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HomeMy WebLinkAbout96-06742 ~ -c) , ~ ~ "~ ... ~ 1l. , .. ~ - . . .:) - CJ ~ " ,Ii , " . 7. At the atorem.ntion.d time and plac., D.t.ndant Joan S. Gallhar oau..d or .llow.d her v.hicl. to collide with the r.ar portion ot the vehicle occupi.d by plaintitt vicki L. Fox. 8. Imm.diately th.r.att.r, Defendant Joan S. Gamb.r aqain cau..d or allow.d h.r vehicle to collid. with the rear portion ot the v.hicl. ocoupi.d by Plaintitf Vicki L. Fox. 9. Th. action. ot the Detendant were neqliqent in that sh.: (a) Failed to keep her vehicle under control; (b) Fail.d to keep an adequate watch on the roadway and traftic ahead; (c) Failed to .top at a red liqht; (d) Failed to .top in time to avoid a colli.ion with Plaintitt'. vehicle; and (e) Pailed to control her vehicle followinq the initial impact to avoid a .econd collision. 10. As a direct result ot Defendant's n.qliqence, Plaintitt Vicki L. Fox .ustained serious injuries to her upper body, includinq, but not limited to, straine and sprains of her neck and .houlder mu.culature. 11. As a turther result ot the neqliqence of the Detendant, Plaintitt Vicki L. Fox has .ustained, and in the future may continu. to Bustain, the followinq damaqe.: (a) Pain and sutt.rinq; (b) Lo.s ot lif.'s pleasures; (c) Loss of .arninqs Bnd earninq capacity; and (d) Liability tor paym.nt ot m.dical .xp.n.... - 2 - ?f OI:l '>- It: I. ',. 1,-' (~ ,.\ ~8 t.)n; :It': r ):t "-. :l~ p .. - ~".. (" li1i .. a ?- ,I, -") ~.~! -, l"i ,.. :3 O"l ~ OFFICE OF PROTHONOTARY COURTHOUSE C,.._f,:t(.) Ann"r'Rnn, F~~. Carlisle PA March 4, , - 19 98 -, ---.. __~l~rl;!Lfront St. Harrisburg, PA 17011 1';1 ;nn Fpp fnr Arbitration $15 00 ..---.--.---. - Tr 1>0' \/; ~ld L, Fox et al -. vs. - - Joan S. Gamber .--- 96-6742 Civil Term ----- ,-- ---- ----- ----_.~----_.- -- ----. - - .----.- -,- .-..-. -_.~-----_.- -, .... - ...-...-- -..- I- .---,.. ----. "- --r"--' .-----..- ----- --,.- ADOW 0(1" ---,------. ---- ~.- -, 515 00 .. r--=-=.. '-'-- r--- -, -----_._~._---- ----.--- r- -- -----. -.--. '-- r'-- u._._..._ ,---- ---. -"---'~'" .-..-.. r--- ---.-.- --.--- ---- -------- _.n. -,-, .--- '..--.- --- -~- -..- .. I .'---... -- .--- .----.-- --. ----------.---.----- .-.. ----.-- ,.. ---- - - ..-- -- -- ..-' --"- .-.---. ---- -,.. ------- --.--.- ---- .. 1---- .... - "-- ..--- .-.-.- -.-. -----.-...-..- -- --'- - --"- - _._--- ---. .'.---...- n__ -..-....---. -.-.-.------.-..-. u__ --.---- -.. ,-, -- MAKE CHECK PAYABLE TO PROTHONOTARY, COMMON PLEAS COURT TO The County of Cumberland 1 , " 6 Hoffer VICKI L. FOX and MICHAEL FOX. her husband. PIa inti f f IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA V, JOAN S, GAMBER. Defendant CIVIL ACTION - LAW 96-6742 CIVIL TERM IN TRESPASS (M, V,) lH.uRL.___ERE.IRLAl CON ffRENCE A pretrial conference was held before the Honorable George E. Hoffer. President Judge. on Wednesday. February 25. 1998, In this auto accident case. C, Lee Anderson. Esquire. represents the plaintiff. and Donald R, Dorer. Esquire. represents the defendant. Defendant admits liability in this rear-end collision and it appears the case for damages can be tried in a day to a day and a half, Each party has examined the witness list and exhibit list of the other party and no one is raising objections to the other's presentations, Plaintiff incurred approximately $7500 in medical expenses; she alleges that approximately four thousand of those expenses have not been paid by the insurance carrier, These expenses largely relate to after care by way of massages. et cetera, Defendont submits that she has not properly forwarded these bills to her husband's own health insurance carrier which defendant claims should pay these bills, In any event. counsel suggest to the Court that they will be resolve this matter with, A stipulation or otherwlse. riot involving the Court, and we M N N I '8 QI ~ ~ I .~ ~~ I ! I &4)oC4)~ I e III ~en~~ I .a 1Il'~ .,,.. 1 :l (&l &...en~ I .S I 'tl~ .1 .1Il~ ... 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" n (, ~ ... ~.... ~,; '; r.,-.:f_ 1,.\.. .' .:i 11.'+ 9(. .~ '7.' ,','J [" .) ::~ -q ~ N (,"I 'lliQ -i.: ~> ::1 ,j'U.. r ~-, ....; " .', .", ,.... ~~) <..; a' u ... ~...._. "- 97.066 LAW OFFICES OF RUBINATE, JACOBS & SABA 214 Senate Avenue, Suite 503 Camp Hili, PA 17011 Telephone Number: (717) 731-0988 Attorneys for Defendant, Joan S. Gamber VICKI L. FOX AND MICHAEL Fox, HER HUSBAND, PLAINTIFFS IN THE COURT OF COMMON PLEAS CUMBERI,AND COUNTY, PENNSYLVANIA No. 96-6742 CIVIL TERM VS. JOAN S. GAMBER, DEFENDANT CIVIL ACTION - LAW JURY TRIAL DEMANDED CERTIFICATE OF SERVICE Donald R. Dorer, Esquire hereby certifies that he is the attorney for Defendant herein, and that he caused a true and correct copy of the attached Pr.leCipe for Listin2 Case for Trial to be served by regular first class mail upon: C. Lee Anderson, Esquire Smigel, Anderson & Sacks 2917 North Front Street Harrisburg, PA 17110-1223 Date: December 9. 1997 (jft; ~ ." _,. R. "",..'W- Attorney for Defendant, Joan Gamber ~ ,... (.;; "'" ...'?': .. ~"l,'1~ ~n - f' - '. L . - , -~ " .1.:,,~, ~#' ~ ..,):.:i Cl;) <i';j (~ I J0 I,J' - :..j(O 'I,' ;, '.'} <.I. ~-- -', l5 ~ :i en (J HOLISTIC TH[----APY 717 761-3652 Judy Downey, L.P.T. 103 April Drive. Camp WII, I'A 17011 DATE --L~~V.b-- -- -~!L:;J...._--A'<fI,{).tL..j..Y41:f:: _ .-4/),-,- ._Lb". .t1. Ld" (L. v:' ,..:.' ,.(. --.--- CjJ ~ Lf'd~.y,~ _'=-~.I..-.;,:i"~_d!u ut.<t/-.....,u . /1.(-"'.'\ t,.,.J"ud. '.----.- TI..~~~~1J.e,,;~~~---AJ&IC./~-u....----/U:.."'- L1..~(_ {" ,'..<l ----Jh.-_~~ lA'1<M..d..,[(D''?:~I.l:}-L..lt.fl__~''.J!.--1 ,)(.\! .. /l((,.{. r /..1.1 . (JI.'l4" /4.bU!.k2L, I l~_u,__..i~'uJll,n~__,.L-L1d.i!.u..."/JA/' .,,, rl,;) ..--....-.a. J. ,H/- J '1 'r I. .c.Z',?}', al}.(. ---">.~---'---: II .v>~_=....L '-'('Rl7~-~' _L....... .'... . .. , ,j) f' ~ h/l.1.L. ,/fJ'A A /l.J..z., ~~J.~L...JJj,.L A.!e.~"_A&~'r...(,. {i<'~ .. '. 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'.J . . q"~, _ 1 . -IF I! f~ _.1~.3.1:...._~ .~n:.t-<"Hl~'/.J ,J2l,--.!::tt1.{f'-"-'Joc-.....L...... d.. . .. ...:.!)~.:H S -)S!JJ..",6J.!.t<&_L_.Lfr..& "__Ii)!). A. At. = ., v.lc".J.d "C. t ... I I, 'J. ' --,--- -.~-..J.1.tL~t!....n_:::..-.--~O<;.(m~,./L~.h)j)J, ;"'6/ ,"" ,(. .- ---r~id!Yl. 6..__I!.('S'':t-,_TL c:~L,(.,_.. '~I>' 'LL L ,,,. t'L_ ~2__9~ ~_..L~~'H3.._li?/~L"1L.J1.1:/<I..,. . ._~~~,q~... t:!t-~:~:.":.,"'''~A'l-:;:--:'-I~;~.u''.d --.. . ~n__~ _ 7' t;- /J,&-,t;J1. "~tJ;,:,;~\L.- . ... ,J ~..~;J \. .. / _+_1"'-_ ,.. ~'>.!-.::----- _ 'v-.-.-L;,..'~Ln--li--.--..-hn..L... n,l --2.~al) '1,:> ~-/ .-IJ):7f!=o-.~,..~~.J.::~n--/0:r.)'/.-'-..~t\,..Q..J.i~!.> "./, 'I, ,--,--- ,.JSr;;llL....!:2.:J!.'#Hr.(~.~?J ... ". ... u..... ___,:-L..:. _N~b -75:--L--,.lLa~~j-!~~-u..A1-t.-.<,&.1J~(..,t' 11., . -:.l'__:.__,:3 'I; ch___J:__~r '-'''-. ce.,.rC' ~ _c~.-:A.JlEt.Jl"IJ..~ 11;' t'r 'wi.. . I' I2Jl I X. u.....L.{-:P1 ,"Jt.~<) iJ-><!J..L~.'.!J.d..'L(.'Ji~A { tr L' I I'ATlFNI'SNAMF 'leU .,:~ PROGRESS FLOW CHART I t /,. I. Reiki · Thl:r3peutic Exercise & Massage · CraniUS,lfr.l1 Thrr,lpy . MYllf,l'II,11 llu.r.lflY HOLISTIC THf"APV 717 761-3652 Judy Downey, L.P.T. 103 April Drive · Camp Hill, PA 17011 DATE~j~j9-C PROGRESS FLOW CHART -------------- ------- -- --- - - - ---. - -------------.-- 06/13/95 Vicki Fox Same as above. _._~---------------------- ---------- ,- -.. 07/06/95 Vicki Fox There has been a gap in treatment time due to difficulties with scheduling. Discomfort persists. Relief is obtained for short periods of time, but work performance duties delay complete resolve of discomforts. 077117~~------------'~ Vicki Fox Patient complains of increased shoulder discomfort. This is probably a referred pain from the cervical area. ROM exercises, CST and myofascial release given. 07728/95 Vicki Fox Report from Dr. Bonnie Bennett says cervical and thoracic strain with upper and mid ligamentous articular strain with soft tissue to intercostal muscles - trapezius and deltoid muscles. Program to continue to relieve above discomforts, Will continue CST, myofascial release techniques, and other modalities as necessary. 08/18/95 Vicki Fox Patient continues to have discomfort in the cervical area and shoulder. I feel her occupation as a court stenographer and having to carry heavy equipment does not allow full healing to take place. __~_'____ 09/14/95 Vicki Fox Patient still having distinct painful area C2 through C5, more on right than left. Strain Counter Strain used with my~fascial release techniques. Therapeutic massage given to palnfu~ sites, Progress slowed due to patients occupation, Patient advlsed to wear soft collar several hours after work each day. -- -1-- -- - - -- - - - - --- -- - -- - - -- - -- - - -- - - - - - - -- -_.~--~~~--" PATIENT'S NAME VI (}6: ~)<;. Reikl · Therapeutic Exercise & Massage. Craniosacral TI1I'rapy · Myofascial Thl'rapy HOLISTIC THF~APY 717 761-3652 Judy Downey, L.P.T. 103 April Drive · Camp Hill, PA 17011 PROGRESS flOW CHART . .DAIE.._.______.__n.....________.___ ._._.___________._________.____........ '. . 9/27/95 Vicki Fo" Patient reporta leA diacomfor~ e"cept at end ranges of motion. ROM only 25 degrees, e"tefllllon and restriction 10 len rotation. Deep therapeutic maaaage used 10 para.cervical muadel, Itrllinlcounler Itrain maneuvcfll used on C2 through C5, Myofascial release given to cervical and thoracic areas, 10/11/95 Vicki Fo" Patienl reporta new equipmenl has been obtained for her job as court slenographer. She will no longer have to cany the heavy machine to side bMS and for decoding. End range painful rcStrictiOflll remain in cervical area. Counter strain, therapeutic rnastage and myofaacial release givm, Patient reporta pain relief poll treatment. 11/8/95 Vicki F 0" Reporta more discomfort in cervical area, Nodules found both sides of cervical area, (C-3-4) and in upper traps, Myofascial release and CST givj@enalSOusedSlrainCOUnlerstrainteChniques, Continues to have discomfort. See next week, . -~-------------~----------------------------------------------------------------..----------------------------.---~ 11/22195 Vicki Fox Reporta righl ann very sore and lender. Entire righl arm tender, fa.,ciallighlness especially around the elbow and forearm 10 the wrist. Spot found in right cervical area also, V cry involved arm. Myofascial release and atrain counler-strain given. See next week. 'P[J ----------------~-----------------------------------------------------------------------------------------------. I _ H~ _~_____. _ ___......... 11/30/95 Vicki Fox Reports having much less pain in the arm. Small area of ra.,ciallighlness found in forearm and wrist. Slrain Counler.Slrain, myofa.,cial relea.,e given. Good relief reported. ~ Al -- -----1- .----..---.---....--...---..........-...--..-....:=:,..::::::::.:-.:::::::.:::::::.::::::::.:.::..:.--.-. . '. ,-. . ~I d~ ,t:~ PATIENT'S NAME Relki · Therapeutic Exercise & Massage · Craniosacral Therapy. Myofasdal Therapy HOLISTIC THF"APY 717 761-3652 Judy Downey, L.P.T. 103 April Drive · Camp Hill, PA 17011 PROGRESS flOW CHART 12/13/95 Vicki Fox Moderatc amount of pain persists with fascial lightness, especially in the foreanll. Strain-Collnter Strain and myofascial given. {' ~., \ \ ,\/J '\ - -~_.. .......,lUIJ"I.....-UO'............. .......~~....- .-~~.~..... ~"I.'" ~......... 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"!."' ,...... ~_....,...... ...._.,_...... -.... 12'20/95 Vicki Fox Tightness in forearm persists as docs small area in cervical area (C 4-5 area), Patient reports ovemU good relief of pain, \: /-.; -'UV!.."l.'tJV".J'L"~~~"---""""."""----:' _ 12/27/95 Vicki Fox Large amount of fascial tightness present in right forearm, Cervical lesion., fell C 2-3-4 areM, Myofaseial release and Strain-CoWlter Strain given with good results, , ---,---~....,...-,------------------_.------------_._--------_._------------------------------------_._-------~~- , 1/17/96 Vicki Fox Patient reports relief post last session, Some fascial tightness remains in right forearm, Cerncal area only slightly involved today, Am seeing patient on a biweekly basis at this time. \~.c __ _....:-:_...."':':..-.::"'::_..___-:_-:_-.:":':"'_-:_-.:':".::-.:-_-.:'_..:_...:':.r.:'::.r.:"-~~~.J"'_.._"U'"_~l'"l'"_.._..!""'!"-.....................................................-.... 1/31/96 Vicki Fox Patient had to cancel duc to seheduling problem, i __________~.rw..............._.._............_..___......................................................__.............._........._.___.