RE: Fw: LBP case... follow up2

November 6, 2008

my earilier impression was possible higher level disc,

but gnawing pain in calf is likely to be L4-5, or L5-s1, consistent with

the MRI.

next step, in my book,

transforminal epidural steroid injection

the piriformis is a red herring, not the cause

Marc

Marc Heller, DC

mheller@...

www.MarcHellerDC.com

glenntam@... wrote:

>

> Sorry I forgot to sign my last post.

>

> Glenn Sykes, DC

> Gresham/Newberg Oregon

> 503-538-5433

>

> -----Forwarded Message-----

> From: glenntam@...

> Sent: Nov 5, 2008 4:45 PM

>

> Subject: LBP case... follow up

>

> The Trameel was in a mixed cocktail that included Lidocaine,

> B-complex, B-12, and Magnesium. It was administrated by our

> naturopath. It was injected into the piriformis in an attempt to

> break-up the spasm. Since the piriformis stretch helped so much

> we were hoping that the spasm was the primary problem. The

> cocktail made no difference. In fact he went to the urgent care

> and got a morphine shot which resulted in no pain reduction. He

> also got a Rx: Vicodian and Soma... again no help.

>

> I have the report from the radiologist: " L4-5 small annular tear

> extends through the left foramen with hypertropic facets causing

> moderate left foraminal stenosis. L5-S1 degernerative and facet

> change contribute to a mild to moderate left foraminal nearowing. "

>

> The naturopath spoke to him on the phone today and now he says,

> " the worse area is a severe gnawing pain in the calf. "

>

> Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections???

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,,,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St.

> PDX, OR 97211

> www.spinetreepdx.com <http://www.spinetreepdx.com>

>

> * Re: LBP case

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland.

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytime and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill, DC

> Eugene, OR

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38

PM

>

November 6, 2008

my earilier impression was possible higher level disc,

but gnawing pain in calf is likely to be L4-5, or L5-s1, consistent with

the MRI.

next step, in my book,

transforminal epidural steroid injection

the piriformis is a red herring, not the cause

Marc

Marc Heller, DC

mheller@...

www.MarcHellerDC.com

glenntam@... wrote:

>

> Sorry I forgot to sign my last post.

>

> Glenn Sykes, DC

> Gresham/Newberg Oregon

> 503-538-5433

>

> -----Forwarded Message-----

> From: glenntam@...

> Sent: Nov 5, 2008 4:45 PM

>

> Subject: LBP case... follow up

>

> The Trameel was in a mixed cocktail that included Lidocaine,

> B-complex, B-12, and Magnesium. It was administrated by our

> naturopath. It was injected into the piriformis in an attempt to

> break-up the spasm. Since the piriformis stretch helped so much

> we were hoping that the spasm was the primary problem. The

> cocktail made no difference. In fact he went to the urgent care

> and got a morphine shot which resulted in no pain reduction. He

> also got a Rx: Vicodian and Soma... again no help.

>

> I have the report from the radiologist: " L4-5 small annular tear

> extends through the left foramen with hypertropic facets causing

> moderate left foraminal stenosis. L5-S1 degernerative and facet

> change contribute to a mild to moderate left foraminal nearowing. "

>

> The naturopath spoke to him on the phone today and now he says,

> " the worse area is a severe gnawing pain in the calf. "

>

> Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections???

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,,,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St.

> PDX, OR 97211

> www.spinetreepdx.com <http://www.spinetreepdx.com>

>

> * Re: LBP case

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland.

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytime and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill, DC

> Eugene, OR

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38

PM

>

November 6, 2008

ps-

I think it is so important for us to have referral relationships with

anesthesiologist pain docs,

spine surgeons

neurologists

develop relationships with these people,

refer to them, send good typewritten notes,

and tell them what you do.

It will eventually result in referrals to you , as well

Marc

Marc Heller, DC

mheller@...

www.MarcHellerDC.com

glenntam@... wrote:

>

> Sorry I forgot to sign my last post.

