Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 253

From the Desk of Dr. Mark Studin
Academy of Chiropractic
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.

"Creating MD Relationships Through Triaging Trauma Cases"

The following is a string of e-mails from a doctor in the northwest sent between 12:04 AM and 2 PM today.
Hi doc- Clinical question for you.  Recently new PI patient, 25 y/o female with headache, neck, mid-back, lower back complaints post MVA 4 weeks ago.  Rear ended, car totaled.  Went to MD initially and referred to me.  typical exam findings decreased ROM, segmental fixation, (+) c-spine orthos for localized pain, spasm, etc..  No radiating neuro symptoms to upper extremities and negative neuro exam for muscle, reflex, sensory.
Over the past 2 weeks she has developed increasing episodes of neck pain that radiates severely to her face and side of her head.  One day it will be left sided neck pain extended to left side of face and the next time it will be right-sided neck pain radiating to right side of face/head.  These episodes are also associated with nausea, headache, and some mild visual sensitivity.  They typically last for 24-36 hours and then decrease but have been occurring every 4-5 days and she has had to leave work the past 2x.
 Would you recommend a c-spine MRI to rule out pathology even though these aren't typical nerve root radicular symptoms.  If not, do you have any other recommendations for diagnostic testing to rule out something I may be missing or at this point should I simply consider that these symptoms could certainly just be typical whiplash symptoms without underlying pathology?
 Your thoughts would be appreciated. 

My Response:
First the easy part...Your re-mail signature can get you in lots of trouble...You are holding yourself out to be an MD or that is what a prosecutor can say because you do not identify your specialty...That is a very bad place to be. Please remove the "Dr" in front and put "DC" at the end of your name. Secondly, your patient has signs and symptoms of an upper motor lesion. She needs a brain scan IMMEDFIATELY, but I would send her to a neurologist and have him/her do it. The appointment needs to be made "post-haste," like today!!!!

The Outcome:
Thanks for your prompt reply.  My email signature line is now changed, thanks for the advice.  Guess I never looked closely at that to catch it. 
Regarding the patient, I contacted their MD and did a 5 minute phone consult describing her symptoms and findings and my thoughts on a neuro consult.  First, the MD totally agreed with my assessment (your assessment, thanks) and said to have the patient call their office and they will route her appropriately today, and second, he THANKED me for the personal phone call to keep him informed and asking his opinion regarding our patient (yes he actually said OUR patient). Third, I suggested we should get together face-to-face to learn how we can best work with each other and I now have a meeting with him at his office next Tuesday.
 I love win-win-wins.  Thanks doc!!!

Clinical excellence is the only path to true success in practice.

PLEASE TAKE FURTHER NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE:  This email including attachments is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender.  Nothing contained in this message or in any attachment shall constitute an Electronic Signature or be given legal effect under 44 U.S.C. 3504 Sec. 1707.  The information is intended only for the use of the individual or entity to which it is addressed.  If the recipient of this message is not the intended recipient, you are at this moment notified that any unauthorized disclosure, dissemination, distribution or reproduction of this message or any attachments of this communications is strictly prohibited and may be unlawful.  If this communication has been received in error, please notify the sender immediately by return email, and delete or destroy this and all copies of this message and all attachments.