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Published on July 28, 2015

In Pain? Feeling Sick? Start with your primary care provider

Dr. Stotz and PatientWhen Melissa Egger of Colton, S.D., woke up one morning with excruciating shoulder pain that only got worse, there wasn’t any question in her mind who she should call: Her primary care physician, Michael Stotz, DO.

Melissa had gotten to know Stotz after starting work for Avera Medical Group’s new clinic at Dawley Farm in Sioux Falls. “I was on the Avera Health Plan, so I needed to find an Avera provider. We just clicked and now my whole family sees him,” she said.

At first, Melissa hoped the pain would go away on its own. “I hadn’t done anything to injure my shoulder, so I was very perplexed. By the time I came into see Dr. Stotz, my entire arm was in pain and I was totally immobilized,” Melissa said.

“When Melissa came in, I could see that she couldn’t move her arm. Yet there was no obvious reason for her intense pain,” said Stotz, family practitioner with Avera Medical Group McGreevy Dawley Farm in Sioux Falls.

X-rays didn’t give a conclusive answer, so Stotz brought up a couple of options. Melissa could have an MRI and see an orthopedic specialist, or she could try a cortisone injection. Melissa was in such pain that she couldn’t bear the thought of an injection, so she opted to see a specialist.

The MRI showed inflammation in the bicep muscles, tendons, rotator cuff and shoulder joint itself. “There were particles and unexplained fluid,” Melissa said. Her orthopedic specialist also recommended a cortisone injection, and within a few days, the pain calmed down. Melissa learned that the condition was caused by a virus which had settled in the area.

Unfortunately, this wouldn’t be the last time that Melissa would need to call upon Stotz to help her navigate through a painful episode. A few months later, she was at a stop sign when the rear of her car was struck by a driver traveling at a high speed.

The violent jarring caused a concussion, but no fractures or internal bleeding. The emergency room physician told Melissa she’d be hurting all over the next day. “They said I was to follow up with Dr. Stotz,” Melissa said.

Stotz had notes and test results from Melissa’s emergency room visit at hand through Avera’s electronic medical record. “When someone is in an accident like that, my first action is to provide pain relief, and wait for things to calm down while the body starts healing,” Dr. Stotz said. After Melissa got past the initial pain, she began to have intense back spasms.

Stotz recommended physical therapy, and as a doctor of osteopathy, he also tried some manipulations. “That combination helped me to the point that I only needed pain medications for a short time,” Melissa said.

“She was getting better, but she still would occasionally have episodes of intense back pain,” Stotz said. CT and MRI scans didn’t show any condition that needed surgery. “We kept doing what we were doing, and I also recommended prolotherapy.”

Prolotherapy is an injection technique for chronic musculoskeletal pain resulting from an injury or overuse. “I was a little skeptical as to whether or not it would help me, but I hit a breaking point and thought I had nothing to lose. It was either going to help me or not,” Melissa said.

The prolotherapy did help. “I’m really glad I had it. It made a big difference in the amount and intensity of the spasms I had,” Melissa said.

Melissa said she’s thankful for the coordination of care through her primary care provider. “He never dictated what I should do. He always gave me options and together we made the decisions for my care.”

“My job as a primary care provider is to be able to handle 90 percent of the care, and then know when I need to refer to a medical specialist or other health care provider such as a physical therapist or chiropractor,” Stotz said. “It’s kind of like being a quarterback on the team. I don’t run all the plays, but I’m right there at the center of all the care that’s taking place.”

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