Putting Out The Pain Fire

I see many patients that come to me every day with pain and lots of it. Often they have pain in several similar global areas. These seem to occur in groups like neck, upper back and shoulder pain some with arm pain some without; or low back, sacrum and hip pain as a group some with leg and some without leg involvement just to name a few. I have talked in the past to Drs. Spurlock, Matz and Hadley of the UAB Dept of Neurosurgery, as well as our doctors about this phenomena. They too have seen this in their practices. Over the years I have concluded that Pain is often not of a single source genesis or origin. Meaning that pain often comes from more than one cause. Further pain seems to begot pain. In that once the body is in pain the second or third pain seems to combine with the other pains to make the global area painful.

We the patients, want our pain to be from a single origin or cause as we feel that in someway it might be easier to stop or turn off the pain. However, I now believe in the multi genesis pain origin theory. This theory says that pain is often cumulative in the body. I often compare this to lighting a book of matches. If one were to light one match, one would have a small fire. Light the whole book and you get a much bigger fire composed of many smaller fires.

I find the same is true for the body. Let us take the low back pain for example. The origin of low back pain can often be traced to several pain generators. Say for example, a patient presents with low back pain radiating into the hip. How many times have we found that the patient did indeed have a disc problem, a same side facet problem, sacroiliacs, and bursitis of the hip or similar findings. This perhaps, is part of the reason for so many failed low back surgeries. Yes the surgeon dutifully decompresses the disc but does nothing to treat the co-concomitant conditions(other problems).

I often tell my doctors that if you can't find the problems you can't fix the problems. This can only be done through examination, treatment, re-examination and continued treatment. I often find it necessary to bring in other doctors or specialist in their respective areas to confirm diagnosis or treat. I find by accurately diagnosing the multi genesis pain and its several pain generators we can often separate and treat the overall pain putting out several of the pain fires and then determining the extent of the core problem. Kind of like turn off the background noise and see what is left.

Patients like this kind of treatment as they feel the progress. This progress gives them hope that their pain may be treatable. Surprisingly it is. Often the average doctor does not take the time or have the inclination to tease out the many pain generators. It is far easier to just say you have a bulging or herniated disc and treat only that problem. We encourage our doctors to look globally at our patients, diagnosing multi genesis pain generators and then treat them all.
Dr Greg


Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Cervical Herniated Disc

I had a 36 year old male present with a Cervical herniated disc today. He presented with neck pain rated an 8 on the 0-10 scale and radiating pain into his left arm and hand of one month duration. He felt that his wrist was beginning to get weak. He had been to his primary doctor who sent him for an MRI of the cervical spine. His medical doctor had given him a medrol dose pack and pain meds. His MRI demonstrated two herniated disc, one at C5-6 and one at C6-7. His primary then referred him to a local orthopedist who wanted to do surgery immediately. The surgeon wanted to do a two level fusion. The patient wanted another opinion.

I did a complete history and physical. After examination I concluded that he had NO neurological deficits. He had numerous positive orthopedic and neurological test but non indicated a true neurological deficit. I needed further NCV testing to differentially diagnose between radiculopathy (radiating pain from the neck) vs Carpal Tunnel Syndrome (an entrapment of the Median nerve at the wrist) both of which could produce a pain in the hand. I ordered an NCV the next day. Dr Gary Cohen our Physical Medicine doctor at Millar MultiMedical preformed the test. The test concluded that yes there was a mild radiculopathy (radiating pain) coming from the neck but also there was carpal tunnel syndrome.

I started the patient on daily CMT, Chiropractic Manipulative Therapy with the Activator and DTS - Decompression Traction of the cervical spine at 22lbs at 15 degrees for 20 min a day. I also included in his care e-stim and ultrasound treatment. I told him he would get worse before he got better and indeed he did. But after only a few pulls his pain started going down. We also started treating the carpal tunnel syndrome with e-stim, ultra sound and manipulation. He is now nearly pain free.

I think this case demonstrates always get a second and even a third opinion if surgery is the option and it's not an emergency.
Dr Greg


Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Headache that turns into a Migraine

Problem: Today I had a 39 year old female present with what she described as a sinus headache that turned into a migraine about 1-2 times a month. This problem began several years ago when they moved to Alabama from St. Louis. She is having the sinus headache almost daily. She finds that every spring and fall she has terrible sinus problems. She further stated that the headaches became a full blown sick migraines several times a month. She took allergy shots years ago and knows she is allergic to grass trees and flowers. But she was frustrated as the shots did not help much and besides you cant help the trees and grass there everywhere. She had talked to her primary care physician and he even prescribed Imitrex which made her sicker with nausea, muscle weakness in the neck and back as well as tongue and mouth pain and then he prescribed Topamax which made her legs and feet tingle and feel numb. The Topamax also made her fatigued and she felt like she could not function due to the confusion and fatigue. She had been off all headache medication for 6 months. The day she was seen she rated her headache as a 8 on the 0-10 scale with the night before being a 10/10. Exam: The normal orthopedic, neurological, palpation, spinal exam, range of motion, muscle test, and posture exam was preformed. X-rays of the sinus and cervical and thoracic spine were preformed in our office and the films were sent to Dr Mike Jokich MD radiologist for review. Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Stenosis and Degenerative Facet Disease

