Ask Dr. Rob: Attitude Adjustment

October 25, 2007

Lots of good questions are coming in.

Dear Doctor Rob,
I’ve recently had pain in my lower back and down the back of my left
leg. A friend of mine talked me into setting up an appointment with
her chiropractor. But I’ve always thought chiropractors were quacks
and I only made the appointment in a weak moment of annoyance when I discovered I couldn’t even sit through an entire movie. And when I
tried to talk to my doctor about the pain, he called me a pillhead
told me to hit the streets. What do you think? Should I go through
with the appointment?
Sincerely,
Sciatically Sidelined in Steamboat Springs

Since your name is so long, I will from this point on refer to you as S⁴. I apologize for leaving out the word “in,” but that would have complicated the nickname significantly.

Just Say No

First of all I need to talk to you about a very important subject that is being faced by kids these days: peer pressure. It is clear to me that you are really trying to fit in with the “in” crowd. In teen circles there are all sorts of pressures, such as doing drugs, wearing the right clothes, cussing, smoking, and going to alternative medical providers.

I know that your friends probably try to get you to do Feng Shui as well (I had to fight that hard battle when I was a youngster). I am sure they are all saying things like: “Come on S⁴ , get the high colonic. Every one else is doing it. What are you, chicken??” You hear that kind of sad talk all the time from kids these days. It is sad when such peer pressure leads to the tragic consequences of a hyperosmolar, super-caffeinated state due to the high concentration of coffee in the colonic. You see it every day.

So next time your friends are heading off to acupuncture or drinking highly-diluted solutions containing Ebola virus, ask yourself if you really need to fit in with them. Ask: if they were jumping off of a cliff, would I do that too? That always helped me stay away from alternative medical providers.

Doctors and Pillheads

It grieves me to hear that your doctor called you a pillhead. There are very strict codes among doctors not to comment on the shape and/or size of a person’s head. Certainly he should not have sent you out of his office just because of your head. It is sad to me that there are still people who can’t accept others just because they have unusually small heads that are totally white. My hope is that one day we will be able to be blind to the size and shape of the heads of our patients and treat them all like regular people, no matter how utterly ridiculous they look.

There is a misunderstanding that is common among many in the medical profession regarding people who are…. challenged regarding their head-ness. Many believe that since they don’t have a mouth but just a large score across their face that they cannot take medication and so are only candidates for alternative medical providers. This is clearly not the case. Many of the newest drugs come in the form of a patch or injection that can be easily given to a person of…pill persuasion. Plus there is the compounding technology done by some of the local pharmacies that can turn medications into gels that are absorbed through the skin. All of these ways of delivering medication can make the pill-headed life a very normal one.

Step on a Crack, Crack your Mother’s Back

So what about Chiropracty? Can it help? Is it any good?

First let me say that many people are led astray by the name. A chiropractor is not someone who puts a pen into a gear-looking thing and makes fancy designs on a piece of paper. There is common confusion between the word chiropractic and the term Spirograph.

When I was a child there were two things I wanted more than anything else: a Super Spirograph, and a Bizzy Buzz Buzz (a pen that was shaped like a bee and would, when turned on, make the pen move in circles to provide hours of entertainment to children everywhere). I remember staying awake at night dreaming about a life fulfilled by having the ability to make really neat designs on a piece of paper. While I am still in counseling due to the fact that I never did get the Bizzy Buzz Buzz, I did get the Super Spirograph. It was great. Never before and never again has my deep desire to make squiggles on paper been so fully met.

If you were thinking that your friend felt that making fancy design would help your back feel better, I can say that perhaps you would have been right. Perhaps the joy you felt in letting your creative inner self out by making fancy designs would cause relaxation of the paraspinal muscles and diminish pain. This has not ever been shown with the Super Spirograph, although it has been shown with the Bizzy Buzz Buzz.

Unfortunately, your friend was probably signing up to go to a Chiropractor. A chiropractor is a doctor in chiropracty. While I am not qualified to say what exactly they do behind those closed doors, there is a very interesting article in Knudsen’s News regarding the alarming trend of subluxations that are becoming resistant to reduction. It seems that chiropractors are indiscriminately reducing subluxations just for common colds. This causes subluxations to become resistant to reduction when you really need them reduced. The potential consequences are scary to consider.

My Approach to Sciatica

So what is the deal with sciatica? Sciatica is caused by irritation of the nerve roots by either inflamation of the surrounding soft tissue, arthritic changes to the facet joints, or impingement by the intravertebral disc slipping out of place. This causes a “toothache” pain that radiates down the leg - starting at the buttock and going down the leg.

Since sciatica is literally a “pain in the butt,” it has long be held that annoying friends can also cause severe sciatica. We have already established that these friends are up to no good. Perhaps spending time around your annoying friends has made your symptoms worse. I suspect you were sitting next to one of these social-misfits in the movie, and that caused your pain to worsen. Since it is far more difficult to get a butt-transplant than it is to get new friends, I suggest you do the latter. I am sure there are online community of pill-headed individuals where you can meet people more like yourself and get rid of this constant soreness to your south-end.

The actual approach to sciatica is to treat medically for the first six weeks or so (with physical therapy - or physical terrorism, as some have called it) and medications. If a person is having persistent pain despite the conservative treatment or is having progressive weakness to the lower extremity, I send them for an MRI scan.

I have previously discussed the working of an MRI scanner (and some of the side effects) as well as the useless reports they can generate. If we can avoid magnetizing the patient and can get a report that is in English that we can understand, then we can make a plan. The MRI reports usually have one of three basic messages:

1. Patient is a wimp. Back looks fine. Send the little baby back to mommy.
2. Yikes!! How the heck are they walking?? Their back is falling apart!!
3. There is hypertrophy of the lateral wing of the ligamentum flavum causing impingement on the thecal sack in the area of the posterior fornyx.

If the first result comes in, we pat the patient on the head and tell them to get a Super Spirograph. If the second result comes in, we send them to the neurosurgeon and curse the insurance company under our breath. If the third result comes in, we act like we understand the report in front of the patient and then dump it on a subspecialist who knows the foreign dialect of the radiologist. Personally I am allergic to the fornyx.

The End of the Tail

Sometimes back pain is caused by a problem with the tailbone, which bears the unfortunate name coccyx. Coccyx is an unfortunate name for several reasons: first, it is kind of embarrassing to say - like you are saying something bad when you really aren’t; and Second, because it is spelled in a very unnatural way. It should be spelled “Coxix,” but someone felt it would be fancier to use lots of c’s and a y. They should leave the naming of these bones to the professionals.

You know you have injured your…uh…tailbone when you cannot sit on anything except for a donut. I am not, of course, talking about a real donut (the kind you eat and the kind that are filled with mysterious dark matter), I am talking about an inflatable or fabric donut-shaped pillow that allows your…uh…tailbone to hang in the air rather than be squashed by all of the weight you got by eating the regular kind of donuts.

There is nothing you can do for a broken tailbone except for sitting on a donut and waiting for it to get better. You also spend a lot of your time avoiding saying the word coccyx.

Oh yes, and don’t get a tattoo down there.

So should you go to the Chiropractor? Well S⁴, I will leave that up to your friends who seem to carry your remote button. Regardless of what I say, you will probably follow what they do. Still, let me try to give you some advice:

C’mon, S⁴! Go to Rebuildyourback.com. What are you, chicken?? Sissy! Everyone else is doing it!

Thanks for the question!

(7 votes, average: 5 out of 5)

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Posted in Ask Dr. Rob, Humor