3 Must-Have Android Health Apps, Part I

When the Verizon cellphone account headed for expiration, I decided to (a) look for a better deal, and (b) do some serious upgrading. My old folder did its job and did it well, but had gone a wee bit hinky on me over the past few months,  randomly shutting down, making phone calls on its own, occasionally beeping uncontrollably, and generally acting like a patron of the Pig & Whistle at last call on a Saturday evening. Being a fan of Open Systems software, I was naturally drawn to phones running the Android operating system, and the increasingly large ecosystem of apps surrounding it. So I ended up with a Samsung I897 smartphone. And, of course, immediately began looking at the 1.3 gazillion health and fitness apps for it.

Most of them, unsurprisingly, are less than impressive, and fall into one of several categories. There are the Body Mass Index calculators, calorie counters, weight loss trackers, and celebrity fitness apps. The first group does nothing more than a pencil and paper, hand calculator or a smart digital scale can do; the second group has utility if all you want to do is reduce input, not recalibrate your diet for a healthy intake; and the only appeal of the final group is to assure you that "YES, YOU CAN LOOK LIKE HER," or alternatively, "YES, YOU CAN GET HER," depending on your gender and orientation.

But after slogging my way through the swampland, I found what I consider to be the three Essential Health Apps. They are available for both Android and iPhone platforms, and all three of these applications have the twin advantages of Doing Something Useful and Doing What They Say They Can Do. Neither of these attributes should be taken for granted in the world of applications software.

Two of these apps are for fitness, and the third is for nutrition. All three are free. And if you are engaged in any level of healthy activities, I encourage you to download them and employ them.

The app we will review today is, to my mind, the best reason for getting a smartphone. Health App #1: Endomondo

Endomondo is an application for cyclists, runners, bladers, skiers and walkers. Like all of the other apps in this category, it uses the phone's built-in gps to track your location, and will report your speed, distance traveled, and average speed as well as other assorted data, both visually and verbally. You can look at a screen that resembles the cyclocomputer on your bicycle, or follow your progress on a map. And at user-set times, Endomondo will verbally give you your performance data. All of these are typical of the breed. However, Endomondo goes a notch higher than the competition in several respects.

First of all, Endomondo's use of the gps is far better than any of the other apps in this category that I tried (I tested the top 6.) I live in an area where gps reception is dicey. I've had $500 gps units sit in front of my house for minutes trying to get a fix on its location, only to report failure and retire from the field.

Endomondo, it seems, can variably adjust its filters on the fly to accept weak-signal situations. As soon as I punch the start button, Endomondo is ready to ride, while others -- notably SportsTracker, SportyPal, and CardioTrainer -- took several minutes to acquire a position fix. And My Tracks, allegedly a premier program, never did get a location fix over the course of a 25 mile ride.

Even with the acceptance of lower-level gps signals, Endomondo's accuracy did not notably suffer. In 25 and 30 mile rides, the app was within .05 miles accurate, as compared to a cyclocomputer which had been previously calibrated against a measured 100-mile distance, and the Endomondo distance measurement fell within the range of error of the calibrated device.

In comparison, CardioTrainer gave me an extra 5 miles over a 25-mile distance, something for which I was grateful but hesitant to accept, even though the CardioTrainer error boosted my average speed to the minor diety level.

SportsTracker can occasionally get a fix, and once fixed, would track with admirable accuracy. But before it would let you take off, you had to add a name and description to your ride. And since my rides are usually unremarkable, this feature made little sense. After all, how many times can you type in "milk run"?

SportyPal's interface was unsuitable for low-signal conditions. Until the gps would initialize, it would seize, leaving me sitting in the driveway waiting for the software to get ready. And that's just not an option in my world.

In comparison, I liked Endomondo's no-muss, no-fuss startup. You just picked your activity (surprisingly enough, the list includes "transport cycling" as an option, which pleased me to no end), pressed the "Start" button, then started. Clean and simple.

Endomondo also has the ability to gather heart rate data from a bluetooth-equipped sensor, which it will incorporate into your ride data.

At the end of your activity, you press "Stop," and all of your data is automatically uploaded to your online Endomondo account.

Online, you can look at your history, your maps, graphs of your ride data in a few different formats; but best of all, you can interact with friends. There are activity challenges constantly going on, and if you set up your phone app to do so, you can allow your friends to track you online in real time. Your friends can help you along by sending freeform text messages via endomondo, which are then read to you by the phone's text-to-speech engine. Imagine how much fun it can be, as you struggle up some desperate incline, to hear your best friend cheering you on with such encouraging phrases as "speed it up, lard butt!" or "enjoying your ice cream stop, pal?"

(Such exhortations can be made somewhat more enjoyable, I found, by equipping your phone's text-to-speech engine with a sexy British accent, making your buddy's ribbing much more pleasant.)

Although some may not like them, the social networking features of Endomondo are definitely a selling point for me. Misery always loves company. So that, plus the easy user interface and the weak-signal GPS performance make this my Number 1 health app.

NEXT UP: We take the Android to the gym and let it show its muscle.

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.

Happy Anniversary

Fifteen years ago this week, I made the very long commute from Ansonia to Kent, and as a freshly-minted doctor, opened my doors to the public. Oh, my...if I had only known what was in store for me.

I had decided to begin practicing in the northwest corner because I knew that somewhere up here was where I wanted to raise my family, and at the recommendation of a doctor who at the time was practicing in New Milford. The good Dr. Hess has since passed away, but when I called him for advice for a place to open a practice, he said, "If I could do it all over again, I would have practiced in Kent."

So there, for better or worse, was where I started. On the largely-abandoned second floor of a building in the center of Kent, above a toy shop, as the "Kent Chiropractic Health Center," a name which to this day floats around the internet, cropping up in the search results from time to time. On that first day, I received a surprise delivery -- a ficus plant from my parents, to wish me good luck. I put it in the reception area.

Kent did turn out to be a wonderful place to start, and I developed good reputation there for treating muscle and joint problems. But my vision of being a chiropractic physician had always been broader than that, and while one might say my concept of a chiropractor as an alternative care primary care physician was forward-looking at the time, it was actually backward-looking. The early history of chiropractic is filled with chiropractors in rural America treating all manner of illness, naturally, using their hands and good food and their hearts to heal patients seeking a more humane form of treatment than the "heroic" medicine in vogue during the 20th century. It was not until the 1980s when chiropractors got painted into the back/neck corner, as mainstream medicine tried to contain the chiropractic threat to its pocketbook.