________ 2/7/96 Vicki 1'0:< Patient'e arm again had a lot of fascial tightness in the bicipital groove area, oleeranon process and \ the dorsum of thc right forearm. Myofascial release and strain-counter strain techniques given for C-*,\i> tendernellll at C 3, 4, 2/21/96 Vicki Fox . b' Patient reports significant relief post last trcalment. Ncw equipmcnt a! the courthouse IS clOg used so she doesn't have to carry the heavy machine between hcr ontce and the courtr~)Om, I'ro~cr seating to prevent cen;c~ll strain i., still being alrivcd for. Treatment of myofasclal release, icing, and strain-counter strain given.. .of" ,. ,,-:;- HOLISTIC THE"APY 717 761-3652 Judy Downey, L.P.T. 103 April Drive · Camp Ii ill, PA 17011 PROGRESS flOW CHART DATE ._--------------------_.~---~.._------------~-- Vicki Fox 3/20/96 . . Polienl has returned fromll'aveling and l'epOl1K mild inCl'eaKe of poinliol1\ canYUlg sUllcose~. Cervical tightness felt at C 4,5; trealed with Strain-Counter Strain. Myofll.!ldol re(ell.,e and Ice massage to right elbow and forearm, Relief repol1ed. ~~ .._........._._____~.__.______.._________.__________________a_____f~!:--------------------------------------------- 4/18/96 Vicki Fox , Spasms persist in upper ann C 3,4, tend~r on both side~. Left shoulder IDvolvementtoday. Treated with myofascial release and stram counter-strain. ~~-_----...-.-..--m-----..-.-. -_---.-----..----~.------~-------------------_.._.._-----------._---- S/R/96 Vicki Fox . Deep cervical discomfort continues at C 3,4 level, top shoulders and scapul~ areas, Str~m.counter strain and ~Yo~' al release given. Taught exercises ala Hanna-Feldenkrals. Some relief reported post exerCise, ".---------_._----_.-.------_.---- ----------------.. --------------.---.------------ Sn.9196 Vieki Fox Discomfort persists at the C 3,4 level, right elbow and scapular areas. Treatment helps to keep this ~n at I tolerable level. Treated with myofascial release and neuromuscular rc-cducation,~ . - - - ----....._-------.._--.._-_.._--~- ---- -- - ---------..---..- -. . ~/011,,/(~ Vicki Fox ROM in cervieal area now within nonna! range!, except extension and lell rotation, Mild spasms felt in C 3 through , area, right aide, Patient continuea to haw discomfort C 3 through' level with some radiation into the right ann. She has periods of fairly pain free moments, but ~:Jllcerbation of pain occurs with moderate to heavy exercise, I feel she is in a chronic atage of di"ahility whieh in aU probal>ility will continue fin a long lime, and may need some sessions of therapy to aUeviatc: the symptoms, She lias been Iaught a home exercise pW810m that should help, but her activities of daily living keep her symptomalic. l:lm however, disc~rging Vicki atlhis time. MyofasciaJ release and atrain-counter strain teclutiques given tod.lY:~ ___ _~~~.'t~~~~~_lnI2 _;t&:UL.aU.. _______._~_~__M____________._______________~ __ ___.._ __ _ _ M__ .___ PATIf.Nf'S NAME /~K eX. Reiki · Therapeulic Exercise & Massage · Craniosacral Therapy. Myofa,dal Therapy ~ ,....... 111.: VICKI fOX ------- ~ DEFENDANT'S I EXHIBIT ..;L J !l~_SItlHY .\ EXI\M!NI\I!lJl . :r..,....~ I, ICI '2>'1 Mrs. Fox corne~> 1n cOll1plnlnlnq of sporr~ic pnln In lower back rndlntinq dnwn ttw rlqht let). lhls hns b,~"n qolnq on for npproxlmntely six yenrs wltli exacerb'1- t.Inns omJ remissions. 'ih" comes In COfllfllnlnlnq nf pnln In ttlP. nn'a of llie rlqht mlel-IIIAc crest ~ 'j/lll.." 'M",~,,\ with rnr.Jlotlons dnwn the poslerlor Internl aspect of the thlqh, stOflplnq ahov" the knpe. A reelJrrent r>plsndr> beqan nbout two weeks H'10, when she st.retched Hnel felt rf[sahllnq pnln, Immedlatl"ly. 51"",. tlint time s~le has hnd exncerbntlrms nnd II"ml5slons which nre worse when she plnres welqht on the rloht foot, however there are 00 other provocations which she II'1s noted. She has lifted n twelve pound computer very frequent! y And this hn'; !lot CRlIser! any exacerhations. The pain usunlly comes on ns a shot nnd m'1Y nnly Inst for An Instant, or It Inny last for severAl steps. There 15 no pnsltlve Vnlsnlva maneuver. It Is not arfected by ranqe of motion. She hnd ynrln lnst. nlqht which bad her do fl qreat deal of extreme stretchlnq, and shp I1nd no discomfort froln this. Shr? noUced ttlflt In the pnst when her younCl 'orl WflS small nnd she was carrylnq him nrnunclufl to nbout the welqht nf ~\(J or more pounds, she would hAve r>xacerbatlons or rr>misslons concornl.t~a"t tn the deqree of Ilftln(1 she W8S pf!rforminq. There is no evidence of numboess or wO(1kness in the lower extreml- tlcs. There 15 no Sel1Sfltion of coldness in tho leqs. EXm~INATJON: Finrls fl C8L1CflSlfln female who isl8 years old, welqhs 115 pounds, (,1 inches t811, blood flressure 108/78 mm m"rcury right arm sitting. Her pulsp Is 52 be8t.s per mlnut.e, Gross tendon reflexes nf the bleeps, t.rlceps, brflchial radialis, patella and <,!Chilies Are all rated 2,//1 ('qllal bil8t.er811y. Sl.ttlng straiqht lee) raise Is normal. There Is qood extensor hallucl~ 10nqlJS strength bllflterally. Supine st,rfllqht IN] raise flS well 80, r.8nsl"ns maneuver and F8bere Patricks slllo flre all neqAtlve. Posterior fllumbll",' eXAm finds level occipital base Alld s~loulder level, however n ml Idly dedln"d rluht i l.IflC crest line. Ranqes rjf motion of the Illmhnr sfllne are full 80r! cnmfllete with flexion flppconchlnq 110 deqrees. Kemps slqn Is neqatlve bllnt"r,llly. Ine walk and heel walk nre normnl. X-r,ws are t8ken nf th'? low ba,:k ronslst 111>1 nf A lflternl bendlnq study. RMS/qclltrll W.'lqht 1t5 pounds; Hf'l.qht: (,1 lochr>s; m': WR/l8; Pulse: 52 br>ats/mlnute. '.j1jC'l 9 ,~qi We rovl"wed Mrs. Fnx's x..mys with h'?r tod;oy nod discussed her cnse with her. Shr> Is tr'?A~ed torlny with m'lll, 11'1111 (11\(1 RPr.l nnr! F1F'C7. IIflr>rwArrJ, she felt mIlCh Imprnve,!. W" wi II f'(,ncirl,'r the IJ<," of n 11ft wh,," she rdurrI' 10 F'f'nnsylv;ud". PW,/t dl .-.., ~ 1"IlIP ) '- n~. ___'t'-' CK I rl~ JUN 2 'i 1989 Vleld [s feeling much better now. She hall some adl\nq thf' day arter hf"r last treatment, however after that all of her paIn suhslclf'd. Palpation fInds rf'strIction of Ltl In lert rotaUon And In tllr> left SAcroiliac. fhp.re Is also some restriction In cf'rvlcal rnngf' of mnt Inn by motIon palpatIon. Silf' Is treAted with CMf hy McManus traction RlIO r In II drop sections. RMS/tdl ~/U' / jYiJlI. VIcki had some aching for a few days aftf'r lIer last treatment however. after that felt much better. She Is trpAted today with very mild TrT 8nd side posture adjustment for l.PI III nndl.PIN as well as a cervIcal manipulatIon. RMS/Jcs ~ II' 1 '1 I9llY VIcki 11ad a lot of discomfort After she was Sr>f'rl lnst time. IIpparently began after shl! was Jogg Ing the day a Her treatment. Shl! odm! ts to running on a very uneven track. I suqgested she change this to a more eveo surface, She presents - In the lower lumhar rl"lIlons. Shl'! Is treated today with Md~arnls dlstractlon tractlon both liP and Intf>rally,\It, sIgnificant suhluxatlons n f the lumbar sp Ine ami th I s I s followed hy cr>rv lca I manipulation. RMS/gle .JlJl ',! 1 1769 ~!rs. F ox took our adv lef' and ran on a part 0 f tll" t rAck that was even as opposed to the IJneven surface she had heen running on. SInce that time she feels much hetter. She still has minor palpatory spasm and tenderness. This Is lOCAted ht'trle extreme low back In the reqlon of l.s. 'ihe Is treatf'd with CMf as ahove. flMS/.Jcs '.1111 ~ 8 ~9 Vicki hafj no pain in her low b.,ck ncw. She hil" a w'nse of heightenN:1 awareness tn h"r low back and fecls ROl11cwhat IJ'Oro srnsit iv,) to the r<'gion, hCJ\o.>')ver, frank I" in has loft. Sh0 is trrntr<l with RPIN nnd HL!'r, as well as anterior thor.,cic anel c:c'rvicnl rmnipulntion. IlI-IS/rr<'<! IlU(; ~ 196'1 Vidd i,; (('(,II1Jg ~('III'I';lIly w"II. hIlWflV('r, ..;1,.. rllll'" IJ,IVI' ',orn,' paipiHory polin ill lh.. 10\01 kick Ollld III'ck. SIp' Is r rf',lrl'd with Ull. H~I'l/~~I( IG 1 8 1<189 Vlckl lias ff'1t Cjenerally well. Shf' did h:1vl" some ep!sndf's last week of shin splints nn tile right. ExamlnAt,lon finds dropped metatilrsAI heads especially at the second metatarsal. She alsn WAlks arollnd iI lot !n non-shock absorbIng shoes, thprefore, we have sIIqqe..tf'd th:1t since her podiatrist Is How:1rd Slodof, still con- St) I t with h 1m and qet a sd n f metatilrsa I ""ppor t sand sorbnthane In the orthnt Ic which will house thi> othr>r sllpports. 91r> i1le,fI flnly IJSF'S the orthot ,es tn run :1nd WI" SllqqestF'd shF' lIse thpm :1 II thr> t 1mF'. 'III' 1st reated tndilY with eMf for flI'lti and U'l.-s i1S wpll as mltpr!"r thorar'!r' :11101 rf>rvk;ll m,grllp,JI:1tlon. RMS/med .,"""" ~, 1'1111" , !!LL V'lCK.!.lQX.__ rAUG 3 0 \989 Mrs. Fox WflS find until she WflS cflrrying dqlll hundrr?ll pflges of transcript And a twelve pound computer Bnd Iwisted qulckly flml developed left low back pain. It was on Wednesday and she lias had sOllie pflln ev~r since. palpatlon finds fixation of t.lle left. sAcroiliAc Joint Alll! L-II AS being left and posterior. She Is t.reated with nil for this. RMS/cml SEP I '(~ 1909 Vicki consulted with Dr. llotoff who snw Oil t1r!f!d fill' metfltarsAl support. StlE does think she hAS a stress frflcture In IlIe tibiA. lie hAS Advised her t.o do no exerclslnq for three weeks. We Arp qolnq to strflt her out. by having lIf!r walk on a t.rack when she Is able to stnrt eXf!rclslgn agflln And then Ilulld up to dolng mAll walklnq. She hns b,,"n AdvisecJ of the proper mechanics for walking and the proper fr,ot weAr to III III Ie. ~;he Is treat.ed today with McManis dlst.raction trAction and eMf. f1M~,/ldl lSlP <I 'f I~U!::l C " '~EP I. 'I 1~~9 Mrs. Fox hAS A lot of mid back discomfort. Sl1e is treated with CMf for a rIll subluxation and thoracic AS well as cervical and lumbar manipulation. nWj/lrJi 0(; r 2 ~l 1!11l9 Vicki is feeling generally well. She has so",,, ach.lng in her back at various levels, however this Is low grade. She is treAted with CMT. RMS/tdl NOV :' 1'189 L ) "1"1 " ., ,~~~ Mrs. Fox has sOllie achlnq In her neck And I'nck, I s some minimal spasm found In bolh r...glons. distraction tract !on and eMT. TlMS/ Jen II" i'Jlll These are low grade and there She .Is treated with McMAnis Mr!ll, Fo)( ~p~nt thl" wp.l"I-:r'nd In WA'1tltnqtofl wltll tlPf hlJ~bnnd flnrl chlJrlren And <;lppt .1n A vpry '~nft I llncnmfnrtnhlr hf'rt, "ihp rtevr'lopert a '1trAln or the UrpF>r lumbar parA~plnid mU'irulnttJrr. Hdr, I... ,110;0 f':luo;ed tlet to hAV" !;omp. dtCicomfnrt 1n th.. Inwttr lumhnr rl"'qlnno;, 'ih,:, to; tr":ltpfl wLth IPI to th~ upper IIJmhRl' !Iud lowpr thnr::trif' p;'lr;':l~plnnl mIJ''H'IJlntIJrr> nnd HI';o thp. qtJFlfjrAtlJ~ lumhorum tdlAlernlly. rhl... I... folln\'uofl hy r"u tly MrMnnl... rtt'itracllon traction hoth nr And lAterAlly. f~M~/rmt {IAN 2 9 nlllJ C S 'Hl'\ " .M'l , MrR. f'ox Is do!ng gene!'a lly \/1' 1.1. She is treated with CMT. RMS/jen She 11",,\ Bome mi 1<1 aching in her bac~. ,- ~ Page 4 !lli: V],CKl FO.!' MM~ 7 1990 'vlcl<1 has some aching In her neck and hock. lieI' husband currently has pneumonia ond Is confined to hed, therefore she has some additional duties. She Is treated with CMT. RMS/tdl .../V. ;' ~ IJOfJ Vicki was walking down the concrete stairs at the West Shore Farmers' Market when she got her boot heel caught In the lining of her jacket and started to stumble forward. She caught herself and didn't fall, however did jerk herself violently and has aching In the low and mid back as well as the neck ever since. She is treated today with CMT. R~lS I tdl API! 2 3 199fJ" ( '.