Whilst I love getting deep into research (this is what’s at my side as I write this article), there is nothing quite like a challenging case to get the dopamine flowing.
That is, of course, if you are taking the time to reassess your patient objectively and subjectively on a regular basis.
Don’t be afraid to ask your patient how they’re feeling, it’s just feedback, nothing personal.
If you consider yourself wellness-based, for some people, this seems to strike fear into their heart. Because talking about symptoms means you’re not interested in their overall health and wellness.
Or maybe once they feel no symptoms, they might leave you as a satisfied customer and never return.
How terrifying.
I suspect deep down it is fear and insecurity. They might not be feeling any better, and so it is best not to ask, because the depth of care they deliver is so shallow.
They simply cannot do anything else, they talk a great game about Chiropractic and “expecting miracles”, but deep down they know it isn’t so.
The illusion that laying someone on a bench and doing static palpation, then an adjustment is somehow “wellness” does not stand up too well to reality.
Some people that consider themselves mechanists or “evidence-based Chiropractors”, feel that they should only talk to them about symptoms and that once the symptoms stop, they shouldn’t ever offer them care on an ongoing basis.
It creates dependency, and the GP round the corner that refers you to a patient now and then might not like it.
They would never make a patient dependent on life-long medication to control functional expressions of a poor lifestyle…… 😙.
Anyhoo, I digress.
Recently a young lady (let’s call her F) came back into my life after an absence of about 8 ish years (see if you do a good job, they and their family do come back).
I have cared for her mother, father, grandmother and grandfather over the years.
She came in as a newborn, and was pukey, very pukey.
In fact, it was projectile, so much so, we sent her to A&E and she subsequently had surgery for pyloric stenosis.
And I have seen her a handful of times when she was younger. But now she is all big, thirteen years old.
F cannot walk, she is on crutches and cannot weight on the right leg at all. Her right leg hurts a lot with pain, and in a sitting position, pain and tingling/numbness, and even more alarming, complete loss of power.
She has been to A&E multiple times, and has had full spine MRI after she lost control of her bladder.
As you can imagine, this is very distressing for a thirteen-year-old and also for her parents.
She is also very tired in general, and is a bit subdued.
NOTE: please do not project your own ideas of teenagers onto teenagers. Many of them are full of energy just fine. Please do not write their symptoms off mearly as being a teenager.
REMEMBER THIS CLINICAL RULE: Weird neurological stuff = always consider B12 and gluten
Now we then dig into the history even more. I remember that her grandmother had terrible “IBS”, that got better when she removed gluten and dairy, and in fact mum isn’t great on those either.
So would you believe it, she is currently gluten-free, BUT she was of a large amount for gluten for six weeks in the run-up to a coeliac blood test and biopsy.
Why are they testing her? Due to gut symptoms.
But the idea of gluten as a gut disorder is a historical relic.
Note, whether you have full coeliac disease aka gluten sensitivity with enteropathy, is to some extent irrelevant.
What really matters: Is your immune system reacting to gluten and then creating a GLUTEN RELATED DISORER.
One of those disorders we call coeliac disease aka gluten sensitivity with enteropathy, but there are many from gluten ataxia to gluten neuropathy to psoriasis, to osteoporosis and on and on and on – GLUTEN SENSITIVITY is what matters.
Hence, we have this chart in clinic:
If you want a copy, it is attached or ask for a real version in matt lamination.
In F’s case, she is a partial +ve for Coeliac disease, with minor changes in the villi and +ve levels of tissue transglutaminase (Anti-ttg IgA/IgG) the official blood test for Coeliac.
That means for six weeks her immune system was furious (she had been very poorly in those six weeks) and her nervous system MIGHT have been in the firing line.
But it gets worse. She also has had many “normal” blood tests.
Except her total B12 was right at the bottom of normal.
Not enough the NHS care to inject, but still low normal.
Remember the functional ranges (note some labs use pmol/L, some use ng/L:
Now, given her Coeliac partial diagnosis that is hardly surprising, B12 is hard to absorb at the best of times and remember of all the B vitamins, it is the only one we have no natural endogenous source.
Explained here, worth a re-read it explains why animals eat 💩
So, that alone, I would be giving her LIPOSOMAL HYDROXO B12 plus supporting B vitamins for MYELIN and ENERGY as per the B12 protocol.
But here is where it gets fascinating because her symptoms came the week after her biopsy.
I asked her mum, “did they use nitrous oxide as part of anaesthesia?”
Turns out the anesthetics did not knock her out, so they did use nitrous oxide which we know permanently destroys your B12.
👇️
Many of these patients will have NHS “normal” levels, and unless they see a consultant that knows this stuff, it gets missed.
So, we have an immune system that has been provoked and might be attacking her nervous system, plus low B12 (you cannot make MYELIN without B12 =weird neurological stuff) which might have been suddenly dropped further by nitrous oxide (NO).
But also note that during the procedure, they lost her airway and had to intubate her fully, which meant a lot of cervical extension on the table.
I have seen several cases where they woke up with very odd issues related to the neck from an operative neck position with anaesthesia.
Upon examination, would you believe that she is bendy, very bendy. Note the SLR is 35-40 is very poor, especially for a thirteen year old with hypermobility/EDS, that is poor, very poor and it HURTS.
Very real and significant neural tension, which FYI was diagnosed as “functional neurological disorder” or FND.
And we know what is associated with HMS/EDS….gluten !!
That is 19% full coeliac in the HMS/EDS group compared to 1% in the general population.
Next time I will take you through the treatment, supplements and lifestyle changes and how she got on.