RehabEdge Physical Therapy Forum

Forums  Register  Login  Forgot Login?
  My Profile 
My Subscription
  My Forums 
Search
  FAQ  Log Out
Follow @RehabEdge

"Dizzy" case presentation 2

 
Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Medical Complexity >> "Dizzy" case presentation 2 Page: [1] 2   next >   >>
Login
Message << Older Topic   Newer Topic >>
"Dizzy" case presentation 2 - July 4, 2006 12:17:00 PM   
Dr.Wagner


Posts: 1242
Joined: January 25, 2003
From: Indianapolis
Status: offline
A 45 year old female presents with the primary complaint of being "dizzy"...


Go

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum
Post #: 1
Re: "Dizzy" case presentation 2 - July 4, 2006 1:35:00 PM   
jma

 

Posts: 2639
Joined: August 25, 2000
From: NY
Status: offline
1. When did this begin? Is this the first time this has happened? If not, how many times has she experienced her "dizziness".

2. When does/did this occur? Did it happen in the morning/afternoon/evening? Did/does it occur after performing certain activities or did/does it arise even at rest?

3. What is her current health status? Is she taking any medications? Did she ever notice the "dizziness" while taking the medications, if any?

4. Are there certain body positions that bring on the dizziness? Are there certain positions that alleviate the dizziness when it does occur?

5. When the dizziness occurs, does she feel like she will lose her balance? Does she feel like she is spinning or the room spinning?

JMA

(in reply to Dr.Wagner)
Post #: 2
Re: "Dizzy" case presentation 2 - July 5, 2006 8:35:00 AM   
USAPT

 

Posts: 284
Status: offline
What does she mean by "dizzy"?(pt., please be more specific)

_____________________________

Jason, PT
Board Certified Orthopaedic Specialist

(in reply to Dr.Wagner)
Post #: 3
Re: "Dizzy" case presentation 2 - July 5, 2006 9:24:00 PM   
Dr.Wagner


Posts: 1242
Joined: January 25, 2003
From: Indianapolis
Status: offline
The patient looks at you (you notice she has one eye patched), she states "I feel off balance, sometimes the room spins, other times I do"
Most recently this happened 2 days ago...but I had this happen to me once before, about a year ago."

"Nothing changes the sensation, I just feel better when I am not walking around"

When you ask her about past medical history and meds she states "I sometimes get headaches, but I don't take any medications...I am on birth control, I have had my gall bladder taken out and my appendix taken out"

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Dr.Wagner)
Post #: 4
Re: "Dizzy" case presentation 2 - July 5, 2006 9:42:00 PM   
Sean_Collins

 

Posts: 74
Joined: October 21, 2005
From: Massachusetts
Status: offline
As a PT, if a patient came to me with a prescription (or referral) for PT with the diagnosis of "dizzy" I would first have to know what was done by the physician to come up with that diagnosis. So, first - did she see a physician for this symptom? What was done? Any tests? Are they ruling out anything? Or did she just walk into PT one day?

_____________________________

Sean M. Collins, PT, ScD, CCS
Associate Professor
Research Coordinator
Department of Physical Therapy
Coordinator, Graduate Program in Disability Outcomes
Adjunct Professor, Department of Work Environment
School of Health &

(in reply to Dr.Wagner)
Post #: 5
Re: "Dizzy" case presentation 2 - July 5, 2006 10:04:00 PM   
drbuddy

 

Posts: 429
Joined: July 31, 2005
From: Pennsylvania
Status: offline
What is the reason for the eye patch?

(in reply to Dr.Wagner)
Post #: 6
Re: "Dizzy" case presentation 2 - July 6, 2006 8:19:00 AM   
Shill

 

Posts: 1377
Joined: February 14, 2003
From: Madison WI USA
Status: offline
I think she's a pirate. Hang on to your wallet. Does she have a peg leg? ARGH.

Or, she may have diplopia, and the patch "fixes" this for her. Where she got the patch (and of course why she wears it) would be a good question to ask. Visual changes in a pt at this age who is on birth control and a smoker may mean that TIA should be ruled out.

