Dex's Blog

Hello, everyone. The weather down here in Florida is finally cooling off, and it feels incredible. Don't get me wrong, I love hanging around the beach and cooling off in the pool, but not much beats sitting at an outside bar on a Sunday watching some football and not sweating through your clothes.

Speaking of watching some good football, how about those FSU Seminoles? Granted we played Duke this past weekend, but 48-7 was a blowout, and I got to see it live and in person. My younger brother and I made the trip up to Tallahassee for the weekend to catch the game and party a little bit. We had a great time, and I realized how much I miss college.

All College Day

We had a really cool, world-learning adventure last week at St. Pete College's All College Day. Dr. Jennifer Illes recruited us 10th trimester interns to perform blood pressure screenings at this SPC faculty event. We set up our NUHS table, outfitted it with brochures and cards, and started with the screenings.

I was happy to see so many of the SPC faculty and staff take so much interest in our school and clinics. This wasn't just an opportunity to practice taking blood pressures on people, it was killer practice on how to market and communicate with people who weren't all that familiar with our clinics, or profession for that matter. Now, more than ever, I am realizing how important of a trade it is to be able to communicate with the public in such a way that shows that you are knowledgeable, but at the same time able to show that you are likeable and easy to understand. This skill is invaluable, and only comes from practice.

I would recommend jumping at any opportunity you could that requires you to talk to the public. Being able to communicate with patients in the treatment room is extremely beneficial, but you first have to get them in the door. I will be performing screenings for my own office in the months to come, and the practice we had last week really opened my eyes to how the public really views our profession, and how I'll have to work to sway people my way.

Negative Nancys

My uncle forwarded me an article last week that I thought was awesome and would like to share with all you Negative Nancys out there. The article by Hope Gillette titled "Negativity and Complaining is Bad for the Brain, Experts Say," alludes to the fact that the brain reacts differently in response to disturbing or negative information. Listening to as little as 30 minutes of complaining can damage neurons within the hippocampus, the part of the brain that deals with problem solving. The article gives some simple tips to avoid the inevitable day-to-day complaining that will be hurled your way, and even how to flip the problem on chronic complainers. It's an easy read that I thought was pretty cool, plus it gave me an excuse to tell the complainers in our office to keep it to themselves.

Congratulations!

Congratulations to everyone who passed their board exams; all the interns down here in the Florida clinic did extremely well. Hard work always pays off; so don't stop now! 

I'd also like to congratulate our very own Dr. Rudy Heiser on his second consecutive WAG (Wild Ass Guess) award win this past weekend at the ACCR (American College of Chiropractic Radiology) convention. The WAG is the pride of the DACBR community and Dr. Heiser has brought it home to NUHS Florida for the second year in a row. Florida campus representing!!

I hope everyone has a great week.

Catch you guys later,
Dex

Hello, and welcome back to another installment of Dex's blog adventures. I'd first like to thank everyone for the positive response to last week's case report. I'll do my best to put together a few more cases to share in the weeks to come.

Cases really are the best way to train your mind to think critically and to pick up on subtle clues to reach a diagnosis. If you like radiology and case reports, as I do, try the American College of Radiology website's Case In Point. Each day the ACR posts a new case with images to subsequent. These cases are pretty challenging at times, as the ACR targets their cases towards radiologists, but they are at the very least a decent learning tool. 

Perfecting the Diagnosis

So today I'd like to share with everyone yet another semi-pitfall I had with a patient here in clinic. I've been treating this individual twice a week for four weeks for lower neck/upper shoulder pain. The history and exam led me to a diagnosis of cervical sign facet syndrome with some upper trapezius muscle, levator scapulae muscle and pec minor muscles hypertonicity. I treated the patient as I would any patient with these diagnoses, which you will see a lot, with adjustment of the cervical and thoracic spine, myofascial work, and postural correction. Not to toot my own horn, but I've seen a lot of success with these treatments for these issues, but not with this patient.

The patient would find some mild relief from the treatment I was giving him, but no lasting gains. Therefore, I took a step back and did some research on something else that could be causing these signs and symptoms and found a paper on Levator Scapula Syndrome.

The paper describes the origin of some forms of shoulder pain to the Levator Scapula muscle and how to treat the issue. According to the paper, I had been treating the condition pretty right on, but it alluded to the fact that an over-facilitated infraspinatus muscle on the ipsilateral (same) side could contribute to a dysfunctional levator scapula. Duh, right? The very next patient visit, I stressed the infraspinatus by resisting external shoulder rotation, and boom, the symptoms were perfectly recreated. I reformed my treatment plan to include some myofascial release of the infraspinatus muscle and within two weeks, the patient was right as rain.