Only a few years after opening my practice, I returned to school for post-graduate education, while keeping my practice running. Those were busy years, as I hired my first employee, worked all day on Saturdays, and  spent every fourth weekend at the Long Island clinic of the New York Chiropractic College, culminating in passing my board examinations and becoming one of Connecticut's few doctors who were board certified in clinical nutrition.

I also moved my office during that time, so that I was no longer above the toy store, but in what was then Kent's bustling Medical Center building. I shared the building with two MDs and the northern branch office of a radiologist based in Danbury. The ficus plant came with me. With my additional knowledge base and growing clinical experience, I began to expand out more and more from muscle and joint problems into treating people with other health problems.

Kent is one of those small towns which, lacking a diverse employer base, goes through boom-and-bust cycles. When I had opened my practice, Kent was on the cusp of a boom cycle, riding the dot-com wave with a local internet company, Cyberian Outpost.

When the dot-com crash came, Kent suffered a bit. The bustling medical center bustled not quite so much, as the radiologist closed his satellite office, one MD retired and the other moved. For quite a while, I was the sole occupant of the building, which occasionally felt like practicing in a ghost town.

Satellite Office

During that time, I noticed that I could find some office space cheap in Litchfield, and opened a satellite office there. I was in Litchfield two days a week, and Kent the rest of the time.

The Litchfield office surprised me. With little marketing, only word-of-mouth, my practice in Litchfield grew rapidly. I had two rooms -- a consultation room and an exam/treatment room in an office complex otherwise filled with mental health professionals, and it was during that time that I gained a deep understanding and respect for psychologists and clinical social workers. They, too, were drug-free professionals like me, choosing to treat people with mental illness with skill and finesse instead of the blunt tools of psychiatric medications. My association with this group led to my lecture presentation at the 40th annual meeting of the Connecticut Psychological Association.

And, of course, running two offices and lecturing weren't quite enough to keep me happily busy, so I continued with my education. This time, I added to my arsenal by pursuing postgraduate board certification in medical acupuncture, giving me what turned out to be a perfect trifecta in natural medicine -- chiropractic, herbs/nutrition, and acupuncture -- the 1-2-3 punch which has served my patients well ever since.

To reflect the growing cachement area of my practice, I again changed names, this time to "Northwest Chiropractic Health Center." After a few years in Litchfield, and after having moved my family here, I realized that in all likelihood, the future of my practice was going to be in this town. The Litchfield practice continued to grow, and I was increasingly stealing time from Kent to support my patient load in Litchfield. The Kent office's days were numbered, despite my enjoyment of that small, quiet town.

Opportunity struck when, of all things, a local veterinarian decided to move across the street. When I found that this office, on Route 202 only a mile from my house, was for sale, I knew where I wanted to be.

So I took a deep breath and jumped in. Of course, after the purchase, extensive renovations were required. I really didn't think my patients needed kennels, or a place to be hosed down after their treatment here. With much thanks to the now-retired Paul Mattson, who broke every rule in the contractor rulebook by finishing the project in budget and on time, I was ready to move my practice for the fourth -- and presumably final -- time.

That's not to say that there weren't a few hiccups along the way. I learned that any time your contractor calls and says "we need to have a meeting with the plumber," it's going to be an expensive meeting. I also learned that zoning regulations can be as obscure, dated and nonsensical as any New England blue law.

I once again changed corporate names, again for the last time. The change reflected the slow but inevitable transformation in the nature of my practice, as what had once been the Kent Chiropractic Health Center became the Center for Alternative Medicine.

Opening the new Center was an exercise in blindfolded tightrope walking, as I was simultaneously closing the Kent office. Trying to ensure a seamless transition, I closed down operations in Kent on Monday, and with the help of the entire Tuz family, moved everything to Litchfield in the space of two days. I was ready to begin seeing patients -- indeed, had already scheduled them -- except for the small but vitally missing Certificate of Occupancy.

On Wednesday, the Building Inspector came to his final inspection, during which he deemed one of the outlets in one of the treatment rooms too close to the sink. It must be converted to a special GFCI outlet before the CO would be issued.

I called Paul in a panic. His office assured me that this sort of thing happened all of the time, and I was not to worry. Again, it was a testament to Paul's prowess as a general contractor that he had the electrician out on Thursday morning to fix the outlet. The building inspector returned on Friday at 10 a.m., and certified the building. Minutes after he left the building, my first patient arrived.

I had expected to lose some of my patients as a result of the move, and for a time, I did. But over the past few years, more and more of those patients have returned to my care, and I am always glad to see one of my patients from Kent. We swap stories about the old days, and they bring me up to date on the happenings in Kent.

Another milestone was passed shortly after I opened the Center, as I suddenly realized I had begun treating the third generation of a family who had began seeing me in my early days in Kent. The adolescent children I had seen back then had grown to young adulthood and begun families of their own. Realizing that this entire family had depended on me for care through so many changes was enlightening. I was finally beginning to understand the richness and depth that being a family doctor brings. I didn't have to ask these patients about their family health history. I already knew it, and had participated in it.

The Center for Alternative Medicine also brought to fruition one of my long-held goals to bring multiple health disciplines under one roof, as Dave Pavlick, one of New England's experts in EEG neurofeedback moved his offices to the building. Once again, having a mental health professional, especially one of Dave's stature, has added an interesting dimension to my professional alliances.

The thread running through this history has been my patients. The woman with asthma, who was in the midst of an attack and had no inhaler. The man in the middle of a heart attack, who had just left his MD's office after receiving a diagnosis of a cold, and who told me "something just doesn't feel right." The patient with anorexia, whose last visit was less of a discharge than a sad goodbye, as we both knew she had utterly succumbed to this most awful disease. The patient who hugged me and said, "Thank you for giving me my life back."

It is not only those dramatic moments, but also the smaller, simpler ones -- when someone sits up on the adjusting table, rotates their head in directions impossible just minutes before, and says, "thanks a lot, Doc." Or who looks at me after I take the last acupuncture needle out and says, "that feels really good."  It is really those times that keep me coming back to the office morning after morning and staying through the evening hours.

The warp to that woof is the learning. Being a doctor, especially the kind of doctor that I am, means that my education never stops. When I first began practice, nutritional analysis was in its infancy, and we had to rely heavily on questionnaires and history to deduce our patient's problems. Now nutritional doctors have an array of laboratory tests available to reduce the guesswork. And each patient visit, regardless of the problem or whether I have seen them before,  is a 30-minute postgraduate course in health, if I only have the eyes to see and the ears to hear.

