We know that there's a little bit higher incidence among the females of the population than the males for this process of arterial dissection. We don't know but she may have been on birth control. She was certainly within an age group that persons in their mid-30's. Females in the mid-30's would typically be using birth control. She may have a family history of aneurysm or vessel disor- ders. We don't know that but it's a possibility. She may have had an undiag- nosed collagen disorder increasing her previous position for dissection. Each one of these circumstances, if they existed increase the predisposition like the good that that pose she held contributed to the dissection itself and to the complication of the dissection over time. The most important for us as chiropractors looking at this unanswerable ques- tion in this manner is very simply had Ms. May never sought care from a chiro- practor, had she gone to Starbucks instead of the chiropractor and she's gone to a medical doctor or the movies, would she have had the same fate in the fi- nal analysis? We don't know that. Obviously, it is more comforting for us to think, yes, she would have. We need to be honest and we need to be candid in evaluating that and try and learn as much as we can about this situation as we move forward. Next slide, please. Now what can we learn from this experi- ence? First and foremost, as much as we see neck pain day in and day out, and it becomes a normal routine for us, we need to continue to be alert to the pos- sibility of dissection and progress. Dissection and progress, the most common pay and most common symptom presentation of a dissection in progress is the presentation of neck pain and headache. We want to look for neck pain and headache that has an unusual origin or unusual character to it. When this presents, you want to explore the symptoms of neck pain and headache with those patients during your assess- ment as fully as possible. You want to learn as much as possible about the type of pain they're having, the presentation of the pain, the history of it, how long its been around, where it came from, how it started. You want to look for unique characteristics in terms of the pain and its intensity. Next slide, please. Now one of the things that's also important for us to learn from this experience is, is the social value, the clinical value and the legal value of informed consent documentation. Now you can make the argument very clearly. I could probably help you make the argument that if there is no greater risk for vertebral artery dissection under chiropractic care in comparison to medical care for persons with neck pain and headache, then how can we develop an informed consent and say, "The person has this risk or that risk relative to chiropractic care and the development of this dissection." I get that. I understand that.
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