Do I need an MRI after my Baltimore auto accident injury?

Do I Need an MRI After My Baltimore Auto Accident Injury?

As a Baltimore chiropractor that treats many patients involved in Baltimore auto accident injuries I am often asked whether a patient’s injuries from a Baltimore auto accident requires an MRI. It occurred to me that in my previous blog posts I have not spent much time discussing MRIs so I figured it was time to do so.

MRI stands for magnetic resonance imaging. It is a diagnostic test that involves having a Baltimore auto accident injury patient to lay down in a large tube in order to have a region of their body scanned. Typically following a Baltimore auto accident injury the regions of the body that I would typically refer for MRI include the neck, lower back, shoulder or hip. MRIs are fantastic tools to better help a practitioner appreciate the living anatomy of an injured patient. The school of thought is that if a patient is having pain in a region of his body and the MRI shows altered anatomy in that region, that the altered anatomy is usually responsible for the pain in that region.

Let’s take an example. I am treating a patient for a Baltimore auto accident injury. I start their therapy off at 3x/week for the first four weeks. At the end of the first month (12 visits) I perform a re-evaluation where I re-perform orthopedic and neurological evaluations and I ask questions about the frequency and severity of their pain. Provided that the patient has been making an acceptable level of progress towards resolution of his chief complaints (>50% improvement per region both subjectively and objectively) we decide to move on with care on a reduced treatment frequency (say, 2x/week). If, on the other hand, the patient continues to mention daily pain, or radiating pain from the neck into the arms, or radiating pain from the lower back into the legs, that may be a different story. In those instances, I will typically refer out for an MRI of the region involved, in order to rule out a “worst case scenario.” These worst case scenarios are disc herniations, ligament tears, muscular avulsions, etc. Basically, these are conditions that exist that I can not treat as a chiropractor and that require specialist referrals.

So the question as to whether or not a patient requires an MRI following their Baltimore auto accident injury is not always straight forward. It depends on the patient, and it depends on their response to treatment. If they are not improving as expected, then I have my staff refer them for an MRI and we will take whatever steps we need to to resolve their injuries moving forward. Typically following a positive MRI my staff and I will make referrals to orthopedic, neurological, or pain management specialists for second opinions and future treatment recommendations.

MRIs are wonderful tools because they do not expose the subject to any radiation. A patient can undergo as many MRIs as often as they need to without any harm to their body. The pictures produced by MRI are considered the “gold standard” for advanced imaging, with resolution and clarity that greatly exceeds CT scan and x-ray.

If you are involved in a Baltimore auto accident injury give your injury time to heal. Commit to the process of treating for your injuries and give your body time to heal. If you feel that something isn’t right and after enough time the pain is still present, an MRI may be a good idea. It is truly a case by case scenario. Please contact Mid-Atlantic Spinal Rehab & Chiropractic if you have questions about whether or not your Baltimore auto accident injury requires an MRI.

Dr. Gulitz

Baltimore Chiropractor with Evening and Saturday Hours

In response to the feedback from our existing referral sources and current patients, Mid-Atlantic Spinal Rehab & Chiropractic has extended their office hours to better serve the Baltimore and Baltimore City community. By hiring a new chiropractor, Dr. Erica Wise D.C. and expanding office hours (see below) we pledge to serve you, the patient, better. We will offer quicker access to new patient appointments and faster appointment times.

You will notice that we are now open all day Monday and Tuesday, which allows us to better serve the injured weekend warriors and Baltimore auto accident patients that get injured on the weekends. Additionally, we now offer full days on Thursday and Friday for those heading out of town to travel or who are unlucky enough to have injured themselves throughout the week.  Finally, we are now back to offering Saturday morning Chiropractic appointments each Saturday, with Dr. Gulitz and Dr. Wise alternating. These changes should mean faster access to pain relief and less interruption in your days.

Effective 10/05/15, the new office hours are as follows:

Monday:     9a-1p ; 3p-7p

Tuesday:    9a-1p ; 3p-7p

Wednesday: Closed;  3p-7p

Thursday:   9a-1p ;  3p-7p

Friday:       9a-1p ;  3p-7p

Saturday:   9a-1p

Please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help with any of your Baltimore auto accident treatment or Baltimore chiropractic needs.

