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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for pain in neck caused by neck injury

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1412 Questions

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Posted on Fri, 24 Oct 2014 in Brain and Spine
Question: I hurt my neck 5 days ago and would appreciate your opinion. Five days ago I was in the hot tub. The hot tub cover folds back like the attached photo, and the hot tub was half open. I jumped up and hit the back of my neck on the open edge of the cover (I was kind of bending forward). The edge of the cover hit the back of my neck in the center and slightly to the right (I'd guess between C5-T1). It hurt. I have iced the area often since then, but it is still hurting and has felt worse in the last 2 days. The area is slightly swollen, no bruising. I have full range of motion, and moving my neck does not affect the pain. The pain is pretty constant. I do not feel any tingling in my arms or shoulder. I do feel a little tingling in the pinky of my right hand at times, but I also have mild carpal tunnel in my right arm which gives me tingling in my pinky. So I'm not sure if the tingling I am currently feeling in my pinky is due to carpal tunnel or my neck. I have taken 200mg of ibuprofen per day since the injury occurred. I would take more, but I am on Zoloft and was told by my pharmacist not to take too much ibuprofen.

What do you think my diagnosis is?
Am I in any danger?
Will the injury just go away with time?
Anything I should not do?

I have a 3 year old active child. Thank you.
doctor
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Sounds like you're on the right track

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I have read your concerns and questions. Essentially, you injured your neck 5 days ago on the open edge of the cover that struck your neck in the center and slightly to the right. You believe the major force of impact was between C5-T1. You felt immediate pain but no bruise has surfaced to date. You've iced the area but it is still painful and perhaps slightly worse in the past 2 days. You believe the area is mildly swollen. Full ROM is present and moving the neck doesn't change the pain. There is no tingling in the arms or shoulders. Slight tingly feeling in the right 5th digit but you state that you have CTS and you state that this is the reason for chronic tingling of this digit or perhaps the neck. You have been taking 200mg. of Ibuprofen since the injury. You are also on Zolft but were advised by the pharmacist not to overdo things.

Bottom line is, I think you'll be just fine. Traumas such as these can take days to sometimes weeks to heal since they are primarily soft tissue. I am noticing that you are using cold still on this area although it's been 5 days. One of the common dictums in dealing with trauma to joints is to ice for 1-2 days at most then, to switch to heat therapy strategies. Therefore, I would recommend switching your ice pack to the neck out to a heat pack.

I also wished to make a quick correction to your statement of the 5th digit being numb. That is typically not a symptoms associated with CTS but rather with ulnar nerve pathology which can either be in the cubital tunnel region of the elbow or possibly at a more distant and medial peripheral area where the ulnar nerve itself could be suffering from some type of entrapment.


What do you think my diagnosis is?

>>>> I believe your diagnosis is soft tissue injury, mild contusion to the cervical spine/paracervical muscles.

Am I in any danger?

>>>>You have not provided any signs or symptoms that should concern you with regard to your short or long term safety as it applies to this cervical spinal injury.



Will the injury just go away with time?

>>>>Sometimes these types of soft tissue injuries or injury to the bony cervical spine itself in the form of a contusion (bruise) can take days to weeks and in extreme cases, months to fully heal as if nothing happened but you should be fine in that regard).

Anything I should not do?

>>>I might consider switching from ice to HEAT at this point and apply a nice warm compress (to the limit of tolerability with degree of heat but not to a point of being uncomfortable or burning yourself) at least 15-20 min. at a time 2-3x/day for the next several days. I would consider doing some slow and methodical stretching of the neck in all directions. Doing the stretches with a partner in a slow and relaxed format with regard to speed and force applied is recommended. I would also recommend a slight higher dose of analgesic or anti-inflammatory though this would be tempered by any discomfort or history of GI pathology. I would check with your doctor on the exact dosing limits of the Motrin based on your other medical conditions.

I would NOT go to a chiropractor...high risk of major complications with type of head thrust maneuvers they typically like to do with this sort of neck injury.

Easy also on the deep massages by a masseuse or friend as the injured area may already be contused or slightly predisposed to spasms and any deep tissue massage could unknowingly hit a painful trigger area which could exacerbate the condition.

