Question
QUESTION: Hello. I've written you before but am putting my history below anyway.  Thank you.

Hello.  I am 44 a year old female and have received chiropractic care for 15 years.  Last fall I began to experience some shoulder pain.  December brought muscle spasms of the upper back and lower neck left side.  January 5th I had an episode of strain/sprain and severe pain with radiculopathy on my left arm.  MRI showed herniation at 6 ,7 towards the foramen exit of left arm and moderately large. I have received chiropractic adjustments along with trigger point therapy all along since then, sometimes often, rarely less than weekly.  Most of my symptoms are gone except for pain at the base of my neck that comes and goes.  The only other symptoms I have are a numb ventral side of my index finger, occasional hot wrist and some weakness, minimal, in the back of my upper arm. It comes and goes as well. I also have tighter muscles after my treatments and need to recover for a day, even sometimes laying down.  I use ice a lot at those times. My range of motion of my neck seems fine. I do MacKenzie exercises and walking on a treadmill and practice good nutrition with supplements.  But I wake up in wrong positions and feel weakness in my arms and legs, very minimally, and I feel a slight choking in my throat and heaviness in my chest. Also at that time my bowels speed up and seem to speed up whenever I have pain.  Recently I've had trouble maintaining SI alignment. I have also lost 22 lbs. since March. The malaise and visceral signs after compression while sleeping concern me. Could I have stenosis or the beginning of myelopathy, or any kind of spinal cord impingement or involvement?  My chiropractor doesn't think so. Should I get a repeat MRI or see a neurologist?  Can cervical adjustments worsen my condition?  Is it possible for the herniation to worsen even after five months of therapy?  Thank you.

ANSWER: Joni,

Your MRI should have mentioned if you have stenosis or not.  If there was no mention or it was disregarded, ask the doctor to review it or get another radiologist to read it.   If you are losing weight for no good reason, that's not a good sign.  Have your PCP review this and make sure you don't have anything more serious going on.  If there is a suspician of something worse, then a brain MRI might be ordered to rule out stuff like MS, or a bone scan to rule out metastatic disease from cancer.  Hopefully you don't have anything like that going on, but since you mentioned visceral symptoms and weight loss, I thought I'd mention it.  In other words, don't screw around with this and get more than one opinion if you are not making progress with your treatment.  A neurologist should also be able to rule out signs of myelopathy, cord syrinx, or simple disc irritation.  The heavy throat feeling is common when there is a lot of hypertrophy to the cervical bones from arthritic change.   Your MD-internal medicine specialist is the best person to check systemic symptoms.   

'Hope this helps.  Good luck with this.

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Thank you. My weight loss is due to reduced calories or not wanting to eat when I feel pain.  I also get bouts of diarrhea when the nerve pain is bad, like the last two days.  Its actually not so bad, just inflammed, with one muscle at the base of my neck that seems to be weakened easily.  Is it normal for CHDs to flare up and get quiet or should that be treated by a NS?  Today, advil is helping and I hope this flare up doesn't require something like celebrex or percocet.  My stomach gets worse on these and I'm even on protonix.  Do you think more chiropractic during flare ups is indicated?  I remember these visceral symptoms, weakness, catch my breath when I'm walking up and diarrhea from pain, could that be right?

Answer
Joni,

I don't know what your current treatment frequency is.  You stated you've gone to a chiro for 15 years.  Treating 3x/week is different than 2x/year for 15 years.  So I don't know what your current treatment pattern is.   Regardless, assuming you are undergoing active care at 2 or 3 times per week, the bottom line is this: are you getting better or not?    You should have a Neck Disability Index questionnaire form filled out and then filled out again after three or four weeks to see if your score changes.  That, combined with your symptom profile, proves if you are getting better or not.  If not, then you must find an other way or get a second opinion.  Your chiro' should have a NDI form available if you didn't already do one.

'Regards,

Dr. G