Re: clinical question- case

[Guest guest]

Hi again,

Got a bit more information, but still want your opinions. I spoke with a friend of mine up in Seattle, MD of 30 years in speciality of chronic pain, accupuncturist, chelation therapy etc, wholistic MD. He says that microcurrent can cause LOC or altered states in patients with known seizure disorders. Unusual for it to cause it when you use the current in areas remote of the cerv spine and brain, but possible. SO.....just a word of caution to others using micro stim. Evidently this patient of mine doesn't even know if she has a disorder. But I won't be using this procedure on her again. The other doc in my office sees her today. I gave him a heads up and will post further findings for your inquiring minds.....

Minga Guerrero DC

In a message dated 2/13/2004 7:01:03 PM Pacific Standard Time, AboWoman@... writes:

Dear listservmates,Had an unusual occurance in the office. Last patient on Friday of course. 36 yr old Hispanic female, 115 lbs, 5'1" in MVA. Head didn't strike anything, but side impact approx 45 mph, did cause jaw pain, neck/upper thoracic pain, and lower back pain with left sided sciatica. All s/s were worse on the left (side of impact). Exam reveals decreased and painful spinal ROM, pain chewing and slight headache compression and stretch test = pain. sprain/strain facet problems with sciatica. Four visits using activator and microcurrent stim have mopped up the pain in the neck, upper thoracic and jaw pain by 80%. Lower back remains markedly tender with sciatica still down left leg to foot. Xrays taken:Mild th scoliosis, moderate foraminal stenosis C5-6 bilat, Moderate DJD and assoc uncovert arthrosis C5-6, Left short leg 1CM, Moderate facet imbrication L5-S1, NO FRACTURES OR OTHER PATHOLOGY.MEDS: 2 advil in AM 2 PM for pain assoc with auto accident. No others. Problem begins with 5th visit: Did essentially same type of adjusting, activator, adjusted the lower back. Omitted any cervical adjusting. Range of motion in C-spine =WNL without pain.Did about 15 minutes of microstim (attended) to lumbar spine, left glut and left TFL. Retested tender lumbar areas. Noted pain remaining in left lumbar area and decided to treat a bit longer. Patient says "her feet feel asleep." I decide it's prob a variation of the sciatic nerve irritation and continue. SHe is talking and under no apparent distress except to report that her feet continue to feel asleep. I also think this may be due to the accupuncure points I'm stimulating on bladder meridian of the lower back, as other patients have reported similar things while procedure is done. A moment later she stops responding to verbal communication. SHe doesn't respond to gentle shaking of the upper arm. Her arms are limp. Her older son is in the room with her at the time. He's a calm 17 yr old. ( PS, this is a normal hispanic thing for the men of the family to accompany the females at appts after dark. They're big into protection and the father had just died a couple months prior, so the son is the man of the house now.) Anyway, she is completley unconscious. I check breathing. fine. Pulse, fine, auscultate heart, fine. I tell the son i should call 911 and he says NO. Let me call my grandma, she's used to this. In a calm voice. About 5-7 min later she regains consciousness and is fine about 10 min later. She says that she has very low blood pressure and the doctors in Mexico told her this was normal. SHe has passed out before but not for about 8 years. I ask her about eating. her last meal was over 10 hours ago. I took her blood pressure soon after she was conscious, 78/58. 5 min later= 90/60. I'm thinking could be lots of things...Low blood sugar? a reaction to the microstim? Epilepsy?They refused going to a PCP as they have no insurance. Suggestions?Minga Guerrero DCOregonDCs 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.

[Guest guest]

Hey Minga,

Your Seattle colleagues points are well taken I believe. Becker (The

Body Electric) described use of polarized microcurrent frequencies to induce

sleep states in patients undergoing surgery. However, I wonder more about

blood sugar regulation in your patient. As an aside...

I had 4 FMS patients last year who, despite extensive behavioral,

prescription, herbal, nutritional, hormonal interventions, still could not

sleep more than 2-3 hours at a stretch. I did some research, and after

discussing the procedure with them, tried a CES unit (NutriPax from Biotics

Research). I was skeptical, and lets face it, transcranial current

immediately brings nurse Ratchet and those scenes from One Flew Over the

Cuckoo's Nest to mind. However, all 4 of these unresponsive insomnia cases

were sleeping >6 hrs. at a stretch within 1 wk. The therapy is FDA approved

for insomnia, anxiety and depression intervention, and you can read the 106

human studies and 20 animal studies referenced in Kirsch, L., The

Science Behind Cranial Electrical Stimulation, Medical Scope Publishing,

1999.

