traumatic brain injury article

[Guest guest]

Doctors:

http://online.wsj.com/article/SB120156672297223803.htmlIf you deal with motor vehicle collisions, please read this article from the Wall Street Journal.  The diagnosis of mild traumatic brain injuries is underdiagnosed, and the life long impact can be very serious.  A high percentage of the PI cases that I handle involve mild traumatic brain injuries.  If any of you have questions about what you are seeing in a difficult case, please feel free to contact me.  I am also hoping to provide some free lectures on brain injuries for doctors later this year.Respectfully, DeShaw, DC, JD Dr. DeShaw, Esq., P.C.Portland OfficeFox Tower805 SW Broadway, Suite 2720Portland, OR 97205(503) 227-1233Seattle OfficeColumbia Center701 5th Ave., Suite 4200Seattle, WA 98104www.doctorlawyer.net(866) THE-FIRM

[Guest guest]

Great article. And ditto what has said. Concussion and mild traumatic brain injury are extremely common in motor vehicle collisions, particularly rear end collisions. They are not diagnosed in the E.R., because they are not life threatening and no inquiry is made by the E.R. physicians. They are not diagnosed by the PCP M.D. who next sees the patient, because the appropriate questions are simply not asked. Sadly, they are also not diagnosed by the treating chiropractic physicians, because the appropriate questions are simply not asked. Most patients don't bring the subject up to their physicians, because they do not relate the symptoms to minor traumatic brain injury. They tend to self-diagnose their problems and symptoms as flowing from stress, pain, not working, interrupted sleep caused by pain, etc. It is the doctor's job (in my opinion) to inquire into these issues. It's not the patient's job to diagnose themselves and tell you from what they suffer.

I have a client who is a Board Certified psychiatrist and former chief resident of the psychiatric ward at OHSU. She herself suffered moderate traumatic brain injury and its aftermath following a motor vehicle collision, and I had to essentially do the diagnosis myself months after the collision, because none of her various doctors (all M.D.'s) had asked her any relevant questions. She herself believed all her cognitive and emotional symptoms (which were severe in my opinion) were related to stress, pain, sleep, etc. I finally had to tell her in my office to shut up, to stop trying to be her own doctor, and to consider the following hypothetical as if it were a Board Exam: Patient A presents with a history of acceleration/deceleration injury following a motor vehicle collision, Patient A has had headaches, dizziness, forgetfulness, difficulty concentrating, bouts of crying for no apparent reason, bouts of inexplicable anger and frustration at inanimate and animate objects (such as the kitchen cupboards), Patient A feels overwhelmed going into a grocery store with all the lights and colors, she doesn't want to be touched by her husband or daughter and has no real desire to touch them, she feels like being alone to the point of sitting in the chair as opposed to the couch so no one will sit next to her, the television is always too loud and irritating, she forgets conversations she has with her clients, etc. Doctor, what is your differential diagnosis and explain your answer? She looked at me and said, "Holy shit, I have PTSD and post concussive syndrome, don't I?" She saw Darien Fenn within a week and is now all better.

I've done several new client intakes in the past couple of months of patients of some very experienced chiropractic physicians, where the patient was obviously suffering the sequelae of concussion, but no diagnosis had ever been made. I am perpetually amazed how often I ask my clients (after doing a basic closed head injury inquiry) if anyone has asked them any of the questions I have. Sadly, very often the answer is, "No." I am always pleased when the answer is: "Oh, yeah, Dr. ______ asked me all those questions." I have to be honest with you, the latter answer is unfortunately rather rare. Many doctors still let their C.A.'s do the initial intake interview, or worse, the initial intake interview is done by the patient by filling out a form. If a Board Certified Psychiatrist misses and cannot appreciate her own symptoms of closed head injury, how can we possibly expect the run of the mill lay patient to be able to appreciate those symptoms and to tell you about them unless they are specifically asked by you?? I also must opine that many of the "intake forms" I have seen used by doctors have no spaces or questions whatsoever which would alert the doctor that there may have been a concussion. I met a lady a couple of weeks ago who had an mva almost a year ago. She actually had fallen down twice due to equilibrium problems, was unable to close her eyes in the shower to wash her hair without holding onto the rail, was having anxiety attacks whenever she was a passenger in a car which was so bad that she and her boyfriend had several arguments about her "freaking out" whenever he drove through intersections, and I was the first person to ask her any questions related to those issues. That's clinically pathetic (in my opinion). I know I and others have written about these issue before, but it just seems that the message is not getting through.

Best Regards, G. , Gatti, Gatti, et. al.

From: [mailto: ] On Behalf Of Dr. DeShaw, Esq.Sent: Wednesday, February 13, 2008 12:40 PM Subject: traumatic brain injury article

Doctors:

http://online.wsj.com/article/SB120156672297223803.html

If you deal with motor vehicle collisions, please read this article from the Wall Street Journal. The diagnosis of mild traumatic brain injuries is underdiagnosed, and the life long impact can be very serious.

A high percentage of the PI cases that I handle involve mild traumatic brain injuries. If any of you have questions about what you are seeing in a difficult case, please feel free to contact me. I am also hoping to provide some free lectures on brain injuries for doctors later this year.

Respectfully,

DeShaw, DC, JD

Dr. DeShaw, Esq., P.C.

Portland Office

Fox Tower

805 SW Broadway, Suite 2720

Portland, OR 97205

(503) 227-1233

Seattle Office

Columbia Center

701 5th Ave., Suite 4200

Seattle, WA 98104

www.doctorlawyer.net

(866) THE-FIRM

[Guest guest]

Perhaps Dr. Pfieffer in Pendleton should

be asked to speak at the next convention ? He has the knowledge and the forms

to share. Or he could produce a CD for sale ?

s. fuchs dc

From: [mailto: ] On Behalf Of

Sent: Wednesday, February 13, 2008

1:50 PM

Dr. DeShaw, Esq.;

Subject: RE:

traumatic brain injury article

Great article. And ditto what

has said. Concussion and mild traumatic brain injury are extremely

common in motor vehicle collisions, particularly rear end collisions.

