Tough Case

[Guest guest]

I may have lost a patient who has not responded to treatment over the

past 3 weeks. 49 year old male presented with right leg pain going from Rt

SIJ to ankle. Happened 2 months ago while demonstrating the discus (he's

the coach) where he repeatedly landed on the right leg. He tried his usual

chiropractor for 2 months and did not improve. He saw one of our flyers and

decided to come in and see if we could help him. After treating for 3

weeks, he is no better symptomatically.

I treated as a right for two visits without any kind of relief, then

tried treating as a left for two visits without relief, then went back to

right because of sit test and have stayed right since then, thinking it will

just take more time. But it hasn't improved even a little bit! So he calls

in today and says he wants to cancel appts because he doesn't think it's

getting anywhere.

Where did things go wrong? Is this a case where it will just take more

time, or did I not do something right, or is it a problem with me explaining

my expectations? Because I told him from the start that he will be feeling

better in 1-2 weeks... and that didn't happen.

Has anyone else had any cases like this that would like to share what

their experience was and what they learned from it?

Thanks,

Jamey Dyson

Salem, OR

[Guest guest]

Sorry, please disregard this email... I sent it to the wrong group.

Thanks,

Jamey Dyson

Tough Case

I may have lost a patient who has not responded to treatment over thepast 3 weeks. 49 year old male presented with right leg pain going from RtSIJ to ankle. Happened 2 months ago while demonstrating the discus (he'sthe coach) where he repeatedly landed on the right leg. He tried his usualchiropractor for 2 months and did not improve. He saw one of our flyers anddecided to come in and see if we could help him. After treating for 3weeks, he is no better symptomatically. I treated as a right for two visits without any kind of relief, thentried treating as a left for two visits without relief, then went back toright because of sit test and have stayed right since then, thinking it willjust take more time. But it hasn't improved even a little bit! So he callsin today and says he wants to cancel appts because he doesn't think it'sgetting anywhere. Where did things go wrong? Is this a case where it will just take moretime, or did I not do something right, or is it a problem with me explainingmy expectations? Because I told him from the start that he will be feelingbetter in 1-2 weeks... and that didn't happen. Has anyone else had any cases like this that would like to share whattheir experience was and what they learned from it?Thanks,Jamey DysonSalem, OROregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Dr. Dyson -

It certainly appears as if it is time to get a second opinion. It may be nothing that you are doing wrong, but you may be missing something and are too close to see it. You have only described this patient's persistent complaints, but you have not shared other pertinent information. You said she was in an MVA, but we do not know the nature of the collision or her initial complaints. There is no past history, nor initial exam findings, nor current findings. Has she shown objective change? What treatment have your tried to date?

However, if you do send this patient to another doctor for a second opinion, which would certainly be appropriate, these questions would be addressed at that time. Contact a trusted colleague in the area and ask if he (or she) would evaluate the patient and report back to you. Blind testing and a "shotgun" approach to other therapies is not finding the problem. It may be that chiropractic will not correct her problem, or that some aspect of your treatment is missing some component.

Recognizing that something is not right and that your current treatment is not providing relief is the sign of a true professional.

Good luck.

Tom Freedland, DC

9735 SW Shady Lane

Suite 103

Tigard, Oregon 97223

503 684-1273

In a message dated 1/27/2008 1:50:47 P.M. Pacific Standard Time, jcaadyson@... writes:

Group,

I need some recommendations for a 50-year-old female patient who has failed to significantly recover from MVA injuries. 99% of my patients eventually respond to our form of chiropractic care and massage, but after a few months, she has not. She continues to have HA's, sporadic dizziness & nausea, neck pain, midback pain, and low back pain all without radiation, numbness or tingling.

I have referred her to Dr. Finn in Woodburn for brain injury evaluation and treatment and even for some physical therapy. Any type of physical work on her body (adjusting, massage, exercise) seems to aggravate her symptoms. She is very frustrated and feels like she is going to be like this forever.

I may send her out to try acupuncture, but I feel like I'm running out of options for her.

As far as diagnostic imaging goes - only x-rays so far, which showed nothing atypical.

I am thinking of sending her out for further diagnostic testing such as MRI of the head, neck and thoracic spine? Not sure if this would help answer why this woman continues to hurt... any thoughts? What would you do?

Looking for suggestions,

Jamey Dyson, D.C.

Salem

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