question

[2moml]

Hi!  Let me explain a little about my history.  I was diagnosed with Chiari in November of 2000.  I started having symptom that August when my son was 6months old.  I had surgery in Dec of 2000--craniectomy subocipital with cervical laminectomy posterior.  I went on to have another child (delivered by c-section, and I was knocked out because the anesthesiologist didn't want to risk messing with my spinal cord--no epidural).  A couple of years ago, I started getting bad headaches, but different then the ones I got originally.  I chalked them up to being either migraines (which run in my family) or sinus issues.  Last spring, my neck started cracking occasionally and when it did, it hurt like crazy.  I went to see a neurologist in Aug, and besides have bulging discs in my neck, he said there was a herniation again, but less than 1cm (not sure how much).  I also saw a neurosurgeon who confirmed it, and both said there was no compression.  I was put on some medication to help with some tingling I've had for years, which has helped greatly.  I had physical therapy for 3 months to help strengthen my neck and upper back.  I still have the headaches sometimes, especially with weather changes.  I have times when I feel dizzy for no reason at all, times when the room feels like its spinning.  I also have lower back pain (I had therapy for that years ago--I have a sway back, which is part of the problem).  I have noticed recently that when my lower back hurts, my legs hurt as well.  It's not muscle soreness, it feels more achy (like when you're sick).  I have had a couple of instances of memory issues (for instance, I went grocery shopping one day and didn't realize until 2 days later that I didn't bring home 4 packs of meat--I never noticed as I was putting up my groceries).  I also am at the age where I could be starting pre-menopause, so it's hard for me to know if some of my issues are due to that, just age in general, or the Chiari.

My question is this--I don't know what to do about work.  I work at a preschool, with children anywhere from 12 months-3 yrs.  This, of course, involves lifting at times (which I keep to a minimum as much as I can), and alot of up and down.  It is the time of year where I have to decide if I am returning.  I see my neurologist next month to discuss things with him, but I was wondering if I could get some opinions.  I know that lifting can affect my back, but can it make the herniation worse?  Can lifting too much cause a compression when there isn't one now?

Thank you in advance.  I really appreciate it.  

[selmaS]

  Well that could be part of the issue if the space is not large enuff to allow flow...who knows...A CINE MRI may help u figure out what is going on.

I know, I went to Drs when I was in high school long b4 MRI's were available...so it took even longer to get a DX....I really think this is y the info states it is asymptomatic till later in life...look at all the younger ones with Chiari...it was that MRI's were not there to be used to dx this....and the info on what is was was also lacking and still yet to catch up....but it is getting better.

[2moml]

Thank you for explaining about a dura plasty.  No, then, I don't have one.

I feel like there is so much that I don't know that I've only found out about recently (especially through this forum!).  When I was originally diagnosed, most of the information online was written for neurologists/neurosurgeons and very difficult to understand.  There is so much more out there now.

[selmaS]

  No a dura patch is tissue not bone....this is done when the Dr opens the dura during surgery and uses a patch made from bovine, cadaver, synthetic or ur own pericardium....this is to reseal it so u do not have a leak,

Those DX'd with EDS can have rejection issues with these patches if they r foreign matter, we need our own skin to be harvested for our patch...less risk of infection and rejection.

[2moml]

Well, I do know that he took out the base of the skull and put in a bone graft--is that what a dura plasty is?

I have never had a drop attack, but there are times when I lift that I will feel a little light-headed.

Thank you for all the info.  I am definitely going to ask my doctor about the CINE when I go back next month.

[selmaS]

  Hi...a CINE MRI is done to see if u have restriction to the CSF flow, this is one reason they do surgery is to restore CSF flow...a disruption in flow can cause a syrinx to form, having one is called syringomyelia...a syrinx can lead to perm nerve damage so u need to have MRI's to rule them out....a syrinx is generally only looked for in the cervical spine by most Drs, but they can form in the thoracic and lumbar spine too,

A dura plasty is done to help make more room, since this was not done I wonder if ur surgery was considered non invasive?

Lifting can be more problematic for u with symptoms, I do not think it should cause the herniation to worsen., the only thing is if u strain to lift and u have a CSF obstruction u may experience a drop attack which would not be good when holding a child....I do not know how u r being affected so, if u do not have the obstruction I do not know what may happen,....we r all so different.

ICP- they do a lumbar puncture or LP....they must be aware of the Chiari dx and surgery u have had so they draw slowly ,this done wrong can cause ur herniation to increase in size.

I have weather related issues too,...no ICP to date.

[2moml]

Thank you!

No, I do not remember my original neurologist saying anything about related conditions.  I was also never told I needed to be seen every 1-2 yrs, so this is the first time I've seen someone in 10 yrs.  I had gone back about 2yrs after my surgery when all the tingling started, but I was told it wasn't related to Chiari.  I had gotten the flu shot right before it all started, and I was under alot of stress, so I assumed it had something to do with that.

The MRI I had this past summer was neck/spine.  He didn't say anything about a CINE--what is that?  Is it a special MRI?

When I was originally diagnosed, the symptom I had was the horrible headaches that would come and go and feel like contractions.  Right before my surgery, I started noticing balance issues.  I feel like I was very lucky in that my original neurologist (who has moved across the country!) saw the malformation on my CT scan, and then ordered a MRI to confirm it.

I did not have a dura plasty (at least, to my knowledge).  When I went back to the neurosurgeon after my surgery, I asked him what exactly I had done (so I could answer correctly on other medical forms), and he told me exactly what I wrote above.  MY new neurologist didn't mention it, either.

Let me ask you this--what about the lifting?  Do you know if it can make the herniation worse?  I know that this is something I really need to talk to my doctor about, but I'm just trying to get an idea of the road I should take as far as work.

How do they test for ICP?  Sometimes I think I have that going on, especially when I feel alot of pressure, but then I think it could be the weather.

I just want to make sure  I make good decisions so I can be there for my husband and children.

Thank you again for your help!

[selmaS]

Hi and welcome to the Chiari forum.

May I ask, did ur original Dr check u for related conditions to Chiari b4 ur surgery...or since?

Syringomyelia, tethered cord, ICP, POTS, disk issues sleep apnea, ehlers-danlos, all can affect how we feel  and heal post op....and going forward.

A small herniation like u mentioned can still obstruct CSF....ask about a CINE MRI...could ne ICP...till u get the tests it is hard to say.

U did not mention a dura plasty....did u have one?