[Cybersprings]

Originally Posted by golfing eagles

Can anyone spell hyperbole???? That being said I get the impression that some posts are trying to equate medical care with some ancillary services. IT IS NOT THE SAME THING. To suggest that I would advise a patient that “I would recommend you see an ENT rather than an audiologist for your vertigo “ is absolutely bizarre. The concept of referring a vertiginous patient to an audiologist would never, ever enter the mind of even an average physician, only someone with limited knowledge and no experience would even suggest it. It’s no different than the suggestion that seeing a chiropractor for hip pain is the equivalent of seeing an orthopedist. And my concern is that posts that suggest such things could be harmful to some readers out there

It would not have been a recommendation from you to see an audiologist. It would have been a thoughtful response to someone else recommending it. And everything in it would have been factual. As it is, you got your point across, wrote an incorrect statement that audiologists do not diagnose balance issues(regardless of whether or not they are anywhere close to the best at it), and did it in a way that was degrading to a profession.

Going back to your right wrong right right wrong response to someone else, I don't think you get to be the authority on your bedside manner. If you treated your patients the way you treat others on this site, I am guessing that persons assertion would get a "right"

[Cybersprings]

Originally Posted by golfing eagles

Common??? I think not.

If a patient came in with the complaint of vertigo, the second to last referral that would ever cross my mind is to an "audiologist" (chiropractor being the last ) The patient first of all needs an MRI, probably with gadolinium, to exclude a space occupying lesion or vascular anomaly. They may need brainstem evoked potentials and advanced vestibular testing, which is squarely in the purview of the neurologists and otolaryngologists. Many times the diagnosis comes down to BPPV caused by otoconia in the labyrinth, and may be amenable to the Epley maneuver.

Amazing how some people just go on posting when they don't even know what it is that they don't know. I also think someone just criticized a person with a master's in political science because they claimed some degree of expertise. Regardless, I assure you that I AM an expert, know about a zillion times as much medicine as some that post, and I will be watching, as usual, to make sure no one is misinforming others on this site.

All seriousness aside, the humour of your last recommendation was not lost on me. I did actually chuckle.

[golfing eagles]

Originally Posted by Cybersprings

We were cross posting, so I posted my last post before reading this.

I do not question your medical knowledge or experience. I do not know if you were a horrible doctor, great doctor, or something in between. But l have no basis to assume anything other than the best. I have never tried to stack my medical knowledge and experience against yours, it would not be pretty for me.

But I believe that doctors should be precise or people die. And you are far from precise. You make blanket statements that are categorically wrong. And its obvious from many posts that people trust you because you are a doctor. You owe them thoughtful responses if you are going to speak with the authority of a doctor.

No offense, and I'm really not looking for a p!$$!ng match, but please point out a statement that is "categorically wrong". Some may be exaggerations to make a point, but overall they are accurate. You cannot hunt for rare exceptions and hold that up as a standard. I think I have been pretty consistent---I acknowledged referring patients to chiropractors and other ancillary services when appropriate, but pretty harshly warn against getting evaluated by those fringe practitioners first. Sorry if I ruffle some feathers, but the public sometimes just doesn't "get it". There are a lot of quacks and snake oil salesmen out there, and if I can do some small part to protect the innocent, I'm going to take it.

As far as "having a degree and being retired" goes, I think my career is a bit more than that. For all anyone knows, when they play Dr. Google they may be quoting me from the content that I myself have written. When they need inpatient medical care, they may be receiving treatment under protocols that I have written. So, consider it arrogant if you will, but I feel obligated to utilize my extensive knowledge to benefit others, within certain constraints of law and ethics. And yes, sometimes I get overzealous.

[martyahill]

Originally Posted by hawk1021

My Husband suffers from dizziness constantly someone said something about the Epley Maneuver. Has anyone done this before ? Did it work ? and if so can you recommend a doctor down here in the villages area.

I have done the Epley procedure and it did work but I like the foster procedure more.

[Cybersprings]

Originally Posted by golfing eagles

No offense, and I'm really not looking for a p!$$!ng match, but please point out a statement that is "categorically wrong". Some may be exaggerations to make a point, but overall they are accurate. You cannot hunt for rare exceptions and hold that up as a standard. I think I have been pretty consistent---I acknowledged referring patients to chiropractors and other ancillary services when appropriate, but pretty harshly warn against getting evaluated by those fringe practitioners first. Sorry if I ruffle some feathers, but the public sometimes just doesn't "get it". There are a lot of quacks and snake oil salesmen out there, and if I can do some small part to protect the innocent, I'm going to take it.

