Guest guest Posted December 31, 2003 Report Share Posted December 31, 2003 I have a new patient that suffered a stroke 23 years ago. He has very little use of his right arm and diminished use of his right leg. He has been training for a 13 mile walk and has had to stop due to pain in the groin which is increased with hip flexion. He walks with a foot drop, but recently obtained a knee brace which is intended to help him heel strike. I have never worked with someone who had a stroke. Psoas is obviously involved. There are the obvious things that I can do for a tight psoas, but I am wondering if there is anything else that I need to take into consideration with the stroke. Thank you, Dr. Bingham Namaste Chiropractic 1809 NW St. Portland, OR 97211 (503) 226-8010 Dr. Bingham Namaste Chiropractic 1809 NW St. Portland, OR 97211 (503) 226-8010 Dr. Bingham Namaste Chiropractic 1809 NW St. Portland, OR 97211 (503) 226-8010 Dr. Bingham Namaste Chiropractic 1809 NW St. Portland, OR 97211 (503) 226-8010 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2003 Report Share Posted December 31, 2003 , Don't forget that the thigh muscles do different things in different parts of the gait. i.e. the butt muscles are external rotators when standing but become hip extensors when the foot is forward and the thigh is pulling the pelvis forward; in both positions these muscles act as hip abductors to keep the body from falling to the opposite side. All that to say, the guy's groin muscles may be being asked via recruitment to perform some action that should be done by muscles that have atrophied. One good way to build activity as well as strength is wobble boards. BTW: adjust the hip if you haven't. Keep us posted. E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic Please note " New address " 315 Second Street Lake Oswego, OR 97034 503-635-6246 drscott@... or info@... > From: Bingham <bingonis@...> > Date: Wed, 31 Dec 2003 08:51:47 -0800 > Oregon ((E-mail)) < > > Subject: clinical question > > I have a new patient that suffered a stroke 23 years ago. He has very > little use of his right arm and diminished use of his right leg. He > has been training for a 13 mile walk and has had to stop due to pain in > the groin which is increased with hip flexion. He walks with a foot > drop, but recently obtained a knee brace which is intended to help him > heel strike. > > I have never worked with someone who had a stroke. Psoas is obviously > involved. There are the obvious things that I can do for a tight > psoas, but I am wondering if there is anything else that I need to take > into consideration with the stroke. > > Thank you, > > > > Dr. Bingham > Namaste Chiropractic > 1809 NW St. > Portland, OR 97211 > (503) 226-8010 > > > Dr. Bingham > Namaste Chiropractic > 1809 NW St. > Portland, OR 97211 > (503) 226-8010 > > > Dr. Bingham > Namaste Chiropractic > 1809 NW St. > Portland, OR 97211 > (503) 226-8010 > > > Dr. Bingham > Namaste Chiropractic > 1809 NW St. > Portland, OR 97211 > (503) 226-8010 > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to foster > communication and collegiality. No personal attacks on listserve members will > be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. However, it > is against the rules of the listserve to copy, print, forward, or otherwise > distribute correspondence written by another member without his or her > consent, unless all personal identifiers have been removed. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2004 Report Share Posted February 6, 2004 Hold on there doctor $1200 MRI! How about some simple and cheap blood work? (Especially since that's what you will need to do AFTER the MRI comes back negative.) R/O viral or bacterial infection; remember neutrophils and monocytes? Also, some enzymes in a Chem Screen can point the way to other damage being repaired; is sounds like post-dental reaction depending upon how she responds to anesthetic, and how much drilling went on with the crown prep. Did she have a root canal? do you think the neuro sx in the extremities are related to the face? pattern of occurrence, worsening, improvements; a cheap fix might be to load her up with supplements; Vit C with bioflavinoids to build collagen integrity; B complex for neuritis; a short course of high dose multivitamin/mineral because it can't hurt and might help; could a trigeminal branch be injured? nah; 10 days later. could her jaw need an adjustment? Tight muscles from having your mouth stretched to trout size could compress nerves causing trouble; now I'm reaching... keep us posted. E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic Please note " New address " 315 Second Street Lake Oswego, OR 97034 503-635-6246 drscott@... or info@... > From: " mattydread " <mattydread@...