As physicians we won't always get the perfect diagnosis on the first go round. Even more important than getting the correct diagnosis the first time, is recognizing you hadn't and rectifying that. It's all about putting the patient first.

Perfecting the Weekend

This weekend I took a break from putting patients first and enjoyed myself a bit. Friday, my pals and I were first in the VIP line (no big deal) for the Brews By the Bay craft beer and food tasting at the Florida Aquarium. Needless to say we had a great time. There were over 200 beer vendors and over 100 handing out food, all with the back drop of live music, shark tanks, sea turtles, and any other creature of the sea you could think of.

Then just for good measure I hit the Bucs game on Sunday. I helped my uncle out by taking his tickets off his hands in the 5th row on the 50-yard line while he was out of town. On top of that, my Florida State Seminoles and Tampa Bay Buccaneers put wins up on the board. Pretty darn good weekend.

Catch you guys on the flip side,

Dex

Welcome back. I hope everyone's weekend went well. I definitely feel as if I need at least one more day off to recuperate. Seemed as if my weekend was jammed full of activities.

Friday kicked off the weekend when I met with the doctor I will be associating with once I graduate. The doc I'll be working with has 5 offices in the Tampa/St. Pete area and I will be lucky number 6. For the past 4 months it has been my job to find a space for my future clinic, and Friday was the day I presented the space to my future partner for approval; needless to say it was a big meeting. It has taken close to two months of going back and forth between the owner of the building, and the person currently leasing the space to concede to allowing us to take a look and hopefully take over the building.

The space is perfect. It is currently a doctor's office and therefore there is almost zero build out necessary. In addition to being a killer building, it is in the heart of South Tampa directly across the street from Palma Ceia Country Club on a major roadway. I guess I didn't need to be as nervous as I was with all things considered, but the nerves were there nonetheless. Long story short, the doc loved it, and he asked for the lease to be drawn up! So it looks like I have a place to set up shop, and we even set a tentative opening day of March 1, 2013.

Purvi Patel, Dustin Bledsoe, and myself at Campus Visit Day.

After a heavy night of celebrating, I was up bright and early on Saturday to speak with prospective students at our Campus Visit Day. We could not have asked for a better turn out. I highly recommend the visit day to anyone reading who is considering the chiropractic program down here in St. Pete. This was the first time I was a part of the day, and I was completely impressed.

We began with a brief introduction of NUHS, its philosophy and the DC program, then proceeded on a campus tour. The first stop was our evaluation and management lab where Dr. Jennifer Illes spoke a little more on the curriculum, and Purvi Patel, Dustin Bledsoe and myself worked up a mock patient to show off some of the skills we've accrued throughout our education. From the technique lab we hit the always-popular anatomy lab, and finished up at the clinic. The day itself wrapped up with a question and answer period that put us students in the hot seat. We answered a lot of great questions, and did our best to give as accurate a portrayal of student life as we could. Even after all the talk of studying and practicing we had 7 applications turned in at the end of the day.

Tailgate party with friends.

I wasn't done after the visit day. Saturday my FSU Seminoles played the USF Bulls here in Tampa at Raymond James Stadium. The visit day concluded at 12:30 p.m. and I was at a tailgate at 1:30 p.m. I had a blast catching up with old college buddies who were in town, and even more fun watching the Noles put another "W" on the board.

As, if my weekend couldn't get any better, I was invited to the Bucs game Sunday against the Washington Redskins. The Bucs didn't have the same fate as the Noles, but the game was exciting nonetheless. The Bucs went up 22-21 with about 45 seconds left. Unfortunately, the Skins used those 45 seconds to march 80 yards down the field and kick a field goal of their own to win the game 22-24. Regardless, we had a good time.

At the Bucs game.

If anyone has any questions on Campus Visit Day, or getting going on a new practice, please let me know. Have a killer week.

Go NOLES! #3 RANKED!!

Dex

Hello all. Well, my weekend was capped off right, with Spain winning the EuroCup for the second consecutive time. Sunday morning my pals and I met for breakfast, all in our Spain jerseys and began getting ready for the final match that started later in the day. By 5 p.m., my buddies and I, along with anyone else in a red jersey, were on cloud nine watching La Furia Roja raise the EuroCup once again. This was the first time in history a national team has won 3 major titles in a row (EuroCup2010, World Cup 2010, EuroCup 2012).

I suppose that's enough gloating for now. Today I'd like to share a little tale about a patient I began to see last week. This patient had been seen before in our clinic about a year and a half ago for the same complaint of dizziness. The patient had been previously diagnosed and treated for cervicogenic vertigo. The treatment given a year ago did help her condition, the patient reported, but never really got rid of her dizzy spells. I say dizzy spells, because what the patient described didn't sound like vertigo. The patient was experiencing a sensation of falling through the ground, almost as if she was riding a down-going elevator. The spells could come at anytime during the day and were reported to not have any correlation with head movement or any other triggers. After working the patient up, my differential diagnosis was leaning towards a cerebellar issue, possibly cerebellar fatigue.

