Wellness Fair

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.

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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.

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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

A Great Weekend

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".

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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 me. 

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Lessons Learned

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 end.

Catch ya on the flip,
Dex

Cases in Point

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.

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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.

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Catch you guys on the flip side,

Dex

A Stressful Patient Encounter

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!

Case Report

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 emergency room.

Thoughts?

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.

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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,
Dex 

An Exciting Weekend

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.

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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.

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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.

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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