What To Do When You Set Off Cauda Equina

So as promised from last week, here's how I caused cauda equina in a patient and avoided getting sued. This is something that happened to me a while ago, true story of a patient of mine where they came in, I adjusted them, it triggered cauda equina next day and then they had a double laminectomy. And this is the nightmare situation, as we all know as chiropractors, that something awful like that is going to happen afterwards could have gone very badly. I could have ended up in court, I could have had medical negligence solicitors coming after me, I could have ended up in front of the GCC defending my license. Could have been the worst scenario you could picture as a chiropractor. Fortunately it didn't and it had a happy ending. And I'll tell you why, and I'll tell you what I think I was able to do to help do that. And it's all about getting out of that fear based practice that we were talking about last week and into more of a patient centered focus where it is about them. And that actually made a huge difference for the outcome for me personally. So this was a patient who I'd seen a couple of years ago before. They'd come in for a few visits and you know, it was fairly dysky looking, low back pain, no leg stuff, dropped off, then came back in again going, yeah, it was better for a bit, then it came back and I know you said I probably should have come back for a checkup, I just, I kept forgetting, but it's flaring up. So here I am and I treat her a few times, fairly standard stuff from adjusting a low back. And I remember after the fifth visit reflecting back at the end of the day going, you know what, like every time I adjust them it flares up badly for a day or two and that's fine for the first session or two. But I'm like, that was the fourth visit last time and it was still happening. Maybe I've missed something. Like maybe there's an inflammatory arthritis, maybe there's some kind of axial arthropathy, something rheumatic. I was like, it sounds a bit inflamy and I've missed some cases like that before. So I thought, you know what, next time they're in, I'm going to run them through the spade questionnaire, I'm going to screen for inflammation and see if I've missed something there because I've missed a couple of patients similar to that before who turned out to have something like ra. And so I'M thinking this and this is the Friday treat them and then the Monday when I'm expectancy that week, friend comes in who they referred in, said, oh, did you hear about so and so they had spinal surgery on the weekend. No, like I didn't hear about that at all. That sounds terrible. She's like, yeah, some kind of emergency or something, I don't know. Then right after that, front desk lets me know, by the way, I've had an email from this patient. They're not coming in, they had surgery and the email just said there's two lines. That's what I remember, two lines just said, by the way, not gonna be coming in for a bit. I woke up doubly incontinent and paralyzed after my last session. Turns out it was called a quina. And I've had a double laminectomy. So I'll keep you updated. You know, panic stations. I freak out, my stomach just drops, the blood drains from my face. I'm freaking out, thinking, oh God, this is the worst case scenario. Oh my God, I'm gonna lose my license, my life's over, this is just awful. And I said, I've got to call the patient. Like I've got to check the notes. So go through all the notes quickly, make myself late for the next patient. Go through the nights. Yeah, no, I check reflexes and myotomes and dermatomes and I ask about bowel and bladder and there was no leg symptom. Like, I did everything right. I didn't get anything wrong. And then just for that, now I'm late for my next patient. Fortunately, because I then had a whole run of patients, I did not have time to call this patient to defend and explain myself and tell her why she shouldn't sue me. And that's really good because by the time I had space after these next few patients who unfortunately didn't get my full focus, although somewhat understandably, by the time I was ready to call a patient, I'd been able to calm down and think it through a bit more. And I went, no, I'm not going to call her in fear. I'm not going to call her to justify, defend and explain my panic reaction and put my fear based reaction on her and make it about me. This sounds like a horrible experience. This sounds really frightening. I'm gonna call her to find out how she is and make sure she's okay because that's probably, that's what I would want in this situation. So I call her and I find out that Yep. After the treatment, she woke up doubly incontinent the next day and paralyzed and was rushed in for emergency surgery. And when she. Well, actually, no, she wasn't rushed in for emergency surgery. Rushed into A and E, the triaging nurse, despite the fact that I checked this and she said, yep, I told them that I was doubly incontinent. I told them I couldn't feel my legs in the patient's perception. I don't know what the nurse said, but all I know from my patients said, she just said, you're wasting our time. This is just science. We wouldn't send you home with painkillers. This is a waste of our time. No, no. Bad move. But anyway, fortunately, the wards were full, so she's in a hospital bed in the corridor. Feels like she really needs to go to the loop. Can't go. Grabs a doctor