25 things you didn't know a chiropractor could do: Chiropractic management of depression.

Many people think of chiropractic care as nothing more than a spinal adjustment. While that is the core of our therapeutic interventions, there are a number of other ways we restore patients to health.

I employ lifestyle and nutrition interventions with almost every patient I see; and when you include the ability to utilize blend custom herbal formulae as well as acupuncture and other modalities, the scope of a chiropractic physician's interventions are wide-ranging indeed. The multidisciplinary skillset of the modern chiropractor makes us unique and uniquely valuable to patients suffering from chronic diseases.

People suffering from depression are frequent visitors to my doorstep because, like most chronic disorders, depression is poorly managed by mainstream medicine. Pharmaceuticals -- medicine's primary response to depression -- really don't work that well, especially over the long term. Prozac and the other SSRI's are based on a scientifically-unsound model of depression; and while more recent innovations, such as ketamine, can in certain cases be more effective than an SSRI, medical management of depression largely remains a crapshoot.

Which is why I have made it a point to study the myriad causes of depression and the most effective drug-free therapeutics for people suffering with this disorder. And what the research shows -- and what any evidence-based doctor should realize -- is that there are many ways to successfully address the problem of depression, ways that are far more effective than taking a drug. In this vein, I also make frequent use of the clinical social workers and psychologists who are truly skilled at diagnosing and managing depression without drugs.

I was recently asked to give a presentation on this topic to the annual convention of the Connecticut Society of Medical Assistants. As always, I immensely enjoyed talking before this group. They are interested, animated, participatory and questioning, which are the best qualities for any audience to have.

At the request of several of my patients and others, I am posting the slides I used for this lecture. While I try to pack as much information as I can on my slides, much of the content of the lecture is necessarily lost. Please contact me if you would like more information on any of the topics I cover.

depression-CSMA

Chiropractic Care and Anxiety

Anxiety is a problem which has afflicted us all at one time or another. Fortunately, our anxiety is usually the result of a specific context or situation, and it resolves as we move to meet the problem or it is otherwise solved. Not so for many, however, who have to deal with anxiety on a day-in, day-out basis. Many people experience panic attacks for no reason, where their heart starts pounding, they get short of breath, and they get a feeling of dread. Generalized anxiety, a free-floating sense of worry that is out of proportion to the cause, can last for weeks or months, and can result in insomnia, hyperactivity, headaches, irritability, abdominal distress and other symptoms.

Mainstream medicine, of course, relies primarily on drugs to treat anxiety disorders, but these drugs can create more problems than they solve. Benzodiazepines, for example, interfere so much with mental functioning that anyone who is taking that class of drug is not permitted to have a commercial drivers license, and they are also highly addictive. A common anxiolytic, Xanax, is one of the most frequently-used drugs to treat this condition, despite the fact that there are no long-term studies confirming either it's effectiveness or it's safety.  Overall, the use of anti-anxiety drugs increases your risk of death from a variety of causes, so with all of this in mind, drugs may not be the best answer for this particular problem.

Fortunately, there are several ways of managing anxiety that do not require drugs. EEG neurofeedback, a technique which uses real-time electrical signals in your brain to alter its patterns, has been used quite successfully to manage anxiety. Fortunately, Litchfield has an excellent clinical therapist who is also highly skilled in EEG neurofeedback. David Pavlick is a clinical social worker with an office at the Center for Alternative Medicine, and has helped many people overcome their anxiety.

Cognitive Behavioral Therapy, or CBT, is the current darling of psychology, and it, too, appears to be  very effective in treating anxiety. In fact, a variety of talk therapy techniques have been shown to help people with anxiety.

But, as is the case for most chronic problems, a multidisciplinary approach usually results in better results. People with chronic problems, especially mental and emotional disturbances, should also be examined by a primary care chiropractor to eliminate underlying physical and nutritional causes for the anxiety.

Multiple studies have confirmed that balancing the essential fatty acids (EFAs) can reduce the symptoms of stress. Back when I started practicing, I used to hand a patient a bottle of EPA or DHA and have them take it for a month to see what kind of response we would get. These days, however, I can order a simple blood test, covered by insurance, which will show me the patients' levels of the various essential fatty acids, eliminating the guesswork. I can tell without trial and error whether or not such an approach is likely to work, and if so, exactly what kind of dosages of which EFAs I need to make my patients better.

The B vitamins, magnesium and calcium also play a role in anxiety states, and adjusting these levels may help as well. Imbalanced hormones will also often play a role, as an over- or underactive adrenal gland, or an imbalance in the hypothalamic-pituitary axis can be primary causes of anxiety symptoms.

Very often, I find, that in order to correct my patient's nutritional status, we have to begin by fixing impaired digestion, one of the most common -- and most overlooked -- causes of mental and emotional issues that I see.

With all of these conditions, once again, instead of guessing, I test, and use objective measures to tell me if these types of intervention will be useful.

Finally, Traditional Chinese Medicine can be successfully employed to help patients with anxiety. From a TCM point of view, there is no separation between mind and body, and the freedom from that false duality gives us the ability to view anxiety from an entirely different angle.

In TCM, anxiety stems primarily from an imbalance in the Spleen organ system. Because the Spleen, in TCM, is responsible for extracting qi from the food, Spleen imbalances result in qi stagnation or depression.

When qi becomes depressed in the middle jiao, then you start to experience the signs and symptoms of panic attacks, as well as other classical signs of anxiety. Thus, from a TCM point of view, restoring normal Spleen functioning is primary to the treatment of anxiety. (As a side note, I find it very interesting that in both TCM as well as Western alternative medicine, the digestive system is found at fault in mental disorders.)

So, fortunately, for people experiencing anxiety, there are a number of approaches that can be used to assist them. From nutrition to acupuncture to lifestyle and herbal interventions, a variety of forms of alternative medicine can be used as an adjunct to, or even primary means, of helping people deal with anxiety disorders.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

25 Things You Didn't Know a Chiropractor Could Do: DOT Medical Exams

Last week, I attended a seminar with a few hundred other doctors to get prepared for the new federal regulations about DOT medical exams. Anyone who has a commercial drivers license (CDL) knows about the medical exam they have to take every 2 years (sometimes more often) in order to keep it. I've been doing these exams for several years, and over this time, the federal Department of Transportation has been reviewing and upgrading their medical exam program.

The result is that, in 2014, any doctor providing DOT medical exams will have to pass a test and be certified by the agency before they will be allowed to issue medical certificates to drivers. Always one for being on the bleeding edge, I'm one of the first physicians in the country to have undergone the new DOT training, and I will be among the first wave of doctors to be taking the test later this year. The regulations have gotten complex enough so that this has become a bit of a speciality, and can no longer be adequately performed by most primary care physicians.

In order to make it easier for drivers, I've developed my 65-15-24 Guarantee.

65 -- The full cost of the exam is $65. Unlike others, I will not charge for reviewing medical histories, consultant reports, or additional visits that might be required by DOT regulations.

15 -- Once you have completed your paperwork, you will not wait more than 15 minutes to see me. If you do, your exam will be provided at no cost.

24 -- You can get in to see me for your exam within 1 business day.

If you've ever read my previous post on my core principles, you will see how this service fits, and why I've chosen to incorporate this guarantee.

Check your paperwork. If you need to re-up your medical exam, or you know someone who does, have them give me a call at 860-567-5727. Or, go to www.dot-exams.com for more information.

And the Answer Is...

Last Friday, I issued the first DocAltMed IQ Test, with a reward of 10% off any supplement purchase from our Dispensary. The question was:

What institution provided the first acupuncture education for doctors in the U.S.?

Before revealing the answer, I would like to first thank the many competitors who submitted a response. Your answers were thoughtful, informed, and well-researched.