~.. , 'APIl 2 7 1990 Vicki had experienced transient prer.ordlal pain. She consulted with Dr. Ilogland who stated that It was not a serious condition. Testing today finds significant pain on palpation of the Pflcl~ ,major and minor on the left. Patient is working very hard at a a6I:t,{ track and she Is very right dominate. She has strained the anterior chest wall muscles on the left and this has caused her pain. She is further treated with full spine CMT. RMS/drc NAY 2 1 1990 Mrs. Fox has a lot of aching In her mid thoracic and upper lumbar spine. Palpation finds marked subluxation. She Is treated with CMT fOl' anterior and left posterior T8 and anterior T12. She Is starting yoga and we are giving her Instructions as to what to be care of so as not to cause her any ]rOblems to g~b. the most benefit from this technique. RMS/tdl ,~~ ~ ~ I~~I (l..J Mrs. Fox Is feeling relatively well. with McManis distraction and spinal AUG , 3 1990 She has no areas of spasm. manipulation, RMS Idrc She Is treated Vicki is doing quite well. treated with full splnli! CMT. SIP t 0 1990 There are no significant complaints. RMS/dmb She Is Vicki Is doing generally well. She Is trl!ated with full spine CMT. RMS/drc S[P l!, HttO-.. ~, i"""'- pnue 5 RE: VICKI FOX Mrs. Fox returns from a trip to New York where her father is terminally ill with cancer. She hos a great deal of stress due to this condition. She 15 traveling back ond forth from lIarrlsburg to Long Island where her father resides due to the severity of his Illness. She also has the stress of taking care of her husband and family as well as a full time lob. She went to New York and walked around carrying an overnight bag which wos quite heavy and ended up straining the right quadratus lumborum and then came bacl< and used a Nordic Track machine which had jammed somewhat and strained It even worse. Today she 15 treated with eMT and 15 told to rest. RMS/dmb ') f' nnn. ,,) '-''I OCT Vicki has some upper quadratus lumborulII aching. It 15 only mild. There Is some palpatory tenderness In this region. It 15 due to many hours sitting at a transcription machine. She 15 given stretching exercises for this and is treated with CMT. RMS/drc NOV 1 9 1'~ Vicki is doing generally well. treated with CMT. RMSI tw ULG J '( lq~IO She has some minimal aches. She 15 Vicki's father pasted away last month. She was moving him while he was very III and developed sharp sacroiliac pain. She has had exacerbations and remissions of this pain ever since. She says now that It feels like someone kicked her In her fanny. Palpation finds Immobility of the right sacroiliac. She 15 treated with sacroiliac manipulation and sacrum manipulation. Afterwards she feels much Improved. RMS/drc JAN - 6 1991) Vicki comes in with right temporal pain. Palpation finds an exquisite trigger point at the temporo'sphenoldal line In Its anterior region. She 15 treated with trigger point therapy to this area. She Is also <ldjusted full spine and has some mild right posterior rotation at LS, RMS/tdl .IAN ~ 8 1')'.11 Mrs. Fox is doing a great deal better, She no longer has the pain In the temporosphenoldal line. She 15 Instructed today In the use of trigger point therapy at home for the treatment of trl~Jger points In the temporosphenoldal line. Additionally, she Is treated with full spine CMT. RMS/rmt FEll 2 b )~111 Mrs. Fox is rather tired. lIer son has an attention span deficit and apparently he has been a bit of a challen~Je this month. She Is very tired trying to keep up with all of his activities and all of her activities as a wire and mother of another child as well, She has not hael the time to do the exercises for the temporosphenoldal line, She ha~ some low grade tension in her back and neck. She Is treated with GS and CMT. RMS/rmt --- Page 6 RE: VICKI FOX MAR 2 2 l!l',;\ Mrs. Fox stili has a lot of stress In her lire however she appears t'l he dealing with It milch better. She's cllrr"ntly deciding ',,'llIilther to keep het' children In the lIarrlsburg Academy or send them to the Comp lUll school district. This Is causing a (Jreat den I of discussion betwepn she and her husband, ,They appear to h" resolvlrl~1 the difficulty rother well. She Is treated with full spine GMT. RMSldrh APR 1 7 \99\ Vicki has somt! minor palpatory tendenlt!ss at two levels In the thoracic spine. There 15 no 1055 in range of motion nor 15 there any pain during range of motion. She's tre::1ted with G5 and CMT. RMSldrb APR 1 9 1991 Mrs. Fox left our office and was stopped at the light on Route 15 at the Intersection of 21 st when 0 panel truck hit her from behind at low speed. She developed some IIpper bAcl( pain on the right which has persisted. She has full range of motion and neurologlcolly she 15 Intact. She has spasm of the upper traps and to a lower degr"" the pnrasplnols In the cervical region. She has right posterior upp"r thoracic: subluxatlons. She was apparently looking Into the review mirror when Impact occurred. She's treAted with RPT2 and will call us nl!xt we"l( If she has any further exacerbations of her pain. RMS/drb IfH 2 6 1??1 Vicki st I II has a lot of neck aching however, now she has a headache. She went to the Henchshaw Itea I th Center \'oIlere she got a Il'llssage and It re II eved a lot of her aching however, she developed a headache thereafter. She has subluxatlons found in her neck \'oIllch ore significant. She Is treated today with G5 and P to A cervical manipulation after \'oIllch the headache appears to be Imch Irrproved. ~1S/drc MAY 1 1991 Vicki stili has various aches; however, they arc no longer severe. treated today with CMT. RMSlrmt MAY I 5199' Mrs. Fox fl'els generally well however neck. Palpation finds restriction In rotation at C3. Sile's treated with 0130 adjusted for anterior thoracic RMS/drb M^Y ? 9 l~Yl She 15 still has a lot of stiffness In her Ip.ft rotatilln at C2 and on right eMT for these two levels. She's and minor low back corrections. Vicki woke up Saturday morning with ~evere rl~lht lower neck pain. She could hardly mover her neck. For ~ome reason she did not call me at home to help her. She suffered with the pain till today and then called to corne In, She has pain at the thoracal cervical junction on the right. There is no associated I.lrOl pain and hrr rangE\ of motion of thEl shoulder joints arc normal. St.e has restriction on right lateral flexion In rotation with pain at the cE\rvlcal thoracic iunrll'lll, Thrre Is upper trap spasm I>il;"'" <Illy. She j, lr~"'r" with \lltra~'llllld to trigger points found In the ,-, ,...... ... Paga 7 RE: VICKI FOX MAY 2 9 199\ CONTINUED Infraspinatus bilaterally as well as the upper traps. This Is followed by RPTl and 2 adjusted supine and afterwards she feels much Improved. RMs/drb ""N 4 199' Vicki Is noticing progressive stiffness In hcr neck. She has aching on bilateral rotation which Is accomplished to approximately 750 to 800. All other ranges of motion of thc cervical splnc are lull and complete. Rangcs of motion of the shoulder are within normal limits and there Is no weakness In the upper extremities. She Is treated with CMT. Additionally. Is given range of motion cxcrclses to do and range of motion along with Isometric exercises. RMS 1 drc au" 2 4 1991 Cs JUN 2 6 199' Mrs. Fox stili has occasional to f,'cquent neck aching. She's doing her Isometric exercises for strengthening her neck once a day. We are going to Increase this to twice a day. Additionally she had some low grade spasm which persists In th.. cervical raglon and some vertebral off cantering. She's treated with CMT. RMS/drbv JUt.' 1991 Vicki carried her computer down an clevator and one block to her car. After that she had a lot of aching In the center part of her neck. It bothered her most 01 the evening however Is much Improved today. Testing today finds a 3/5 weakness of the upper trapezes IInd sternocleidomastoid both on the right, She Is told to continue her range of motion exercises as well liS the Isometric cxerclses. She's treated In the office with CMT. RMS/drb JUL 1 0 1991 Mrs. Fox Is doing hetter. She has q/5 strength of the right sternocleidomastoid and neck flexors. There Is a 5/5 strength of the right upper trapezius. She's doing her cxerclses twice a day. She's feeling much better. She's treated with CMT. RMS/drb JUt ? fj 1991 Mrs. Fox fell relatively well until this past wcck when she had a flare up of her upper back and neck pain, She has ahout 50 degrees of right rotation of Ihe cervical spllle with Ihe ,'cmainder of the ranges being within normal limits, She is trcaled today with CMT afterwards she docs leel Improved, RMSI drh "-, t"""\ Poge 8 RE: VICKI FOX AUG 2 1991 M"s. Fox stili has restriction In right rototlon. It Is slightly Improved b~ t certolnly stili present. She Is treated with CMT. RMS/jcs AUB 0 9 199" Vickie comes In with 0 great deal of pain In the left lower neck. She wos working In another judge's chamber which caused her to have to look over the right shoulder a greot dcal. Because she Is recovering from the automobile Injury to her neck. this coused her to hove Increosed symptomatology from this moneuver. There Is palpable sposm In the lower cervlcol region on the left and palpable subluxation In the upper thoracic and cervical region. She Is treated with soft tissue manipulation and CMT. RMS/tdl AUG 1 6 199,1 Mrs. Fox stili has 0 great deal of aching In the mid ond upper cervlcol orca. There Is palpable spasm In the region. There Is tenderness on palpation in the mid onu upper cervical areo. She Is treated today with soft tissue monlpulotlon of the cervical spine followed by CMT. RMSlrmt AUG 2 3 1991' Mrs. "Fox Is doing her cervical exercises quite well. Todoy we are adding to that exercises for the scapular region. She's to do these daily. They Include exercises to lend flexibility to the rhomboid major and minor as well as the abductors of the scapula. We will asses her progress after one week of doing this. She's treated today with CMT. RMS/drb AUG 3 0 199t Mrs. Fox Is doing a bit better. She stili has aching In her neck which It occasionally worse on rotation; however, this Is not nearly as bad as It has been. She does have some scapular aching, however this may be w..rk related. We've told her to make a wrist rest which will help this problem. She Is treated today with CMT. RMSlrmt SFP 6 1991 Vicki stili has frequent aching In her neck. Again there are no symptoms Into the upper extremities. There Is some pain on palpation to the left of C3. She Is treated with CMT. RMS/drc ,-.., Page 9 RE: VICKI FOX September 20. 1991 Mrs, Fox continues to Imflrove, There 15 better range of motion In her neck. She 15 treated Vllth GMT for left lateral C2 and uflper thoracic adjustment. RMS/rmt OCT 7 - 1991 Mrs. Fox felt well until Thursday of lost week Vlhen her pain began to return. Over the later part of last Ilcek her pain Intensified, and she tried to call me, I was out of tOI~n at a confcrence. She didn't want to go to anothcr doctor. thercfore. she had her husband massage her neck and this afforded her some dcgrcc of relief. She 15 doing her flexibility as wcll as her isometric exel'ciscs. thcrefore. this is not a factor She had difficulty In thc right lowcr part of her heck, and It Vias worse on right rotation which was somewhat limited, There Is palpable restriction In the upper thoracic and lower cervical spine on the right. After this Is manipulated she feels much improved. RMS/mmm ,OCr 2 1 1991 Mrs. Fox has had a Charleston vacationing. offensive for her neck, She is treated with GMT, good couple of weeks, She spent four days In Apparently the 11'11' down and back was not too She stili has some minor swelling in the area of C2. She 15 doing her exercises RMS/tdl NOV . 4 \99\ Vicki went to a seminar this past weekend which was very emotional wrenching for her, She felt her upper back and neck tighten up as the stress of the emotional items brought up for discussion were revealed, This emotional stress 15 translated into physical tension and she ended up with a great deal of aching In her back and neck, She had some restriction of her range of motion In the cervical sfllne because of its tightness, Today it 15 Improved and Indeed she Is surprised as how she can move her neck, She Is treated today with CMT, Afterwards. she feels much improved, RMS I drc Nav J 6 1991 Vicki has moderate aching in the thoracic und cervical regions. There 15 moderate spasm, She is working very hard and moving a lot of her equipment around, however. never hod any problems in her' back and neck with this before her recent automobile occident. She is treated today with soft tis3ue manipulation and eMT, She will be spending thc next four days in Williams port working to hclp a colleoguc in that area. I am concerned about her carrying all of her equipment up there and working in that region. She states that she now has a carrying device for her equipment and hopes that there Vlill be a bell person at the hOlel, I told her to avail herself of their services if one is available, RMS/cml NOV 2 5 1991 .- Paue 11 RE: VICKI FOX fEB 2 4 1992 Ms. Fox went to the movies with her family the other day and had her held In a fixed position for quite a while and this caused her neck to stiffen up. This never happened before her accldcnt. I suggested when this happens again to perform her range of motion exercises. She's treated today with CMT. RMS/mmm MAR 9 1992 ~ MAR ! 