Re: Interesting Case input please!

January 22, 2008

First off: Just how cold is it in Day, Charlie?

Those of us here in the tropics of Portland hope you are wearing your long-john-days!

Syrinogmyellia in the lumbar spine seems unlikely; not much spinal cord there.

Diabetic neuropathy and MS don’t come on suddenly.

There is a good argument for adjusting spinal subluxations while waiting for a more grave pathology. The reasoning being, another pathology will frequently not become apparent and you are further down the road with spinal care.

An MRI of the low back seems reasonable. Call big Jim’s firewood hauling and Mobile Equine MRI to getter done. These are the mysteries that these things were designed to investigate.

If I had to bet, I’d say, Spinal stenosis for the win.

Keep us posted.

( E. Abrahamson, D.C.)

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: " Dr. Charlie Caughlin DC " <caughlindrc@...>

Date: Tue, 22 Jan 2008 09:34:47 -0800 (PST)

< >

Subject: Interesting Case input please!

40 y/o female presented with a chief complaint of not beeing able to feel

her legs or " konw where my feet are " . s/s started in Oct while working as

a checker in a grocery store, s/s came on gradually but got to the point

where she needs help to walk because she can't feel her feet. Has been to

neurologist..mri of head and t spine all neg. for path, blood work all

with in normal limits, spinal tap neg. Just found out this am that there

was no mri of lumbar spine.nerve conduction of lower extremeties wnl, no

weakness in lower extremity and dtrs wnl, positive romberg. In my intake

she did reveal that she had been eating alot of shrimp prior to the onset

of s/s. Psychosomatic?? (she reports no life changes or stressors). Any

one heard of syrinogmyellia in the lumbar spine??? Your thoughts please!!

DR CHARLIE CAUGHLIN DC. CAC

155 NW 1ST AVE

JOHN DAY, OR 97845

OFF-541-575-1063

FAX-541-575-5554

HM-541-575-1103

January 22, 2008

It was 8 below at my house when I fed my horses at 6:00 this am. Thanks

for the input oh and btw Jim went south for the winter and took his mri

with him!!!

> First off: Just how cold is it in Day, Charlie?

> Those of us here in the tropics of Portland hope you are wearing your

> long-john-days!

>

> Syrinogmyellia in the lumbar spine seems unlikely; not much spinal cord

> there.

> Diabetic neuropathy and MS don¹t come on suddenly.

>

> There is a good argument for adjusting spinal subluxations while waiting

> for

> a more grave pathology. The reasoning being, another pathology will

> frequently not become apparent and you are further down the road with

> spinal

> care.

>

> An MRI of the low back seems reasonable. Call big Jim¹s firewood hauling

> and

> Mobile Equine MRI to getter done. These are the mysteries that these

> things

> were designed to investigate.

>

> If I had to bet, I¹d say, Spinal stenosis for the win.

> Keep us posted.

>

> ( E. Abrahamson, D.C.)

> Chiropractic physician

> Lake Oswego Chiropractic Clinic

> 315 Second Street

> Lake Oswego, OR 97034

> 503-635-6246

> Website: http://www.lakeoswegochiro.com

>

> From: " Dr. Charlie Caughlin DC " <caughlindrc@...>

> Date: Tue, 22 Jan 2008 09:34:47 -0800 (PST)

> < >

> Subject: Interesting Case input please!

>

> 40 y/o female presented with a chief complaint of not beeing able to feel

> her legs or " konw where my feet are " . s/s started in Oct while working as

> a checker in a grocery store, s/s came on gradually but got to the point

> where she needs help to walk because she can't feel her feet. Has been to

> neurologist..mri of head and t spine all neg. for path, blood work all

> with in normal limits, spinal tap neg. Just found out this am that there

> was no mri of lumbar spine.nerve conduction of lower extremeties wnl, no

> weakness in lower extremity and dtrs wnl, positive romberg. In my intake

> she did reveal that she had been eating alot of shrimp prior to the onset

> of s/s. Psychosomatic?? (she reports no life changes or stressors). Any

> one heard of syrinogmyellia in the lumbar spine??? Your thoughts please!!