As far as "having a degree and being retired" goes, I think my career is a bit more than that. For all anyone knows, when they play Dr. Google they may be quoting me from the content that I myself have written. When they need inpatient medical care, they may be receiving treatment under protocols that I have written. So, consider it arrogant if you will, but I feel obligated to utilize my extensive knowledge to benefit others, within certain constraints of law and ethics. And yes, sometimes I get overzealous.

Three statements categorically wrong:

1. Audiologist---not even close to diagnosing anything other than hearing loss.
2. First of all, the term "good chiropractor" is an oxymoron.
3. I’m pretty sure I have more than just a clue, having spent over 30 years cleaning up their disasters. (referring to chiropractors) How many times in 30 years did you have to clean up disasters from chiropractors? What percentage of your time would you estimate?

[golfing eagles]

Originally Posted by Cybersprings

Three statements categorically wrong:

1. Audiologist---not even close to diagnosing anything other than hearing loss.
2. First of all, the term "good chiropractor" is an oxymoron.
3. I’m pretty sure I have more than just a clue, having spent over 30 years cleaning up their disasters. (referring to chiropractors) How many times in 30 years did you have to clean up disasters from chiropractors? What percentage of your time would you estimate?

OK

1) I'll amend the statement to 99% cannot diagnose anything other than hearing loss. One of the first steps in assessing vertigo is an MRI. An audiologist is not even permitted to order an MRI (unless the rules have changed in the last 8 years), so how can they even begin to diagnose anything?

2) Withdrawn. It was a hyperbole intended to draw attention to the mistake of starting the assessment of a problem with a chiropractor rather than a qualified doctor. Apologies, especially to 2 good friends of mine that are chiropractors

3) I stand by that assertion. How many disasters, how many dead patients does it take to qualify as not being "categorically wrong"???? I don't measure unnecessary deaths in "percentage of time"

[Cybersprings]

Originally Posted by golfing eagles

No offense, and I'm really not looking for a p!$$!ng match, but please point out a statement that is "categorically wrong". Some may be exaggerations to make a point, but overall they are accurate. You cannot hunt for rare exceptions and hold that up as a standard. I think I have been pretty consistent---I acknowledged referring patients to chiropractors and other ancillary services when appropriate, but pretty harshly warn against getting evaluated by those fringe practitioners first. Sorry if I ruffle some feathers, but the public sometimes just doesn't "get it". There are a lot of quacks and snake oil salesmen out there, and if I can do some small part to protect the innocent, I'm going to take it.

As far as "having a degree and being retired" goes, I think my career is a bit more than that. For all anyone knows, when they play Dr. Google they may be quoting me from the content that I myself have written. When they need inpatient medical care, they may be receiving treatment under protocols that I have written. So, consider it arrogant if you will, but I feel obligated to utilize my extensive knowledge to benefit others, within certain constraints of law and ethics. And yes, sometimes I get overzealous.

My apologizies (very seriously) for minimizing your career and your benefits to medicine. If not thing else, maybe this thread gave you an opportunity to share a small glimpse of your accomplishments that we should be appreciative of. Too be honest, I still don't know specifics, but thank you for your contributions to the medical community and our benefit.

You say, "You cannot hunt for rare exceptions and hold that up as a standard." I believe that is EXACTLY what you are doing regarding chiropractors. Is only one of us held to that standard?


And I did not hunt for a rare exception. I googled what an audiologist did, I saw the Mayo clinic as the first result and assumed that would be a reputable source (but what doctors can you really trust???) and posted the result which contradicted your emphatic statement. I didn't try to match my medical knowledge and experience with yours, I used the medical knowledge and experience of what most people think is a reputable institution.

[golfing eagles]

Originally Posted by Cybersprings

My apologizies (very seriously) for minimizing your career and your benefits to medicine. If not thing else, maybe this thread gave you an opportunity to share a small glimpse of your accomplishments that we should be appreciative of. Too be honest, I still don't know specifics, but thank you for your contributions to the medical community and our benefit.

You say, "You cannot hunt for rare exceptions and hold that up as a standard." I believe that is EXACTLY what you are doing regarding chiropractors. Is only one of us held to that standard?