> > Date: Fri, 6 Feb 2004 18:02:36 -0800 > " " < > > Subject: Re: Clinical Question > > , > > Depending how long these symptoms have been going on, I > might be inclined to do an MRI of her brain and spinal cord. > > > Matt Terreri, DC > Clinical Question > > >> My 53 yoa patient has several odd symptoms. Deep and raised redness >> over the left side of her face and chin, burning in her mouth and >> tongue, periodic numbness in her left hand and left leg. >> >> Original sx was numbness in both legs, now with adjustments this has >> been reduced to approx. 25% original sx. and only in the left leg. >> >> The mouth sx. began approx. 10 days ago after a visit to the dentist >> for a crown. He thought she was suffering from yeast infection so >> placed her on 3-4 doses of yogurt per day. (by the way, it hasn't >> helped) She has since been back to the dentist and had the crown >> replaced and different glue used. >> >> Her md did a series of blood tests that appear to be normal. >> This does not fit the normal pattern of Trigeminal Neuralgia, and is >> not Bell's Palsy as her md dx. >> >> Anyone with any tidbits of info? >> >> Grice, DC >> 821 Elm Street SW, Albany, OR 97321 >> >> >> >> >> OregonDCs rules: >> 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated. >> 2. Always sign your e-mails with your first and last name. >> 3. The listserve is not secure; your e-mail could end up anywhere. > However, it is against the rules of the listserve to copy, print, forward, > or otherwise distribute correspondence written by another member without his > or her consent, unless all personal identifiers have been removed. >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2004 Report Share Posted February 6, 2004 , Depending how long these symptoms have been going on, I might be inclined to do an MRI of her brain and spinal cord. Matt Terreri, DC Clinical Question > My 53 yoa patient has several odd symptoms. Deep and raised redness > over the left side of her face and chin, burning in her mouth and > tongue, periodic numbness in her left hand and left leg. > > Original sx was numbness in both legs, now with adjustments this has > been reduced to approx. 25% original sx. and only in the left leg. > > The mouth sx. began approx. 10 days ago after a visit to the dentist > for a crown. He thought she was suffering from yeast infection so > placed her on 3-4 doses of yogurt per day. (by the way, it hasn't > helped) She has since been back to the dentist and had the crown > replaced and different glue used. > > Her md did a series of blood tests that appear to be normal. > This does not fit the normal pattern of Trigeminal Neuralgia, and is > not Bell's Palsy as her md dx. > > Anyone with any tidbits of info? > > Grice, DC > 821 Elm Street SW, Albany, OR 97321 > > > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2004 Report Share Posted February 6, 2004 Dr. , Go back and re-read the posts. I said " Depending how long these symptoms have been going on " . Also Dr. wrote " her md did a series of blood tests that appear to be normal " . I also said " I might be inclined " . Key word being " might " . I'm not jumping the gun, just considering some possiblities. Dr. has not told us how long this numbness has been going on - only that " the mouth sx. began approx. 10 days ago after a visit to the dentist for a crown " . What if the numbness has been there for a year, and now she recently has had the problems with her mouth/face? What if the two are not even related? Also, if it would be something like MS blood work will not show anything. If there was a temporal relationship with the numbness, mouth, skin, and dental work then yes I would hold off on an MRI, but would still consider it later down the line if nothing else helped. Did she do anything different before or after that visit? Like try a new sport or something? I think we need more information. Matt Terreri, DC From: " Dr. " <drscott@...> " mattydread " <mattydread@...