>

> DR CHARLIE CAUGHLIN DC. CAC

> 155 NW 1ST AVE

> JOHN DAY, OR 97845

> OFF-541-575-1063

> FAX-541-575-5554

> HM-541-575-1103

>

DR CHARLIE CAUGHLIN DC. CAC

155 NW 1ST AVE

JOHN DAY, OR 97845

OFF-541-575-1063

FAX-541-575-5554

HM-541-575-1103

January 22, 2008

Hi Doc,This is interesting; but some of the most interesting cases at outset turn out to b just unusual ways pts have of describing s/s. "Can't feel my feet," might be another way of saying, "my feet are numb". Have you r/o myofascial origins in legs from so much standing? The simple way to rule this out would be to suggest 3-4 nights of soaking in epsom salt bath for 15 - 20 minutes. The magnesium salts will have a relaxing effect on tonic musculature which may reduce s/s in few days. If so, then those legs need to be worked up to reduce all tonicities. Has she been able to continue with her work? Is she 'trapped' by needing income, but not wanting to stand and check any more, requiring some creative escape? When the available info doesn't describe the condition, then more info is needed. Best of luck. Sears, DCNW PDX On Jan 22, 2008, at 9:34 AM, Dr. Charlie Caughlin DC wrote:40 y/o female presented with a chief complaint of not beeing able to feelher legs or "konw where my feet are". s/s started in Oct while working asa checker in a grocery store, s/s came on gradually but got to the pointwhere she needs help to walk because she can't feel her feet. Has been toneurologist..mri of head and t spine all neg. for path, blood work allwith in normal limits, spinal tap neg. Just found out this am that therewas no mri of lumbar spine.nerve conduction of lower extremeties wnl, noweakness in lower extremity and dtrs wnl, positive romberg. In my intakeshe did reveal that she had been eating alot of shrimp prior to the onsetof s/s. Psychosomatic?? (she reports no life changes or stressors). Anyone heard of syrinogmyellia in the lumbar spine??? Your thoughts please!!DR CHARLIE CAUGHLIN DC. CAC155 NW 1ST AVEJOHN DAY, OR 97845OFF-541-575-1063FAX-541-575-5554HM-541-575-1103

January 22, 2008

Chas,

When you said all her blood work was within normal limits.............I hate to ask....but was an iron or ferritin done. I've had people with weird paresthesia in the lower extremities be deficiency. Just a thought. Her shrimp eating (was it a red herring or shrimp....hmmmm?) got me thinking about mercury toxicity. When I looked it up, it said "various neurological defects". I guess my next question would be...how big was that shrimp?

Dr. SEars mentioned the psychoemotional end of things, and I've seen people have conversion reactions and not be able to stand or walk....all the while completely oblivious to the nature of their problem (La Belle Indifference). Just a couple of thoughts.

Don WHite, RN, DC

Don dhdhdhd_._,___ Start the year off right. Easy ways to stay in shape in the new year.

January 22, 2008

She states that her whole legs feel numb from groin down, no she has not

worked and the muscles of the lower extremities are not tonic. She had to

have help to walk in the office to help her maintain balance ie posterior

column dz. I have seen this before (3x's actually) but all ended up being

tumors in mid thoracic, I have also had 2 Gullain Barre' but that was

confirmed with spinal taps and she has no weakness

> Hi Doc,

>

> This is interesting; but some of the most interesting cases at outset

> turn out to b just unusual ways pts have of describing s/s. " Can't

> feel my feet, " might be another way of saying, " my feet are numb " .

> Have you r/o myofascial origins in legs from so much standing? The

> simple way to rule this out would be to suggest 3-4 nights of soaking

> in epsom salt bath for 15 - 20 minutes. The magnesium salts will

> have a relaxing effect on tonic musculature which may reduce s/s in

> few days. If so, then those legs need to be worked up to reduce all

> tonicities.

>

> Has she been able to continue with her work? Is she 'trapped' by

> needing income, but not wanting to stand and check any more,

> requiring some creative escape?

>

> When the available info doesn't describe the condition, then more

> info is needed. Best of luck.

>

> Sears, DC

> NW PDX

>

> On Jan 22, 2008, at 9:34 AM, Dr. Charlie Caughlin DC wrote:

>

>> 40 y/o female presented with a chief complaint of not beeing able

>> to feel

>> her legs or " konw where my feet are " . s/s started in Oct while

>> working as

>> a checker in a grocery store, s/s came on gradually but got to the

>> point

>> where she needs help to walk because she can't feel her feet. Has

>> been to

>> neurologist..mri of head and t spine all neg. for path, blood work all

>> with in normal limits, spinal tap neg. Just found out this am that

>> there

>> was no mri of lumbar spine.nerve conduction of lower extremeties

>> wnl, no

>> weakness in lower extremity and dtrs wnl, positive romberg. In my

>> intake

>> she did reveal that she had been eating alot of shrimp prior to the

>> onset

>> of s/s. Psychosomatic?? (she reports no life changes or stressors).

>> Any

>> one heard of syrinogmyellia in the lumbar spine??? Your thoughts

>> please!!

>>

>> DR CHARLIE CAUGHLIN DC. CAC

>> 155 NW 1ST AVE

>> JOHN DAY, OR 97845

>> OFF-541-575-1063

>> FAX-541-575-5554

>> HM-541-575-1103

>>

>

DR CHARLIE CAUGHLIN DC. CAC

155 NW 1ST AVE

JOHN DAY, OR 97845

OFF-541-575-1063

FAX-541-575-5554

HM-541-575-1103

January 22, 2008

All,

yes, have a case of a 43 yr old male with syrinx in thoracic spine. It's worth checking. It slowly (over 8 yrs extended to his C-spine. He was in surgery over the summer.

Minga Guerrero DC

Interesting Case input please!

40 y/o female presented with a chief complaint of not beeing able to feel

her legs or "konw where my feet are". s/s started in Oct while working as