Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
The doctor will take a complete medical history and perform a physical examination.
This history will include questions about other illnesses, prior spine problems,
arthritis, injuries, duration and type of symptoms, and response to treatments. The examination includes a spine examination, testing of basic nerve functions, an abdominal examination, and a general screening.
Often no diagnostic tests are needed for adequate treatment. In certain situations, imaging studies or laboratory tests of blood and urine may provide your doctor further information necessary to establish a diagnosis. If needed at all, they may not be necessary immediately
for a diagnosis. Sometimes they are ordered later if basic treatments fail to improve your condition.
Imaging studies may include the following:
Plain X-rays (and even computerized axial tomography, CAT scans) cannot depict a prolapsed disk and can only identify bony abnormalities. These
X-rays are best used to evaluate back pain that is from causes other than a prolapsed disk, such as bony displacement, tumor, or broken bone. Most young or middle-aged people without a history to suggest trauma or
suspicion of a tumor are best served without the expense and radiation associated with obtaining these
X-rays. In most cases, the bones seen on X-ray are normal.
More specialized tests include magnetic resonance imaging (MRI) or myelogram (which involves injecting a contrast dye into the spinal column). These are ideal for diagnosing a deformed disk and how a specific nerve is affected. In the absence of signs or symptoms suggesting severe nerve damage, however, these studies are very rarely necessary early in the course of the evaluation. This is because of the fact that the findings rarely affect initial treatment decisions. Your doctor may obtain these tests after a course of treatment fails to provide you relief.
A bone scan can detect infection, healing fractures, or tumors. This test is essentially never ordered as part of an emergency evaluation. But may be part of a further evaluation to find the cause of your symptoms.