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Season 1: Episode 9 - Are You Someone We Can Help?

Season #1

In this episode, Dr. Mandy addresses the different types of patients she sees in her clinic. If you have scoliosis as a secondary diagnosis, have osteoporosis, are a woman in menopause, or even have spine issues from a traumatic injuries - then you need this episode.

Listen in to find out helpful tips and be sure to check out the links below for more information!

 

*****Resource Links You Need:

 

 *****Transcript*****

ā€ŠHi, I'm Dr. Mandy Dietz and you're listening to The Behind the Brace podcast. Each week I'll be sharing conversations and resources to help families and providers navigate the world of scoliosis. This is your place to find hope for a better solution so that you can live your best life.

Welcome back. This episode is called "Are You Someone We Can Help?" This week, I wanna talk a little bit about who we see in our office and what that looks like, and if it's something that could potentially help you. The majority of the patients that we see in our office are pediatric patients -so adolescents that have scoliosis, maybe have been diagnosed with scoliosis, or maybe they are worried that they might have scoliosis and haven't gotten a diagnosis yet.

The research shows us that up to 5% of the population of adolescents are affected by scoliosis and of that population, 10% of those patients actually have a really significantly delayed diagnosis. Which can be really important and can affect the treatment options, in a very, very big way because if we miss a diagnosis of a progressive scoliosis, sometimes that might change our options from being able to manage that with a rehabilitation program and potentially a brace to that Scoliosis now becoming surgical.

And instead of talking about how do we stabilize this and get correction of this scoliosis, we're now talking about how do we delay surgery or how do we prepare for a surgery and then a post-surgical recovery. So those are really important things to note. Of course, you know, the adolescent population is what we mostly think of when people think about scoliosis, they're, they're thinking about, you know, like in our generation, if we had the scoliosis checks in our schools. Which they don't typically do anymore. But, you know, as adults we're thinking about that. Like, oh yeah, we got checked for scoliosis when we were kids, and if something showed up, then they gave us a note, we went home to our parents and then we went to the doctor.

So I think that's what comes to mind when we're talking about scoliosis. And I will say that that's a, a very large part of my practice is working with kids. You know, mostly, I would say between the ages of like 10 to 16 and through there, we definitely have kids that we're seeing under the ages of 10.

Uh, the big thing to note with those age groups is if there's a history of scoliosis in your family or if you have any sort of indicators with your child that there might be a possibility of a curve. Especially if they're under the age of 10, make sure that they're getting checked appropriately, early and often because you wanna catch that ahead of time instead of finding it down the road maybe when they're 12, 13, or 14.

Because typically at that time, it's now a little bit less manageable, especially if it's progressed. So in addition to that population, we also see a lot of patients that have scoliosis as a secondary diagnosis. And so what that means is that someone has a primary diagnosis of something else, like for example, cerebral palsy or some other neurological diagnosis that affects muscle tone, or flexibility and increase in flexibility in their body, their joints and spine. In addition to that, it could potentially be secondary diagnosis to degeneration if we're talking about adults. So if we think about adults in their like fifties, sixties, or seventies. If we have a lot of degeneration, if we have a lot of spinal problems then sometimes what can happen is, is you can actually get a scoliosis or a kyphosis from something like that. So an example might be if we have an accident or something like that and the spine starts to degenerate.

It doesn't always just stay in the spot that it's supposed to. It can become unstable and then we get a scoliosis and those things tend to be really painful. And so a lot of patients come in, in that population in pain. And so the initial diagnosis would be whatever the injury would be, but then the scoliosis comes next or the kyphosis comes next.

In addition to that, one of the things that I really wanted to bring up today that might, might not be on everybody's, um, you know, at the front of their mind is sometimes we have kids and adults, I should say, with different types of leg length inequalities. So essentially you might know somebody that maybe in like third grade they fell off of a slide and broke their leg.

