"Doctor Moments"

Please don't confuse this entry w/ GMDH. I'm going to reserve that title for actual reader questions.

So, I graduated from Parker Chiropractic college in August 2007. Those who know me know that I've wanted to be a chiropractor for a very long time. And although my first year hasn't been terribly glamorous (though there have been some bright spots), I can soundly say that I love my profession, and I love practicing chiropractic.

If I ask myself what I like most about practice, it would have to be what I call "Doctor Moments." Doctor Moments (DMs) are those instances where I feel like a really good doctor. They're when I get to help someone in a unique way or put my knowledge to work to solve something challenging. Or sometimes one might just be an interaction or a connection with a patient. They're really cool and always feel great.

Let me share one with you. . .

A few months ago a friend of mine was very concerned with his little sister. She had been complaining of back pain for a good while and was unresponsive to previous chiropractic and medical care. She was also getting worse. He wanted to have me take a look at her during a brief visit to Orlando. I told my friend that I would be happy to take a look, but thought to myself "how am I going to help? She's already seen a few doctors and a chiropractor." I thought, "my office doesn't have advanced imaging; I'm probably just going to be wasting this poor girl's time and disappointing my friend."

As I inquired more about her pain, I learned some key information. The pain had started after she went to a volleyball camp, and she is in her early teens. She described her pain as starting in the low back and radiating to both sides of her back and down her legs. Typically radiating pain is caused by a disc injury. I knew I wanted an MRI to rule out disc. A disc injury in someone so young is just so unlikely though. Then it occurred to me, "maybe she suffered a pars fracture at volleyball camp?" This commonly happens with young gymnasts. Volleyball is kind of like gymnastics. . . The pars is this little piece of bone that connects the anterior elements of the vertebrae, like the body, with the posterior elements, like the facet joints and spinous process, etc. It is most vulnerable in extension and with "jarring" blows. When the pars breaks the vertebral body can "slip" forward and then it is called a "spondylolisthesis."

So, I had a strategy. She would come to my office and I could take lateral and oblique x-rays. But then what? I opened up my radiology texts from school and got some more details. If I suspected a pars fracture on X-ray, I would want to confirm if it was "active" or "inactive," and the imaging of choice for that is a bone scan. That was disappointing b/c it's pretty invasive. I didn't want to have to expose someone so young to that much radiation if I didn't have to.

Right before she left for Orlando we had her taken to an imaging center for a lumbar MRI and a lumbo-pelvic x-ray. Perfect! My friend emailed me the films, and I could just hallucinate something at L4--I couldn't be sure. The next day the mom had the radiology report faxed to my office and sure enough, I was right. Pars fracture at L4 with accompanying marrow edema. That told me that this was an "active" fracture also, so I knew how to proceed.

I showed them how to order a "Boston brace," which is indicated for these types of injuries and suggested she avoid extension type movements and attempt flexion exercises. Also, I recommended she see a chiropractor so L5 could be adjusted underneath L4. Awesome. I could tell from my conversation with her mom and my friend that they were very happy to know and understand exactly what was going on and how to help. I didn't even need to see this patient, but it was an excellent "Doctor Moment."

I know that if I'm going to really enjoy my career, I should seek out as many DMs as possible. I've got to learn more and beef up my detective skills. The more I know, the more I'll be able to catch. Maybe I'll go out of my way to take some extra continuing ed. in 2009?

I hope you all have a most wonderful and prosperous new year!

Look out for more blogging from me in 2009,

Yours with the love of Chiropractic,

Darren, DC