Tips From The 2014 Omaha Medical Education Forum

Did you know that I can still remember clearly all the things that I learned from the 2014 Omaha medical education forum? The speakers for the said event did great in sharing their knowledge to all the participants. I felt like I got the best value for my money because I did not only get a chance to acquire new learning but also to connect with people who are from my circle.


In the said event, I was reminded of the importance of taking good care of one’s health. When it comes to being healthy, it does not only refer to being physically okay but also in having a stable mental condition. Mental health is also as important as physical health. Below are some of the strategies that I learned during the forum:

  • Be mindful of what you eat and drink. Take note that some of the common illnesses and diseases are caused by obesity. As such, you have to start choosing a balanced diet on a regular basis. Do not give it to temptations. Eva Selhub MD says that, “Eating high-quality foods that contain lots of vitamins, minerals, and antioxidants nourishes the brain and protects it from oxidative stress — the “waste” (free radicals) produced when the body uses oxygen, which can damage cells.”
  • Talk to the right people all the time. Avoid those who will only bring in negativity in your life because they can affect the way you look at things. “Staying involved with people who constantly try our patience, attempt to involve us in unhealthy interactions, undermine our own beliefs, and demand allegiance to their own cause above all else is a painful and exhausting ordeal, to say the very least. Abigail Brenner M.D. points out. Instead, surround yourself with positive individuals so that you can attract better things in your life.

Get enough sleep every night. As much as possible, avoid exhausting yourself because it will only lead to some personal issues. The more you sleep late, the crankier you become the following day. “When your body is sleep deficient, it goes into a state of stress. The body’s functions are put on high alert, which causes high blood pressure and the production of stress hormones,” Mark Stibich, PhD adds. For this reason, it is best if you follow a bedroom schedule so that you will not have a hard time going to sleep.


Make sure to practice the tips mentioned above for a better and healthier life. Start living the life you deserve today.



Recognizing Chiari Malformation In Babies

“Chiari malformations, types I-IV, refer to a spectrum of congenital hindbrain abnormalities affecting the structural relationships between the cerebellum, brainstem, the upper cervical cord, and the bony cranial base,” wrote Peyman Pakzaban, MD.


The symptoms of Chari Malformation in adults are difficult to notice since they do not necessarily occur. How much more of a challenge it is in babies? However, given it can be congenital or present at birth, diagnosis can be as early as infancy.


According to Mark Luciano, MD, PhD, Bryn Martin, PhD, Phil Allen, PhD, and Francis Loth, PhD, “While Chiari crowding may occur in 1 to 3 percent of the population, symptoms may occur in only 0.06 percent.”


It may be challenging to say if there is something we should concern ourselves as parents about our baby’s behavior. They are after all hard to understand as they may throw a tantrum from time to time. They are also prone to getting illnesses such as flu, fever, and other infections. So how do we know if what we see is already serious?


What Are The Signs of Chiari Malformation In Babies?



 1. Misshaping Of The Skull 



Chiari malformation may be congenital and hereditary, and its symptoms may begin to show during infancy while your baby develops. The obstruction and accumulation of cerebrospinal fluid in the brain cause pressure and can then change the shape of the skull entirely.



 2. Minimal Cognitive Function


Cognition includes our ability to comprehend, concentrate, and remember. When your baby is behind his cognitive developmental milestones, especially when he becomes a toddler, it could be a sign of Chiari malformation. It may also include poor communication and use of words.



3. Choking



Difficulty swallowing is alarming already, and it could worsen as it could be a sign of Chiari malformation. There are times when your baby has problem eating or drinking as if he is choking or something is obstructing his esophagus



4. Bone Defects



Chiari malformation has a direct effect on the spine, but it also affects the surrounding structures. It could appear as if the bone is too thin and weak to support the body. 



5. Premature Spine



Having a premature spine is normal for babies since they are still developing. There is a condition called infantile scoliosis which could very much be a sign of Chiari.  It could begin due to the misshaping of the skull.



6. Spasticity



Spasticity or the sudden involuntary movement of the muscles can also be a sign of Chiari. For instance, your baby would suddenly move his head or his extremities, and it seemed to be beyond his control.