Or if you have like an athlete and they have a fracture in their leg somewhere and it hits the growth plate, it can affect how the bone grows. Or you might have a leg length inequality from something else, like a medical condition, uh, or something of that nature where one of the legs actually grows longer than the other.

It's not extremely common, but it is something that happens and that can cause a scoliosis. So if you think about like a building, right? If we have like a 10 story building. If at the very bottom, if we have a six inch difference, by the time you get to the top, that whole building is going to be leaning over.

It's the same thing with the structure of our spine and our body. So if something happens to one of our legs where it doesn't grow the same as the other, or if we have some type of condition that affects the growth of one of your legs that can actually create that tip on the base of your pelvis and then a scoliosis forms.

So I work with quite a few patients that are younger, that have had that happen. So most of the time it's something that happens like early on, like maybe grade school, or something from birth that causes the bones to grow not quite how they should. So that's something that we definitely want to address early.

So most parents, if they're told this, they're not necessarily told that that problem can create a scoliosis. It's something that just shows up down the road. So if you're a parent or if you know somebody that has had something like that happen, or there's a problem in like the leg length equality of, of somebody, you know, if give them a heads up because most of the time doctors don't talk about that and then they get like a year or maybe two years down the road and they just happen to find, they're like, oh, you have a scoliosis.

Well, we know that that's an indicator that can show us that a scoliosis is much more likely if you have an unstable base. The same thing can be for something going on with the, the pelvis or in your hips. So it would be things like hip dysplasia or if you have any sort of traumatic injury to your pelvis.

So whether that's an accident or you know, something from birth or something that comes from a different type of condition. Anything with the legs, anything with the pelvis. It's actually responsible for almost half of the scoliosis cases that show up in that low to low back into the middle back because it shifts your pelvis and then your body tips to try to compensate from that.

And over time it develops into a scoliosis. So if you have any sort of indication that that's something that's coming about, make sure that you have a proper assessment to make sure that your spine is developing, growing appropriately. And that's, you know, obviously for children when they're growing, but we can have those same types of injuries as adults if you have an accident and have a, a fracture in your leg or if you have a surgery or even sometimes I have seen adults, if they have a hip replacement or a knee replacement, sometimes that can affect the structure of your legs and your pelvis, and then over time, a scoliosis can develop even as an adult.

So those are things that aren't talked about a whole lot, but are really important because I keep seeing it over and over in my clinic and people just aren't made aware of it.

In addition... so a lot of times when I'm talking to people, they think that we work mostly with really significant or severe cases, so surgical cases or cases that need braces, and we actually see a really large, uh, group of adults.

Well, not just adults, adults and children that have more mild cases. So if you aren't needing a brace, if it's not a surgical recommendation, oftentimes you're just told like, okay, you know, you're lucky counting your blessings, you're on your way. We don't need to do any of these interventions. Over time, even those mild cases can develop into a more significant, I don't wanna say problem, but a more significant, has more of a significant effect on your life. So maybe you're not having pain or a lot of symptoms and maybe it's not preventing you from doing the things that you want, but over time you might notice it more or you might notice how your clothes fit a little bit differently.

A lot of women that come in will talk to me about how they look in a bathing suit because their rib cage might be shifted. They might feel like their posture's a little distorted or one shoulder's higher than the others. So more of an aesthetic effect. And those are a lot of things that we can pretty easily do an assessment and give some treatment recommendations and work through that. And they use that in conjunction to the things that they're already doing.

So, most of these people are already doing, you know, whether it's chiropractic care or maybe they're doing some massage or physical therapy or acupuncture or you know, yoga, any of, any of those types of things. But what we recommend and really help implement are scoliosis specific things that can actually correct the posture.

It can actually correct the imbalances that they see, and if they are having any sort of symptom or any sort of noticeable change in how their body's functioning, it can really show them how to incorporate those things in their day-to-day life so they can use it as they do normal things. So that is a huge population of people we see, and I think a lot of people just aren't aware that we have the ability to help with even those more minor things that you can pretty easily work through and then just carry those tools with you in the future.