W. Snell, D.C.

127-G NE 102nd Avenue

Portland, OR 97220

Ph. 503-253-0827

Fax 503-253-4760

>From: AboWoman@... > >Subject: Re:

> clinical question- case >Date: Mon, 16 Feb 2004 12:44:59 EST >

> >Hi again, >Got a bit more information, but still want your opinions. I

>spoke with a >friend of mine up in Seattle, MD of 30 years in speciality of

>chronic pain, >accupuncturist, chelation therapy etc, wholistic MD. He says

>that microcurrent can >cause LOC or altered states in patients with known

>seizure disorders. Unusual >for it to cause it when you use the current in

>areas remote of the cerv spine >and brain, but possible. SO.....just a word

>of caution to others using micro >stim. Evidently this patient of mine

>doesn't even know if she has a disorder. >But I won't be using this

>procedure on her again. The other doc in my office >sees her today. I gave

>him a heads up and will post further findings for your >inquiring

>minds..... > >Minga Guerrero DC > >In a message dated 2/13/2004 7:01:03 PM

>Pacific Standard Time, >AboWoman@... writes: >Dear listservmates, >Had

>an unusual occurance in the office. Last patient on Friday of course. 36

> >yr old Hispanic female, 115 lbs, 5'1 " in MVA. Head didn't strike

>anything, but >side impact approx 45 mph, did cause jaw pain, neck/upper

>thoracic pain, and >lower back pain with left sided sciatica. All s/s were

>worse on the left (side >of impact). Exam reveals decreased and painful

>spinal ROM, pain chewing and >slight headache compression and stretch test

>= pain. sprain/strain facet >problems with sciatica. > >Four visits using

>activator and microcurrent stim have mopped up the pain in >the neck, upper

>thoracic and jaw pain by 80%. Lower back remains markedly >tender with

>sciatica still down left leg to foot. > >Xrays taken: >Mild th scoliosis,

>moderate foraminal stenosis C5-6 bilat, Moderate DJD and >assoc uncovert

>arthrosis C5-6, Left short leg 1CM, Moderate facet imbrication >L5-S1, NO

>FRACTURES OR OTHER PATHOLOGY. >MEDS: 2 advil in AM 2 PM for pain assoc with

>auto accident. No others. > >Problem begins with 5th visit: >Did

>essentially same type of adjusting, activator, adjusted the lower back.

> >Omitted any cervical adjusting. Range of motion in C-spine =WNL without

>pain. >Did about 15 minutes of microstim (attended) to lumbar spine, left

>glut and >left TFL. Retested tender lumbar areas. Noted pain remaining in

>left lumbar >area and decided to treat a bit longer. Patient says " her feet

>feel asleep. " I >decide it's prob a variation of the sciatic nerve

>irritation and continue. SHe >is talking and under no apparent distress

>except to report that her feet >continue to feel asleep. I also think this

>may be due to the accupuncure points I'm >stimulating on bladder meridian

>of the lower back, as other patients have >reported similar things while

>procedure is done. A moment later she stops >responding to verbal

>communication. SHe doesn't respond to gentle shaking of the upper >arm. Her

>arms are limp. Her older son is in the room with her at the time. >He's a

>calm 17 yr old. ( PS, this is a normal hispanic thing for the men of the

> >family to accompany the females at appts after dark. They're big into

> >protection and the father had just died a couple months prior, so the son

>is the man >of the house now.) Anyway, she is completley unconscious. I

>check breathing. >fine. Pulse, fine, auscultate heart, fine. I tell the son

>i should call 911 and >he says NO. Let me call my grandma, she's used to

>this. In a calm voice. About >5-7 min later she regains consciousness and

>is fine about 10 min later. She >says that she has very low blood pressure

>and the doctors in Mexico told her >this was normal. SHe has passed out

>before but not for about 8 years. I ask her >about eating. her last meal

>was over 10 hours ago. I took her blood pressure >soon after she was

>conscious, 78/58. 5 min later= 90/60. > >I'm thinking could be lots of

>things...Low blood sugar? a reaction to the >microstim? Epilepsy?They

>refused going to a PCP as they have no insurance. >Suggestions? >Minga

>Guerrero DC > > > > > >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. > > > >

> >

[Guest guest]

It could be a seizure disorder. Have you checked her for signs of vestibular disorder following the crash (horizontal gaze nystagmus, tandem rombergs)? I have found some cases with absence and epileptiform seizures following crashes, and side impacts have a much higher propensity for head injury.