Dr. Gulitz

EMS vs. TENS after Baltimore Auto Accident Injuries

As a Baltimore Chiropractor that spends the majority of my time treating patients injured in Baltimore auto accidents, I often get asked what the difference is between EMS and TENS. These are acronyms used for two common pain modulating modalities. EMS stands for electric muscle stimulation. TENS stands for transcutaneous electrical nerve stimulation. In my clinic we utilize EMS following Baltimore auto accident injuries. So whats the difference?

EMS uses a cycle of electrical current that allows the muscles to contract and relax, increasing blood flow and promoting healing. It helps to relax spasmodic muscles and sooth the deep ache of muscle pain such as that experienced in Baltimore auto accident whiplash injuries. As the name implies, the purpose of the EMS modalities to stimulate injured and atrophied MUSCLES. There is also a pain modulating effect, but it is not the primary goal of EMS. EMS helps to improve ranges of motion as well by reducing swelling.

TENS is thought to promote the production of ATP at a cellular level by stimulating NERVES and helping to modulate pain by overriding the sensation of pain prior to its interpretation in the brain. Typically speaking TENS units are usually sold over the counter and can be worn conveniently on a belt clip and can be taken with you.

Truth be told, utilizing either TENS or EMS following a Baltimore auto accident injury will help you regardless of which you choose. I often tell patients in pain following injuries that if they have a machine at home, regardless of which one they have, that they are better off using the machine than not using it. EMS gives the treating provider a few more options to help with muscle spasm and pain, but TENS works just fine.

Despite the benefits of TENS and EMS, not every injured patient can utilize these therapies. Patients with open wounds, eczema, patients with pacemakers, or pregnant women (over a gravid uterus) can not utilize these modalities for pain.

If you, or someone you know, is suffering from muscle and/or nerve pain following a Baltimore auto accident injury, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

ICD-10 Coding for Baltimore Auto Accident Injuries

Since approximately 1979 the health care providers in the United States have been using a series of 4 and 5 digit codes to represent our diagnoses for patients. This code base is called ICD-9, which stands for International Classification of Disease, 9th edition. For example, I may diagnosis a sprained neck as 847.0 cervical sprain/strain. While it is fairly fast and easy for Chiropractors such as myself to code with just four digits, it is not entirely accurate. That is, if someone sprains the zygapophyseal joints in their neck following a Baltimore auto accident, why should it be coded with the same codes 847.0 that also reflects a strained upper trapezius muscle? The problem with the “old way” of coding for health care was that one code pointed to many different conditions. And then, there’s the problem of “sidedness”. If someone were to sprain their right shoulder (840.9) or their left shoulder (840.9) there would be no way based on the numbering scheme to know which side was actually injured.

That’s where ICD-10 comes in. With the exception of the United States, the rest of the world has already moved on from ICD-9 and has implemented and been using ICD-10 diagnoses for years. Much like our desire to avoid the metric system, the U.S. has been burying its proverbial head in the sand and has only JUST NOW decided to implement a transition to ICD-10 coding.  As of October 1, 2015 (approximately 16 days away as of the time of the writing of this blog post) all new diagnoses for patients need to be coded in ICD-10 rather than ICD-9. Let’s take a look at some of the perils of this “instant transition.”

Hypothetically I could be treating a patient on September 30, 2015 and I can diagnose them with a cervical segmental dysfunction (739.1). If they return for treatment the following day on October 1, 2015 that same person with the same diagnosis is now considered to have a “segmental and somatic dysfunction of the cervical spine” (M99.01). That’s not too bad…

Let’s look at the cervical sprain/strain example from above. If that patient presents for an evaluation on or before September 30, 2015 their diagnosis would be 847.0. However, should they present on or after October 1, 2015, their diagnosis is now “Sprain of ligaments of cervical spine (S13.4xxA) (initial encounter) with strain of muscle, fascia, and tendon at neck level (S16.1xxA) (initial encounter)”. While it does make the diagnosis more specific, where one disease process is mapped to one code, it makes coding as a whole more difficult.

