one in a million. Who am I to think a one in a million thing is going to happen in my world? Well, I live in California and twice a week I go down and I put down my dollar and I buy a lottery ticket. The chances of me winning that lottery are about 1 in 40 million, and I think every week with my dollar I'm going to win the lottery. The reality here is, it can happen in your office. It can happen with your patient. It doesn't matter how good your technique is. It doesn't matter how skilled you are as a clinician. It doesn't matter how long you've been in practice, nothing matters other than the fact that it can occur. It could have walked in the door and it was undetectable. It could have happened on your adjusting table. I don't know. I don't know how to divine that out and seek that out one versus the other, but the entertaining of the possibility that it can happen, and that it did happen in the office, is one that you have to entertain for your sake, as well as for the patient's. If the patient at that point shows any of the five D's, the ataxia or the 3 N's, the dizziness, the drop attacks, the diplopia, the dysarthria, the dysphasia, ataxia, nausea, nystagmus or numbness, your antenna should go up. These are not the signs you want to see developing secondary to an adjustment. As you see them they should get more and more of your attention as they develop. If the symptoms are very mild and appear to be transient, it's your responsibility to monitor them, and monitor them for their continued decrease and on to the resolution. If those symptoms are severe or become severe, it's your responsibility to seek emergency services immediately. Each and every situation will require a different response on your part, but in general we should be monitoring the patient's vital signs at this point, as well as the specific neurological signs that drew our attention. The important issue here is, to go back to Tom Cruise and the movie Top Gun, you never leave your wingman. I don't care who's on the waiting room, I don't care if the governor's in the waiting room, I don't care if the President of the State Association is in the waiting room, the Chairman of the Board of Examiners, doesn't make any difference, you never leave the patient at that point. Imagine you're in deposition down the road, you've had an adverse circumstance that occurred secondary to an adjustment, and in questioning it comes up, "What did you do?" "Well, I monitored the patient. I went on a few, adjusted a few more patients and came back and looked at him again." The minute you stepped away from that person in distress you're in trouble. Even if your stepping away caused no complication or harm to that individual, the fact that someone who is not in distress was put in a greater priority position than someone who was in distress creates a problem for you and for your liability carrier as well. Your attention needs to be this patient and no one or nothing else at that point. In this environment, the availability of baseline vitals can be very helpful for you to appreciate what's normal or abnormal. If a person's heart rate is changing in response to this not knowing what normal is will be viewed a significant disadvantage.
Now, if the symptoms are very transient and they are very limited and they resolve
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