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Picture a delicate dance between the brain and the spine – a choreography that, when disrupted, can lead to a mysterious and often debilitating condition known as Chiari Malformation. In this episode, join host Dr. Kevin Pecca as he delves into the intricate world of Chiari Malformation with special guest Dr. Christopher Loy. Together, they shed light on the symptoms, treatments, and ongoing research surrounding this neurological condition. Dr. Loy talks through the anatomy of the cranial cervical junction, where the brain and spine meet. He explains what differentiates between true Chiari malformations and those induced by trauma, offering clarity on the distinct diagnostic approaches. The discussion then takes a turn as the hosts explore the symptoms that commonly accompany Chiari Malformation. From brain fog to headaches, numbness to depression, and even vision problems, the intricate interplay of the cranial cervical junction becomes clear. Dr. Loy also underscores the importance of considering even seemingly minor traumas as potential triggers for these symptoms. The journey to understanding Chiari Malformation is a collective effort. By embracing diverse perspectives and advancing research, the medical community is paving the way for enhanced treatments and improved patient outcomes. Join us and be educated with Chiara Malformation.
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Chiari Malformation With Dr. Christopher Loy
Symptoms, Treatments, And Research
We have a very special guest, Dr. Christopher Loy. Dr. Chris is an upper cervical chiropractor out of Middlesex, New Jersey at Upper Cervical Chiropractic of New Jersey He's an excellent guest. We are going to talk about a topic we’ve never touched on before, Chiari malformation. This is a big topic in the upper cervical world because there are a lot of people suffering from this. We are going to identify what it is, what causes it, how it can be helped, and everything you need to know about Chiari syndrome.
Read up because it goes undiagnosed a lot and it can help out a lot of people. If you want to, follow me on Instagram and TikTok. You could also watch these live episodes on my YouTube and on Facebook @MontclairUpperCervical. Be sure to leave the show a nice review and share it. It helps spread our message. Hope everybody likes this episode and more on the way. Cheers, love.
We have an amazing guest for you, Dr. Christopher Loy. Dr. Chris has an upper cervical practice in Middlesex, New Jersey, Upper Cervical Chiropractic of New Jersey He's an excellent upper cervical doctor, very passionate about what he does. I'm excited to have him on the show because we are going to talk about one topic we have never touched on in upper cervical. Without further ado, please welcome Dr. Christopher Loy. How are you?
Doing well. How are you?
I am doing well. I'm always fascinated by why people get into upper cervical chiropractic, even chiropractic because upper cervical is pretty rare. I love hearing stories about how people find it and why they do what they do. What made you pick chiropractic in general, want to become a chiropractor, and then, we'll get into why you chose upper cervical?
I had a lot of athletic injuries growing up. My background is undergrad, I was an athletic trainer. My twin brother was diagnosed with Chiari malformation and learning more about it in school, it was a presentation by Dr. Julie Mayer Hunt, who practices Orthospinology down in Clearwater, Florida. She did a presentation on it where you can see those cerebellar tonsils.
As they start to dip down through the foramen magnum of the skull into the upper cervical spine. Seeing those tonsils receding back up into the brain, I was like, “This is it. This is what I need to do.” Their only option is basic surgery where they have a massive decompression surgery. I got this gnarly scar back here. The outcomes aren't always the greatest. I even talk to the surgeons.
Did your brother have that?
He's got that.
He had the surgery.
He can't see traditional chiropractic with the whole rack and crack him. Me using a sound wave percussive instrument to adjust the top of his neck gets rid of his migraines, and his overall health is improving his affect and quality of life, you can tell he gets his life back.
What were some of the symptoms your brother had that you guys were like, “Something's going on and we need to fix this?
He played baseball. Anytime he would lookup for a fly ball and his head comes back to the middle, instant headache. He would describe it as a tug of war from front to back. They're pulling and wrenching. He'd be out for 30 minutes to 2 hours type of stuff. It made it tough to play sports. He started having more cape distribution like loss of sensation on the upper back, and then also loss of grip strength, numbness, and tingling in the hands.
How old was he?
We're twins. We were 12 or 13 and he had the surgery when we turned 14.
Back up, what did you guys do? You have blaring headaches and other weird neurological stuff going down the back. What was the first thing you guys did? What doctors did you see?