With 15 years of experience under my belt, and my first book on its way, I feel that I am poised on the precipice of what will be a second half equally as exciting as the first. I am excited about the new patients that I will see, new associates I will greet, and new challenges that I will meet (so long as they don't involve plumbing).

But most of all, I am thankful. Thankful to have had 15 years to serve my patients to the best of my ability and knowledge, and grateful to have received the trust of so many.

Though my parents have long since passed away, the ficus tree remains with me. It, like all other living things, has gone through periods where it hasn't been so healthy, was dropping leaves and looking barren. But with care and attention, it has always returned to health and continued to thrive. These days, it spends its summer next to the bench and the front door, and winters in the reception room, a reminder to me of that day long ago when a much younger doctor unlocked the door to all that would follow.

The Map of Human Health

On the surface, it was just another typical moment in a chiropractic physician's office. I was walking down the hall from one treatment room where I had just left a patient with an injured knee, to check on another patient who was receiving care for a painful shoulder. But on that short walk down the hall, I was actually walking the long divide between two health care paradigms. While the patient with shoulder problems was receiving what would normally be considered "standard" treatment -- heat, ultrasound and chiropractic manipulation -- the patient with the bum knee had several acupuncture needles inserted around her knee and ankle.

In one room, the basics of applied physiology were being utilized: Heat was being used to perfuse the injured area with blood, bringing with it oxygen, nutrients, and other supplies for healing, and taking away the detritus of repair. Ultrasound was altering the permeability of the cell membranes, allowing the injured tissues to more readily imbibe the blood's bounty. And joint manipulation was restoring normal physiological shape and function to the ligaments surrounding the joint.

But in the other room, a completely different process was apparently taking place: The normal flow of qi, a nebulous "life energy," was being restored. Excess yang, represented by the heat of inflammation, was being quenched by employing the water principle of the body, as water is always used to put out a fire; meanwhile, meridians controlling the patient's earth energy were used to nurture the damaged tissues.

How do I, as a doctor trained in both eastern and western medicine, reconcile these two utterly divergent approaches? One is so clearly logical and wrapped in the science of the west, while the other explodes with image and allegory, as if the needles tell a parable of health in their placement and actions.

And with increasing frequency, I find that I not only combine these disparate therapies in my practice, but in the treatment of singular patients. Some patients receive both chiropractic and acupuncture. Some are treated with eastern herbs and western physiotherapy. Others are treated with western nutrition and acupuncture.

"Do I contradict myself? Very well then I contradict myself," said the poet Walt Whitman. "I am large, and contain multitudes."

Perhaps the best way of uniting these two approaches to human health which do not speak the same language either literally or figuratively is to apply the principles of scientist and philosopher Alfred Korzybski which can be best summed up by this statement:

The map is not the territory.

Too often, Korzybski argued, we look at a thing and we conceptually "map" it. We assess its shape and weight, its color and texture, and assign those properties to that object, forgetting that it may have other properties of which we are not aware -- or that it may not always have those properties which we have assigned to it.

That's a mouthful, I know. An easier way to understand the concept is to imagine two maps of the same place, for example Ansonia, Connecticut.

One map is a road map.  It clearly shows all the roads in the area, what their names are, and where they go.

The second map is a topographic map. This map does not show the roads so clearly, but it does give us other information that the road map does not. Through the use of contour lines, it shows us the hills and valleys of the terrain, where the swamps are, the steepness of the slopes.

Both maps show us the exact same territory. But they provide us with entirely different types of information.

In the pursuit of understanding, we all too often forget that the theories and hypotheses that we make -- the maps, as it were - are only maps. They are not the territory itself. The map of the human body developed by western medicine is certainly not the only map, nor is it the "true" map. It is merely a map that shows us certain characteristics of that territory. Imagine the arteries and veins as roads, the organs as cities and villages, the nerves as railroad tracks...you get the picture.

The map developed by Traditional Chinese Medicine shows us different features of the human body. Instead of roads and tracks, we see the swamps and the forests, the peaks and the valleys. Entirely different information, but also of great value as I help my patients navigate their way back to health.

Is one more valid than the other? I think it would be the height of arrogance to claim that the western medical map was superior to the eastern. After all, 100 years ago, the eastern map of human functioning was already highly detailed and had been refined for centuries, while western medicine was still scrawling  "here be dragons" on the margins of its crudely-drawn understanding.

I employ both, because I find both to be useful. They help me and my patients reach their destination. And as I continue to proceed along the twin paths of east and west, I find that I can increasingly see one in the other. From the road I see the hills, and from my path in the hills I can hear the hissing of cars on the road. I think -- I hope -- that my patients will be the beneficiaries of this understanding.  As the wise Siddhartha said, "In the sky, there is no distinction of east and west; people create distinctions out of their own minds and then believe them to be true."

What To Do When The Drugs Don't Work

I'm kicking off this year's fall/winter lecture series with what I think may be one of my best -- and most important -- lectures ever. It will be held at 7 p.m. at the Litchfield Community Center, on September 22. The title of the lecture is What To Do When The Drugs Don't Work, and will discuss the ways that alternative medicine can assist people suffering from chronic illness.

From diabetes to heart disease to osteoporosis, 45% of Americans suffer from one or more chronic diseases. Chronic diseases cause 7 out of every 10 deaths; they significantly impair your quality of life; and they account for 81% of all hospital admissions.

The bad news is that these diseases are poorly managed with drugs, and even when they are, the side effects can make the 'cure' almost as bad as the disease.

But the good news is that many chronic diseases can be prevented or controlled without drugs.

It will be a 90-minute lecture, and at the end, you will learn how to take control of your health and prevent or manage your chronic illness without becoming dependent on medicines. Using research and science-based strategies, Dr. Jenkins will demonstrate why non-drug therapies are more effective, less expensive, and better for your health.

All seminar attendees will receive a workbook which will help them develop a custom health plan that matches their needs. Attendance is free of charge, but registration for the seminar is required. Call 860-567-5727 and ask Teresa to reserve your seat.

Good News For Chiropractic Patients!

For most of the past 100 years, chiropractic physicians and their patients were the only torch-bearers for safe, patient-centered alternative medicine. During the anti-alternative purge of the 20th century, homeopathy was all but wiped out in this country, surviving only on the fringes in Europe for 60 years. Osteopaths, once allied with chiropractors in their unique approach to health, threw in the towel and were co-opted by mainstream medicine; today, the difference between an osteopathic doctor and a medical doctor is indistinguishable except for the initials after the name. Providers of nutritional and herbal medicine such as the Thompsonians and Eclectics were all but exterminated, and by the 1950s, chiropractic was the only profession left that could provide patients with informed, educated, alternative medicine.

