Letter from Pablo Koval:
With regard to your November newsletter ‐ a very interesting update on the subject (Neural therapy and surgery).
One point I would like to add is the possibility that the surgery, although minimal, may act as a "second" blow and trigger a sometimes serious clinical picture that actually has to do with the patient's previous health status. At this point we have to think if many malpractice lawsuits are actually due to that second blow and not to a real malpractice action. Therefore, it is appropriate to point out that it is the surgeon´s responsibility to discard previous states that could facilitate that response ‐ basically a good evaluation of the mouth/teeth.
The problem is that the examination by an orthodox dentist is not enough. It is necessary that the examination be performed by a neural therapist who knows how to recognize dental problems that may act as interfering foci, for example, a bad positioned wisdom tooth, etc..
Dr Koval brings up a very interesting and important subject ‐ the development of a complex problem after surgery that has nothing to do with the surgery itself. The surgery is simply the "second blow" as described by Speransky.
I would like to take Dr. Koval's warning a step further and submit that trauma of all kinds, and not just surgery, can be second blows and make for very complicated clinical and medico-legal situations. I see this commonly after motor vehicle accidents, especially "whiplash" accidents, where the injury seems to be relatively minor but the ensuing disability major. These cases are difficult to deal with from a medical standpoint and even more difficult to explain to lawyers and insurance companies. Personally, I dread requests from lawyers for medical reports for these reasons, because it demands from them a whole new way of thinking about the results of trauma.
Here is a case I saw a few years ago:
A 34 year old woman was the driver of a car that was struck from behind by another vehicle. Some damage was sustained by her vehicle, but she apparently was not injured and left the accident site unscathed. It was only a few weeks later that she developed neck pain, balance disturbance,etc.
At first I thought that this would be an ideal case to deal with using neural therapy. The interval between the injury and the manifestation of symptoms was a perfect example of the latent period described by Speransky. And indeed she had interference fields in her stellate ganglion, etc.
However she did not do well, despite my best efforts. Response to treatment if any was short-lived, and she began to deteriorate with fatigue, depression, etc. It was only many months later that I began to realize that the automobile accident was acting as a "second blow" and there was an underlying undiagnosed medical condition. This turned out to be Lyme disease.
I suspect that the current epidemic of post‐concussion syndrome is similarly a result of cranial trauma acting as a "second blow" and awakening a number of underlying medical conditions. These are often related to systemic problems with nutritional, toxicological and immune components, not likely to respond to neural therapy alone.
Robert F. Kidd, MD, CM