They are not diagnosed in the E.R., because they are not life threatening and

no inquiry is made by the E.R. physicians. They are not diagnosed by the

PCP M.D. who next sees the patient, because the appropriate questions are

simply not asked. Sadly, they are also not diagnosed by the treating

chiropractic physicians, because the appropriate questions are simply not

asked. Most patients don't bring the subject up to their physicians,

because they do not relate the symptoms to minor traumatic brain injury.

They tend to self-diagnose their problems and symptoms as flowing from stress,

pain, not working, interrupted sleep caused by pain, etc. It is the

doctor's job (in my opinion) to inquire into these issues. It's not the

patient's job to diagnose themselves and tell you from what they suffer.

I have a client who is a Board Certified

psychiatrist and former chief resident of the psychiatric ward at

OHSU. She herself suffered moderate traumatic brain injury and its

aftermath following a motor vehicle collision, and I had to essentially do the

diagnosis myself months after the collision, because none of her

various doctors (all M.D.'s) had asked her any relevant questions. She

herself believed all her cognitive and emotional symptoms (which were severe in

my opinion) were related to stress, pain, sleep, etc. I finally had to

tell her in my office to shut up, to stop trying to be her own doctor, and

to consider the following hypothetical as if it were a Board Exam:

Patient A presents with a history of acceleration/deceleration injury

following a motor vehicle collision, Patient A has had headaches, dizziness,

forgetfulness, difficulty concentrating, bouts of crying for no apparent

reason, bouts of inexplicable anger and frustration at inanimate and animate

objects (such as the kitchen cupboards), Patient A feels overwhelmed going into

a grocery store with all the lights and colors, she doesn't want to be touched

by her husband or daughter and has no real desire to touch them, she feels like

being alone to the point of sitting in the chair as opposed to the couch so no

one will sit next to her, the television is always too loud and irritating, she

forgets conversations she has with her clients, etc. Doctor, what is your

differential diagnosis and explain your answer? She looked at me and

said, " Holy shit, I have PTSD and post concussive syndrome, don't

I? " She saw Darien Fenn within a week and is now all better.

I've done several new client intakes in

the past couple of months of patients of some very experienced chiropractic

physicians, where the patient was obviously suffering the sequelae of

concussion, but no diagnosis had ever been made. I am perpetually amazed

how often I ask my clients (after doing a basic closed head injury inquiry) if

anyone has asked them any of the questions I have. Sadly, very often the

answer is, " No. " I am always pleased when the answer is:

" Oh, yeah, Dr. ______ asked me all those questions. " I have to

be honest with you, the latter answer is unfortunately rather

rare. Many doctors still let their C.A.'s do the initial intake

interview, or worse, the initial intake interview is done by the patient by

filling out a form. If a Board Certified Psychiatrist misses and

cannot appreciate her own symptoms of closed head injury, how can we possibly

expect the run of the mill lay patient to be able to appreciate those symptoms

and to tell you about them unless they are specifically asked by you?? I

also must opine that many of the " intake forms " I have seen used

by doctors have no spaces or questions whatsoever which would alert the doctor

that there may have been a concussion. I met a lady a couple of weeks ago

who had an mva almost a year ago. She actually had fallen down twice due

to equilibrium problems, was unable to close her eyes in the shower to wash her

hair without holding onto the rail, was having anxiety attacks whenever she was

a passenger in a car which was so bad that she and her boyfriend

had several arguments about her " freaking out " whenever he drove

through intersections, and I was the first person to ask her any questions

related to those issues. That's clinically pathetic (in my

opinion). I know I and others have written about these issue before, but

it just seems that the message is not getting through.

Best Regards, G. , Gatti,

Gatti, et. al.

From: [mailto: ] On Behalf Of Dr. DeShaw, Esq.

Sent: Wednesday, February 13, 2008

12:40 PM

Subject:

traumatic brain injury article

Doctors:

http://online.wsj.com/article/SB120156672297223803.html

If you deal with motor vehicle collisions, please read this article

from the Wall Street Journal. The diagnosis of mild traumatic brain

injuries is underdiagnosed, and the life long impact can be very serious.

A high percentage of the PI cases that I handle involve mild traumatic

brain injuries. If any of you have questions about what you are seeing in

a difficult case, please feel free to contact me. I am also hoping to

provide some free lectures on brain injuries for doctors later this year.

Respectfully,

DeShaw, DC, JD

Dr. DeShaw,

Esq., P.C.

Portland Office

Fox

Tower

805 SW Broadway, Suite 2720

Portland,

OR 97205

(503) 227-1233

Seattle Office

Columbia

Center

701 5th Ave., Suite 4200

Seattle,

WA 98104

www.doctorlawyer.net

(866) THE-FIRM

[Guest guest]

,

Are there key questions regarding this issue you can share with us, or is it that we need to ask about emotional, cognative, memory and concentration and follow up on any answer that leads us to a deeper meaning?

Christian Mathisen DC

3654 S Pacific Hwy

Medford, OR 97501

cmathdc@...