And I did not hunt for a rare exception. I googled what an audiologist did, I saw the Mayo clinic as the first result and assumed that would be a reputable source (but what doctors can you really trust???) and posted the result which contradicted your emphatic statement. I didn't try to match my medical knowledge and experience with yours, I used the medical knowledge and experience of what most people think is a reputable institution.

Looks like responses "crossed in the mail" again. Mayo Clinic is a great place, but their structure, protocols and procedures are not the mainstream. They may have glorified audiologists with more capabilities than Podunk, Iowa. But I assure you they would be few and far between. Additionally, how many audiologists do you think even want to take on the responsibility of managing a new, undiagnosed vertiginous patient?

An example---Sloan Kettering is a great oncology institution, but everyone there is on an "experimental" protocol (I did a month rotation there). Unfortunately they almost killed the 23 year old daughter of my mother's friend years ago. Why? She had stage 3B Hodgkin's lymphoma, which had at the time a 96% CURE rate with traditional chemo regimen and mantle + extended Y external beam radiation. Instead they put her on some weird protocol that was ineffective. Fortunately she responded to salvage therapy but had an unnecessarily rough time of it.

[Cybersprings]

Originally Posted by golfing eagles

OK

1) I'll amend the statement to 99% cannot diagnose anything other than hearing loss. One of the first steps in assessing vertigo is an MRI. An audiologist is not even permitted to order an MRI (unless the rules have changed in the last 8 years), so how can they even begin to diagnose anything?

2) Withdrawn. It was a hyperbole intended to draw attention to the mistake of starting the assessment of a problem with a chiropractor rather than a qualified doctor. Apologies, especially to 2 good friends of mine that are chiropractors

3) I stand by that assertion. How many disasters, how many dead patients does it take to qualify as not being "categorically wrong"???? I don't measure unnecessary deaths in "percentage of time"

1. You are an esteemed doctor. You then make the statement that 99% of audiologists cannot diagnose anything other than hearing loss. You or your proctologist got that statistic from the same place. But people listen to you. And that is why I keep pushing back. Can you please provide any source for that data. If you say your extensive experience, that cannot cover even 1 tenth of 1% of the audiologists/audiology departments.
3. Your assertion was that you"spent your career cleaning up after chiropractors. Either that statement is completely false, or your assertion that much of what we find on google or the procedures we go through at the doctors office were developed by you is completely false. No one disagrees that their are unnecessary deaths( I don't think) and that one is too many. But that was not the assertion. You spent your career cleaning up after chiropractors. I would be a HUGE sum of money that you cleaned up after more medical malpractice in your 30 years than you did cleaning up after chiropractors(maybe none that were as serious as the one case with your nurse). I completely get hyperbole. But, you put it out there in the exact same way you put out there all the steps you should go through for the diagnosis of the cause of vertigo or your 99% statistic above. Was that intended as fact or hyperbole? If it was hyperbole, are you actually using hyperbole to prove a point?

I hope 100% of the people can wade through what you write and get to what you really mean, because I am sure your heart is in the right place. If I went to a doctor and got an xray/MRI and diagnosis, every time I threw my back out, I would be a very poor man, and I would be in pain/incapacitated for much longer than I need to be.
If someone posts that they are looking for a good chiropractor because they are new to the villages, a public service post to make sure a chiropractor is what you need and strongly consider getting a medical opinion first because this is what happened to a nurse patient of mine would be great. You get to help prevent the same thing from re-occurring but you haven't made statements which could preclude people from getting the help that they need. And if you say that no one needs a chiropractor, I will add that to my list of categorically wrong statements.

[Cybersprings]

Originally Posted by golfing eagles

Looks like responses "crossed in the mail" again. Mayo Clinic is a great place, but their structure, protocols and procedures are not the mainstream. They may have glorified audiologists with more capabilities than Podunk, Iowa. But I assure you they would be few and far between. Additionally, how many audiologists do you think even want to take on the responsibility of managing a new, undiagnosed vertiginous patient?

I didn't post this as refutation to your point about how many can do it, because it is from Audiology associations and organizations. This is to respond to your point that they wouldn't want to. It looks like, from the top resonses on google, that many will welcome you. several sites state that they may/will refer you to a specialist if they are unable to diagnose or see something beyond their capability (paraphrased).