Please don't forget that your written feedback as well as a STAR RATING to this question is GREATLY appreciated if you've found the information of value. And also, CLOSING THE QUERY on your end so that the network may process, archive, and properly credit this case for future reference as well garners my THANKS.

Please do not hesitate to contact me directly in the future by looking me up on this network and sending questions to my specific attention (Dariush Saghafi, M.D.). You may also get to my specific webpage at:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This case required 24 minutes physician specific time for review, research, and final draft documentation for envoy.

Hope all goes SWIMMINGLY WELL for your neck! LOL!



Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Dariush Saghafi 9 minutes later
Thank you - the area is swollen. Should I still apply heat even though it's swollen?
doctor
Answered by Dr. Dariush Saghafi 4 hours later
Brief Answer:
Can you upload a picture of your cervical region?

Detailed Answer:
Thanks for the return question.

You did say that pain and swelling has been getting worse over the past couple of days, didn't you....Can you take a picture and upload so I can see it?

Also, upload a picture of the neck PRIOR to the accident so I can compare. If you have very specific POINT tenderness in the neck (especially at the nape of the neck in the center) which would be right over the bump of the neck which represents C7 then, if swelling is getting WORSE rather than better after 5 days of icing you really should get that area X-rayed to rule out either a small vertebral body fracture or a transverse process fracture.

If swelling is still persisting at this time then, continue with icing until swelling stabilizes...however, sessions should be no less than 20-30 min. using bags of crushed ice or frozen vegetable bags at least 2-3x/day.

Obviously, if the X-ray shows a fracture, dislocation, or severely bulging disk then, you need to visit a physician (orthopod of preference) and you may require immobilization of the neck. If there is no fracture by x-ray, you still may benefit from a physician's examination followed by possible soft collar support but I wouldn't use a collar until clearing with an orthopod.

Please don't forget that your written feedback as well as a STAR RATING to this question are GREATLY appreciated if you've found the information of value. And also, CLOSING THE QUERY on your end is equally thanked by yours truly.

In the future please look me up on this network and send questions to my attention (Dariush Saghafi, M.D.). You may also get to my specific webpage at:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This case required 35 minutes physician specific time for review, research, and final draft documentation for envoy.
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Follow up: Dr. Dariush Saghafi 3 days later
I had X-rays taken of my thoracic and cervical spine. Results were normal. My physician said he thought a collar would make the situation worse. The area is still swollen and painful. What do you suggest? I am still icing occasionally. Is there anything I should not do? Thank you.
doctor
Answered by Dr. Dariush Saghafi 17 hours later
Brief Answer:
Ultrasound of the neck or MRI may define swelling

Detailed Answer:
Good morning. Thank you for your update.

Are you able to upload any pictures of your neck NOW vs. what it looked like PRIOR to your injury. Soft tissue injuries can take a very long time to fully heal. If the x-rays are clean for any fractures or disc problems then, it's just tincture of time that you need.

Does your doctor have you on some anti-inflammatory and pain medication? I would likely prescribe something on the order of ibuprofen of prescription strength and/or another NSAID in that category. There are other options such as lidocaine patches but other than that...time is what is really needed.

I think enough time has passed where you can switch from ice to heat and do that...but perhaps another thing to consider would be either an Ultrasound of the neck or even MRI to identify soft tissue damage or collections of fluid which could be impeding the healing process.

You should talk these over with your doctor. Physical or Occupational therapy may be able to offer relief as well. Again, that would have to be ordered through your PMD. I agree that a collar is not in your interest. Since there is no fracture you should try and use the neck as normally as possible, not immobilize it.

Oh, BTW, I highly DO NOT recommend chiropractic or deep massage types of therapies as these can cause much more harm and are even dangerous in the way they're done so I advise strongly against this form of intervention.

There are also other modalities of intervention that you can talk to your doctor about such as TENS units which may help with pain and possibly help reduce swelling. There is also a device called a sootheaway (www.sootheaway.com) and they have pads that you can use for the neck (Universal Pad, I believe is the one you can use....not sure if they have a specific NECK pad).