0 1992 . ,\Is. Fox continued to have aching aftcr I saw hcr last time. It Increased and caused radiations of pain Into the TM joints. I t lasted about two or three days and then began to subside. Shl) Is feeling much better nOl'I but stili has some aching In her neck. Today she is treated with RPC2 adjustment. RMS/cml IICAR 2 ) 1992 0S APR I 0 ,,,. Vicki was unable to come In for the last two weeks due to schedule conflicts. I am very pleased that she did not have to call us because of an emergencies. She demonstrates tenderness and spasm to the right of Cl and left of C2, There is some slight restriction In rotation. SI-.t! Is treated with CMT. We are going to try and stretch her out to a month again. RMS/drc MAY 8 1992 VIcki has had a number of bouts of neck pain and aching. She has had some of these travel into headaches. She stili has tenderness \'11th spasm to the right of C-l and to the left of C-2. She has slight I'estrlctlon in rotation bilaterally and also there Is some restriction of extension. She is treated today wit:, CMT. Additionally, she Is given some stretching exercises to help relax the tension in the mid back. These consist of stretching exercises fOl' the medial scapular muscle and the rhomboids. RMS I crnl ~1Jfl 1 0 tl'l? Vicki has stiffness and aching In her neck. with pain at Cl. She Is trealed with CMT. She ha~ difficulty on right rotation RMS/drc 'JUl 6 1992 Vicki continues to get occasional lightening like pain in the suboccipital region and into the head with left cervical ,'otation. This only happens on left rotation and is centered in the region of C4. Palpation finds block f,ixatlon of C5 and 6 on the rig:,t in extension and the left In rotation. She's treated with CMT. RMS/drb - Page 12 RE: VICKI FOX 'AUG 3 \992 Vicki has n lot of neck aching and stiffness on left rotation. with mild CMT. RMS/drc SFP 4 1992 She Is treated Mrs. Fox Is doing well, but stili has aching at C2 on the left. She occasionally gets tenderness at that area and sharp lightening-like pllln. She Is treated with CMT. RMS/tdl Ocr 2 1992 Mrs. Fox continues to have ochln!) and stiffness in her neck toward the end of the month. She Is treated with CMT fot' left posterior cervical and anterior thot'oclc adjustment. RMS I cat ocr 30 1992 ~. NOV 4 1992 Vicki had moderate stress In the court room on Monday and has had neck pains and headache ever since. There Is moderate suboccipital lamming and cervical parasplnal spasm. She Is treated with CMT and two hand cervical pull. RMS/drb ,DEe 2 19911 It Is now a year and half post accident and we ore re-evaluatlng her today. Mrs. Fox states that she gets neck stiffness and aching with restricted motion after long hours of working. She works as a court stenographer which entails sitting at a stenographic machine for many hours and then at a word processing computer for another series of hours. She never had this problem before her accident. She's able to perform all of her other activities of dally living hours because of Mrs. Fox's personality. She Is not one to let mild or moderate pain come In the way of her activities or dally living. Examination finds spasm to the left of C2 and the right of C3. There Is restricted right lateral flexion and rotation. Left rotation and lateral are normal as well as normal flexion and extension. There Is spasm of the mid and posterior and scalenus as well as the upper traps bilaterally, Shoulder ranges of motion are normal. . Mrs. Fox Is treated with C2 and C3 adjustment. RMS/mmm OEe 3 0 \992 ~ rJAN 6 1993 Mrs. Fox stili has aching In her neck. There Is restriction to rotation to tile left of C2 and the right C3. She's adjusted prone for this and also adjusted In the low back. RMS/drb -, Page 13 RE: VICKI FOX FED 5 19!13 c.eo FEBRUARY 7. 1993 I received a call at home from Mrs. Fox stating that she wall In extreme pain. I mllde Ilrrllngements and met her at the office at q: 30 PM Sunday. She came In antalglcally straight forward with severe thoraco-cervlcal pain. She states that she has been working very hard all last week as a stenographer for Judge Rambo In the federal district court In Harrisburg. Apparently, the trial she has been working on Is quite nasty with lawyers yelling at each other frequently. Additionally, there are many side bars which have her unhook her stenographic machine from Its tripod and then 11ft It up to a pedestal which extends from the judge's bench, take dictation there and then 11ft her machine again, put It back on the tripod 'and then proceed again. Additionally, she has to transcribe all these notes during the r'est of the day. This Is extremely physically demanding and emotionally stressing because of the time factor Involved. She had been straining to do this all through the week and then Friday she lIIas making supper for the family and put some very hot chili In her mouth and burned the roof her mouth. As she did this, she lurched away and felt pain In the thoraco-Iumbar parasplnal muscles. She and her husband then went off to Baltimore yesterday, even though she was experiencing this discomfort, and as the,! got out of the car she had gusts of cold wind which hit her back and threw her even Into more pain and the antalgla Increased to the point where she was crying In pain and had to come back home. She has been resting, however has not been ablp. to get any sleep and, Indeed, has been In severe pain. She called me at home and that Is when I made arrangements to meet her In the office. The pain Is In the parasplnals slightly more to the left than the right at the level of T1 0 to L2. There are no GU symptoms or renal symptoms. There Is marked spasm In these regions. There Is no pain on palpation Qf the spinous processes In the thoracic or lumbar region. She also states that as this was worsening she was developing a cold which had her coughing and this Increased her pain as well. There are no radiations Into the anerlor aspect of the chest wall or down the legs. Observation finds marked spasm In this region as well. There Is pain to <lven mild palpation. She Is diagnosed as having a severe strain of the thoraco-Iumbar parasplnals and Is treated today with ultrasound and Is given a 10 Inch thoraco-Iumbar corset to wear. Additionally, she Is told to go home and use moist heat In the form of a hot water bottle 15 minutes twice today and to assume Trendelenberg's position just getting up to go the bathroom and eat. Tomorrow, she Is allowed to return to work as long as she uses the corset,. I have Instructed her In great detail on how this Is to be worn. If she notices any deterioration of her condition, she Is to call us Immediately. She will call us to report her condition sometime during the day and we will determine If we need to see her Monday or at the latest Wednesday. RMS/tdl - Page lq E: VICKY FOX PI! III 1993 Mrs. Fox feels significantly Improved. She stili has palpable spasm In the right lower and left upper r'eglons. These are treated with muscle. !Illmulatlon and this Is followed by mild CMT. RMS/tdl fEe , 5 1993 Mrs. Fox's low back continues to Improve. She has had some aching over the weekend. however this Is not severe. She tried to do some leg lifts lInd this did cause some cramping In her back. She stili has palpable spasm In various levels In her back. She Is treated with soft tI~sue manipulation followed by CMT. RMS/tdl ffO 2 2 H1S3 Mrs. Fox has slightly Increased aching In her back. Apparently. she was exercising on her Nordic track machine and It developed a catch In It and therefore gave her random Increase of Its motion causing It to lurch forward or backward. This restrained her back. She Is treated with G-5 and CMT for RPL5. After this. she felt much Improved. She also has a headache for which she Is treated with cervical manipulation. RMS/cml MAR 3 1993 of. MAR - 5 1999 Mrs. Fox has low back aching. She's adjusted for RPL5 and RPIN motion palpation. RMS/drb lIer neck Is feeling significantly better. as well as upper thoracic adjustment by NAR , ., /99J Mrs. Fox RPL5 and stili gets occasional aching In her low back. RPIN as well as LPC2 adjustment. RMS/sae "'lR 3,\ 199] Vicki sll1l gets occasional aching In her neck. There is left lateral and left posterior subluxation of C2. She's treated with full spine CMT. RMS/sae APR 2 8 lY!J:J ('.2,. She Is treated with APR 3 0 19!13 Mrs. Fox has some mid thoracic aching. She has anterior displacement of T6. She Is treated with anterior thoracic adjustment as well as RPL5 and RPIN lInd left lateral left posterior C2. RMS/cml 'MAY 2 6 1993 Mrs. Fox Is doing much better. She stili has however It Is not as severe. She Is again treated by RPL5 and RPIN and left posterior C2 adjustment. discomfort on palpation of T6 ante.-lor T6 adjustment followed RMS/sae .-- Pnun 15 t. RE: VICKI FOX JUN 3 0 1993 Mrs. Fox Is doing generally well. She has no severe discomfort In any region. She Is treated todAY with anterior thoracic adjustment at T6 as well III RPIN and RPL5 adjustment and LPC2. RMS/sae AIIG 0 A 1993 Vicki Is doing generally well. She 15 treated with full spine CMT, RMS/sae ,m 0 1 It" ~ 5EP 1 0 1993 Mrs. Fox developed pain to the right of T -12. She went to her family doctor thinking that It might be related to her kidney and found that It was not. Palpation finds spasm and tenderness to the right of T-12. There Is also poor motor function In rotation and lateral flexion at this level. She 15 treated with CMT to that level as well as full spine. She Is adjusted for RPIN and RPL5 as well as LPC2. RMS/cml OCT 0, 19f5 Vlclll feels much better. She has some minor aching In her neck and back frolll long hours of Ilorklng. She Is treated with RPIN and RPL5 as well as LPC2 adjustment. RMS/sac lev '" ~. RPL5 DEe dI ~ 1ge1 Fox has low grade aching In her neck. She Is treated with RPI Nand as well as LPC2 and anterior thoracic adjustment. RMS/slle Mrs. Fox 15 doing generally well, however, palpation finds significant restriction and rotation at L4. She 15 adjusted for RPL4 and RPLS as well 8S cervical and Iliac adjustment on the right. RMS/kls DEe 2 9 199.J Mrs. Fox Is doing generally well. She has some minor aching In the upper paralumbars and quadratus lumborum. She I~ In Kung Fu and has been doing a lot of high kicks and has apparently strained the Involved muscles. She Is treated with 50ft tissue manipulation nnd full spine CMT. RMS/sae FEe 4 1994 Vicki has no specific complaints. She has some minor restrictions In .,.. motion In her necll Dnd back. She 15 treated with CMT. RMS/ sae I1R 0 4 1994 Vlclli is doing \Jenerally well but has r.orne minor "ching in her neck. She Is treated with CMT for RP1.5 and II nnd '.PC2, RMS/soe NAn R 5 I ~~~ki hilS ri!Jht lower thoracic pain. She had been moving a lot of sllltcar.cs and \)rocer'l ba~Js (Jlld apparclltl'f 5uhlu:,ed the Imler thoracic.s on the right. 5he is trp.atccl "lith eMT for RP lovler thorades anet this is adjusted in the supine mode. She is also ndjllstp.d in the neck and "",'1 badl, RMS/r.lle December 19, 1994 RE: VICKI FOX Vicki was Involved in a motor vehicle aecidenl on 12/17/94 at approximately 2: 15 In the afternoon. She was procec(llng east on Market Street In Camp HIli near St. John's rood and was sll')pped at a traffic light In a line of traffle. She saw a car approachln,' her from behind that wasn't slowing and she tried to avoid the car l v veering to the right and was hit from behind. The jolt was so sharp tilat the cigarette lighter flew from the dashboard Into the bock seat and the ashtray fell onto the floor. The ashtray was closed before the Impact. After that, she thought everything would be OK and then she was struck from behind again. She denies any loss of consciousness. After the accident, she was shaken up but had no particular pain. The night of the accident, she began to develop a frontal headache which 15 stili present. Since that time, she has developed left lower neck achIng which Is worse on left rotation. She notices restriction In this range of motion as well. There Is also restriction of left lateral flexion In the cervical spine. Additionally, she has noticed left upper lumbar pain. It began yesterday and has progressively worsened. It 15 worse with prolonged driving. Examination finds a Caucasian female who 15 62" tall and weighs 116 pounds. Pulse rate Is 60 beats per minute and blood pressure is 90/70mm of mercury In the right arm seated. Gross tendon reflexes of the bleeps, triceps, brachial radialis, patella and Achilles are all rated as 2-/4 and equal bilaterally. There Is rock like spasm of the upper traps and these are exquisitely tender to palpation. There is spasm and swelling In the lower scalenes on the left. This is also quite tender. On the right, there is some swelling and spasm In the mid region, however , It is not as tender. There Is exquisite tenderness to palpation of the spinous process at C3 and C4 and to a lesser degree at C5. Shoulder ranges of motion are normal, however, there Is crepltlce in bilateral shoulder extension. Cervical range3 of motion find pain '., fluxion, however, It is able to be carried out to 210, there are 30 of extension with almost all of It occurring in upper cervical nodding, Right lateral flexion is 120, left lateral flexion is 100. right cervical rotation is 640, left cervical rotation is 7So, rotation In lateral flexion bilaterally were all noted with cog wheel motion. Palpation of the thoracolumbar parasplnals find moderate spasm throughout the area. There Is tenderness to palpation In the lower and mid thoracic spinous processes. Posterior plumb line exam Is normal. Lumbar flexion and extension are normal. Right lateral bending Is normal, however, there Is a 50% restriction of left lateral bending and observation of thc spinous processes shows mechanical restriction of motion In this plane. There Is about 50% restriction of rotation bilaterally without pain. Positive left Kemp's Sign. Toe walk and heel walk are normal. Straight leg raise Is negative bilaterally. There is good extensor hallucls longus strength and full hip flexion bilaterally. Patient Is given Instructions to Ice her neck for fifteen minutes out of Page 2 RE: VICKI FOX HISTORY AND EXAMINATION 12/19/94 Con't. each hour. The low back Is less Injured and we are going to begin manipulating that today. She Is treated with LPIN and LP lumbar. She Is also given a cervical pillow and we will see her Wednesday. RMS/cml ,DEe 2 j 1994 Vicki has noticed an Increase In general aching In her necl<. She has also noticed some sharp twinges in her neck and upper back with certain motions. She also notices that In the morning after she has be n working Just a bl'lef period of time it feels as though she has be:n working all day and Is exhausted with regard to the feeling of her neck and upper back. It Is difficult for her to go through the whole day because of this aching and tired feeling. Today, we palpate a spasm of the upper traps. There is also marked spasm of the anterior scalenes and the ~CM's bilaterally. There Is tenderness to palpation with the patient lurching away with palpation of C2 and C3 slightly more on the left than the right. There Is exquisite pain on palpation on C4 and CS post spinous processes. There 15 pain on palpation of the spinous processes at TS ,:,nd 6. She Is treated with ultrasound to the region followed by a very mild mobilization: She is also given a microwavable heating pad for home use. Next time we will begin explaining the active exercise program to her. RMS/mh ' DEe 2 3 1994 \llcki continues to have aching in her neck and back. Today we are reviewing exercises with her. I am Instructing her in the method performing short arch supported cervical exercises. I showed her how to do the complete program on the Nexus in the office and I am giving her one for home use. She is to be performing these with a collar (see attached) and I am giving her instructions for home use regarding the same. She is also adjusted in the low back. RMS/baa DEe 2. Ii- 1Q9.11 Mrs. Fox still has a m?derate amount of aching in her back and neck. received a call on mobile phone over the weekend stating that she had a great deal of aching in the lower thoracic region. After discussing this with her on the phone I instructed her the proper use of hot moist applications and told her to do this and try to refrain from heavy lifting. She presents today with the same aching throughout her neck and back. Palpation of the region finds very tender muscles In the anterior and posterior cervical region as well as the full spine and the paraspinals. She also has tenderness and anterior displacement In the mid thoracic vertebrae. She is treated with HMP and massage to the entire back and neck both anteriorly and posteriorly. Massage to the neck had to be performed extremely mildly because of the tenderness of the muscles. She is further treated with anterior thoracic adjustment and P to A cervical adjustment. She Is then taken into the exercise room and performs her I'bve revhlewed this with her and made certain corrections o serve er as she performs them, RMS/acs exercises. and then \. .. .' ;1 Page 3 VICKI FOX 12/30/94 Vicki stili has moderate aching In her back and neck. She Is treated with HMP and mild massage to this area. Even mild massage 15 to strong for her to tolerate to the anterior neck flexors. I discussed her accident with her again In great detail and find that she was hit from behind by a Lincoln Town Car. the front end of which completely crushed and her car didn't crush very much at all. This means that the forces were not transferred to the Individual In the town car because the car took the shock. however. her car didn't crush which means that the shock was transmitted to her causing her severe Injuries. RMS/cml lIAN 4 1995 ~., .f' { l Vicki still has marked tenderness In the neck and she feels "locked" In her low back. Motion palpation finds an absence of motion In the lower lumbar motor units on the right and this apparently gives her that feeling. Observation during lateral bending finds an absence of motion In the lower lumbar region and right lateral bending. Shp. has exquisite tenderness to palpation of the cervical region especially at C2 and In the neck flexors. She 15 still doing her exercises with a collar on with almost no restriction at all. She Is bending from the waist and not flexing at the neck when she does them, She Is treated with ultrasound to the Involved areas of the neck and Catagory I for RPIN/LAIN and this 15 followed by RP lumbar adjustment and there's an expiration fold In the lower sacrum which 15 adjusted on inspiration. She's also adjusted in the cervical spine and a P to A mode for RLLPC2 without any rotational component. RMS/baa IJAN 6 1995 , Mrs. Fox continues to have a great deal of neck aching with occasional locking in the low back. She had pain on palpation of the cervical structures both 50ft tissues and bony. There is also palpable segmental restriction of motion. She is treated with adjustment to the HMP followed by ultrasound to the cervical thoracic parasplnals. Following this she is adjusted for inspiration fault in the sacral base and P to A adjustment of the upper cervical complex. RMS/baa JNl o. 1.t/~ (pI"." Print) L8.lIName' I='OY- :;i:~,.i, '::. 'FintNallle' \/ia...r...J M.I_ L-, Home Address:-'.CoO al"lIV'1g-r-e,t"\ "RtL City: CEwnp I-\i \I Stllte: '1=>~Zip: '7D \ \ Home Phonel/" 3\ ,'B'C!.(a'B, l3irthdale~3-1S I Age:-43 Sex: M <D Height:5':2." Weighl' \\"2- Social Security IIOISI-4<a-~~:'S - II oCChlldrcn '2. Murilal Status:@ S D W Occupation'c.ou..-'t vepov-'e.r' Employed By'U,"', D\~-'rY\c.7' Co'-"\lwork Phonc II' :2.~8-'\? ::LOI Work Addrcss:'BoY. ~3, federal B\d9City: ttbq Slatc: '?a. Zip: 1/ \Og, How were you reCerred 10 our office? GiYkefcrred by somcone: Namc JaneT ~r a\ie.. D Phone Book D Newspaper ... D Sign or Location D Radio DOLher Spousc's Name (or parl/" nam. /fund" ~8) }--\icY\C\e\ c..... 'Fa)(. Spouse's Occupation: a-tt'a <r '<112'1 Spouse's Employer' K \"t'e - PII cl-' em'- P . Spouse's Work PhoncN a,.., vs - 1'5 '60 'S Have you had previous Chiropr&ctic ~arc? DNo ~Ycs WherctJ~ic}'1avC\ S12\c\OuJ X.Rays Taken? 0 No ~s Approx. Dalc of Last Visit;.., --;/ Iv I q 4 Dale of Last Physical Examination Is therc any chance that you are pregnant? ~o DYcs . CONF...:fNTIAL PATIENT HIS. JRY .". ~ ' \ ::.' ,- PH. I () "1 <J Date: 7/\ ql 0.4 . .. ~~'I" Lbt your Main Symptoms In Order of Severity: I c.\e.IpV-eo;;.s"\Dv:)';: " ' 2, \c:lW 'i:-e\~-€~-\e e.VV) .'" ',' 3, , '" For How Long t What do you believe is wrong wl'iii 'you'? ~ ,nQ -to UJOYL ~YO\..lqh ~C\vni,\..( <.:>f \~'S~l"!;.. code~li\oe~ a.v"I'c\ \\U\v"'O, W\W'\ a hus.'a:::I....u \V\ eeur-l~ s e.s;. elf v-€c.a:>uex\\ ~1e.\<:..t:i>Y\d\\S.vYl oV-C\-:-'t"O.)C UJoV\c.'~\ 'r.:I n~ y\ r- Have 11 ev1el' had same or SIJtlillll' cOl)dltlon ? D No Dyes.... V\\ o.\re~ d\9-Q, V\'os.~Q\" W\~ ~~D. List ot er Doctors Consulte~ ""'. I Address: .,-_.,-; . 2 Ad9ress Is your present Injury./lIIne.l;~iie)o'an' A'ccident ? 0"No 0 Yes, If yes, DOn the Job' ,..., DAuto Accident OPersonal Injury DOther Have you reported your Accident? DNo DYes If yes, 0 To Employer '10'''' . D Auto Ins. Carr,ier::f\.:,.o OJ!1er,..,', Date of Injury: , Are You Now or Have You Ever Dee~ Disabled? (mviee or w""k) 6J.'No 1"'_.".'. For How Long ? For How Long ? D Yes, When: Have You Retained An Allol'Oey?' ~o . ,: ,.',:. " .. D Yes, NAme & Address: Please check any thai apply [) headache I) uPlie;.back pain [ )artxiety (.(neck pain [ ) mid Iiack pain [ J ncuritlS ( J neck stiffness [ J ch~ll'pain' [.(fatigue [ J doublc viSion [ J shortness of breath [ ) swelling [ I numbne,,, In ann. 1110';' back pain [..,r.en"on [ I d,uIn..' [ I nun,hne.. in lei' [~old (eel II pain radlltinilnto neck [ J numbne55 in feel [ I cold hand, [ I shoulder/ann pain (L or R) I ) leg pain (L or R) [ J irrllabilJty [) d,fftculty In rising 10 walk after ( J difficulty in bending ( J pain while ..ltln. Sllling [ I difficulty in liI\ing [J pain while standing i I difficulty in "andln~ I i dlrfi~ulty in working [ ] falntln8 [ ) pain behind cyes ( ] tremors [ J nausea/vomiting ( J cxce5'lve pc:rspiulion ( 1 rc~Hllcllon or molion [ ) JlnU' trouble ['Ij'depremon [ ] p"n while walking r J eqUilibrium problems DR. WEEKS - ADVANCED CARE CHIROPRACTIC CONFIDENTIAL Date Printed: Time Printed: Vlckl Fox 03..03-1951 1079 January 21, t99a 11:34 a 07-19-1994 Subjective: Ms. Fox stated on her visit today that she Is feeling frequent moderate pain in the neck area, MI. Fox further pointed out inflexibility, restricted movemen~ and stiffness with achy and dull pain, The patientslaled that ber neck psin is made morc pronounced by looking down, looking up. tumingthe head let\, and turning the head riaht. Ms. Fox also stated that she is suffering from depression and low self-esteem due to family issuaes. Objective: CI is subluxated riahtlateralward wilh a moderate fixation of the spinal joints. The CS seamentahows a right posterior subluxation with a moderate 10'" of joint function. Today's evaluation of the spine Included a check for pain at the scgmentallevel. Thcre wao a moderste pain at C I and CS on the right. Assessment The patientl, condltion is acute, Plan: The next appointment is set for a 3 day interval. SDWIkm 07.22.1994 Subjective: On loday's visit. Ms. Fox related her current symptoms. She stated that she continues to experience pe..istent pain in the neck area. She h!U also noticed inflexibility, restricted movement, and stiffness with achy and dull pain. Ms. Fox's ncck pain i. sggravaled by looking down, looking up, tumingthe head left, and tumina the head righ!. M.. Fox was requested to evalualc her perception oflhe cu"ent statu. of her condition. On a pain se,le of Ita 10, she reports her neck pain at4. Objeclive: The atlas vertebra shows a right laleral shift with a fixation of a moderate degree. A right posterior rotalionalsubluxalion ofCS i. nOled with a moderateloos of joint function. A medium level of pain at CI and CS on the right W!U elicited on examinalion of the spine with a medium degree of edema at C 1 and CS on the right. Assessment: Adjustment of the spinal segmentsloday was performed by specific chiropractic manipulation. ^ slight amount of mOlion al CI and CS was noted. The palient is suffering an acute condition, Plan: In S days the patient is scheduled to return for treaunen!. The cervical spinal region received chiropnctic adjustment 10 correct subluxation snd reduce vertebral fixation. In order to promote functional mobility, intersegmental mobilizalion was administcred 10 Ihe area of the cervical spine. thoracic spinal area, and lumbar area. SDWIkm 07.27.1994 Subjeclive: Ms. Fox Slated on her visil today that ,he has been feeling a slight bit beller in the cervicsl area. The patiem was asked to rate her pain and severity on a scale of 110 10, She estimated her neck pain at2. 