It was after 10 p.m. on a Sunday night, and my wife and I had just brought a patient and friend to the hospital because she was incoherent on the phone. The ER doctor called in the covering neurologist. The neurologist was petulant and incorrectly noted the patient was deaf, because she didn't respond to his directions. In our opinion, the patient's history and presentation indicated that she had pseudo tumor cerebri. She needed a spinal tap to prove it, because there was no papilledema. Whether it was sexism, classism or racism, we didn't get through to the doctor by asking for the tap - then my wife got within two inches of the neurologist's nose and asked if he was willing to deal with the consequences of not doing so. Bingo: A tap was ordered; it showed more than a 200 percent increase over the normal reading. A shunt was performed within days, along with retinal surgery, and the patient's vision and life were saved.
Most chiropractors feel we are nerve specialists. We adjust the spinal column, but that is just our avenue of approach to the spinal nerves, which flow everywhere in the body. This parallels a medical doctor who gives a shot or a pill. He is not limiting himself to the treatment of skin or stomach problems, but those are his avenues of approach to achieve changes in the bloodstream. Many chiropractors (nondiplomates of neurology) feel inadequate in the more arcane areas of this subject. It is not the fault of our education, as there are only so many hours in the day, but it is such a huge subject that it is hard to be good at it without specializing.
As the above anecdote shows, even a medically credentialed neurologist may not be conversant with all the esoteric areas of his own speciality. Harry Truman said that war is too important to trust to generals; likewise, health is too important to completely trust to physicians. There was no textbook in my library that had anything on pseudo tumor cerebri or its myriad other names. Thank God, the Internet had material on it, or we could have never stood our ground. But searching for Internet articles instead of using a textbook, hours were wasted.
Merritt's Neurology Handbook has half a chapter on pseudo tumor cerebri and mentions it at least one other time. This resource, along with a good medical dictionary, evens the playing field. It can give you badly needed expertise in a hurry. Other topics it explores include EMGs; evoked potentials; different gaits; headaches; neuropathies; and a multitude of other conditions too numerous to mention. I mentioned the above example because it is a relatively rare condition; neither we nor the neurologist in question had ever seen a case of it previously.
This book would have shortened the learning curve by hours; in critical conditions, that just might make the difference. The full-sized Merritt's Neurology is more inclusive, but I believe the handbook is just what most chiropractors need. You should buy it for the same reason you have insurance: just in case you need it. For a busy practice, it is a no-brainer. The book is broken down into 165 chapters and an index. If there is a criticism, it is the index. Pseudo tumor cerebri was not listed there, although it is in the table of contents under "Disorders of Cerebrospinal and Brain Fluids." The argument could be made that they were saving space because it is a handbook, and space is at a premium, but it was still a bit disappointing not to find it in the index. However, they did have the listing, and that's what counts. What's also important is that this handbook has most of what a chiropractor needs a reference book in neurology for in the first place.
Dr. Lavitan's rating:
10out of10
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