>

> Glenn Sykes, DC

> Gresham/Newberg Oregon

> 503-538-5433

>

> -----Forwarded Message-----

> From: glenntam@...

> Sent: Nov 5, 2008 4:45 PM

>

> Subject: LBP case... follow up

>

> The Trameel was in a mixed cocktail that included Lidocaine,

> B-complex, B-12, and Magnesium. It was administrated by our

> naturopath. It was injected into the piriformis in an attempt to

> break-up the spasm. Since the piriformis stretch helped so much

> we were hoping that the spasm was the primary problem. The

> cocktail made no difference. In fact he went to the urgent care

> and got a morphine shot which resulted in no pain reduction. He

> also got a Rx: Vicodian and Soma... again no help.

>

> I have the report from the radiologist: " L4-5 small annular tear

> extends through the left foramen with hypertropic facets causing

> moderate left foraminal stenosis. L5-S1 degernerative and facet

> change contribute to a mild to moderate left foraminal nearowing. "

>

> The naturopath spoke to him on the phone today and now he says,

> " the worse area is a severe gnawing pain in the calf. "

>

> Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections???

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,,,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St.

> PDX, OR 97211

> www.spinetreepdx.com <http://www.spinetreepdx.com>

>

> * Re: LBP case

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland.

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytime and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill, DC

> Eugene, OR

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38

PM

>

November 6, 2008

ps-

I think it is so important for us to have referral relationships with

anesthesiologist pain docs,

spine surgeons

neurologists

develop relationships with these people,

refer to them, send good typewritten notes,

and tell them what you do.

It will eventually result in referrals to you , as well

Marc

Marc Heller, DC

mheller@...

www.MarcHellerDC.com

glenntam@... wrote:

>

> Sorry I forgot to sign my last post.

>

> Glenn Sykes, DC

> Gresham/Newberg Oregon

> 503-538-5433

>

> -----Forwarded Message-----

> From: glenntam@...

> Sent: Nov 5, 2008 4:45 PM

>

> Subject: LBP case... follow up

>

> The Trameel was in a mixed cocktail that included Lidocaine,

> B-complex, B-12, and Magnesium. It was administrated by our

> naturopath. It was injected into the piriformis in an attempt to

> break-up the spasm. Since the piriformis stretch helped so much

> we were hoping that the spasm was the primary problem. The

> cocktail made no difference. In fact he went to the urgent care

> and got a morphine shot which resulted in no pain reduction. He

> also got a Rx: Vicodian and Soma... again no help.

>

> I have the report from the radiologist: " L4-5 small annular tear

> extends through the left foramen with hypertropic facets causing

> moderate left foraminal stenosis. L5-S1 degernerative and facet

> change contribute to a mild to moderate left foraminal nearowing. "

>

> The naturopath spoke to him on the phone today and now he says,

> " the worse area is a severe gnawing pain in the calf. "

>

> Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections???

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,,,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St.

> PDX, OR 97211

> www.spinetreepdx.com <http://www.spinetreepdx.com>

>

> * Re: LBP case

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland.

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytime and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill, DC

> Eugene, OR

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38

PM

>

November 6, 2008

Hi Marc

Are epidural injections worth the risk of acute arachnoiditis???

Bob

W. Pfeiffer, DC, DABCO

P. O. Box 606

Pendleton Or 97801

541-276-2550

Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections???

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,,,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St.

> PDX, OR 97211

> www.spinetreepdx.com <http://www.spinetreepdx.com>

>

> * Re: LBP case

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland.

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytime and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill, DC

> Eugene, OR

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38

PM

>

------------------------------------

All posts must adhere to OregonDCs rules located on homepage at:

/

Tell a colleague about OregonDCs! (must be licensed Oregon DC)

Links

November 6, 2008

Hi Marc

Are epidural injections worth the risk of acute arachnoiditis???

Bob

W. Pfeiffer, DC, DABCO

P. O. Box 606

Pendleton Or 97801

541-276-2550

Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections???

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,,,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St.

> PDX, OR 97211

> www.spinetreepdx.com <http://www.spinetreepdx.com>

>

> * Re: LBP case

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland.

