Good luck and God bless.
Chapter Two
A Lesson on the Impact of Migraines: The Case that Changed Me Forever
Every once in a while a patient leaves a huge impact on a healthcare provider. In the doldrums of practice the monotony becomes the normal day. As one day rolls into the next, a surprise occurs. Well, maybe more of a revelation for the provider.
Since my first day in practice, I wanted to help people, much like every other healthcare provider. Then healthcare became a business. Paperwork replaced the passion. Taking care of people gets harder and harder with few rewards, so we look for any glimmer of hope, much like our patients, only to have the light burn out. But then it happens.
A few years ago, a single mother with three children came in with severe migraines. She was about to lose her job because the migraines were significantly affecting her employment. She began having migraines as a teenager but lately the frequency greatly increased. During our consultation, she stated in several different ways that she hated life. She had nothing that made her happy and felt the pressures of single parenting overwhelming.
I have always believed in the healing power of laughter. I use it as much as I can. During this consultation, my best wit was met by her boulder of resistance. Nothing I said or did could lighten the mood or relieve the tension. She sat across from me with arms folded and a lethal scowl affirming her employer’s reason to cancel her employment. After a harsh consultation (interrogation) it was determined she was experiencing migraines exhibiting the following symptoms:
1.Nauseous to certain smells especially paints, gas fumes, and perfumes.
2.Sensitivity to light in the right eye
3.Occipital (base of skull) tension with pain
4.Temporalis muscle tension with tenderness
5.TMJ dysfunction due to grinding teeth
6.Forehead pressure with severe fogginess
7.Sharp stabbing pain behind right eye
Related to her headaches and migraines were severe muscle guarding at the base of skull, trapezius muscles (more on right), paraspinal spasms down to T7, and SCM spasms. X-rays revealed the typical culprits with this kind of symptology: Atlas right lateral and posterior, Axis left rotation, loss of cervical lordosis with a mild case of degeneration, and head tilt to left. Basically, she was a wreck, but appeared typical to patients with severe headaches and migraines.
I had seen this same case at least a thousand times before, so why did this one affect me so significantly? Let me explain, I knew her coworkers as patients, employer, and treated her children as well. She came in for an evaluation because her children and coworkers insisted. She wasn’t about to let me help her. She fought recommendations, treatment, therapy, and advice. Oh, by the way, she didn’t want me to adjust her. Did I tell you that I am a chiropractor and that is my job? She was a challenge and I don’t back down from a challenge. We made a lot of compromises, but I insisted on a treatment plan of twelve treatments over four weeks and recommended a very gentle treatment type that doesn’t require the “popping” sound. She was relieved.
Note: Some patients fear the “popping” sound so much they will never seek treatment as a result. For patients like this mother, I have adapted two other techniques that are much milder for the fearful patient. I would much rather treat them with alternative techniques than to have people scared. Fear causes more guarding and leads to more symptoms.
The cards were totally stacked against me. During the first treatment I walked on eggshells in fear of scaring her. She left feeling indifferent and didn’t know if she would be back. I thought it was a rough consult, exam, and treatment. I was exhausted and didn’t expect her to come back. I wrote on her chart to be back in two days, but for no real reason.
In the evenings, I like to call new patients and any patients who were experiencing substantially difficult issues. This particular evening, I was dreading the call, expecting the worst. I called her home number. Answering machine: … not going well so far, I thought. I left a message, but without resolution, I didn’t sleep very well. Every healthcare provider wants the best for their patients and experiences feelings of failure when relief cannot be provided.
The next day, I gathered all her medical data and created a plan to address her migraines. My primary goal in treating patients is to empower them by identifying all causes and preventions of migraines. Some patients’ learning process is different than others. For this particular patient, I developed a standard plan of twelve treatments over a course of four to six weeks.
Typically in the first two weeks, I am learning the triggers that cause each person’s migraines. I do this by understanding her misalignments upon each treatment. Let me explain, I make adjustments and the patient comes back within two to three days. If the patient has symptoms, misalignments, or findings, then I identify habits that could have caused the problem. I then teach them possible habits that may have caused the problems to resurface. Then the patient can avoid the migraine by avoiding the cause.
Two days after the first consult, exam, and treatment, I waited for her to return. Her appointment was at 3:00 p.m. I was fairly busy that day and didn’t have time to worry. She arrived early with the same scowl. In between treating my other patients, I saw her sitting in the reception room. Her glare was a little unnerving. Boy, I couldn’t wait for this report of findings. I had finished treating my last patient and took a little break to gather my thoughts. I walked into the report room and sat down in front of her. The tension was heavy in the air. I asked her about her previous treatment and if she had any questions before we discussed the report. She didn’t. Her arms were still crossed.
So, I proceeded with the report. We discussed her findings, the consultation, and some causes of her symptoms. I told her my main goal, as with all my patients, was to teach them how to take care of their migraines on their own. Unfortunately, in order to achieve that goal, we would have to learn all the triggers that cause her migraines and how to avoid them, as well as perform home rehab to stabilize her spine and shoulder muscles. I then presented the treatment plan and the scowl deepened. I could tell my voice was falling on deaf ears. She was absolutely not going to cooperate. She didn’t understand why one treatment wouldn’t magically fix her several decades of problems forever.
We discussed that she was still doing the same habits or triggers that caused her previous migraines. We needed to change her in order to stop the migraines. If she was still doing whatever caused the migraines, all we had done was treat the symptom, not the cause. She said she understood, thank goodness. This was going to be a battle of wills and I wasn’t going to give up on this mother, because a lot of people were relying on our success. I then asked her the question I had been dreading: How was she after the last treatment? I got a “fine” and that was it.
Let me explain, I am accustomed to patients not being very cordial the first few treatments due to the amount of pain they are encountering. Plus, by the time a patient gets to me, they have lost hope in the medical establishment and start becoming depressed due to hopelessness. Migraine patients have experienced severe pain for a long time and have lost hope for any cure. This isn’t unusual. Unfortunately, these patients are not tolerated by many healthcare providers and are labeled as “drug seekers or non-compliant.” This mother of three had been to medical establishments only to acquire enough medication to take down an elephant. The treatment of choice was sedation. During our first couple of treatments she admitted her frustrations with the typical treatment of migraines. On several websites, my type of care was actually frowned upon. Her family doctor also discouraged my type of treatment.
