Medications Can Be Deadly- Try Chiropractic First
Medications Can Be Deadly- Try Chiropractic First
As a Baltimore Chiropractor that treats patients with headaches, neck pain, back pain and muscle pain, usually stemming from Baltimore auto accidents and Baltimore worker’s compensation injuries I see many patients who are taking too many medications. While there is certainly a time and place for medications, I find that many patients are either knowingly or unknowingly taking too much medicine to treat their pain and this can have serious adverse health effects.
The two most common forms of medications that I see being over used are opioid medications and acetaminophen.
Opioid medications are drugs such as oxycontin, hydrocodone, percocet, and vicodin. These are prescription narcotics that can help with pain. Originally these drugs were designed to treat patients recovering from surgeries or who suffer from debilitating pain such as cancer patients. Now, many of my Baltimore auto accident and Baltimore whiplash patients with acute injuries are taking these pain medications, as prescribed to them by local emergency rooms and family doctors. While it is not my place to say which medications a patient should or should not be taking when they are under appropriate medical care, it is startling to me how many of these patients assume that these medications are “safe” just because they have been prescribed by a doctor. Many of these opioid medications are highly addictive (in some cases, more so than heroin!) and patients generally have to continue to up their doses just to get the desired level of pain relief.
Opioid use has skyrocketed in the past decade and now hydrocodone based opioids are among the most commonly precribed medications in the U.S. Some 46 people per day (approximately 17,000 per year) die from complications associated with these medications. Nearly 30 people a day are admitted to the emergency room or local hospitals for complications associated with opioid usage.
Unfortunately opioids are not the only dangerous type of medication. Acetaminophen (Tylenol) is largely overused in this country as well. Due to its ubiquity in every drug store and medicine cabinet across the country many people believe that acetaminophen use is safe. In small doses it absolutely is. However, there is such a wide variety in terms of the dose per pill and the recommended daily allowance that it is hard to know how much acetaminophen is “too much”, leading to surprise overdoses.
Depending on the bottle that you read, some bottles of acetaminophen recommend not exceeding 4000 mg per day. Others recommend no more than 2400 mg/day. While you may think that the FDA would streamline what the maximum allowable dose should be, it is astonishing how many different guidelines are out there. Additionally, some pills offer 200 mg per pill, others 325 mg, and others 800 mg. With all of these different dosages it is hard to remember how much has been taken and how many should be taken maximally in a 24 hour period.
Patients who knowingly or unknowingly take too much acetaminophen can develop liver damage, liver failure, dark urine, pale stools, abdominal pain, and jaundice (a yellowing of the sclera of the eye).
To further complicate matters some of the opioid based medications are actually coated with acetaminophen to help with pain. Therefore patients who are taking opioids and acetaminophen for pain can easily exceed the maximum daily dosage of acetaminophen and can be feeling better from their pain but poisoning their livers unknowingly.
No matter the cause of a patients neck pain, back pain, or muscle soreness, the key to feeling better is staying physically active. Yoga, physical therapy, massage, acupuncture and chiropractic care have all been shown to demonstrate improvement in these conditions without the use of drugs. Again, while I am by no means against the appropriate use of drugs, I just wanted to point out how dangerous inappropriate use of these drugs can be.
If you, or someone you know, is consuming opioid medications or acetaminophen in excess to deal with headaches, neck pain, back pain, or muscle soreness please have them contact their primary care provider so that they can make sure that they are not accidentally taking too much medication. Then, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 to schedule an appointment for chiropractic treatment. We would be glad to help!
Dr. Gulitz
BY: Mid-Atlantic Spinal Rehab
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Consider Chiropractic Care Before Steroid Injections For Back Pain
Consider Chiropractic Care Before Steroid Injections For Back Pain
As a Baltimore Chiropractor that treats a lot of patients with neck and back pain, typically following auto accidents or work related injuries, I often see patients who have had a history of chronic recurrent neck and back pain. In many instances they have gone to their primary care providers, been given pain medications, tried physical therapy and STILL they have back pain. In these instances their primary care providers will usually refer them to a pain management clinic. These clinics are becoming more and more popular. The typical form of treatment in these clinics are “injections” into the spine. They will inject the affected areas with corticosteroids to try and help with inflammation and decrease a patient’s level of pain.