Again, let's look at the big picture. You are more right than me on this obviously with your very clear steps outlined in one of your posts. I stated earlier a way that you could push the person to the correct medical professional without incorrect statements or denigrating.

You keep trying to keep people healthy and I will continue to push back when you make blanket statements that are unnecessary. People will stay healthy (because of you) and maybe every now and then you will think about what you post and the weight it carries. Win win



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[ton80]

To Golfing Eagles and CyberSpring, I offer a hopefully useful summary on audiologists and Balance Issues.

Based on a Google search of various topics, my observation (Non Doctor) follows:

1. Golfing Eagles Post #3 regarding the sequence of diagnosis steps basically matches what Mayo and others recommend.

2. Audiologists are not medical physicians and therefore do not provide medical-based treatment such as surgery or medication. They can help with doing the tests prescribed by a physician.

3. Audiologists and other rehabilitation professionals can help improve your balance and reduce dizziness and bothersome symptoms. Vestibular rehabilitation may include exercises with specific movements of the head, eyes, and/or body. Certain types of dizziness may be treated with repositioning procedures. (Epley maneuver?)

In summary, Audiologists have a role but are not the primary place to start. They can help with the testing and non medical treatment.

[golfing eagles]

Originally Posted by Cybersprings

I didn't post this as refutation to your point about how many can do it, because it is from Audiology associations and organizations. This is to respond to your point that they wouldn't want to. It looks like, from the top resonses on google, that many will welcome you. several sites state that they may/will refer you to a specialist if they are unable to diagnose or see something beyond their capability (paraphrased).

Again, let's look at the big picture. You are more right than me on this obviously with your very clear steps outlined in one of your posts. I stated earlier a way that you could push the person to the correct medical professional without incorrect statements or denigrating.

You keep trying to keep people healthy and I will continue to push back when you make blanket statements that are unnecessary. People will stay healthy (because of you) and maybe every now and then you will think about what you post and the weight it carries. Win win



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I had already checked out those sites as well. The profession is probably evolving, but my gestalt is still that very few community practicing audiologists would want to take this on.

Now here's an interesting idea: There are other physicians on this site, so I ask them to answer the following if they would.
1) How many times have you referred a vertiginous patient to an audiologist?
2) How many time would you recommend a patient with hip pain see a chiropractor first?

I think the answers will be telling

[Cybersprings]

Originally Posted by ton80

To Golfing Eagles and CyberSpring, I offer a hopefully useful summary on audiologists and Balance Issues.

Based on a Google search of various topics, my observation (Non Doctor) follows:

1. Golfing Eagles Post #3 regarding the sequence of diagnosis steps basically matches what Mayo and others recommend.

2. Audiologists are not medical physicians and therefore do not provide medical-based treatment such as surgery or medication. They can help with doing the tests prescribed by a physician.

3. Audiologists and other rehabilitation professionals can help improve your balance and reduce dizziness and bothersome symptoms. Vestibular rehabilitation may include exercises with specific movements of the head, eyes, and/or body. Certain types of dizziness may be treated with repositioning procedures. (Epley maneuver?)

In summary, Audiologists have a role but are not the primary place to start. They can help with the testing and non medical treatment.

ton80, thanks for the post. I did have to chuckle, because I think as you were writing your post backing up Golfing Eagles with Mayo Clinic reference, Golfing Eagles was typing his post saying Mayo is a little out there.

And at the same time, I was writing my post trying to do what you were trying (I think). Your post was much better, but you didn't have any mea culpas to do like I did.

I hope Golfing Eagles (and others) can take from my post that I know he is right in his main point. I have been arguing form over function.

[Cybersprings]

Originally Posted by golfing eagles

I had already checked out those sites as well. The profession is probably evolving, but my gestalt is still that very few community practicing audiologists would want to take this on.

Now here's an interesting idea: There are other physicians on this site, so I ask them to answer the following if they would.
1) How many times have you referred a vertiginous patient to an audiologist?
2) How many time would you recommend a patient with hip pain see a chiropractor first?

I think the answers will be telling

I think you missed my point in the middle just before the list of sites.
The response to your survey could hammer in the point, but I really have already conceded it.

[golfing eagles]

Originally Posted by Cybersprings

I think youh missed my point in the middle just before the list of sites.
The response to your survey could hammer in the point, but I really have already conceded it.

My bad. I’m still recovering from COVID and not 100%