Long Time, No See
If it's been a while since your last visit we will ask that you update us. If anything has changed in your health history since you have been seen last, please let us know. This includes surgery, trauma (falls, motor vehicle accidents, injuries), illnesses, changes in medications, new hobbies, change in occupation, etc. Any of these may impact decisions that we make together about your care. Please remember that the more I know about your situation, the more efficient and specific your care will be. I need to know of these changes for your safety, which is paramount.
If it has been as long as two years since your last visit, or if there is a new injury or condition, I will need to update your physical exam. This is critical for your safe care, and I will insist that we take the time to reassess your situation thoroughly and accurately just like we did at your first visit.
Not everyone who presents for chiropractic care will need imaging. The decision to x-ray is made with you according to the presence or absence of “red flags.”
Red flags are patient signs, symptoms or history that indicate possible serious pathology and hence support the decision to image. If no red flags are present, there is a negligible risk of serious pathology and the patient can be reassured that imaging is not indicated and treated with conservative measures. This list is based upon research, and is widely accepted among multiple medical professions.
Red flags include:
recent significant trauma
unexplained weight loss
age <20 or >55 years
pain worse at night or at rest
severe or progressive sensory or motor disturbance
bladder or bowel dysfunction
history of malignancy
history of immune compromise
intravenous drug use
(prolonged) glucocorticoid use
poor job satisfaction
difficulty at work
lack of social support
These are not the only factors involved in the decision to take x-rays, but when these are present, x-rays are indicated. Anytime x-rays are taken, I will review them with you in some detail and correlate them with the history and physical findings. By the time we are finished, you will have a deeper understanding of what is happening to you, what we can do about it, and your prognosis.
If you do not achieve at least 50% improvement by subjective and objective criteria within the first four weeks of care, or if there is progression of a neurological deficit, we will discuss further imaging, possibly including MRI, CT, or ultrasound. I will review with you in detail the pros and cons of imaging so that you are fully informed.