A recent warning was issued by the Food and Drug Administration (FDA) on April 23, 2014 that warns of the use of these injections for neck and back pain. They stated that the injections may cause rare but serious adverse effects, such as loss of vision, stroke, paralysis, nerve damage, and even death. You can click on the link to read the warning here: http://www.fda.gov/Drugs/DrugSafety/ucm394280.htm.
While the use of these epidural corticosteroid injections is very common, the FDA has not approved the use of corticosteroids for injection into the epidural space (the space surrounding the spinal cord within the spinal canal) to help with neck and back pain. Because of the FDA’s recent report the Public Citizen’s Health Research Group now designates steroid injections as “do not use” drugs for neck and back pain.
This group suggests that the use of over the counter medications such as aspirin, ibuprofen, and naproxen along with exercise, physical therapy, and spinal manipulation by a chiropractor may provide more effective relief of pain with less adverse reactions.
Simply put exercises, physical therapy, and spinal manipulation are at the core of our offerings at Mid-Atlantic Spinal Rehab & Chiropractic. If you were considering epidural steroid injections for neck and back pain and would like to try conservative care before more invasive care, please contact us at (443) 842-5500. We would be glad to help!
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Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain
Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain
As a Baltimore Chiropractor who spends a lot of time treating acute injuries such as those commonly experienced in auto accidents, slips and falls, and work-related injuries, one thing I do not spend a lot of time addressing is the benefits of chiropractic care in cases of chronic pain. That is, typically I talk about new injuries and the importance of restoring normal spinal motion to help patients get relief from acute pain. Unfortunately not every patient that I treat related to these acute injuries is able to return to pre-injury status and to become pain free. Rather, a small percentage of these patients become chronic pain patients that I will either refer to other specialists (neurologist, orthopedist, pain management specialist, etc) or that choose to live with their chronic pain.
When it comes to chiropractic care there is often a concern from prospective new patients that once they begin a course of treatment that they will have to continue care indefinitely. I can assure you that that is not the case. Like any good book there is a beginning, a middle and an end. I make sure to let patients know that care will not be forever. Typically they will have an initial evaluation, a course of treatment over the next several weeks, a re-evaluation to assess their improvement (if any), a new course of treatment, and soon thereafter a final evaluation.
A recent article set out to address whether or not maintained spinal manipulation (that is, continued lower back spinal manipulation after the acute phase of care has ended) would lead to better clinical outcomes such as reduced recurrences of lower back pain and decreased pain levels. The article can be found here: http://www.ncbi.nlm.nih.gov/pubmed/21245790. For those who may be reading this article in print you can click the link to the article on my blog at www.midatlanticspinalrehab.com.
In the study a total of 60 patients were enrolled. Each had a history of nonspecific chronic lower back pain lasting at least six months or longer. During the study the participants were divided into three treatment groups.
Group 1: Participants were subjected to 12 “sham” manipulations within one month
Group 2: Participants were subjected to 12 “true” chiropractic manipulations within one month
Group 3: Participants were subjected to 12 “true” chiropractic manipulations within one month plus “maintenance” manipulations once every two weeks for the next 9 months.
Each of the categories of patients were followed up with at one, four, seven, and ten month intervals to assess their subjective pain levels and to perform self reporting guidelines regarding their degrees of disability, if any.
The results of the study concluded that patients in the third group that received “true” chiropractic manipulations as well as “maintenance” manipulations biweekly for several months showed the most improvement in their pain levels and disability.
The conclusions from this study are important. Firstly, they demonstrate that spinal manipulation is an effective tool for managing chronic lower back pain. Additionally, it demonstrates the importance of continued chiropractic spinal manipulation even after the first month of therapy to help “maintain” progress.
While I can empathize with patients who might be concerned about needing to follow up with treatments forever, it is important to know that research supports the need for periodic “tune-ups.” Even patients that I have treated for acute neck and lower back pain would benefit from periodic adjustments to help maintain the improvements that they received while under my care. It is not uncommon to have patients that were once under my care for acute auto accident or work-related injury care to return to my office for periodic adjustments just to maintain their levels of improvement.
If you or someone you know are suffering from chronic lower back pain and need some help to get out of pain please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We are conveniently located at 2001 Eastern Avenue in Fells Point, Baltimore. We would be glad to help!