_____________________________

Steve Hill PT

(in reply to Dr.Wagner)
Post #: 7
Re: "Dizzy" case presentation 2 - July 6, 2006 10:12:00 AM   
Dr.Wagner


Posts: 1242
Joined: January 25, 2003
From: Indianapolis
Status: offline
You ask her about the eye patch and she states...

"Well, I AM a pirate, but that isn't why I wear the patch...I have double vision, this clears it up"

As for the referral, the physician didn't order anything yet, is currently out of the office.

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Dr.Wagner)
Post #: 8
Re: "Dizzy" case presentation 2 - July 6, 2006 10:19:00 AM   
Sean_Collins

 

Posts: 74
Joined: October 21, 2005
From: Massachusetts
Status: offline
So why is she in the Physical Therapist's office?

_____________________________

Sean M. Collins, PT, ScD, CCS
Associate Professor
Research Coordinator
Department of Physical Therapy
Coordinator, Graduate Program in Disability Outcomes
Adjunct Professor, Department of Work Environment
School of Health &

(in reply to Dr.Wagner)
Post #: 9
Re: "Dizzy" case presentation 2 - July 6, 2006 12:11:00 PM   
Dr.Wagner


Posts: 1242
Joined: January 25, 2003
From: Indianapolis
Status: offline
I must restate.

She says "I have had a CAT scan a year ago, it didn't say anything"

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Dr.Wagner)
Post #: 10
Re: "Dizzy" case presentation 2 - July 6, 2006 12:19:00 PM   
Sean_Collins

 

Posts: 74
Joined: October 21, 2005
From: Massachusetts
Status: offline
This just does not sound like a patient that would wander into a PT clinic. Perhaps an ER, or a physicians office, but not your ordinary PT clinic. Is the point that IF it did happen the PT needs to know what to do - besides sending them to a physician?
Also - a CT scan a year ago - from patient report - does this say much at all about what is going on now?

_____________________________

Sean M. Collins, PT, ScD, CCS
Associate Professor
Research Coordinator
Department of Physical Therapy
Coordinator, Graduate Program in Disability Outcomes
Adjunct Professor, Department of Work Environment
School of Health &

(in reply to Dr.Wagner)
Post #: 11
Re: "Dizzy" case presentation 2 - July 6, 2006 12:27:00 PM   
Dr.Wagner


Posts: 1242
Joined: January 25, 2003
From: Indianapolis
Status: offline
Sean please, this is a case of differential diagnosis. A chance to actively work out a problem with a patient with a vague "medically complex" presentation.
I am not asking for treatment.

I am asking for a way to systematically work through a problem of differential diagnosis.

Please, if you do not wish to participate, please do not ruin this discussion with others.
Thank you.

If there is anyone left, plese lets continue this case.

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Dr.Wagner)
Post #: 12
Re: "Dizzy" case presentation 2 - July 6, 2006 12:36:00 PM   
Sean_Collins

 

Posts: 74
Joined: October 21, 2005
From: Massachusetts
Status: offline
I understand the concept of differential diagnosis, however, I also understand when a patient does not belong in a PT clinic being worked up by a PT when there has not been a ruling out of other medical conditions. You are presenting cases that come from the ER to Physical Therapists - last I checked PT's do not work in the ER. I really do not understand the benefit of cases like this to the development of differential diagnosis for a physical therapist. Perhaps asking therapists that work in outpatient clinics suggest cases from their actual case loads, and then you, as an ER physician can assist them in their differential diagnosis?
I am not trying to be disruptive, I merely desire an appropriate direction to this activity, and cannot just sit aside while this happens without providing my opinion.

_____________________________

Sean M. Collins, PT, ScD, CCS
Associate Professor
Research Coordinator
Department of Physical Therapy
Coordinator, Graduate Program in Disability Outcomes
Adjunct Professor, Department of Work Environment
School of Health &

(in reply to Dr.Wagner)
Post #: 13
Re: "Dizzy" case presentation 2 - July 6, 2006 1:04:00 PM   
drbuddy

 

Posts: 429
Joined: July 31, 2005
From: Pennsylvania
Status: offline
Why did she have the CAT scan done?