RE: traumatic brain injury article

Great article. And ditto what has said. Concussion and mild traumatic brain injury are extremely common in motor vehicle collisions, particularly rear end collisions. They are not diagnosed in the E.R., because they are not life threatening and no inquiry is made by the E.R. physicians. They are not diagnosed by the PCP M.D. who next sees the patient, because the appropriate questions are simply not asked. Sadly, they are also not diagnosed by the treating chiropractic physicians, because the appropriate questions are simply not asked. Most patients don't bring the subject up to their physicians, because they do not relate the symptoms to minor traumatic brain injury. They tend to self-diagnose their problems and symptoms as flowing from stress, pain, not working, interrupted sleep caused by pain, etc. It is the doctor's job (in my opinion) to inquire into these issues. It's not the patient's job to diagnose themselves and tell you from what they suffer.

I have a client who is a Board Certified psychiatrist and former chief resident of the psychiatric ward at OHSU. She herself suffered moderate traumatic brain injury and its aftermath following a motor vehicle collision, and I had to essentially do the diagnosis myself months after the collision, because none of her various doctors (all M.D.'s) had asked her any relevant questions. She herself believed all her cognitive and emotional symptoms (which were severe in my opinion) were related to stress, pain, sleep, etc. I finally had to tell her in my office to shut up, to stop trying to be her own doctor, and to consider the following hypothetical as if it were a Board Exam: Patient A presents with a history of acceleration/deceleration injury following a motor vehicle collision, Patient A has had headaches, dizziness, forgetfulness, difficulty concentrating, bouts of crying for no apparent reason, bouts of inexplicable anger and frustration at inanimate and animate objects (such as the kitchen cupboards), Patient A feels overwhelmed going into a grocery store with all the lights and colors, she doesn't want to be touched by her husband or daughter and has no real desire to touch them, she feels like being alone to the point of sitting in the chair as opposed to the couch so no one will sit next to her, the television is always too loud and irritating, she forgets conversations she has with her clients, etc. Doctor, what is your differential diagnosis and explain your answer? She looked at me and said, "Holy shit, I have PTSD and post concussive syndrome, don't I?" She saw Darien Fenn within a week and is now all better.

I've done several new client intakes in the past couple of months of patients of some very experienced chiropractic physicians, where the patient was obviously suffering the sequelae of concussion, but no diagnosis had ever been made. I am perpetually amazed how often I ask my clients (after doing a basic closed head injury inquiry) if anyone has asked them any of the questions I have. Sadly, very often the answer is, "No." I am always pleased when the answer is: "Oh, yeah, Dr. ______ asked me all those questions." I have to be honest with you, the latter answer is unfortunately rather rare. Many doctors still let their C.A.'s do the initial intake interview, or worse, the initial intake interview is done by the patient by filling out a form. If a Board Certified Psychiatrist misses and cannot appreciate her own symptoms of closed head injury, how can we possibly expect the run of the mill lay patient to be able to appreciate those symptoms and to tell you about them unless they are specifically asked by you?? I also must opine that many of the "intake forms" I have seen used by doctors have no spaces or questions whatsoever which would alert the doctor that there may have been a concussion. I met a lady a couple of weeks ago who had an mva almost a year ago. She actually had fallen down twice due to equilibrium problems, was unable to close her eyes in the shower to wash her hair without holding onto the rail, was having anxiety attacks whenever she was a passenger in a car which was so bad that she and her boyfriend had several arguments about her "freaking out" whenever he drove through intersections, and I was the first person to ask her any questions related to those issues. That's clinically pathetic (in my opinion). I know I and others have written about these issue before, but it just seems that the message is not getting through.

Best Regards, G. , Gatti, Gatti, et. al.

From: [mailto: ] On Behalf Of Dr. DeShaw, Esq.Sent: Wednesday, February 13, 2008 12:40 PM Subject: traumatic brain injury article

Doctors:

http://online.wsj.com/article/SB120156672297223803.html

If you deal with motor vehicle collisions, please read this article from the Wall Street Journal. The diagnosis of mild traumatic brain injuries is underdiagnosed, and the life long impact can be very serious.

A high percentage of the PI cases that I handle involve mild traumatic brain injuries. If any of you have questions about what you are seeing in a difficult case, please feel free to contact me. I am also hoping to provide some free lectures on brain injuries for doctors later this year.

Respectfully,

DeShaw, DC, JD

Dr. DeShaw, Esq., P.C.

Portland Office

Fox Tower

805 SW Broadway, Suite 2720

Portland, OR 97205

(503) 227-1233

Seattle Office

Columbia Center

701 5th Ave., Suite 4200

Seattle, WA 98104

www.doctorlawyer.net

(866) THE-FIRM

[Guest guest]

