area or the inability to urinate or to start a bowel movement. Cauda equina syndrome is always a medical emergency because the nerves that control these functions can permanently die and these functions will be lost or compromised forever. The standard approach is to surgical decompress the nerves and the window to do so is only 12 to 72 hours, depending. If you," meaning me talking to my patients, "If you have any of these symptoms, tell us immediately, and if we cannot be reached, go to the emergency department." I think what lit me up on this was I was asked to look at a case where they never accused the chiropractor of causing the cauda equina syndrome, but the patient started to get some of these symptoms and they started to have a saddle anesthesias and the inability to initiate urination. The result is they called they're chiropractor who was out of town and they couldn't get ahold of the chiropractor, and they thought, "Well, we've got an appointment Monday. We'll just wait." Well, this was Friday, so the patient just hung miserably all day Saturday and all day Sunday until they got ahold of the chiropractor on Monday, who immediately referral to the ER. Well, they went after the chiropractor basically state, "You should have told the patient that if any of these things raise their ugly head, that it is an emergency and they should go to the ER," so the consequence is we have changed our informed consent, we have added that in, I have a section on cauda equina, and chiropractors themselves should be clear on it and they should know that even if we, as chiropractors, have the technical ability to decompress this thing, if the nerve dies before we decompress it, the nerve is dead and it won't come back. Again, there could be permanent nurological defecits. Consequently, a section like, I think, is invaluable in an informed consent, so we've added it into ours, as in the tail-end of the last year, and Stu, what do you think? I like it and I think that it's ... Well, I want to ask you, for all of our friends that say, "I only adjust subluxations. I'm not really addressing any of these medical issues." I'm in agreement. We're talking about protection both for the patient and for the doctor through informed consent, but I do run across that around the country that there's, let's just say, an entire segment of our population in the chiropractic world, that thinks we only adjust subluxations, but we are a doctor. We don't really need to get into the medical realm here. What would you say to that, Dan? Well, I would say that the short-sightedness of that is that the state laws look at you as more than something that would only adjust subluxation. You are a primary health care provider, which means you have a responsibility to determine whether or not the patient is in the correct office and, consequently, having that attitude would probably get that it's not protected by the chiropractor, it would probably get the chiropractor in trouble, meaning that they would probably be an easy mark to a skilled plaintiff attorney. Plus, I think that that attitude could be a little callus also towards the patients themselves.
Dr. Hoffman:
Dr. Murphy:
If compressive neuropathology onto the cauda does occur, we know it occurs and,
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