When the Best Treatment is NO Treatment

By Dr. Leslie El-Turkmani

I am so excited to be here at Performance Health Center! I’ve met so many nice people, and have already seen some amazing things.  Last week for example……I saw a patient with severe symptoms, crying in pain during the consultation, and could barely get through the physical exam. I knew something more serious was happening.  I told her to come back tomorrow with the MRI of her spine she had taken 1 year ago. The next day she came back, her MRI revealed a “Chiari Malformation.” A congenital condition where the bottom of the brain pushes down the spinal canal at the base of the skull. I knew she needed a neurological consultation right away.

I called our “go to” neurosurgeon, Dr. Krishna Nirmel and got her a priority appointment in 4 days. She should have seen a neurosurgeon at the time of diagnosis, as this condition should be monitored for life. Unfortunately, I had to refuse to treat her. Manipulation could be a contraindication to care. The good news is I may have saved her life or more serious complications from happening by referring her.

At Performance Health Center, we do a detailed consultation, and a thorough physical, orthopedic and  neurological examination on every patient we see. From the examination and my professional training from New York Chiropractic College, I was confident in my diagnosis. Sometimes the greatest treatment you make is to not treat. And you have to know the difference, and when.

“Arnold-Chiari malformation” (CM-1) is caused by the “cerebellum” dropping down the “foramen magnum.” Named after German pathologists, Hans Chiari and Julius Arnold. The cerebellum, Latin for “little brain” is responsible for balance and motor control. The foramen magnum, Latin for “the great opening” is located at the base of the skull, about the size of a quarter with an oval shape. It allows passage of the brain stem and major arteries from brain to body, and vice versa. This herniation of the cerebellum down the foramen magnum is measured in millimeters. It can continue to drop further down over the years. This can lead to poor circulation due to unwanted pressure, and this pressure on the cerebellum can lead to issues with balance, dizziness, headaches, nausea, blurred vision, neck pain, and even atrophy of the structures.

The exact cause of CM-1 is unknown. It is a “malformation” because the individual is usually born with it. It can be symptomatic with signs like what my patient had, or asymptomatic for the individual’s entire life, depending on severity. It is fairly common, every 1:1000 births. It is more common in females. It is best diagnosed by MRI.

Take home message to my patients…pain is not a lifestyle! Nobody likes going to the doctor, but at least when you go see the chiropractor, you’re getting looked at nose to toes, inside and out to find the root of the problem

For more information, or to make an appointment call 508-655-9008.  If you have any questions please email me at DrEl@PerformanceHealthCenter.com