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wllwrt4fd 11-07-2012 10:30 PM
Reaching a Diagnosis
 
Hi everyone,

I've been in and out of doctor's offices for almost a year now. Last year, during my senior year of college I began to get an unusual feeling of numbness every time I wore any clothes on my lower half. It seems lately though that my right leg is far worse off than my left. I'm really starting to get discouraged because it seems like they've tried almost every conceivable test and yet still no answers. My condition has baffled multiple doctors and specialists. I've a cervical, thoracic, and brain MRI all of which came back clear.
Recently my chiropractor discovered that I have a little bit of Lordosis and Scoliosis, although my neurologist says that doesn't really explain all of my symptoms. I've also had a spinal tap, which came back negative for everything. I have one of the best doctors in the US looking at my case and even he's stumped. I don't know what to do anymore. The only thing they haven't done is an MRI of my lumbar Spine. How can I pressure the insurance company into getting this done for me? What else should I try? I've also had every blood test imaginable for all those who were wondering and they all came back negative, but I know something is wrong. I just don't feel normal. My chiropractor also recently discovered that my Atlas was misaligned. I don't know what to do or think anymore. It's so frustrating.

gatorhead 11-08-2012 12:22 AM
Lower numbness for me would be an automatic lumbar MRI. Sure the Cervical and even thoracic could play roles with the lower body but the Lumbar is the nerve exodus to the lower extremities.

Dr. Smith 11-08-2012 12:35 AM
Quote:
Originally Posted by wllwrt4fd (Post 929663)
How can I pressure the insurance company into getting this done for me? What else should I try?
If one of the best doctors in the US can't justify one to your ins. co., I don't know any way you could pressure them.

If you want it badly enough to pay for it out of pocket, shop around. Prices (w & w/o contrast) range from ~$500 -- ~$2000.

Doc

Dubious 11-08-2012 02:17 AM
Quote:
Originally Posted by wllwrt4fd (Post 929663)
Hi everyone,

I've been in and out of doctor's offices for almost a year now. Last year, during my senior year of college I began to get an unusual feeling of numbness every time I wore any clothes on my lower half. It seems lately though that my right leg is far worse off than my left. I'm really starting to get discouraged because it seems like they've tried almost every conceivable test and yet still no answers. My condition has baffled multiple doctors and specialists. I've a cervical, thoracic, and brain MRI all of which came back clear.
Recently my chiropractor discovered that I have a little bit of Lordosis and Scoliosis, although my neurologist says that doesn't really explain all of my symptoms. I've also had a spinal tap, which came back negative for everything. I have one of the best doctors in the US looking at my case and even he's stumped. I don't know what to do anymore. The only thing they haven't done is an MRI of my lumbar Spine. How can I pressure the insurance company into getting this done for me? What else should I try? I've also had every blood test imaginable for all those who were wondering and they all came back negative, but I know something is wrong. I just don't feel normal. My chiropractor also recently discovered that my Atlas was misaligned. I don't know what to do or think anymore. It's so frustrating.
You didn't say where your numbness was, other than insinuating it was your legs. Since it is associated with your clothing, has anyone considered meralgia paraesthetica? It IS curious with your stated lower extremity complaints that a lumbar MRI was not considred by your neurologist....perhaps your clinical findings did not support one?

Regarding the chiropractic dogma, give it 2-4 weeks...if not improving....well...IMHO!

wllwrt4fd 11-08-2012 11:26 PM
The condition you listed meralgia paraesthetica could definitely be a possibility. I'll mention it to my doctor. Thanks(:

Dubious 11-09-2012 01:24 AM
Quote:
Originally Posted by wllwrt4fd (Post 929963)
The condition you listed meralgia paraesthetica could definitely be a possibility. I'll mention it to my doctor. Thanks(:
I am hoping that is what it is! If it is so, MP is an irritation to a superfiscial (lateral femoral) cutaneous nerve that is an annoyance, not a serious problem. Usually it just involves identifying the offending problem then it all fades away. But you of course, need someone to definatively diagnose your problem. Good luck!

wllwrt4fd 11-09-2012 12:35 PM
Quote:
Originally Posted by Dubious (Post 929989)
I am hoping that is what it is! If it is so, MP is an irritation to a superfiscial (lateral femoral) cutaneous nerve that is an annoyance, not a serious problem. Usually it just involves identifying the offending problem then it all fades away. But you of course, need someone to definatively diagnose your problem. Good luck!
Unfortunately, my doctor doesn't think that condition is consistent with my symptoms, but I might get a Lumbar MRI next Friday as long as the insurance company approves it, so maybe I'll get some answers after that. Thanks though, I appreciate it. It also made me think about looking into problems with sensory nerves a little bit more(:

Leesa 11-09-2012 04:56 PM
I can't believe that the doctors didn't do a lumbar MRI first!!! Why a spinal tap? That doesn't even sound reasonable! I would think that the lumbar MRI would have been first in their minds, but who knows what goes thru their heads.

