weren't in a car accident, they weren't doing this, they weren't doing that. They just out of the blue woke up with it, that should be important to us. I'll come back and talk about the automobile accident case in just a little bit, but that individual that it just came out of the blue, should be an important consideration for us relative to that neck pain and that headache. Then we look at the 5 D's, the ataxia, and the 3 N's to see where we are and it's that constellation of symptoms and the development of the symptoms, as well as the degree and the severity of them, that should cause our respective alarms to go off in our brain. Also, we all need to bring the staff in here and they should always be involved. If it's me, I'd want to have my staff watching this presentation right along with you. If they aren't, you certainly could have a staff meeting and educate your staff about these types of situations. Specifically, if the patient complains to your staff after you've already adjusted them and you're already back with another patient, they know that something may not be right and that it is important to have an office policy as to exactly what steps should take place next. Let's look at what you and your staff should be looking for when you have any concern or any potential concern about a VAD response to care. Frankly, these are things that your staff as well as you, should be looking at regardless of whether you've got any concern, they're just good indicators and good markers to keep in mind. One of the important reasons to involve your staff is that while a patient maybe with you receiving adjustment, you have good conversation after the adjustment, everything's fine, you move on to the next patient, the patient moves to the front desk. In that time that they move away from you, they may develop symptoms that you should know about and be aware of, but they simply didn't develop them while they were with you, but given that few minutes to get out to the front desk they did develop them. Your staff, as well as you, should be attuned to listening for any changes in speech patterns, whether the speech is slurred, whether there's a change in the intonation in the voice, whether there is some modification to how the patient is articulating, anything of that nature should cause bells to go off for you and for your staff. You want to listen for the context in speech. You want to look for the presence of any giddiness or inappropriate, what we might call pseudobulbar behavior, where the person is just not responding to the situation normally. They're laughing at areas that aren't funny, they're terribly sad about areas that aren't, and we get this whole out of sorts consideration going on. But there's one important, almost pathognomonic statement from a patient and we need to keep this in mind, whether it's the first adjustment or the hundredth adjustment, whether you've seen this patient once a week for their life or you've seen them once every 10 years, when you hear this statement from the patient every one of us should stop dead in our tracks. The phrase, as I refer to it is very simple, when the patient says, "I have a pain in my head and neck or a pain in my head or neck unlike anything I've ever had before in my life." Stop. What the patient is telling you and I when they say that, "Pain in the head or neck unlike
Dr. Stu Hoffman:
Dr. Gerry Clum:
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