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Can I be a nurse with Chiari Malformation?

Nurse Beth   (137 Views 1 Comments)
by Nurse Beth Nurse Beth, MSN (Advice Column) Writer Innovator Expert

Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

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Dear Nurse Beth,

I am an LVN that just applied for my associate nursing degree. I was just diagnosed with Chiari Malformation type 1. The tonsils of my brain are 6.5 mm below the foramen magnum. If it reaches 7 mm then she will recommend surgery. She said it will most likely not change, but she said "do not lift over 10 pounds" anymore to prevent further injury/dropping of the tonsils. I love being a nurse, but I don't understand how to be a nurse who can not lift.

Dear LVN,

Herniation of the cerebellar tonsils into the cervical spinal canal through the foramen magnum is a structural condition called Chiari Malformation. The cerebellar tonsils should lie no more than 3mm below the foramen magnum. 3mm-5mm is considered borderline. According to Conquer Chiari.org, disruption of cerebral spinal fluid and symptoms may be a more significant indicator of severity than descent of cerebellar tonsils.

The most common complaints are pain, headache, weakness and paresthesia of the upper extremities. Type I can develop in infants, children and adults while Types II and III are present at birth. Type I is the most common type and may or may not not cause symptoms.

Have a conversation with your neurosurgeon about the fact that restricting you to lifting no more than 10 lbs basically means you cannot work as a nurse. Is this his/her conservative opinion, or is  there evidence behind this restriction? Do you have symptoms or this this an incidental finding?

It can be hard to find an expert with experience in this field as it's not a recognized sub-speciality. How many surgeries has your doctor performed and how many patients have they seen with this condition? You must do your due diligence research. There is not consensus on when surgery is indicated in patients who have few or mild symptoms.

At minimum you need a second opinion. I would find the best doctor possible, and then follow her/his instructions.

Best wishes, 

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

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