Vertigo and Balance Problems; Screening for Appropriate Referral

With complaints of dizziness, vertigo or disequilibrium,in this day of managed care, many providers must
symptoms can be the result of vestibular, neurologic,succumb to time constraints prohibiting extensive
vascular, psychologic and even orthopedic pathology.examinations, necessitating referrals to specialists.
As such, it is not always clear which specialty isCurrently, 50% of patients seen in the primary care
appropriate for referral. In this age of cost awarenesssetting receive no diagnosis for their complaints of
and effectiveness, the primary care physician mustdizziness, yet 70% receive a prescription for meclizine,
make important decisions as to the appropriateness(Antivert). Meclizine has not been demonstrated to be
and cost-effectiveness of diagnostic procedures andeffective or appropriate in the treatment of chronic
referrals to specialists. Patient's complaining ofdisequilibrium, dizziness or imbalance. It is occasionally
dizziness or disequilibrium without obvious objectiveeffective in reducing nausea associated with vertigo
signs, for lack of a more specific diagnostic direction,spinning in some forms of chronic vertiginous disease,
are often referred for MRI/CAT scan imaging studieshowever, it is not curative in any way, and in fact
to rule out the possibility of brain lesions. The costinterferes with the natural recovery process often
effectiveness of this decision deserves scrutiny, as theworsening matters further. It is appropriate to state at
yield of these studies is very low whereas thethis time, that you do not need a specialist referral to
diagnostic yield of appropriate physical examination inconsult with me in my office.
the doctor’s office is very high. "BalanceDr. Scopelliti is a chiropractic neurologist, practicing at
disorders are common, while brain tumors arethe 279 Professional Arts Bldg at the rear of
rare". Prior to the commencement of tests suchMonmouth Medical Center, in Long Branch, NJ. He is
as MRI, points that need consideration are the likelihoodalso currently the president of the NJ Chiropractic
that MRI will provide any relevant diagnostic informationCouncil on Neurology. His office specializes in the drug
and whether the sensitivity of less expensive morefree management of vertigo, dizziness, balance loss,
diagnostically useful tests can be performed first. In ourpresyncope, dystonia and headaches. Dr. Scopelliti
office, the goal of the initial office examination is tooffers a free no obligation consultation to discuss your
determine the probable cause of the patient'sproblem prior to the commencement of any
symptoms. A directed history and extensive neurologicexamination/treatment. The office can be reached at
physical examination allows for more exacting(732) 229-5250 to arrange a free consultation, ($75
diagnosis and thus successful treatment. Unfortunately,value). Dr.