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CLINICAL HISTORY
Mr. X.P. aged 60 came to see me two years after being treated by a Chiropractor for
lumbosacral pains using chiropractic methods. Patient claims the chiropractor
ordered X-Ray of lumbosacral spine but did not have X-Ray interpreted by a
Radiologist. He chose first to go to a chiropractor instead of his primary care/
family doctor. Mr. X.P. presented to my clinic with complaint of persistent pain in
lower back, loss of weight (over 20 lbs. in last 61/2 months),
mild nocturia, mild hesitancy, and mild dysuria for the past two years.
INVESTIGATIONS
Hb.-6.0 grams/100
ml. (normal 12-16)
PSA - 98 ng/ml.
(normal 0-4)
X-ray L/S spine -
three osteolytic lesions highly suggestive of metastatic disease
Liver function
tests - all elevated
Prostate Biopsy
and ultra sound scan - adenocarcinoma.
Bone scan -
metastases to spine, pelvis, tibia, neck and ribs
TREATMENT
Patient is having Goserelin (Zoladex) monthly and is free from pain for past three
months. (April 99, May 99 and June 99).
DISCUSSION
The lessons to be learnt are as follows:-
Patient was
ignorant of symptoms and signs of prostatic enlargement and cancer of the prostate.
More health education and health promotion programmes in Trinidad and Tobago
are needed to educate our males over forty years.
Patients have to
be educated about importance of consulting their primary care doctor/ family doctor first
before any other practitioner whether medical or alternative or complementary
practitioner, because the primary care. family doctor is the first contact person trained
to screen and detect cancer early.
Chiropractors must
not accept patients with back problems until they have been seen by their family doctor
and had proper assessments including x-rays with reports of x-rays issued by a qualified
radiologist.
END
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