DEAR DR. ROACH: My 11-year-old daughter suffered a stress fracture on her lower spine a couple of years ago from doing back handsprings in gymnastics. She wore a back brace for a while, and now has no more problems in that area. However, her upper back/shoulder area has never been the same. We went to several orthopedic pediatric surgeons, who dismissed her problem, so we started her with a chiropractor, who gives her relief. She started out going several times a week and now is going just when she needs it.

However, the last orthopedic surgeon we saw (we visited him two different times) makes us feel guilty and says we are harming her by letting her spine be adjusted. Is this correct? We really like this chiropractor, and he seems very knowledgeable. I know of several children who go to chiropractors. Are we really doing our daughter harm? — J.B.

ANSWER: Chiropractic manipulation is mostly safe, and has been found to be an effective treatment for adults with back pain. The data on effectiveness in children is less clear.

By “mostly safe” I mean that there is one form of chiropractic manipulation — rapid velocity neck manipulation — that, rarely, can cause severe side effects, including stroke and death. To be fair, treatments ordered by orthopedic surgeons, such as anti-inflammatory agents, also rarely cause serious side effects. Still, I strongly recommend against rapid velocity neck manipulation in both adults and children. I don’t know what the chiropractor is doing for your daughter, but I understand that many chiropractors use light thumb pressure alone for their therapies, especially in children.

I think an important point here is that your daughter is getting benefit from the chiropractor, and on an as-needed basis. It’s also important that you had her evaluated by orthopedic surgeons who presumably demonstrated the absence of orthopedic problems. As long as the chiropractor is avoiding the dangerous form of manipulation, I think the possibility of harm is remote.

DEAR DR. ROACH: I am a healthy 68-year-old female with a family history of pancreatic disorders. Do you know of any genetic testing available to determine whether I am predisposed to suffer from any pancreatic disorders?

I am a retired registered nurse who worked for an endocrinologist for several years. She has suggested that metformin may be advantageous, as it has been shown to reduce pancreatic cancer by 65 percent. Do you have an opinion on this?

I have asked my general practitioner these questions, but he does not currently have the time to investigate this on my behalf. — P.M.

ANSWER: Pancreatic cancer remains a feared disease, as I have discussed in several recent columns. Only 5 percent to 10 percent of pancreatic cancer patients have a family history of the disease. Although there are genes that are known to increase the risk of pancreatic cancer, the only test I found that is commercially available doesn’t provide a lot of information about risk. I couldn’t find much about genetic risk for pancreatitis, but there are some genes identified. A genetic counselor would have more information.

I looked at the recent literature on metformin, one of our oldest oral diabetes medications, and found that there is suggestive evidence of a decreased risk in pancreatic cancer, especially in women, but an article published in February 2013 suggested no benefit from metformin. I wouldn’t recommend this medication for the purpose of preventing pancreatic cancer.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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