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Michael Voss

    Hi Katy,

    Thank you for the additional detail.

    So, Dec 3 2021 was the original injury per his report. The visit to the Liddy Healthworks on 12/6/21 just three days later: “I found mild redness. Palpation revealed mild to moderate swelling, warmth and the feeling of ropy tissue that was variant from the typical rectus abdominis.” The note does not specify specifically where on the abdomen these exam findings were located. What I find most interesting is there was no bruising documented. The studies he has had leave little doubt that there has been an injury at some point in the past. If he did sustain an injury during that massage that tore rectus muscle from it’s attachments, it seems there should be some bruising by 3 days, but it isn’t documented. Also does he have pictures of his abdomen that are date and time-stamped on his phone for example? Just curious. I do think he has had the correct imaging, first and MRI then followed up with the ultrasound. That appears to be appropriate in the evaluation of the abdominal muscular defect.

    Regarding possible MALS:
    3/20/2023- Bariatric-Referred by GI
    ****Suspicious for MALS*****
    Additional studies recommended to rule in or out MALS:
    EGD with Dr Shamsi
    4-hour Gastric Emptying Scan
    Here is a very clear workup/treatment plan for possible MALS. It would be good to discuss with him the importance of following up with the bariatric surgeon and his/her recommendations. If he is focussed on what is occurring to the prior left rectus muscle injury, this may be why he has declined proceeding with the further workup.

    You made an interesting statement “I have to advocate for what the client wants but, at the same time I am being honest and realistic with educating him on his goals and outcomes.” My background is as a Family Physician. Prior to retiring, I found that medicine was becoming more and more business like where patients were being viewed more like “clients or customers”, at least this was my experience here in the United States. The phrase “the customer is always right” was becoming something to be dealt with in medicine…but the customer (and hence the patient) is not always right. In those cases I had to educate him or her and provide the best options based on the diagnosis. In the end, they had to decide whether or not to take my recommendations on their treatment.

    Now, I could be wrong (and if there are more seasoned advocates out there reading this, please feel free to correct me), but I don’t think that advocating for the client always means we have to push for everything they say they want, especially if we find through our research that their thinking is flawed, may lead to harm or lead to a large financial loss, for example. Now, we do listen. We always listen. That is probably a very large factor in why clients hire advocates is to know they have been heard (it is certainly a reason that patients change physicians), but we also want the best outcome for the client/patient which means educating him or her the best we can… which is what you said in the second part of your statement. Ultimately, though, they are the ones to make the decision for their care, we are coming along side them. That kind of honesty and communication with the client I think is important.

    Lastly, listening to his story, whether or not he actually received the injury to the abdominal musculature during that massage in December 2021, there seems to be a great deal of fear surrounding what happened there. And sometimes with fear comes pain. Is it possible he received an injury there at some point previous to December 21 which was the reason he specifically told the massage therapist not to massage that area. That could be something to consider delving into.


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