History of Illness
On June 29, 1992, a 23-year-old, white female reported to our office complaining of right-sided low back pain with bilateral thigh pain. The pain was a constant, dull aching, with occasional sharp pain. the patient, who experienced vomiting from the flu a few days prior, felt the violent vomiting might have triggered the pain. She also has a history of dancing in theater and carrying trays of food as a waitress.
P)hysical Examination:
Physical examination showed an inability to laterally flex to the left side, left lumbar muscle spasm, positive leg lowering, positive Kemp's on the left, and rebound on the left. She had a left high hip and fixations noted at C2, L4, and the left S1.
X-Ray:
AP and lateral full spine x-rays revealed the following:
A diagnosis was made of vertebral subluxation complex consisting of:
The patient was seen in our office and received specific chiropractic adjustments to the levels of subluxation with special emphasis to the fourth lumbar vertebrae. The patient was seen at approximately three visits a week using Gonstead technique. She was re-examined on September 11, 1992. The patient reported relief within the first two weeks of care. At the conclusion of her care program she was x-rayed again in the thoracolumbar area. The follow-up films revealed reduction in the scoliosis from 22 degrees to seven degrees. The left leg was still 20 mm short. At that time, a heel lift was given and a care program of one visit per week was recommended, for six weeks. After six weeks another x-ray revealed a continuation of the seven degree curve with only a 13 mm differentiation in leg length. The patient now reports that she is "much improved." Her back disability index went from 20 percent originally, to ten percent at last exam. She still experiences some back pain and spasm, as well as headaches. She has now been placed on monthly supportive care. She is contemplating breast reduction surgery in hopes of reducing stress to her spine.
Discussion:
This case represents the impact chiropractic care can have on such a complex condition. It is not uncommon to see a scoliosis in combination with a spondylolisthesis. The reduction of 22 degrees is significant in that none of that improvement can be attributed to correction of the short leg. While chiropractic adjustments are intended to reduce the vertebral subluxation complex rather than being used as a "treatment" for curved spines, the reduction in curves is very gratifying. We anticipate that the L5-S1 disc will eventually proceed to degeneration and will thus lend stability to the spine. The patient was also counseled about the tendency for scoliosis to progress during pregnancy since she is of child-bearing age.
Joseph S. Siragusa, DC, FACO
Patrick D. McLaughlin, DC
Monroe, North Carolina
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