Dr. Gulitz
BY: Mid-Atlantic Spinal Rehab
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Proper Positioning of Safety Belts in Baltimore Auto Accidents
Proper Positioning of Safety Belts in Baltimore Auto Accidents
According to the Centers for Disease Control and Prevention (CDC) there are approximately 6,400 adults injured in auto accidents daily in the United States. Probably the easiest thing we can do as passengers in vehicles in Baltimore or elsewhere is to wear our safety belts correctly. Safety belts are designed to keep occupants restrained during a collision. Without these safety measures many people would be ejected from a vehicle through the windshield following a rear-end auto accident. Despite the ubiquity of safety belts there is a growing concern that many adults either do not wear them at all or mistakenly do not use them properly. When used improperly safety belts can actually cause increased injury to occupants.
For a seat belt to function as it was designed, the seat and the occupant must be in the correct position. The seat back should be upright and the occupant should be sitting back into the seat, with their lower back, hips and shoulders all touching the seat. The headrest should be adjusted to its maximum allowable height in order to cut down on the likelihood of the head hyper-extending over the top of the headrest during a rear-end impact.
Before engaging a safety belt, make sure to check that the material is flat and not twisted like a rope. At high speeds the edges of a twisted safety belt can cut into the soft tissue of the skin and caused abrasions and lacerations superficially, or worse, caused damage to internal organs.
The lap portion of the safety belt should be placed across the pelvis. Many people make the mistake of wearing this portion too high across the abdomen. During an automobile accident this can cause injuries to the abdominal muscles as well as the visceral organs and intestines.
The shoulder belt portion of the safety belt should be placed across the rib cage, sternum (breast bone), and mid way across the clavicle (collar bone). This puts the most pressure on bony structures that can withstand impact and not on soft tissue structures that can easily be injured at high speeds. Never make the mistake of placing this shoulder portion under your shoulder or behind your back. When the shoulder belt portion is not enable properly your body will not be protected in cases of auto accidents.
Fortunately for the citizens of Baltimore and the rest of the United States every vehicle we enter has access to safety belts which do a wonderful job at protecting and saving our lives during the unfortunate periods of automobile accidents. Unfortunately, if ignored completely or if used improperly, safety belts can and will cause injury to their occupants.
The next time you step into an automobile take the extra few seconds and make sure that you and those you are traveling with are safe. You will be glad you did!
If you, or anyone know you know, has been injured in an automobile accident in Baltimore and require treatment please contact Dr. Marc Gulitz and his team at Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!
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Baltimore Auto Accidents and PIP Coverage
Baltimore Auto Accidents and PIP coverage
As a Baltimore Chiropractor that spends a lot of my time treating patients involved in Baltimore auto accidents and provides treatment to patients with whiplash, headaches, neck pain and back pain I get asked about how patients can have their medical and chiropractic bills paid. Although this is not a clinical discussion, but rather a financial one, I think it comes up in conversation enough that it warrants a small discussion.
Personal Injury Protection (PIP)
In the State of Maryland it is mandatory that all drivers carry auto insurance. A component of the auto insurance that drivers carry is called PIP, or Personal Injury Protection. PIP is designed to pay for medical care (including x-rays, chiropractic care, and physical therapy) and up to 85% of lost wages for injured people in automobile accidents in Maryland. PIP is a no-fault benefit, meaning that it is available regardless of whether or not the driver caused the crash or was the victim of another driver’s negligence.
PIP is written in different amounts depending on the auto insurance policy. It is usually written in amounts of $2,500, $5,000 or $10,000 and can be waived in writing at the time of purchasing of auto insurance.
Maryland law dictates that medical bills and lost wages that are reasonable, customary, usual, and causally related to the automobile accident will be paid by PIP up to the policy limits.
In cases of non-faulted auto accidents, your auto insurer will not raise your auto insurance premiums even if you file a PIP claim with your own auto insurance company. That is, you can access PIP and use the benefits to pay for your treatment and lost wages without any negative financial consequences to yourself if you were the victim of an accident. If accessed during your treatment, PIP does not need to be repaid upon the conclusion of your treatment.
How do I apply for PIP ?
If you’ve been involved in an automobile accident contact your auto insurance company’s claims hotline to let them know you were injured.
Speak to your claims representative and confirm that you have PIP on your auto insurance policy.
Ask your claim’s representative to mail you an application for PIP benefits. Typically these forms are about a page long and take less than ten minutes to complete.
Ask the claims adjuster to mail you an Attending Physician’s Report and Salary Verification Form. Hand these to your treating chiropractor and your supervisor at work to be completed.
Upon receipt, complete the applications and mail the PIP application, Attending Physician’s Report and Salary Vertification Form back to your claims adjustor.