And PLEASE -- since you dont' know what the problem is DON'T GO TO THE CHIROPRACTOR!!! Any manipulation at this point could put you in a wheel chair. Two different neurosurgeons told me that any spinal patient needs to steer clear of Chiros' unless they want to end up paralyzed, and especially if you don't have a diagnosis! :eek:

I hope your neuro can convince the insurance company that this MRI is needed for a proper diagnosis! And please let us know what the report says once you have it. We can help decipher it when you get it. Best of luck & God bless. Hugs, Lee :)

Dubious 11-09-2012 06:52 PM
Quote:
And PLEASE -- since you dont' know what the problem is DON'T GO TO THE CHIROPRACTOR!!! Any manipulation at this point could put you in a wheel chair. Two different neurosurgeons told me that any spinal patient needs to steer clear of Chiros' unless they want to end up paralyzed, and especially if you don't have a diagnosis! :eek:
Enough with the "scare" tactics. To put manipulation into perspective, here is what is published:
A number of literary reviews of serious occurrences from chiropractic adjustments have been documented. The most exhaustive study discussed 113 cases of vertebro-basilar accidents following spinal manipulative therapy, from 1934 to 1987, a period of 53 years. Of the cases documented 66 were chiropractic, 18 medical, 9 osteopathic, 2 physical therapist and the remaining 13 were divided between “wife,” “self,” and “unknown”.

Let’s put these numbers in perspective. There were 66 chiropractic cases in 53 years; a little more than one per year. There are currently about 52,000 chiropractors in practice treating, on average, about 100 patients per week. That works out to 5.2 million adjustments per week or 286 million adjustments per year. This works out to 1 to 2 cases of stroke, paralysis or death per 286 million adjustments. Maigne has stated, “there is probably less than one death of this nature out of several tens-of-millions of manipulations.” No matter how one interprets the results, more people die from complications of drugs and surgery in one single afternoon than in decades of cervical adjustments. As a comparison to the risk of manipulation, the risk of paralysis from neurosurgery of the cervical spine is 15,000 cases per million.

Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine 1999:24(8), pp785-794 Excerpt from http://scnhs.com/faqs.
In short, spinal surgery is many times more deadly and injurious than manipulation. Death and injury from anti-inflammatory medication is more dangerous than manipulation and less than surgery.

Dr. Smith 11-10-2012 07:53 PM
"of the cases documented"
 
Documented by whom? Many things have been published, and while rare, vertebro-basilar stroke is only one of the risks associated with chiropractic.

Quote:
Published Reports

In 1992, researchers at the Stanford Stroke Center asked 486 California members of the American Academy of Neurology how many patients they had seen during the previous two years who had suffered a stroke within 24 hours of neck manipulation by a chiropractor. The survey was sponsored by the American Heart Association. A total of 177 neurologists reported treating 56 such patients, all of whom were between the ages of 21 and 60. One patient had died, and 48 were left with permanent neurologic deficits such as slurred speech, inability to arrange words properly, and vertigo (dizziness). The usual cause of the strokes was thought to be a tear between the inner and outer walls of the vertebral arteries, which caused the arterial walls to balloon and block the flow of blood to the brain. Three of the strokes involved tears of the carotid arteries [3]. In 1991, according to circulation figures from Dynamic Chiropractic, California had about 19% of the chiropractors practicing in the United States, which suggests that about 147 cases of stroke each year were seen by neurologists nationwide. Of course, additional cases could have been seen by other doctors who did not respond to the survey.

[More...]

Excerpt from http://www.quackwatch.org/01Quackery...irostroke.html
In short, there are at least two sides (and often more) to any/every issue. Reports published by chiropractors tend to support chiropractic; reports by others tend to be more objective, or biased in other directions.

Even the Mayo Clinic, one of the most conservative sites online, which grants:
Quote:
Chiropractic adjustment is safe when it's performed by someone trained and licensed to deliver chiropractic care. Serious complications associated with chiropractic adjustment are overall rare, but may include:
http://www.mayoclinic.com/health/chi...DSECTION=risks
still cautions:
Quote:
Don't seek chiropractic adjustment if you have:

Severe osteoporosis
Numbness, tingling or loss of strength in an arm or leg
Cancer in your spine
An increased risk of stroke
An unstable spine

Ibid.
IMO, both sides should be examined to get a balanced perspective.
risks of chiropractic includes articles by both chiropractic proponents and opponents. Each patient must ultimately decide for themselves if the risks justify the benefits.