Even then, the level of harassment was formidable. The chiropractic doctor who treated me as a child was -- unbeknownst to me -- one of the leading forces in the fight for chiropractic equality. Dr. Reeve, of Dayton Ohio, was jailed no fewer than 6 times for "practicing medicine without a license," during his struggle to obtain licensure for chiropractic doctors.

Slowly, the tide has turned. Chiropractors are the first and only alternative medicine doctors to obtain licensing in all 50 states. And although few people know this, it was at a chiropractic college that acupuncture first found a home in this country, as New York Chiropractic College was the first college in the U.S. to offer training in acupuncture for doctors.

We are, in a way, accepted by medical insurers. But on a very limited basis and at rates that are prejudiced against chiropractic doctors and their patients. So much of what I could offer patients is denied because their insurance companies refuse to pay for procedures which are medically necessary and part of my scope of practice. And even if they were to pay, the reimbursement offered to a chiropractic doctor runs from 10% to 40% of what a medical doctor is paid for the same procedure -- despite our superior skills and training in many procedures.

But that's all about to change.

TheNational Association of Chiropractic Attorneys (NACA) has announced that it has issued a proclamation recognizing “the historic and profoundly positive legal ramifications for the chiropractic profession and the patient community it serves in Section 2706, ‘Non-Discrimination in Health Care,’ recently enacted as part of the federal ‘Patient Protection and Affordable Care Act.’”

The provider non-discrimination provision says that “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”

Once in full effect, health insurance companies will no longer be able to deny my patients their right to receive coverage for their acupuncture treatment, their nutritional therapies or the many other medically necessary services which I provide but which insurers routinely reject.

The provision has long been championed by the American Chiropractic Association (ACA) and members of the Chiropractic Summit. It was achieved primarily due to collaboration with Sen. Tom Harkin (D-Iowa) and help from other key players such as Sen. Chris Dodd (D-Conn.). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision. ACA will continue to fight for proper implementation during the regulatory process.

“It is important to recognize this provision as a historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against doctors of chiropractic and other providers relative to their participation and coverage in health plans,” said NACA Vice President Mike Schroeder. “While there is still much work to be done in the regulatory process, we are encouraged by the fact that Congress has finally acted to end provider discrimination based on one’s license.”

It is also important to note that Section 2706, and its assurance of non-discrimination in terms of participation and coverage, effectively requires that doctors of chiropractic be allowed to provide any“essential benefit” that is within their scope of practice. This will prove to be a particularly significant victory as the essential benefitspackage under the health care reform law is defined over the next couple of years.

“As significant as Section 2706 is to the chiropractic profession, it is possible to lose ground during the regulatory drafting process,” said NACA President Paul Lambert.

Believe me, the opponents of chiropractic care will work long and hard to keep chiropractic patients out in the cold. In fact, the American Medical Association has already begun attacking the provision, once again fearing the economic competition that chiropractic physicians represent.

To support the work being done to ensure the proper implementation of the provider non-discrimination provision, please add your voice to the thousands demanding full and fair insurance coverage at www.chirovoice.org.

The Power of Touch

While on vacation last week, I had the opportunity (and the need) to do something I rarely do at home: Get a chiropractic adjustment. The need was spurred by a headache subsequent to a 100-mile bike ride that saw me traverse Cape Cod from outermost Provincetown to downtown Hyannis, and back again. It was a pleasant trip, though exceedingly hot. And even though I ride a recumbent bicycle, which is far more comfortable for the neck over long distances than a standard upright, the recumbent in the extremely laid-back configuration can produce significant neck strain over time.

I was greeted on the morning following my ride, by a classic cervicogenic headache -- that is, a headache caused by the vertebrea in the neck becoming fixed in position. This is the cause of most headaches, which in the popular literature are often referred to as "tension headaches."

I had been needing an adjustment for some time, but like the average bad patient, I kept putting it off. In part, because most other chiropractic physicians work the same hours as myself, and in part because I've just been too busy. Sound familiar?

I was fortunate, however, to find that Dr. Donna Heitzman, in Provincetown, would have a few minutes to see me that afternoon. As Dr. Heitzman, a delightful woman with a puckish sense of humor, treated me, I was reminded of just how powerful the act of simply touching someone can be.

Arguments for the healing power of touch sends skeptics into paroxysms of denial, as healing touch is often so closely associated with fundamentalist religious practices, and the denial of the spiritual aspect of humanity is a fundamental tenet to the skeptic's belief system.

Nonetheless, there is a significant body of research which demonstrates the power of touch. Most recently, researchers found that the quality of objects that people were touching -- heavy vs. light, hard vs. soft, rough vs. smooth -- caused people to form unconscious associations between what they were touching and unrelated experiences. For example, rough objects made social interactions more difficult and hard objects made people more rigid in negotiations.

Massage has been shown to prime the brain for release of oxytocin, commonly known as the "empathy" hormone, making people more capable of bonding with and trusting others.

But touching is even more powerful than that. Touch has been shown to reduce cardiac arrythmias in ER patients, and even have beneficial effects on the red blood cells of comatose patients. Touch also increases one's overall sense of well-being and reduces blood pressure.

Of course, chiropractic adjustments are all about touch, and I am very conscious of the quality of my touch when I am treating patients. Not infrequently, patients will experience an overwhelming emotional response to a chiropractic adjustment. Crying, laughing and sudden relaxation are all common responses to a chiropractic adjustment. Part of it is due to the neurological and biochemical changes which adjustments create, and part of it is simply due to being touched.

Which brings us back to Dr. Heitzman's office. Immediately after being adjusted, my headache disappeared, which is a common response to chiropractic treatment of tension headaches. But more surprising to me was the overwhelming sense of relief I felt. In addition to the emotional relaxation, I felt the muscles of my upper back and shoulders let go of tension that I didn't know they held.

Dr. Heitzman and I spent a few more pleasant minutes talking shop, and then I proceeded to hop on my bike and ride an easy 7 miles back to the house where I was vacationing. A long nap that afternoon ensued, unusual for me.

