Booking

In virtually all cases involving spine, head or neuropathic problems, I will need to review your imaging. It does not matter if they were reported as normal.

To send the images 1., copy all the imaging disc’s content into a folder (use different folder names if multiple discs). 2., compress the main folder using Winzip or similar (file should be at least 30 megabytes, usually more; if the file is tiny then something is usually wrong. Compressing the main folder (the folder that holds all the files) is sufficient). 3., Send the compressed file to [email protected] using wetransfer.com (link valid only 3 days; please note that I do not have time to double-check this prior to session — Please do not email me and ask me to confirm your imaging outside of session), google drive, or similar. If you don’t understand how to do it, please get someone to help you (I do not have time to guide you on how to do this personally; my apologies). If you choose to use Google drive or Dropbox, please make sure that you send me a download link, not a sharing link (Google drive: click “get link”, and configure it so that “anyone with link” can access the files. Send that link). These two are not the same.

You can also review this link: https://www.linkedin.com/pulse/guide-doctors-patients-how-send-medical-cd-via-internet-posavec/

If you want to confirm that the files that you are sending me, work, and this is indeed a good idea, you can download a free DICOM reader (eg. HOROS for mac software or RADIANT for Windows) and check for yourself whether or not the files that you have prepared actually work. Please ensure that you are sending actual professional imaging files (DICOM files) and not JPEG or PNG (picture files).

In virtually all cases involving spine, head or neuropathic problems, I will need to review your imaging. It does not matter if they were reported as normal.

Exact necessities will be individual, but I will attempt to create a general template of requirements and “wants”, ie. studies that may be helpful but not necessarily mandatory, to various popular maladies:

• Chronic or violent [nerve] pains in the neck, arms, chest, or upper back: Cervical spine MRI
• Chronic or violent [nerve] pains in the legs or lower back: Lumbar spine MRI
• Chronic or violent [nerve] pains in the legs, genitals, lower back and pelvis: Lumbar spine & bilateral hip MRIs (the hip MRIs should preferably include fluid sensitive axial and sagittal PD-fat sat sequences)
• Thoracic spine pain: Cervical & thoracic spine pain (depending on exactly where the pain is. Most cases of upper back pain originate from the cervical spine and not the thoracic spine, mainly via the dorsal scapular nerve).
• Chronic or violent headaches, fatigue, brain fog, vestibular problems, visual problems, tinnitus, pulsatile tinnitus: Brain MRI (mandatory), cerivcal spine MRI (mandatory), Ultrasound doppler carotid and vertebral arteries (optimal), digitally exported — well zoomed retinal (fundus) photos (optimal), CT angiogram of the head neck and subclavian arteries (optimal) (late arterial phase of contrast, preferably infused via the femoral vein and not the brachial vein, as it causes great distortion of the ipsilateral subclavian veins).
• Suspected neurogenic jugular outlet syndrome (applicable for, eg., Tourette’s disease, Dystonia, diffuse non-systemic myoclonias): Brain MRI, CT of the craniocervical junction (this is usually included in a head CT, but not always. Always included in a neck CT.)
• Hip pain: Hip MRI and/or x-ray. If you suspect the pain is neurogenic, then a lumbar spine MRI may also be required.
• Genuine wrist, knee and ankle problems (that are not mere manifestations of proximally originating nerve pathologies) are difficult to diagnose and treat virtually, and typically require a physical assessment with close imaging correlation. However, if you still want to give it a shot, then we will at least require imaging of the joints. Fluid sensitive PD fatsat imaging is helpful. The imaging should be acquired while the joint is painful, as this increases the likelihood of capturing the inflamed area.

During a virtual session, we will review your case history, medical imaging or bloodwork. I will ask you very specifically about your symptoms, their locations, triggers, etc. Although I cannot examine you physically, we tackle this by instructing you on how to perform certain tests or provocative movements yourself (eg. Spurling’s test (radiculopathy), Roos’ test (thoracic outlet syndrome), etc) while I watch. Sometimes, I may also instruct your friend or spouse to perform certain tests on you (eg. myotome tests for radiculopathy). The way I conduct my online consults work well and I have helped numerous patients online since 2017. Certain regions are more difficult to evaluate online, especially wrists and knees due to highly specific manual diagnostic techniques that cannot easily be reproduced by the patient nor replicated on guidance. Not impossible, but it tends to take longer to reach conclusive diagnostic certainty.

Once we have narrowed down the diagnosis, or most likely differential diagnoses, you will be given homework that is done weekly / daily depending on what the actual issue is. The treatment can be postural, exercises, pharmacological, or referral for surgery. I may also refer you out for additional testing if necessary.