Finally, if you wait another week or so and there is just no improvement perhaps, you can request your doctor write for an orthopedic referral and let them take a good look and perform examinations of the cervical spine to really check for mobility and range of motion.

Please don't forget that your written feedback as well as a STAR RATING to this question are GREATLY appreciated if you've found the information of value. And also, CLOSING THE QUERY on your end is equally thanked by yours truly.

In the future please look me up on this network and send questions to my attention (Dariush Saghafi, M.D.). You may also get to my specific webpage at:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This case required 14 minutes physician specific time for review, research, and final draft documentation for envoy.


Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Follow up: Dr. Dariush Saghafi 2 hours later
Thank you for all of your suggestions. Unfortunately I don't have any photos. I tried to take a photo of the swelling for you but it's difficult to see it. I don't have a photo from before the injury to compare.

I am on Zoloft 50mg per day. Can I still take ibuprofen?

Are you suggesting an ultrasound or MRI because you think there is an undiagnosed injury that is important to identify for proper healing?

Are there any activities I should not do right now?I am feeling scared.

Is it possible that I have a fracture that didn't show up on the X-rays? I had the X-rays five days after my injury.

If I do have a fracture and don't know it, am I in any danger?

What would the treatment be for such a fracture?

Is it likely that I have a small fracture or a bone bruise or something else?

Is it necessary for me to get an MRI or am I safe if I do not?

Is there anything I should not do in terms of activities? I have a young toddler.

My pain is not severe and mostly just uncomfortable. The pain is primarily on my vertebrae on the right edge- I think it's at T1/C7 or maybe a little higher. The swelling is mild and is at the same location. The swelling also extends about 4" away from my spine to the right.

Thank you.
doctor
Answered by Dr. Dariush Saghafi 24 hours later
Brief Answer:
Unlikely that x-ray missed something important

Detailed Answer:
My apologies for not getting back sooner. I always try to get back on questions as soon as possible. The network asks that we respond back within approximately 1 day which I believe is reasonable given other obligations and duties.

I've read your recapitulations and don't believe there is any cause for alarm. In fact, it sounds as if things are healing nicely from what you're saying.

You must also understand the limitations of what you are asking me to comment on since I cannot physically examine or see you. You say that you could not get a picture of your neck nor do you think that the swelling is that apparent in your neck to begin with. I think that is very telling with regard to the possibility of an occult or undiagnosed fracture. If there were a fracture, swelling should be at least obvious to the individual (not just subtle which is what it sounds like at this juncture). You've also said that pain is not truly that bad...just "uncomfortable." Again, these are descriptive terms which as a doctor leads me away from believing that you are suffering from a fracture.

X-rays are very sensitive to picking up fractures and if they are negative and especially if there is no bruising or other discoloration of the overlying skin then, I doubt that there is a fracture that has been missed. If, however, there is additional concern on your part you can always ask your primary doctor to ask that the radiologist who read the first report as negative re-read it to doubly sure they didn't miss anything.

I had mentioned ultrasound and MRI only as a way of looking at SOFT TISSUE given your comment of swelling, however, if swelling is not that apparent to begin with then, neither of those 2 tests will likely show anything. Neither of those tests are very good at detecting fractures so again, I was not suggesting they be done for bony examination.

Can you not get someone else to take a good picture of you (doesn't have to be a close up because I definitely won't see a thing)...just a normal snapshot of your head and neck from a couple of feet back....front shot, back shot where the injury occurred, and a side view. But if you don't have anyone that can easily do that for you, it's no big deal.

I believe I've mentioned that the healing time necessary for SOFT TISSUE injuries such as what you likely have can be weeks and sometimes months. You simply need to give it time. You can do physical therapy with a trained professional (prescribed by your doctor) or stretching exercises (again by a therapist and ordered by your doctor) and you can take simple analgesics and anti-inflammatories. It is also possible you have "bruised" the bone....again, not possible for me to be sure since I'm not right there looking at either you or the films...but that is the case.....it doesn't XXXXXXX that it's taking time.

I agree with your physician that a neck brace or collar is not justified for you at all and would only serve to magnify your pain and discomfort.

