NH Eval Clinic LLC

10/30/2025

We are eager to hear about your experiences and results with hydroxychloroquine. Our patients have reported impressive benefits, including reduced brain fog, increased muscle strength, and relief from chronic nausea.

Can you tell us about your experience?

10/28/2025

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10/27/2025

A patient had an upright MRI done to rule out cervical instability. The radiologist reported slight disc herniations. Nothing else.

When I review the images, I see:

☑️Arthritis of the Dens indicating chronic hypermobility

☑️Cerebellar ectopia of about 4mm (mild herniation)

☑️Disc bulging exaggerating with flexion and extension

☑️Evidence of instability by CXA and Grabb-Oaks measurements, both worse in flexion

☑️Brainstem compression in flexion

☑️The potential for CSF flow impedence

Have your images reviewed by someone who specializes in hypermobility disorders and who recognizes CCI.

10/27/2025

There are two ways of measuring the clivoaxial angle (CXA) for CCI on MRI. These are both well-documented and used by radiologists reviewing images. The first image demonstrates the CXA using the soft tissue as markers for the angle, which measures 124.7º.

The second image demonstrates the CXA using the bony prominences as markers, and the angle measures 138.4º. This is a huge difference, which can mean the difference of having 'concerning' instability and 'pathologic instability'.

A "normal" CXA is between 145º - 155º, and a reduction of about 10º is expected with flexion, and increase of 10º with extension.

From our research, the most widely accepted measurement uses the soft tissues as markers. When compared to CT scan images using bones as landmarks for the CXA, the measurements are within an acceptable range (+/- 2º). Additionally, upright/open MRI has more shadowing, which may have a wider variability of bone density. Therefore, we have adopted the technique of using soft tissue when measuring the CXA.

And yes, this patient has CCI based on the CXA. We perform additional measurements, including Harris' measurement, Grabb-Oaks measurement, and basin-dens interval (BDI).

10/26/2025

Mast cell activation syndrome (MCAS) symptoms vary substantially among patients, ranging from mild to severe. Commonly, patients present with fatigue, shortness of breath, and chronic gastrointestinal symptoms.

First-line treatment typically involves nonsedating antihistamines, such as Zyrtec, Claritin, or Allegra, often combined with Pepcid or Tagamet. These medications are usually administered once or twice daily. Alternative prescription options include Singular, Cromolyn, or compounded Ketotifen.

Notably, diagnostic testing for MCAS has limitations, with approximately 51% of patients with symptoms obtaining negative results. Therefore, clinicians must be prepared to listen to patients' concerns and consider aggressive treatment despite negative test findings.

10/25/2025

POTS & BEYOND 2025 CONFERENCE
November 21 | 22
Join Virtually! See you there.

HYBRID CME Conference Join us in person in Salt Lake City, or online from the comfort of your own laptop—it's your choice! WHAT: POTS & Beyond is a two-day...

10/25/2025

Dr. Klinge's presentation today highlighted the importance of clinical evaluation in diagnosing occult tethered cord syndrome. According to Dr. Klinge, prone MRI is not necessary for accurate diagnosis, and standard MRI may not be diagnostic. Many patients have been accurately diagnosed despite normal MRI findings.

Dr. Klinge emphasizes the importance of a thorough physical examination and attentive listening to patients' symptoms. Commonly reported symptoms include buzzing sensations in the leg, leg cramping, muscle fatigue, leg heaviness, and bladder dysfunction.

Physical examination findings may include hyporeflexia, foot clonus, and tight leg musculature. Dr. Klinge stresses that imaging should not supersede history and physical examination.

Imaging is necessary to rule out alternative problems, such as tumors, infections, or disc herniation. Tethered cord surgery may improve headaches in patients with coexisting Chiari malformation by altering CSF flow.

Patients with EDS are inherently prone to occult tethered cord syndrome due to complex collagen issues. It is essential to be vigilant for patients with joint hypermobility and lower extremity weakness.

A huge thank you to Dr. Klinge for sharing her expertise. ❤️

10/25/2025

Dr. Petra Klinge, MD will be speaking about tethered cord syndrome in RI today.

10/25/2025

The evaluation of CCI demands a discerning eye and meticulous assessment, though the process is not inherently complex. Nevertheless, CCI assessment is not typically included in cervical spine imaging protocols.

Therefore, we undertake our own measurements and consult outside specialists when necessary. Our findings indicate that numerous individuals with hypermobility syndromes exhibit mild to moderate CCI, but surgical intervention is almost never recommended. Instead, stability exercises, bracing, and proper posture often help reduce pain and instability.

10/24/2025

Upper cervical instability (UCI) is characterized by craniocervical and atlantoaxial instability. I believe the term “Candy” is synonymous with this condition. Have you come across this term in your experience?

These symptoms are consistent with UCI. It is unfortunate that most radiologists do not meticulously assess the cervical spine for instability or hypermobility.

10/24/2025

To arrange a consultation, please call our office or schedule online.

Our free consultation offers a chance to learn more about our provider, diagnostic testing, and treatment options. We have extensive experience treating patients with hypermobility disorders, which are often misdiagnosed or overlooked by other offices.

Our patients typically suffer from chronic pain, severe fatigue, migraines, positional dizziness, and symptoms consistent with MCAS and POTS. These symptoms often appear during teenage years and intensify with adulthood. We recognize the complexity of conditions stemming from connected tissue disorders.

If you would like to learn more about our New Hampshire Evaluation Clinic, please register for a free consultation to meet with our medical provider.

10/24/2025

This thought-provoking question was posed on another page, and I wanted to share it with you.

Are you still masking your pain and fatigue, or is this strategy contributing to your exhaustion? Many people find that hiding their emotions drains their limited energy resources.

If you identify with this sentiment, it may be time to seek help. The NH Evaluation Clinic has provided effective support to hundreds of patients struggling with chronic fatigue, severe pain, autonomic dysfunction, and profound cognitive dysfunction/brain fog.