Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart. He was also obese, had a terrible diet and was out of shape. These factors placed a strain on his heart and circulatory system, all of which are risk factors for DVT formation.
Bobby had driven home to see family for Thanksgiving. The trip usually takes 13 hours by car, but Bobby made the trip in just over 11 hours. On the Sunday following Thanksgiving, he began to have trouble breathing and became dizzy when he stood up. He sought help in an emergency room and was diagnosed as being dehydrated, given IV fluids and told not to travel again until he was rehydrated and could stand without experiencing dizziness.
The Tuesday after the ER visit, Bobby woke with labored breathing and asked a family member to call the emergency medical system. He slumped over and died while the call was being placed.
Deep-Vein Thrombosis: Risk Factors and Signs
DVTs form in the lower extremities when blood pools and clots due to prolonged inactivity. Movement is important in lower extremity circulation. The contraction of leg muscles helps pump blood back to the heart. Without muscular contraction, blood flow can stagnate.
DVTs are a serious problem and can easily lead to death if not detected early and proper treatment initiated. The combination of DVTs and PEs is currently the third leading cause of cardiovascular-related deaths in the U.S., resulting in 100,000 deaths annually.1-2
Table 1 lists clinical circumstances and signs associated with the Wells Score System for DVT probability. Each risk factor has been assigned a value. The sum of the factors relates to the probability of developing a DVT.3 Note that the scale lists paralysis, paresis, being bedridden and immobilization of the lower extremities as factors. All of these factors relate to prolonged inactivity. The same risks are present for traveling long distances with little or no activity during the trip, the same situation described in the story above.
Table 1: The Wells Score System For Dvt Probability
Doctors must be aware of the clinical circumstances of DVT and PE for the sake of all patients. The importance of movement as a deterrent for both conditions and for a patient's overall health cannot be stressed enough. All patients must be encouraged to get up and move to the best of their ability, and all doctors must be able to identify DVT and PE in the clinical environment. References
December 2016
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Jamy Antoine, BS, DC, BCN
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Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
Garrett Cuneo, BA
Chronic / Acute Conditions
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
Donald DeFabio, DC, DACBSP, DABCO
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