D Freeman Mailing address: 1165 Union Street NE, Suite 300Salem, Oregon 97301ph 503 586-0127 fax 503 763-3581cell 503 871-0715 drmfreeman@...

-----Original Message-----From: AboWoman@... [mailto:AboWoman@...]Sent: Monday, February 16, 2004 9:45 AM Subject: Re: clinical question- case

Hi again,

Got a bit more information, but still want your opinions. I spoke with a friend of mine up in Seattle, MD of 30 years in speciality of chronic pain, accupuncturist, chelation therapy etc, wholistic MD. He says that microcurrent can cause LOC or altered states in patients with known seizure disorders. Unusual for it to cause it when you use the current in areas remote of the cerv spine and brain, but possible. SO.....just a word of caution to others using micro stim. Evidently this patient of mine doesn't even know if she has a disorder. But I won't be using this procedure on her again. The other doc in my office sees her today. I gave him a heads up and will post further findings for your inquiring minds.....

Minga Guerrero DC

In a message dated 2/13/2004 7:01:03 PM Pacific Standard Time, AboWoman@... writes:

Dear listservmates,Had an unusual occurance in the office. Last patient on Friday of course. 36 yr old Hispanic female, 115 lbs, 5'1" in MVA. Head didn't strike anything, but side impact approx 45 mph, did cause jaw pain, neck/upper thoracic pain, and lower back pain with left sided sciatica. All s/s were worse on the left (side of impact). Exam reveals decreased and painful spinal ROM, pain chewing and slight headache compression and stretch test = pain. sprain/strain facet problems with sciatica. Four visits using activator and microcurrent stim have mopped up the pain in the neck, upper thoracic and jaw pain by 80%. Lower back remains markedly tender with sciatica still down left leg to foot. Xrays taken:Mild th scoliosis, moderate foraminal stenosis C5-6 bilat, Moderate DJD and assoc uncovert arthrosis C5-6, Left short leg 1CM, Moderate facet imbrication L5-S1, NO FRACTURES OR OTHER PATHOLOGY.MEDS: 2 advil in AM 2 PM for pain assoc with auto accident. No others. Problem begins with 5th visit: Did essentially same type of adjusting, activator, adjusted the lower back. Omitted any cervical adjusting. Range of motion in C-spine =WNL without pain.Did about 15 minutes of microstim (attended) to lumbar spine, left glut and left TFL. Retested tender lumbar areas. Noted pain remaining in left lumbar area and decided to treat a bit longer. Patient says "her feet feel asleep." I decide it's prob a variation of the sciatic nerve irritation and continue. SHe is talking and under no apparent distress except to report that her feet continue to feel asleep. I also think this may be due to the accupuncure points I'm stimulating on bladder meridian of the lower back, as other patients have reported similar things while procedure is done. A moment later she stops responding to verbal communication. SHe doesn't respond to gentle shaking of the upper arm. Her arms are limp. Her older son is in the room with her at the time. He's a calm 17 yr old. ( PS, this is a normal hispanic thing for the men of the family to accompany the females at appts after dark. They're big into protection and the father had just died a couple months prior, so the son is the man of the house now.) Anyway, she is completley unconscious. I check breathing. fine. Pulse, fine, auscultate heart, fine. I tell the son i should call 911 and he says NO. Let me call my grandma, she's used to this. In a calm voice. About 5-7 min later she regains consciousness and is fine about 10 min later. She says that she has very low blood pressure and the doctors in Mexico told her this was normal. SHe has passed out before but not for about 8 years. I ask her about eating. her last meal was over 10 hours ago. I took her blood pressure soon after she was conscious, 78/58. 5 min later= 90/60. I'm thinking could be lots of things...Low blood sugar? a reaction to the microstim? Epilepsy?They refused going to a PCP as they have no insurance. Suggestions?Minga Guerrero DCOregonDCs 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.

[Guest guest]

Listmates,My apologies to the group re: my recent post and the use of the unexplained acronym, CES. CES stands for Cranial Electrotherapy Stimulation. A link to a PubMed search is below. The unit I have had success with is sold thru Biotics Research and is called Nutripax. Find their website at the second link. Find more research in Kirsch DL, The Science Behind Cranial Electrotherapy Stimulation, Medical Scope Publishing, 1999.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Search & DB=PubMed

www.nutripax.com

Also, I recently saw an article in the Oregonian regarding an unexpected side effect of brain MRI studies of bi-polar patient. I believe the study they referenced is the one which follows.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=14702256 & dopt=Abstract

Happy reading!