A couple of additional things, and this is one that just recently I started talking to patients about in my office, and nobody's talking about this one either really, until it's a big problem. So, perimenopause, menopause, and osteoporosis are things that really affect scoliosis. It wasn't until I started seeing more of an adult population, a lot of these patients are patients that either maybe had a more significant scoliosis but didn't have surgery, or maybe they had a, a more mild scoliosis. And when they were turning 18 and being discharged from their pediatric provider, they just said, okay, you know, you're done growing, things are stable. You're, you're good. Go on your way.

But what they don't talk about, and what a lot of people don't know is that even with those more mild cases. When your hormones start changing, when you start going into that like perimenopause and menopause, we start to see some changes. And so if we have any changes in bone density, we have changes in hormones, we can actually see progression of a scoliosis in that period of time.

And that's often where I'll see women coming in, in their fifties or maybe in their sixties, and they'll come in and they'll tell me that they've got, you know, really bad low back pain or some other type of symptom that's affecting them or they'll kind of have a story of, you know, they told me I had a curve when I was younger. It wasn't a big deal. I've just noticed over the last five years or eight years that it's slowly gotten worse and I've been noticing this more, and now I'm having these troubles. And I would say most of these patients have not had any type of scoliosis follow up. Mostly because they weren't told that they needed to.

And so we don't really have x-rays, even sometimes I've had patients where they had an x-ray 35 years ago, but have had no x-rays or no evaluation since then. So we will get the, maybe the report or maybe they have the report from when they're a kid, and then we'll do the new x-ray and we'll see where they have like 20 degrees of progression from when they were a young adult over their lifespan.

And now as an adult they have this really high unstable degenerative curve and they have a lot of pain. And so when we go back and we look at that and we think about when that started to happen, typically it's when they start to go into menopause. And when I ask these questions, a lot of them might say that they have had an osteopenia diagnosis or an osteoporosis diagnosis.

And we link all of those things together and they're really big risk factors for progression of the curves for having a lot of changes in the curves and women just aren't made aware of it, they, it's not something that is top of conversation. And sometimes I think even in the history, like maybe we go to our OB's or our primary care doctors, and we might be talking about this, but if we were diagnosed at a young age, like maybe in high school that we had scoliosis, or maybe they did the scoliosis check, and they're like, ah, don't worry about it. It's not bad enough. It's not at the forefront of our mind. And now, you know, 30 years later we're in front of our whatever doctor we're seeing, and we might be talking about our, our women's health and different things.

And that's not something that always comes up because I've had a lot of patients say, gosh, like I didn't even, I didn't even talk to my OB about the fact that I had scoliosis. And it's not something that I find that our primary healthcare doctors bring up either in that stage. Which is really interesting because the more I talk to women in my office, I'm like, gosh, we should be having that conversation with women this age.

Just like we're having the conversation with teenagers as their curve may or may not be progressing. So we've been able to help a lot of patients with things like that even at a later stage. So I bring that up, we're gonna have another topic on this where it'll go really more in depth with this, but if this is something that you find yourself in. I would just say if you're in that stage and you know that you have any sort of history of scoliosis, make sure that you have that evaluated and that you have it checked and do it early if you can. And if you kind of miss that part of your life, like it's never too late to come in and get it checked because we wanna make sure that you're stable.

So one more group of patients that we see in our office, and this is kind of more of a group of people too that is also not talked about are people that have more traumatic injuries, so that could look like a lot of different things actually. Um, I've had really young kids or kids in their twenties that have been either like on a motorcycle or a dirt bike or doing like motocross stuff, and maybe they take a jump and they land on the other side and they land wrong or they hit wrong and they have an injury where maybe now they've got a compression fracture in their upper back, or I've seen a compression fa fracture in their lower back.

And even though they're young and they have no history of a scoliosis or a kyphosis, now all of a sudden we have an issue with the spine and they have lots of pain and they have other things going on that are affecting them. And this is also something that you know, that maybe they go in, they go to the doctor, they go to the emergency room, whether they're in a brace, they're in a cast, they get healed up, they go to PT, they're discharged.