As far as the sidedness argument. If a patient comes in and sprains both shoulders in a Baltimore auto accident on September 30, 2015, then they will be diagnosed with 840.9. If, however, they came in on October 1, 2015, they would have two separate diagnoses, one for the sprained right shoulder, and one for the sprained left shoulder. And if it is “more than” just a sprain, that is if there is any muscular involvement, we would have to code for both the sprain and the strain component of the injury, which is not uncommon. So here is what it would look like:

Right shoulder rotator cuff sprain (S43.421A) (initial encounter)
Left shoulder rotator cuff sprain (S43.422A) (initial encounter)
Strain of muscles and tendons of the rotator cuff of right shoulder (S46.011A) (initial encounter)
Strain of muscles and tendons of the rotator cuff of left shoulder (S46.012A) (initial encounter)

In that previous example, it is clear that 1 code (bilateral shoulder sprain/strain) mapped to four separate codes, inclusive of the right vs. left side shoulder and inclusive of the sprain (ligamentous component) vs. strain (muscular) component of the injury. While it is not that difficult to hit a few buttons on a keyboard, you can see how it makes diagnosis coding way more complex.

As with any transitions, errors and omissions will be made. These errors will not only be made by me and my staff but by health insurance companies, third party payors, patients, etc. It is not feasible to transition to an entirely new language over-night without a few bumps in the road. Gurus in the insurance industry are predicting a cash flow interruption for small offices of anywhere between 3-6 months worth of normal cash flow as the mistakes get ironed out.

So what does this mean for the auto accident injury patients of Baltimore and more specifically, of Mid-Atlantic Spinal Rehab & Chiropractic? Absolutely nothing!

Our proprietary software has the ability to duly code in both ICD-9 and ICD-10 languages and will retain that ability moving forward. You will still be bound by the contracts you signed with your health insurance provider and will still have to pay copays, deductibles, etc. Literally nothing changes other than the codes we use to record your injuries. So rest assured, it should be business as usual moving forward.

If you, or someone you know, is experiencing neck or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

The Role of Traction in Recovery From Baltimore Auto Accident Injuries

As a Baltimore Chiropractor that spends the majority of his time treating patients recovering from Baltimore Auto Accident Injuries I get asked many of the same questions each day. It finally occurred to me that I should address these common questions in a series of blog posts on my website. That way a patient can know what I am going to say before I say it (and it will keep me from repeating myself.).

One of the questions I get asked most frequently is whether or not my office offers “traction” therapy. The answer is quite simple, “yes, we do.” However, the question is somewhat incomplete. That is, there are two different types of traction that we offer and each are used for different types of injuries. Let me explain.

The first type of traction that most patients are referring to is called “mechanical traction.” A picture of a mechanical traction machine that I might use on a Baltimore auto accident injury patient can be seen here. It is a table where a patient is harnessed down such that their torso is fixed, and a gentle mechanical stretch can be applied to the neck, or conversely, their torso is fixed and a gentle mechanical stretch can be applied to their lower backs. I generally will use mechanical traction as a form of therapy when patients either fail to improve with traditional forms of chiropractic care and rehabilitation, or when traditional spinal manipulation is ill-advised. Many of my Baltimore auto accident patients with neck disc herniations or lower back disc herniations swear by mechanical traction to help open up their locked joints and to take pressure off of their inflamed discs. The machine is somewhat cumbersome and it takes about 20 minutes from start to finish between setting an injured patient up on the machine, and administering the desired traction effect. As far as I am concerned, as long as it helps my injured Baltimore auto accident patients then it is time well spent.

The second type of traction that we offer is called intersegmental traction, or more colloquially, the “roller table.” A picture of an intersegmental traction table (or IST table) that I might use on a Baltimore auto accident injury patient can be seen here. It is a machine that has a series of massage-type rollers on a moving conveyor belt. It travels from your neck, through your middle back, and down to your lower back. It focuses on lifting and gently separating all of the spinal segments of your spinal column, one by one. The nice added benefit from utilizing an intersegmental traction table is the soft tissue paraspinal massage that it offers the patients utilizing it. Many patients refer to their time on the IST table as their “favorite part of their treatment.” They feel relaxed, looser, and a lot less stiff.

In future blog posts I will address other modalities and therapies that we offer, as well as other commonly asked questions that commonly arise during Baltimore auto accident injury treatment at Mid-Atlantic Spinal Rehab & Chiropractic.

If you, or someone you know, has been injured in a Baltimore auto accident injury and requires treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz