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, 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,
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!!
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
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
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,
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
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.
• The Florida Campus
• Shadowing a Chiropractor
• President's Visit & Lecture
• What to Do in Florida
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