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytime and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill, DC

> Eugene, OR

>

> ------------------------------------------------------------------------

>

> No virus found in this incoming message.

> Checked by AVG - http://www.avg.com

> Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38

PM

>

------------------------------------

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/

Tell a colleague about OregonDCs! (must be licensed Oregon DC)

Links

November 6, 2008

ï»¿

I was hoping i wasn't the only one who thought that was invasive. These cases can be very effectively treated via standard chiropractic treatment.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com

* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytime and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ---------------------------------------------------------->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------------------------------All posts must adhere to OregonDCs rules located on homepage at: /Tell a colleague about OregonDCs! (must be licensed Oregon DC)

November 7, 2008

Do any of you have good statistics on the prevalence of acute arachnoiditis with this procedure? It would be helpful for patients who are weighing the risk/benefit ratio.Jay Lindekugel, DCConcordia Chiropractic Center5425 NE 33rd Ave.From: joe medlin <spinetree@...>Marc Heller <mheller@...>; glenntam@...; " W. Pfeiffer, DC" <drbob@...>Cc: < >Sent: Thursday, November 6,

2008 6:29:48 PMSubject: Re: Fw: LBP case... follow up2

ï»¿

I was hoping i wasn't the only one who thought that was invasive. These cases can be very effectively treated via standard chiropractic treatment.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx. com

* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC)

November 7, 2008

Epidural injections are to be extra- duralnotintra-dural. If one gets arachnoiditis it would seem the injection went toodeep. s. fuchs dc From: [mailto: ] On Behalf Of joe medlinSent: Thursday, November 06, 20086:30 PM'Marc Heller'; glenntam@...; W. Pfeiffer, DCCc: ''Subject: Re: Fw:LBP case... follow up2 ï»¿Â I was hoping i wasn't the only one who thought that was invasive. Thesecases can be very effectively treated via standard chiropractic treatment. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St.PDX, OR 97211www.spinetreepdx.com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytime and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ---------------------------------------------------------->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------------------------------All posts must adhere to OregonDCs rules located on homepage at: /Tell a colleague about OregonDCs! (must be licensed Oregon DC)Groups Links

November 7, 2008

Epidural injections are to be extra- duralnotintra-dural. If one gets arachnoiditis it would seem the injection went toodeep. s. fuchs dc From: [mailto: ] On Behalf Of joe medlinSent: Thursday, November 06, 20086:30 PM'Marc Heller'; glenntam@...; W. Pfeiffer, DCCc: ''Subject: Re: Fw:LBP case... follow up2 ï»¿Â I was hoping i wasn't the only one who thought that was invasive. Thesecases can be very effectively treated via standard chiropractic treatment. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St.PDX, OR 97211www.spinetreepdx.com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytime and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ---------------------------------------------------------->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------------------------------All posts must adhere to OregonDCs rules located on homepage at: /Tell a colleague about OregonDCs! (must be licensed Oregon DC)Groups Links

November 7, 2008

Literature Review of Arachnoiditis : Page 12 (vii) begins the summary : http://nzhta.chmeds.ac.nz/publications/arachnoiditis.pdf From: [mailto: ] On Behalf Of Sharron FuchsSent: Friday, November 07, 20089:48 AMCc: Subject: RE: Fw:LBP case... follow up2 Epidural injections are to be extra- duralnot intra-dural. If onegets arachnoiditis it would seem the injection went too deep. s. fuchs dc From: [mailto: ]On Behalf Of joe medlinSent: Thursday, November 06, 20086:30 PM'Marc Heller'; glenntamearthlink (DOT) net; W.Pfeiffer, DCCc: ''Subject: Re: Fw:LBP case... follow up2 ï»¿ I was hoping iwasn't the only one who thought that was invasive. These cases can be veryeffectively treated via standard chiropractic treatment. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St.PDX, OR 97211www.spinetreepdx.com Re: Re: LBP case>> Excuse my ignorance, but Trameel injections???> > Sounds to me like the n. root is the main culprit of pain> referral especially with reflex loss and Spasm etc. is most> likely the cause of that irritation. It is curious that he > gets relief from stretching etc, but with a mild bulge many> times the symptoms aren't as constant and clear as a full on> herniation. In my opinion i'd also be sure to be very gentle> with stretching in order to not irritate the nerve and> gradually increase intensity. As you know a mild bulge will> relent much faster than a herniation so treat and monitor.> > me 2 cents on this wonderful Obama morning,,,,,,,> sorry, couldnt resist.> > ph Medlin D.C.> Spine Tree Chiropractic> 1607 NE Alberta St.> PDX, OR 97211> www.spinetreepdx.com <http://www.spinetreepdx.com>>> * Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytime and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill,DC> Eugene,OR>> > ---------------------------------------------------------->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------------------------------All posts must adhere to OregonDCs rules located on homepage at: /Tell a colleague about OregonDCs! (must be licensed Oregon DC)Groups Links