I also believe I mentioned that warm compresses would be reasonable to employ at this time as opposed to ice even though you still believe there is some swelling. It's been a long enough time and if you use some heat to that area and try and open up a little circulation I think you may feel better. I would AVOID the use of chemical heat such as XXXXXXX XXXXXXX or ICY HOT. Those things are NEVER GOOD to use and I am a strong proponent of MOIST HEAT in the form of warmed towels in the microwave or on a pot of boiling water as opposed to straight heating pads which I think have more of a chance to burn the area and do not give quite as much penetrating heat as that given off by warmed or heated water.

By the same token, don't BURN yourself by putting the towel in the microwave for too long. They also have gel packs in the pharmacies. Those are fine too but at the same time they can get REALLY REALLY hot so be careful. I mentioned a sootheaway device but that might be a little pricey for something like this since I've no doubt that you are going to start resolving your symptoms in due course.

In conclusion:

1. No need to panic. No need to worry.

2. Unlikely that X-rays missed anything important

3. Recommendation for U/S or MRI is simply based upon YOUR ongoing complaint of soreness which is MOST LIKELY soft tissue and beginning to get better.

4. Personally, if it were my neck I would continue to treat conservatively, not get anymore tests done and perhaps take some OTC analgesics like ibuprofen or tylenol but nothing more.

5. I would also use warm compresses as described above and strive very hard not to engage my neck in activities that could strain it for the time being.

6. BUT I would try and work it out and stretch it a bit using exercises that were given to me by a physical therapist if the pain or discomfort were truly annoying and interfered with my ability to work or be productive with the family or at home.

I hope this is helpful to allay your fears/anxiety. Soft tissue injuries take a while to heal...I'm sure you've had your share in the past....this is no different.....and do be more careful next time you get in and out of the hot-tub...obviously....you've learned that one...right? LOL.

Please don't forget that your written feedback as well as a STAR RATING to this question are GREATLY appreciated if you've found the information of value. And also, CLOSING THE QUERY on your end is equally thanked by yours truly.

In the future please look me up on this network and send questions to my attention through my specific webpage at:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

This case required 44 minutes of physician specific time for review, research, and final draft documentation for envoy.


Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Dariush Saghafi 3 hours later
Hi again,
Attached are 4 photos of my upper thoracic/lower neck for you taken by my husband. He said the swelling is moderate, not mild. He also drew a diagram of the swollen area. He tried to show that the swollen area is a palm-sized area located slightly off-center to the right of my spine, and there is one smaller angled area that is more swollen. I do not have any photos pre-injury.

Do these photos change your opinion on whether I need any additional tests or could be in danger?

I am okay dealing with the pain and waiting for time to heal. My main concern was just wanting to make sure I don't have a fracture that the x-rays missed.

Thank you for your help - especially on a weekend - I greatly appreciate it.
doctor
Answered by Dr. Dariush Saghafi 20 hours later
Brief Answer:
I can almost see the swelling..buttttt- not really

Detailed Answer:
Thanks for the effort at taking the pictures. Maybe the lighting isn't optimal. The shots I have appear to be shadowed on the right side of your body exactly where you want me to see the swelling.

There are certainly no areas of bruising that are obvious to my eye. There is no obvious asymmetry of the shoulders, the neck itself looks fine although I would've liked a full straight on back and front shot focusing on the neck so I can really just see the symmetry of one side vs. the other.

But no matter....I think what you took was adequate. Have you started using heat yet? How about some anti-inflammatories like either Motrin or Naproxen or Voltaren?

The diagram was helpful for me to zoom in and for that reason I was trying very hard to see some moderate degree of swelling but I just couldn't convince myself that I really saw it....c'est la vie. You say it's there and I'm sure it is.....

To be honest, and as I pointed out in my previous responses to you, I believe we are on very firm ground with negative x-rays and that certainly should allay any fears you may have of "being in danger." I'm not sure who may've given you any information that seems to have scared you into believing that simply based on a bit more prolonged healing process this could result in some real disastrous consequence....maybe some hungry chiropractor???....but you're going to be fine based on everything you've provided to me so far.

And also, please clarify for me which and how many doctors have actually LAID HANDS on your neck and shoulder since this occurred. I was under the impression that at least your PMD and maybe an ER doc....but now from what I'm reading, I'm not really sure who's actually seen you.

