(Keywords: Dizzy, Bernard Preston, vertigo, chiropractic, lumbar facet syndrome)
This short story is taken from Dr Preston's third book, Stones in my Clog. I can assure you that it's absolutely true!
It took the sum total of ten minutes to go from obscurity, to fame and on to infamy. One of the longest ten minutes of my life. Of course I knew the TV crew was coming to the clinic, but nobody prepared me for the fact that I was going to be making a guest appearance.
Dizzy, also known as VERTIGO, though not quite the same.
Treating Mr and Mrs Spiertz had been difficult from the first day. Jack Sprat could eat no fat, his wife could eat no lean. Mr Spiertz was enormous with a giant pendulous gut but his delightful wife Noleen was a trim little formidable lady. The Dutch can be very direct and abrupt and, until you get used to it, it can be quite disconcerting. Mr Spiertz replied brusquely: ‘I came here to for you to adjust my back, not get a lecture about my weight!’ Having said my piece (when Scott O’Connor died I vowed I would not shirk my responsibility ) I was ready to hold my tongue. After all I needed patients and he needed a chiropractor. I didn’t finish the discourse with the lovely Dutch idiom: “Those who will not hear, must feel.” They have a saying for every situation. It makes Dutch a colourful and interesting language.
‘When does your back hurt?’
‘It wakes me every time I turn in bed. For about six months I have not been able to get more than an hour’s sleep. I wake at least six or seven times a night, and I am sick and tired of the doctor’s bullshit. Your’s too!’ He winked, it was the first sign of the delightful sense of humour that characterizes the Limburgers.
Mr Spiertz had had a back operation ten years previously, and it had really been quite successful though nobody had thought to mention the word ‘exercise’ or that good weight management was going to be important if he didn’t want to have another operation, or at least become a permanent chiropractic patient. For nearly ten years he had had minimal trouble despite his belly, but it had seriously reduced his mobility, and now for six months he had had nothing but grief. Anti-inflammatories had started giving him a stomach ache, and even a touch of blood in the stool, until his doctor wisely stopped them. Physiotherapy hadn’t helped much either. Mr Spiertz and I were both lucky: a few gentle adjustments of his very arthritic spine and a disciplined set of exercises did wonders. Now he came for his six weekly adjustment which kept his spine mobile. But, at any mention of Mr Spiertz’s weight, a very dark cloud would storm his otherwise handsome features. Amazingly, despite his weight and the degenerative arthritis, his back was remarkably good. I wished that all my patients responded as well. Generally, chiropractors love the lumbar facet syndrome.
Mrs Spiertz had been very well managed by a colleague since a car accident some years previously, and she too was ‘prima’ . Except for one fact: a terrible vertigo that had plagued her for five years, and no medical or chiropractic treatment had helped in the slightest. She had been completely unable to sleep on her left side since the condition had started, and even ordinary changes of position had to be very guarded and careful. Sleeping on three pillows helped. Not a good patient to show off my skills on television.
Vertigo is usually a benign and self-limiting condition though it can be caused by a myriad of conditions from a stroke of the lower part of the brain to a viral infection of the nerve. Three separate systems work together to give our brains confirmation of our body position, allowing for the most fine control of movement as we swing and dance, and duck and dive. But when one of the systems starts giving information that does not agree with the other two, dizziness results. There was nothing wrong with Mrs Spiertz’s eyes. They were giving perfectly correct positional sense to her brain, and her feet too were conferring the correct information of where her body was in space. But some tiny misplaced crystals floating in the so-called Semi-circular canals in her inner ear had started giving mismatched information, and her brain reacted violently. An injudicious movement would cause instant extreme nauseousness, making her break out into a sweat as waves of dizziness swept over her, and she would instantly have to sit up into the upright position. Instantly, whether she was on television or not; whether it was causing severe embarrassment to her chiropractor or not!
