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What Should I Expect On My First Visit
First, we will review your file and take your history. It has been said in all healthcare settings that in the majority of cases encountered, the most probable diagnosis becomes evident from this initial process of reviewing the file and interviewing the patient.
Based on the patient’s history, usually a brief regional exam follows. For more serious cases a more in depth exam is required. During the history and examination process, the presence of red flag signs and symptoms are ruled out. Red flag signs and symptoms are those signs and symptoms that would require an immediate referral to another healthcare practitioner. A classic example of a lower back condition in which we would find red flag symptoms is Cauda Equina Syndrome. In this rare condition, a patient is experiencing such severe compression on one or more lumbar nerves, they typically lose the ability to control their bowel and/or bladder. They may develop a complete inability to urinate or they cannot stop themselves from urinating in their clothes. Patients with Cauda Equina Syndrome may develop complete paralysis in the leg. This type of patient needs an immediate referral to a neurosurgeon for possible emergency surgery. Dr. Mark has seen only 2 of these cases over more than 22 years in practice. Another example of a red flag condition occurs in the neck, known as Cervical Myelopathy. In this relatively rare condition, a patient has such severe nerve compression in the neck, the spinal cord becomes compressed which damages the nerves not only to the arm(s), it also affects the nerves going all the way down to the legs. This rare condition can be ruled out through examination procedures. After ruling out the red flags through the history and exam process, an initial diagnostic impression of your condition is formed.
Based on the initial diagnostic impressions, a trial of treatment is usually started on the first visit. In most cases additional diagnostic tests such as x-rays or an MRI are not needed to get started. We have many therapeutic tools at our disposal to resolve your problem. The form of treatment we choose to start with will be the form of treatment we have found to be the most likely to cure your particular problem in the shortest period of time, with the least amount of visits.
The majority of our patients find relief from their symptoms with “in clinic” care, whether that consists of chiropractic, physical therapy, acupuncture, or a combination of these tools, in addition to a few simple exercises. A minority of our patients have to exercise more vigorously and sometimes modify their diet, in addition to receiving chiropractic care, to get relief. A smaller minority of patients are also educated in body detoxification methods to further enhance the healing process. In most cases, the first line of treatment is effective. Occasionally, the first type of treatment tried fails to fully resolve the patient’s problem. Like all doctors, problem solving is a part of our job. When we experience this situation, we reassess the situation and either, a) modify the treatment to find the ideal combination of treatment tools to solve your problem, b) order more tests such as x-rays or an MRI, or c) refer for a second opinion from another healthcare practitioner. If we ever reach a point in a patient’s case where we feel the services of another healthcare practitioner are better suited to a patient’s needs, we never hesitate in referring for another medical opinion. We have developed a network of many other medical professionals to call upon when the need arises for a professional referral. In the case where a referral is necessary, we will send a referral letter to the other medical professional to review prior to seeing you. The advantage of this approach is that the other medical professional will have some background information about your case, including what has already been tried, prior to seeing you. In this way, you get the best continuity of care, rather than having to start over from scratch. Furthermore, we favor referring to other healthcare professionals who prefer to exhaust all conservative methods first before considering more invasive approaches such as surgery.
How To Prepare For Your Visit
If possible, fill out the patient questionnaire before your visit. The form is posted in this section. Try to come at least 15 minutes early. If you come early and we have a little extra time, we will spend it with you rather than take a coffee break. If you come late, we will still deliver the best care possible however, we usually run on a tight schedule which can influence the amount of time spent with you. To further prepare for your visits, please keep in mind our following requests:
1) Avoid wearing excessive jewelry. Wearing earrings, necklaces, hair clips and bracelets should particularly be avoided.
2) Avoid using moisturizing lotion on your body on the days you will be coming for treatment. We often need to grasp a body part, or make a firm contact on a body part to perform a mobilization or manipulation. The lotion makes it difficult to make a good contact on the skin. The lotion also leaves a residue on our treatment tables which is difficult to clean up.
3) Avoid having a massage prior to your visit. Occasionally a patient will show up right after a massage with the mindset that this will make it easier for us to do our work. It doesn’t. If your muscles need to be relaxed prior to mobilization and manipulation procedures, we will do it at our clinic. We need to observe your muscles and joints in their normal state to properly assess you, not after they have just been worked on. Furthermore, oil massages leave a residue of oil on your body which interferes with our ability to treat you in the same way that body lotion interferes with our ability to treat you.
4) Avoid eating a heavy meal just prior to your appointment. Likewise, avoid coming in while really hungry. If you haven’t eaten for several hours and you are hungry, have a light snack to tide you over until after the visit. Keep in mind our visits usually take longer than what most people are used to when visiting a chiropractor. The last thing we want is to have to cut your visit short because you need to eat. We want you to get the most out of each visit to minimize how many times you need to come in.
5) Turn off the ringer on your mobile phone when in the treatment rooms. We want you to get the most out of each visit to our clinic. To get the most out of your visit, we need to have complete focus on you without the intrusion of this distraction.
6) If you have had previous x-rays, an MRI, or relevant lab tests, bring them if possible. If you have had regular x-rays, we prefer the real films over a CD-ROM. Try to get the real films if possible.
7) Try not to be in a hurry if possible. The first visit runs about 1 hour to 1 and a half hours and sometimes even longer. Occasionally we encounter a patient who expects top quality service at fast food speed. The reality is, in the world of healthcare, you can’t have both. If you only have limited time we will work to give you the most out of your visits but it is not the ideal way to deliver a top quality service.
How Long Are The Visits?
For most cases, visits usually last about an hour. The first visit usually runs longer. For difficult cases, the subsequent visits sometimes run longer than an hour as well. There is no additional charge when additional time is required. Those patients who come early are most likely to receive the benefit of additional time. Visits typically incorporate deep tissue trigger point and fascia release-massage, physiotherapy modalities and chiropractic manipulation in one comprehensive service. Acupuncture is also used in some cases in addition to the other treatment methods and sometimes as a standalone service. We find we get quicker results by combining all these tools into the treatment regimen rather than performing only 1 type of treatment alone.