X-rays today on this patient. This would normally include a cervical Davis Series as well as AP-Lat lumbar films.

Extension view of DT’s cervical spine.

Neutral Lateral view of DT’s C spine.

 Lumbar AP view of DT’s low back. Left side is on left here, we are viewing this film from “behind.” 33 Degrees of scoliosis was measured.

DIAGNOSIS (original):
Initial working diagnosis: Based on the patient's subjective comments, the case history, and the DDX analysis during the physical exam, it was opined that the patient sustained a Cervical-Lumbar/sacral strain/sprain Grade II with full spine pathomechanics and gross  myospasms, all as a result of the accident the patient suffered on or about 1/1/08. This all compounded by the patient’s pre-existing scoliosis. This is to a reasonable degree of medical certainty.

Analysis: The patient responded very well to care. Treatment parameters extended just over 30 visits.

Our first case study shows us a number of interesting things about an interesting patient. It also points out that plain film X-Rays still have a place in the everyday practice and can reveal postural issues that may have been fomenting for years only to have "pain" appear years later. Let's see how this patient's history and findings came together:

HISTORY AND PRESENTING COMPLAINTS: 
Haley (39 yo female) presented seeking treatment for acute upper mid back pain, right arm radiculopathy and neck pain. She told us that although she has had discomfort in the back for a fairly long time, it was very recently that the pain in her back and arm became so profound that she “felt like her arm was coming off.” She told us further that she had sought two massages and began taking Ibuprophin. As a result of that, she continued, her pain seemed to calm down. Haley presented to us due to continual pain in the areas described. She stated that the worst of it is in her upper middle thoracic region, medial scapular area. She described the pain as being heretofore stabbing in nature but more of a noticeably achy sensation now as well as constant. She stated that stress issues as well as sitting at a desk all day aggravate as does sleeping. Haley added that movement relieved the pain somewhat. She further described the right arm pain along a specific C7 locus to the elbow. That is to say, a pure triceps pattern. She described this pain as achy/sore now, constant, where again, stress and sitting all day aggravate and movement offers some relief.  Haley further told us that the neck pain is right sided and more of a casual ache and least bothersome of her three big pain issues. It is also constant with the same aggravating and relieving factors.

RADIOGRAPH DISCUSSION:
Due to the patient’s presenting complaints and objective findings, a clinical decision was made to perform AP/Lat/APOM views of the C-spine. Of note:

C-spine: The AP view reveals most prominently, a gentle dextro scoliosis reaching from the upper thoracics to the cephalad portion of the C spine. See documenting digital photos of the region in this view as well as the lateral view. The unco-vertebral joints were clear and well maintained. The lateral view is the other view that revealed much about Ms. H’s situation: noted was a frank kyphosis of the entire region. As well, her entire C spine is tilted slightly forward. Disc and body heights appear proportional and are well maintained. Finally, we have the APOM shot. Ms. H’s C1-2 segmental interface is intact and perfectly normal in relative body spacing. Due to the possible involvement of the thoracic spine in her scoliosis, we may opt to shoot an additional AP Thoracic X-Ray in the near future.

No evidence of fx, dislocation or neoplastic activity to the extent visualized on these films. *800 speed Rare Earth systems were used with full lead collimation and the inclusion of the thick lead gonadal shield to absorb lower limb/abdomen scatter. Ms. H was also given a lead apron for another layer of protection. Technique was good in this set. All views were weight bearing.

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  Ms. H’s lateral Cervical shot. Note the frank kyphosis (curve reversal, as opposed to a normal “lordosis”). Disc spacing is good and there is a minimum of any other indication of early DJD.

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DIAGNOSIS:
Based on the patient's subjective comments, the case history, the DDX analysis and the physical exam, it was opined that the patient suffers from a chronic Cervico -Thoracic scoliosis that has finally begun to cause cognizant pain to this patient. Thus, a variant of the pathomechanical syndrome, the scoliosis is a long term issue. Noted also, pathomechanics in the entire spine with appreciable muscle spasm and cervicogenic radiculopathy. This to a reasonable degree of medical certainty.

Analysis: The patient enjoyed her first two treatments and felt markedly better. She was admonished to use the ortho pillow regularly and sleep on her back henceforth. Patient involvement with care is crucial to ongoing success in treatment, especially in a "wholistic" approach to care in which a patient's lifestyle, postural and sleeping habits and exericise are taken into consideration.

Judicial used of X-Rays are indicated in many cases. When findings like we have here come up, they make for a compelling "Report of Findings" when explaining a diagnosis to a patient.

Remember, pain is NOT a reliable criteria with which to judge one's health. The deformation in this woman's spine took years to happen, yet she only felt serious pain more recently. Get checked by your chiropractor when there is the slightest suspicion of back/leg/arm pain and any of the other common issues we regularly treat such as headaches.

Yours in Good Health, Dr. Haberstroh

Dear Friends,

Please bear with me. This blog option literally just went up today, May 5, 2009. I will begin posting interesting chiropractic case studies and other issues as soon as possible.

Thank you for your patience.

Dr. Haberstroh