This was a difficult question to answer, however, because of the many competing claims for "first." For example, one organization claims that it "has the unique distinction of being the first acupuncture course for physicians in North America," by virtue of its first course in 1979.

Wikipedia, in a marvelous display of acupuncture misinformation, reports on no postdoctoral programs whatsoever. Of course, that Wikipedia page is so filled with half-truths and innuendo that only about every third word is believable. (Overall, I have found that when it comes to Wikipedia, the entries on alternative medicine are dominated by a few skeptics lacking any credibility (and also, presumably jobs, since it would appear that their main calling in life is to disseminate crowdsourced falsehoods)).

The American Academy of Medical Acupuncturists was presented to me as a possible candidate; however, it was not formed until 1987, and restricts training and membership to a subset of physicians, as only MDs and DOs are eligible. DCs, despite being physicians, are not participants in the AAMA.

The physicians who practice acupuncture the most are chiropractic physicians, and may be board certified by two agencies. One is the recently-formed ACA Chiropractic College of Acupuncture, and the other is the International Academy of Medical Acupuncture (I am a Fellow of the latter organization, through which I obtained my postgraduate education). Interestingly, the chiropractic interest in acupuncture extends  way beyond James Reston's re-introduction of acupuncture to the West, as I described in my earlier post.

In fact, the modern founder of chiropractic, DD Palmer, mentions acupuncture in his 1910 textbook, The Art and Science of Chiropractic. Other investigators since that time have noted the coincidence of chiropractic manipulation's success with visceral diseases, and the presence of acupuncture points along either side of the spine which can influence those very same conditions. From 1910 until 1972, however, acupuncture utterly disappears from the printed page in the U.S.

It is not terribly surprising then, that chiropractors be among the vanguard of doctors who adopted this new and powerful technique. Thus, it was at the Columbia Institute of Chiropractic, in New York, which began the first postgraduate program in acupuncture in the fall of 1972. Columbia has since become New York Chiropractic College, and has moved from the city to beautiful Seneca Falls, NY.

Dr. John Amaro, founder of the IAMA, recalls it this way:

"I am personally proud to have been in that very first acupuncture certification program which was taught by masters of acupuncture who were physicians from the United States, Great Britain, The Republic of China and Japan. As few early Asian educators of acupuncture spoke English the lectures and demonstrations were translated. Chinese acupuncture practitioners from Communist People's Republic of China would not begin the introduction of Traditional Chinese Medicine (TCM) in the United States for as much as an entire decade later when communication was established. Virtually all acupuncture in North America from 1972 to 1982 was performed through Japanese or Taiwanese "Meridian Style" influences. Likewise, virtually all acupuncture in North America was performed by chiropractic and medical physicians as "acupuncturists" as a profession would not become a reality until the National Commission for the Certification of Acupuncture was established in 1985.

The Chiropractic profession had always taken the lead in acupuncture education and certification. Even though the National Commission for the Certification of Acupuncture would not become established until 1985, the State of Arizona established Board Certification in Acupuncture through the Arizona State Board of Chiropractic Examiners as early as 1983."

So, interestingly, not only did the chiropractic use of acupuncture predate any other health profession, but chiropractic doctors were the first to properly certify and regulate its members who practice the art, a full 4 years before the medical profession even started to form its acupuncture college, and 2 years before the acupuncture-only profession was created. Today, over 35,000 chiropractic doctors practice acupuncture.

Surprised? I thought you would be. Chiropractic is full of interesting history which is rarely reported or discussed.

Thank you very much to all who participated, and since nobody won, everybody is eligible to participate in next week's Alternative Medicine IQ Test.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

25 Things You Didn't Know A Chiropractor Could Do #4: Osteoporosis

It appears that the medical community is about to foist yet another quack "cure" for osteoporosis on the women of this country. Prolia, the latest alleged treatment for osteoporosis, is an injectible that was approved by the FDA primarily on the basis of a single study paid for and conducted by the company that developed the drug. Ok, let me repeat that one more time. The FDA has approved a dangerous (we'll get to that in a minute) drug on the basis of research that the developer bought. Not to put too fine a point on it, but government oversight of BP's woebegotten Deepsea Horizon was more stringent than this.