The blood flow to the highly sensitive balance apparatus in the head courses up the spine in two small arteries which wind their way around the upper most vertebrae of the neck, before entering the skull. Any change in that blood flow will also cause dizziness. Whilst Chiropractic is one of the safest forms of treatment in the world, just witness the insurance premiums of chiropractors compared to their medical colleagues, but it has to be admitted that adjustments of the neck in cases of dizziness is one area where we tread warily. Dizziness vertigo is both an indication and a contra-indication to adjustments! Hundreds of thousands, perhaps millions upon millions of people with dizziness have been helped by chiropractic, but a very small number have had strokes resulting from the treatment, especially if crudely and repeatedly done, despite warning signs. Adjustments of Mrs Spiertz’s neck proved a very safe procedure. They controlled her headaches caused by the whiplash injury, but the adjustments did absolutely nothing for her positional dizziness vertigo. The problem wasn’t in her neck, it was in the delicate mechanism set in the three tiny canals set at right angles to each other in the inner ear, where tiny crystals had found their way into the posterior canal, wreaking havoc by sending information that conflicted with that coming from the other ear, and from her eyes and feet.
There was a knock on my treatment room door. It was the clinic director. ‘Dr Preston, the TV crew have finished their interview with me, and are doing some general pictures of the clinic. They want some live pictures of treatment of a patient. Would you ask your patients if they would consider going live on television whilst you treat them?’
‘Live! Are you crazy? Anything could happen with a dizzy patient!’ I said.
‘Yes, I know, but they are insistent. They will be ready in about two minutes. Will you ask your patients, please? Hurry.’
Mr and Mrs Spiertz were as excited as I was anxious. Fortunately they were both responding excellently to the treatment, and I had nothing to fear. ‘On television! Of course we don’t mind. That would be so exciting, for the first time in our lives. Wonderful, bring them in!’
The TV crew was experienced and very professional. As I went through the motions of adjusting Mr Spiertz’s low back, they had the cameras and microphones carefully placed. The popping sounds from his back as tiny bubbles of nitrogen gas were released deep inside his joints, were clearly heard, and the complete trust, and lack of anxiety, was cleverly portrayed. I heaved a sigh of relief. This wasn’t so bad. And fortunately they didn’t want to hear me murdering their Dutch verbs.
Mrs Spiertz’s turn came next, and she lay gamely down on the adjusting table. I adjusted two joints that were subluxated in the middle of her back, and then asked her to turn onto her right side for the treatment of her lower back.‘Ahhhh,’ she yelled as a paroxysm of dizziness vertigo swept over her, and she sat abruptly up, anxiety and misery covering her face, the cameras cleverly picking up every contortion and grimace of her face. It wasn’t supposed to happen on her right side!‘What’s happening?’ called out the director.‘Cut,’ shouted the TV presenter, stopping the live feed, that was showing the whole of Holland how a chiropractic adjustment could cause severe nausea and discomfort. I hung my head.
‘I’ll speak to you later about this,’ the clinic director said curtly, as the TV crew left the treatment room and finished with more shots of the clinic, and a few unconvincing words from the director about how the attack of vertigo had nothing to do with the treatment. Who in their right mind would believe that?
‘Was that seen all over Holland?’ asked the shaken and pale Mrs Spiertz. I nodded glumly.‘I’m sorry,’ she went on. I have those sorts of attacks every day, but I haven’t had one in here for months because I’m so careful when I turn, and you never put me on my left side. I really don’t know what happened.’
‘It’s okay, Mrs Spiertz. It’s not your fault. The truth is we should have planned this far more carefully, and frankly we should never have chosen you. All the anxiety of being on national TV is just the sort of stress that would produce one of those attacks. It was all our fault.’ I had brought her a glass of water, and gradually the effects of the attack passed. Still, she left the clinic looking a little green about the gills. Several patients gave a laugh when they told me about the TV program which thankfully I had not seen. Nor wanted to see. One patient even had the nerve to ask if I had had any invitations to start a sort of Dr Welby sitcom!
I believe in coincidences. Some people call them God-incidences. Maybe. Certainly the Good Lord was more concerned about Mrs Spiertz’s health than about Chiropractic’s image it seemed. Several weeks earlier I had signed up for a continuing education course on the jaw joint. Amongst other things, I was introduced for the first time to something quite new. A simple technique for guiding the crystals blocking the flow of fluid in the semi-circular canals back into a sort of garbage dump called the utricle. Mrs Spiertz was, of course, uppermost in my mind. At her next consultation, six weeks later, I said to her, ‘How would you like to be a guinea pig, Mrs Spiertz? I’ve learnt a new technique that is supposed to cure your condition, but I’m afraid I’ve never tried it.’