It was good to be reminded in such a direct, clear way of the powerful treatment that I can offer to my patients. When the "Gee, thanks Doc, that feels a lot better" response becomes commonplace, it is all too easy to forget the powerful sensations lying behind those words, the power of a chiropractic adjustment and the power of a healing, caring touch.

How To Reduce Your Risk of Chronic Disease By 78%

What would you say if health scientists had discovered a way to reduce your risk of chronic disease by almost 80 percent? If it were a pill -- one with no side effects -- would you take it? How much would you pay for it? $50/month? $100/month?

In fact, health improvement of this magnitude was one of the goals of the billions of dollars spent on gene therapy research. Billions which were wasted, as I noted in a previous post. Even had genetic manipulation proved successful, you would still have paid through the nose to avail yourself of its solutions.

But because you are one of the five dedicated readers of this blog, I will tell you how to significantly reduce your risk of chronic disease for free.

A 2009 study involving over 23,000 Germans found that taking the following steps reduces your risk of diabetes by 93%, reduces your risk of heart attack by 81%, cuts stroke risk by 50%, and drops your chances of developing cancer by 36%.

Here's how you do it:

• Don't smoke.
• Keep your BMI under 30.
• Exercise 3.5 hours every week.
• Eat a diet rich in vegetables, fruit and grains, and low in meat.

That's it. No gene-manipulating drugs, no daily aspirin, no useless statins, no anti-osteoporosis drugs, none of the other unscientific nonsense daily fostered  on an unsuspecting public as "prevention."

Just "good, clean livin'," as my Ohio ancestors would have described it.

Now, that doesn't mean that even within those guidelines, additional nutritional or other resources might not be necessary, to combat the imbalances created by a frequently-toxic environment and food supply, or the vagaries of communicable diseases. Nor does it mean that you won't need some assistance to put your lifestyle on that healthy path. But once you are there, and the longer you are there, it will get increasingly difficult to knock your health off balance or to knock your lifestyle out of whack. But adhering to those four principles is the foundation for all of the rest.

That, of course is where my profession comes in. If you can't say yes to each of those four guidelines, I or one of my colleagues is likely to have the tools to help you get there. In fact, I can rather comfortably say that chiropractic physicians are the health care professionals best equipped for the prevention of chronic disease.

It was the great American inventor, Thomas Edison, who once said:

"The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease."

I think I know which profession represents Edison's ideal doctor. And we're here right now.

Board Decision: Chiropractic Does Not Cause Stroke

From the American Chiropractic Association: In a comprehensive and detailed ruling published on June 11, the Connecticut State Board of Chiropractic Examiners confirmed that Connecticut’s chiropractic physicians are taking the proper steps to inform and protect their patients. Through its ruling, the Board reaffirmed that the informed consent process practiced by the state’s doctors of chiropractic is the standard of care for the profession.

The announcement caps a process that began more than a year ago when the Connecticut Chiropractic Association asked the Board to issue a declaratory ruling on whether the current standard of informed consent is sufficient or whether, as opponents demanded, it should specifically include the possibility of a stroke or cervical artery dissection as a possible side effect of cervical manipulation/adjustment.

The Board’s decision follows four days of testimony in January in which an extensive range of evidence was presented. In making its determination and declaratory ruling, the Board cited the most comprehensive scientific study to date on the subject, by J. David Cassidy, DC, PhD, DrMedSc, et al. The Cassidy study is considered the definitive research on the subject. The abstract and complete paper can be found at PubMed Central.

In issuing its final judgment on the matter, the Board wrote: “After a careful and thorough review of all the testimony and documentary evidence admitted at the hearing, the Board concludes that there is sufficient evidence to establish that a stroke or a cervical arterial dissection is NOT a risk or side effect of a joint mobilization, manipulation or adjustment of the cervical spine.”

Our Servicemen and Women Deserve Chiropractic Care!

That's the conclusion of Brigadier General Becky Halstead, who herself found relief from fibromyalgia through chiropractic care. The men and women of the military have given us the best of themselves...why should they be denied the best care for many of the illnesses that beset them?

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.

My Core Principles

Every organization needs principles. Even the bad organizations, the ones that rob you blind, pick your pocket and leave you bleeding in the alley (think "insurance companies") have a set of guiding principles, however warped and twisted they may be. I've always liked to think of my practice, the Center for Alternative Medicine, as one of the good companies. And for most of its existence, it has only had one stated principle. In organizational management language, its mission statement would go something like this:

The mission of the Center for Alternative Medicine is to provide therapeutic interventions in a health-affirming environment to eliminate disease and dysfunction and enhance the well-being of the residents of Litchfield County and surrounding areas, without regard to race, age, sexual orientation, gender or financial status.

I've always preferred the short version: My job is to make people better using whatever means I have at hand. I'll take on all comers.

But the fact of the matter is, even the plain-language version embodies a number of underlying principles. And it wasn't until I was preparing a speech for the annual meeting of the Connecticut Society of Medical Assistants that, for the first time in 15 years, I sat down and actually elucidated them.

What came out of it was interesting. My 7 Core Principles, I've come to call them. And they truly are the principles that make this doctor, and his practice, tick.

• Primum non nocere.

This is latin, meaning "First, do no harm." It is my job as a doctor to, more than anything else, avoid injuring my patients. This principle is why I became the type of physician that I am. Although the mainstream medical community pays lip service to this principle, you could hardly call it a guiding element of medicine's philosophy. If it were, you would see a lot less blather about rising malpractice rates, and a lot more effort directed toward reducing malpractice. (Did you know that the number one cause of non-traumatic death in the U.S. is medicine? And that's according to published research.)

In contradistinction, my interventions for the same conditions are far safer and at least as effective, if not more so (fertility treatments, for example. Recent research has found a higher success rate for acupuncture than for the far more risky IVF.)

• Systems Integration

This simply means that I place my focus not on a single system, such as the cardiovascular system, or the pulmonary system, or the digestive system. Instead, I evaluate patients in terms of these systems' interdependence. Or, as the brilliant Buckminster Fuller in his dense eloquence has stated: "Synergy is the only word in our language that means behavior of whole systems unpredicted by the separately observed behaviors of any of the system's separate parts or any subassembly of the system's parts. There is nothing in the chemistry of a toenail that predicts the existence of a human being."

Understanding the whole by examining the interconnectivity of its parts -- the data network, if you will, that allows the brain, heart and stomach to coordinate their activities -- has led me to solutions for patients who have suffered for years and whose well-known specialists proved ineffective. In fact, it was precisely because they were specialists that they could not see the solution.

