For decades, the holistic integrative medicine movement has been gradually leaving its imprint on more hospitals, universities, health care budgets and medical schools worldwide.
Introduction
By: Dr. Tom Nottingham with assistance from radiologist Michael Fergus
For decades, the holistic integrative medicine movement has been gradually leaving its imprint on more hospitals, universities, health care budgets and medical schools worldwide. NDs, ODs, DCs as well as AP/LAcs are referring to and collaborating with MDs in more diverse healthcare settings every year.
High level integrative care management has been a standard best practice at Chiro One since our inception. The following case study of highly comprehensive evaluation and expedient decision-making is just one life-saving example that reflects our integrative approach.
Abstract
Objective
To describe the effects of Chiro One’s proprietary assessment protocol on a 73-year-old retired construction worker with low back, hip and hamstring pain.
Clinical Features
Initial Exam & Report of Findings: 10/2022
Symptoms
73-year-old Male presented with mild to moderate pain in the low back, hips and bilateral hamstrings that had become more severe in the previous 2 days.
Subjective Examination
Activities of Daily Living
The patient had spent 35 years performing physical labor in the construction industry. The only easing factor reported was after a non-Chiro One DC appointment one year prior to Dr. Nottingham’s exam. After 4 visits — which did not include Xray assessment — his pain eased, and he discontinued care.
Pain returned and escalated to 8/10 pain levels, then fluctuated in the week prior to assessment. Movement pace, lifestyle and sleep patterns were disrupted. On the day of exam, the patient reported a 4/10 pain level.
The “yellow flags” noted — patient’s age, occupation and sudden pain escalation — led to an imaging recommendation, which was positively accepted.
No other health issues were reported or observed. The patient chose not to take pain medication and expressed expectations of negative news after seeing his x-ray.
Objective Examination
A standard Chiro One low back exam was administered including:
- A standard Chiro One low back exam was administered including:
- Derifield Leg Check: short RIGHT leg —> pulling up pelvis causing pelvic instability
- Straight Leg Raise (SLR): positive on the RIGHT leg
- Yeomans test: positive —>detected SI (sacro-iliac) joint pain
- Quadratus Lumborum (QL): taut and tender fibers tender to palpation (TTP)
Xray revealed:
- Mild scoliosis
- Severe deterioration of lumbar spine
- White spot (radiopaque) on L2, L5, possible one on L3
DC referred “red flag” findings to radiologist who confirmed:
- Total of 5 white spots: UH-543, L2A, L3 and one in L5
- App view revealed 4 or 5 white spots in pelvis
Diagnosis
After detecting white spots on the Xray reflecting radiopaque, Dr. Nottingham referred the patient to St. Vincent’s oncology center for in-depth imaging where:
- MRIs detected a total of 9 radiopaque spots
- Patient’s oncologist made a diagnosis of Osseous Hemangioma
The DC was contacted by the extremely thankful patient who communicated that his cancer was found to have originated in the lung.
Intervention
The DC followed up just as the patient was being admitted for surgery to remove half of a lung. Chiropractic treatment is not applicable until after surgeons’ post-operative exam and approval. Only then would a low force treatment plan potentially be prescribed and implemented gradually. The patient stayed in contact with Dr. Nottingham throughout his cancer diagnosis and treatment.
Outcome
The patient has had surgical intervention on his left lung to remove some cancer and is currently receiving radiation treatments onto a spot on his scapula. His prognosis is favorable. He told Dr. Nottingham he would like to stop by the clinic in the near future to discuss the possibility of chiropractic care.
Description
The patient called his DC from the hospital where he was about to have surgery to say: “Dr Nottingham, I’m telling everyone how great you are!”
Conclusion
In 40 years of practice this was the third time Dr. Nottingham enabled detection of cancer. By recognizing the “yellow flags” during his Day 1 examination — age over 50, new onset pain intensifying daily, no response to trial of conservative care — he was able to recommend the critically needed intervention that followed.
Post-surgical care continues to be coordinated with the patient’s orthopedic surgeon who will determine whether chiropractic follow-up is appropriate. Although no longer under his professional care, the patient has expressed effusive gratitude and referred Dr. Nottingham to multiple friends and family members.