November 7, 2008

ï»¿

Despite the fact that the risks may be remote, it's advisable for a patients to understand that arachnoiditis, nerve root damage, infection etc. are inherant risks. Not to mention the damage the steroid does to the rest of the body. Theres a reason they only allow 3/year. They only help about 50% and thats only temporary. THey should be reserved for extreme cases of stenosis in my opinion not a mild bulge such as we see in this case. An argument can also be made that it will slow healing time down in the long run.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com

* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a "numb> feeling" into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg. com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/2008 9:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: http://groups. / group//Tell a colleague about OregonDCs! (must be licensed Oregon DC)

November 7, 2008

Only the patient can make thedetermination of their pain level and what options they wish to try for relief.I donâ€™t think it is up to us to bias them about all the negatives when in somecases it might be of great benefit. I know you know that. I donâ€™t want to argueabout it but this is a sensitive point for me as I was posting in the pastabout a 90 year old person who was suffering terribly and the DC that wastreating them essentially held them hostage in their pain to their bias. It wasabuse in my mind and I think we need to consider all things that might help thebenefit as we practice to the standard of providing adequate pain relief. s. fuchs dc From: [mailto: ] On Behalf Of joe medlinSent: Friday, November 07, 200810:22 AM Lindekugel; Marc Heller;glenntam@...; W.Pfeiffer, DCCc: Subject: Re: Fw:LBP case... follow up2 ï»¿Â Despite the fact that the risks may be remote, it's advisable for apatients to understand that arachnoiditis, nerve root damage, infection etc.are inherant risks. Not to mention the damage the steroid does to the rest ofthe body. Theres a reason they only allow 3/year. They only help about 50% andthats only temporary. THey should be reserved for extreme cases ofstenosis in my opinion not a mild bulge such as we see in this case. Anargument can also be made that it will slow healing time down in the long run. ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St.PDX, OR 97211www.spinetreepdx.com* Re: LBP case>> > >> > I have a 52yr old male (desk worker) with severe> LBP(8/10 VAS),> gradual onset over the coarse of a few hours, about 2> weeks ago.> Pain levels have been increasing, and now he is also> getting a " numb> feeling " into his anterior left thigh, medial knee and medial> proximal calf. His only position of relief for LBP is> squatting.> Can't find relief for the numbness.> >> > exam: Initially neuro exam was negative but now loss> (0/2) of> Patella reflex on left. Sensation still intact, Lower> extremity str> all +5/5, except iliopsoas +3/5 due to local LBP, heel and> toe walk> neg. SLR/SLR max both neg. Kemps neg. Stretching of> iliopsoas or> piriformis gave an immediate relief of symptoms (1/10 VAS)> >> > I have done 3 treatments consisting of massage, stretch> of affected> muscles, microcurrent, and side posture manual adjustment.> Home> stretches were assigned. We also have a naturopath and an> acupuncturist in our office and he received acupuncture as> well as> Trameel injections into the piriformis. Each treatment> helped for a> few days. Before symptoms would return, and worse than> before. Home> stretching only gives small and temporary relief.> >> > Due to appearance of neuro finding I sent him for a MRI:> > finding: mild bulge with a small annular tear L4-5> >> > First any ideas for annular tears.> >> > Second, I am fairly confident that the leg numbness is a> parathesia> and is referred from the muscle spasm and not due to nerve> root> impingement. Due to the fact I am able to reduce the> numbness and> back pain with in-office stretching, SLR max is negative and> adjusting helps so dramatically and quickly.> >> > However I am concerned about the loss of patellar> reflex, and the> patient is concerned about long term neurological> ramifications, so> does anyone have a good neuro referral in the East side of> Portland.> >> > thank you all in advance.> >> > Glenn Sykes, DC> > Gresham/Newberg, Oregon> > 503-550-8806> >Don't give up to soon. Ultrasound right over the piriformis> (O,I,Belly)everytim e and stretching to release it will> help. Getting> the inflamation down in the piriformis is critical. I have> seen the> reflexes come back to normal in two to three weeks.>> Brad Rethwill, DC> Eugene, OR>> > ------------ --------- --------- --------- --------- --------- ->>> No virus found in this incoming message.> Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.6/1768 - Release Date: 11/4/20089:38 PM>> ------------ --------- --------- ------All posts must adhere to OregonDCs rules located on homepage at: group//Tell a colleague about OregonDCs! (must be licensed Oregon DC)Groups Links

