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keep your eyes open
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keep your eyes open - February 1, 2007 11:22:00 AM
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3.5fig
Posts: 97
Joined: July 13, 2005
Status: offline
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This is just a reminder to all of you that treat patients with Low Back Pain to always remember that the pain has many sources. I just learned that a patient of mine died of Acute Lymphocytic Leukemia. He presented as a typical mechanical LBP patient. 26 years old in great shape who worked as a tile-setter. Complaint was non-specific back pain with no other health complaints. Nothing unusual in the exam except some joint/muscle tightness and very poor squatting mechanics. Treated him for two weeks with no improvement. He then complained of some non-related(he thought) arm ache...which being a tile-setter could be normal. However, the little bell in my head went off and I encouraged him to follow up with his PMD for some blood work and an evaluation just in case this wasn't mechanical back pain. He didn't make the appointment and the next time I saw him I got all over him to do it which he promised that he would do....He never followed up with us and today I read in the paper that he died. 26 years old with a 9 month old daughter. I found out that he finally went to see his PMD once he had a bad nosebleed. The initial treatment with bone marrow worked, but then the disease came back and got him. So, always listen to that voice in your head and keep your eyes open.
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Re: keep your eyes open - February 1, 2007 11:38:00 AM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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Yes indeed. I had a patient about 14 months ago come in with low back pain. Exam findings didnt add up, so we sent him for an MRI. Long story short, he ended up in emergency surgery for a dissected AAA. A few months after that I had a patient complain of posterior/lateral throracic pain. Heart rate was sky high and she had SOB. She went by ambulance to the ER and they found endocarditis and bronchitis.
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Re: keep your eyes open - February 1, 2007 12:51:00 PM
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keldada
Posts: 20
Joined: December 13, 2006
From: ny, ny
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scary stuff. We can never become too complacent.
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Re: keep your eyes open - February 1, 2007 1:13:00 PM
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Jeep
Posts: 353
Joined: March 28, 2003
From: USA
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Absolutely!!
A good example of how clinical reasoning/best practice trumps RCTs.
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Re: keep your eyes open - February 8, 2007 1:48:00 AM
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blast7
Posts: 114
Joined: July 28, 2005
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You PT's are doing a great job. I think it would be great to let HMO's know that you are making these types of referrals. I'm not sure exactly how. Maybe an annual report just to show that PT's are making appropriate referrals back to PCP when things do not add up.
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Re: keep your eyes open - February 8, 2007 5:32:00 AM
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3.5fig
Posts: 97
Joined: July 13, 2005
Status: offline
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Thanks for the compliment, I think one of the most important things in clinical care is to realize when to refer. We all know what we can treat, it is knowing what you can't treat that makes one a better clinician. The ultimate goal of all quality clinicians, be they PTs, DCs, DOs, MDs, etc....is to get their patients better and back to a normal independent life as quick as possible and knowing when to refer is an important part of that process. And by the way, I am a DC, not a PT...not that it matters much in regards to this subject, but I say that just as a point of information...
Thanks
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