• Multi-disciplinary Therapeutics

Another way of saying this is that when the only tool you have is a hammer, everything looks like a nail. Any repairman worth his salt will equip himself with an array of tools, of the finest quality possible. A chiropractor who only adjusts has only a hammer; the medical doctor who only dispenses drugs posesses only a wrench.

I've got wrenches, hammers, pliers and a full set of torx drivers, by gum. And I'm not afraid to use 'em.

• Diagnostic Rigor

An accurate and finely-grained diagnosis is the key to success when you are doing alternative medicine. To properly treat my patients, I need to know more than that they simply have a case of sinusitis. I need to know why. I need to know what put that patient in a state that made them susceptible to this bug, and why they responded as they did. With that knowledge in hand, I can then go about fixing the underlying problem. To my mind, this is better than patching it over.

• Relational Equivalency

Ok, I did use some fancy words here, but I could find no others that could capsulate my intended meaning. I have found over the years that the greatest success comes when I work together with my patients to solve a problem. I work often as a mentor, a coach, a teacher. But I advise and recommmend -- never do I dictate. I work as a partner with my patient, and we each shoulder part of the burden.

This type of care cannot happen if a doctor is standing on a pedestal issuing commandments. The feedback and course modifications necessary to any successful outcome is missing in such a relationship.

• Long-term Focus

Many of my patients come to me with problems they have dealt with for two, three, or five years. Rarely am I going to get a resolution in a week or a couple of visits -- though sometimes I have seen it happen. And for all my patients, I am looking not only how their health is now, but how it will be 20 years down the road. Because right now is the time to create the environment for future health.

• Therapeutic Minimalism

Call me lazy if you want, but I prefer to figure out how I can provide the most benefit to my patients with the least intervention. This reduces the patient's costs, and it also refers directly back to principle #1. By minimizing my interventions, I also minimize any risk to the patient.

To me, therapeutic minimalism has a certain aesthetic appeal to it. Occam's Razor proclaims that the simplest answer in science is most often the correct one. And, the most minimal of equations, e=mc², explains nearly an entire universe in four simple symbols.

So that's it. My Core Principles, if you will, the entirety of my practice philosophy. I found that developing and elucidating these core principles to be a valuable process, one that has given me insight into my professional past and a glimpse into its future. I recommend this process for anyone, especially to examine your personal life. You might discover some things about yourself that you thought you didn't know.

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.

The Spectrum of Being

It's very often the first thing we ask about someone. "A baby! How wonderful -- is it a boy or a girl?" Or when we meet someone: "She's a nice-looking girl," or "He's a handsome guy." Gender identification is a core classification that everyone makes, automatically, without consciously thinking about it. Until you are confronted with just how limited that way of thinking is. I have been  fortunate to attend the past few Transgender Lives: Intersection of Health and Law conferences in Farmington CT, and from those conferences, I brought home a single, yet far-reaching fact.

Although we think of the expression of gender as binary, either boy or girl, feminine or masculine, gender is actually a spectrum of human expression in which the elements of masculine and feminine mix and combine over the entire range.

None of us are fully masculine or fully feminine. We are all a combination of gender traits to varying degrees. This mixture of yin (feminine) and yang (masculine) are what the ancient chinese philosophers had in mind in the development of the taijitu:

That small dot of the opposite color within each side represents the simultaneous, mutual existence of opposites within each other. While the taijitu is the reflection of larger universal truths, the characterization of yin and yang as feminine and masculine principles makes the meaning unmistakeable with regard to gender.

The individual intermixture of gender is also embodied in the work of the psychologist Carl Jung, who developed the concept of anima and animus, representing the female aspect within the male psyche and the male aspect within the female.

The idea that we, psychologically, embody both genders has long been accepted. But that the blending of gender would be reflected physiologically and neurologically is a concept that has fought an uphill battle to, first of all, be recognized, and secondly, to be regarded not as a psychological or moral pathology but as a normal variant.

Transgenderism is the umbrella term for the expression of gender identity that differs from the strict male/female dichotomy recognized as normal by society. Transgender people range from those who enjoy dressing as, and behaving as, a person of different gender than their birth gender; to transsexual people who, with the assistance of hormones and surgery, change their entire appearance to live their lives as a different gender; to people who are born with the physiology of both genders and choose not to identify as strictly male or female.

Because it is so basic to our patterns of classification, gender expression outside of the norm can be quite disturbing to many people. Transgender characteristics are usually lumped together with sexuality, although sexual orientation is entirely different and unrelated to gender expression.  Transgender people, like everyone else, may be straight, gay, both, or uninterested. Unfortunately, transgender people are considered by some to be morally corrupt, or predators disguising themselves to gain intimate access to the opposite gender (this is the laughable -- and indefensible -- argument used by some in Connecticut to restrict restroom access by transsexual people).

And, though once thought of as a psychological disorder, research is making it evident that transsexual people do not suffer from some sort of behavioral aberration. More and more it becomes obvious that transsexualism is the result of neurological and hormonal activity and development in the womb. Studies of the brains of male-to-female transsexuals show that their brains are much more similar to the gender they identify with (female) than the gender they were born as (male).

Unfortunately, that research goes unrecognized at many doctors' offices, where both doctor and staff have little understanding of this segment of their patient population, and transgender people may be subjected to anything from embarassment at the hands of thoughtless and poorly-trained staff to outright discrimination because of their gender preferences.

Like most doctors, I received absolutely no education on the requirements of treating transgender people, either from a clinical standpoint or from a practical standpoint. But once I became aware of my ignorance, I undertook to rectify it. From talking to people, to reading, to attending the Transgender Lives conferences, I learned.

Much of it boils down to simple things that I already know and try to practice. Things like respecting my patients. Accepting what they bring to me as people and understanding their needs and goals for their care. Recognizing people's boundaries, and not transgressing them without permission and without good reason.

That last sentence bears a little more explanation. For obvious reasons, both personal and social, a patient may not be comfortable revealing to me their gender history, though clues may be evident in the general health history with which they provide me. But the more important question is whether gender is pertinent to the problem at hand.

And, frequently, it is not. For example, most musculoskeletal issues are gender-neutral, and whether or not my  patient is a transgender person is simply not important. Why make someone uncomfortable by delving into aspects of their life that they would rather not reveal? Being a doctor gives me great latitude to explore another person's privacy in the search for clues to the nature of their problem, but that license must be used with discretion.