We see a conservative chiropractor. He was diversified, Dr. Keith Wilson. He is no longer in practice, but phenomenal chiropractor. He is the one that found it, saying, “There's something else going on here. We got to dive deeper.” He sent him to a neurologist, then went to Hackensack, New Jersey to go see Dr. Friedman, who was the surgeon who did the surgery. He is a great guy. He eventually had to have that. Pretty much a chiropractor who found it, but I like to think now knowing after going through the upper cervical diplomate and everything I've learned with upper cervical, could it be possible that we caught this sooner? We don’t know. I know for future patients, I want to try to do everything I can.
What is Chiari malformation? I was born three months early. I was a preemie. I was diagnosed with it from birth. I remember having to go to the neuropsychologist or neurologist when I was about 10 or 11. They put all these electrodes in my head. They were testing to make sure everything was functioning well.
It was never like, “We need to fix this.” It was always in a good position where we didn't need to do anything. It's interesting because I always had chronic sinus infections and headaches, but not to the point where it was almost life-altering like your brother’s. I don't know if that was from an upper neck misalignment, Chiari malformation, who knows what came first, or if it was causing symptoms. What is Chiari malformation and the different types of Chiari malformation?
Hans Chiari was an Australian pathologist who essentially pioneered a lot of this. Normally, if you're looking at a side view of the skull, and if you look back, maybe that the frontal lobe is going to be here on my left, and then the cerebellum and base of the skull are going to be down here. Your cerebellum has these two tonsils.
Typically, they need to be superior to the foramen magnum which is the big old hole at the base of the skull. Normally, the tonsils are about 1 millimeter above the superior margin of the foramen magnum, but when we lay on our back, those tonsils are about 3 millimeters above the superior margin of the foramen magnum. With any type of a Chiari or also a CTE, those tonsils descend down through the foramen magnum at any magnitude.
It could be 1 or 10 millimeter but any abnormal because it's going to obstruct the flow of the CSF or the Cerebral Spinal Fluid, essentially making what we call the craniocervical junctions with the top of the head and the skull meet a choke point. I’ll go into the difference between Chiari and CTE. A true Chiari malformation is a congenital malformation. That was the hand that you're dealt, which is what you're born with caused by flattening of the occiput, the back of the skull, and causing those cerebellar tonsils essentially to descend down through the foramen magnum.
Cerebellar Tonsillar Ectopia or CTE is also caused by trauma and instability of the craniocervical junction, causing those tonsils to begin to pull down an arachnoid cyst or an enlarged cisterna magna. It's important to have a good DDX or differential diagnosis between a Chiari and CTE. A lot of times, an upright and a recumbent, meaning lying on your back, MRI is going to be your best gold standard to differentiate that.
Somebody gets that recumbent MRI. They're told they have Chiari. What do people do after that?
We first want to diagnose if it is coming from a congenital abnormality or trauma. With Chiari, there are five different types. There is no official consensus because research is always constantly going on. A prime example would be concussions back in the ‘90s and 2000s, it was okay if you got a concussion. Wake them up every hour. We know not to do that anymore. Chiari is often undiagnosed and considered normal. It's very symptomatic.
It could be that the cerebellar tonsils are 1 millimeter, but for a true Chiari, it's not within that threshold. If it's between 3 and 5 millimeters, that protrusion of those cerebellar tonsils, that's typically known as a Chiari Type 1. Chiari Type 2 is a protrusion greater than 5 millimeters but also will have spinal bifida and tethered cord. Chiari 3 is very similar to the second one, but the occiput is going to be far higher or having like a higher cervical more of a congenital abnormality. Chiari 4 is of the cerebellum and Chiari 5, unfortunately, typically, doesn't thrive after birth but it's the absence of the cerebellum on the occipital lobe because they descend in through the foramen magnum.
What symptoms might people want to get checked to see if they've been to a couple of places? What symptoms do Chiari commonly present with?
The patients may present with similar or the same symptoms as a Craniocervical syndrome. They could experience brain fog, headaches, numbness, and tingling in the fingers. They could have a lot of throat and GI issues. Headaches, pain, depression, fatigue, and trouble sleeping are typically some of the most common types.