says, help. I can't move, but I feel like I really need the loo. Doctor picks up what's going on, goes, wait, have you had an mri? No. Okay, let's get you an mri. Sends for the mri. Massive disc herniation. Like blown out all across the chora equina. Like, full blown. Emergency surgery, double laminectomy. She comes back round, the surgeon says, you're going to be all right. Thank God we caught it. If it had been another hour, you'd have been paralyzed and incontinent for the rest of your life. Like, scary stuff the next day. This is all happening on the weekend. And then I'm talking to patient Monday and they're like, my back hurts because I've had surgery, but my legs are much better. Like, I can walk now and I've got bowel and bladder control. I then checked in on her again a week later and she said, other than some residual numbness on my thigh, I'm actually feeling fine, fully recovered. Happy ending for her. Fortunately, I didn't go in and defend myself because then she says, and you know, I looked like I googled it. And it turns out this gets missed all the time. Like loads of people misses They've got a big problem with it because all the paid ads are for medical negligence solicitors. So I'm going to be inquiring into them. Stomach drops again because that nurse nearly left me paralyzed. Completely missed it. And I told them that I had no bowel or bladder control. I told my doubly incontinent. So I'm going to talk to them about that nurse because I was nearly had my life ruined there so I'm like, okay, that's a little bit better. The problem is these solicitors often say, go after everybody in the chain. And then right at the end she goes, and you know, I spoke to the surgeon and the surgeon said, yeah, you know, it was probably that adjustment that did it. But that was probably the final straw. If this was ready to go, if it wasn't going to go, then it was going to go you bending down in the shower next week or something like that. So it was just a ticking time bomb. I think it was just a bad coincidence. It was right after I saw you. So just mentally like, okay, thank God surgeon was sensible and didn't try and blame the chiropractor and didn't have an anti chirop thing. But I can tell you that if I'd got into that conversation a different energy, panicked, justifying, defending the best case scenario, she would have felt, oh, Chris just wanted to make sure I wasn't going to sue him. The worst case scenario would have gone, should I sue him? Like, Chris seems awfully worried about something and the solicitors are only going to encourage that kind of thinking there. So it could have very easily gone the other way. So the lesson from this is, yes, it's about communication. Obviously Chris is going to say that, but really what I want you to take from this is when you have a situation like this and you will at some point in your career, hopefully not this terrifying, but you'll have situations where patients have a reaction treatment and they're upset and you need to talk to them and you need to call them and find out what's going on, switch your energy. If it takes you an hour or two to do it, that's fine. Like this wasn't an emergency situation where I had to talk to her there and then switch the energy. So take the focus off you and take it away from fear and panic and put it on the patient and try to get curious because you cannot be curious and panicked like they're opposing energies in that respect. So if you can think, no, I'm going to find out what's going on this patient and get curious as to how they are, find out how they are, then you won't be making it about yourself. And that can be the difference between this being a nightmare situation and actually a conversation that I look back on very fondly. I think of that as a lovely conversation. It's a really happy memory because I found out they were doing okay. She really appreciated me. Thank you so much for calling like that's really nice of you to check in. I'm really glad that you took the time to do that and everything worked out okay. Might not so think about that if you ever have this situation, you know, like we're talking about last week, fear based practice. If you come at everything driven from fear, it will actually make things worse. Worse it will actually can create some of the situations you look for. You know what it's like if you've got somebody who's a bit paranoid, they spot signs and things that maybe aren't there. You can do that too if you're practicing that fear based paradigm. So get curious, think curiosity. That will really, really help this. Hopefully this never happens to you, but if it ever does, don't worry so much. Like it can be okay. I had the worst case scenario for a chiropractor happen to me. I'm alright, everything was fine, patient's fine, I'm okay. And if it happens again, I'll know. Oh, this happened before. I don't need to panic so much. So let that be the lesson that these things can happen. Doesn't have to be an absolute disaster, but really key. Just try. Anytime you've got a situation, patients freaked out or unhappy or worried, get curious because it will take the focus off you and it will make you genuinely patient centered. Not just using it as a buzzword because that's a trendy thing to say when you're evidence based. So have a think about that as always. Any questions, let me know in the comments below. Otherwise I'll see you soon for another video. Take care.