>; " " < > Sent: Friday, February 06, 2004 5:55 PM Subject: Re: Clinical Question > Hold on there doctor $1200 MRI! > How about some simple and cheap blood work? (Especially since that's what > you will need to do AFTER the MRI comes back negative.) > R/O viral or bacterial infection; remember neutrophils and monocytes? > Also, some enzymes in a Chem Screen can point the way to other damage being > repaired; > is sounds like post-dental reaction depending upon how she responds to > anesthetic, and how much drilling went on with the crown prep. > Did she have a root canal? > do you think the neuro sx in the extremities are related to the face? > pattern of occurrence, worsening, improvements; > a cheap fix might be to load her up with supplements; > Vit C with bioflavinoids to build collagen integrity; > B complex for neuritis; > a short course of high dose multivitamin/mineral because it can't hurt and > might help; > could a trigeminal branch be injured? nah; 10 days later. > could her jaw need an adjustment? Tight muscles from having your mouth > stretched to trout size could compress nerves causing trouble; > now I'm reaching... > keep us posted. > > E. Abrahamson, D.C. > Chiropractic physician > Lake Oswego Chiropractic Clinic > Please note " New address " 315 Second Street > Lake Oswego, OR 97034 > 503-635-6246 > > drscott@... > or > info@... > > > > > From: " mattydread " <mattydread@...> > > Date: Fri, 6 Feb 2004 18:02:36 -0800 > > " " < > > > Subject: Re: Clinical Question > > > > , > > > > Depending how long these symptoms have been going on, I > > might be inclined to do an MRI of her brain and spinal cord. > > > > > > Matt Terreri, DC > > Clinical Question > > > > > >> My 53 yoa patient has several odd symptoms. Deep and raised redness > >> over the left side of her face and chin, burning in her mouth and > >> tongue, periodic numbness in her left hand and left leg. > >> > >> Original sx was numbness in both legs, now with adjustments this has > >> been reduced to approx. 25% original sx. and only in the left leg. > >> > >> The mouth sx. began approx. 10 days ago after a visit to the dentist > >> for a crown. He thought she was suffering from yeast infection so > >> placed her on 3-4 doses of yogurt per day. (by the way, it hasn't > >> helped) She has since been back to the dentist and had the crown > >> replaced and different glue used. > >> > >> Her md did a series of blood tests that appear to be normal. > >> This does not fit the normal pattern of Trigeminal Neuralgia, and is > >> not Bell's Palsy as her md dx. > >> > >> Anyone with any tidbits of info? > >> > >> Grice, DC > >> 821 Elm Street SW, Albany, OR 97321 > >> > >> > >> > >> > >> OregonDCs rules: > >> 1. Keep correspondence professional; the purpose of the listserve is to > > foster communication and collegiality. No personal attacks on listserve > > members will be tolerated. > >> 2. Always sign your e-mails with your first and last name. > >> 3. The listserve is not secure; your e-mail could end up anywhere. > > However, it is against the rules of the listserve to copy, print, forward, > > or otherwise distribute correspondence written by another member without his > > or her consent, unless all personal identifiers have been removed. > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2004 Report Share Posted February 7, 2004 Matt, I stand corrected. I would get a copy of the blood work myself to see if something was off but fell within the realm of normal as decided by the lab. I find we read lab work better than the average internist. How sad. You're right, of course. An MRI would rule out a glaring neuro problem. I see so many brain scans ordered for severe headach with no neuro complications. All paid for happily by insurance carriers. But suggest a half dozen chiro. treatments for a clinical trial without ABSOLUTE CERTAINTY that we have a chiropractic problem THOROUGHLY DIAGNOSED with a CAREFULLY WORDED TREATMENT PLAN and it doesn't hurt to have PICTURES WITH CIRCLES AND ARROWS AND A PARAGRAPH ON THE BACK EXPLAINING WHAT EACH ONE IS, and you'd think we were trying to rob a Brink's truck. Dough! E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic Please note " New address " 315 Second Street Lake Oswego, OR 97034 503-635-6246 drscott@... or info@... > From: " mattydread " <mattydread@...> > Date: Fri, 6 Feb 2004 23:25:17 -0800 > " " < > > Subject: Re: Clinical Question > > Dr. , > > Go back and re-read the posts. I said " Depending how > long these symptoms have been going on " . Also Dr. wrote " her md did a > series of blood tests that appear to be normal " . I also said " I might be > inclined " . Key word being " might " . I'm not jumping the gun, just considering > some possiblities. Dr. has not told us how long this numbness has > been going on - only that " the mouth sx. began approx. 