Dr. Steven Gould, board-certified chiropractic radiologist, shares an “lightbulb” moment he had after treating a young woman with back pain.
Posted in Chiropractor on Tuesday, March 16, 2021
Dr. Gould’s patient was a 26-year-old woman with a six-week-old baby. She had no prior history of back pain but was suddenly experiencing a 6 or 7 on her pain scale just from performing everyday activities such as lifting objects, rolling over in bed, and even simply turning. During the intake process, the patient noted that she was currently taking a daily aspirin after having a stroke at age 21 and was still taking her prenatal vitamins.
During the exam, Dr. Gould immediately noticed how limited her range of motion was. “We did our examination and her range of motion was limited on extension,” Dr. Gould said. “I think it was 70 degrees flexion with pain, and then she could not do a sit-up. We tested her on flexion distraction table that we have in the office and she could not tolerate that movement.”
After trying electric STEM interferential therapy on the patient with no results, Dr. Gould recommended X-rays and an MRI. “The plain film was negative, but on the MRI, we had slight super in plate depression and bone marrow edema at L1, L4 and L5,” Dr. Gould said. “Then in discussing the MRI with her, it's like, OK, why does your back look like a 70-year-old lady here? You've got three compression fractures from no trauma. This looks like an osteoporotic type pattern - what's going on here?”
And that’s when the lightbulb went off. Dr. Gould asked his patient what medications she had been on over the course of the last several months, in addition to her current medications. He knew that pregnancy itself comes with an increased risk of osteoporosis, but medications taken while pregnant can also increase that risk. His suspicions were correct: the patient had been prescribed Lovenox, a heparin derivative, for 11 weeks to 36 weeks of the pregnancy. Heparin, as it turned out, can induce osteoporosis during pregnancy.
But why was she experiencing pain now, and not when she was taking the medication during the pregnancy? “Etiology is from increased activity with lifting the baby, bending over, lifting her out of the crib,” Dr. Gould explained. “And then there goes the compression fractures because of the weakened bone. It's a type of insufficiency fracture. Her next pregnancy she did not take any prophylactic, blood thinners or anything like that. She did just fine.”
Dr. Gould’s Lessons Learned
- Ask about previous medications on the intake form and in discussions. “It's just another piece of the puzzle we need to kick in there and remember. Let's look at past medicines as well, or that [the patient has] maybe recently been off of.”
- Plain, film-ready graphs aren't the only diagnosis options. “Even though we have good negative plain films, there still might be something else we need to look for with advanced imaging.”
- Chiropractic can identify issues that the standard medical model may not. “If she had gone through the standard medical model, her PCP would have probably referred her to a physical therapist. And that makes me worry because exercise probably is not the best thing for these compression type fractures, especially in a weakened bone state.”
- Treatment plans might not always include manipulation. “This lady just needed rest and somebody else to lift the kid for a while.”
Hear Dr. Gould’s full interview on episode 9 of our Chiropractical podcast — you won’t want to miss the story about the 8-year-old gymnast he treated. You can also watch our free webinar to see the X-rays and MRIs he references and get a more in-depth discussion of medications and their reactions.