A “Stroke” of Luck

I have a friend who practices Chiropractic in the region who had a health scare almost a year back. Late 30s, fit (sub 12% body fat), never smokes or drinks he was doing intense intervals on the treadmill for 45 minutes.  After stepping off the treadmill a bit lightheaded and dizzy, but that only lasted for about 15 seconds, and he chalked it up to just pushing too hard on the treadmill. 

Walking to get some food, he had mild blurry vision that lasted for about 1 hour, at which time if resolved and he felt 100% normal.  2 days later while adjusting a patient he bent forward and felt his right arm go numb for a few seconds.  He finished with the patient and a few minutes later while resting he went to use his phone and noticed he didn’t have much feeling into his hand and it felt almost like it wasn’t there and he had no control over it.  Out of an abundance of caution he went to the hospital and told the doctor he suspected he might have had a mini stroke (TIA) and in a SE Asian country got that “Shut up Chiropractor” look.  He humored him and ordered an MRI of his brain which showed an acute infarct of his left parieto-occipital lobe.  This obviously worried the doctor and he ordered him to stay in the hospital for further tests.  

In his own words: 

“I took that order as a suggestion and told him I had patients the next morning but would be back after I was done.  We compromised and I did what I wanted and came after I finished work.  The next day, Saturday, he ordered an ultrasound of my heart which was normal, but he also ordered an ultrasound of my left carotid artery which showed abnormal flow.  At that point he ordered a CTA (CT-Angiogram), which showed I had a spontaneous dissection of the left internal carotid artery with a 90% narrowing.  No plaque buildup, nothing like that…. they suspect it just happened from the vigorous running…. At this point they said there were 2 options.  One was to put in a stent and the other was to take blood thinners and monitor for the next 6 months, avoiding all strenuous exercise.  I opted to fly to Bangkok for a second opinion.  The doctor there told me he was the one to do the surgery if needed, so he had all the monetary reasons in the world recommend it, but he advised against it and said to take the blood thinners and monitor and take a follow-up CTA in 6 months.”

Mind you this Bangkok doctor also asked if he had recently gotten his “Neck cracked.”

“I got a bit impatient and after 3 months I took a new CTA and the artery was only 10% occluded and the doctor was amazed.  He asked what I did to treat it, and I told him “Chiropractic” 😉

In the almost year since this event my friend has been symptom free.

If that kind of cerebrovascular event can affect a healthy person what else is lurking out there?

I ask these questions because of the scrutiny Chiropractors are subjected to when our patients have these events, even when the evidence suggests we are not a causative factor.

My friend, oddly enough, hadn’t had access to a Chiropractic adjustment for some time, as he was practicing solo, but if he had its almost certain that it would be labeled a contributing factor.

As I have said before, in cases where we initiate treatment we are usually blamed for the event.

Then there is this case of Medical Doctors working diligently with an equally tough case. 

A Woman in her thirties presents to a local neurological clinic with pain localized in the left occipital and temporal regions of her head, rotational vertigo and vomiting from the previous day.

She undergoes an unremarkable CT scan of the head and radiograph of the neck.

She is initially diagnosed with suspected Herpes Zoster.

She was then prescribed Valaciclovir, pregabalin, and acetaminophen, none of which improved her symptoms.

Carbamazephepine and aspirin were added to the prescription which proved ineffective as well.

She was then hospitalized in an anesthesiology pain clinic with a 100 mm on the Visual analog scale.  She had a throbbing pulsating pain that demanded bedridden during the day and sleeplessness during the nights.  Blood pressure was 160/100 mmHg.

Her symptoms were considered consistent with Headache without Aura and she was prescribed 2.5 mg of zolmitriptan, which was therapeutically ineffective, did partially relieve her symptoms.

Treatment after Hospitalization involved regular oral lomerizine with zolomitriptan and loxoprofen as needed.  

From day 2 after admission, patient showed a 50% decrease in VAS score that would intermittently shoot up to the maximum again.

Persistent high blood pressure necessitated a cardiologist referral on day 3 where anti hypertension therapy with calcium antagonists were commended.

5 days later on day 8 (DAY EIGHT!) because of the ineffectiveness of the zolmitriptan an MRI and  MRA (Magnetic Resonance Angiography) was performed showing right and left VAD (Vascular arterial dissection) with occlusion on the left and an aneurysm.

She was then referred to the neurosurgeon department and was treated with fluid replacement and oral anti platelet drugs.  This appeared to work for 10 days until the 18th day when not only her headaches increased but she presented with vertigo, nausea, vomiting, motor ataxia, hiccups, hoarseness, dysphagia, and thermal hypoalgesia on the right upper and lower extremities.

A follow up MRI showed progression of the left VAD, occlusion of the left posterior inferior cerebellar artery and previously unseen left cerebellum and lateral medulla oblongata infarction from the imaging 10 days prior.

6 Months later, after conservative treatment of edavone, argatroban and glycerine she was able to rejoin society.

Lets recap:

She shows up with vague symptoms, is misdiagnosed several times, is correctly diagnosed after a week and a week and a half after correct diagnosis she gets worse as the treatment is failing.  6 months later she is able to reintegrate into society.

Another medical miracle.  Katie May’s Chiropractor would love that level of scrutiny.

I highlight this story not because I want to second guess medical doctors but to show how much leeway they have in a confusing situation.  They can order a battery of tests and prescribe a course of pharmaceuticals in an effort to get to the bottom of a complicated situation.

GOD FORBID… this woman walked into a Chiropractors office.  The Chiropractor would have taken a history, and perhaps an X-Ray and have taken a shot at adjusting the neck of a nominally healthy 30 something year old who the case study believes tore her artery while turning her neck while driving.

What would be blamed if she went to the Chiropractors office, That neck crackery witchcraft or the turn of her head as she backed out of her driveway in the morning?

It took 8 days for the Medical doctors to adequately diagnose the VAD and over two weeks to start to effectively treat the correct diagnosis. 

Imagine a common scenario if this woman, impatient with her doctors after several days, decided to “try a different approach” and walked into a Chiropractors office with the following history:

Female, 30’s, localized pain in the left occipital and temporal regions of her head, rotational vertigo and vomiting of several days duration. Negative CT scan of the head and radiograph of the neck.

Diagnosed with Herpes Zoster and Headache without Aura.

Prescribed Valaciclovir, Pregabalin, Acetaminophen, Carbamazephepine, Aspirin 

Zolmitriptan, oral lomerizine and loxoprofen “as needed”.  

Clear CT and X-ray, desperate patient, confused MD’s on what appears to be a fishing expedition… Would you adjust.

I can’t say I wouldn’t.  Who wouldn’t want to be a hero?

It doesn’t matter how many studies we have saying we cannot tear an artery with an adjustment, it doesn’t matter how many everyday routine activities carry more biomechanical stresses than a chiropractic spinal adjustment and it doesn’t matter that an already torn artery cannot be made worse by our actions the sad fact is that there is a bias against us in what we do.  

We only get one shot at our patients, we have to make the correct referral and hope they make the correct diagnosis. 

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