Question
OK, with that said......... (by the way, it's great info) I have a consult for bariatric tomorrow and plan on having WLS as soon as I am allowed. Because my health care is limited (because I only have Medicare) can you advise me on where to start.  True enough it is a very ugly thing (the hump) but more than that I cannot stand, sit or walk for prolonged periods.  I have to have various rubs put on it daily and the  pain is beyond words. The pain medication doesn't work so I just suffer with it every day.  I really believe that this is the cause of my slow downward spiral into a depression.

Can you tell me a specialist in Dallas, Texas who accepts Medicare for this condition? I am at wits end for help! I am willing to do what I need to do to correct it but I don't know where to begin.
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The text above is a follow-up to ...

-----Question-----
Can this hump be corrected............EVER?  I am 38 with 3 children, 5'11" and 360lbs.  I am in the process of weight loss surgery (hoping that will help ease the pain of the hump) Here lately, the pain is getting harder and harder to take but my doctor only gives me mild pain meds and never addresses that issue or treatment of the hump.  Any advice?
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Dear Starla,

We have some issues to handle:  First of all, yes getting rid of the excessive weight is going to help the problem from a gravity and stress perspective, but it will not solve it.  A dowagers hump can easily be the result of multiple factors such as:  forward head posture, rounded shoulders and a kyphotic spine, being overweight, thryroid dysfunction, trauma to the thoracic spine (kyphoplasty proceedures help), or congenital malformations of the thoracci vertebra.  This is a multifaceted question.

Being 360 lbs, I am assuming that you already have thyroid problems...most likely hypothyroid.  You are also likely to be in adrenal fatigue due to prolonged cortisol release, and probably already have pancreatic trouble...may be diabetic.  The bottom line is that there is endocrine dysfunction for sure and may encompass all of the above or just some.  When this happens, the body is prone to fat deposition, and consequently we often see fat deposited in the upper back and neck.  This may contribute to the problem.  Cushings Syndrome would be an advanced form of endocrine dysfunction due to high cortisol levels,high ACTH levels, or steroid usage...this may be where you are headed.  It should be obvious from the above that weight loss is important for your overall health even more than to eliminate the dowagers hump.

Posture:  Again this is very important...you have alot of extra stress on the spinal column and cord due to the added weight on your frame.  If your posture is poor (very likely) then you are compounding the increased loads even further.  Forward head posture causes a host of systemic (body wide)problems, but the 1st and main problem is with the eck and upper back.  Research shows that this posture directly increases ligament strain, disk degeneration, muscle stretch and contraction, as well as deconditioning of the multifidus muscle which is the prime stabilizer of the disk and the facet joints in your spine.  Some quotes:

揂bnormal postures are well known to play a role in the causation of pain and functional impairment leading to disability.? Calliet, R. M.D., Low Back Pain Syndrome, Edition 4, Pain Series, F.A. Davis Company Fourth Printing, 1991, pgs. 5-8 and 26-43.

. {Dr. Alf Breig, Neurosurgeon and Nobel Prize Recipient stated, 揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? 

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000.  

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.}

Now if you have a previous trauma or congenital defect in the upper thoracic spine, then you are going to have more difficulty with the hump.  If the underlying structure has been not only functionally changed, but the bones are mechanically deranged individually, then a proceedure such as ballon kyphoplastic or vertebroplasty may give you benefit.  Kyphoplastic is usually nused in acute traumatic cases like compression fractures.  Others have used a similar proceedure called vertebroplasty to aid in the redction of bony abnormality.  You would have to be screened, and discuss this with an orthopedic surgeon, radiologist, and or neuro surgeon for a more indepth review and examination for efficacy.

Lastly, if you do lose the weight, and you do not have a traumtic collapse of the vertebra, then you can actually be helped by a technique in chiropractic called Chiropractic Biophysics.  You can check out the technique at www.idealspine.com.  I have seen profound changes in patients who have been treated this way in my clinica and in other clinics around the country.  If you so choose this option, make sure that you find a doctor who is certified in the technique for the best examination and results.  You have to get the weight down first though...probably need to be under 200 lbs before this technique will be an effective choice for you.

Listen Starla, don't give up.  Do explore your options, and make damn sure that whatever you pick, you remain committed to the process.  This will take some time to address properly, testing your mental fortitude, stamina, and will.  You are way too young to not do this, and your children will be counting on your for years to come.  Don't let your current docotr stand in the way of your health...see 15 different ones if that is what it takes, and remember you may need the combination of a medical and chiropractic courses of care...I would actually recommend that.

Respectfully,
Dr. J. Shawn Leatherman  

Answer
Dear Starla,

Bariatric is a good first step, but remember that the procedure is a crutch and that continued resolution of the weight problem is up to you...dietary intake, exercise, supplements etc...  With the bariatric you will have to be on nutritional supplementation, make sure that it is quality...not store bought.

Concerning the endocrine function/dysfunction, I want you to read a few books...don't worry bariatric takes time and you will be able to get through all these books.  The information is paramount.

1.  Adrenal Fatigue- James L. Wilson, N.D., D.C., Ph.D.
2.  Living Well with Hypothyroidism - Mary J. Shomon
3.  The Antidepressant Fact Book ?Peter R. Breggin, M.D.
4.  Potatoes Not Prozac: Are You Sugar Sensitive? - Kathleen DesMaisons, Ph.D.
5.  Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol - Mary G. Enig, Ph.D.
6.  The Schwarzbein Principle - Diana Schwarzbein, M.D.
7.  The Schwarzbein Principle II - Diana Schwarzbein, M.D.
8.  The Omega RX Zone ?Barry Sears, Ph.D.
9.  Health and Nutrition Secrets That Can Save Your Life ?Russell Blaylock, M.D.

The above list is not to be considered comprehensive, but it is pretty close.  The information is amazing, referenced well, and comes not only from evidence-based research but from clinical practice as well.   The 摂know your fats敂 book is pretty complex, and you may want to save it for last.

Now concerning the chiropractic part...structural rehabilitation, the first thing you can start doing is self traction while lying on your back.  This is simple and requires no special education/training/or devices.  You simply lay flat on the ground with your palms facing upward.  This will probably be difficult for you (due to weight and posture), may cause added discomfort, but start slow a few minutes at a time working up to 25 minutes 2x a day.  If you cannot lay flat on your back, try a small pillow under your neck with the realization that the pillow needs to be removed soon so that you can progress.  You should not experience any sharp pain. **It is also possible that this will reduce the blood supply to the legs because of your weight pushing on the aorta.  If your legs feel any numbness or tingling, you should take a break, and keep the legs moving while lying down.  Flexing the muscles every minute or so will do the trick.

For advanced structural rehabilitation...post weight loss, I would consult either Dr. Scott Buchanan (214)327-9222, or Dr. Stuart Meyers (214)828-1212, both are in Dallas and have extensive training in Structural rehabilitation.  You will have to discuss payment terms with them.

Respectfully,
Dr. J. Shawn Leatherman