Expert: Dr. Victor Dolan, DC, DACBSP - 5/21/2009

Question
i was recently in a bad car wreck and  had 3 fractured ribs, 1 collapsed lung, 1 fractured clavical and the doctor said that i had a fracture in my neck but he said that it looked like an old injury. i picked up my hospital report regarding my injuries so that i could go to a pain clinic and recieve treatment but as i wait for my upcoming apointment i am having a hard time understanding the report regarding my fracture in my neck. it reads - "there is no gross evidence of boney fracture. there is a hairline thin lucency present along the anterior ring of c1. this may be artifactual as the c1 ring appears intact. there is no soft tissue edema. this could be reevaluated on follow up imaging."
my question is what exactly does this mean ? if it suggests a stress fracture then why does it say there is no gross evidence of boney fracture ? will the doctor at the pain clinic be able to evaluate my neck pain with this report alone or will i need an additional ct scan ? any help will be greatly appreciated and thank you.

Answer
Staten Island Volunteer Ambulance , Staten Island Auto Accident





Hello Chris,

Sorry to hear of your accident/ injury.

First, let me say that this question would BEST be answered by one of my Radiologist Colleagues (MD Radiologist,  - or - DC Radiologist; yes Chiropractic Doctors have specialties also!- see:  http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf )

With that said, this 'lucency' could be some kind of artifact (some kind of 'mistake', 'defect' in the film, in the processing).  In all likelihood- this is probably an artifact- given that there are no EXPECTED associated findings= "....this may be artifactual as the c1 ring appears intact. there is no soft tissue edema....".

In my Staten Island Chiropractic practice, when I get a report that even vaguely HINTS that a further test is needed , , , you know what I do?, for the patient's best interest, for my peace of mind, if a radiologist (or some other specialist with a test report) recommends a possible further test- I DO THE TEST.

Years ago, in my younger days, even after I became a Doctor of Chiropractic, I was (and still have the certification) an EMT (emergency medical technician).  I used to ride with a Staten Island Volunteer Ambulance.  One of my first tours included a response to a motor vehicle accident.  We were the first ambulance on the scene, and the police were already there.  The police had arrived first, and had actually, over the radio, canceled the need for an ambulance.

Our volunteer ambulance (Staten Island Volunteer Heart Resuscitation Unit - VHRU ) had four EMTs on it.  One or two EMTs were relatively inexperienced in critical prehospital care.  At least two of the EMTs were well experienced veterans.  I was riding with two veterans of 20+ years.

We arrived at the scene, there were six cop cars!  Why so many?- a brother officer had been involved in the MVA (motor vehicle accident).
He was up, talking, ambulatory.
But,
his car was WRECKED !

The 'mechanism of injury' - the wrecked car looked like three people should have been dead- twisted metal!, and here is this guy- walking/ talking around!

We began to examine/ interview him.

He said the magic words to the EXPERIENCED EMTs-  'I feel fine, I am a-okay,  but my neck hurts a little bit'.  These two EXPERIENCED EMTs
immediately 'kidnapped' him.  Put him in a cervical collar to immobilize him, placed him on a back board (hard immobilizing spine board), 'tied him up'; and brought him to the hospital.

All the while he protested.

We brought him to the emergency room (now called the emergency department), immobilized, and they proceeded to evaluate, and Xray him.

We went back out on the road.

Within a couple of days, we learned that this patient, a NYC policeman who DID NOT want care,

was in a halo brace, had fractured an upper cervical, and the actions of the two veteran EMTs had saved his life (over his protests).

I would have walked away from the patient.

That incident taught me never to assume anything.

In all likelihood your line of lucency is an artifact.  But, if you were in my office,,, I would want to make sure.  "....this could be reevaluated on follow up imaging...."- do it.

Once you have ruled out spinal fracture, I would recommend your local Doctor of Chiropractic.  IF you have a fracture you need orthopedic MD care.  Once you have healed, if you have a spinal fracture, then I would be evaluated by your DC.

"...will i need an additional ct scan ?...", yes.  You will need another CT or MR scan.

Some information I give out in my office to my Staten Island Auto Accident patients:



PAIN     

Pain  is a  ‘red light on the dashboard’.

Pain is your body telling you that something is wrong.

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  

Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?   

Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?

     NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;

The  American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse.  These medications cover up the pain, and cause the problem to worsen.


Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.



Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.


The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine

+++++++++++++++++++++++++++++++++++


THANK YOU for the question! and if further information is needed,,,
please do not hesitate to RE-contact me here at AllExperts.com : -
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm




Thanks,


Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com (Email NewsLetter)