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
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.
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 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,
Hello, all. I don't mean to brag, but I had an incredible
weekend. It was my good friend Alex's birthday, so Friday after
clinic, my buds and I took off to Orlando for a celebratory
weekend. We took it somewhat easy the first night, staying in for a
homemade fajita/taco night, but hit the ground running Saturday
morning. After my buddy Joe and I cooked up a breakfast feast for
everyone, it was to the nearest watering hole for a day of college
football rounded out by a FSU victory over our in-state rivals, the
Miami Hurricanes. The win was a little too close for my liking, but
hey, a "W" is a "W".
The weekend was still far from over as we made our way to Epcot
on Sunday for the International Food and Wine Festival. If you've
never been to the Food and Wine Festival, do yourself a favor and
head on down one year. There were over 30 countries represented at
the festival, each offering incredible food and local libations.
Needless to say, Sunday night we were feeling good, not so much
Monday morning, but I guess you have to pay to play sometimes. The
exclamation point on the weekend came on Monday night at the
Orlando House of Blues when we saw Passion Pit kill it live. I
think Al had a pretty decent birthday weekend if you ask
Speaking of cutting loose, I have a little story from a few
weekends ago that combines a work with play. A few weeks ago, my
dad, uncle and I went out for dinner and a few drinks in downtown
St. Pete. We had a great dinner, had more than a few laughs, caught
up, and then decided to hit a little jazz bar down the road for
some good music and few drinks. It was a busy night, but
miraculously we scored a table right up front, which was even in
close proximity to the bathroom.
Not even two minutes after sitting down, we noticed a young girl
being helped to the bathroom by a few of her friends. She was
having a bit of a hard time getting there on her own, but hey,
we've all been there at some point or another. As she stepped into
the bathroom, her friends made their way back to the bar, but
before she could close the door, she fell straight back and struck
the back of her head on the concrete floor. At this point Dr.
Stepanovsky's emergency medical situations class took over. I could
hear Dr. S's voice in my ear; stabilize the head, and check your
ABCs (airway, breathing, cardiac). The poor girl was unresponsive,
but had a clear airway, was breathing, but had a faint rapid
heartbeat. The girl's friend, a terrified bar manager, and I kept
the girl stable as she began to come to, and the paramedics
arrived. I gave the paramedics the run down of what had occurred
then Pops, uncle and I immediately made our way to another bar for
a much-deserved drink.
These things really do happen, and I'm very lucky to have
remembered all the training we've been given. As much as you think
that some of what we learn will never happen to you, or that we are
forced to learn some things that seem out of our scope of practice,
when those situations do happen, you will be very happy to know
what you do.
Well, I hope everyone has a quick week and a relaxing weekend.
Don't forget to continue to stay current with all your material,
and never stop studying or practicing. It all pays off in the
Catch ya on the flip,
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
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,
Hello, all. Hope everyone is doing well. I had a pretty exciting
day last week that I'd like to share with everyone. I'm going to
set this up kind of like a case report, so try to read the case
without looking at the last part of the blog, and try to formulate
your own differential diagnosis and next appropriate steps in
management. Mind you, this is a real case that presented to the
clinic last week, so this does happen!
A 24-year-old male who has been under your care for 3 weeks
for insidious onset of back pain, presents to your office 3 days
after his last appointment with a new chief complaint of difficulty
urinating. Hopefully some bells are starting to go off already. The
patient relates that after his treatment 3 days prior, which
included IFC, ice therapy and a Thompson drop counter-nutation
sacral adjustment, he has had difficulty urinating but his low back
has been feeling much better. Upon questioning, the patient states
he has been drinking about 120-170 ounces of water per day since
the onset of urinary difficulty in hopes of having a complete void
of his bladder, but has only experienced "dribbling" urinary flow,
and feels as if he has to go every 10-15 minutes. The patient had
not tried to forcefully urinate in fear of "hurting himself" and
has not experienced any loss of control with coughing, sneezing or
laughing. Patient denied any bowel issues, any burning with
urination, loss of muscular function in the lower extremities, or
any abnormalities in lower extremity sensation. It was suggested
that if the patient had to urinate at any time during the
appointment for him to try to forcefully push out the urine; he did
go to the bathroom, but was unable to forcefully urinate. Before a
physical exam could be performed the patient began to experience a
deep cramping low back pain that referred somewhat to his flanks
and down the lateral portion of both legs to about the knees. At
this point the patient was told to make his way directly to the
So what are you thinking? By this time you should have at least
3 differential diagnoses rolling around in your noggin. The first,
and most severe thought should be Cauda Equina Syndrome (CES). My
other two differentials included nephro- or uretero-lithiasis
(kidney or ureter stone), and possibly a urinary tract infection.
The reason the patient was immediately asked to make an emergency
room trip was to rule out CES and if surgery or decompression was
necessary, he was at the hospital already.
Cauda Equina Syndrome is a serious neurological condition that
occurs when nerves of the spinal cord beyond the conus medullaris
(the cauda equina) are impacted and the functions they control are
disturbed. A disc herniation, a tumor, or any other space-occupying
lesion could cause the neural compression. With the patient's
history of aching low back pain, with progressive loss of the
ability to use his detrussor muscles (the muscles which push urine
flow), it was our concern that he may be on the verge of bladder
rupture, and/or ascension of urine back into the kidneys which
could cause a whole slew of other problems including hydronephrosis
and maybe even death.
The patient was very fortunate that an MRI study of his lumbar
spine revealed no compression of the cauda equina. I hope no one
thinks that this was a waste of time sending the patient out for
advanced imaging. As a physician you must always put the patient's
well being above all else. There would be no way I would be able to
sleep at night if I discounted a patient's signs and symptoms and
down-played a condition which ended up hurting the patient
indefinably. The patient was extremely relieved that he was
CES-free, but he isn't out of the woods yet. He still is having
urination issues, and therefore we referred him to an urologist for
consultation. You have to know when something is out of your scope
of practice, and not be too proud to refer someone to a physician
who could help them.
Well, I hope someone took something away from this patient
encounter of ours down here in the Florida clinic. Remember to
always put your patient first, and an expensive procedure to rule
out a life threatening condition will always be worth the money. If
anyone has any questions on Cauda Equina Syndrome or appropriate
management, shoot me an email and I'll do my best to find out any
answers you may have.
Have a great week,
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
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
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
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
Go NOLES! #3 RANKED!!
• The Florida Campus
• Shadowing a Chiropractor
• President's Visit & Lecture
• What to Do in Florida
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