Doc

Dubious 11-10-2012 08:31 PM
Quote:
Originally Posted by Dr. Smith (Post 930421)
Documented by whom? Many things have been published, and while rare, vertebro-basilar stroke is only one of the risks associated with chiropractic.



In short, there are at least two sides (and often more) to any/every issue. Reports published by chiropractors tend to support chiropractic; reports by others tend to be more objective, or biased in other directions.

Even the Mayo Clinic, one of the most conservative sites online, which grants:

still cautions:


IMO, both sides should be examined to get a balanced perspective.
risks of chiropractic includes articles by both chiropractic proponents and opponents. Each patient must ultimately decide for themselves if the risks justify the benefits.

Doc
Haldeman's review was balanced; he is a medical doctor, a neurologist out of UC Irvine, California a medical teaching institution with his first degree prior to that being a doctor of chiropractic (he does not practice this as far as I know). His work is still quoted more than most others regarding manipulative adverse events. There are other researchers, i.e. Dr. David Cassidy out of Canada, Rand Corporation, etc. with most coming to the same general conlcusions; that while no procedure is 100% safe, in comparison to surgery and medications, the risk of adverse event from manipulation is minute.

Then there are extremist, on both sides, with the owner of Quackwatch being a psychologist (think he knows much about manual medicine? I don't know, I'm just say'in) and on the other side, the "straights" who are a group within chiropractic who think all disease can be cured by an "adjustment." Both are whacked, in my humble opinion and neither have performed controlled peer-reviewed papers on the subject, at least to my knowlege! And I am not sure I agree with the statement that a paper from a D.C. is biased while a paper from an M.D. is not. Junk science knows no ideological or academic boundries. The power of a paper lies in it's research design, whether it's a clincial trial, review or meta-analysis, controlled or not, blinded or not, intrinsic and extrinsic biases and so forth. So I think you would agree that a series of well constructed research papers whose results consistently are in agreement are probably more reliable than anyone's web page opinion, no matter who owns it!

As far as chiropractors publishing mostly positive literature about itself, I suppose that's sometimes true but you could say that about any organized body of knowlege (Big Pharm). BTW, one of the major contributors to the Quackwatch site was from a group of chiropractors called NACM (National Association of Chiropractic Medicine), who was harder on it's own profession than just about anyone. Right or wrong, they bashed the living he** out of chiropractic.

So in short, I think we agree.....right?!

Dubious 11-10-2012 08:58 PM
Quote:
Originally Posted by Dr. Smith (Post 930421)
Documented by whom? Many things have been published, and while rare, vertebro-basilar stroke is only one of the risks associated with chiropractic.



In short, there are at least two sides (and often more) to any/every issue. Reports published by chiropractors tend to support chiropractic; reports by others tend to be more objective, or biased in other directions.

Even the Mayo Clinic, one of the most conservative sites online, which grants:

still cautions:


IMO, both sides should be examined to get a balanced perspective.
risks of chiropractic includes articles by both chiropractic proponents and opponents. Each patient must ultimately decide for themselves if the risks justify the benefits.

Doc
Oh...I forgot this one:
Risk of Vertebrobasilar Stroke and Chiropractic Care
Results of a Population-Based Case-Control and Case-Crossover Study
Spine. 2008 Feb 15;33(4 Suppl):S176-83.
by Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.
(5)


STUDY DESIGN: Population-based, case-control and case-crossover study. OBJECTIVE: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.
SUMMARY OF BACKGROUND DATA: Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke.
METHODS: Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.
RESULTS: There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.
CONCLUSION: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.
Embarrasing, I know! Could this mean that people were more likely to suffer a stroke after seeing their PCP than seeing a chiropractor? Wow....really? :winky:

Dr. Smith 11-12-2012 01:29 PM
Quote:
Originally Posted by Dubious (Post 930431)
Junk science knows no ideological or academic boundries. The power of a paper lies in it's research design, whether it's a clincial trial, review or meta-analysis, controlled or not, blinded or not, intrinsic and extrinsic biases and so forth. So I think you would agree that a series of well constructed research papers whose results consistently are in agreement are probably more reliable than anyone's web page opinion, no matter who owns it!
....
So in short, I think we agree.....right?
No, not entirely, and I would include anecdotal evidence as being unreliable. But since you brought up (not verbatim) well-designed, controlled scientific studies, in the 1987 court decision that forced the AMA's change in position on chiropractic,
Quote:
Judge Getzendanner also went out of her way to make clear what she was not doing:
The plaintiffs [chiropractors] clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study... No such study has ever been done.*** In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence.
http://en.wikipedia.org/wiki/Wilk_v....al_Association
*** I'm still not aware of any such study.

