Winston Lee L. Ac., Ph.D., KMD
Doctors are not omnipotent. We must admit this fact. All the surgeries cannot be done perfect and all medicine cannot work perfect either. Even, Korean and Chinese Medicine have their own strength, but they need to have plan B.
Here are cases which you must send the patient to an emergency medical doctor or an orthopedic surgeon as soon as possible. This information will protect you from critical lawsuit from malpractice.
Foot drop and loss of sensation
Musculoskeletal related pain is the most typical disorder or symptom to be treated by acupuncturists. When a patient states pain on the back or joints, we usually teach him or she to take acupuncture treatment for several times to alleviate the muscle spasm. Yes, it works. Most of pain is better after once or several acupuncture sessions. Unfortunately, some of patient does not show the improvement as expected. But it’s not a big deal. Because pain itself normally does not make permanent disabilities. If any, the risk is very low.
Instead we must focus on the permanent muscle weakness and sensation loss. If power of ankle flexion is weaker than other side, it means that motor nerve was damaged already. If sensation of foot or leg is more numb than other side, it also means the sensory nerve was damaged, seriously.
If the patient shows significant foot drop and loss of sensation on legs and it’s been worse for last 4 weeks, you must refer the patient to any surgeon right away. Based on those symptoms, we can assume that motor and sensory nerve have been seriously compressed by herniated disc or other abnormal tissue. A surgical procedure for reducing compression due to herniated disc or other causes must be removed by traditional laminectomy or any other invasive procedure.
Loss of Bladder Control
If a patient says he/she cannot empty his bladder after having extreme back pain, it is considered as a red flag situation. When it comes to cauda equina syndrome which means end of spinal cord is severely compressed by herniated disc and damaged, patient’s bladder becomes full but he or she cannot feel anything at all. In this case, the patient must be transferred to ER as soon as possible and catheter should be put into urethra to empty the bladder. No other method cannot resolve this acute situation.
Infectious Spondylitis
Infectious spondylitis is a rare but severe disease in adults, caused by a bacterial thrombus in tissue of reduced resistance. It simply means inflammation of the spine. However, it’s not easy even for experienced doctors to distinguish this one from regular herniated disc related disease or symptoms.
It can happen to old aged patient and the symptom is only back pain in the beginning. That’s why it is impossible to be determined just by physical examination. It is able to be diagnosed only by MRI and blood test.
Once again when you see a patient, keep in mind these important cases. If you are able to figure out this special case and refer a patient on time to an emergency rooms or orthopedic surgeons, I am pretty sure that they will recognize you as an honest and reliable acupuncturist.
