Rachel's most memorable case

What is one of the most memorable cases I've had?

This is always such a difficult question! Having been in practise for 24 years now, I’ve had the privilege of treating so many awesome patients and such a variety of conditions. However, one that stands out was in my first year of practice. 

It was Cauda Equina Syndrome. I have only seen a handful of these over many years, so it is pretty uncommon and is a medical emergency, which is probably why it stands out when I was much less experienced! 

A 38 year old lady presented with acute and severe low back pain, which radiated down both her legs. She had numbness in both feet, which were also weak and unsteady. It was difficult to examine her as she was in so much pain. As chiropractors we are used to low back pain and often accompanying leg symptoms. 

A disc prolapse is a big cause of nerve compression, which results in pain along it’s path, changes to sensation and also muscle strength. Most of the time a prolapse is on one side, causing symptoms in only one leg. A central disc bulge is less common but will often result in bilateral issues. A very large central disc bulge, which is even less common, can press on the spinal cord and affect the function of the nerves that supply our bladder and bowel. 

We always ask disc patients about bladder and bowel habits - have there been any changes to frequency, sense of urgency, ability to control these functions etc. The lady that attended my clinic, at the time, had no symptoms in these areas. I told her she needed an urgent MRI scan and to go to A&E. She had an appointment with her GP the next afternoon so wanted to wait for that. The next day I called her in the morning to see how she was feeling, and she had just experienced loss of bladder and bowel function. She was taken to hospital and had surgery the next day. If left, there can be permanent changes to organ function, causing incontinence as well as other neurological deficits. 

It was certainly an eye-opener for me and served as a reminder to always ask the right questions and always be thorough, even if you’re not suspecting anything complicated! 

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