>From: " D Beebe, D.C."

>" Snell"

>Subject: Re: clinical question- case >Date: Tue, 17 Feb 2004 08:06:56 -0800 > >What is a CES unit and do you have a contact # ? > >Thanks > >Danno > Re: > > > clinical question- case >Date: Mon, 16 Feb 2004 12:44:59 EST > > > > > >Hi again, >Got a bit more information, but still want your opinions. I > > >spoke with a >friend of mine up in Seattle, MD of 30 years in speciality >of > > >chronic pain, >accupuncturist, chelation therapy etc, wholistic MD. He >says > > >that microcurrent can >cause LOC or altered states in patients with known > > >seizure disorders. Unusual >for it to cause it when you use the current >in > > >areas remote of the cerv spine >and brain, but possible. SO.....just a >word > > >of caution to others using micro >stim. Evidently this patient of mine > > >doesn't even know if she has a disorder. >But I won't be using this > > >procedure on her again. The other doc in my office >sees her today. I >gave > > >him a heads up and will post further findings for your >inquiring > > >minds..... > >Minga Guerrero DC > >In a message dated 2/13/2004 7:01:03 >PM > > >Pacific Standard Time, >AboWoman@... writes: >Dear listservmates, > >Had > > >an unusual occurance in the office. Last patient on Friday of course. 36 > > > >yr old Hispanic female, 115 lbs, 5'1" in MVA. Head didn't strike > > >anything, but >side impact approx 45 mph, did cause jaw pain, neck/upper > > >thoracic pain, and >lower back pain with left sided sciatica. All s/s >were > > >worse on the left (side >of impact). Exam reveals decreased and painful > > >spinal ROM, pain chewing and >slight headache compression and stretch >test > > >= pain. sprain/strain facet >problems with sciatica. > >Four visits using > > >activator and microcurrent stim have mopped up the pain in >the neck, >upper > > >thoracic and jaw pain by 80%. Lower back remains markedly >tender with > > >sciatica still down left leg to foot. > >Xrays taken: >Mild th scoliosis, > > >moderate foraminal stenosis C5-6 bilat, Moderate DJD and >assoc uncovert > > >arthrosis C5-6, Left short leg 1CM, Moderate facet imbrication >L5-S1, NO > > >FRACTURES OR OTHER PATHOLOGY. >MEDS: 2 advil in AM 2 PM for pain assoc >with > > >auto accident. No others. > >Problem begins with 5th visit: >Did > > >essentially same type of adjusting, activator, adjusted the lower back. > > > >Omitted any cervical adjusting. Range of motion in C-spine =WNL without > > >pain. >Did about 15 minutes of microstim (attended) to lumbar spine, left > > >glut and >left TFL. Retested tender lumbar areas. Noted pain remaining in > > >left lumbar >area and decided to treat a bit longer. Patient says "her >feet > > >feel asleep." I >decide it's prob a variation of the sciatic nerve > > >irritation and continue. SHe >is talking and under no apparent distress > > >except to report that her feet >continue to feel asleep. I also think >this > > >may be due to the accupuncure points I'm >stimulating on bladder meridian > > >of the lower back, as other patients have >reported similar things while > > >procedure is done. A moment later she stops >responding to verbal > > >communication. SHe doesn't respond to gentle shaking of the upper >arm. >Her > > >arms are limp. Her older son is in the room with her at the time. >He's a > > >calm 17 yr old. ( PS, this is a normal hispanic thing for the men of the > > > >family to accompany the females at appts after dark. They're big into > > > >protection and the father had just died a couple months prior, so the >son > > >is the man >of the house now.) Anyway, she is completley unconscious. I > > >check breathing. >fine. Pulse, fine, auscultate heart, fine. I tell the >son > > >i should call 911 and >he says NO. Let me call my grandma, she's used to > > >this. In a calm voice. About >5-7 min later she regains consciousness and > > >is fine about 10 min later. She >says that she has very low blood >pressure > > >and the doctors in Mexico told her >this was normal. SHe has passed out > > >before but not for about 8 years. I ask her >about eating. her last meal > > >was over 10 hours ago. I took her blood pressure >soon after she was > > >conscious, 78/58. 5 min later= 90/60. > >I'm thinking could be lots of > > >things...Low blood sugar? a reaction to the >microstim? Epilepsy?They > > >refused going to a PCP as they have no insurance. >Suggestions? >Minga > > >Guerrero DC > > > > > >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. > > > > > > > >