You do not need to be very computer savvy to have a virtual consultation. If your computer works as it should, just create a Discord account (see “register“, just below “login”). Try to choose at least a screen name (separate from username) that reflects your actual name, or else it will be difficult for me to know who you are in the future. You should send me a discord friend-request at least one day prior to your consultation (details are found in the booking confirmation that is automatically sent to your email). You should make sure your microphone and video settings are checked and working prior to the session. You should ensure that you have a working internet connection with adequate connection speed (this is usually not a problem, as most locations have good internet at this current point in time). Get a local friend or loved one to help you with the creation and pre-checks, if you feel intimidated by the technical peculiarities. It is, generally, however, quite effortlessly done.

Presential consultations in your own home and country 

I can offer my services in domiciliary fashion for the patient who prefers a presential work-up but is not wiling to travel to Colombia. Pricing starts at 5000 USD (+ expenses) per day for the first three days, then 3500 for each subsequent day of travel. I can carry handheld ultrasound equipment, but other necessary imaging will have to be planned locally, with or without my assistance. Send me an email if you are interested in this service. I will only travel to countries where I may enter visa-free with my NORWEGIAN PASSPORT.

Some information regarding in-person consultations in Colombia

My home is located in the city Bucaramanga, which is in the state Santander. It is about 45 minutes (by air) north of Bogota, which is the capital. The airport (Palonegro International Airport) is about 30 minutes outside of the city by car, and driving into town costs 40.000 pesos which is about 10-12 USD. The neighborhood that you’ll be staying (at least by my recommendation) is called Cabecera, which is a high-class, safe neighborhood.

The consultation itself will include the careful taking of your anamnesis, full examination, examination with ultrasound (if applicable), imaging review (MRI, CT, etc.), customized homework that we carefully review together (and videotape), and/or recommendation for case-specific surgical solutions. There is also access to a simple gym where we can work on technical things (if applicable), such as scapular movements, hip and low back stability, etc. Lunch and refreshments are included. As with anything, time spent outside of the six included hours in the booking will be requested after your stay’s conclusion. If you need to elongate your stay, this can usually be arranged, if necessary. If you are visiting on a budget (which is perfectly fine), it is important that we discuss this, so that we can plan appropriately, as well as possible to avoid misunderstandings and additional costs.

Since Dec. 2021, the government of Colombia has made it mandatory for foreigners to be vaccinated to be granted entry to Colombia. Either fully vaccinated, or 1 dose + negative PCR test. See this link for updated news: https://colombia.travel/en/covid-19-information. It is also crucial that you investigate about the rules of access to the country before paying your session. (update as of November 1st 2023; to my knowledge the vaccination implementations have been ceased)

If you want to get imaging done in Colombia, you need to be aware of any potential contraindications to MRI (mainly patients with aneurysm clips, pacemakers, defibrillators or other implanted electronic devices, claustrophobia), CT (contraindication to ionizing radiation, such as pregnancy or already having had numerous CTs prior), or contrast medium infusions (mainly kidney illness, metformin use or certain thyroid treatments with radioactive iodine) at the time of ordering any such extra exams. Speak with your primary physician about this if you are not sure.

If you need to get *a lot of imaging done*, we should plan this either the day before, same evening, or day after the consult has been done. Beware that a followup might be needed to get time to review the images together, if they are not ready by time of the scheduled consultation.

Beware that most people in Colombia do not speak English. Getting to the right airport is not difficult, but if you need help getting picked up at the airport and delivered to a hotel, let me know in advance. Bucaramanga is a safe city as long as common sense is used (eg., not flashing money or jewelry/phones on the street) and as long as certain neighborhoods are avoided. I recommend Hotel Holiday which is a part of the Cacique Centro comercical (mall). This hotel is close to my house and is a high-class hotel.

If you want to go on vacations before or after the consultations, I recommend cities and isles such as Cartagena, San Andres (isle), Santa Marta, or Medellin. I recommend going by plane when you need to travel, but bus can also work in some circumstances. Traveling is mainly recommended for spanish speakers.

Safety tips in Colombia:

https://theculturetrip.com/south-america/colombia/articles/10-essential-tips-for-staying-safe-in-colombia/

https://internationalliving.com/5-places-to-live-in-colombia-2-to-avoid/

Tourism tips in Colombia:

https://theculturetrip.com/south-america/colombia/articles/the-safest-spots-to-visit-in-colombia/

https://www.colombia.co/en/colombia-travel/unique-experiences/colombia-best-country-travel-top-10-travel-tourism-questions-answered/

https://www.tripadvisor.com/Tourism-g297474-Bucaramanga_Santander_Department-Vacations.html

This is a fully private practice. Unfortunately, we do not take insurance. We do not produce special invoices or other documents for insurance coverage eligibility. For insurance coverage, please speak to your insurance company regarding reimbursable clinics with whom they cooperate.