7. Vision Problem



You might notice an involuntary eye movement, and there is a noticeable difficulty following objects. Infants should be responsive to their surroundings, but if they seem to be not responding to actions and lights, it could be a sign of Chiari.



8. Breathing Problem



Difficulty breathing especially when sleeping or sleep apnea could also be a sign of Chiari. You notice the abnormal breathing pattern and the constant grasping of air.



9. Ear Problem



Tinnitus or ringing in the ears could also be a sign of Chiari since it is a condition that starts in the brain. It could affect the senses including hearing since the ears are near the base of the skull.



10. Trouble sleeping




Babies have variation in their sleeping patterns like when they tend to stay awake when we expect them to be all tired and sleepy. They may have trouble sleeping at times caused by discomfort. In Chiari, it frequently happens, and your baby seems not to sleep anymore.


Chiari malformation can affect anyone, and though its symptoms are quite tricky to see as they may seem typical, when they happen or occur altogether, it could be a sign that you may need to visit a doctor to find out for sure.


 It may seem as if Chiari malformation does not pose a threat, and it is not fatal, so there is a chance that parents wouldn’t bother to pay close attention to it. However, this condition can eventually affect a person’s way of functioning, hindering a smooth and happy life. It is imperative that as parents, we are aware and vigilant about the matters surrounding our baby’s health.


Jeffrey W. Campbell, MD, reminds parents, “Many kids with Chiari I malformation do not have symptoms and never need treatment. But call your doctor right away if your child does show any symptoms, such as headache, balance or coordination problems, changes in pee or poop habits, or voice changes.”

Arnold Chiari Malformation, Diabetes Mellitus, And Vertigo: Which Is Which?

It is difficult to confirm whether you have Chiari malformation or not because its symptoms are common among many diseases such as diabetes and vertigo. The only way you can find out for sure is to consult your health care provider as you have to undergo some tests including MRI or a CT scan.


Arnold Chiari malformation and vertigo are diseases affecting the brain while diabetes is a chronic disease affecting the whole body. These three should be dealt with caution since they are directly distressing balance and other essential functions for daily life.


What Are Arnold Chiari Malformation, Diabetes Mellitus, And Vertigo And Their Symptoms?


What Is Arnold Chiari Malformation?


Arnold Chiari Malformation is a structural abnormality of the brain particularly the cerebellum which controls coordination, balance, and motion. It is at the base of the skull, and in Chiari malformation, it extends into the spinal canal. It causes pressure on the brainstem and spinal cord, obstructing the flow of spinal fluid.


Symptoms Of Chiari Malformation I:


  • Headache 
  • Occipital headache (worsened pressure like coughing and sneezing)
  • Neck pain
  • Numbness of upper extremities
  • Weakness or Loss of strength in the extremities
  • Dizziness
  • Loss of balance
  • Vision problems
  • Hypersensitivity to bright lights
  • Sleep apnea


Signs and symptoms of Chiari Malformation I may not occur, but when they do, they can appear or manifest alone or along with the others. According to Ryan W Y Lee MD, “Chiari type 1 refers to herniation of the cerebellar tonsils alone, and radiologically as simple tonsillar herniation 5 mm or greater below the foramen magnum.”


Symptoms Of Chiari Malformation II:


  • Involuntary downward eye movements
  • Weakness in the upper extremities
  • Breathing problem
  • Gag reflex problem


Signs and symptoms of Chiari Malformation II may come from issues related to myelomeningocele or hydrocephalus.


What Is Diabetes Mellitus?


Diabetes mellitus is a disease that affects the body’s ability to use the energy from food properly. It is when the pancreas is unable to produce enough insulin or none at all. It is a problem since insulin is a hormone that helps the body convert sugar to energy. “Early symptoms are related to hyperglycemia and include polydipsia, polyphagia, polyuria, and blurred vision,” Erika F. Brutsaert , MD notes.


