By Tedler D. Depaynos, MD
Due to the strict quarantine, their food supply became limited. Although they can go to the groceries on their scheduled time and can order their kitchen needs to be delivered, they started planting various vegetables using used plastic containers to add to their limited backyard. Her husband remedied where their “sayote” vines to grow by tying wires leading to their balcony. Because of the rainy season their “sayote” production was good so that they even shared some to their neighbors.
The patient who is about to reach her senior year never encountered any problem harvesting. In one occasion however while tilting her head upwards, she suddenly felt something “snap” in her neck. There was a little pain but she was able to finish what she was doing. While cooking later, as she suddenly turned her neck when her husband called her, she felt another “snap” which was followed by dizziness and later vomiting when she tried to lie down.
The patient then had a series of sudden severe episodes of vomiting which practically emptied her stomach and made her weak. Dizziness was worsening and objects before her appeared to be inverted and even the persons in front of her talking, seemed to be lying down or horizontal in mid-air. She was manifesting severe vertigo! It was only lessened by non-movement of her head but closing her eyes worsened the condition so that she has to keep on staring forward. She has to lean then on piles of pillows to maintain her upward stance and tried to be comfortable. Since it was night and the patient felt weak and tired she eventually fell asleep and was not brought to the hospital.
With non-movement of her head, gradually she felt a little comfortable. Her husband attributed the attack to the various medicines she was taking and initially felt like throwing them away.
After a few days she again began to have a series of similar attacks so that she was practically carried finally to the hospital with a towel wrapped around her neck. A cerebral attack was feared considering that she had a history of hypertension and Diabetis Mellitus despite her various medications. Actually she was also taking medications for her “hyperlipidemia” and “joint pains”. Those who brought her to the hospital were praying that her condition was not something very serious.
Considering the “snapping” of the patient’s neck that initiated the initial attack, the young consulted MD examined the patient’s neck before referring the patient to the Ear Nose Throat specialist because vertigo maybe due to the patient’s feeling imbalanced. There may be something wrong with the patient’s inner ear.
The MD felt tenderness and firmness at the patient’s nape and when the neck was bended laterally and turned even very slowly, the patient began to feel dizzy again and wanted to vomit. A neck problem was then entertained and when a plain x-ray of the neck was done, signs of “degenerative arthritis” were appreciated with “narrowed disk spaces” or probable “compression deformities”. A CT Scan was thought of but because of the patient’s severe manifestations with just a little movement of her neck, this was delayed. In layman’s terms, the attending MD surmised that some sensory nerves exiting from the cervical spine or neck vertebrae were probably suddenly compressed during the “snapping” incidents causing the dizziness, vertigo and vomiting. He also mentioned that this may be the reason that Pres. GMA was wearing a neck brace. He then advised her companions to be likewise be careful in harvesting their “sayote”.
Degenerative Arthitis or Osteoarthritis is mainly due to “wear and tear” and “old age”. The cartilage in between the vertebrae degenerate so that the intervertebral spaces or the space in between the vertebrae are narrowed. There may be lateral growth of the bone called osteopyhtes, which may contribute to the compression of the exiting nerves.
The patient then was given medications to relieve her of her neck pains and stiffness. Various medications for her dizziness, vertigo and vomiting were also given. A neck brace was fitted to steady and to prevent neck movements. Actually, it is more of a reminder to be careful with her neck movements.
She was then referred for Rehab, but the Specialist MD decided to do the procedure when the manifestations of the patient would improve. The Rehab MD advised that massage together with hot compress may relax the muscles because contraction of the muscles due to pain may help narrow the intervertebral spaces. Neck traction was also thought of to widen the intervertebral spaces relieving the compression on the exiting nerves. The compressed nerves may also become edematous so that healing may take some time.
With improvement after a few days, the patient was insistent of being discharged from the hospital and promised to return for follow-up, for further work-up and for probable rehab despite the objections of her young MD. Actually she became fearful when she learned that a Covid patient was recently admitted in the hospital. **