Doctors:I have to agree with a lot of what is saying.  Its shocking to see the cases we lawyers get in, where there has been no evaluation of brain injury or inner ear injury symptoms after a collision, and the symptoms seem obvious.  And, I could tell you some stories about cases that came to me after other lawyers, where the lawyers didn't get it either.  So, I don't think Mr. or I are saying PI lawyers as an average are any better.  I think we are both saying please watch out for this after a traumatic injury.Given that I have almost no involvement in this list, and don't know the doctors regularly involved I'm certainly not saying anything about anyone here.  But, please consider this possibility in every MVA case.  Once you ruled it out, great, but until then please look for it.  I think this is another way the DCs can shine, by picking up issues other doctors are missing, because we care enough to look and ask in the first place. DeShaw, DC, JD Dr. DeShaw, Esq., P.C.Portland OfficeFox Tower805 SW Broadway, Suite 2720Portland, OR 97205(503) 227-1233Seattle OfficeColumbia Center701 5th Ave., Suite 4200Seattle, WA 98104www.doctorlawyer.net(866) THE-FIRM On Feb 13, 2008, at 1:50 PM, wrote:Great article.  And ditto what has said.  Concussion and mild traumatic brain injury are extremely common in motor vehicle collisions, particularly rear end collisions.  They are not diagnosed in the E.R., because they are not life threatening and no inquiry is made by the E.R. physicians.  They are not diagnosed by the PCP M.D. who next sees the patient, because the appropriate questions are simply not asked.  Sadly, they are also not diagnosed by the treating chiropractic physicians, because the appropriate questions are simply not asked.  Most patients don't bring the subject up to their physicians, because they do not relate the symptoms to minor traumatic brain injury.  They tend to self-diagnose their problems and symptoms as flowing from stress, pain, not working, interrupted sleep caused by pain, etc.  It is the doctor's job (in my opinion) to inquire into these issues.  It's not the patient's job to diagnose themselves and tell you from what they suffer.  I have a client who is a Board Certified psychiatrist and former chief resident of the psychiatric ward at OHSU.  She herself suffered moderate traumatic brain injury and its aftermath following a motor vehicle collision, and I had to essentially do the diagnosis myself months after the collision, because none of her various doctors (all M.D.'s) had asked her any relevant questions.  She herself believed all her cognitive and emotional symptoms (which were severe in my opinion) were related to stress, pain, sleep, etc.  I finally had to tell her in my office to shut up, to stop trying to be her own doctor, and to consider the following hypothetical as if it were a Board Exam:  Patient A presents with a history of acceleration/deceleration injury following a motor vehicle collision, Patient A has had headaches, dizziness, forgetfulness, difficulty concentrating, bouts of crying for no apparent reason, bouts of inexplicable anger and frustration at inanimate and animate objects (such as the kitchen cupboards), Patient A feels overwhelmed going into a grocery store with all the lights and colors, she doesn't want to be touched by her husband or daughter and has no real desire to touch them, she feels like being alone to the point of sitting in the chair as opposed to the couch so no one will sit next to her, the television is always too loud and irritating, she forgets conversations she has with her clients, etc.  Doctor, what is your differential diagnosis and explain your answer?  She looked at me and said, "Holy shit, I have PTSD and post concussive syndrome, don't I?"  She saw Darien Fenn within a week and is now all better. I've done several new client intakes in the past couple of months of patients of some very experienced chiropractic physicians, where the patient was obviously suffering the sequelae of concussion, but no diagnosis had ever been made.  I am perpetually amazed how often I ask my clients (after doing a basic closed head injury inquiry) if anyone has asked them any of the questions I have.  Sadly, very often the answer is, "No."  I am always pleased when the answer is:  "Oh, yeah, Dr. ______ asked me all those questions."  I have to be honest with you, the latter answer is unfortunately rather rare.  Many doctors still let their C.A.'s do the initial intake interview, or worse, the initial intake interview is done by the patient by filling out a form.  If a Board Certified Psychiatrist misses and cannot appreciate her own symptoms of closed head injury, how can we possibly expect the run of the mill lay patient to be able to appreciate those symptoms and to tell you about them unless they are specifically asked by you??  I also must opine that many of the "intake forms" I have seen used by doctors have no spaces or questions whatsoever which would alert the doctor that there may have been a concussion.  I met a lady a couple of weeks ago who had an mva almost a year ago.  She actually had fallen down twice due to equilibrium problems, was unable to close her eyes in the shower to wash her hair without holding onto the rail, was having anxiety attacks whenever she was a passenger in a car which was so bad that she and her boyfriend had several arguments about her "freaking out" whenever he drove through intersections, and I was the first person to ask her any questions related to those issues.  That's clinically pathetic (in my opinion).  I know I and others have written about these issue before, but it just seems that the message is not getting through.  Best Regards, G. , Gatti, Gatti, et. al. From:  [mailto: ] On Behalf Of Dr. DeShaw, Esq.Sent: Wednesday, February 13, 2008 12:40 PMTo:  Subject:  traumatic brain injury articleDoctors:http://online.wsj.com/article/SB120156672297223803.htmlIf you deal with motor vehicle collisions, please read this article from the Wall Street Journal.  The diagnosis of mild traumatic brain injuries is underdiagnosed, and the life long impact can be very serious.  A high percentage of the PI cases that I handle involve mild traumatic brain injuries.  If any of you have questions about what you are seeing in a difficult case, please feel free to contact me.  I am also hoping to provide some free lectures on brain injuries for doctors later this year.Respectfully, DeShaw, DC, JDDr. DeShaw, Esq., P.C.Portland OfficeFox Tower805 SW Broadway, Suite 2720Portland, OR 97205(503) 227-1233Seattle OfficeColumbia Center701 5th Ave., Suite 4200Seattle, WA 98104www.doctorlawyer.net(866) THE-FIRM

[Guest guest]

I'm not a doctor nor do I play one online, so I would have to defer to you folks about what clinical questions ought to be asked and when and why. Hopefully someone who regularly does a clinical evaluation for closed head injury and PTSD and inner ear dysfunction could chime in and let everyone know what they do, why, and the precise questions that should be asked. It seems like the three types of injuries are often related and jointly present in one form or the other. I just know that I tell my prospective clients that I am going to start with their hair and go down to their toe nails and ask them if they have had any symptoms in each area after the injury producing event, regardless of whether they relate them to the event or not. I usually jokingly start with their hair and say that I assume their hair has not hurt them (although once a client said that her hair did hurt and a few minutes later it was apparent that I was indeed interviewing a wack job). I'll then ask them about headaches and to describe them. It's amazing how often people will tell me they've been having migraines, and when you ask them to describe the headache it is apparent that it is a cervicogenic headache and not a migraine or cluster headache at all. Then when I read the medical records, the doctor will say that the patient has been having "migraines" simply because that's what the patient says. To us lay people, a migraine is just a headache that is so bad that it is almost incapacitating. As physicians, you know that is not the case at all. A lot of folks with a prior history of migraine suffer from cervicogenic or closed head injury headaches that are severe--and they most definitely aren't migraines, but that's how they're charted, because that's the label the patient attaches to them. I then ask them to tell me about headaches they've had in the past, assuming that everyone has had a headache or two, and to get them to describe prior headaches, and it's surprising how often the prior headaches, even where they are so frequent that there has been treatment for them, are symptomatically very different than the headaches that they have after an injury. I spend some time talking about headaches, because it gets my client in the proper frame of mind with respect to the detail that I expect of them, and it also tells me a lot about my client, their personality, their credibility, their penchant for honesty and accuracy, etc. Then, if they've had headaches and they also have had any dizziness, lightheadedness, concentration difficulties, short term memory disturbance, anxiety, etc., then I will do a full blown inquiry into emotions and a lot of other stuff that might lead "to a deeper meaning." That's just me, though, as a lawyer and not as a clinician. My point is that while I may not be asking all of the clinically relevant questions due to my ignorance and lack of professional training, it just floors me how often the people I interview sometimes months after an injury have never been asked any questions even remotely related to those that I routinely ask. Most of the time, the answers to the key introductory questions are "No" so there's no need to delve deeper.

