«Here’s Johnny»

I meant: «Here are your diagnoses»

In this blog Overlook Hotel is a Danish clinic (it could have been German, or even Norwegian?). I’ve put the diagnoses from Jack Torrance in its entirety further down this page (hope you get the metaphor…)

«all work and no play makes Jack a dull boy»

The last couple of years there have been some stories in national media (in Norway) about people who travel to clinics abroad (and probably contributed to the increasing trend). These people have chronic health problems, they have been through the health system, different doctors/therapists and different tests/examinations, and they are still desperately searching for the «right help». The belief that help is to be found within traditional healthcare is gone. These stories have particularly been about people with cancer and chronic neck pain.  In the exotic abroad they seem to have «special» machines for examinations, «special» competence and «special» treatments, that we don’t have in Norway  – one of the best and modernized health services in the world.

This particular case is about an older woman with chronic pain where the neck is suspect number one. Many years ago she was pulled by the hair by an aggressive patient at work and thrown to the floor. This incident was the origin for many years with different bodily symptoms. Examinations through different imaging and by different physicians/therapists have not provided any proof of injury or tissue diagnosis. The many treatments over the years have not removed the pain. A multifactorial and also a psychosocial case, after so many years. She recently e-mailed my own clinic: «Here is the answer from the clinic i Denmark. Depressing. I’m crying». 

I acknowledge that there could be acted in good faith, with honest intentions and with a sincere wish to help people, but in truth this feels more like the evil that arises at Overlook Hotel: Jack becomes haunted by ghosts of the past and eventually driven to madness.

A clinic abroad (or far away) seems exotic and they have «special expertise» where traditional health care falls short – in the guise of unique medical knowledge, unique experience and unique equipment they sell extraordinary claims and promises to desperate people (well we probably have some in Norway as well). On a bed of pseudoscience, anecdotes and placebo (deceit) – for the love of money. Authorized health care professionals. Ethics out the window.

Some people with holy convictions and missionary force have even started companies that offer contact, appointments and travels to these clinics. Charter tours to Overlook Hotel to Dr. Jack who will «chop» away the pain.

The letter the patient got will speak for it self as evidence of the black hole within health care that many are lured into, and invest time, money and energy on. It’s too long to explain all the medical terms but I think it will give you the right (or more accurately: the wrong) impression. But a couple of things:

  • There are very little association between what is seen on scans (for example an X-ray, MRI) and pain. Specially for chronic pain.
  • Scans will almost always show something and much of this ‘stuff’ is poorly linked with pain.
  • Normal age related findings could probably be described in detail in most of the spinal segments for this patient (an elderly woman) if you look hard enough.
  • Most (if not all) of the findings are given too much meaning.
  • Many of the findings seems speculative, unnecessary described and without nuance or context.
  • This information is harmful – it creates fear and the belief that the body is damaged.
  • This information can in light of updated pain science provide a barrier to get better and possibly make everything worse.
  • Such excessive detailed information is totally unnecessary because it can’t explain the symptoms and is mostly normal findings that can’t be «fixed».
  • Dr. Jacks analyses in the 3 last paragraphs is creative guesswork and reading of medical tarot-cards. They don’t belong in a letter to a patient.
  • (but the findings can according to Dr. Jack be fixed. All it takes is some more money, some long trips and some more scans, and THAT gives hope, and to some a strong placebo?)

 

So without further ado, here is Dr. Jack chopping at the door:

Anamnese:
Was bodily attacked by a patient during work, where the patient grabbed her hair, shook her head violently and threw her on the floor. No diagnosis was offered in Norway despite her symptoms. She went to Germany to get an upright MRI scanning of her neck and was diagnosed with cervical instability.