November 7, 2008

Of course the flip-side to this is the

very common bias against what chiropractors do by the medical profession,

especially when related to manual adjusting of the upper cervical spine.

Seitz, DC

From:

[mailto: ] On Behalf Of Sharron Fuchs

Sent: Friday, November 07, 2008

10:35 AM

Subject: RE: Fw:

LBP case... follow up2

Only the patient can make the determination of their pain level and

what options they wish to try for relief. I donâ€™t think it is up to us to bias

them about all the negatives when in some cases it might be of great benefit. I

know you know that. I donâ€™t want to argue about it but this is a sensitive

point for me as I was posting in the past about a 90 year old person who was

suffering terribly and the DC that was treating them essentially held them

hostage in their pain to their bias. It was abuse in my mind and I think we

need to consider all things that might help the benefit as we practice to the

standard of providing adequate pain relief.

s. fuchs dc

From: [mailto: ]

On Behalf Of joe medlin

Sent: Friday, November 07, 2008

10:22 AM

Lindekugel; Marc Heller;

glenntamearthlink (DOT) net; W. Pfeiffer, DC

Cc:

Subject: Re: Fw:

LBP case... follow up2

ï»¿

Despite the fact

that the risks may be remote, it's advisable for a patients to understand that

arachnoiditis, nerve root damage, infection etc. are inherant risks. Not to

mention the damage the steroid does to the rest of the body. Theres a reason

they only allow 3/year. They only help about 50% and thats only temporary.

THey should be reserved for extreme cases of stenosis in my opinion not a mild

bulge such as we see in this case. An argument can also be made that it will

slow healing time down in the long run.

ph Medlin D.C.

Spine Tree Chiropractic

1607 NE Alberta St.

PDX, OR 97211

www.spinetreepdx.com

-----

Original Message -----

From:

Lindekugel

joe medlin ; Marc

Heller ; glenntamearthlink (DOT) net ; W.

Pfeiffer, DC

Cc:

Sent: Friday, November 07, 2008 9:01 AM

Subject: Re: Fw: LBP case... follow up2

Do any of you have

good statistics on the prevalence of acute arachnoiditis with this

procedure? It would be helpful for patients who are weighing the

risk/benefit ratio.

Jay

Lindekugel, DC

Concordia

Chiropractic Center

5425 NE 33rd Ave.

From: joe medlin <spinetreeqwestoffice (DOT) net>

Marc Heller <mhellermarchellerdc>; glenntamearthlink (DOT) net;

" W. Pfeiffer,

DC " <drboboregontrail (DOT) net>

Cc: < >

Sent: Thursday, November 6, 2008

6:29:48 PM

Subject: Re: Fw:

LBP case... follow up2

ï»¿

I was hoping i

wasn't the only one who thought that was invasive. These cases can be very

effectively treated via standard chiropractic treatment.

ph Medlin D.C.