And I haven't even gotten to the good parts yet. Prolia, it turns out, suffers from the same problem as all of the other osteoporosis drugs -- it actually kills bone, rather than create healthy bone. This rather unfortunate tendency is already the subject of multiple lawsuits from women who have been permanently disfigured and disabled by the drugs that were supposed to cure them. Despite the fact that Prolia destroys bone, the FDA has allowed it's release as a treatment for osteoporosis.

Lest I forget, some of the other effects of Prolia include back pain (!), severe calcium deficiency, increased urinary tract infections, increased respiratory infections, increased risk of cancer, eczema, cataracts and joint pain.

I respectfully suggest that if your medical doctor recommends that you receive Prolia injections for your osteoporosis, you should run, not walk, to your nearest chiropractic doctor for osteoporosis treatment that is safe, effective, and inexpensive.

Which brings me to the point of this column. Yes, Virginia, chiropractic doctors do treat osteoporosis, and quite successfully.

Osteoporosis is yet another one of those lifestyle diseases that is most appropriately treated at the source, with changes to habits and diet, using both supplementation and in some cases acupuncture to correct the initial imbalance.

Using these tools, I have been able to reverse bone loss, a reversal which was significant and measurable by laboratory testing.

And it's with the laboratory tests that I begin. Because the cancer-causing radiation tests that medical doctors like to use (they *did* tell you that the bone scan increased your risk of cancer, didn't they?) provide only a snapshot of limited value. They tell you nothing about the health of the bone nor of the rate of calcium loss from the bone, both of which I would consider absolutely fundamental data to have before beginning any treatment.

With labs and physical examination results in hand, I can then put together a treatment plan goes a bit further than "take 1,500 mg of calcium daily" that the medical community substitutes for informed nutritional advice.

With my patient we work on diet, we work on exercise, we work on all of the factors that have led to the bone loss from which they suffer -- and which can lead them out of it.

Drugs? -- Who needs 'em? When it comes to osteoporosis, chiropractic physicians have a far better answer than any other health care provider.

25 Things You Didn't Know A Chiropractor Could Do, #3: Mental Health

Believe it or not, the treatment of mental health problems constitutes a fair amount of my practice. People who are stuck in the chiropractor = back pain paradigm get all squinty-eyed when you bring this topic up. But the fact of the matter is that every chiropractic physician has had training in the evaluation and treatment of depression, anxiety, and other behavioral issues. It is part of our standard education. It has also been a substantive part of my postgraduate education as well. While the squinty-eyed among us may find this hard to accept, the use of drugs to manage moderate mental health issues is (thankfully) on its way out.

The first death knell in the pharmaceutical paradigm was sounded several years ago, when the American Psychological Association published a groundbreaking article, Listening to Prozac, which found that the effect of the most common type of antidepressant medications such as Prozac were largely due to the placebo effect -- that is, Prozac works only because people believed that the pills would work, because their medical doctor told them so. According to this and subsequent studies, SSRIs -- the class of drug to which Prozac belongs -- are almost next to useless.

With the pharmaceutical option on the ropes, people suffering from anxiety and depression are increasingly looking to their chiropractic physicians for relief.

And, fortunately, we have some answers.

First of all, since chiropractic doctors don't live in the pill-for-every-ill world, we're more comfortable with approaches like talk therapy. I, for one, have a ready list of therapists with a variety of skills and specialties whom I frequently turn to for co-management of these disorders.

And as you might imagine, mental health problems are no mystery to Traditional Chinese Medicine. Interestingly, TCM diagnosis and analysis of these problems is very sophisticated. Though, in the peculiar idiom and allegory of TCM, the diagnoses have some inadvertantly humorous names, such as Plum Pit Qi, Oppressive Ghost Dreams, and my all-time favorite, Running Piglets:

I'm very sorry Mrs. Jones, but you've got a bad case of running piglets!