I'd also ask her if she had any other doc's examine her for her vision problems. If so, ask what they came up with or ask to see her medical records.

I agree with Sean to a point. I'm not so sure this would walk into a PT's office, and if it did, no one would expect the PT to manage it. But, this exercise could be helpful nonetheless. I think it's important to understand the clinical reasoning behind ddx. If you do, you might pick up on things the physician misses. Beleieve it or not, MDs and DOs can be way off the mark at times.

(in reply to Dr.Wagner)
Post #: 14
Re: "Dizzy" case presentation 2 - July 6, 2006 1:10:00 PM   
Sean_Collins

 

Posts: 74
Joined: October 21, 2005
From: Massachusetts
Status: offline
I agree that ddx is critical, and even if the physician provider was off the mark with this case - there would at least be a mark, so the PT would know what they had done, were thinking, etc.
I will not interupt again, unless I have somethind to add to the case.
Best

_____________________________

Sean M. Collins, PT, ScD, CCS
Associate Professor
Research Coordinator
Department of Physical Therapy
Coordinator, Graduate Program in Disability Outcomes
Adjunct Professor, Department of Work Environment
School of Health &

(in reply to Dr.Wagner)
Post #: 15
Re: "Dizzy" case presentation 2 - July 6, 2006 5:20:00 PM   
USAPT

 

Posts: 284
Status: offline
what are her vitals? anything out of ordinary to correlate with her other complaints?

_____________________________

Jason, PT
Board Certified Orthopaedic Specialist

(in reply to Dr.Wagner)
Post #: 16
Re: "Dizzy" case presentation 2 - July 6, 2006 8:45:00 PM   
jma

 

Posts: 2639
Joined: August 25, 2000
From: NY
Status: offline
Did an opthalmologist examine her in the past? What was the cause of her diplopia? Was there a reason it could not be corrected and that she has to use a patch instead?

(in reply to Dr.Wagner)
Post #: 17
Re: "Dizzy" case presentation 2 - July 6, 2006 9:27:00 PM   
FLAOrthoPT

 

Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
sean this is way more common of a scenario than you may realize, and even if it is not the primary reason you are seeing her, you may be the one to help figure something out a doctor misses, you spend WAY more time on a clinical eval than ANY other medical professional, so you must be ont he lookout, even if all she came in was for trap strain, but started telling you some of this, you better catch something like this...

ps, test her cranial nerves. get more details about her headaches. keep going I love these things...

Ben Galin, PT, DPT, OCS

(in reply to Dr.Wagner)
Post #: 18
Re: "Dizzy" case presentation 2 - July 7, 2006 12:43:00 AM   
Dr.Wagner


Posts: 1242
Joined: January 25, 2003
From: Indianapolis
Status: offline
Sean, I post based upon ALOT of positive feedback in the past. I post because I enjoy it.
I post because I doubt many physicians would.
I post because perhaps much of this can bring pieces of pathology together for people...these cases have REAL answers...


Back to the patient.


"well, I had a CAT scan because there was this time I had blindness in my right eye for a day...that went away"

You check the vitals
HR 90, BP 110/70, RR 18, o2 sat 98%

You check cranial nerves
You remove "the patch"
There appears to be a dysfunction of CN III and VI
All other cranial nerves are intact

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Dr.Wagner)
Post #: 19
Re: "Dizzy" case presentation 2 - July 7, 2006 5:13:00 AM   
Sean_Collins

 

Posts: 74
Joined: October 21, 2005
From: Massachusetts
Status: offline
Understood - please accept my apologies, ignore my previous posts, and enjoy the rest of the case.
Regards -

_____________________________

Sean M. Collins, PT, ScD, CCS
Associate Professor
Research Coordinator
Department of Physical Therapy
Coordinator, Graduate Program in Disability Outcomes
Adjunct Professor, Department of Work Environment
School of Health &

(in reply to Dr.Wagner)
Post #: 20
Page:   [1] 2   next >   >>
All Forums >> [RehabEdge Forum] >> Medical Complexity >> "Dizzy" case presentation 2 Page: [1] 2   next >   >>
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.156