Those are just my thoughts on the subject. Best Regards, G. , Gatti, Gatti, et. al.

From: [mailto: ] On Behalf Of Christian MathisenSent: Wednesday, February 13, 2008 3:02 PMOregon ChiropractorsSubject: Re: traumatic brain injury article

,

Are there key questions regarding this issue you can share with us, or is it that we need to ask about emotional, cognative, memory and concentration and follow up on any answer that leads us to a deeper meaning?

Christian Mathisen DC

3654 S Pacific Hwy

Medford, OR 97501

cmathdcjeffnet (DOT) org

RE: traumatic brain injury article

Great article. And ditto what has said. Concussion and mild traumatic brain injury are extremely common in motor vehicle collisions, particularly rear end collisions. They are not diagnosed in the E.R., because they are not life threatening and no inquiry is made by the E.R. physicians. They are not diagnosed by the PCP M.D. who next sees the patient, because the appropriate questions are simply not asked. Sadly, they are also not diagnosed by the treating chiropractic physicians, because the appropriate questions are simply not asked. Most patients don't bring the subject up to their physicians, because they do not relate the symptoms to minor traumatic brain injury. They tend to self-diagnose their problems and symptoms as flowing from stress, pain, not working, interrupted sleep caused by pain, etc. It is the doctor's job (in my opinion) to inquire into these issues. It's not the patient's job to diagnose themselves and tell you from what they suffer.

I have a client who is a Board Certified psychiatrist and former chief resident of the psychiatric ward at OHSU. She herself suffered moderate traumatic brain injury and its aftermath following a motor vehicle collision, and I had to essentially do the diagnosis myself months after the collision, because none of her various doctors (all M.D.'s) had asked her any relevant questions. She herself believed all her cognitive and emotional symptoms (which were severe in my opinion) were related to stress, pain, sleep, etc. I finally had to tell her in my office to shut up, to stop trying to be her own doctor, and to consider the following hypothetical as if it were a Board Exam: Patient A presents with a history of acceleration/deceleration injury following a motor vehicle collision, Patient A has had headaches, dizziness, forgetfulness, difficulty concentrating, bouts of crying for no apparent reason, bouts of inexplicable anger and frustration at inanimate and animate objects (such as the kitchen cupboards), Patient A feels overwhelmed going into a grocery store with all the lights and colors, she doesn't want to be touched by her husband or daughter and has no real desire to touch them, she feels like being alone to the point of sitting in the chair as opposed to the couch so no one will sit next to her, the television is always too loud and irritating, she forgets conversations she has with her clients, etc. Doctor, what is your differential diagnosis and explain your answer? She looked at me and said, "Holy shit, I have PTSD and post concussive syndrome, don't I?" She saw Darien Fenn within a week and is now all better.

I've done several new client intakes in the past couple of months of patients of some very experienced chiropractic physicians, where the patient was obviously suffering the sequelae of concussion, but no diagnosis had ever been made. I am perpetually amazed how often I ask my clients (after doing a basic closed head injury inquiry) if anyone has asked them any of the questions I have. Sadly, very often the answer is, "No." I am always pleased when the answer is: "Oh, yeah, Dr. ______ asked me all those questions." I have to be honest with you, the latter answer is unfortunately rather rare. Many doctors still let their C.A.'s do the initial intake interview, or worse, the initial intake interview is done by the patient by filling out a form. If a Board Certified Psychiatrist misses and cannot appreciate her own symptoms of closed head injury, how can we possibly expect the run of the mill lay patient to be able to appreciate those symptoms and to tell you about them unless they are specifically asked by you?? I also must opine that many of the "intake forms" I have seen used by doctors have no spaces or questions whatsoever which would alert the doctor that there may have been a concussion. I met a lady a couple of weeks ago who had an mva almost a year ago. She actually had fallen down twice due to equilibrium problems, was unable to close her eyes in the shower to wash her hair without holding onto the rail, was having anxiety attacks whenever she was a passenger in a car which was so bad that she and her boyfriend had several arguments about her "freaking out" whenever he drove through intersections, and I was the first person to ask her any questions related to those issues. That's clinically pathetic (in my opinion). I know I and others have written about these issue before, but it just seems that the message is not getting through.

Best Regards, G. , Gatti, Gatti, et. al.

From: [mailto: ] On Behalf Of Dr. DeShaw, Esq.Sent: Wednesday, February 13, 2008 12:40 PM Subject: traumatic brain injury article

Doctors:

http://online.wsj.com/article/SB120156672297223803.html

If you deal with motor vehicle collisions, please read this article from the Wall Street Journal. The diagnosis of mild traumatic brain injuries is underdiagnosed, and the life long impact can be very serious.