1201 MARKET STREET LEWISBURO. PA 118J7 (111) lB.1221 03/04/1998 14:13 523.924r SKY WEEKS D.C, PAGE Ul ,- Vicki For 1079 '- ~ Progru. Not.. PIge 2 oC 5 Objective: The CI segmenl is shlfled rlghllateralward with a fixation ofa ,noderale degree, There 15 a posterior rolation oCC5 on the rlghl wilh a modomle degree of fl.ation, There is evidence eliCited on paJp.llon of a minor degree of pain al C I and C5 on the right. A Iwelling of a moderate severity at CI and C5 on the right was alia pre,.nt. Auonman': Adjustment oC thalpinal segmanlj today was performed by apoclflc c~lroproclic manipulation. A moderate dearee oC movement at C I and C5 wal noted, The patient il delennlned to he In an acute phase. Pion: There is 10 be no challge in the Crequency oC treotment atthll time. The next appointment will be It the same inte",al Treslment conlisted oC adjustment to the ~rvicalarea, in order to COlTect subluxation and reduca vertebral fixation. SDW/km Og.02-1994 Subjective: MI. Fa. presented today and Indic'led that the p.in in the neck region has remaIned the same, Ms, Fo. was asked to deteonine her opinion oC her curunt condition status, Based on a Ita 10 pain acale, Ms. fox estimated her neck pain at 2. Objective: The 1st cervical Is deviated rl~htlateral with a fl..tion oC a moderate degreo. Tbe C5 legmenl sbowl a right pOlterior subluxation with a moderate flxallon oC the spinal joints, The spine and pBrBsplnal tissues Wele e.amined and (ound to thow a mild discomfort al CI Bnd C5 on the right There wu allO a medium qUBntlty of Iwelling at C1 and C5 on the right. Assessment: An indIcation of a moderate degree of movement Bt CI and C5 wa. observed tod.y during adjusunent oC th. spine. The pallen! will remair. on acute care status, Plan: Treatment will conllnue occording 10 pia" and the ne", vi,ltl. .cheduled Bt the same Interval. The cervical spinal ilI'ea received adjustment to reduce fixation sublUXBt/on and increa.e mobility, To improve venebral alignment and increase mobility, the Brea of the cervical.pine received activator techniques. SDWlkm OS-IO-t994 Subjeclive: On today's visit, M,. Fa, related her current symptoms, She stated that there has b.en lome general Improvemenl in the cervical pain. Objective: There il a rlghtlaleral sublu.ation al C I wilh a moderate loss oC joint funclion, A right posterior rot.atlonal subluxalion of C5 Is noted with a moderate loss of joint function, !.xamining the spinal tl"ues revealed a .lighllendemess ot C I and C5 on the right Further examination ,howed a moderole swelling Bt CI and C5 on lhe righ.. Asseument: On adjustment, a moderate degree of vertebral move men I at C I and C5 observed The patient will remain on acure care stiruS. Plan: There" to be no challge In O,e frequ.ncy of tre.tment al this time Th. ne.tappolntment will he at the Same interval. Therapy Included adjustment to the cemcallpinal area 10 COlTeel subluxation of the vertebral segmenlS. In ord.. to release fl,atloo and improve the functional mobility, adjustment by activalor meOlO~' was adll'ini'lcnd 10 th-= neck. SDW/km Vicki Fox 1079 PrOI"1I Not" Pas. 3 or 5 08-19-1994 Subjective: The patient indicated on her villt today that the moderately levere pain in the neck hlllhown frequent lecurrence, In addition, MI. Fox mentioned Ihe hll been oxperlencinllnnexibllity. Illltrlctcd movement, and IIiO'neil with achy and dull pain. Looklns down, looklns up, tumins the head left, and tumins the head riahtacom to aSIBvalc MI. Fox'l neck pain. Ms. Fox also il dealins with an Inclelled amount of emotlonalltresa. Objective: Cllhows alatelal ~.vlatlon to the riShl wilh a nOlicoable amounl ofincllllI.d nx.llun. The C5 legm.nl shows a riSM pallellor lublux.tion with a noticeable amounl of increased fiulion. An .Ievaled level of pain at C I and C5 on the lisht was elicited on palpation over the Iplnal segmenll with the lurroundlnlloft tillue Ihowinsa swellins ofa medium sevelity at C I and C5 on the rlSht. Assessment: Chiropractic adjustment ofthe spinal vert.b,a levealed an Indication of moderate movement at C I and C5. The nature of Ihis pallenfs condition is acute. Plan: Tleatment will conlinu. according to plBn Bnd the next visit is scheduled at tho I"",e Interval. Treatment consisled of chiloplactlc adjustment to Ihe c.rvlcal Iplnalleslon, in ord.r to reduce fixation lubluxatlon and incl.ale mobility. To correct veltebral milalignm.nl and lestore intcrsegmental mobility, adjustment by activator methods was admlnlsteled to the cervical Ipinal .rea. SDWlkm 09-06-1994 Subjective: On today's visi~ Ms, Fox related her current symptoms, She stated that the pain in her neck reaion continues to feel about the same. Ms. Fox continued to describe that she noticed innexlbility, le.tricted movement, and stiffness with achy and dull pain. She .lale. that her neck pain is made WOlse by looking down. tooklnl up, lUmlns the head len, and tuminlthe head right. Objective: The atl35 vertebra shows a lighllateral shift with .n Incr.ased degree of joint fiulion. A posterior subluxation of CS on th. light was ob.erved with .n increBsed degle. of joint fix.lion. An analysis of the apinal tissues by digital palpation .how.d .n inclease in s.verity of pain at C I and C5 on the light. There was also indication of an edem. of. moder.te desree at C I and C5 on the light. Assessment: Adjustment of the spinalsesmenLs today was pelformcd by .pecific chiropractic manipulation. A mediocre deJllee of segmental motion at C I and CS was noted, The patient i. determined to be in an aculC phase, Plan: The frequency of treatment will continued .ccOlding 10 plan, The n.xt visit is at th. .am. int.rval. Adjustment was siven to the cervical .pinalarea. The errect i. 10 conect .ubluxation and ,educ. vertebral fiullon, To r.duce misalignm.nt and fixation.lh. <<lvical .pinal r.gion r.ccived activator plocedur.s. SDW/km 09-\9-1994 Subjective: M., Foxlndicat.d on her vi,it today lhat th.re is no change in the dCKrc. of pain in the neck. Objective: Tho atlas vert.bra shows a right lalcral shift wilh a noticeable amount of incr....d fix.tion. Vertebral sesment C5 wa. found 10 be subluxaled posleriol on the light with a nOlic.able amount of incleased fixation, On palpation examination there was elicited an incr...,ed int.nsity of pain at C I and CS on the light with a moderate sw.lling at C I and CS on the right. AIsesamenl: A mod.rate amount ofmov.m.ntat CI and CS w.., oh..rv.d today during adjustment Orthelplne, The palient is lurrerinlln acute condition, Vkkl FOI 1079 Prosr... Not.a Pase40lS Plan: The nextappolntm.nt will be ICheduled at the lime Interval. To correctlpinal mlllllanmenl, \be area olthe cervical aplne received chiropractic adjustment. Activator adjultments WII recommended 10 belp Improve mobility and also to help correct vertebralaUanment in Ihe area of Ihe cervical Ipine. SDWIkm 10-10-1994 Subjective: On today'a vlllt. MI. Fox relat.d h.r currentlymptotna. She ltat.d that her cervical pain II feellnaa aliSh! amount bell.r, Obj.ctive: CI Ihowa a lateral d.viation to the risht with a mod.rate fixation of the lpinaljoints, A risht pOltorior rotational aubluxalion of C5 ia noted with a mod.rate fixation of the Ipinal joints. A diaital inapection of the aplna' ar.a was perfonned. A mild d.sre. of pain at CI and C5 on the riShl wal found. Inlpection also showed a mile! amount ohwelllnsat CI and C5 on the rlSht. Asseument: A m.diocre d.srct of a.sm.nlal mOlion at CI and C5 was obaerved today durinS adjustm.nt of the spin., It is d.l.nnin.d that thil patient'a condition is acul.. Plan: Th.re is to be no chans. in the fr.qu.ncy of tr.atm.nt althis tlm., The n.xtappointm.nt will be at the urne interval. Chiropraclic adjustm.nt was advls.d to incr.... funclional mobility and correCII.em.nlal misallanment in the neck area. Activalor methods was siven 10 the n.ck ar.a. The .ffect is to incr.ase functional mobility and correct seam.ntal misalisnment. SDWIkm tl.tl-I994 Subj.ctiv.: Ms. Fox indicaled on her visit today thatth.r. is mod.rate Int.nniu.nt pain exp.ri.nc.d In the neck area. Ms. Fox furth.r poinl.d oul innexibility, restricted mov.m.nt, and Itiffnels with achy and dull pain, Obj.ctive: The C I lesm.nt is shin.d rishtlat.ralward wilh a mod.rate degree of fixation. The C5 segment was noted to be subluxat.d posteriorward on Ihe risht with a mod.rate loss oC joint function, Palpation of the apinal tislues reveal.d a minor pain level at C I and C5 on th. right with a small desr.e of ed.ma at C I IUtd C5 on the riShl. Alaessment: A moderate d.sr.e of mov.menl al C I and C5 was obs.rved today durins adjustment of the spine, It is d.tennined Ihatthis palient's condili~n i. acute, Plan: The palient will be r.sch.dul.d for follow-up car. al the samc interval. Adjustm.nl was recomm.nded to reduce subluxalion of the s,-sm.nts and al.o to h.lp improve mobility in the c.rvil'al area, Activator adjuaanents was advised to releas. fixalion and improve th. functional mobility in the n.ck ar.a, SDWIkm 11-09-1994 Subjective: On today's visil, Ms, Fox r.laled her curr.nl symptoms. She slaled Ihat she', be.n f.elins some aliallt improv.ment in Ih. n.ck ar.a. Obj.clive: Th. 1st c.rvical is devial.d rishllaleral wilh a mod.rate loss ofjoinl function, The 5th cervical vertebra was found 10 b. in a riaht posl.riorly rUlat.d pOSllion with a sliSh! degr.e of roduced joinl motoricity, Examlnina Ihe spinallissu.. for pain rev..l.d d.cr....d pain at C I and C5 on the riallt. Assessment: Adjuslm.nt was sivon 10 corr.CI seam.ntal misalianm.n!. Th.re was v.ry ..eell.nt mov.mentat Ct and C$, Th. symptoms report.d by th. pali.nlare acul. in ",ru.. I'.',\I,H Jlnlr~ Mil 'Al"! IIllll\fll)J r.{)~1 M I) 1'.\)11110 It t)".I1'Il"l, MIl 'lollt'~,'1~ IhML'IIl ~IJ 'A(~ JlllI,' II '1l"."'lIr"l~ liMO. , A ( ') Ill~ IIM10 II IlAJII)(I\, Mil JAm~" tWI~rttl\ MII",^ (,!l .. DEFENDANT'S \ IX.'1'". 1,1\1,111l1\~ ^ ll,o\J"II' ~II! M'.,\Ahor,ItMI.t,'"'' 'II 1\1J1\fIHIlM'r.IlA 1.'<1 Itll"AW~ UI'I'f,MIl r \. ' J^~J~ Juno'l 'II' !lnH~" ~lllr OJ I IllllHA.'J tlt"JI." ~II ORTHOPEDIC INSTITUTE OF PENNSYLVANIA TELEPlIONE: (717) 761,~~30 . (600)634,4020 . FAX: 17171737.7197 November 12, 1997 Donald R. Dorer 214 Senate Avenue Suite 503 Camp Hill, PA 17011 REI FOX, VICKI L, 460 Arlington Road Camp Hill, PA 17011 057 46 0635 13282335 Dear Mr. Dorer: This is in reference to VICKI L, FOX who I initially saw in my Poplar Church Road Office on November 7, 1997 for an independent medical examination, Ms, Fox is a 46-year old female generally in excellent health who was involved in an automobile accident on December 17th, 1994. She states she was sitting still at a light when a Lincoln Town Car hit her from the rear, She reports she was hit once and then hlt again. She is not sure why that second hit occurred but she reporta it did occur. She does not think the person who hit her could have been going too faet but she does not know how fast the car behind her was going. She did say the front of the Lincoln Town Car had significant crumpling to it and her Volvo hardly looked like it was scratched, She states she was a little shalty. She did not go to the hospital. She did complain of some pain in the right shoulder and pain in the left neck, She went to a chiropractor, Richard Seldow, D.C. who treated her for a period of time, She then went to a physical therapist, Judy Downey, L.P.T, and has had massage treatments to her neck and back, She states she goes once every two weeks now for approximately an hour of massage, She also saw a homeopathic doctor of osteopathy in PhilRlilelph;.