I always ask my patients on their first day, “Are there any traumas?” A lot of times they'll say no. Even if it's a fender bender, there's no threshold of saying, “You went 5 miles per hour. You're totally fine.” That force has to go somewhere. If you are misaligned, especially at the craniocervical junction and your body cannot take that force, then things are going to shift. That can potentially exacerbate a lot of these types of symptoms or could be the thing that pushes them over the edge.
I have many patients that we do a detailed history in the beginning, “Any car accidents? Any slips or falls? Did you fall when you were a little off the swing set?” We rack their brain for everything. A lot of people say, “No. I've never fallen in my entire life,” then we take the 3D X-rays and their upper neck is a mess. They have misalignments on both sides. That goes to show you there's no disc space up there. It's a very vulnerable area. It doesn't take much for that upper neck area to misalign. A lot of people reading this saying, “I never had a big trauma, but I'm experiencing these symptoms.” It doesn't take much. It could be you got pulled out of the birth canal too hard when you were little.
It's fascinating because a lot of times, even diving deeper into finding out when looking at their images, you can start to tell, “This injury has been here for 5, 10, or 15 years.” I have a quick little story about that. I was looking at one patient who wasn’t having a Chiari-type presentation or CTE, but more vision floaters. I go through this history. I was like, “It looks like you had a trauma to your neck around C2, C3, and C1 many years ago. I said, “Does anything ring a bell?” He goes, “No.” He goes home. Mother comes back and she says, “When he was fifteen, he tried to hang himself. How did you know that?”
I was like, “Thanks to Dr. Kessinger. He taught us how to look at the biomechanics of the cervical spine to see where the trauma is and be able to determine based off normal physiology and Wolff's Law. When you have any of those types of misalignments and trauma to that area in the soft tissue, the body's not going to forget an injury. Your first scar is your belly button. Your body's not forgetting that.” You try to go back and provide good information for the patient like, “This is not permanent. We can help. You're here. I'm happy you're here.”
Going back to the hanging situation. You found something on the X-ray that pointed to a trauma and then you asked the patient if he tried to hang. How did the hanging thing come up?
He didn't want to bring that up. When he went home, he talked to his mom like, “Chiropractor was saying this. I'm going back the next day to get my first adjustment.” The mother was already a patient, came back, and explained, “He tried to do that, but he's not going to tell you about that.”
Dr. Chris is a psychic. I thought you told the mom that story.
I apologize. Mom told me.
That's a terrible thing. That will cause some trauma in the upper neck. How does upper cervical care tie in helping Chiari?
I never want to say and promise somebody. The nice thing is that as we are growing as a profession, a lot of the old school MDs and PTs are starting to fall by the wayside, and a new generation of like, “Let's help. It's not just about me, the PT, or MD. It's about the patient. We have to make sure we all come together.” I never tell patients that I'm going to treat their Chiari, “I'm going to treat the misalignment that's resulting in the symptoms. The true diagnosis would be this. However, this is what we're working on.” At least this way, the other healthcare professionals are like, “He's not trying to treat everything. He's going very specific on his approach and how to help this person as well too.”
That's more how I go about it. That craniocervical junction is that choke point. If you have that type of misalignment, especially how the atlas is going to start to loudly translate and begin to rotate, it's going to alter the fluid dynamics. Your CSF going up and down through the brain and the venous drainage is also going to cause a choke point, which I apologize, that makes me think of two.
Some other symptoms where a patient might have some like abnormal feelings in the arms and legs, vision problems, difficulty swallowing, ringing, and buzzing in the ears, vomiting, insomnia, and depression, especially with increased intrathecal pressure. If they bear down and go to the bathroom, cough, or sneeze, that causes more of an increase in headaches. That's very common.
With the upper cervical adjustment and the analysis, you're putting that first bone, the atlas back in place to help restore blood flow up to the brain down back to the spinal cord, help the drainage of the cerebral spinal fluid that can get backed up when there's a misalignment, cause some head pressure and things like that. It's taken the pressure off the spinal cord and the dura itself. Making it more comfortable for the person to live and perform daily activities.
To identify these altered hemodynamics of fancy term for the fluid going up and down from the brain to the body, the best imaging would be a phase contrast. Upright MRI is typically the best. That will identify the presence of any abnormal CSF flow like 3D animations. The CSF flow studies can also identify turbulence and flow, the velocity of abnormalities. The CSF is jutting out certain spots. Like in an MRI, you'd be able to see what we've noticed like CSF pooling where you'd see almost an increase in CSF at one part of the brain compared to the other.
