What are you supposed to do in your office on Monday morning? If there are no clear-cut predisposing factors suggesting a VAD, if there are no testing procedures helpful in ruling out potential VAD practices, and if the great majority of VAD and progress patients present with musculoskeletal symptoms mimicking what we routinely see in practice, then what are you to do on Monday morning? It comes down to appreciating your diagnostic ability, appreciating your evaluative ability, and appreciating the subtle changes you see in patients. The reality is it's time for us to look, to listen, to ask, and to think relative to what's going on in that patient. What are you going to be looking for? Every chiropractor in the world owes a debt of thanks to Allan Terrett. Allan Terrett is the gentleman who went back to the literature and did an analysis of virtually everything that had been published, suggesting a relationship between cervical spine adjusting and stroke. You know as I do, that the literature often makes reference to it being related to chiropractic care or a chiropractor. Dr. Terrett was the one that found that so many of these cases, a chiropractor wasn't involved, a person trained as a chiropractor wasn't involved. That because it looked like what we do it was called what we do, and because the person looked like we do when we do it, they were assumed to be a chiropractor or were referred to as a chiropractor. Allan Terrett gave us that information and dissected out that information, tremendous value to the entire profession worldwide. What Allan also put on the table was what he described as the 5 D's, the A, and the 3 N's, in terms of what to look for in your office. The first of the D's is dizziness. When a patient comes in experiencing dizziness it should be a concern to all of us. That being said, dizziness is a very common symptom among patients who present for chiropractic care. Dizziness is also a common sequelae that we see when a patient gets up off an adjusting table. A person's been laying on a table for a period of time, minutes and so on and then gets up quickly, it's not unusual for them to experience a degree of dizziness. That's not what I'm talking about. I'm talking about a person who has a profound level of dizziness, not just a little bit of lightheadedness, not just a positional change, but a significant level of dizziness. A person for whom this is very unusual. If this is a person with a migraine history, dizziness is a part of the migraine pattern that they've had, that's not what I'm talking about. I'm talking about dizziness apart from any explainable circumstance. Obviously if the individual has Labyrinthitis, something of that nature, dizziness would be expected in that environment and not anything to be associated with a VAD. The reality is that we need to look at the presence of dizziness in our patients. The second thing, which would be a very obvious one, is we need to look for the presence of drop attacks. If we're talking about an individual that in one moment is standing, talking, articulating, and dealing with another individual and bam, hits the deck moments later with varying degrees of consciousness. Obviously that would be a concern to all of us.
The third D from Allan is diplopia, when we have a patient that presents with
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