Problem: Today I had a 62 year old man present with severe low back and leg pain. On taking his history, he stated that his low back hurt worse first thing in the morning and again late at night. He also stated that his pain was increased with slightly bending over say the sink to wash dishes or shaving. He also stated that his low back and leg pain was decreased by sitting down. On questioning, he stated that when he shops he needs to lean over a shopping cart. And while shopping his pain can be relieved if he sits down for a few minutes. I ask him if his pain immediately goes away while sitting or does it take a few minutes to historically differentially separate vascular claudication from stenosis. He has a past history of MRI study showing 2 bulging disc and has had 2 lumbar epidural injections with little success. You know God gives you the right to have more than one thing going on at a time an I think this patient has taken him up on that idea. After taking his history, I have a theory that he had two primary problems 1) lumbar stenosis and 2) degenerative facet syndrome. I feel that his bulging disc may in fact be a red herring and not causing his problems. I did a complete and thorough examination including posture exam, orthopedic test, neurological test, palpatory exam, spinal exam, range of motion and digital muscle weakness exam. Next I completed a surface NCV and EMG of his spine and lower extremities. I ordered X-rays of his lumbar with obliques at the hospital and compared them to his recent MRI films. Discussion: On imaging he in fact does have both soft tissue and bony stenosis. The lumbar canal was narrowed to 9mm at L4 and L5. Since he did not have any pain with a straight leg raiser or well leg raiser and was able to tandom walk heel/toe with no other neurological deficits, I concluded that his bulging disc were red herrings. Spinal stenosis, a narrowing of the spinal canal, which places pressure on the spinal cord or nerve roots. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected. Patients with lumbar spinal stenosis may feel pain, weakness, or numbness in the legs, calves or buttocks. In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down. Cervical spinal stenosis may cause similar symptoms in the shoulders and arms. In some patients the pain starts in the legs and moves upward to the buttocks; in other patients the pain begins higher in the body and moves downward. Treatment: I started him on phisotherapy including Interferrential current (IFC) for 15 minutes along with hot pads. I also started him on ultrasound over the lumbar paraspinal muscles and facets. I started him on DTS Decompression Traction; Cox Flexion/Distraction; and chiropractic manipulative therapy. If he does not improve in two weeks then I will send him for lumbar facet injections. I feel he will ultimately need the facet injections. However if he needs facet injections I want them to be done under floro guidance at the hospital or surgery center. I am also talking to him regarding his overall health and his future health goals and life expectancy. If he develops neurological deficits then I will immediately refer him back to the neurosurgeon for surgical decompression.
Dr Greg Millar

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Interesting Case

Problem: This week I had a 43 year old lady present with chronic fatigue, chronic headaches and pain over all four quadrants of her body. She had yeast overgrowth but did not know it. She had been diagnosed with Fibromyalgia, Irritable Bowel Syndrome, Interstitial Cystitis, Endometrosis, Allergies, Type II Diabetes, Rheumatoid Arthritis, Sinus Problems and Thyroid disorder. Examination revealed tight and tender points across the body with moderate spasms. Numerous orthopedic tests were positive. She had both sensory and motor loss to the upper and lower extremities. She has a past surgical hx of gallbladder and hysterectomy. She has been in several past major auto accidents. She has had past severe hormone problems with past long and painful menstrual periods, severe mood swings and moderate PMS. She has current hormone problems in that she has hot flashes still and every night she goes to bed cold and wakes up about 3-4am sweating and very hot. She has been to numerous physicians. Her primary care physician tells her her problem is in her head and offers nothing to help. In taking her history, I also discovered that her body temperature is always very low in fact her body temp runs around 97.5 and I suspect Wilson's Temperature syndrome as well. I understand in the endocrinology community especially in the Eastern US that Wilson Temperature Syndrome is an unthinkable and unfounded diagnosis. But I think she has it anyway. By the way, this lady ate NO fish EVER and did not drink water. Instead she drank Mountain Due and Coffee all day long. Test: Her Sed Rate was 28/20. Her EBV IgM, IgG and nuclear antibody were all positive and very high. X-Rays demonstrated a mild to moderate scolosis with a loss of cervical curve and degenerative disc disease, spondylosis and moderate loss of disc space through out the spine. Her Complete Blood Count with Differential demonstrated a mildly elevated white count with elevated eosinophils and basophils both possibly elevated to allergic reactions and possible parasites in the case of eosinophils. Discussion: I have seen many patients in the past with this same sequella of symptoms and problems. The first things we need to do is get them sleeping, get them off Mountain Due and Sugar and ON Water and Fish oil. I have consulted infectious disease just to be on the safe side. I think she may have food allergies as well as a permeable/leaky gut and disbiosis. I think she may have bulging disc and other musculoskeletal problems as well. I also took her off ALL Sugar. NO foods that contain any sugar and started her on probiotics. I want her to start stretching daily for the FMS. This is one of those onion cases. These people have many layers of problems and we'll take them one at a time. I will update you on her progress. PS... She will get worse before she gets better. But I think with God's help we can walk her out of the woods. Dr Greg Millar



Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Leg Pain & Groin Pain with NO Back Pain

Problem: Today I had a man present with groin pain and leg pain to the foot worse on sitting and lying down and better with standing and walking. He has had similar groin pain in the past over the years but he has had no similar leg pain. He thinks he hurt himself lifting something heavy a week ago. Today, he had no back pain to speak of. In fact on examination, the low back had very little tenderness or spasms. He had a little edema over the sacrum. His groin and leg pain however he rated at a 9. During the exam his pain was so intense he could hardly carry on a conversation. My exam revealed several things. First, I could make the pain worse by having him sit on the table and raise a leg to 90 degrees. Secondly, with him lying on the table, when I lifted his uninvolved leg up to 35 degrees, pain shot down his leg and into the groin. Third when I tested his lower extremity sensory nerves (dermatomes) he had moderate hypersensitivity (too much) in one area of the involved leg followed by moderate hyposensitivity (too little) of the along the outside of the foot (S1) dermatome. Forth, his muscle strengths were somewhat diminished with some loss of strength at the involved leg quad and hamstring muscles both rated a 4/5. He had a negative heel walk and toe walk and denied any change to bowel. Finally he had a negative braggard's ruling out simple sciatica. Treatment: He had a defibrillator so e-stimulation was out. So I went with moist heat followed by laser to the sacrum and lateral/posterior leg along the nerve route and ultrasound to the upper lumbar para spinal muscles at T12 -L3 on the side of involvement. I did some manual therapy on his low back and sent him for X-rays at the local hospital as I want a radiologist to read these films. I think he has two things going on. First I think he has stenosis (narrowing of the central spinal canal) and secondly I think he has superimposed a bulging disc at L5. He also may have one at L4. I think he has neuroforaminal encroachment (disc pressing on the nerve root) causing inflammation. I will order an MRI after I get the x-rays back. I talked to him about anti inflammatory meds but he was already on Mobic. Discussion: Diagnosis is the key. If a doctor does not know what is causing the problem he can't fix it. God gives us the right to have more than one thing going on at a time. Most people have multiple pain generators. I talk everyday to patients that tell me that the doctor did not touch them in the examination. That means the doctor is guessing and that's why we have so many failures in low back pain treatment. Greg Millar DC CCEP




Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Simple Neck Pain

Problem: Today, I had a patient with simple neck pain. I know from his perspective, no neck pain worth going to the doctor is just simple. However, after examination and x-rays, he had neck spasms and pain with no radiation and no x-ray underlying pathology. He had no prior history of neck pain and had no trauma. He just woke up today with pain worse on turning his head to the left. We in Chiropractic call this condition "torticollis" or neck spasms. Patients often call this a "crick". In this case, his condition was classic. He slept last night with the window open and the cold air blowing in the room. This caused his neck muscles to spasm.

Have you ever woken up in the morning and for some unknown reason have a painful, stiff neck that allows you to barely be able to move your head? If you answered yes, then you are certainly not alone. Neck pain or torticollis neck discomfort is a very common reason for people to seek Chiropractic care. Most neck pain is caused by muscle strain or tension, and although some individuals experience this chronically (can be worse), neck pain is usually not serious. The first step is to identify what activities may be causing this neck pain, such as poor posture, work, sleeping in an uncomfortable position, or specific life activities such as sports or exercise.

While most cases of neck pain do not have serious medical implications and can be often corrected with Chiropractic manipulation, some neck pain could be the sign of an underlying condition or problem that requires prompt attention. Often this type of problem requires an MRI for further imaging. Treatment: Patient was put on ice for 12 minutes along with premod e-stimulation. Patient's SCM, Traps and neck muscles were massaged. Patient was adjusted and sent home with home care of ice tonight and heat tomorrow. Patient stated that he was 75-80% better after today's treatment. He will return on Thurs for another Chiropractic treatment. Results: good.

