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Academy of Chiropractic’s

MD Relationship Program

Clinical Information, Diagnosis and MRI 

Clinical Consultation 

From:  William J Owens Jr DC DAAMLP

This is a copy of an email I received today, this is what we should be doing together...case reviews - this is the best way to learn!

 

 

 

Hello Dr. Owens,

I write to ask your advice about a patient who is a bit complicated. My main questions is: a neurosurgeon ( that I don’t know or trust)  told her that her neck is unstable and she needs surgery right away, because she could be in a wheel chair/quadriplegic if she had trauma. This surgeon is on LOP with an attorney I referred her to recently, and so I think she needs a second opinion. I absolutely agree that she is a severe grade 3, but needing surgery right away is not something I feel comfortable agreeing with. 

 

When you say Grade 3, are you talking spondylolisthesis?  I see below there is cord compression, if it is Grade 3 relating to cord compression that means there are signal changes in the cord, that has to be treated ASAP. 

Here are my questions:

*****So, do you need to actually see the MRI to concur, or, should I send the MRI and info to Dr Shady for a consult? I have his cell number, but want to do this intelligently.

Let’s look at this MRI together using www.GoToMeeting.com.  I have an account and I can see your screen with you.  We will go through the imaging together then discuss a treatment plan.  Dont call Dr. Shady yet.  I will tell you what to say to the surgeon.  

 

I want to also ask my neurosurgeon friend for her opinion, but want to do this in an intelligent way. I get the feeling that I am giving her more work without realizing it. That is the main reason I signed up with you guys.

(I will be putting the MRI training at the top of my trauma team modules, that is for sure. Needless to say, I am grateful to be in the program!)  

 

Great, you will learn a lot when we get to review the films together - at the bottom of the email signature are links to set appointments with me, click on the IMAGING REVIEW and pick a time that is good for you and we can review the films. 

 

I’ll put the pertinent information I believe is important. Hopefully this is enough. I really don’t feel comfortable giving  you extra work like this, and this is my first big clinical question since I signed up. I would try to figure it out on my own, but it’s now pertinent and timely. Please feel free to let me know if this is appropriate since I am new. 

Yes, this is EXACTLY what you should be doing.  That is part of my job and it is the #1 way to build relationships in the medical community, using patient information to market your practice.  It is good care and good for your reputation.  I will help you with that. 


MVA 10-7-2017

First visit here 10-31-2017

Xrays done 11-1-2017 Moderate to severe degeneration and IVF encroachment. Flexion-extention views were taken and no ligament instability seen.( I will say that her ROM was extremely poor.)

 

Treatment started 11-1-2017. She responded extremely well to atlas orthogonal adjustment.

Full Spine treatment started 11-6-2017. She received 12 adjustments and a re-exam which showed an improvement in all aspects.

 

Care continued until 12-21-2017 and then due the holiday, did not resume until 1-3-2018. Her symptoms worsened over that break. and were difficult to contain in January.

 

MRI finally done 2-8-2018. Significant findings showed mild cord compression C4/5 and mild- moderate at C5/6, stenosis at C6 and right anterolateral spinal cord compression.  ( Among other issues obviously. )

The MRI should not have waited so long - I will explain.

 

I feel I have a handle on the discs, numbness and tingling, and severe degeneration. My main question is the canal and stenosis. Her intermittent arm pain would be the one symptom that I can attribute to myelopathy. It came and went and actually responded the best to ART (Active Release Technique) of serratus anterior, interestingly enough.

 

Cord compression is the issue that we will address...

 

Since she had two exacerbations when she wasn’t in here for treatment due to traveling and such, I told her she should get an attorney, because she will need more aggressive maintenence for life. This was in the last couple of months. She just finally secured on in the last few weeks, and he sent to pain mgmt and a neuro surgeon.

 

Ok…that was the right thing to do. 

 

Please advise. If I can find a fax number for you, I will fax over her reports, or I can have my CA scan and email them, if that is better for you.  I know you like to look at the images, and I can assist that if needed. A DACBR read them, so they are decent, although I will say that he made some mistakes (more than usual) and I corrected them on the sheet. ( Please don’t roll you eyes too much! )

DACBR have little training in MRI on a grand scale compared to Neuroradiology, that is the doctor you want reading your films WITH YOU, we need to make sure you have one in your community that you can rely on.  Dont worry, I won’t roll my eyes!  :). You can fax to 716-239-4371.  Please pick and appointment time so we can review all this - try to do that today or tomorrow, I’d rather not wait. 


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