Humor aside, through the intelligent use of acupuncture and herbs, I have been able to help many people with depression and anxiety disorders.

Another drug-free approach to mental disorders is through nutrition. Nutritional treatment for depression has made great strides since the mid-nineties, when the approach was generally to just throw St. John's Wort at the patient and call it a day.

Today, I am most likely to order a couple of laboratory tests which can tell me a great deal about the physiological origins of the patient's mental complaints. Much can be understood about the neurotransmitters and hormones that affect mood with relatively inexpensive urine and blood tests.

That information takes much of the guesswork out of treatment, and allows me to objectively measure the patient's progress.

Finally, there is the lifestyle counseling that chiropractic physicians revel in. Changing diets, changing exercise, changing habits -- all of these can greatly contribute to mental health.

So, can chiropractors help people with anxiety or depression? Indeed we can, and in this office we do so nearly every day. It is not quackery; it is solid science and clinical decision-making. And, unlike the alternative drugs, the research shows that chiropractic care for mental disorders works.

25 Things You Didn't Know A Chiropractor Could Do, #2: High Blood Pressure

More than a few patients have come to me for assistance in management of their high blood pressure, but these patients are easily outweighed by the patients I have who are already on anti-hypertensive medication -- and are now seeing me because of the side effects. I'm not surprised that few people know that high blood pressure can be managed by alternative means. It's an easy diagnosis to make for the MD, and a given money-maker for pharmaceutical companies. Because, once you get a patient on blood pressure medication, you've got a captive customer for the rest of their life. That's a pretty sweet deal if you're a drug company, but maybe not so hot if you're the guy taking the pill and stuck with the bill. Let's take a look at the common side effects of blood pressure meds:

Electrolyte imbalance, potassium depletion, elevated blood sugar, impotence, insomnia, depression,asthma, bradycardia, cold hands and feet, heart palpitations, swollen ankles, constipation, headaches, dizziness, skin rashes, loss of taste, chronic hacking cough, kidney damage.

And those are just the common side effects. Fully 20% of those taking blood pressure meds report 1 or more of these adverse reactions. The full list of side effects is just too long to get into here.

The problem is that patients are not given the information needed for full informed consent before being given their pills. If diet or lifestyle is mentioned by the diagnosing provider, it is at best a drive-by recommendation, perhaps accompanied by a third-generation copy of the egregiously erroneous Food Pyramid or a recommendation to see a "nutritionist," who will -- guess what -- recommend a diet low in fat and sodium and suggest lots of fruits and vegetables.

There's a whole lot more to controlling blood pressure than that. Most importantly, the side effects of managing blood pressure naturally are all beneficial to the patient, in comparison to drug-based management which creates a whole new set of diseases, which require additional medications to control them. Is anyone surprised?

The Drug Free Alternative

How can a chiropractor help manage blood pressure?

The first step is through spinal manipulation, of course. A study published in the Journal of Human Hypertension in 2007 found that chiropractic manipulation of certain joints in the neck was as effective as two-drug combination therapies in reducing blood pressure. Prior studies in 1991 and 1993, and published in peer-reviewed journals have shown similar effects with chiropractic cervical adjusting.

Lifestyle alteration is step number two. Chiropractors excel at helping patients make healthy lifestyle changes. It is labor intensive, but highly effective. And it involves far more than cutting out the cookies and eating your fruits and veggies. Hard work, but worth it in the end. Side effects of this therapy may include increased energy, improved infectious disease resistance, lower cancer risk and improved looks.

Honestly, would you rather have those side effects, or swollen ankles and impotence? Yeah, that's what I thought.

Herbs and nutritional supplementation can play their role as well. Of course, I have to be careful about statements like this because, while it's ok for Cheerios to claim that a daily bowl will stop you from having heart disease, God forbid that a chiropractic physician suggest that something like Hawthorn extract might reduce blood pressure. The FDA gets all bent out of shape when you start offering alternatives to their clients' cash cows.