Symptoms Of Diabetes Mellitus:



  • Increased thirst
  • Increased hunger
  • Dry mouth
  • Urinary frequency
  • Weight loss
  • Weakness
  • Vision problems
  • Numbness or tingling in the extremities
  • Delayed healing of wounds
  • Dry skin 
  • Itchy skin 
  • Persistent yeast infections


What Is Vertigo?


Vertigo is the feeling of losing balance when standing up or walking. There is also the sensation that makes you feel like you or your surrounding is spinning. It can be from a problem in the ear where there is calcium formation in the canal of the inner ear called canaliths.

“Persons with Chiari may develop vertigo after spending some time with their head inclined on their trunk. Thus the Chiari can cause cervical vertigo,” Timothy C. Hain, MD wrote.


Symptoms Of Vertigo:


  • Ringing in the ears 
  • Spinning sensation
  • Tilting
  • Swaying sensation
  • Loss of balance
  • Pulled to one direction
  • Headache
  • Involuntary eye movements
  • Nausea
  • Vomiting
  • Sweating


Arnold Chiari malformation, diabetes mellitus, and vertigo have similar symptoms, and though they may appear to be simple, they will eventually affect how you function since they can cause loss of balance, weakness, and others which are hindrances to completing daily tasks.


Doing a self-treatment is a tremendous risk since early diagnosis is crucial in managing diseases. You need to consult a doctor right away to find out for sure, especially there are series of tests that need to be undertaken to rule out the other conditions. People are often scared to know the diagnosis, but they should be more afraid when they do not get the appropriate treatment early on because their situation could worsen.


It will help if you treat your body as an ally. It shows symptoms to ask you for help that it needs thorough attention. You must take care of it and get treatment for even a headache. Your feeling should always be great, and if you feel otherwise, going to the doctor is a treat that you shouldn’t be depriving yourself.


I Found Out I Have Chiari Malformation: Wait, What?

I am on my mid-30s, and as of this age, we are all expecting to have a little weirdness in our body. However, mine was a little too extreme for me. I came to the point where I suspect myself of dying from cancer. I thought of several diseases that could be causing the suffering I am feeling.

For over ten years, I was working as an executive secretary, working in front of a computer all day, doing all tasks and errands from the bosses. I was experiencing overwhelming stress, and I thought this contributed to the way I was feeling lately.


For the past year, I was feeling weak, having headaches and vision problems which were understandable given the nature of my job. I went to see an ophthalmologist, and I had my first eyeglasses. He said my eye problem could probably be due to my exposure to radiation, looking all day in a monitor.


At first, the eyeglasses helped. I had fewer headaches than before, but eventually, my condition worsened. I had funny gait. My colleagues would often comment that I walk like a drunk person, and would often tease me, “It’s too early for a drink!”


There were times I had stuttering and neck pain, and I thought I was having a stroke. I looked up on the internet regarding my symptoms, and I suspected my condition to be diabetes or vertigo. It was tormenting not to know what exactly I was experiencing, but then, I was too much of a coward to find out. I was afraid that the doctor might say I only have a few months to live.


Then one day, the beginning of the revelation of my life happened. I was as usual busy at work when I decided to get some coffee because I was feeling sleepy and lazy. On my way to the pantry, I felt dizzy and lost my balance. It was a good thing the glass wall at my senior’s office caught me. I couldn’t stand up for a while, and one of my colleagues saw me sitting on the floor. She called for help, and I was rushed into the clinic. The nurse said I needed to see the doctor as soon as possible. My condition could be nothing, but it could also be something, so I better find out.


The next day, I got a day off, and I went to see the doctor. I was hesitant, but I did it to free myself from the fear of knowing my condition. He reviewed my medical history and my symptoms. He also conducted a physical examination and requested that I get an MRI or magnetic resonance imaging. It is a test to diagnose Chiari malformation. It uses radio waves and magnets to resemble the body and creates 3-D images of physical oddities inside the brain that could mean an illness like the Chari malformation where the cerebellum extends into the spinal canal.


At last, the result came, and I was positive for Arnold Chiari malformation type 1. I mean, what? He said this type of condition could only manifest during late childhood or even adulthood which what happened to me. He also said that since my case was not severe, I will only be under medications and not a surgery where they need to eliminate a part of the bone at the back of the skull and to take away the pressure in the brain caused by the extension of tissues into the spinal canal.