You certainly don't seem to be overweight to any significant extent from what I can see in the pictures...so I doubt that the X-rays could've been fooled by too much tissue overlying the cervical spine or anywhere else....

Now, there is just one other possibility that could be chased down here....the cervical spine films....did they JUST look at the cervical spine or did they also capture the wing bone on the right side (the scapula)? Because that would be the only other thing I can think that could be x-rayed looking for pathology that may have been missed on the c-spine films....but, if the technician doing the study opened the windows out a bit to include the shoulder blade then, we don't need to worry.

Again, the idea of a scapular fracture (even if it were a chipped bone or something) without producing some bruising that would be visible by now (we're at about 7-10 days post injury, right) is just way too long for my taste. So, even if you did clip something on that bone itself I think bruise is the worst that could've happened.

You're the only one that find out all that kind of information about the x-ray. So are we clear on what we're looking for at this point?

Ok...waiting to hear from you....although we're going to have to think about CLOSING THE QUERY and reopening if we're going to continue the discussion. Remember, the initial charges cover for 3 questions and I think we're beyond that at this point so please keep that in mind.

If you do need to close you can post your next series of responses/questions to me by using the following link:

http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474

I see that you rated our conversations with 5 stars and I am very pleased that YOU are pleased. To that end could you also include a little written feedback when CLOSING THE QUERY.

If it's a nice set of comments I may be able to solicit some time in the company Hot-tub myself....which would nice now that the temperatures are getting down there! LOL......And from your unfortunate experience, you know what you taught me? ALWAYS TAKE THE WHOLE LID OFF THE TUB....isn't that right? Don't you agree? Not worth the hassle to leave half of it on and bang yourself up......HA!

This case required 32 minutes of physician specific time for review, research, and final draft documentation for envoy.

P.S. No problems at all helping you out on the weekends. Thank YOU for your patience on the responses.....you really don't know how CRAZY it's going here....sometimes I wanna just tell the world to stop and let me off at the next comet that comes by so it can take me to the depths of outer space and chill me out for awhile.....I'm good coming back in 150 years or so and surprising everyone!! HAHA!

Take care....and tell me if you're feeling even just a LITTLE better compared to a week ago?


Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Dariush Saghafi 1 hour later
Thank you so much. Before my last question, I actually did close the query and then re-opened to pay again, so I think we are all set. I also did provide (glowing) written feedback - did it not register?

I really appreciate your help. My primary doctor did see me and examined me 5 days after the injury. He saw the swelling and ordered the X-rays. He thought it was either a bone bruise or a soft tissue injury but wanted to rule out a fracture. He retired from practice the following day so I have not seen him since.

As I said, the X-rays were negative. On a side note, the X-rays said that I have mild scoliosis. I never knew about the scoliosis before and believe it is new. I've had past spinal MRIs (for a T9 thoracic disk problem caused by a chiropractor - I will never see a chiropractor again) and was never told about the scoliosis before. I just took a photo of my back and can actually see the curve in my spine which I think I would have noticed in past photos of myself. What would be causing this scoliosis? Is mild scoliosis dangerous? It's kind of freaking me out.

I'm not sure if my X-rays showed my scapula, although the pain is quite localized right on the right edge of my neck vertebrae so I doubt there would be a scapula fracture.

I did try heat yesterday, although I then felt tingling in my arm so returned to ice in case it was increasing the swelling. I'm really not sure I am feeling any better. It's still quite uncomfortable. Maybe a little. I did take some Advil.

I appreciate your getting back to me - it sounds like you are quite busy!
doctor
Answered by Dr. Dariush Saghafi 4 hours later
Brief Answer:
What DID you DO to your PMD? :)

Detailed Answer:
So you scared your PMD off? Nice...... HA! Did you know he was planning on retiring? Usually they send letters out with projected shutdown dates....so is there a replacement for him? Will be interresting to see who is filling in....

So, as we've stated already (as well as other people have stated from other consults you've done)...the likelihood of an X-ray missing a fracture is very small. I wouldn't worry about that anymore....but again, if you are the only thing I can tell you is that you'll need to check with your NEW PMD. There's not much I can do in my capacity as a telemedicine physician.....but the chances of them missing something like that are extremely small.