Present symptoms:
1. Throat tightness – difficult swallowing
2. Painful hands and arms
3. Mid dorsal pain
4. Left hip and left leg pain

X-ray examination:
Static X-ray findings:
To evaluate the spine and its positive and negative potentials the discs are viewed and evaluated for fluid content relative to segmental spine function. The fluid content of the intervertebral disc, governs its mechanical response and biological behavior which varies with the external load placed upon it by the vertebrae above and the degree of fixation (lack of motion ability) of the vertebra.
In this case the cervical discs exhibit the following properties relative to fluid density:
C2: Normal
C3: Increased
C4: Increased
C5: Normal

C6: Increased
C7: Decreased

Other static findings of the spine:
Cervical: anterior inferior and superior arthritic border markings with exostosis on C4 and C5 most likely from a hyper-flexion impact force to the cervical spine; C5 anterior superior body compressed. Observed calcification of the thyroid gland.
Lumbar: exostosis on the L2,3,4,5 segments
Pelvis/sacrum: clockwise rotation of the pelvis; markings of acetabular, sacro-illiac and sacro-lumbar arthritic affectation.
Abdomen: signs of calcification of the abdominal aorta

Dynamic X-ray analysis of the cervical spine
Dynamic lateral flextion and extension
Atlanto-occipital: restrictive motion in flexion but in extension motion is noted.

Atlas: exhibits a posterior arch superior erratic flipping motion upon flexion-extension movement, where the posterior arch compresses towards the occipital base rather than separating from it during the forward motion. The odontoid space increases at full flexion. During extension, the occipital base and the Atlas posterior arch touch and this does not prompt the arch to approximate the Axis spinous process as is normally seen.
Axis: shows no motion on flexion – extension as the Axis and C3 are locked together, due to a form of long standing adhesion of the facet joints. Fluid content of the disc is apparent.
C3: exhibits slight anterolisthesis in static position and during flexion; anterior wedging of the disc during extension. Judging from the fluid content of the disc this vertebra exhibits hypermobility to compensate for the Atlas-Axial fixation. Right and left oblique views indicate foraminal encroachment during motion.
C4: Slight anterolisthesis during flexion. Discopathy apparent with anterior longitudinal ligament calcification; The spinous process separates in excess of normalcy indicating ligamentous strain or damage. Anterior wedging of the disc during extension; Right and left oblique views indicate foraminal encroachment during motion.
C5: Anterolisthesis during flexion, extending the inferior border into the anterior longitudinal ligament which appears damaged due to the strain; anterior wedging of the disc during extension; interspinous and supraspinous ligaments stretch beyond their normal capacity indicating strain/ damage of the ligament.
Posterolisthesis during extension. Given motion beyond normal range during flexion and extension indicates instability of the vertebra.
C6: Hypermobility of the segment during flexion-extension with posterior and anterior wedge formation respectively as well as hyper stretched interspinous and supraspinous ligaments indicate instability of the vertebra with ligamentous damage.
C7: This vertebra is fixated in its position and shows no motility except for a slight stretching of the spinous process caused by the nucal and supraspinous ligaments. This segment is a key subluxated segment that prevents the lower cervical spine from being agile, which contributes to the anterior carrying of the head by the patient, having the weight bearing line in a forward position.

To explain especially the Atlas motion phenomenon is rather complex having to consider multiple functional elements in the lower brain and upper cervical areas. One element is to verify or eliminate the presence of Cerebellar tonsil herniation into the foramen Magnum. However, despite such a possible complicating issue, the Atlas subluxation remains to be resolved nonetheless. It is my opinion that the space available to accommodate the tonsils will be reduced with an atlas subluxation that can cause an erratic motion pattern by the vertebra. The further complicating factor is the Axis-C3 fusion relative to the faulty Atlas motion.

With a normally positioned cerebellum and its tonsils, the Atlas erratic motion pattern can cause vascular impairment of the arterial flow of the vertebral arteries to the vital lower brain centers. It is my opinion that the neurological function of the upper and lower body may be impaired by the subluxations and of the instabilities of key cervical vertebrae.
Restoration of the subluxated vertebrae should be instituted to attempt to restore and provide the maximum flexibility and space for the neurological structures.

Also noted is the irregular motion of the epiglottis and the swallowing mechanism. The neurological control of these structures is of cervical origin although cranial nerves are also involved. It could be expected that better function could be restored if the C7 subluxation is cleared.
The overall interpretation of the spinal function and its physical shape is that it correlates with the symptoms presented. As further diagnostic advice for the patient is to have a quality Upright MRI scanning of the cerebellum made.

 


The letter from the clinic is published by permission from the patient (she even wanted it to be published after my colleague spent 1 1/2 hours with her reassuring, comforting and explaining.)

Picture are from the movie «The Shining».