A high percentage of the PI cases that I handle involve mild traumatic brain injuries. If any of you have questions about what you are seeing in a difficult case, please feel free to contact me. I am also hoping to provide some free lectures on brain injuries for doctors later this year.

Respectfully,

DeShaw, DC, JD

Dr. DeShaw, Esq., P.C.

Portland Office

Fox Tower

805 SW Broadway, Suite 2720

Portland, OR 97205

(503) 227-1233

Seattle Office

Columbia Center

701 5th Ave., Suite 4200

Seattle, WA 98104

www.doctorlawyer.net

(866) THE-FIRM

[Guest guest]

We use a form that asks

the pt to check all the symptoms apply to them. There are about 30 or so statements. There is no cutoff point but when they

choose 15 or more of the 30 it is pretty obvious that they have a post-concussive

syndrome or some call it minor traumatic brain injury.

Larry L. Oliver, DC

408 NW 7th

Corvallis, OR 97330

dro@...

voice 541-757-9933

fax 541-757-7713

The information contained in this

electronic message may contain protected health information which is

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-----Original

Message-----

From:

[mailto: ]On Behalf

Of Christian Mathisen

Sent: Wednesday, February 13, 2008

3:02 PM

Oregon Chiropractors

Subject: Re:

traumatic brain injury article

,

Are

there key questions regarding this issue you can share with us, or is it

that we need to ask about emotional, cognative, memory and concentration and

follow up on any answer that leads us to a deeper meaning?

Christian

Mathisen DC

3654 S

Pacific Hwy

Medford,

OR 97501

cmathdc@...

-----

Original Message -----

From:

Dr.

DeShaw, Esq. ;

Sent: Wednesday, February 13,

2008 1:50 PM

Subject: RE:

traumatic brain injury article

Great article. And ditto what has said.

Concussion and mild traumatic brain injury are extremely common in motor

vehicle collisions, particularly rear end collisions. They are not

diagnosed in the E.R., because they are not life threatening and no inquiry is

made by the E.R. physicians. They are not diagnosed by the PCP M.D. who

next sees the patient, because the appropriate questions are simply not

asked. Sadly, they are also not diagnosed by the treating chiropractic

physicians, because the appropriate questions are simply not asked. Most

patients don't bring the subject up to their physicians, because they do not

relate the symptoms to minor traumatic brain injury. They tend to

self-diagnose their problems and symptoms as flowing from stress, pain, not

working, interrupted sleep caused by pain, etc. It is the doctor's job

(in my opinion) to inquire into these issues. It's not the patient's job

to diagnose themselves and tell you from what they suffer.

I have a

client who is a Board Certified psychiatrist and former chief resident

of the psychiatric ward at OHSU. She herself suffered moderate

traumatic brain injury and its aftermath following a motor vehicle collision,

and I had to essentially do the diagnosis myself months after the collision,

because none of her various doctors (all M.D.'s) had asked her any

relevant questions. She herself believed all her cognitive and

emotional symptoms (which were severe in my opinion) were related to stress,

pain, sleep, etc. I finally had to tell her in my office to shut up, to

stop trying to be her own doctor, and to consider the following

hypothetical as if it were a Board Exam: Patient A presents with a

history of acceleration/deceleration injury following a motor vehicle

collision, Patient A has had headaches, dizziness, forgetfulness, difficulty

concentrating, bouts of crying for no apparent reason, bouts of inexplicable

anger and frustration at inanimate and animate objects (such as the kitchen

cupboards), Patient A feels overwhelmed going into a grocery store with all the

lights and colors, she doesn't want to be touched by her husband or daughter

and has no real desire to touch them, she feels like being alone to the point

of sitting in the chair as opposed to the couch so no one will sit next to her,

the television is always too loud and irritating, she forgets conversations she

has with her clients, etc. Doctor, what is your differential diagnosis

and explain your answer? She looked at me and said, " Holy shit, I

have PTSD and post concussive syndrome, don't I? " She saw Darien

Fenn within a week and is now all better.

I've

done several new client intakes in the past couple of months of patients of

some very experienced chiropractic physicians, where the patient was obviously

suffering the sequelae of concussion, but no diagnosis had ever been

made. I am perpetually amazed how often I ask my clients (after doing a

basic closed head injury inquiry) if anyone has asked them any of the questions

I have. Sadly, very often the answer is, " No. " I am

always pleased when the answer is: " Oh, yeah, Dr. ______ asked me

all those questions. " I have to be honest with you, the latter

answer is unfortunately rather rare. Many doctors still let their

C.A.'s do the initial intake interview, or worse, the initial intake interview

is done by the patient by filling out a form. If a Board Certified

Psychiatrist misses and cannot appreciate her own symptoms of closed head

injury, how can we possibly expect the run of the mill lay patient to be able

to appreciate those symptoms and to tell you about them unless they are

specifically asked by you?? I also must opine that many of the

" intake forms " I have seen used by doctors have no spaces or

questions whatsoever which would alert the doctor that there may have been a

concussion. I met a lady a couple of weeks ago who had an mva almost a

year ago. She actually had fallen down twice due to equilibrium problems,

was unable to close her eyes in the shower to wash her hair without holding

onto the rail, was having anxiety attacks whenever she was a passenger in a car

which was so bad that she and her boyfriend had several arguments about

her " freaking out " whenever he drove through intersections, and I was

the first person to ask her any questions related to those issues.

That's clinically pathetic (in my opinion). I know I and others have

written about these issue before, but it just seems that the message is not

getting through.

Best

Regards, G. , Gatti, Gatti, et. al.

From:

[mailto: ] On

Behalf Of Dr. DeShaw, Esq.