Dr. Humphreys

Neurological issues are somewhat difficult to nail down with a definitive diagnosis and treatment. Realizing I may be a tad over my head, I called in the big guns, Dr. Robert Humphreys, neuro-extraordinaire. It just so happened that Dr. Humphreys was here in Florida at the time, and took an hour out of his busy day to help me and my patient, and perform a neuro evaluation. I can now say from experience, that sitting through a lecture is one thing, but actually watching Dr. H perform his exam and reason through subtle cortical findings to reach a diagnosis, is something completely different and extremely educational. Dr. H used functional neurology to determine that the patient was experiencing this symptom of falling due to a decreased ability of her left cerebrum to communicate with her right cerebellum. Activating, or jump-starting, the left side of her brain with propioceptive input and known left-sided brain activities eliminated the patient's secondary symptoms and previous positive cortical findings. It is our hope, that with the treatment plan Dr. H and I came up with, the patient's dizzy spells will also be eliminated.

I learned a lot from this patient. Aside of this being a cool case, and getting to work with Dr. Humphreys, I think the real lesson here was knowing when to ask for help. Yes, I could have treated the patient how she was treated previously, she had reported that the previous treatment had even helped, but would that have been what was best for her? The patient's best interest should always be at the forefront of treatment, not the doctor's pride, or ease of a treatment regime. My patient appreciated me telling her that I didn't know exactly what was wrong with her, but I would find someone who could find out.

I hope everyone enjoyed the story today, and enjoys a nice break in the middle of the week for Independence Day. I plan on spending the day on the beach Wednesday doing what I do best.

Catch everyone on the flip side,
Dex 

Hello all. I can't believe its already Week 6! Since I've been in clinic, the weeks fly by. It's definitely a different feel once you hit your internship and classes drop substantially. I'm currently only in a radiology case report elective and Journal Club, so the study load has decreased quite a bit. The studying has decreased, but reading and learning will never end. We are part of a profession that is ever evolving and changing, and it's important to stay up on the current research to know the best way to serve our patients.

Since I've been in clinic I've realized that the HVLA (high velocity low amplitude) adjustment that we've all grown to love, can't always be applied to every patient. It's important to always have a few other techniques up your sleeve just in case, because this situation will happen to you, as it's happened to me.

One case in particular jumps out at me about a patient who is training to become a Physician's Assistant. The fact that this patient is training to be in the same profession as us, but on the more allopathic side, excited me. Traditionally, the majority of allopathic doctors I've experienced are skeptical of chiropractic, and I take it as a personal goal to show them the scientific aspect of what we do and to prove to them the credibility of chiropractic and alternative/complementary medicine. This being said, I wanted to be prepared for this patient's neck pain issue, so I went to PubMed and read up on the all the different treatment options and how effective they are reported to be.

After reading through several articles, I found a killer paper performed at UCLA that compared the effectiveness of the HVLA adjustment to spinal mobilization. The study followed 336 neck pain patients between the ages of 18 and 69 who received spinal manipulation (HVLA) or spinal mobilization for care for 6 months. The patients were reassessed at 2 weeks, 6 weeks, 3 months, and 6 months with the results showing that manipulation and mobilization have comparable results in the reduction of neck pain. Good thing I read this paper, because sure as the sky is blue, there was no way my PA patient could have tolerated an HVLA adjustment as acute as he was. Being that a cervical manipulation was out of the question, I used cervical traction and some passive range of motion mobilizations to treat his condition.

After the first treatment, there came the question, "Is there a reason you didn't 'crack' my neck? Is this going to work without it?" Without a hesitation, I blew his mind with an educated answer and even printed out the paper for him after the appointment. Needless to say, he was impressed, and has since referred me to two more of his PA classmates. Long story short, being prepared pays off, so just because you don't have any more exams to study for, the reading will always pay off.

Though I keep busy with clinic and reading during the week, as you all know, I like to make up for all the work with some good times during the weekend. This past weekend was full of sports--the Ray's crushing the Miami Marlins, Florida State Seminoles blowing past Stanford to make it to the College Baseball World Series, and the start of the EuroCup 2012 that will hopefully end with Spain raising the championship cup once again. I enjoyed sports from a bar stool, the pool, and my couch; I couldn't ask for more.

I would also like to wish my fellow interns, Jeff Bourguignon (pictured above), and Brandon Fields very happy birthdays; I hope you guys had a killer weekend celebrating.

GO Rays/Noles/Spain!!!

Dex