~, a female physician \,'ho treated her with a medicine called arnica montana. It was made f~om a white flower and she reports it ooes take away swelling. Ms, Fox states that she does not give into pain, She is a court reporter. She reports she has missed a few days over the last couple of years from work because of the accident. She states some of the days were for doctors' visits and I think early on she may have missed a couple of days because of pain. She did tell me in long trials, she will wear a cervical collar, She reports she does not wear it all of the time but she reports if she does wear the cervical collar, it prevents headaches, She reports on long bike f).des, if she does not wear the cervical collar. she will get headaches. She did report to me that she did a ten mile bike ride without a collar and she did develop a headache. C",..,..., ~lIlL nHI<T ^[)O~E.')S ALL CORf.!LS~'O"1LJf.'NCf TO 87~ POPLAR (1IWKH RUAD CA,"'P till I V\ \ ;(1 t I HARRI!i:B<lRG OFFICf HARRISHUR(lOFFICE" HERSHEY Of.Fle[ CAMP till! (I ". , ~,' "',~ I I. \ '. ' 'l ~, i, I I, I , 'I, .1" \ ,,,,, I', ,I l " ~ ' RE: FOX, VICKI L, PAGE 2 November 12, 1997 She reports that she can do almost anything but she sometimes pays for activities for a day or two if she does too much activity with her neck, Ms, Fox states that she does feel like she has more range ot motion to the ri~ht than to the lett when shoe tilts her spine, I questioned her about her arm pain and she states it is essentially resolved, She states on a very rare occaeion, she'll get a little bit ot teeling of weakness in the right arm but other than this she has no other problems with her arm. She states, "The right arm is not much of a problem anymore." Ms, Fox did state to me that she had a previous accident. She states in 1991, three years before the accident in question, she was rearended. Shill reports that she treated with Dr. Seldow for approximately six months for that particular injury but that her symptoms abated and she was back to work full time without any signs or symptoms of neck problems. Ms, Fox states that one of the positions she has difficulty with is holding her head in a hyperextended position, I did ask if she took any medicines regularly and she states she will occasionally take an Advil but other than this, only the homeopathic medicine described above. On physical examination Ms. Fox sat in the examining room and moved about the room without any apparent evidence of pain. She had good range of motion ot her neck as she talked to me during the interview. She had no increased pain with vertex compression, She could touch her chin to her chest. She could hyperextend her neck fully without difficulty but states that on occasion, that maneuver will give her problems, She could rotate her head to the right and to the lett without difficulty. ~he could tilt her head to the right without difficulty. She reported that it hurts to tilt her head to the lett, There is no muscle atrophy about the shoulders or upper extremities, She was entirely intsct neurologically in the upper extremities, Deep tendon reflexes, motor strength and sensation are within normal limits, She has no pain on palpation in the soft tissues of the upper extremities. There was no muscle spasm on observation about the cervical spine or her back. She had full range of motion ot her lumbar spine. She could touch her toes, hyperextend, laterally bend without difficulty and she did tell me that she does not think her low back was in any way injured as a result of the accident. She also did tell me that she does do Yoga exercises frequently. I did x-ray her cervical spine, X-rays ot her cervical spine reveal that she does have seven cervical vertebra. The disc spaces between vertebra 4 and 5, 5 and 6, and Ei and 7 show some degenerative r;:hanges, the most significant degenerative changes being present at C5.C6. There is posterio, spurring ot C4 - 5, C5 - 6 and C6.7. Flexion extension films do not show any marked ligamentous instability. I have reviewed the information provided to me regarding Vicki Fox including vehicle damage photographs, the police accident repott, recorda of Judy Downey who is a physical therapist, t'ecords of St, B;lrnabar; Hospital, records of Bonnie Bennett, D,O" records of Richard S~ldr)''''', [),(', hot.h pre and poet accid~nt. I also revle~~d th~ stat~fn~llt of d~mand by Vickt Fox and Michael Fox againnt Jean S. Gamh~r. Aft~~ revL~wing all af tlli~ itlformation, examining Ms, Fox and inter'/i€'I/intj r,t:, , Fox, I can At,.t~l th,: fclluNing: REI FOX, VICKI L, PAGE 3 November 1~, 1997 I think Me. Fox was in an automobile accident on December 17th of 1994. . I think it did cauoe a Roft tissue injury to her cervical apine as well as some strain to the lumbar spine snd poosibly to the thoracic spine. I do believe that she had a pre-existing condition with history of neck pain suggesting that Mrs, Fox did have degenerative disc disease prior to her accident of December 17th of 1994. It is noted, and Mo. Fox reported, that she was involved in an accident on April 19th of 1991, Records from Dr. Seldow show that she had numerous visits to him after that accident with a complaint of neck pain and thoracic pain, Records also indicate that prior to her 1991 accident, she had had problems with her low back, On examining Ms, Fox in the office, I can find no evidence that this woman had any significant neurologic inj,"ry at the time of her accident in 1994, that is she has no evidence in the chart that she had any damage to the spinal cord or to any major nerves exiting the cervical spine. On examination today, she has no neurologic deficit whatsoever, X-rays taken in our office show that she does have degenerative disc disease of the cervical spine involving at least 3 vertebra and 2 disc spaces, The changes noted on x'ray appear to be longstanding. It is also important to note that a flexion extension film performed did not show any subluxation of one vertebra on the other which would suggest that she had a significant ligamentous disruption in the past, (It would be good for me to see x-rays of her cervical spine if they are available prior to her accident of December 17th, 1994.) I think it's very important that Ms, Fox is back functioning at her job and performing most of her daily activities. I think this bodes well for her long term outlook with respect to her cervical spine. I do think at the present time she essentially has degenerative disc disease of the cervical spine with no evidenc of cervical radiculitis or evidence of myelopathy being present. I do believe her prognosis is generally favorable. People with degenerative disc disease do seem to function reasonably well and the fact that she does not have any neurologic deficit and the fact that she has actually slowly improved over time from the days shortly after her accident are positive signs, I do not anticipate that she will need any surgery as a result of this specific accident, It is possible that even at this late date, that as time passes, her symptoms will slowly abate. Ligamentous injuries generally repair themselves in a period of four months or so, Certainly sometimes the inflaffimation can last for longer periods of time but eventually intlamr:1atory process as~"..iillted with ligamentous injury abates, healing occurs and the symptoms subside, I hope this information is helpful to you. Sincerely, N-L'/7 (~--/ Richard J. Boal, M.D, PJB/mee ......, BONNIE BENNETT, D.O. 14 1 word for it is that it was stuck, meaning that if 2 you evaluated movement of the vertebrae, the 3 ligaments, the muscles, you would have a difficult 4 time getting them to be synergistic and moving 5 with each other. 6 Q. What part of the body are we talking 7 about here in this examination? 8 A. You usually evaluate the base of the 9 head and the neck. But you must understand that 10 osteopathically, we think of the body in three 11 units because the head and the neck is divided 12 into two parts of the structure. And so, it 13 extends down into the thorax. so, let,'s talk 14 about head, cervical area, and thoracic area. 15 Q. Okay. And cervical refers to the 17 neck; is that correct? A. Yes, sir. Q. And what does the thoracic refer to? A. That would be below the neck, namely that which is abridged by the rib cage. 16 16 19 20 21 Q. And so, your examination of Mrs. Fox 22 consisted of examining those parts of the body; is 23 that correct? 24 A. Yes. KRAUSS, KATZ & ACKERMAN, INC. ~ ....... BONNIE BENNET'!', D.O. 18 1 cannot recover from the force. And so, the 2 geometry is affected and changed. Therefore, the 3 working mechanics of those tissues is also 4 altered. 5 Q. Altered in what way? 6 A. It means that they have a saturation, 7 that they are no longer able to endure that kind 8 of implosive effect, and they work differently. 9 They give different signals, an in pain, as in the 10 ability to stretch, and so on and so forth. 11 Q. And is that the type of mechanism 15 that you believe occurred in vicki Fox's accident? A. Yes, sir. Q, As a result of your examination and history that was taken, did you decide on a course of treatment for Mrs. Fox? 12 13 14 16 17 A. Well, I had continued with the work 18 that we do, which is called osteopathy in the 19 cranial field, but it's a particular approach to 20 decr.ease that which the body perceives as a 21 noxious stimulant, whether it's anatomical or 22 physiological. She had the effect of stress 23 chemistry, which puts it in physiological realm, 24 and she had repositioning at that time, which is KRAUSS, KATZ & ACKERMAN, INC. ,,",, - BONNIE BENNETT, D.O. 21 1 shock case to help resorb whether there's congestion from lymph or small microcapillary. Extravasation means blood goes out into the tissues and so on. Q. Was there any physical therapy considered at that time? A. I believe that she was seeing someone named Judy Downey. Ms. Fox is two hours from my office and she conjointly sees other people. Q. Did you feel a continuation in physical therapy was appropriate for her? ;I 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 A. Yes, because it really wasn't the gross kind of physical therapy that some people this -- this woman is trained in something called myofascial release. Myo- meaning muscle, -fascia meaning the connective tissue which surrounds muscles and is interconnective throughout the body. since she seemed to -- Ms. Fox was using a great deal of muscle protection for the areas, it was appropriate that she be seen by someone who could carry that out somewhat further. Q. Were you aware of what Mrs. Fox did for a living at that time? A. '{es, I was. KRAUSS, KATZ & ACKERMAN, INC. --- 1 Q. 2 A. --. BONNIE BENNETT, D.O. 27 What was the purpose of the change? The purpose of the change was to 3 institute more sort of catalytic conversions of 4 more tissues than just the general deshocking of 5 tissues overall. Pulsatilla has an effect on 6 muscles, as it were, whereas the Arnica, when it 7 was prescribed, is for a general deshocking 8 approach. 9 Q. Mrs. Fox? A. Q. that point? A. 10 11 12 13 14 All right. When did you next see On February the loth. Okay. And what was her situation at It's interesting. I note at the 15 onset it said decreased court work. So, the work 16 load had decreased and showed better overall, also 17 that she was seeing physical therapists twice that 18 week. 19 Q. 20 that time? 21 A. 22 Q. 23 examination? 24 A. Did you perform an examination at Yes, sir. And what was the result of that The examination showed that she was KRAUSS, KATZ & ACKERMAN, INC. ....-.. BONNIE BENNETT, D.O. 43 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 convalescent period. And so, that challenges the body's ability to construct those things which it needs because there is not enough energy in the system to do that. so, it's a house divi.ded, if you were. She had her own situations prior to the accident. T~e accident, for her, complicated it, shows lack of ability to recover. And do we talk about this in gross form or subtle form? It's still the -- the inability of the body to manifest what it needs when it needs it. Q. Were you able to find that next date where you address any head, neck, shoulder injuries? A. Q. A. the bathtub. August 24th, '96. And what was going on at that point? It's noted that there is a fall in And the neck muscles had also acted up again. Now, I do know that she fell in the bathtub. I remember her telling me about an ecchymotic or very bruised spot on her hip. But once again, you have to use a degree of contractility, protect yourself, and muscles which were active and are being used all the time come into play. So, neck muscles would have abserted KRAUSS, KATZ & ACKERMAN, INC. . ........,_._._-----_._-----~._.~ BONNIE BENNETT, D.O. 44 1 .. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 themselves again in order to protect her in the fall. Q. Was there any change in her treatment or medication? A. The medication, as indicated, is a deeper acting remedy again that would be helpful for her whole self, as well as working on areas that had shown repeated weakness. Q. And then after that August 24, 1996 visit, when did you next see her? A. December 18th, , 96. Q. What was her situation at that point? A. Apparently, there was an infection in place and circumstances of her life were that she was in a divorce situation. Q. Any change in her medications, treatment? A. Repeat of a medicine that affects the muscles and a repeat of a medicine that affects her organically in a very deep sense. Q. Okay. After that visit of December 18th, '96, when did you next see her? A. May 30, 1997. Q. And what were the circumstances of -- KRAUSS, KATZ & ACKERMAN, INC. .-....._--_....~-- ....~"----_.__.~----~.~--_..--_. BONNIE BENNETT, D.O. 45 1 you say Mayor 2 A. I have -- that's the next one I have. 3 I think the note at the bottom of the page -- were 4 notes that were sent to you. And the date, are 5 you looking at 2/16/97? 