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VIRTUAL VISIT
 
At the Chiari Care Center, we strive to evaluate all aspects of your health using a multidisciplinary approach. We do not just focus on the Chiari as the only condition that may be causing the symptoms you are experiencing, but expand our focus to include many aspects of your health.
 
Your health care provider can fax a referral to our office (303-752-5240) to request evaluation, or you can self-refer. The information needed to schedule an appointment can be found at: http://www.chiaricare.com/Consultation/Schedule-a-Consultation.aspx
 
You must have an MRI within the previous 6 months that shows evidence of Chiari malformation or syringomyelia prior to scheduling the appointment.  If you have had previous surgery for Chiari malformation or syringomyelia, you will need to fax the operative reports (these can generally be requested from Medical Records department at the hospital where the surgery was performed). You will need to hand carry any recent MRI discs with you for your appointment- do NOT rely on the facility to mail the MRI disc. If you have older outside MRI scans of the brain or spine that may be helpful, bring them as well.
The Chiari Care Center is located at 1444 S Potomac St, Suite 170, Aurora CO- on the first floor of the office building. The office building is directly across the street from the main hospital (The Medical Center of Aurora). Please arrive about 30 minutes early for your first visit to complete paperwork. If possible, please print the new patient forms (http://www.chiaricare.com/Consultation/Patient-Forms.asp ), complete ahead of time and hand carry with you to the appointment.
You will be greeted at the office by our front desk receptionists: Sylvia. You might have already talked with her by phone. You will receive the rest of the paperwork that needs to be completed for your appointment. Please bring your insurance card and a photo ID with you. Your insurer may require a co-pay- check your insurance card or call your insurer to find out the amount. You will also meet our Medical Office Assistants: either Kelly or Linda, who will escort you to the exam room and take your vital signs. You will be asked to complete a list of your current medications (including the dose and reason for taking the medication). Please bring a copy of your current medication list so we can document all medications (including over the counter, vitamins and supplements). You will also be asked about your pain- or a numeric rating of your pain (from 1-10). If you have any outside records (such as previous medical office visits, test results or procedure reports) please give them to either Sylvia, Kelly or Linda to make copies for our records.
The first day of your visit will take about 1 hour and you will meet with one of the Nurse Practitioners: Ms. Kimberly Sexton, MSN, FNP or Dr. Diane Mueller, RN, FNP (see their bio at this link: http://www.chiaricare.com/Our-Center/Our-Staff.aspx ).  Time will be spent to extensively review your symptoms, medical/surgical history, medications, and previous treatments. You will have a complete neurological examination (described on this link: http://www.chiaricare.com/Chiari-1-Malformation/Treatment.aspx ).  If you have had an MRI at an outside facility, please hand-carry the MRI disc for your appointment- do not rely on the disc being mailed to the office. After your history and physical exam have been completed, your scans will be reviewed and determination will be made if additional scans or tests will be needed. In some cases, blood samples may be recommended to evaluate other medical issues (such as thyroid, diabetes, inflammation, etc.). If additional tests are recommended, you will meet with one of the Medical Assistants to schedule the tests during your visit. Your insurance will be notified by a member of our office staff of any additional tests that require pre-certification.
The second day of your visit will consist of a general health evaluation by one of the Nurse Practitioners. You will complete a brief pencil/paper test (called BBHI-2, or Brief Battery of Health Improvement-2) - this form will be given to you when you check in at the front desk on day 1. The test will be analyzed and the results will be discussed. The general health evaluation consists of discussion of nutrition, sleep, medications, and any other general health issues that can affect your symptoms. General health recommendations will be made if indicated.
On the third day of your visit, you will meet with Dr. Oro’ to review your neurological examination. During this time, Dr. Oro’ will also review your scans and explain the images/findings with you and your family.  Not everyone with Chiari will need to have surgery. Conservative treatments will be considered, including medications to help manage your symptoms, management of other medical illnesses, dietary recommendations, and lifestyle changes.
The decision for surgery is multi-dimensional and involves your neurological examination, general medical history, general health, current medications and the MRI findings. Symptoms related to the Chiari malformation/syringomyelia will be discussed in detail, including the effect of symptoms on your quality of life. If surgery is indicated, Dr. Oro’ will discuss in detail the surgical procedure using diagrams and models. The risks and benefits of surgery will be discussed. This is your opportunity to bring a list of your questions to discuss with Dr. Oro’ and make sure all of your questions are answered.
If the decision for surgery is indicated, you will receive a phone call regarding available dates. Our surgery days are Tuesday and Thursday. After deciding on a surgical date, you will receive a surgical handbook in the mail, which describes how to prepare for surgery and what to expect in the months after surgery. If you have questions prior to surgery, please feel free to call the office and discuss with either Kimberly Sexton or Diane Mueller.