Sent: Wednesday, February 13, 2008

12:40 PM

Subject:

traumatic brain injury article

Doctors:

http://online.wsj.com/article/SB120156672297223803.html

If you deal

with motor vehicle collisions, please read this article from the Wall Street

Journal. The diagnosis of mild traumatic brain injuries is

underdiagnosed, and the life long impact can be very serious.

A high

percentage of the PI cases that I handle involve mild traumatic brain injuries.

If any of you have questions about what you are seeing in a difficult

case, please feel free to contact me. I am also hoping to provide some

free lectures on brain injuries for doctors later this year.

Respectfully,

DeShaw,

DC, JD

Dr.

DeShaw, Esq., P.C.

Portland

Office

Fox

Tower

805

SW Broadway, Suite 2720

Portland,

OR 97205

(503)

227-1233

Seattle

Office

Columbia

Center

701

5th Ave., Suite 4200

Seattle,

WA 98104

www.doctorlawyer.net

(866)

THE-FIRM

[Guest guest]

Dr. Alan is speaking on the neurological issue and Dr. Phieffer WILL be there!

Sunny ;'-))

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: sharronf@...Date: Wed, 13 Feb 2008 13:57:17 -0800Subject: RE: traumatic brain injury article

Perhaps Dr. Pfieffer in Pendleton should be asked to speak at the next convention ? He has the knowledge and the forms to share. Or he could produce a CD for sale ?

s. fuchs dc

From: [mailto: ] On Behalf Of Sent: Wednesday, February 13, 2008 1:50 PMDr. DeShaw, Esq.; Subject: RE: traumatic brain injury article

Great article. And ditto what has said. Concussion and mild traumatic brain injury are extremely common in motor vehicle collisions, particularly rear end collisions. They are not diagnosed in the E.R., because they are not life threatening and no inquiry is made by the E.R. physicians. They are not diagnosed by the PCP M.D. who next sees the patient, because the appropriate questions are simply not asked. Sadly, they are also not diagnosed by the treating chiropractic physicians, because the appropriate questions are simply not asked. Most patients don't bring the subject up to their physicians, because they do not relate the symptoms to minor traumatic brain injury. They tend to self-diagnose their problems and symptoms as flowing from stress, pain, not working, interrupted sleep caused by pain, etc. It is the doctor's job (in my opinion) to inquire into these issues. It's not the patient's job to diagnose themselves and tell you from what they suffer.

I have a client who is a Board Certified psychiatrist and former chief resident of the psychiatric ward at OHSU. She herself suffered moderate traumatic brain injury and its aftermath following a motor vehicle collision, and I had to essentially do the diagnosis myself months after the collision, because none of her various doctors (all M.D.'s) had asked her any relevant questions. She herself believed all her cognitive and emotional symptoms (which were severe in my opinion) were related to stress, pain, sleep, etc. I finally had to tell her in my office to shut up, to stop trying to be her own doctor, and to consider the following hypothetical as if it were a Board Exam: Patient A presents with a history of acceleration/deceleration injury following a motor vehicle collision, Patient A has had headaches, dizziness, forgetfulness, difficulty concentrating, bouts of crying for no apparent reason, bouts of inexplicable anger and frustration at inanimate and animate objects (such as the kitchen cupboards), Patient A feels overwhelmed going into a grocery store with all the lights and colors, she doesn't want to be touched by her husband or daughter and has no real desire to touch them, she feels like being alone to the point of sitting in the chair as opposed to the couch so no one will sit next to her, the television is always too loud and irritating, she forgets conversations she has with her clients, etc. Doctor, what is your differential diagnosis and explain your answer? She looked at me and said, "Holy shit, I have PTSD and post concussive syndrome, don't I?" She saw Darien Fenn within a week and is now all better.

I've done several new client intakes in the past couple of months of patients of some very experienced chiropractic physicians, where the patient was obviously suffering the sequelae of concussion, but no diagnosis had ever been made. I am perpetually amazed how often I ask my clients (after doing a basic closed head injury inquiry) if anyone has asked them any of the questions I have. Sadly, very often the answer is, "No." I am always pleased when the answer is: "Oh, yeah, Dr. ______ asked me all those questions." I have to be honest with you, the latter answer is unfortunately rather rare. Many doctors still let their C.A.'s do the initial intake interview, or worse, the initial intake interview is done by the patient by filling out a form. If a Board Certified Psychiatrist misses and cannot appreciate her own symptoms of closed head injury, how can we possibly expect the run of the mill lay patient to be able to appreciate those symptoms and to tell you about them unless they are specifically asked by you?? I also must opine that many of the "intake forms" I have seen used by doctors have no spaces or questions whatsoever which would alert the doctor that there may have been a concussion. I met a lady a couple of weeks ago who had an mva almost a year ago. She actually had fallen down twice due to equilibrium problems, was unable to close her eyes in the shower to wash her hair without holding onto the rail, was having anxiety attacks whenever she was a passenger in a car which was so bad that she and her boyfriend had several arguments about her "freaking out" whenever he drove through intersections, and I was the first person to ask her any questions related to those issues. That's clinically pathetic (in my opinion). I know I and others have written about these issue before, but it just seems that the message is not getting through.

Best Regards, G. , Gatti, Gatti, et. al.

From: [mailto: ] On Behalf Of Dr. DeShaw, Esq.Sent: Wednesday, February 13, 2008 12:40 PM Subject: traumatic brain injury article

Doctors:

http://online.wsj.com/article/SB120156672297223803.html

If you deal with motor vehicle collisions, please read this article from the Wall Street Journal. The diagnosis of mild traumatic brain injuries is underdiagnosed, and the life long impact can be very serious.

A high percentage of the PI cases that I handle involve mild traumatic brain injuries. If any of you have questions about what you are seeing in a difficult case, please feel free to contact me. I am also hoping to provide some free lectures on brain injuries for doctors later this year.