Much of being a transgender-friendly practice also boils down to attending to simple things that are easily overlooked. For example, the patient whose legal name on their insurance card is Jennifer Smith would rather be addressed as David. Or that gender isn't as simple as circling the M or the F on the intake form.

So I don't use M or F on the form anymore. Instead there is a blank line for the patient to provide the gender information which most suits them.  And in addition to the Last Name and First Name entries, I have a Preferred Name entry, so that we know that Jennifer should be addressed as David, the name he prefers.

These and other alterations are subtle changes, unlikely to even be noticed except by those to whom they are directed. But for that very reason they are important.

I hope that other doctors, particularly those who provide alternative medicine services, take it upon themselves to enhance their practices in this manner. It is not difficult and the rewards can be significant.

I will unfortunately not be able to attend the Transgender Lives conference this year. It will be the first time in several years that I will miss it. But I am grateful for what the conference, and my patients, have taught me.

A Big Win for Chiropractic Patients

No matter where you stand on health care reform, the new law is a big win for chiropractic patients. Although the coverage of health care reform reported nary a whisper about chiropractic physicians, the legislation is set to affect chiropractic physicians and their patients in some very profound and positive ways. First and foremost, the law contains anti-discrimination provisions, which will require insurance companies to cover the full scope of chiropractic services. While you, as a patient, may not see, it, insurance companies have set up a number of roadblocks in front of your care. The first one is that most insurance companies will only pay for one, or maybe two, of the many therapies that a chiropractic physician can perform. So if you need more care than a hot pack and a spinal adjustment, you're out of luck. Either your chiropractic doctor provides the service for free (which is what most of us end up doing) or you get charged an additional fee for your chiropractic insurance "benefit."

The second roadblock is that insurance companies have artificially restricted the diagnoses for which chiropractic care is covered. Usually anything outside of purely musculoskeletal conditions is also outside of your insurance "benefit." Do you suffer diabetes, or heart disease, and are seeking alternative care? Sorry, not covered. Are you looking for fertility treatment that has proven more effective than in-vitro fertilization, is safer, and costs far less? Oops, your insurance doesn't cover that. Would you like acupuncture -- a research proven treatment -- for those chronic sinus infections? We're sorry, but your "benefit" doesn't cover that.

In fact, I'll bet you didn't know that your chiropractic physician could treat those conditions. He can, and that's only the surface. Chiropractic doctors are skilled in treating those chronic conditions that are usually very poorly managed by drugs. But you've never been able to get that care because your insurance company refuses to cover it. In some cases, insurance companies have forbidden chiropractic doctors on their plans to even tell patients that they can provide those services.

But all of that ended with the passage of health care reform. Here's what the president of the American Chiropractic Association had to say:

“Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against doctors of chiropractic and other providers relative to their participation and coverage in health plans. Such discrimination based on a provider’s license is inappropriate and now must stop,” said ACA President, Rick McMichael, DC.

“While this does not fully level the playing field for doctors of chiropractic in our health care system, this is a highly significant step that has the potential for positive, long-range impact on the profession and the patients we serve. Congress has finally addressed the issue of provider discrimination based on one’s license, and they have said that such discrimination must stop.”

When this law finally goes into effect, that discrimination will stop, allowing you to utilize your chiropractic physician for the full scope of services for which he is qualified.

And that will be a good day for your health, and a great day for the health of this nation. Perhaps then we will begin to turn away from the pill-for-every-ill mentality that has made us one of the unhealthiest of the industrialized nations.

Happy Feet!

Yesterday's event was a tremendous success! Rebecca from Foot Levelers was booked all day long, and we were able to start bringing relief to a lot of people with foot, knee, and back problems.

Sportsmens of Litchfield also came through in a big way, providing not only discounts at the store for people who came to get their feet scanned, but also some very nice swag for everyone. Water bottles, bags and t-shirts -- many thanks to Jay and Michael at Sportsmens, for being such good sports!

Teresa did her usual fine job of managing things from the front desk, unsnarling bottlenecks and being everywhere for everyone simultaneously.

As for me, one of the things that I really enjoyed about the day was that it brought in some patients whom I haven't seen in a while. It was a real treat to catch up with people, and reminded me once again what it is that I really like about what I do.

Sure, I enjoy the detective work of being a good diagnostician, unraveling the myriad causes of a patient's health problems. And practicing the physical skills required of my profession, manipulating joints, inserting acupuncture needles, or doing hands-on soft tissue work, is a pleasure as well.

But above it all are the relationships I have with my patients: The give and take, hearing my patients' amazing stories, and telling a few of my own.

That, more than anything else, is what I look forward to when I unlock the door to the office every morning.

Barefoot Running

A reader brought to my attention the growing trend of barefoot running, given fuel recently by this study:

Foot strike patterns and collision forces in habitually barefoot versus shod runners.

Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y.

Department of Human Evolutionary Biology, 11 Divinity Avenue, Harvard University, Cambridge, Massachusetts 02138, USA. danlieb@fas.harvard.edu

Comment in:

• Nature. 2010 Jan 28;463(7280):433-4.

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

It's an interesting idea, and certainly has its appeal, falling in line with other fitness trends such as functional strength training and the naked warrior concept. I've known people who have been running barefoot since the mid-90s.

But I suspect the faddishness of the trend, and I see some real problems with the research. The first is that it was not until last fall, with the Wolf study, that a decent examination of the consistency of lower extremity kinematics was even performed (to my knowledge, at least). Without that base consistency data, drawing conclusions from a comparison of shod versus barefoot kinematics is perilous. How do we know that the data from the Lieberman study (and others) even falls outside the range of normal variation? The fact is, we do not. So to to make conclusions about technique from such studies is rash.

While the research does show some force reduction at the joints, from that data the researchers are *presuming* a reduction of injury. There are not any studies which actually show a reduction of injury, and it is quite possible that none will be found. Lieberman admits this limitation in his study. What is most probable is that barefoot running may tend to reduce the risk of certain types of injuries, while increasing the risk of others, and as I note below, the benefits are likely to vary widely based on individual biomechanics. There truly is no such thing as a free lunch.

Similarly, performance has not been evaluated. The argument held forth thus far is the "Ethiopian runners do it and they are the best," which is an argument beset with obvious problems, from cardiopulmonary functioning to femorotibial ratios. Until I see some good studies, I am inclined to dismiss barefoot running performance claims.

Interestingly, the kinematics of shoeless running point to the fact that, in all likelihood, the runners who do benefit most from shoeless running are those that are free of foot dysfunction in the first place. Which makes sense.