Provide your claim number, adjuster name, claim office address, and phone number to all of your health care providers. This will allow your providers to be paid for your care while you are still in treatment. This also lowers, or in some cases, eliminates any money owed to your providers for treatment rendered upon conclusion of your care.
What If I don’t have PIP?
Injured patients that do not have access to PIP do have other means to get their bills paid.
If there is no PIP coverage available on your auto insurance you can use your health insurance to pay for your medical care.
If you do not have health insurance you can speak to a qualified personal injury attorney to see what other options may be available to you. Please let us know if you are interested in speaking to an attorney.
Automobile accidents are stressful but recovery from your injury does not need to be.
If you have questions please speak to the office manager La Keesha Arrington-Vega by phone at (443) 842-5500 or by email at [email protected]. The team at Mid-Atlantic Spinal Rehab & Chiropractic would be happy to help you.
Dr. Gulitz
BY: Mid-Atlantic Spinal Rehab
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More on Spondylolisthesis in Baltimore, MD
More on Spondylolisthesis in Baltimore, MD
In my last blog post I discussed a lower back condition called spondylolytic spondylolisthesis. If you recall, it was a condition that resulted from an bilateral acute bony fracture and a resultant slippage of one vertebral body on another.
As a Chiropractor that uses X-rays to help me determine the structure of a patient’s lower back prior to spinal manipulation I see these pretty regularly. One of the questions that I get a lot is how I know whether to have a patient see an orthopedist/consider bracing or to undergo spinal manipulative therapy in my office and return to activities.
The first thing I consider is the mechanism of injury. If a patient comes in with an acute injury (they were weightlifting, playing sports, etc) I am more inclined to consider the injury (if present on standard x-ray) to be acute, or “hot.” In cases like these I tend to air on the cautious side and refer patients out for STIR MRIs to look for acute spondylolytic spondylolisthesis. If positive, these patients are referred for orthopedic evaluation and bracing. Bracing typically includes the fitting of a boston brace which allows for patients to spend over 23 hours a day not loading the posterior elements of the spine, and giving their bones time to heal. Research has shown that appropriately used bracing in these instances can “cure” the spondylolisthesis.
If, on the other hand, a patient presents with a spondylolisthesis and their physical examination does not seem to indicate that it is the cause of their pain I will begin treatment to include spinal manipulation of the joints above and below the effected segment. Much of the time spondylolistheses are “red herring” diagnoses- in that they are present but are not the cause of a patient’s lower back pain.
As a provider I have two concerns with these patients. The first is the pain that they are experiencing. As mentioned, most people present due to pain and want to be out of pain as quickly as possible. I will generally perform lesser invasive techniques and then progress to more aggressive techniques as tolerated. The second concern I have is the stability of the segment. If the patient has had a STIR MRI and there is evidence of an acute spondylolisthesis, I will refer the patient for orthopedic evaluation and have them discontinue provocative activity. Generally speaking, non-acute spondylolistheses are stable structures and will not continue to slip, whereas acute spondylolistheses that are active on STIR imaging are considered unstable and should be referred out to orthopedists and braced.
In summary, spondylolisthesis are one cause of lower back pain seen in my chiropractic office. X-rays are a good starting point to determine what MAY be the cause of lower back pain. In some cases it is safe to proceed with spinal manipulation of the lower back and in some cases it is not. I am trained to know when it can be handled in my office and when I should refer it out and I work with several orthopedists who are equipped to handle these conditions if they are outside of the scope of my practice.
If you, or someone you know, thinks they may have a spondylolisthesis please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!
Dr. Gulitz
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Spondylolisthesis in Baltimore, MD
Spondylolisthesis in Baltimore, MD
As I have spoken about in several other blog posts, there are many causes of lower back pain. Part of the challenge (but fun!) of being a chiropractor is trying to determine which structure or structures in any given patient are responsible for their presenting lower back pain.
One form of lower back pain that is not given much attention but is never the less important is spondylolisthesis. Though it is hard to pronounce, it is easy to describe. It is a condition where one bone slides forward on another bone. There are several types of spondylolisthesis, but the type that I come across most clinically and are the most challenging to treat clinically are spondylolytic spondylolistheses. These are mainly seen in the lower back (lumbar spine) at the L5/S1 level, although not exclusively.