Having Chiari malformation made me incompetent in my job as I couldn’t move much like how I used to, and the simple task of getting documents from another department became a challenge for me. I realized that we should never ignore any symptom, that anything we experience outside of the normal is worth a visit to the doctor’s clinic. Now, I can sleep well, and all it took was a confirmation that I’m going to be okay.

Treatment Options For Adults With Arnold Chiari Malformation

Arnold Chiari Malformation is usually developmental, meaning that they are formed as the body develops before birth. Many Chiari patients, though, don’t present with symptoms until they reach adulthood. They also don’t receive treatment until they are older. But for those with symptomatic malformations but have unsuccessfully to non-surgical treatments, there are several tested and proven surgical treatments available.



Conventional And Minimally Invasive Treatments


These are the two general options that the surgeon will use. Conventional or traditional surgery involves open surgery, which includes cervical laminectomy and decompression surgery. These two procedures have been proven to treat patients effectively. 


However, with the advent of new technology, minimally invasive surgery has become possible. This involves the surgeon using specialized medical equipment to make very small incisions to decrease blood loss and tissue damage. 


Majority of patients who can undergo conventional surgery can also opt to do the minimally invasive approach. In fact, in the current years, specialists have preferred the traditional method because it is equally effective and with more advantages to patients.


Some benefits can Chiari patients can expect from the minimally invasive approach include: 


  • Lesser pain and shorter hospital stay
  • Shortened recovery time
  • Decreased blood loss
  • The procedure is shorter than the traditional approach
  • Relatively quicker time to go back to work and do normal daily activities


A List of Surgical Treatments For Adults With Chiari Malformations


There are several options that patients can choose from to help alleviate their condition. However, it is important to remember that the goal is one and the same – to increase space for the brain and spinal cord and decrease the pressure that has been building up in the said structures. 

  • Decompression Surgery. This is the most common procedure preferred by patients and used by surgeons. What the surgeon does it primarily incise the patient’s neck from the back to remove a small part of the skull. He then opens and expands the dura mater. Minimally invasive decompression is another option that results in decreased pain and healing time and reduced hospital stay.




  • Cervical Laminectomy. This procedure can be used together with decompression surgery. Aside from removing a portion of the skull, the surgeon will also remove a portion of the upper vertebrae to make more space within the spinal cord. These two procedures combined results in an increased space in both the spinal cord and the cerebellum.




  • Spinal Fusion. For a Chiari patient with spinal instability, spinal fusion is the treatment of choice. The head and neck are protected by placing specialized instruments in the skull and upper vertebrae. Fusion material is also inserted to connect and join the two structures together and form a single structure. Few weeks post surgery, the patient is required to wear a cervical brace to limit neck movement. Physical therapy is also recommended.





  • Transnasal Decompression. The surgeon approaches the front of the skull through the mouth or nose, and then he removes the bone. This procedure, which is rarely used, is done on those patients with other skull deformities. 




  • CSF Diversion. Cerebrospinal Fluid Diversion is the treatment of choice when there is a buildup of the CSF within the skull. A tube is implanted to ‘divert’ the fluid to another part of the body, usually to the abdomen. This provides a quick resolution to the increasing intracranial pressure, and patients are relieved immediately after the procedure.



Which Is The Right Treatment For You?


Your surgeon may have already suggested the treatment that is appropriate for you, as Chiari malformations are different for every patient. The doctor chooses the treatment according to your previous medical history, current age, and weight, or medications that you are recently taking. If you are older or have preexisting conditions, traditional surgery may increase your risks.



Some patients may not qualify for the former and are candidates for the minimally invasive approach. If they are, then choosing a Chiari specialist is advisable – someone who has trained specifically for the meticulous procedure. 


Now that these procedures have been laid out to you, you will be more confident to ask any questions or discuss concerns that you may have. Consequently, you are now able to better understand what your health care team will be explaining to you about your procedure. The next thing that you should focus on is your successful recovery.