As far any questions on scoliosis are concerned....that is clearly not an area of specialty that I can or should comment so perhaps, again, you'll want to ask your PMD to refer you to a specialist on that issue and get looked at since making statements or observations long distance isn't nearly as good for something like that as when the patient is right there to examine...make sense?

I understand the idea of the pain localizing to an area of your neck instead of your scapula....it's just that the diagram that either you or your husband drew seems to be including the area of the scapula more than the neck...at least that's my interpretation of it....but that's fine. Less to worry about if we don't invoke the scapula as being involved in any way.

Heat will not increase swelling after this many days following an acute injury and so I would certainly feel comfortable using it if it were my neck. Ice after the first few days actually inhibits healing and slows things down....think about....cold....constriction of blood vessels, less active circulation....healing is slower....My recommendation is heat but by all means if you're more comfortable with the ice then, that is a choice I can support as well....just expect a bit of a longer healing process.

And let me try and inject just a little bit of that GO GET 'EM TEAM attitude and say that if you're not sure that you're feeling better then, the statement that you COULD BE feeling better is not false, right? So when you combine the 2 statements of "Maybe a little" with "I could be feeling better"....what is the result of that statement? How about, "Maybe I could be feeling a little better?"

Now, tell me that isn't DEFINITELY BETTER than what you were feeling the day you smacked yourself? Gee....I could probably sell you a car if I keep going....CAN I? HAHA!

So, as the saying goes....I'd like you to look at the glass as half full instead of half empty....whaddya say??? We need some PMA here in the room, as my wrestling coach always said, in order to help us get over this hump (not this lump! LOL).....PMA- POSITIVE MENTAL ATTITUDE. Work with me on this....cmon'.....work with me......yes?

I think (as the good Dr. XXXXXXX thinks....) that your back looks pretty good in pictures at least. You may even have XXXXXXX lines a bit but there's no swelling that either of us can really see....where are you guys at? Somewhere enviously warm I bet!

And THANK YOU my dear for your GLOWING feedback.....BUT---- I'm afraid I did not see it....don't know why....I saw the 5 stars...that seemed to register but not the lovely words that would impress the bosses! HAHA! Well, if you're so moved another recap wouldn't hurt! ROFL!

So are we finally with all this? I think the upshot is the following:

1. You've now got 2 neurological opinions who strongly believe that you DO NOT have a fracture based on all the avaialble evidence. You've got 1 who is telling you that if you still needed more clarification on that to talk with your PMD so they can call the radiologist and have them reread the study....but honestly, you're good in our opinion.

2. If there is a read of a mild scoliosis I would check with the PMD to send you over to ortho for an opinion although again, my opinion? Don't go to surgeon if you really have not intention of getting surgerized....cuz that's all they're interested in....they don't do nearly as well when they have to THINK ABOUT THINGS.....Whack 'em and leave 'em I think is their motto! LOL hysterically! Hey, my dad's still a practicing surgeon at 84....whaddya think of that....so I can poke all the fun I want at them......but my dad is tops in what he does....yep...Pops is Tops!

3. I believe continued ICING is potentially slowing down your recovery time and I would use nice, DELICIOUS, SOOTHING, INVIGORATING, HEAT...because we are way beyond the time that acute swelling is going on....independent of what you feel or what your husband sees.....opening up the circulation is what we want to do.

4. If there's a concern with scoliosis you need to ask your PMD for an opinion and/or a consult with an orthopod....but again, why walk into the den of the lion if you know he probably wants to eat you??? Hey, a spontaneous analogy....makes sense, no?

5. Forget the scapula....it's just a "wing and a prayer anyway...." oh man, I'm on a roll.....

6. That GLOWING FEEDBACK....I'd LOVE to see it...I promise I won't tell anybody I made you do it a 2nd time! HAHA!

7. Ohhhh....almost forgot...THANK YOU very much for closing the previous query and reopening a new one....I believe you get 3 questions with the first charge and then, I think you get like 4 with the 2nd one? No? Something like that? If you recahrge a 3rd time....who knows what you get.....a medal maybe?? Or do you become my private patient even though you live somewhere which is OBVIOUSLY no where near XXXXXXX OH?