That could be Chiari.
That could be more the misalignment of the atlas, but also seen with Chiari or Cerebellar Tonsillar Ectopia.
Is there a difference in treatment whether it's Chiari or it's the one that's induced by trauma? Do you go about it differently or is it the same?
It’s typically the same. I have taken the upper cervical but I've been trained in Grostic, Advanced Orthogonal, Atlas Orthogonal, and Epic. I use an instrument adjustment because I'm not as skilled as you are with my hands as a Blair adjuster but it would still be the same.
Is there any research on Chiari malformations pre-upper cervical adjustment and post of it getting better, the tonsils going back up, anything, like millimeters? Do we have any of that yet?
I'm sure it's out there. I don't have anything off the top of my head, but the two people that I would say for all the readers to look into would be Dr. Julie Mayer Hunt, Orthospinology. She practices in Clearwater, Florida. Also, a gentleman named Dr. Scott Rosa is up in Rochester, New York. He's an AO or Advanced Orthogonal practitioner. His one research study, the craniocervical junction syndrome rings a bell. It's a free PDF, a fascinating read. He goes over all of the anatomy, the physiology. He has pre and post. The man is a research guru. Dr. Scott Rosa works with a gentleman named Dr. Hartsfield, who works at Hopkins. Those would be fantastic resources to dive deeper into it.
Anything else you wanted to cover?
I can go over a little bit of clinical considerations.
As far as any other insight into clinical practice, treatments, upper cervical or not that will help the readers that are going through Chiari
You're going to want to try to find someone that understands something known as lines administration and identifications like on an MRI. Typically, some clinical considerations would be retroflexed dens which is very common meaning. The dens is like a big thumb, but it's more flexed back. That can also maybe change your approach a little bit.
There's a bone that comes off your C2. If you have X-rays and no one's ever told you if that top bone on C2 is being pulled backward, that might be consulting with a radiologist and your doctor. That might be an indicator that there might be some Chiari malformation going on on your X-rays.
You want to work with a radiologist or chiropractic radiologist known as a DACBR who's going to look at a lot of these measurements. Another one would be like your Grabb Oakes line if it's over 9 millimeters. That's typically you'll have any type of ventral and posterior brain stem compression. McRae’s line is also the gold standard with the tube. Typically, you'll see that the cerebellar tonsils are 5 millimeters below.
Typically, with that type of imaging center because one of the best images is upper upright MRI and you want your sagittal, coronal, and axial, which should be at a 2.8-millimeter slice because we want to get specific into it. Typically, those types of MRIs take a little bit longer, but we need to see what's going on in that craniocervical junction.
Dr. Chris touched on this before. There are several different upper cervical techniques. If you follow me on Instagram and TikTok, you've seen my adjustments, it's done by hand. What's interesting with Dr. Chris is he uses instrumentation sound waves to put that upper neck bone back in place, which is awesome for people that don't want a twist-crack-pop adjustment. He was mentioning before, his brother has Chiari malformation. He has to be extra gentle and precise while adjusting his brother. Chris, explain the technique you do and what it's all about because it's different than what people are used to or haven't even seen before.
It's table mounted instrument. If I have this little pen, that would be a little stylus. When I click the button on top of it, it will send a sound wave percussive instrument to come through. I always get the questions like, “How can sound move a bone?” Sound is traveling through the air as potential energy. It's coming through your speakers.
As that sound travels, it's going to hit your ear, travel through the Eustachian tube, your canal, hit your tympanic membrane, your eardrum, and then it's going to oscillate the three bones. That's how your brain perceives sound. It happens all the time, especially even with kidney stones. There's something known as lithotripsy, which uses a percussive sound to help break up calcium or those kidney stones. This technology's been around since the late 1970s and 1980s precise way to help realign everything in the upper neck.
It's so light and gentle. How can you tell if you move the bone?
With our technique, we need to take 4 pictures, 2 from the front, 1 from the side, and 1 from over top to get a 3D image of how the atlas is misaligned, then do my analysis. I get the vectors on how to best correct it, then have them come in, explain everything to them, and lay them out on the table. It is a sideline adjustment. You take the phone. That's going to lay right here on the side then the stylus will go behind the ear then you hear a little click. Afterward, I'll go back to the X-ray room, and take two after pictures. I can see and measure specifically how much we reduce that misalignment of the atlas. Also, what else do we need to take care of them?
