"Wilma, I believe that is the best adjustment I have ever given you," I said.
"I agree. It did feel pretty good, Doc."
"Typically, you are tense and you are hard to adjust.
"We are and I am glad, Doc. It gives me time to ask you about something."
"What's that?"
"A few years ago, I was driving down the road and my right arm started feeling weak. I ignored it at first, but it got worse over the next few minutes. It got so bad that I started to pull over on the side of the road. I was afraid I wasn't going to be able to grip the steering wheel and thought I might lose control of the car."
"What happened?"
"Well, just before I decided to pull over, it went away. It just stopped. So, my question is, why did it come and then go so quickly?"
"To tell you the truth, I don't know," I admitted.
"What do you mean you don't know? You're supposed to know these things, Doc."
"You say it was a few years ago?"
"Yes."
"How many is a few?"
"Four or five."
"Did it ever happen again?'
"No."
"Do you recall it ever happening before that particular time?"
"No."
"Since it had never happened before, went away in a few minutes, has not happened since, and it has been years since it happened, it is probably nothing to worry about," I reassured her.
"But what could cause such a thing?"
"Again, I don't know. It was probably just a fluke."
"You're not going to offer a guess?"
"OK, let's look further. Did you go to a doctor when it happened?"
"No."
"What were you doing just before it started?"
"Driving, like I said."
"What were you doing during the 24 to 48 hours before it started?"
"I don't remember."
"Were you tense when it happened? You get really tense. Were you gripping the steering wheel really tight because you were tense?"
"I don't think I was tense, no. Well, I don't remember."
"Where were you going? Were you going to a funeral or something that would have upset you?"
"No, if I recall, I was just going over to my sister's house. You know Janet. I know that is where I was going because I think I remember telling her about it when I got there."
"Yes, I know Janet, and the two of you do seem to get along – there doesn't seem to be any tension between you."
"We're like sisters."
"That's funny, Wilma."
"Still no clue, Doc?"
"Ah ... how about resting your arm on an arm rest? The nerve that is known to create the 'funny bone' feeling can be irritated if you rest the inside of your elbow against something for a long time."
"No; like I said, I was gripping the wheel. I wasn't resting my arm. And I wasn't in the car very long. Janet doesn't live far from my house."
"No injuries near that time? Falls? Bumps or bruises?"
"None that I can remember"
"Wilma, since it was so long ago and you cannot remember many of the things that were going on at the time, it is almost impossible to tell what happened. The episode did not last long and it never happened again, so I really don't have a good guess. Maybe a muscle cramp?"
"Well I have had cramps occasionally and it wasn't a cramp."
"I really wouldn't worry about it any more, Wilma. I am sure it would be nice to know the cause, but obviously you did not wreck the car and your arm is still attached. We are at a dead end."
"Well, Doc, I thought if anyone would know, it would be you."
"I appreciate that, Wilma, but I am stumped. Like I said, though, I am sure it is nothing to worry about."
Easing the Patient's Mind
You're probably thinking what I was thinking as Wilma and I talked: This is an odd conversation. But if you have a few years of practice under your belt, I bet you have had one like it. These conversations are even harder if the patient is asking on behalf of a third party: "My Uncle Fred told me he was sitting at a stoplight one day and he got a really sharp pain in his back when a brown dog walked across the street. Now he gets the same pain every time he sees a brown dog. What causes that?"
After answering questions like these over the years, I started kidding the patients I thought had a sense of humor. Since most of the female patients who ask about these odd occurrences are older, I typically say, "In a patient your age, that is a sign of pregnancy." Unfortunately, I am not always good at determining which patients have a sense of humor, so my response has received mixed reviews over the years. I tell the men it is the antifreeze their (partner, spouse, etc.) is putting in their food.
For some patients, the symptoms are a point of curiosity; for others, it is a little more serious. The more serious patients tend to be the ones who worry or obsess over things. Particularly with these patients, you have to give a thoughtful answer, even if that answer ends up being, "I don't know."
Complaints of this nature generally don't warrant performing or ordering a battery of tests. A brief inspection of the area(s) in question, though, does help ease some patients' minds.
Making Sure: Questions to Ask
If the episode the patient describes was recent, but the description is still vague, tell the patient to note the circumstances surrounding the next episode, if one occurs. Have the patient make note of the information that was requested during the initial conversation:
- When did it occur?
- Where did it occur?
- How long did it last?
- What were you doing at the time it occurred, just before it occurred and during the 24 to 48 hours before it occurred?
- Did it happen again?
- How often has it happened?
- Were the circumstances similar?
- Did it prevent activities or events?
- Did you do anything about it (self-treat or see a health care provider)?
You also can instruct the patient to come in right away, if possible, should the symptoms begin again. Using what has become a universal recommendation in health care is also a good idea: "If you feel it is an emergency, call 911 or go to the closest emergency room."
It can be difficult to diagnose a patient when you are standing in front of them while they are having an episode or symptom. You are right there as it is happening, have resources for doing the job, yet you cannot pinpoint anything. It is tougher if the episode occurred weeks, months or years ago, the patient has a bad memory and/or it never happened again.
Personally, I never noticed any strange symptoms when I was younger. But once I reached the age of 40, I started having a few. Sometimes I could explain them; sometimes I couldn't. After I reached 50, I started having them more frequently and they are everywhere. I find these strange symptoms to be like stray cats: If I don't pay attention to them, they go away; if I do pay attention to them or "fret" over them, they end up like pets. Move along.
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