Greg Millar DC CCEP

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Failed Cervical & Failed Low Back Surgery

Today is Wednesday February 11th, 2009. Problem: I had a lady see me in the Decatur Disc Treatment Center today that had four previous surgeries with the last two being fusions. She had her first neck surgery in 1993 and her last low back surgery in 2007. She was in intense pain all the time. She described the pain as 9/10. She had neck pain with radicular symptoms into her hands bilaterally. She had low back pain radiating down her left leg to the inside of the left foot. Her left thumb and first two fingers were numb on the right and her great toe was numb on the left. She came to my office in tears. I first saw her in December 08 and told her she needed pain control; two new MRIs; and a Nerve Conduction study of the upper and lower extremities. I told her pain control was going to take sometime but she wanted a quick fix. She left in December and went to a pain doctor who did exactly what I said and ordered new MRi's of the cervical and lumbar spine an NCV of the upper and lower extremities. After looking over the studies the pain doctor decided to put her on heavy meds and see her for monthly for refills. She did not want to take large quantities of meds and came back to see me for treatment. Yes she has recurrent bulges and adjacent segment syndrome. The MRI's were ordered without contrast so it's nearly impossible to see if any adhesion of scar tissues have occurred. Treatment Plan: I am starting her on conservative chiropractic care (Activator only no manual adjustments) and the disc pump for the cervical and lumbar spine. I will do some Cox Flex/Dist work on her. I am also consulting with UAB Dept of Neurosurgery as I think she is a candidate for Pulsed Radio Frequency treatments to the lumbar facets or perhaps an internal cord stimulator. I will start her on modality treatments including IFC and Short Wave Diathermy for deep heating. We will have to do some trigger point and deep tissue work to help her heal. I am consulting in Gary Cohen, DO Physical Medicine for IMS/NMS dry needling of the lumbar paraspinal muscles, SI Joints and traps. And I'm consulting in Michael Dick MD for treatment of the OA and Bursitis. I put her on vitamins, fish oil, glucosamine sulfate, Boswella and B-6 vitamin. I see pool therapy in her near future. I told her today It's going to take a year to get feeling better. Results: Too New to rate, I will let you know.



Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Fibromyalgia and Multiple Herniated Disc

Today Monday Feb 9th was a most interesting day of practice. CASE: I had a middle aged female patient in the Decatur Disc Treatment Center office who had multi level degenerative disc disease with stenosis and neuroforaminal encroachment with 2 herniations and 2 bulges in the lower cervical spine; 2 prolapsed disc in the thoracic spine at T7-8 and T8-9; and 2 herniations in the lumbar spine at L4-5 and L5-S1. She also has Rheumatoid arthritis. I have treated her for several years. She has been through several rounds of DTS decompression traction with good success particularly in the lumbar spine. She has also had several rounds of physical therapy again to good success particularly in core stabilization and in making her stronger and more vital. What made today so different was that she has for some time been experience mild fibromyalgia like symptoms. Today her FMS (fibromyalgia) was flairing and was setting off her neck and low back radiating pain. FMS is normally considered a non- inflammatory disease and her SED rate was a 2 on the 0-20 scale meaning that she had little or inflammation. However she stated that her fibro fog and fibro pain was at it's highest ever today. She also stated that the FMS pain (pain evenly divided in all 4 quadrants) was always there as background pain then as the day progressed her radicular or discogenic pain would break through and progress. Treatment: I treated the FMS by helping her to get to sleep and stay asleep. I put her on Fibromalic brand of magnesium with malic acid. I asked her to control her sleep time and make changes in her going to sleep patterns. I told her to use breath right strips at night. I ask her to take warm Epsom salt baths. I put her on (krill) fish oil 3000mg a day. I measured her anti-occident scan and it was under 12000 where it should be a min of 35-40,000. I put her on physician grade multi vitamins and water as her serum Co2 was in the 30's. I consulted in Dr. Gary Cohen Do physical medicine/rehabilitation and he suggested Gogi juice as well. We are going to repeat her NCV to make sure that no radiculopathy changes have taken place and were starting her on a round of conservative chiropractic care along with physical therapy core stablization. Results: Too new to rate. I will revisit this case in two weeks.

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Hello and Welcome

Welcome to the Millar Chiropractic "BackTalk" blog. The Doctors of Millar Chiropractic will openly share patient problems, treatment and results. We do this for two reasons. First, if you have the same or a similar problem then you may be helped by our discussion. Secondly, you can see the results of treatment of others and dispel any fear or uneasy feelings you may have about trying Chiropractic. Each day a different doctor will share a case and his treatment. Please join us in our quest to empower the people of Northern Alabama and Southern Tennessee to exchange ordinary healthcare for extraordinary wellness through discovering and implementing Chiropractic, Nutritional, and Whole Body Prevention, leading to a Wellness Lifestyle and longer life. Visit us online at www.millarchiro.com.
Thanks
Dr Greg

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.