In spondylolytic spondylolisthesis the posterior aspect of a bone undergoes a systematic overload of force that leads to an eventual acute bony fracture. If this occurs on both sides of the posterior aspect of a bone the vertebral body can actually slide forward on the bone below it, causing not only back spasms and pain, but in some cases, instability. These are generally developed in youth with hyperextension loading mechanisms such as those seen in baseball pitches, wrestlers, and young dancers.
While high velocity low amplitude chiropractic spinal manipulation (what patients refer to as “back cracking”) is used on many patients with acute and chronic lower back pain in my office, it is not the only tool that I use to treat lower back pain. Though not an absolute contraindication to spinal manipulation, chiropractors and PTs need to exercise caution when handling spondylolisthesis patients.
The question that comes to mind is how to best help with the symptoms of pain and whether or not the spondylolisthesis is stable (not going to slide) or unstable (active and able to keep sliding).
Traditionally, SPECT bone scans have been used to determine clinically active sites of nuclear uptake which correlate with active acute spondylolistheses. While this has helped to determine the cause of active and unstable spondylolisthesis, it has recently come to light that the degree of exposure to patients to radioactive material has made these tests less desirable.
Fortunately a more readily available less deleterious test exists that is highly specific in detecting active spondylolisthesis in Baltimore, MD. The test is referred to as a STIR imaged MRI. STIR stands for short tau inversion recovery. It is a “fat suppression technique” that looks for signs of edema and fluid changes in and around the pars interarticularis- the location of spondylolytic spondylolistheses.
As a Baltimore Chiropractor that treats patients with acute and chronic lower back pain including active and inactive spondylolytic spondylolisthesis it is important to understand the use of STIR MRI imaging and what it means for patient outcome and treatment recommendations. I will discuss management of these conditions in a future blog post and how to determine whether it is appropriate to avoid activity, continue activity, undergo chiropractic care, or undergo bracing and/or surgical fusion.
For now, if you, or someone you know is suffering from lower back pain including spondylolisthesis please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!
Dr. Gulitz
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Digital vs. Analog X-rays
Digital vs. Analog X-rays
In previous blog posts I wrote about the importance of obtaining x-rays following Baltimore auto accidents. I wrote about how often clinically important diagnoses went unnoticed either because a hospital did not think a patient’s symptoms were severe enough to warrant x-rays or because a given Chiropractor treating the patient for whiplash, headaches, neck pain or back pain did not have x-rays on site for their patients.
Technology is ever changing and the technology of x-rays is no different. The machinery and chemicals that used to require dark rooms and expensive, smelly chemicals is long since behind us. Today’s x-rays look the same once developed but they are digital (on a CD) rather than analog (think the old big floppy x-rays).
There are several advantages to using new digital x-ray technology in a chiropractic office:
1. Radiation exposure to patients is decreased. This makes x-rays safer for patients.
2. Diagnostic imaging quality is improved. The radiologist or chiropractor can read the films with more clarity, make appropriate diagnoses, and direct care with more confidence than ever before.
3. Decreased development and storage/copy costs. There are no more smelly chemicals to process the films and no more necessity for dark rooms in small offices. A modern digital x-ray can be stored on a flash drive, hard drive, or CD in a matter of seconds and can be archived in a matter of seconds for little cost.
4. Faster interpretation: In a matter of 15 seconds digital x-rays can be transmitted securely to a teleradiology group that can read, interpret, and report their findings. It is not unusual for me to get x-ray interpretations back within 15 minutes of taking x-rays in my office.
The x-ray technology used at Mid-Atlantic Spinal Rehab & Chiropractic is state of the art. Patients involved in Baltimore auto accidents that have neck pain or back pain that require x-rays can have them taken quickly in the office. They can be viewed nearly instantly and interpreted in minutes. This allows patients to get on the road to recovery on the first visit rather then being sent down the street to wait in another office.
If you, or someone you know, has been involved in a Baltimore auto accident and require digital x-rays, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!
Dr. Gulitz
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Sleepy Monday Is Upon Us
Sleepy Monday Is Upon Us
Spring is right around the corner and we finally got a break from the frigid cold temperatures that have been plaguing us all winter long. Combine warmer weather with daylight savings time and it seems like long sunny days are right around the corner. So what could be so bad about that?