I have done my own homework, and IMO, chiropractic is still pseudo-science/quackery, and I will not allow a chiropractor to come anywhere near my spine or any other part of me.

Doc

Dubious 11-12-2012 03:01 PM
Quote:
Originally Posted by Dr. Smith (Post 930838)
No, not entirely, and I would include anecdotal evidence as being unreliable. But since you brought up (not verbatim) well-designed, controlled scientific studies, in the 1987 court decision that forced the AMA's change in position on chiropractic,


*** I'm still not aware of any such study.

I have done my own homework, and IMO, chiropractic is still pseudo-science/quackery, and I will not allow a chiropractor to come anywhere near my spine or any other part of me.

Doc
OMG! Really....1987 Wilks v. AMA?

That suit was to get the AMA off of the backs of the chiropractors as they were instituting an illegal boycott of the the profession. It was not to validate efficacy and outcomes of manipulation. That would come later and since then, there has been almost 3 decades of research to that end (you can't find what your not looking for) since that suit ended!

And I hate to tell you but Wilks, a chiropractor, won the suit spurring a plethora of ensuing research (by MD's, PhD's, DC's, etc) validating manipulation and opened up open referals between the two profession that benefited everyone, that once existed before the AMA boycott.

Look Doc, no one is going to force a quackerpractor on you or anyone else and I could certainly tell you about a lot of unbelieveable crazy crap I've seen them do but let's at least be accurate in our degradation and trashing of a profession!

wllwrt4fd 11-20-2012 11:05 AM
Need help deciphering MRI Results for Lumbar spine
 
Indication: Numbness of legs



Technique: MRI lumbar spine with sagittal and axial T1 and T2
weighted images, postcontrast sagittal and axial T1-weighted images.



Contrast: 11 mL Multihance IV.



Findings: Alignment is near-anatomic. Vertebral body and disk
heights relatively preserved. No suspicious focal T1 dark marrow
lesions. Small Schmorl's nodes are noted at some levels for example
superior endplate L3. No significant compromise of the canal or
neural foramina at any level. Distal cord and conus is within normal
limits position T12/L1 and roots of cauda equina appear within normal
limits.



Probable nerve root sheath cyst noted along the extraforaminal S1
nerve root and to a lesser extent S2 nerve roots more proximal, not
uncommonly seen.



No abnormal enhancement cord, cauda equina, or coverings.



Impression: Unremarkable MRI lumbar spine except for probable nerve
root sheath cysts associated with right S1 greater than S2 nerve
roots, not uncommonly seen. No explanation for bilateral lower
extremity numbness.

Dubious 11-20-2012 11:53 PM
Quote:
Originally Posted by wllwrt4fd (Post 933215)
Indication: Numbness of legs



Technique: MRI lumbar spine with sagittal and axial T1 and T2
weighted images, postcontrast sagittal and axial T1-weighted images.



Contrast: 11 mL Multihance IV.



Findings: Alignment is near-anatomic. Vertebral body and disk
heights relatively preserved. No suspicious focal T1 dark marrow
lesions. Small Schmorl's nodes are noted at some levels for example
superior endplate L3. No significant compromise of the canal or
neural foramina at any level. Distal cord and conus is within normal
limits position T12/L1 and roots of cauda equina appear within normal
limits.



Probable nerve root sheath cyst noted along the extraforaminal S1
nerve root and to a lesser extent S2 nerve roots more proximal, not
uncommonly seen.



No abnormal enhancement cord, cauda equina, or coverings.



Impression: Unremarkable MRI lumbar spine except for probable nerve
root sheath cysts associated with right S1 greater than S2 nerve
roots, not uncommonly seen. No explanation for bilateral lower
extremity numbness.
These are not huge findings but does underscore the necessity to correlate your physical exam findings with your imaging findings or lack thereof.

I assume that all has been exhausted looking for metabolic causes? At this point, if all has been explored, it may be time to go fishing for the outlires. From what I am reading, your issues are more sensory than they are inclusive of motor involvement so less common neurodiagnostic tests like DSSEP's (derma somatasensonsory evoked potentials) do tests the sensory portion of the nervous system and may be worthy of persuing should your profile warrent it. It is possible that your symptoms could be coming from higher up and probably should now be considered but I wouldn't put a lot of stock in that direction...


Good luck!


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