Re: overcautious?

[Guest guest]

After getting the findings from MD land, you might want to send him

to Dr Dean in s Landing for a thermogram of his back and

front. I just had my breast thermography today and he also took

images of my back and abdomen and gave me very helpful information.

He does not treat your patients, but will share his input with the

doctors and I found it very helpful. He's super and very

professional.

Joan Schultze, DC

Lake Oswego

On 10/26/2011 3:49 PM, Dr. Glenn Sykes wrote:

Like to have the

groups input on a case…

75 year old man,

presented with right mid back pain of 2 years

duration, 10/10 VAS, 75% on Oswestry. He denies any

precipitating event. He told me, “doctors have done

every test and there’s nothing wrong with me. But I

still have pain.” He also noted that the mid back

pain is worse when he is lying down and the pain

increases with breathing. He admitted to a chronic

cough, which really increases the pain. He is a

non-smoker.

He worked for many

years as a scuba diver in the navy; then for 20+ years

in the ship yards exposed to asbestos. The only other

pertinent history is an untreated hiatal hernia.

The only significant

exam findings were severe spasm in the thoracic

paraspinals, rib and thoracic subluxations and severe

limited aROM in the thoracic spine.

I took AP and Lat

Thoracic films. There was an inch and a half deviation

to the right of the tracheal shadow and a very dense

radiopacity which appeared to be causing this

deviation. This opacity appeared to be the aortic

arch only larger and more dense.

My initial concern was

aneurism of the aortic arch or lung cancer so I sent

him to the ER with a quick referral note and the

films. I was hoping maybe the deviation was caused by

scar tissue from years of diving.

Apparently the ER doc

implied that I was over cautious and this amount of

deviation to the tracheal shadow was within normal

limits. (16years in practice and I’ve never seen

anything close to half that much deviation) The

patient also reported, “that white shadow ain’t

nothing but my heart and its normal.” (side note – it

may have been the aortic arch but it surely wasn’t his

heart)

I’d love to hear from

the group…. Over cautious? Or prudent clinic decision

making?

BTW after implying I

was over cautious, the ER doc not only repeated the

thoracic films but did a thoracic MRI, CBC, full chem.

screen and cardiac enzymes. I feel like calling the

ER doc and asking, “If I was ‘over cautious’ your

additional tests imply either A) you are more ‘over

cautious’ or you were just running up the bill?”

Glenn Sykes, DC

Gresham

Town Fair Chiropractic Clinic

Phone:

(503) 667-6744

Fax:

(503) 661-7896

WWW.GRESHAMCHIROPRACTOR.NET

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[Guest guest]

Glenn, I do not think you were being over cautious. I probably would have called his primary instead of ER and punted it to him.....but not if the guy didn't have good insurance. ER is obligated to do due diligence and see him. I encourage you to give the ER doc a call and ask what the findings were, then twist the knife a little on his comment about being over cautious.!!!! AND.....yes, hospitals do run a business. Kind of like going to the car dealership for service!!!

Don WHite, RN, DC

Like to have the groups input on a case…

75 year old man, presented with right mid back pain of 2 years duration, 10/10 VAS, 75% on Oswestry. He denies any precipitating event. He told me, “doctors have done every test and there’s nothing wrong with me. But I still have pain.†He also noted that the mid back pain is worse when he is lying down and the pain increases with breathing. He admitted to a chronic cough, which really increases the pain. He is a non-smoker.

He worked for many years as a scuba diver in the navy; then for 20+ years in the ship yards exposed to asbestos. The only other pertinent history is an untreated hiatal hernia.

The only significant exam findings were severe spasm in the thoracic paraspinals, rib and thoracic subluxations and severe limited aROM in the thoracic spine.

I took AP and Lat Thoracic films. There was an inch and a half deviation to the right of the tracheal shadow and a very dense radiopacity which appeared to be causing this deviation. This opacity appeared to be the aortic arch only larger and more dense.

My initial concern was aneurism of the aortic arch or lung cancer so I sent him to the ER with a quick referral note and the films. I was hoping maybe the deviation was caused by scar tissue from years of diving.

Apparently the ER doc implied that I was over cautious and this amount of deviation to the tracheal shadow was within normal limits. (16years in practice and I’ve never seen anything close to half that much deviation) The patient also reported, “that white shadow ain’t nothing but my heart and its normal.†(side note – it may have been the aortic arch but it surely wasn’t his heart)

I’d love to hear from the group…. Over cautious? Or prudent clinic decision making?

BTW after implying I was over cautious, the ER doc not only repeated the thoracic films but did a thoracic MRI, CBC, full chem. screen and cardiac enzymes. I feel like calling the ER doc and asking, “If I was ‘over cautious’ your additional tests imply either A) you are more ‘over cautious’ or you were just running up the bill?â€

Glenn Sykes, DC

Gresham Town Fair Chiropractic Clinic

Phone: (503) 667-6744

Fax: (503) 661-7896

WWW.GRESHAMCHIROPRACTOR.NET

__________ Information from ESET NOD32 Antivirus, version of virus signature database 6568 (20111023) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com