Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1111
Lawyers and Medical 65 L
Lawyers and Medical Specialists Meetings & Communications – 65 L
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
"How do I explain AOMSI to a co-treating Neurologist?"
Dr Studin: So, what's going on?
Guest Doctor: So, I had a patient that was injured in a motor vehicle crash and I'm working with a new neurologist and this patient has come back with a alteration of motion segment integrity on her fluxion extension x-rays. And so I set up an appointment to meet with this neurologist. I'm kind of close as to help familiar this neurologist as with impairment and how familiar this neurologist things with alteration, motion segment integrity. So we have a lunch set up next week to call manage the patient plan of wanting to advice and how to go about bringing this topic of conversation up.
Dr Studin: So, understand that in neurological training and Dr. Owens, by the way, up in the state University of New York of Buffalo School of medicine was just appointed to the neurology department to have a neurology residents rotate through his clinic so they can learn about chiropractic. The reality is no medical doctors, understand spinal biomechanics or anything related to mechanical spine pain. They all call it nonspecific. If there's not an anatomical lesion, meaning fracture, tumor or infection, they don't understand and don't know what to do and that's just a hard rule. Neurologists are no different. Neurologists are wonderful with systemic neurological diseases and never forget that they are 4k is systemic neurological diseases or compression, neuropathies like carpal tunnel, tarsal tunnel or cubital tunnel or a compressive radiculopathy like herniated disk or a tuber or an inflamed barracks. Those are the things that neurologist work with, but they work also in the world of psychiatry because the brain is about neurology and neuro chemicals, so their degree is really neurology and psychology. So, understand if that's where their training is, not just their basic training, but their advanced training. The short answer to your question is absolutely clueless. How do you broach the subject in a way that they will understand that you're trauma qualified? Correct?
Guest Doctor: That is correct.
Dr Studin: So therefore, you start the conversation by saying, I'd like to talk about your patient and co-manage it. I'd like to tell you what I found in diagnosis. Now the first thing you say, I'm trauma qualified than a lot of my courses are from the State University of New York, Buffalo School of medicine. And one of the things I've learned through the medical school was filed biomechanical engineering, and working with the professors there and doing this for many years since my academics and then I would you have a copy of the A.M.A guides with you?
Guest Doctor: Yes.
Dr Studin: You bring the fifth or sixth edition, fifth is probably easy to understand and you take the book out of the briefcase and you plot the book down and say, a lot of medical specialists I work with don't understand in impairments and all this other stuff. So, here's the book, clip the page, here's the page we're looking at lacks and ligament alteration of motion segment integrity. I want you to know that I x-ray digitize as per required by the A.M.A guides and my training. The patients fine. There are three kinds of ligament tears, primary, secondary, tertiary. They have a secondary strain sprain, which is a partial tear. As a result of that, it's going to wound repair with internal scar tissue called adhesion that already has and we have significant amber at motion, which is going to cause premature degeneration based upon Wolff's law. And You bring the article about, premature degeneration. Do you have the name of that article?
Guest Doctor: I've read it up, but off the top of my head I don't have it.
Dr Studin: The answer is no. So, I'm just looking it up while we are… Do you have Pencil and paper?
Guest Doctor: Yes, I do.
Dr Studin: Here it is. Ut’s called ligament and healing injuries.
Guest Doctor: It is a 2013 article?
Dr Studin: Yes, and the author is Houser, open rehabilitation journal. Bring that. And it says, in fact, studies in healing ligaments consistently shown that certain ligaments do not heal independently following lecture. And those that do, you'll do so characteristically inferior compositional properties compared with normal tissue, meaning Collagen and Elastin, they are replaced only with Collagen. As a result, that's going to be a permanent abnormal joint, which is going to degenerate Wolff's law. So therefore, they're going to need to be manage, you can't fix them at this point in time because there's a little bit of arthritis or remodeling, well I don't know if there is a reason if your patient has any arthritis, they can't be fixed, just like the diabetic can't be fixed. So we've got to manage this patient because the connective tissue, it's got permanent pathology. The secondary strain sprain, which is partial tear, which is a ligament laxity of ligament creates of alteration of motion segment integrity. So this is what we're looking at with this particular patient. I just wanted you to understand where I'm coming from. I'm an evidence-based provider based upon the literature and here's the literature. The patient is also open the book to the A.M.A guys. There are 25% whole person impairment, just like an amputated leg in a few spines. The same impairment rating because the A.M.A guides all the authors from all these medical schools realized that over time they're going to be severely degenerated and it's not my opinion. Then the literature also goes on to say hypermobility and ligament become clear risk factors for the prevalence of osteoarthritis, which it says, highlight at me in the article here, and then see Ricoh, he's just going to say, okay, what do you want me to do? Oh, I just want to let you know where I'm coming from, what I do with the patients I do desperately need a neurologist to work with. If there's times I'm going to need nerve conduction studies, they'd be, he and g's with concussion cases, crazy people, electrocution cases, people in against electrified fences, all these things I've come up with that I just want to have a relationship because I desperately need a neurologist to work with. But I want you to understand, what my credentials are, who I am, what I do. I just want to have a relationship moving forward.
Guest Doctor: Wonderful. Let me give you a 45 second prior medical history on why this person ended up in my office. She was in a motor vehicle crash in September of last year, 2018 she was managed by the primary care with medication and a PT. She had a prior ACDF at C 5/6, a year and a half before. she also went back and saw her surgeon. He took imaging and said, there's no problem. Finally, the primary care setting, not getting better because you got to call in. So primary referred decent to me and I got the patient, six to nine months post-crash. And the patient has what I would call dynamic residual apathy, meaning when she moves her neck, no pain comes and goes. And she didn't have any hard-neurological symptoms as all sensory, but there was no motor deficit, so that's where we've got the neurologist involved because the surgeon has already said nothing. So, we're going to be going in and talking about this patient instead of prior a fusion when interestingly enough, the alteration of motion, second integrity has anger emotion that translation that can level up balls and a level below.
Dr Studin: Well, interesting.
Guest Doctor: I can almost predict what was going to be on that. And this is the case. And so now we've got the surgeon saying, know there's no big deal. And that's why get them involved because of this dynamic.
Dr Studin: Yeah, but there's nothing that neurologists can do.
Guest Doctor: right.
Dr Studin: But you should tell them that. It's funny because I'm working on an article right now that that's going to be a monster for me to write up, and it's chiropractic involved in both pre and post-surgery, which deals with this very issue. And that article probably be published in the best six months. That's a hard one. But you know, it's exactly what you just said, and you know what, maybe I'll bring you with in the article. You can comment on it and help go through it. It'll be fun.