Friday, January 23, 2009

Heart Pain -or-Shoulder Pain?

64 year old male presents to my office in August of 2006 with complaints of pain in his shoulders and upper arms & pain in his upper back. This wasn’t unusual for this gentleman. He’d come to my office periodically with various shoulder and upper back pain after playing tennis. Tennis is his love and he plays 3-5 days per week and for about 2-3 hours each day.

This day he had one curious complaint. He said he had increased shoulder and upper back pain with generalized torso and body aches that went down into his forearms. This was a symptoms he’d never complained to me about. He further stated that these symptoms would come on when playing tennis or running on the treadmill, but when he would stop and rest, the symptoms would go away.

Chest, back, shoulder and forearm pain upon exertion. This wasn’t good. An orthopedic exam of his shoulder was positive for various rotator cuff and other shoulder strains and these were apparently overshadowing a potentially serious condition. Nothing in the way of orthopedics reproduced his other symptoms. Blood pressure was no different than his baseline blood pressure; pulse rate was also the normal.

I instructed him to go to his cardiologist to explore his pain upon exertion and I told him to refrain from any exercise until cleared by his cardiologist. He was in denial and didn’t want to go to the cardiologist - Classic Denial. Something I had never seen before. I told him the seriousness of what this could be then reminded him he has had a history of cardiac problems in the past and he must go-period. He was also told to apply ice to his shoulders and go to the cardiologist. He was to report back to me when he gets some answers from his cardiologist

Today he came in and gave me the answers - Finally.

He came in today with some complaints of good ole' low back pain. He told me that he eventually went to his cardiologist who he said was quite concerned with these symptoms. He eventually developed a shortness of breath as well. His cardiologist prescribed a Thallium Stress Test which revealed an occlusion (blockage) of a cardiac artery. A cardiac stent was implanted and he was back playing tennis again in 2 weeks.

Although we as chiropractors don’t treat every condition, we have to be trained to recognize them and differentiate between what can be treated by us and what must be referred to another medical specialist. This gentleman is a health care professional who was coming to me for “sports related injuries” because of my training in sports medicine. He trusted me with his problems in the past and thought these symptoms were more of the same. Because I was able to differentiate between a musculoskeletal condition and a potentially serious cardiac symptom when both were present, meant the difference of his playing tennis in the Florida Sunshine rather than his family mourning while he pushes up daisies.

The moral of this story: Chiropractors are trained as primary care physicians. Just make sure you pick yours carefully. Their schooling, post graduate training and style of practice does make a difference. Ask your friends or ask your primary care physician for a good chiropractor in your area that they know others have been to and had a good experience with. Don’t choose one based on some cheesy or good looking advertisement.

In the right hands, chiropractic care can be wildly successful.

‘nuff said

DocT

Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

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