More Cases from family medical practice

Hypoglycaemia and stress.

Mrs Y had a very stressful life. Her husband was paranoid, accusing her of infidelity. She complained of a tic in her right cheek and eye and the right side of her neck. 

Suspecting hypoglycaemia, I gave her 10ml of 50% glucose solution intravenously. After the injection, the tic improved, along with nausea and numbness of her right second toe!

A fortnight later she reported that "the tic had gone away and she felt better - but they were on holidays as well - and it came back a day before they came home."

Difficulty with toilet paper

It hurt in the web between thumb and index fingers, attempting to pull the paper.

Examination of the offending hand showed no abnormality. The neck was a different matter, although there was no pain there.

After mobilizing the cervical 6-7 and atlanto-occipital joints, the hand was immediately better.

When a subluxation happens at a cervical spine posterior (facet, zygopophyseal or just Z) joint, the spine has basically kinked sideways at that level. This tips the head sideways. We need our eyes at the same horizontal level so the body automatically levels the head, usually at the A-O joint. I assume this would re-correct eventually, but prefer to have the person walking out with their eyes level so correct it immediately.

The chicken or the egg?

A woman with tennis elbow asked for help. On examination with her forearm flat on the desk palm down, pushing her middle three fingers up backwards against resistance hurt at the elbow. This confirmed her diagnosis. I didn't push on her lateral epicondyle as it would have hurt badly and provided no more information.

She wasn't complaining of her neck but that got my next attention and as expected she had a stiff joint needing mobilization. After that was attended to, the first examination now had only the middle finger extension causing the same pain.

She had a tender part of her lateral brachialis muscle. Pressure on this gave her pain in her hand, but no change in the finger extension examination - so this muscle was not contributing directly to the "tennis elbow."

On down to her forearm and the extensor muscles below the lateral epicondyle, another tender muscle yielded to sustained pressure. The same old examination with finger extension now no longer produced as much elbow pain.

People usually assume that the enthesopathy at the lateral epicondyle is the cause of the pain, but it can be the other way around. The sequence here appears to have been neck subluxation then tight sore forearm muscles (from referred pain) then finally the enthesopathy where these large muscles are attached to a tiny area on the lateral epicondyle.

Yawn - T3 thyroid medication - no yawn

One of my patients wrote....
"When I was on thyroxine I was suffering from excessive yawning which was unexplained at the time. When I started on T3 medication the yawning largely ceased. But I now know when I need my next T3 dose if I start yawning excessively, and within 20-30 minutes of taking it, the yawning ceases again.

At first I put this down to the T3 being directly responsible for curbing the yawning. But with more research, that didn't seem likely. What did seem likely was that the T3 was affecting my autonomic nervous system in some way, which meant that it indirectly fixed the yawning.

I'm told that the rapid heart beat, loose bowels and nerve pain are all common amongst sufferers of dysautonomia, and excessive yawning would also fit within the spectrum of ANS disorders."

Anti-depressant intolerance.

Mrs C had previously tried moclobemide, paroxetine and dosulepin. She experienced nausea and shakes with each of these anti-depressants.

Using spray cans made her sneeze; She would feel cigarette smoke "hit her lungs"; Cleaning agents used in a confined area caused an "overpowering feeling" in her nose; She sneezed in the soap isle at the supermarket.

I advised 1/8th of a citalopram but she took 1/4 and reported a week later that it was "far too much." On a reduced dose "nausea improved, still a bit and lot of flatulence and gas build up in stomach. It gave a lot of clarity in mind. Then got tremors in body so stopped it. Then got nervous for two weeks." (Which I suspected was a withdrawal syndrome.)

Off the medication and another month down the track she reported that her mood and motivation were OK now.

She had numerous other medications also causing side effects, most likely all due to petrochemical allergy.

Forgotten injections

Memory was unreliable (both the patient's and the doctor's equally.) This guy had two and a half years without a vitamin B 12 injection, despite an earlier response...
"Lost a lot of the soreness out of the body, not near as much as before. More energy. Sleeping a bit better as not as much pain at night. Feels better. Started playing bowls again – off all last year.”
The result of the gap was a hike in his homocysteine from 9.2 to 17.4 and the average size of his red blood cells from 96 to 105, over two years - not good.

Spiralling into control.

This chap's response to treatment for his Parkinson's disease was reflected in the spirals...

Less Parkinson's tremor now.

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