Believe it or not the effects of daylight can dramatically impact our sleep patterns. Most people take a few more days to accommodate to the new sunrise and sun set schedule. Sometimes this manifests as a few later nights and earlier mornings than we would like. This may lead to general sluggishness in the morning. Scientists have developed a term for this condition referred to as “Sleepy Monday.” Most of us will be waking up what feels like one hour earlier (assuming we fall asleep at the time our body usually tells us to). The results of this relative hour shift of awake time can actually cause injury during our morning commute. By some accounts there is expected to be a 6-10% increase in auto accidents across the country on the first Monday following daylight savings time.
Unfortunately, folks, that’s this Monday. With a 6-10% increase in auto accidents, there should be an increase in Baltimore auto accidents, neck pain, back pain, and whiplash. While that is not necessarily a bad thing for me and my practice, I do not wish harm on anyone and want you to take any necessary precautions that you can to avoid becoming a patient.
Generally speaking this is a short term adjustment that we all must make and generally takes most people only 1-2 days to adjust back to a normal circadian rhythm. Besides drinking an extra cup of coffee in the morning on Monday, make sure to go to bed a little bit earlier the night before. Turn off the television as you drift off to sleep to make sure that you are rested the fully recommended 8 hours of sleep the night before.
So that’s it for now- enjoy your warmer weekend and have as much fun as you can with the one hour less of weekend that we have. Remember- there will be a lot of sleepy drivers on the road on Monday, so make sure you are extra rested to avoid being involved in a Baltimore auto accident and getting baltimore whiplash.
If you are unlucky enough to be involved in a Baltimore auto accident and require Baltimore auto accident treatment please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!
Dr. Gulitz
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X-rays in a Chiropractic Office?
X-rays in a Chiropractic Office?
As a Chiropractor with a busy practice in Baltimore I see a lot of patients. Mainly they have headaches, neck pain, and back pain or some combination of the above. Most are referred to me by friends, family, doctors, previous patients, etc. Regardless of how patients find me one of the most common questions I get asked is “do I need an x-ray?”. Like most questions in clinical practice, there is no simple yes or no, but rather a series of guidelines that can be followed which, when combined with clinical intuition, can lead to an answer.
The first thing you should think about is why a patient might need an x-ray. Simply put, x-rays look at bones. They give me a picture at a moment in time as to the underlying spinal structures so that I can determine if it is safe to perform physical therapy with or without chiropractic manipulation. Essentially, I am looking to rule out contraindications to chiropractic care and physical therapy. If there is any indication of fracture, dislocation, cancer, infection, or instability found on x-ray then I know how best to proceed with care. I will not take an x-ray simply because you “want to see what you look like.” That is irresponsible care.
The good news is that generally speaking, most new patients do not require x-rays. If a patient has an acute case of non-radiating, reproduceable spinal pain then chances are a short course of conservative chiropractic therapy and physical therapy modalities will help and the patient will respond quickly. I tell most patients that if the therapy I am going to provide will help they should expect to see some form of improvement (be it better range of motion, decreased pain frequency and/or severity, less radiation of pain, etc) within 2-4 weeks. If at that point they are not improving or if they are getting worse, we can either take an x-ray at that point or consider referral for other advanced imaging (MRI, CT, ultrasound, etc) at that time. By some accounts 80-90 percent of new chiropractic patients with neck and back pain fall into that category and do not require an x-ray on their first visit.
The last 10-20 percent of patients typically do require x-rays on their first visit. These are patients who have a history of metabolic diseases (think decreased bone density), history of spinal fractures, history of spinal surgery, new onset of radiation of pain past the elbows (upper extremity) or past the knees (lower extremity), pain that wakes you up at night, new onset of pain over age 50, and acute trauma (think motor vehicle collisions, whiplash injuries, auto accidents, slip and fall injuries, worker’s compensation injury, etc).
Fortunately for me and my patients I purchased and installed a new digital x-ray developer. This allows me to take any necessary x-rays and have them developed and read in about 60 seconds. Patients that require x-rays do not need to reschedule or be referred off-site prior to getting the care that they need. I will always give patients a copy of their x-rays on a CD so that they can archive them for their records and/or bring them to any other medical provider should they need to do so. I transmit all of my x-rays digitally to a teleradiology group to make sure that board certified radiologists confirm my findings and protect the health of any new patient. A second set of eyes is always better than just one.
If you are not sure that you require an x-ray on your first visit we can discuss the pros and cons given your specific circumstance and make an appropriate choice at that time. If you, or anyone you know requires chiropractic care that may include the need for an x-ray, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!
Dr. Gulitz
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