6 Q. I do have a note from January 30th of 7 1997. 8 A. Oh, good. I don't happen to have 9 that. January 30th, '97. 10 Q. Allow me to show you a note that I 11 believe I received from your office. I'll ask you 12 if you recognize it as your 13 A. Yes, that's my handwriting. 18 Q. Okay. Do you want to take a look at that and -- A. Thank you. Q. -- if that refreshes your recollection, tell us about that visit, please. 14 15 16 17 19 A. Let's see. It notes that there is 20 still neck strain in place, right upper 21 extremities are showing tingling and spasms. She 22 had been seeing the physical therapist. 23 Q. Any note in a change of medication or 24 treatment at that point? ......-....-...,.---- -- -_._...._---_._.~....~....._.--_._--~-_._.._' .-..._._~-----_..-_._. KRAUSS, KATZ & ACKERMAN, INC. ---- ~ BONNIE BENNETT, D.O. 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 A. Yes, I did. And I would just restate that what was evaluated is basically bones at nerve endings, and spinal cord compression. It is noted on the third page that he thought that there was a soft tissue injury to the cervical spine, as well as some to the lumbar and possibly to the thoracic spine. So, he himself said that that was a concomitant. What these -- the evaluation shows that it's, from my point of view while I agree with it, it's incomplete Q. How is it incomplete? A. -- because it doesn't take into account the -- the biodynamic disc function that the other tissues that have to help, when there is a change in geometry, there is a change in symmetry, they have to work over a long period of time and they cannot recover because their endurance exceeds those considerations, namely the anatomy, the physiology, the implosion factor that any injury would give. So, I just -- while I agree, I disagree because there is more to be said about it than what's been said. MR. ANDERSON: Thank you, Doctor. Cross-Examine. KRAUSS, KATZ & ACKERMAN, INC. -- -- BONNIE BENNETT, D.O. 57 1 Q. All right. Does it appear today you 2 now have the additional records I just referred 3 to? 5 A. YOU said '89? Q. Yes. A. June of '89? Q. Yes. A. Uh-huh. Q. You just r.eceived those particular pre-accident records today; is that correct? 4 6 7 8 9 10 11 A. Yes, sir. 12 Q. All right. And the other sets of 13 records; the Dr. skyler records and the 14 post-accident records of Dr. seldow, you received 15 within the past few weeks? 16 A. Dr. Skyler? Do you mean Skyler 17 Weeks? 18 Q. Listen to my question, please. 19 A. I'm trying to. 20 Q. The records of Dr. Skyler from July 21 through December of '94 you received within the 22 past few weeks; is that correct? 23 A. Well, my confusion is that I don't 24 have records from Dr. Skyler, I have records from KRAUSS, KATZ & ACKERMAN, INC. -- ..-... .. BONNIE BENNETT, D.O. 65 1 then returned back to Dr. Seldow post-accident? <I A. No. 3 MR. DORER: I am going to mark your 4 office notes predating the accident from 5 December -- beginning of December 4, 1993, 6 consisting of some 20 pages, I believe, as 7 Defendant's Exhibit 4. 8 BY MR. DORER: 9 Q. And you have provided copies of that 10 particular subset of records before today's 11 deposition; is that correct? 12 A. Yeah. Yes. December 4th, '93, 13 correct. 14 Q. Okay. Now, you mentioned during your 15 deposition that you would treat Ms. Fox for the 16 musculoskeletal complaints post -- post-accident, 17 but would also treat her for the things you had 18 been talking to her about in the past, as well; is 19 that correct? 22 A. Yes. Q. What kind of things were you treating her for or counseling her for pre -acc ldent? MR. ANDERSON: Go off the record. I'd like to make an objection. 20 21 23 24 KRAUSS, KATZ & ACKERMAN, INC. ...... ._~ .__m_...__._____________.__ ------- BONNIE BENNETT, D.O. 68 1 the record.) 2 3 VIDEOTAPE TECHNICIAN: stand by, 4 please. The time is 3:36. We ~re back on 5 the video record. 6 BY MR. DORER: 7 Q. Are you in a position to answer the 8 question, Doctor? 9 A. Would you mind repeating it? I 10 forgot. 11 Q. Well, noting -- noting the objection 12 that's already been raised, I'll rephrase the 13 question to make it easier. What types of issues 14 were you treating Mrs. Fox for before this 15 accident beginning in December of '93? 16 A. circumstances of life and some 19 medical concerns. Q. Okay. What kind of medical concerns? A. A series of infections. Q. What kind of infections? A. Some of them were acute and there are some chronic complaints indicated in the notes. 17 18 20 21 22 23 Q. Such as? 24 A. I'm sorry, I'll have to go back KRAUSS, KATZ & ACKERMAN, INC. ~_..___......____... n ..._,',,_ .._.. ..~. BONNIE BENNETT, D.O. 77 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 from Ms. Fox as to what her prior condition was; is that correct? A. I made it based on my osteopathic examination. I knew of her history, but the tissues behave differently if they are asked to do a different workload. Q. But when you first made the diagnosis of an aggravation, you were not acquainted with the prior chiropractic records as we have discussed al,eady; is that correct? A. Not the records, but the knowledge of the treatment for that. Q. Based on what she told you subjectively at that time? A. Of course. Q. Okay. Let's look at your records postdating the accident, which I will mark as Defendant's Exhibit Number 5 for trial purposes. And I am going to do my best not to be repetitive with what Mr. Anderson has already gone through, but I would like to touch upon a couple of items, if I could. A. Q. Sure. The note of 1/14/95 -- KRAUSS, KATZ & ACKERMAN, INC. '"" ~ BONNIE BENNETT, D.O. 81 1 significant enough that merely making her passive 2 or inactive would have brought about changes. 3 She's the kind of person 8 Q. So, she was not A. -- who plows through Q. All right. A. -- things. Q. So, notwithstanding -- and I 4 5 6 7 9 understand that. But nonetheless, you did not 10 attempt to restrict her; is that correct? 11 A. No. 12 Q. And she was allowed to continue 13 . working as a court reporter after that visit? 14 A. working, yes. 15 Q. And as far a~ you are aware, she has 16 continued to work as a court reporter through to 17 the present time; is that correct? 18 A. I believe that there were some 19 circumstances that she had a few days off, but for 20 the most part, right. 21 Q. would you agree that family issues, 22 including behavioral problems or issues with her 23 husband and her children, persisted in February 24 10, 1995? ..____ _._.. __ _ ______~__.__.___._.___________________.____m._____~.________._____~_.__ __.~___~ ..".__ _.. _+u__._____..u__.._+_ . KRAUSS, KATZ & ACKERMAN, INC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ,""'1_..________._____ ,-., BONNIE BENNETT, D.O. 82 A. February 10, 1995. Yes. Q. Let me ask you about the 3/10/95 note. I know you touched upon the -- A. 3/10? Q. 3/10. 3/10. A. Okay. Q. Very next page. A. Yes. Q. There is a reference to happy birthday, and you did mention that in your testimony. But there is a reference to the best -- be~t ever, her year of abundance? A. Her words, again. Q. All right. Do you have any recollection as to why she would make that characterization or statement? A. She had been in counseling for a long period of time and is just coming to realize her own self worth. Q. Had she had self esteem issues to deal with before this accident? A. I thinK that that was even mentioned in the notes when I first saw her. Q. Did you finish answering my question? ._~---_._---_._-_.~---_. -.-- --- -------.- _._---~-------_.------_.- KRAlISS, KATZ & ACKERMAN, INC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ____._.,--...____._00_. '_00'_'''-'' BONNIE BENNETT, D.O. 85 Q. All right. There were only two entries on that date. But would you agree that there is no specific entry as far as the neck or right shoulder is concerned? A. No. Q. Do you agree with that? A. I do agree, uh-huh. Q. All right. Very next entry is 5/18/96, you note decreased bowel problems. Then there is a reference to, quote, disappointed love, closed quote. Do you know what that was about? A. Yes, I do. Q. What was that about and why is it relevant to the notes of a doctor? A. That is relevant to her impression of herself and how she's dealing with her life. We -- we have family history about certain circumstances, which will go unnamed. And also, the indication that she's resolving issues, the remedy that I was going to consider at that time was an indication that her personal self was resolving. It says mentioned it as disappointed love, means she's facing some facts of life that have been plaguing her. KRAUSS, KATZ & ACKERMAN, INC. ,....., ,-, _.n BONNIE BENNE'fT, D.O. --.. -..-----.----.----- ---- ---...-........ -,--_.--~_.----.-_....---- 89 1 bigger issue was the divorcing situation more than 2 anything else? 3 A. Well, yeah, l.t was slated to go 4 through the __ I don't knoW if they did mediation 5 or court case or how it was handled. 6 Q. Well, you knoW -- all you know is 7 that it was resolved in some fashion? 8 A. I know that it's legally been 9 determined that they are divorced. 10 Q. Would you look at 8/25/97? 11 A. Yes. 12 Q. Well, I'm sorry. I apologize for 13 bouncing around. Go back to 5/30, if you would? 14 A. Right. 15 Q. First thing you write is she's doing 16 well. Would that encompass both physical as well 17 as emotional issues? 18 A. Yeah. That's the I, the integral 19 role as a person perceives himself. Then they 20 usually tell you in what realm they have 21 dysfunction. 22 Q. All right. And then there is 23 reference to divorce issues with support, am I 24 reading that right? ..--... .--~._.-.__....--_.__.----_._~_._---_. __,._d__' ____... .--- KHII,USS, KATZ & ACKERMAN, INC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 """I "....., BONNIE BENNETT, D.O. 91 Q. Was it your impression, in addition to roller-blading, another -- that she was doing other activities, as well, too? A. Well, we noted the yoga, that much I know. Q. Okay. A. I think there was something about camp, but that might have been the children. I could be off on that. Q. Do you know anything about whether or not she was trying such sports as tennis, maybe? A. I think she -- I know the children played. I'm trying to remember if she played or not. It's not clear to me right now. Q. Can you point to any physical activities or functions, whether it be sports or hobby or anything like that, that Ms. Fox enjoyed before the accident in December of 1994, but cannot do now, medically? A. I can't say that I could answer that. Q. You are saying you can't answer that? A. I don't think I could answer that. Q. All right. If she were to indicate that she is essentially enjoying or performing _.___._,___.__________.__~_'__._n._____.._.__~____..__ ,. _..____.. __.__________ _ ___.._.~__.,,__..____,._ _____u_._. --- KRAUSS, KATZ & ACKERMAN, INC. r"""\ -_..-.. -.. ...--..---...-.--.. . - ~... ,..... BONNIE BENNETT, D.O. 93 1 complaints of pain or stress as a result of the 2 two-hour drive down here and the two-hour drive 3 back to Harrisburg on the occasions when she 4 visited you? 5 A. Sometimes. Now the children share 6 the drive sometimes, too. Q. Sometimes people will drive her? A. Yeah, that has happened, as well. Q. Who has driven her down here? A. A sister or -- I am trying to 7 8 9 10 11 remember her name. 12 Q. Would you be able to tell us how many 13 times she drove down by herself and how many times 14 she drove with assistance? 15 A. No. 16 Q. Was she ever -- 17 A. Often I -- often they let themselves 18 in and I wouldn't know the circumstances of their 19 arrival, because this door is locked. 20 Q. Would you agree that -- would you 21 agree that she was not medically restricted in any 22 form or sense from traveling either as a driver or 23 a passenger? 24 A. No, hut it had been noted that -------.---.-----.---.......-...... . .....-.--.-------- KRAUSS, KATZ & ACKERMAN, II/C. & ~ -.. _or ~ ~ r{ L" I . '-' ~ t". ,. lJ\/" \,': .!,"- '\ f\ 1.:)' ," , I"~ '.' I. ~ , S)~. ~ ~ ~ I ~Ij. I,;" ~ ~ I , . ~ ('-I; ~ ... t'" lid I ,.' ,I.).. ~ ~ .", ,. m ~ "j ,-. O' U . :l < (I'J ~ i ;; i ~!<~;I~ Ii: u..il'i '" I'" o<!;;~J;;;'" ~""Z53~t::' :ic.l'~"'=~;:: f; .. - - :..~ :'.1"'-" .....N <-~ ~ U r:: &J .. ~ -. CO) r M -~ "'!"'i ~~ Q.. Q ..~ C', L.(l .- g. ~ ~ . t" u.. ~, L'. ~ ~ U -< III -< CIl ::l 10 ~ ~ l!!11 !!l~e!:l;;S..!. CO-<~IlOI;::! ~~S~~i:!6 "" z .. = _.... is: 1IICI'J to-_ :J "": ill c .. ~- ~ ~ ;l!:'" t,) - III :. 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