It is important to note that the foot scans I'm providing are not with the intent to provide a rationale to fit every athlete with orthotics, but more to detect those individuals whose foot dysfunction or pathology tends to increase their risk of injury or hinder their performance. For such individuals, there is absolutely no data to suggest that they would benefit from barefoot running and a wealth of research to suggest that custom orthotics would be beneficial.

I'm not a one-size-fits all kind of doctor, and I may happily recommend seemingly contradictory advice to two different patients with the same (apparent) problem, because I think that any protocol needs to account for the huge individual variability in physiology and biomechanics. It is one of the core ingredients missing in most of mainstream medicine.

So I'm not going to utterly dismiss barefoot running out of hand, because it may have some genuine utility for some people. But the majority of runners, I suspect, will continue to benefit from a well-made shoe and proper foot support.

Public Agrees With Chiropractic Doctors: No Special Regulation Needed

In a classic set-up, the Hartford Courant published an online poll asking readers if chiropractic patients should be required to sign special consent forms, as I mentioned in a previous post. The poll question was placed directly across from a Rick Green anti-chiropractic screed, in which Mr. Green manages to disclose both an appalling lack of understanding of scientific research as well as feeble rabble-rousing skills in his attempts to mislead the public about this topic.

I wouldn't mind so much about the anti-science bent of his column if Mr. Green was at least able to generate some fire underneath his supporters.

But, alas, he could not even do that. Normally, the placement of a survey as the Courant did in this situation virtually guarantees that the results are skewed in favor of the opinion of the columnist. Not so in this case. Here are the most recent poll results:

I'm sorry, Mr. Green, but it looks like the public has spoken.

And they think you, and the proposed regulation, is wrong.

Expertise, recognized.

I've just been selected as one of the on-line experts at MDinfo.com. Don't be confused by the name. There are a lot of smart doctors on there handing out good advice.

If I do say so myself.

An Open Letter to the Connecticut Chiropractic Board

I am writing regarding the hearings in Hartford on the requirement for chiropractic physicians to disclose to patients the risk of harm from cervical manipulation.

I am troubled in two ways by the legislation. First, I am concerned that the legislation is based on unsubstantiated fear and rumor rather than established science. Second, I am troubled by the way in which it singles out one medical provider among all others for this invasion into the doctor-patient relationship.

Stroke due to cervical manipulation is an exceedingly rare event. In fact, the most in-depth examination of this topic, a study published in the journal Spine in 2008, concluded that stroke due to chiropractic manipulation may be a non-event. The authors of the study reviewed 10 years worth of hospital records, involving 100 million person-years. Those records revealed no increase in stroke risk with chiropractic.

Even if you argue that spinal manipulation can result in injury, it is exceedingly rare. Another study, reviewing 10 years' worth of malpractice claims in Canada, concluded that the risk of stroke following chiropractic treatment could be only 1 in 5.85 million cervical manipulations. Another way of looking at this number is that it would occur only once in a chiropractor's lifetime if he were in practice for 1,430 years. And even then, the study did not find that chiropractic manipulation caused stroke.

Thus, I must ask the question: Will the government require that chiropractic physicians lie to their patients about the risks of chiropractic-induced strokes, when, in fact, the best science available shows that none exists?

Any good doctor, whether chiropractic or medical, cares sufficiently for his patients to inform them of the significant risks and consequences of their chosen course of treatment. This is simply good patient care, respectful of the patient and his rights and the doctor and his responsibilities. And any therapeutic intervention carries with it some degree of risk, although, as in the case of cervical manipulation, it may be extremely small, and the injury typically limited to a pulled muscle.

There is no need whatsoever for the legislature to involve itself in this process and begin the micro-management of the doctor-patient relationship, nor should it single out one single provider for its intrusiveness. The legislature would never even consider mandating that every medical specialty disclose in writing specific but rarely occurring abreactions to their treatment.  Why then would chiropractors be held to a different standard? 

Or, if a 1in 5.85 million risk of injury is sufficient to require specific notification, will the legislators also require an MD to obtain specific written consent every time he tells a patient to take an anti-inflammatory? That is not a low-risk treatment. Anti-inflammatory medications are the 15^th leading cause of death in the country today.

Will the thousands of other procedures conducted by medical doctors with much higher risk of serious injury or death also come under the scrutiny of the legislators?

After all, during the two days in which your hearings were held, 4,296 people died as a direct result of their medical care.

Who provided the informed consent for that?

Very Truly Yours,

Avery L. Jenkins, D.C.

My Christmas Gifts

Probably the best thing about this holiday, in my mind, is that it gives us all the opportunity to be grateful. As a friend of mine recently pointed out, when you spend your time being grateful, you don't have a lot of room in your life for stuff like anger, or fear, or jealousy. It's hard to be grateful and angry simultaneously. Try it. See? Weird, it just can't happen. So I'm feeling really grateful today, as I sit and type this beside a wood stove cranking out the heat and eating a clementine. I'm grateful for the warmth of the stove. The children upstairs still sleeping. The deliciously healthful food made possible by a civilization which, for all of its many faults, gives me the capability to eat an orange in the middle of a cold New England winter. And I'm very grateful to the patient who brought me the fruit.

It is always somewhat surprising to me, when holiday season comes around, and patients bring such wonderful gifts to share with Teresa and me.  Diets be damned, they say, and bake with abandon, creating the most  delicious concoctions enticing me to keep my energy up with a quick midday sugar fix. Or two. Or three. (Hmm. I'm pretty sure I'll be doing the Center's New Decade - New Me weight loss program in lead-by-example format!). I am touched by these gifts, as I know that they signify my importance in their lives. And when I realize that, I am immediately humbled and awed by the trust which my patients place in me.

There were two gifts this year which particularly moved me.

One of my patients, whom I know is no stranger to philanthropy, took her largesse to an entirely new level this year. In honor of me, she said, she gave the gift of a cataract operation (through Seva, a charity devoted to restoring sight and preventing blindness in the developing world)  so that another person might see again. When she told me, it brought tears to my eyes. To be the inspiration for such magnaminity is overwhelming. Thank you, Joan.

Another gift came in the form of an email from a grateful patient whose holiday was brightened by a new addition to the family -- whose presence, she said, was the result of the care which I provided.  I was deeply moved by her thanks as well, and reminded of the joy I experienced many years ago when my first child arrived.

So has it been a good Christmas? You bet! New eyes, new life, tasty treats and fruits and honey. My cup runneth over.

I hope your Christmas has been equally  joyful.