We keep thinking that quackery and medicine can co-exist. Complementary medicine and alternative medicine is a big business, preying on the lack of understanding about medicine, the fears about medical science and the apparent validation of quackery as a legitimate business. We don’t treat “quacks” as quacks. We treat them as doctors. We call their field “alternative” medicine not “bullshit”. An anti-biologist is a creationist. An anti-NASA dude is a flat earther. Not an Alternative Biologist or an Alternative Rocket Scientist. We call them out for the bullshit they peddle. Yet we don’t apply the same attitude towards quacks.
Hippa (names changed for privacy) passed away today. A friend of a friend. She died from complications arising from Necrotising Fasciitis earlier on sunday.
What went wrong? After feeling a pain in her hip she went to a chiropractor. From the Email she sent…
“Chiropractor says its a S-O joint compressing the sciatic nerve. My condition is worsening, as I can’t get up and down by myself or hardly walk. The chiropractic adjustments & massage don’t seem to be helping. I’ve contacted my orthopedic who is working me in today and ordering a stat MRI.”
1. There is no such thing as an SO joint. To my knowledge. In Human anatomy. There is a sacro-iliac joint. There is a Ilio-femoral joint. There is no Sacro-O (Obturator?) joint. We can give the benefit of the doubt as the patient may have transferred the information incorrectly. Happens. Medical Lingo is for the Nerds.
2. The Sacro-iliac joint is fixed… It cannot really impinge on anything barring fractures and what have you. It cannot compress on the sciatic nerve since the sciatic nerve is formed by the sacral nerves.
3. Spinal Disc herniation cannot be fixed by a chiropracter (cause of sciatica)
4. Neither can spinal stenosis and priformis syndrome
5. A chiropractor without a single x-ray, CT scan or MRI made this diagnosis.
NF is a disorder that can be treated. Broad Spectrum antibiotics and rapid surgical debridement can save lives if treated early enough. NF is easily seen (or not seen as I will explain) on X-Rays, CT and MRI scans. It can even be detected courtesy of basic physical examination. It’s a rare disease BUT one you have to keep in mind. Every doctor gets one…
To point out how badly the Chiro failed at basic medicine? During systemic exam the area over the skin would have some decolourisation. In addition to appearing like cellulitis which doesn’t respond to antibiotics there would be crepitations, severe constant pain that isn’t ameliorated by positional changes but is out of proportion to physical signs of damage, systemic illness, skin necrosis and bullae. He didn’t even do any of the things needed to diagnose his ORIGINAL diagnosis.
Two signs that are important to keep in mind is that with ANY joint pain or long bone pain an x-ray, CT or MRI is necessary. Immediately. On visualisation you will see gas even on the x-ray. It’s a sign that something is afoot and that requires exploratory surgery immediately. If you show up to a hospital going “my arm aches” even if it is tennis elbow (or wanker’s cramp) you will still get an X-ray or CT. The second sign is dishwater pus.
Now NF is hard to diagnose. The issue being that it looks like other conditions. But here is the thing. The other conditions are all pretty serious stuff too. Deep Vein Thrombosis, Limb Ischaemia, Gas gangrene or at best erysiplilas and cellulitis. But that’s why we have exploratory surgery and Emergency Debridement. We can save limbs, we can sometimes lose the limb but save a life. The disease still has a monsterous mortality rate (25%) but but 75% is better than 0%.
Like Steve Jobs, we cannot solely place the blame on the Chiro. She may have had medical care and may have still passed away. But the Chiro plays a big big part in why she died. Hindsight may be 20/20 but if she had seen a doctor initally it may have been caught prior to the stage of sepsis and shock and the ground work would have been laid out for a proper treatment. The Chiro’s lack of any professional skill, knowledge as well as the perception that he is a real doctor delayed her treatment.She believed that he had the knowledge to make this call.
And it cost her. It cost her everything. Jokes about medicine and chiropractic aside…
The validation of quacks as real doctors kills. It’s not complimentary. Bullshit isn’t complimentary to science. It’s not harmless.