Bicep rupture (part 2)

[Guest guest]

I posted a few weeks ago regarding a patient who was considering sugery for a

ruptured bicep. He did decide to go through with the surgery. I would like to

start rehab tx with him, but I have been unable to find much on the subject.

The most I have found is stretching of the associated muscles and a little

codman's.His M.D. told him to do nothing for 4 weeks. He is concerned with his

lack of supination. He hasn't got much to go on from his M.D. or the OT.

I am assuming that they used a metal pin to re-attach the bicep so ultrasound is

contraindicated.

Thank you in advance,

Hi , OR DCs,

<<Can Chiropractors " counsel!? " >> Very interesting question. And your

story is a sad (but not uncommon) one.

In my time on the OBCE I think the interpretation was that in the course

of chiropractic care for a condition, some counseling is appropriate and

within the scope of practice.

Use of mental health CPT and ICD-9 codes however tends to cross

licensing boundaries into other professions (PhD psychs, LCSWs, etc, and

MD shrinks) wherein the going gets pretty murky...practicing psychology

without a license for example.

DC training in mental health is pretty skimpy in my experience. To make

much of a case that DCs are trained as counselors is weak IMHO. I do

note that WSCC offers a hypnosis seminar, however.

That being said, it is obvious that many patients that we see have

" mental health " issues causing, as a result of or coexisting with " what "

they came to see the DC about. My guess is that we all spend time

" counseling " patients about the various sources of their clinical

problems including psychosocial stress, what they can do about it and

even make referrals when needed.

In regard to insurance coverage, my guess is that most companies exclude

" mental health " from coverage except by the above mentioned mental

health specialists. " Counseling " that might go on appropriately in a DC

office ( " You know, if you hate your job, chances are it'll make your

back hurt " ) would be done legitimately under the E/M service.

A. Simpson, DC

Re: CJ/R rule

Chuck's response brings a question to mind...

Can Chiropractors " counsel!? " And if so, are 3rd party payers

responsible

to pay for counseling, by Chiropractors, if counseling is " reasonable

and

necessary " in a case of a MVA that brings on PATS, vertigo, social

anxiety,

etc...?

The reason I ask is, Dr. Boothby's case reminds me of a MVA patient I

had

who was a GREAT massage therapist in our area, who ultimately commited

suicide because of the problems she had with her body post MVA (i.e.,

stress, anxiety, inability to work, TMJ, neck and back pain, etc).

She was seeing multiple doctors, but the MVA stress did uncover some

deep-seeded, nasty emotional issues that she had neatly " tucked away. "

(i.e., her emotional traumas resurfaced as a result of the physical

trauma).

In retrospect, I can now see that NO BODY (including me, unfortunately)

was

dealing with the " emotional component " of her injury. We were all only

dealing with the " objective physical findings " (which, in this case, had

a

particularly bad outcome).

(:-)

M. s, D.C.

RE: Re: CJ or CR? getting specific

>

> Judith, OR DCs,

>

> Thank you, Dr Boothby, for coming forward to the OR

> DCs listserve with

> this important discussion.

>

> Your last post contained the central theme of your

> opposition to the

> CJ/R rule (and apparently the whole notion of

> evidence-based guidelines

> in general) when you state...<< your wizard behind the

> curtain is

> making

> a rule that excludes me... to not disallow my truth

> and compassionate

> centered paradym >>

>

> I have heard you and others make this case before and

> frankly I am

> puzzled by it.

>

> You say that it is so, but offer no explanation,

> examples or proof.

> You

> express that it is your fear that EB practices somehow

> will make what

> you do illegal or outside the bounds of EB

> chiropractic, if I

> understand

> you correctly.

>

> Please help me and the others on this listserve

> understand why this is

> so. What is that you do that is threatened by the rule

> and/or EB

> practices? And how does the rule and EB chiropractic

> threaten it?

>

> A. Simpson, DC

> csimpson@...

>

>

>

>

>

> __________________________________________________

>