This is also upper cervical. We want to give these adjustments as few times as possible. We want it to hold in place and let the body heal. Although it's a different type of adjustment, it's the same goal in mind, clearing out the interference in the upper neck and letting the body heal from a ton of different neurological issues. It could be even neck or back pain. You put that first bone in the neck back in place and you see a lot of amazing things happen and it could change somebody's life like mine, your brothers, and many people. That's what we're trying to do.
We spread the message of upper cervical chiropractic. It's always cool to see how well it works with conditions like Chiari, vertigo, and brain fog because people go everywhere. When they're suffering from these issues, they'll get MRIs and CT scans, and sometimes, they're left with no answers. Upper cervical has been able to give a lot of people those answers and help them get their life back. I know Dr. Chris sees that in his practice. We see that in our practice. Chris, tell us a little bit about your practice. It's in Middlesex, New Jersey.
I've been in practice for many years. I was originally at two offices up in Connecticut. I decided to move back to New Jersey because that's where I was from. My wife and I were talking about starting a family. It's going to be a lot easier having grandparents around when that happened. I moved back to New Jersey, open up a small little practice in Middlesex, New Jersey, and practice upper cervical, but also look at other parts of the body as well, but I always start from the atlas and then work my way down.
Where can people find you online, on social media, and things like that?
The website is NJChiro.com. You can find me on Instagram. Hopefully, in the near future, we'll be working on some video or YouTube-type channels as well. Being in practice in New Jersey, things are going pretty well.
I'd like to ask this question at the end of all my shows to all my guests. What is one piece of advice that resonates with you that you would like to gift to the audience? It could be anything.
I'm going to steal this from a great man named Dr. Robert Brooks, who unfortunately passed away a few years ago. He was a neuro practitioner, but he always described that the truth in life is in looking at the truth. In that paper bag, there are these little holes on the front, the sides the top, and everybody's looking into that bag trying to look at the truth. Everyone's saying like, “It's my truth. This is the only way. This is the way I'm seeing it.” If we take a step back and look at how everybody else is looking at too, we're going to do much better as professionals and as human beings and be able to accept and understand how people think and come to a conclusion. It creates a nice dialogue to be open so we can best help people.
Our profession is coming a long way, upper cervically. I feel like many years ago, everybody thought their technique was the best. Now with the upper cervical diplomat program where a bunch of brilliant people is coming together, the techniques are coming together, the technology's getting better, and we're helping more people. There are not a lot of upper cervical doctors out there. If there's not a Blair doctor around, I have no problems referring anybody out to a different upper cervical chiropractor as long as they're doing upper cervical and clearing out the interference in the upper neck. That is a beautiful thing. Keep doing your thing. Have an open mind when you're listening to other people and you could always learn something from somebody.
Thank you much for coming on the show. Would love to have you back on any time you are crushing it in practice. I hope everybody enjoyed this episode. You can find my Instagram, TikTok and Facebook @MontclairUpperCervical. You can also email me at DrKevinPecca@Gmail.com. Thank you, everyone, for reading. Have a great day. Cheers, love. Chris, thank you much.
Thank you.
Important Links
- Upper Cervical Chiropractic of New Jersey
- Instagram - nj.chiro
- Instagram - Dr. Kevin Pecca
- TikTok - Dr. Kevin Pecca
- @MontclairUpperCervical - Facebook
- DrKevinPecca@Gmail.com
- YouTube - Dr. Kevin Pecca
About Dr. Christopher Loy
Dr. Loy earned a Bachelor's degree in Athletic Training from Springfield College, where he was named a multi-year Academic All-League player in Lacrosse.
After his graduation, he encountered a neurological chiropractor at a medical seminar, and his career path was forever altered. He enrolled in the Doctoral Studies program at Palmer College of Chiropractic to help patients of all ages and fitness levels to not only get well, but stay well for life.
Dr. Christopher Loy has completed a post-graduate certification in the Diplomate of Chiropractic Craniocervical Junction Procedure. With a strong background in interdisciplinary care, he prioritizes patient-centered care and works with a team of diverse healthcare professionals to address all of the body’s systems.
He is married to Dr. Clare Henry. They met at Springfield College where she completed her doctorate in Physical Therapy.
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