‘Will it help?’
I shrugged my shoulders. ‘It has been well tested, but I’m afraid I have never used it before. I’m not sure that someone like you with such severe vertigo is a good idea, but I have to start somewhere. I very much doubt if it will make you worse, and it might just help.’
She looked doubtful. Mr Spiertz came to my rescue. He had learnt to trust my judgment as long as it had nothing to do with kilograms. ‘Nothing has helped you up to now, Noleen. Give it a try.’ She stared at him angrily, pondered for a moment, and then gave me a hesitant nod.
Fortunately I had read the procedure again the previous night, and was familiar with it. It all started with a diagnostic test with a strange name. The Hallpike-Dix test. Sitting on my chiropractic table, with her head turned to the right, I lay Mrs Spiertz quickly onto her back, extending her neck over the end of the table. Turning to the right oddly (I was expecting it to be to the left) within a few seconds provoked a severe reaction, and her eyes began to race in a strange circular manner causing her to snatch her head back to the centre. Repeating the test with her head turned to the left produced a much milder reaction.‘This may be awful, I’m afraid, Mrs Spiertz. I am going to put your head in five different positions and we are going to have to hold it there until the dizziness passes. I’m not sure how long it will take, as you see I have never done this before. Perhaps as long as a minute in each position, they said. That will reposition the crystals in the canals in your ears that are causing all your problems. Are you ready?’ She nodded grimly, not far from tears, knowing what was coming, it seemed, better than I. Her husband came over at my beckoning, placing his hand firmly on her body so she couldn’t move, and I gently turned her head to the right, and her quickly onto her back. A violent paroxysm shook her body, and she desperately tried to sit up, giving a loud cry, gagging several times, while we firmly held her in the position. Cruel. Fortunately it only lasted about ten seconds, much shorter than I thought it would, and then slowly she relaxed. Holding her head in slight extension, I turned her head first to the centre and then to the left. The next three positions were also unpleasant, only less so, and the final position produced no reaction at all. By the time we were finished she was perspiring madly, and gasping for breath. She never said a word, just dressed, and left looking glum and shaken. Their chiropractor was equally disturbed, knowing that he had ruined chiropractic’s reputation in Holland. Had he also just ruined a patient’s health too? All through the rest of the day, I was apprehensive, having difficulty concentrating on the patient lying under my hands and didn’t sleep well that night, worrying about Mrs Spiertz.
The next day was very busy as I tramped the treadmill that all doctors walk, trying to put Mrs Spiertz and her problems aside. The note stuck to my computer at lunchtime blew my mind away: Mrs Spiertz phoned this morning. She said to tell you that she slept last night on her left side for the first time in five years!
Unfortunately the dramatic change in Mrs Spiertz’s health only lasted about four days, and gradually worsened again. She flatly refused to let me repeat the procedure.
Should inexperienced doctors be allowed to flounder about out of their depth? However it proved to be a turning point, and in the years ahead, I was to help many patients suffering from vertigo. They don't call it a practice for nothing. Yes, dear patient it's you on whom we hone our skills. There is alas no other way.
Case files are the weakest form of evidence that any particularly treatment has merit. But they do come new insights perhaps, another perspective. Vertigo case file ...
Obese persons, like the pregnant, have an increased curve called the lordosis in the lower back. This puts increased strain on the facet joints which may jam and ultimately become arthritic if they remain jammed.
Also, once the disc has been surgically removed, the facets settle deeper on each other, further aggravating the problem.
Tofu is the vegetable protein that is the source of the important amino acids for a great proportion of the world's people. In addition it contains large amounts of "phytosterols" known to drastically reduce cholesterol. What's more their anti-cancer properties, and their ability to reduce hot-flushes...
High vegetable protein couple with low carbohydrate is the success formula of most weight loss programmes.
Links @ DIZZY
Strictly for Chiropractors, and chiropractic students only:
Should you be interested in treating the dizzy patient, without going
through the dramas that I did, there is a simple course of five email
lectures available. It's free, I believe, and it's really not rocket
science. For more information about the Hallpike Dix Test and how to
treat the dizzy patient, click here:
HALLPIKE DIX TEST ...