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Dr. Mark Kestner: When two doctors form a tag-team for treatment




Over the past three and a half decades I have treated thousands of patients. I stopped counting after 10,000. I would like to think I have learned something from caring for each one. Many years ago, I heard a statement that, “Thirty years of experience is much different than one year of experience repeated 30 times.”

With each patient, even if they are presenting with a condition I have treated a few thousand times, there is always something unique or different. There are so many variations in a way the same condition can present, and we all are so different in our hereditary factors, health history, previous injuries, illnesses and medical procedures that each patient truly is a one of a kind. And that is before peculiar personality factors are considered.

To me, that is a big part of the reason I still love my job. I look forward to each new day in the office. I am constantly learning new things about the human body and the individuals that are experiencing problems.

One of the things I learned many years ago is that often a patient will present with more than one problem, or with a problem that is too complex for me to handle without other providers.

There is a reason that there are so many specialties and sub-specialties in health care. The human body is extraordinarily complex and there are untold ways that things can go wrong. There are also numerous ways to treat a wide range of conditions. My way isn’t always the only or the best way.

One patient came to see me recently that illustrates the point well. His initial paperwork indicated he thought he had sciatica. We treat sciatica well and have since 1988, so this is a typical condition in our office.

As we dove into his health history, however, it became clear that he did not have a typical case of sciatica.

With most cases of sciatica, the patient will experience pain in the lower back, usually on one side. They may complain of pain in the buttocks or hip area. The hallmark of sciatica is that there is radiating pain or other symptoms going into the leg, possibly as far as the foot.

Other radiating symptoms may be tingling, shocking or electrical type pain, numbness or other symptoms that seem to shoot down the leg. This happens because the sciatic nerve is being pinched or damaged. Sciatica should always be considered serious.

The patient did have pain in the back, as well as pain in the leg, knee and foot. In most cases the cause of all of this pain will turn out to be sciatica, as the nerve can cause many kinds of pain.

However, in this patient’s history there were other factors. As I asked more questions about his pain, it soon became apparent that he had at least two different reasons for his pain.

He did, in fact, have a lower back disc problem that was causing sciatica. The particular disc involved, however, was only affecting the nerve that affects the upper and middle part of the leg. The pain in the lower leg and foot was due to a separate issue.

I explained to him that we could indeed help him with the lower back pain and the true sciatica, but he would need to see a different doctor to evaluate the foot pain. I referred him to a very talented podiatrist to evaluate and treat the foot issue.

As we proceeded with his treatment, it was revealed that the foot issue had been present for a while and may have played a role in development of the lower back problem.

I often tell patients that although I have spent many hours in human dissection labs studying human anatomy during my training, the fun song I learned as a child often explains many of the problems that patients encounter. You probably have heard the song, “The foot bone’s connected to the ankle bone,” … and so on.

It would probably surprise many readers how often we discover that a problem that ends up being severe enough to bring a patient to our office began many years ago as a problem in a different body part.

In the example of the foot problem, as the patient began to limp years earlier, then alter his gait to accommodate for the foot pain, this affected the knee, then he shifted further still and this began to cause hip pain. As he continued to deal with the original foot problem, eventually he ended up with one side of his pelvis higher than the other and this induced a curvature in his spine.

Most disc problems have developed over many years before they end up in my office. Had this man had his foot problem addressed years ago, would he still have ended up in my office? There is no way to know.

What is known is that he fared much better having the attention of both a spine specialist and a foot specialist to deal with what turned out to be two distinctly different, but likely connected problems.

Dr. Mark Kestner is a licensed chiropractic physician and acupuncturist with 30-plus years of experience focused primarily on treating complex and chronic spine, joint and neurological conditions in Murfreesboro. His office is at 1435 NW Broad St. Contact him at mkestner@DrKestner.com.

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