Case Management Question

[Guest guest]

Hi all,

I need some advice on a case.

I have a 40 yo female patient, struck by a car on her bicycle over a year ago, I

treated her with chiropractics, injection therapy and finally moved onto

comprehensive GI testing/functional blood/hormonal assessment. She obviously

was in tremendous pain at the onset, although her pain morphed over time into a

" chronic pain syndrome " , central sensitization type of picture. She had a good

head injury at onset as well.

She's a personal trainer so demonstrates a lot to her clients and also puts on a

lot of boot camps. She's extremely fit, active and after finally cleaning up

her gut and getting some food intolerances (gluten was HUGE to decrease her pain

and anxiety), we started making some gains. Getting the candida down in the gut

was also a big ticket win.

However, she was inconsistent with her treatment plan all along the year, so

when she did come in she was in so much pain that we had to focus on getting her

treated that day and not much room to discuss how this was going to play out

long term. She is not malingering, she truly hurts and wants this to end.

Chronic pain all the time, worse when she overdoes it at work.

She never did want to go to the neurologist, and frankly there were no

" lesions " . Just this constant myalgia and sleep disruption.

I'm pretty darn sure there is a autoimmune component here that was flared with

the accident as well, however I don't have any way to prove that was caused by

the accident.

Long story short, her PI has run out, she's got a lawyer and showed up today for

one final visit to assess where she's at, what's the prognosis, can she continue

in her line of work and basically is asking for a 50K settlement.

Here's my issue- as an naturopath is makes perfect sense to me that she's in a

chronic pain picture (trauma induced leaky gut, hormonal imbalance, blah blah

blah). However, my narrative is what is going to support this settlement. She

has arthritis in her neck from previous MVA's, she has subluxations, she has

myalgia. However, as much as I HATE this diagnossis- the closest thing I can

label her chronic picture as is trauma induced fibromyalgia.

My question is- will fibromyalgia even stand up in this case? Is it a BS

diagnosis to put on her?

Our treatments to balance the hormones, heal the gut and address her

autoimmunity are significantly helpful to her, problem is she can't afford any

of this anymore.

I need some direction. This narrative is going to have a lot weighing on it.

Please advise:) Thanks!

-Tyna , ND, DC

Lake Oswego Chiropractic Clinic