So I won't make any claims about herbs or supplements reducing blood pressure. But if you want the research, just email me. I would suggest however, that you get together with your chiropractic physician and discuss these options, because clinical experience can reduce the amount of guesswork you would have to do otherwise.

Finally, a few needles can let some of the pressure out as well. Studies such as this one have shown that acupuncture can significantly reduce high blood pressure. Ongoing low-level  treatment may be necessary, but how is that any different from having to take a pill every morning?

Chiropractic physicians can offer their patients several safer, more cost effective alternatives to drugs for managing their blood pressure.

While drugs may in some cases be necessary, I argue that the non-drug alternatives be employed as the first line of defense against high blood pressure. But I'll wager it is rarely, if ever, done.

In fact, I'll put my money where my mouth is. If anyone can submit proof to me that any mainstream medical provider in Connecticut referred a patient to a chiropractic physician for treatment of high blood pressure -- despite the evidence that this should be the preferred approach -- I will give $100 to that person's charity of choice.

Email me, call me, or send the information by carrier pigeon. But I'm not holding my breath.

25 Things You Didn't Know a Chiropractor Could Do: #1

In my 15 years of practice, there is a comment that I have heard all-to-frequently from my patients. It is not meant unkindly, nor as a slight, but evidences surprise at my hitherto unbeknownst powers, as if I had just unbuttoned my shirt and unveiled a Superman logo on my chest. This remark is often uttered as I say something that I think is relatively innocuous, like, "Yeah, we should probably do an EKG, just to be sure."

The patient will look at me, with eyebrows raised, and say, "I didn't know you could do that!"

The problem, it seems, is that the majority of the public have been trained to see chiropractors as one-trick ponies. Good for spinal adjustments, but little else.

This distorted image stems largely from the disinformation campaign mounted against the chiropractic profession by the AMA. 100 years of lies takes a while to untangle, especially when the bigotry is backed by a few billion pharmaceutical dollars.

And it is complicated somewhat by state laws, which vary widely. In some states, chiropractic physicians can inject substances and perform minor surgery. In others, they are not allowed to treat anything except the spine.

Throw into the mix the fact that most insurance companies will not reimburse a chiropractic physician for many of these procedures, and you get a large number of chiropractic doctors who will simply will not do them, simply to survive financially. It is difficult to justify spending several thousand dollars on an EKG machine if you'll never get reimbursed for its use.

But the fact of the matter is, chiropractors are trained in how to perform and read EKGs, as well as a number of other things which might surprise you as much as it has my patients.

Which is all a very long-winded way of introducing a new feature here at DocAltMed.

Every other Friday for the next year, I will post yet another example of the many ways your chiropractic doctor can serve you that you may not have heard of. And this week, we'll start with the basics, beginning with:

Your Annual Physical Exam

This, to me, is the real shocker. That people would not realize that they can use their chiropractic physician to do get their physical exam. My physical examination is every bit as complete as that you would receive in a medical doctor's office. Actually, I would argue that it is more complete, because my exams are not only looking for signs of pathology or disease; I am also illuminating areas of nutritional or physiological imbalance. It is those latter factors which are the true harbingers of health problems.

Yes, I listen to the heart and lungs, look into your eyes and ears, and peer intently at your mouth. As you might have guessed by now, we do an EKG, and I order the same blood tests that any other doctor would order.

But when I or another chiropractic physician performs your physical exam, you get two distinct advantages. The first I've already mentioned -- we are trained, as MDs are not, to spot dysfunctions before they become pathologies. The second is that when we do find a problem, you are far less likely to end up on a prescription drug.

In fact, studies have shown that patients who use their chiropractic doctor as their primary care physician end up in better health over the long term. They have fewer hospital days, they need fewer drugs to be healthy, and for older people they maintain physically active later in life.

So when it is time for your next annual physical, think hard about what you want -- better health, more active life -- and who is more likely to be able to give that to you.