somebody Saturday night, and we’re meeting for lunch. She might be the one, my friend! She is hot.”
Jack waved him off. He’d become convinced Chet was never going to, find “the one.”
Chet loved the chase too much to settle down.
“Hey, Chet,” Jack called to his retreating friend. “Have you ever had a vertebral artery dissection?”
“Yeah, one,” Chet said, returning to lean back into Jack’s office. “It was during my forensic pathology fellowship in L.A. Why?”
“I had one this morning. It stumped me until we opened the skull. There wasn’t much of a history, and there was no apparent trauma.”
“How old?”
“Young. Twenty-seven.”
“Check out if she’d seen a chiropractor in the last three days or so.”
“I think she did,” Jack said, impressed by Chet’s suggestion. “I think she might have seen one last Thursday or Friday. She died last night.”
“It could be significant,” Chet replied. “In my case, the association was easy to make, since the symptoms began moments after the cervical manipulation. But when I looked into the issue in general, I learned the symptoms of VAD can be delayed for days.
“Listen,” Chet added. “I’d love to talk more, but I got to go to meet my new honey.”
“You’re impressing me no end,” Jack said, jumping up and following Chet down the hall. “I vaguely remember reading about a case, but I’d never seen one.”
“I found it interesting,” Chet admitted as he walked, “and I thought I could get some kudos out of it from my chief, so I researched VAD and chiropractic a bit. I found it to be one of those associations which hasn’t sparked much interest, nor did it then for me.
It turned out my chief went to the same chiropractor and swore by him, so my hand was forced to sign out the case as merely a therapeutic complication.”
“What is it that certain chiropractors do that makes VAD possible? Do you know?”
“I assume it is the force of their ‘adjustment technique,’” Chet explained. “It’s called a high-velocity, low-amplitude cervical thrust. Though it doesn’t happen often, there are apparently times when it can cause an internal tear in the vetebral artery, and the blood pressure does the rest. Sometimes the dissection extends all the way up into the basilar artery.”
“How often is not often?” Jack asked.
“I don’t remember exactly,” Chet admitted. “It was a few years ago. In the L.A. medical examiner files I think I found only four or five cases of VAD associated with chiropractic visits.” Chet stepped into the elevator, holding the door open with his hand.
“Listen, Jack, I gotta go. I’m already late. We can talk more later if you want.” The doors closed, and he was gone.
For a moment Jack continued to stare at the blank elevator door. He was now intrigued, thinking he might have stumbled on the diversion he needed. If it turned out that Keara had gone to a chiropractor for her headache and had had cervical manipulation, there was a chance, he had no idea of how much chance, she’d suffered her vertebral artery damage there.
Turning around suddenly, Jack hastened back toward his office, mulling over the fact that he’d read of a case of VAD caused by cervical manipulation, and that Chet had had one himself as well as having found four or five in the L.A. medical examiner data bank.
On top of that, Jack thought, he may presently have another. What it was all suggesting to him was that paying a visit to a chiropractor under certain circumstances was not necessarily a benign experience.
Although Jack admitted he didn’t know the details of chiropractic therapy, as a form of what was referred to as alternative or complementary medicine, he knew there was a question about its efficacy. He had always vaguely lumped together chiropractic, acupuncture, homeopathy, Ayurvedic tradition, Chinese herbal medicine, Transcendental Meditation, and a hundred others of what he considered
Jack waved him off. He’d become convinced Chet was never going to, find “the one.”
Chet loved the chase too much to settle down.
“Hey, Chet,” Jack called to his retreating friend. “Have you ever had a vertebral artery dissection?”
“Yeah, one,” Chet said, returning to lean back into Jack’s office. “It was during my forensic pathology fellowship in L.A. Why?”
“I had one this morning. It stumped me until we opened the skull. There wasn’t much of a history, and there was no apparent trauma.”
“How old?”
“Young. Twenty-seven.”
“Check out if she’d seen a chiropractor in the last three days or so.”
“I think she did,” Jack said, impressed by Chet’s suggestion. “I think she might have seen one last Thursday or Friday. She died last night.”
“It could be significant,” Chet replied. “In my case, the association was easy to make, since the symptoms began moments after the cervical manipulation. But when I looked into the issue in general, I learned the symptoms of VAD can be delayed for days.
“Listen,” Chet added. “I’d love to talk more, but I got to go to meet my new honey.”
“You’re impressing me no end,” Jack said, jumping up and following Chet down the hall. “I vaguely remember reading about a case, but I’d never seen one.”
“I found it interesting,” Chet admitted as he walked, “and I thought I could get some kudos out of it from my chief, so I researched VAD and chiropractic a bit. I found it to be one of those associations which hasn’t sparked much interest, nor did it then for me.
It turned out my chief went to the same chiropractor and swore by him, so my hand was forced to sign out the case as merely a therapeutic complication.”
“What is it that certain chiropractors do that makes VAD possible? Do you know?”
“I assume it is the force of their ‘adjustment technique,’” Chet explained. “It’s called a high-velocity, low-amplitude cervical thrust. Though it doesn’t happen often, there are apparently times when it can cause an internal tear in the vetebral artery, and the blood pressure does the rest. Sometimes the dissection extends all the way up into the basilar artery.”
“How often is not often?” Jack asked.
“I don’t remember exactly,” Chet admitted. “It was a few years ago. In the L.A. medical examiner files I think I found only four or five cases of VAD associated with chiropractic visits.” Chet stepped into the elevator, holding the door open with his hand.
“Listen, Jack, I gotta go. I’m already late. We can talk more later if you want.” The doors closed, and he was gone.
For a moment Jack continued to stare at the blank elevator door. He was now intrigued, thinking he might have stumbled on the diversion he needed. If it turned out that Keara had gone to a chiropractor for her headache and had had cervical manipulation, there was a chance, he had no idea of how much chance, she’d suffered her vertebral artery damage there.
Turning around suddenly, Jack hastened back toward his office, mulling over the fact that he’d read of a case of VAD caused by cervical manipulation, and that Chet had had one himself as well as having found four or five in the L.A. medical examiner data bank.
On top of that, Jack thought, he may presently have another. What it was all suggesting to him was that paying a visit to a chiropractor under certain circumstances was not necessarily a benign experience.
Although Jack admitted he didn’t know the details of chiropractic therapy, as a form of what was referred to as alternative or complementary medicine, he knew there was a question about its efficacy. He had always vaguely lumped together chiropractic, acupuncture, homeopathy, Ayurvedic tradition, Chinese herbal medicine, Transcendental Meditation, and a hundred others of what he considered
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