10 days ago after a > visit to the dentist for a crown " . What if the numbness has been there for a > year, and now she recently has had the problems with her mouth/face? What if > the two are not even related? Also, if it would be something like MS blood > work will not show anything. If there was a temporal relationship with the > numbness, mouth, skin, and dental work then yes I would hold off on an MRI, > but would still consider it later down the line if nothing else helped. Did > she do anything different before or after that visit? Like try a new sport > or something? I think we need more information. > > > > Matt Terreri, DC > > > From: " Dr. " <drscott@...> > " mattydread " <mattydread@...>; " " > < > > Sent: Friday, February 06, 2004 5:55 PM > Subject: Re: Clinical Question > > >> Hold on there doctor $1200 MRI! >> How about some simple and cheap blood work? (Especially since that's what >> you will need to do AFTER the MRI comes back negative.) >> R/O viral or bacterial infection; remember neutrophils and monocytes? >> Also, some enzymes in a Chem Screen can point the way to other damage > being >> repaired; >> is sounds like post-dental reaction depending upon how she responds to >> anesthetic, and how much drilling went on with the crown prep. >> Did she have a root canal? >> do you think the neuro sx in the extremities are related to the face? >> pattern of occurrence, worsening, improvements; >> a cheap fix might be to load her up with supplements; >> Vit C with bioflavinoids to build collagen integrity; >> B complex for neuritis; >> a short course of high dose multivitamin/mineral because it can't hurt and >> might help; >> could a trigeminal branch be injured? nah; 10 days later. >> could her jaw need an adjustment? Tight muscles from having your mouth >> stretched to trout size could compress nerves causing trouble; >> now I'm reaching... >> keep us posted. >> >> E. Abrahamson, D.C. >> Chiropractic physician >> Lake Oswego Chiropractic Clinic >> Please note " New address " 315 Second Street >> Lake Oswego, OR 97034 >> 503-635-6246 >> >> drscott@... >> or >> info@... >> >> >> >>> From: " mattydread " <mattydread@...> >>> Date: Fri, 6 Feb 2004 18:02:36 -0800 >>> " " < > >>> Subject: Re: Clinical Question >>> >>> , >>> >>> Depending how long these symptoms have been going on, I >>> might be inclined to do an MRI of her brain and spinal cord. >>> >>> >>> Matt Terreri, DC >>> Clinical Question >>> >>> >>>> My 53 yoa patient has several odd symptoms. Deep and raised redness >>>> over the left side of her face and chin, burning in her mouth and >>>> tongue, periodic numbness in her left hand and left leg. >>>> >>>> Original sx was numbness in both legs, now with adjustments this has >>>> been reduced to approx. 25% original sx. and only in the left leg. >>>> >>>> The mouth sx. began approx. 10 days ago after a visit to the dentist >>>> for a crown. He thought she was suffering from yeast infection so >>>> placed her on 3-4 doses of yogurt per day. (by the way, it hasn't >>>> helped) She has since been back to the dentist and had the crown >>>> replaced and different glue used. >>>> >>>> Her md did a series of blood tests that appear to be normal. >>>> This does not fit the normal pattern of Trigeminal Neuralgia, and is >>>> not Bell's Palsy as her md dx. >>>> >>>> Anyone with any tidbits of info? >>>> >>>> Grice, DC >>>> 821 Elm Street SW, Albany, OR 97321 >>>> >>>> >>>> >>>> >>>> OregonDCs rules: >>>> 1. Keep correspondence professional; the purpose of the listserve is to >>> foster communication and collegiality. No personal attacks on listserve >>> members will be tolerated. >>>> 2. Always sign your e-mails with your first and last name. >>>> 3. The listserve is not secure; your e-mail could end up anywhere. >>> However, it is against the rules of the listserve to copy, print, > forward, >>> or otherwise distribute correspondence written by another member without > his >>> or her consent, unless all personal identifiers have been removed. >>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 10, 2004 Report Share Posted February 10, 2004 I think back to that infectious disease unit where I used to work and thought of one-sided face rashes of a deep color, sometimes raised, and shingles came to mind in the early faces. Will sometimes have a predilection for one side of the face..... just a thought. I read the other posts, and it seems like there is a wide differential dx that has to take place, like Dr. Bertrand said. Just wanted to say, "don't forget the zoster". Second choice would be an atypical reaction to the glue or anesthesia. Don White, RN, DC . Quote Link to comment Share on other sites More sharing options...
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