Well, that's fine....cuz we have LeBron XXXXXXX back here on his throne....and we've got some Brownies who came back from a 28-3 deficit yesterday to win 29-28, AND....AND--- we've got Drew XXXXXXX ...and so, what would be wrong if you had to come to XXXXXXX once in awhile so I can practice being an orthopedist and spine specialist on you??!! HAHA!

Alright....that's my story and I'm sticking to it...so you have a wonderful rest of the night and I'll be looking to see if you're going to respond to any of these really bad jokes, send me some more questions to answer, or really make my head swell so much after rewriting that feedback that I won't be able to get out of the house tomorrow morning.

I gotta get outta' here. My youngest has a school orchestra performance tonight and I promised I'd be there....oh don't worry....when I tell my kids that I'll be there for whatever they've got going....wild horses can't keep me away.....True Story- XXXXXXX XXXXXXX called the office (randomly...they were just thumbing through the Yellow pages) many years ago for a concert and he really REALLY REALLY wanted a doctor to make a housecall (down to the venue where he was performing) to give him a B12 shot....he was apparently a fanatic not just about Propofol-- but he LOVED his B12 shots before going out on stage. So, his manager said that they realized they were pulling me from a busy office I had going and stood ready to pay me whatever it would be to recoup the losses of cancelling the rest of the schedule and come down to give him the shot AND stay with him through performance in case he needed something else.....well, I politely declined and wished him a broken leg on his performance because first of all, I had patients who were already sitting waiting for me as well as people who were probably en route who I couldn't just have come and find that I'd taken off to be with XXXXXXX XXXXXXX ...PLUS one of my daughters had a presentation in the evening for the school play and she had a part that we'd been practicing for weeks I wanted to hear! She had no clue who MJ was at that time and I couldn't justify missing the performance for whatever the money was going to be....we would've spent it on Cedar Point or something dumb anyways.....sooooooo.....well, you get it---you'd do the same I'm sure.....adios!

This case required 54 minutes of physician specific time for review, research, and final draft documentation for envoy.


DON'T FORGET-----PMA!
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Dariush Saghafi 21 minutes later
Thanks so much - and you are hysterical!

So yes - PMA. I will do it. Thanks for the push. I will also move to heat instead of ice.

I will re-post my glowing comments, although it's really too bad that they didn't register since they really were quite brilliant. Not sure I'll be able to capture the same glowing essence as before - but I will try! :)

I did know my doc was retiring. He had sent out a letter a month beforehand. I just happened to see him on his very last day in practice. So sad he's retiring.

Thank you again for everything. I greatly appreciate your time and help (and humor)!
doctor
Answered by Dr. Dariush Saghafi 5 hours later
Brief Answer:
You've got it my dear

Detailed Answer:
Bombs away! HAHA!

You lost a doctor on short notice....try this one out.....a friend and musician colleague (we both play violin...he's professional....I play as a strong hobby and never have to worry about where my next gig is coming from! HA!).

Anyways, I've been close to him as a musician and friend along with his wife who my kids actually did matchmaking for to get them hitched (the kids were all under 12 years when they concocted an implemented the plan to get them together!). So you get the picture...pretty close to these guys, right?

His wife is a concert pianist....I'm always calling him to do gigs with me or in place of me when I can't make them (weddings, parties, chamber group festivals, etc.).

So what do I find out today (at my daughter's concert from her orchestra teacher?). Hristo and Eriko hightailed it out of XXXXXXX to Florida like Art Modell snuck the XXXXXXX Browns out of town one night without anybody seeing them!

I looked so silly with my my jaw hanging down lower than my knees for 2 minutes as the orchestra teacher is telling me.....and who did they tell about their move???

Absolutely NOBODY....not even the students who were in their studios....they had busy studios (violin for Hristo and Piano for Eriko)....their students had lessons one week and the next week, POOF.....gone....just like that.

How did we find them? Facebook tells all!

Oh, I'm sure the words will be golden off your pen....and I would love to know how things are going if you end up having a moment to catch me up in a week or 2."

PMA-PMA-PMA
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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