Spine Tree Chiropractic

1607 NE Alberta St.

PDX, OR 97211

www.spinetreepdx. com

-----

Original Message -----

From: W.

Pfeiffer, DC

'Marc

Heller' ; glenntamearthlink (DOT)

net

Cc: ''

Sent: Thursday, November 06, 2008 5:36 PM

Subject: RE: Fw: LBP case... follow up2

Hi Marc

Are epidural injections worth the risk of acute arachnoiditis? ??

Bob

W. Pfeiffer,

DC, DABCO

P. O. Box

606

Pendleton Or 97801

541-276-2550

Re: Re: LBP case

>

> Excuse my ignorance, but Trameel injections?? ?

>

> Sounds to me like the n. root is the main culprit of pain

> referral especially with reflex loss and Spasm etc. is most

> likely the cause of that irritation. It is curious that he

> gets relief from stretching etc, but with a mild bulge many

> times the symptoms aren't as constant and clear as a full on

> herniation. In my opinion i'd also be sure to be very gentle

> with stretching in order to not irritate the nerve and

> gradually increase intensity. As you know a mild bulge will

> relent much faster than a herniation so treat and monitor.

>

> me 2 cents on this wonderful Obama morning,,,,, ,,

> sorry, couldnt resist.

>

> ph Medlin D.C.

> Spine Tree Chiropractic

> 1607 NE Alberta St.

> PDX, OR 97211

> www.spinetreepdx. com <http://www.spinetre epdx.com>

>

> * Re: LBP case

>

> >

> > I have a 52yr old male (desk worker) with severe

> LBP(8/10 VAS),

> gradual onset over the coarse of a few hours, about 2

> weeks ago.

> Pain levels have been increasing, and now he is also

> getting a " numb

> feeling " into his anterior left thigh, medial knee and medial

> proximal calf. His only position of relief for LBP is

> squatting.

> Can't find relief for the numbness.

> >

> > exam: Initially neuro exam was negative but now loss

> (0/2) of

> Patella reflex on left. Sensation still intact, Lower

> extremity str

> all +5/5, except iliopsoas +3/5 due to local LBP, heel and

> toe walk

> neg. SLR/SLR max both neg. Kemps neg. Stretching of

> iliopsoas or

> piriformis gave an immediate relief of symptoms (1/10 VAS)

> >

> > I have done 3 treatments consisting of massage, stretch

> of affected

> muscles, microcurrent, and side posture manual adjustment.

> Home

> stretches were assigned. We also have a naturopath and an

> acupuncturist in our office and he received acupuncture as

> well as

> Trameel injections into the piriformis. Each treatment

> helped for a

> few days. Before symptoms would return, and worse than

> before. Home

> stretching only gives small and temporary relief.

> >

> > Due to appearance of neuro finding I sent him for a MRI:

> > finding: mild bulge with a small annular tear L4-5

> >

> > First any ideas for annular tears.

> >

> > Second, I am fairly confident that the leg numbness is a

> parathesia

> and is referred from the muscle spasm and not due to nerve

> root

> impingement. Due to the fact I am able to reduce the

> numbness and

> back pain with in-office stretching, SLR max is negative and

> adjusting helps so dramatically and quickly.

> >

> > However I am concerned about the loss of patellar

> reflex, and the

> patient is concerned about long term neurological

> ramifications, so

> does anyone have a good neuro referral in the East side of

> Portland.

> >

> > thank you all in advance.

> >

> > Glenn Sykes, DC

> > Gresham/Newberg, Oregon

> > 503-550-8806

> >Don't give up to soon. Ultrasound right over the piriformis

> (O,I,Belly)everytim e and stretching to release it will

> help. Getting

> the inflamation down in the piriformis is critical. I have

> seen the

> reflexes come back to normal in two to three weeks.

>

> Brad Rethwill,

DC

> Eugene,

OR

>

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November 7, 2008