My second shift at the Burnside clinic was an interesting one, to say the least. I told myself to go in with a relaxed mind and confidence, so the shift would feel less chaotic. Wishful thinking is all that was!
The patient I had during my first shift returned reporting that the work we did resolved the issue entirely for one day, then the pain and tightness returned the following. We track outcome markers for bodily function versus pain and all the markers were better for this patient, so I felt we were on the right track. I reminded the patient the problem is chronic and one treatment will not fix twenty years of pain. To have reduced the symptoms completely for a day is in my mind, a good outcome. I took blood pressure again to see if there was in fact, track marks and there were none. Only a slight discoloration of the skin. I left the issue alone and didn't press further. We rescheduled for a week and hopefully the results are still positive. This patient is the only patient I have had where all of my adjustments have not popped anything. No cavitations at all! But, we are on the right track, so popping or not, we should continue the care.
Second patient arrived late and of course, was a new one. Dr. Yancy took over and began the history without me in the room and without writing down anything at all. I hadn't a clue where to take it once she left, so I just started into the physical exam. I was shocked by the findings that presented themselves that day. Positive bilateral Babinski, sensory loss to the hands in a glove-like manner, hyperreflexia to all deep tendon reflexes, jump sign elicited when upper thoracic and upper extremities were palpated with light pressure, hypertonia of the upper thoracic musculature and a positive Soto-Hall with right arm heightened paresthesia. Yikes! I palpated the cervical spine and with light lateral flexion and rotation, right arm symptoms increased. It was then I decided to stop. I didn't feel comfortable with the patient because I felt we needed thoracic, cervical and brain imaging to be safe in our work. I loosened up the thoracic muscles a little and did some light work using Farfan's maneuver in the lumbars and lower ribs which made the patient feel better and more loose. We will continue care on Friday this week and the patient will be getting blood work and imaging (hopefully) Tuesday. To be continued.
Third patient showed up late too. I rushed through the history, but being I had control over the interview, I was able to get all that was needed quickly. We began the physical and nothing bad popped up, so I treated the patient by adjusting the cervicals, thoracics and lumbars with traditional adjusting. The patient responded favorably and I counseled the patient on proper posture and gave specific exercises to complete. It was a good visit overall.
Having two new patients like this is a bit daunting. It leaves no time during the day to get paperwork done. We rush to complete our notes so that we can leave on time and get the weekend started knowing that another day of stress is looming if we do not find time to finish things up. I will have to go in on Tuesday morning tomorrow to finish my CTP's on 3 patients in order to stay on top of things. This means, my personal time is affected and no break will be had this week away from the clinic.
I can't complain though. There are worse situations out there and the work isn't physically demanding at all, just mentally challenging and time consuming.
All for now
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