Post-whiplash visit to physical therapist is certainly in order

DEAR DR. ROACH >> My sister was rearended last summer and suffered whiplash. She went to a chiropractor for adjustment, but that did not help. Ever since the accident, she has experienced excruciating head pain whenever she bends over to do anything! If she lowers her head at all, the pain is so intense that her eyes water. She’s gone to an ear, nose and throat doctor to check her sinuses (clear) as well as for X-rays and MRIs, and to another chiropractor. It’s been over five months, and she has found no relief, nor been given any reason for what’s happening to her. I’m 1,500 miles away and unable to help her. Do you have any suggestions for her? — M.N. DEAR READER >> The term “whiplash” refers to trauma to the neck that involves rapid flexion (like looking at the floor) and extension (as in looking up at the ceiling). It’s not clear exactly what causes the injury, but small amounts of bleeding and inflammation are thought to be part of the mechanism of injury. It is not uncommon to have a normal or nearly normal MRI, yet still have pain.

You haven’t told me whether she has gone to a physical therapist, which probably would be my recommendation. There is some evidence that massage therapy and a TENS unit may benefit a whiplash injury.

The headache getting worse on bending over is not typical. That is characteristic of a rare type of headache, one due to increased pressure of cerebrospinal fluid, the fluid that surrounds the brain. A visit to a neurologist would be worthwhile.

DEAR DR. ROACH >> My husband, 36 and in good health, was scheduled for surgery, and in the pre-op work, his blood showed elevated white blood cells. In particular, he has elevated neutrophils, monocytes and immature granulocytes. The other blood cells, including red blood cells and platelets, are normal. They scared us by talking about leukemia, and now we are both terrified. We will be referred to hematology. — H.M.B. DEAR READER >> Neutrophils, monocytes and immature granulocytes all are types of white blood cells, and part of what is called the myeloid line (“myeloid” is from the Greek word for “marrow,” and the myeloid line makes different cells from the lymphocytic line).

His results are suspicious for a myeloproliferative disorder (chronic myelogenous leukemia is one of these), and that visit to the hematologist is absolutely necessary. There are other possibilities, such as an infection, which can cause similar changes in the blood. I agree that an elective surgery should be put off until things can be made clear. After confirming these results, the hematologist may want to look at his bone marrow. A bone marrow biopsy takes a small amount of bone marrow from the hip. It is the definitive test for most blood disorders, like the myeloproliferative disorders and other leukemias. Genetic analyses are an important part of diagnosis now, so the results may take some time to be definitive.

At this point, I cannot be sure if your husband has a myeloproliferative disorder, let alone guess at which one it might be. The fact that the red blood cells and platelets are normal is a good sign.

Please let me know what the hematologist says.