Respectfully,

DeShaw, DC, JD

Dr. DeShaw, Esq., P.C.

Portland Office

Fox Tower

805 SW Broadway, Suite 2720

Portland, OR 97205

(503) 227-1233

Seattle Office

Columbia Center

701 5th Ave., Suite 4200

Seattle, WA 98104

www.doctorlawyer.net

(866) THE-FIRM

Connect and share in new ways with Windows Live. Get it now!

[Guest guest]

Dr. Phieffer in our own state has an EXCELLENT set of forms with all the cogent quetions. Not only are they all there but they 'walk you through' the diagnosis(es) WITH the documentation that an insurance can't refute.

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: cmathdc@...Date: Wed, 13 Feb 2008 15:02:23 -0800Subject: Re: traumatic brain injury article

,

Are there key questions regarding this issue you can share with us, or is it that we need to ask about emotional, cognative, memory and concentration and follow up on any answer that leads us to a deeper meaning?

Christian Mathisen DC

3654 S Pacific Hwy

Medford, OR 97501

cmathdcjeffnet (DOT) org

RE: traumatic brain injury article

Great article. And ditto what has said. Concussion and mild traumatic brain injury are extremely common in motor vehicle collisions, particularly rear end collisions. They are not diagnosed in the E.R., because they are not life threatening and no inquiry is made by the E.R. physicians. They are not diagnosed by the PCP M.D. who next sees the patient, because the appropriate questions are simply not asked. Sadly, they are also not diagnosed by the treating chiropractic physicians, because the appropriate questions are simply not asked. Most patients don't bring the subject up to their physicians, because they do not relate the symptoms to minor traumatic brain injury. They tend to self-diagnose their problems and symptoms as flowing from stress, pain, not working, interrupted sleep caused by pain, etc. It is the doctor's job (in my opinion) to inquire into these issues. It's not the patient's job to diagnose themselves and tell you from what they suffer.

I have a client who is a Board Certified psychiatrist and former chief resident of the psychiatric ward at OHSU. She herself suffered moderate traumatic brain injury and its aftermath following a motor vehicle collision, and I had to essentially do the diagnosis myself months after the collision, because none of her various doctors (all M.D.'s) had asked her any relevant questions. She herself believed all her cognitive and emotional symptoms (which were severe in my opinion) were related to stress, pain, sleep, etc. I finally had to tell her in my office to shut up, to stop trying to be her own doctor, and to consider the following hypothetical as if it were a Board Exam: Patient A presents with a history of acceleration/deceleration injury following a motor vehicle collision, Patient A has had headaches, dizziness, forgetfulness, difficulty concentrating, bouts of crying for no apparent reason, bouts of inexplicable anger and frustration at inanimate and animate objects (such as the kitchen cupboards), Patient A feels overwhelmed going into a grocery store with all the lights and colors, she doesn't want to be touched by her husband or daughter and has no real desire to touch them, she feels like being alone to the point of sitting in the chair as opposed to the couch so no one will sit next to her, the television is always too loud and irritating, she forgets conversations she has with her clients, etc. Doctor, what is your differential diagnosis and explain your answer? She looked at me and said, "Holy shit, I have PTSD and post concussive syndrome, don't I?" She saw Darien Fenn within a week and is now all better.

I've done several new client intakes in the past couple of months of patients of some very experienced chiropractic physicians, where the patient was obviously suffering the sequelae of concussion, but no diagnosis had ever been made. I am perpetually amazed how often I ask my clients (after doing a basic closed head injury inquiry) if anyone has asked them any of the questions I have. Sadly, very often the answer is, "No." I am always pleased when the answer is: "Oh, yeah, Dr. ______ asked me all those questions." I have to be honest with you, the latter answer is unfortunately rather rare. Many doctors still let their C.A.'s do the initial intake interview, or worse, the initial intake interview is done by the patient by filling out a form. If a Board Certified Psychiatrist misses and cannot appreciate her own symptoms of closed head injury, how can we possibly expect the run of the mill lay patient to be able to appreciate those symptoms and to tell you about them unless they are specifically asked by you?? I also must opine that many of the "intake forms" I have seen used by doctors have no spaces or questions whatsoever which would alert the doctor that there may have been a concussion. I met a lady a couple of weeks ago who had an mva almost a year ago. She actually had fallen down twice due to equilibrium problems, was unable to close her eyes in the shower to wash her hair without holding onto the rail, was having anxiety attacks whenever she was a passenger in a car which was so bad that she and her boyfriend had several arguments about her "freaking out" whenever he drove through intersections, and I was the first person to ask her any questions related to those issues. That's clinically pathetic (in my opinion). I know I and others have written about these issue before, but it just seems that the message is not getting through.

Best Regards, G. , Gatti, Gatti, et. al.

From: [mailto: ] On Behalf Of Dr. DeShaw, Esq.Sent: Wednesday, February 13, 2008 12:40 PM Subject: traumatic brain injury article

Doctors:

http://online.wsj.com/article/SB120156672297223803.html

If you deal with motor vehicle collisions, please read this article from the Wall Street Journal. The diagnosis of mild traumatic brain injuries is underdiagnosed, and the life long impact can be very serious.

A high percentage of the PI cases that I handle involve mild traumatic brain injuries. If any of you have questions about what you are seeing in a difficult case, please feel free to contact me. I am also hoping to provide some free lectures on brain injuries for doctors later this year.

Respectfully,

DeShaw, DC, JD

Dr. DeShaw, Esq., P.C.

Portland Office

Fox Tower

805 SW Broadway, Suite 2720

Portland, OR 97205

(503) 227-1233

Seattle Office

Columbia Center

701 5th Ave., Suite 4200

Seattle, WA 98104

www.doctorlawyer.net

(866) THE-FIRM

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