Nobody really talks to them about the long-term effects of what can happen to their spine after an injury like that, especially as they age. Sometimes those traumatic injuries might be more so in adults. So whether that's a car accident, whether we are having, you know, we have a fall on the ice, or I've seen like somebody fell out of a tractor in the wintertime and ended up having a fracture on one of their vertebrae in their spine.

Things like that. So really any sort of trauma to the spine has an effect on it, obviously. And so whether it's somebody who's young or whether it's somebody who's in their 20s, 30s,, even fifties or sixties, right? That can affect how the spine functions. It can affect the presentation, the biomechanics, and if there's a fracture, something that changes the bone over time.

If that isn't protected, stabilized, and if we don't deal with that, that's where it's not immediate. Right? Not in three months or six months even necessarily. But when I see people come into my office, they'll say something like, oh yeah, you know, five or six years ago I had this thing happen, or you know, I had this accident and it didn't really bother me, but over the last couple years it's been getting worse.

And then sure enough, we take an x-ray and where that x-ray might have been when they had that fracture and where it is now, we've seen degeneration and we can actually have. You know, a scoliosis that comes from that, or even that, you know, kyphosis problem, um, because we've got the fracture on the front of that vertebrae.

So that's something too that I really wanna share with people because it's not always just a straightforward diagnosis, that we talk about. Like June is scoliosis Awareness Month, and most of the time the picture that comes up are young kids. They might be in a brace. Um, they were talking about, you know, idiopathic scoliosis is always at the kind of top of mind of everybody.

But there's all these other situations that come into play with that. And so that's why this week I just really wanted to talk about, you know, are you someone that we can help?

Because it's not always straightforward. It's not always the clear cut scoliosis diagnosis. And then so sometimes people feel like, oh, I'm on the fringe of this diagnosis.

It's not the norm- like, I don't wanna say normal, but it's not the typical presentation that people think of. And even the providers that you're seeing may not be aware that there are things that you can do to help that. Mostly because we haven't had these resources in our community up until, you know, the last 10 years.

And so, just not even being aware that some of those things can be connected in ways that we can work with the providers you're already seeing. So for example, if you've got a neuromuscular scoliosis, we work with the team of providers that you're seeing as well. So you might have a neurologist on board, you might have a physical medicine doctor onboard. You might be seeing a PT for other things like gross motor or high tone or low tone, things like that. And so that's where we're, and in, in addition to, not in replacement of, but these are the, the things that can really help you day to day that can give you the tools as you move forward in life.

Because as you know, if you have something going on in your spine, it's not something that just magically goes away. So we have to try to incorporate that into your day-to-day activity and how do you manage your health as you move forward? So I'm super excited that I was able to share these things with you today.

This is something that's just been, you know, rolling through my head over the last couple of weeks as I've been seeing patients in and out of my office, and these different conversations have been coming up, because most people just don't know that the resources are there and are available. So we'll have some links attached to this episode so that you can kind of check out what we have to offer.

Just a reminder too, we do complimentary discovery calls. And essentially what that is, is if you contact our office and you're not sure if it's something that we can help you with, we schedule just a 15 minute call. And if you have x-rays or CT scans or MRIs or anything like that, we'll have you shoot those over ahead of time. And then also just fill out like a, you know, a quick questionnaire kind of just telling us about your history. And then we just jump on the phone with you and we talk through a few things to see, you know, is this a place for you that we can. Help you or do we feel like we need to refer you someplace else? Is it a good fit? So if you're interested in that, just get ahold of our office. You can find us, we've got all the links here, whether that's through our email or our social media or, or through our office. So, we will be back in, the next couple of weeks with some more information and thanks for listening.

Thanks for spending time with me today. If you could leave a review before you go, that would help us reach more people that need this message. To learn more about the services and resources that we have available, visit us at behindthebrace.com.

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