Case of the Week
We are providing expert recommendations on YOUR difficult cases/patients! These recommendations will be provided by a special panel of well known Chiropractors such as, Dr. Rob Jackson, Dr. Terry Yochum, Dr. Chris Colloca and more. We believe that the more we all talk and work together, the better outcomes we'll experience! So whether it's a patient who's just not responding as they should, or a chronic complaint that you haven't found the right treatment for, or just a question about a case....we want to help.
We need YOUR difficult cases!
Age of Patient: 29
Special Considerations: None
29 yom, 170 # 5' 6" (corpulent, but has been working on weight loss since beginning care in office with simple "clean" diet - no system food, and has lost 6#), initially came in for non-descript but alarming S/S for which he'd gone to the ER on 2 occasions (Lt arm numbness and facial tingling), only to be "cleared" medically on both occasions. Fearing he was dying, as he kept getting symptoms of arm tingling and facial numbness he sought care in the office and had improvement in Back Pain and BP (I put him on a careful CV routine, as his MDs could find nothing wrong and decided to put him on BP Rx as that was the only "finding" they could note at the time of his ER visits. He did improve his BP and soon weaned himself off the BP meds.) His S/S are manifold, and when his progress stalled, and then he reported bilateral symptomatology, I referred him to a neurologist, asking for an MRI of his upper T spine (as this was the region where much of his initial S/S seemed to be related to) but his major CURRENT complaint is M "pain" which he describes as "the Ms feel "EXTREMELY tired" after only minimal work. Eg, lifting a table is no problem, but when he has set the table down, the Ms in his arm/s feel like they "freeze" on him (his words). When showering, his calves get SO tired (from just standing) that they do not respond to his will, and his LEGS start to shake as "though they were exhausted." Then, after 5-6" this S/S will clear up. Obviously, this is affecting his (construction) work. He can hold a tool for a moment, but then his hand and arm are "exhausted" for several minutes afterwards. His S/S can and do "change sides" (of his body). Ortho-Neuro Clinic providers did MRI exams of his head and neck (and skipped the the requested T spine, alas) and found "nothing." At least one of his "providers" has now suggested it is "mental," which confounds the pt, as he can SEE his Ms spasm (eg on his antebrachium) at times.
Age of Patient: 40
Special Considerations: Patient presents with severe back spasms. Upon examination the patient's primary complaint is caused by a strained QL. Electrical stimlulation and adjustments were administered to the symptomatic areas. Patient responded well to first visit, but upon subsequent visits only finds temporary relief from care (several hours).
The pain usually gets worse as the day goes on. Patient's job consists of lifting and twisting. Has difficulty getting in and out of his vehicle, and when standing from a seated position has difficulty standing up straight. Massage therapy was recommended, and while I would like to recommend rehabilitative exercises, the patient's back is too painful for the patient to maneuver at this point.
I guess I am looking for ways to treat the QL that leads to symptomatic relief and, once out of the acute phase of treatment, what can be done to rehabilitate the patient and help them gain independence from care.
Age of Patient: 38
I have a patient who had an acoustic neuroma (vestibular schwannoma) removed from the right side of her brain approximately a year ago. She has complete hearing loss on the right side as a result of her surgery. Most of her pre- and post-op symptoms have gone away, but she still has tinnitus in her right ear. Adjustments haven't been helping with the tinnitus so I was wondering if there is anything that you can recommend (specific techniques, supplements, etc.) to help decrease the tinnitus. Thank you!
Age of Patient:
Special Considerations: PROTOCOL HANDLING A ACUTE EXACERBATION OF A CHRONIC CONDITION
Doctors could you give us your protocol for handling acute exacerbations of a chronic condition, for example a chronic condition that becomes aggravated above the normal degree, due to an injury or aggravation (event)? Chiropractic adjustments will return the patient back to a normal functional level, and without the CMT will get worse . I realize there will become a point when the care will become supportive and no longer active by Medicare, what criteria do you best determine when it becomes supportive care, for example what documentation do you use?. ….Especially in a Medicare setting ...….thank you
Age of Patient: 10
She is a 10 year old girl. Cerebral palsy. Zero cervical tone. Still cannot lift or actively turn her head and relies on being in a stroller at all times and utilizes cervical collar when upright. No capacity to stand and not ambulatory. Left hip is "out of socket" as it has never even developed and acetabulum is too shallow.
She is non verbal and actually spent whole initial visit eyes closed and would not communicate in any manner. Lying her on her stomach really upset her. She was ok on side and back. Babinski and palmar reflexes retained, but not tonic.
Child has had several years of PT, but was just released due to "lack of progress". Only recommendations by PT was for parents to place her on stomach and continue to straighten legs out. Other previous treatment of botox in the bottoms of feet due to the hyper flaring, now toes curl too much and she had breathing issues associated with those injections. Being released from PT with no future recommendations to help her child has the mother a bit distraught and so she ended up here based on recommendation from the special ed teacher. She will of course continue to be monitored by her medical doctor and other specialists as well.
Gender: Male Age of Patient: 70
Special Considerations: Spinal stenosis of thoracic and lumbar spine
Your Case or Question: I have a Medicare patient who has spinal stenosis in the thoracic and lumbar spine, I have worked with him for years he has a stimulator implanted in the lower back and into the thoracic spine. It helps some but he also has severe balance problems and still has a huge amount of pain in the thoracic and lumbar spine. He comes in weekly, I try to get him to go longer between visits but when he does his symptoms increase and he will become immobile without coming in every week to 9 days. I am a walk-in clinic and file this with Medicare but am afraid of having issues with Medicare if the visits remain too frequent. I believe this is not maintenance care, he cannot function he says without CMT, he gets injections in the low back through pain management on a regular basis.
Gender: Male Age of Patient: 65
Special Considerations: Compression fractures, T12 and L2
Your Case or Question: 65 year old female initially consulted for back pain due to compression of T12. I use an instrument, and worked above and below, and she tolerated it well. However, upon resuming weight bearing the pain was severe. This was the first treatment. She opted not to continue care on account of this, and also had abdominal surgery shortly after. Subsequently she developed a compression of L2. She returned for chiropractic care while waiting for evaluation of the spinal surgeon. She never was "cemented" for the collapsed vertebrae. So far treatments are going well and she is gaining some function (endurance for house chores, general mobility). At this point we are wondering if spinal consultation is necessary, and if it is too late to reinforce the compressions. Also, any advice on bone strengthening will be appreciated, I heard diathermy can help circulation.