Q: Hello Dr. Joel, I have a patient who was brought in threw a spinal screening at the mall, we are offering a free exam and consultation in the office, based on the patients history she has been diagnosed with von hippel-lindau syndrome (she spelled it for me and everything), this caught me off guard since i have never heard of it. She has also had multiple tumors (hemangiomas) in her eyes (were removed threw surgery), kidney, spine was never really checked. She gets headaches and mid thoracic and low back pain. Upon examination and threw her husband she often gets dizzy spells. She is only 28 years old a nurse on disability. What is your opinion of this patient chiropractically? she has never been to a chiropractor before. She is also taking Diamox, i think she stated she has some sort of excess csf in her spine. I cannot leave out the fact that she is also on paxil. a pretty scary patient to have come in, what is your opinion? i realize xrays will play a major role which those are scheduled for next week. Let me know what you think. A: Thanks for the e-mail. Remember this is only my opinion so take it for what it is worth. As much as our philosophy often states that the body can heal itself and some seminars spell the chiropractic gospel that just adjust and all else will follow .. there are times when limitations of matter and time prevents us from giving our patients what they are hoping for .. full healing. Nonetheless .. we do offer hope and with time and conservative techniques we often do much more than the patient has experinced in the past. That being said .. this patient has multiple medical problems and is on multiple medications. She did not come to you via a referral or searching through the yellow pages .. she saw you in the mall and took the time with the interest to seek another opinion. My approach is always conservative both in techique and discussion and it dictates if I accept a patient or not. I would let her know that chiropractic offers no drugs just an attempt to allow the body to reduce nerve interference and increase stability. She has multiple issues .. she takes multiple drugs .. she may have multiple doctors therefore conservative assistance with chiropractic may help but it may take time and commitment on her part. If she understands this and you feel comfortable adjusting her conservatively (that is why I use the Activator on all new patients) .. then it is worth both your efforts to see if she can get some relief and possibly the healing her body needs. I would make it very clear what chiropractic is and isn't in her case .. that she should consider it for the long haul .. that there is time and fees she must consider and possibly other "natural" areas she may wish to explore. If you have to work out a deal to get her as a patient .. I would walk away .. the only coercing that needs to be done is her level of commitment to assist you in doing it your way .. the fees you can work out .. her commitment level and agreement that this is what she needs without you selling and badgering the issues to get another patient is very important. Those you wish to help so much and have the greatest need are those that will sue your pants off .. especially if they were not in total agreement with what you have to offer. Remember .. she wouldn't have take the time to speak with you if there wasn't this lone pilgrim with a candle searching for an answer .. she needs your care .. BUT .. she really must understand the commitment level and then WANT it. If you can get it .. have that gut feeling that you can help .. feel that you will not aggravate her condition further .. than take her on .. be conservative and let them know that there are baby steps involved. Then just sit back and watch her get well Have a Great Day Dr. M