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

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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.

Bicycle Hater: CT license plate 730KMT

I was in a parking lot in Torrington 1-2 weeks ago, and spotted this car. As someone who uses a bicycle for transportation more often than a car, and as someone who teaches others cycling techniques and the value of bicycle use, I am utterly offended. Thus, I am offering a reward to anyone who helps me to identify the owner of this automobile. Espousing violence against others because of their mode of transportation is reprehensible.

If you have information that will identify the owner of this car, email me. I will give $75 to the cycling charity of your choice.

identify the owner of this car, CT tag 730KMT to claim a reward

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Are You Integrated?

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Those of you who have followed this blog for some time, or who receive my DocAltMed Newsletter, know that I frequently point out the failings, follies, and dangers of mainstream medicine. I don't do it out of vindictiveness or spite, or because mainstream medicine is competition for the traditional medicine that I practice. However, I do feel that there is the need for a voice -- even a small one such as my own -- to counterbalance all of the advertising, marketing, and whitewashing that passes for medical "research" and news coverage. That said, I need to periodically point out that I am not fundamentally anti-medicine (though I am fundamentally anti-stupid and anti-greed). There are medicines that work, and there are times that they are appropriately used. That they are used too often, for the wrong reasons, and with little regard for patient safety is my main beef.

This is an issue which came to the fore just the other night, as I was addressing a local MS support group.

Multiple sclerosis (MS), is a chronic, disabling disease which often proceeds in a perplexing course of exacerbation and remission. This characteristic makes it exceedingly difficult for a single doctor, or his patient, to adequately assess whether or not their chosen therapy is working.

As is the case for many chronic, degenerative diseases, mainstream medicine doesn't have very good answers for people with MS. One of the points of my lecture was that alternative medicine offers equally good efficacy, typically at a significantly lower cost and with a greatly reduced risk of painful and dangerous side effects.

At the end of the lecture, one of the attendees asked me if I would be willing to treat someone even if they were taking medications.

My instant response was, "Of course I would!" It wasn't something I have to think twice about.

I frequently manage patients who are taking drugs prescribed by other physicians. They can cause collateral damage in the form of nutritional deficiencies, gastrointestinal dysfunction or organ damage, and I consider it part of my job to respond to those issues, but never would I presume to tell a patient that I could not treat them so long as they were taking a prescription drug.

As good as I am, I don't have all the answers. I never will. The other guys have some pretty good tools, too. But on both sides of the Great Medical Divide, there are doctors who put ideology above practicality, and it is exactly that type of either/or arrogance that has put our health care system in its current sorry state, with the patient often getting the short end of the stick.

Interestingly, after the lecture and the Q&A session, as I was wandering around talking to people, someone else came up to me to tell me that on at least one occasion, she had been told by an acupuncturist that she would have to give up her medications in order to begin acupuncture.

Now that's just wrong. There is no injunction against concurrent forms of treatment with traditional Chinese medicine, and in fact, that's how it is most often practiced these days in Asia, let alone the West.

It's not good science and it's not good protocol. It is just ego. And when ego gets in the way, it is the patient that suffers.

The fact of the matter is that MS is another one of those disorders, like asthma, which is likely best co-treated by both a mainstream physician and an alternative medicine physician such as myself. In this "balance of powers" best-case scenario  -- known as "integrative medicine" -- the patient's more frequent contact would be with myself, with the neurologist called in for periodic review or to help manage severe exacerbations. There is no reason for the exclusion of either discipline, and the patient would benefit greatly.

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

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chiropractic physicans do have ways to treat mental disordersBelieve 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.

Beware the Surgeon Selling Spinal Fusion

Spinal fusion, a type of surgery in which the vertebra of the spine are locked together using rods and screws, is a popular surgery promoted by some orthopedists for everything from bulging disks to "weak or unstable" spines (whatever that really means). The trouble is, spinal fusion...umm...doesn't really work better than the alternatives (the safest of which is chiropractic care, by the way). Failure is common and risks are high. So why is it being performed?

Well, according to a study published this month in the Journal of the AMA, the answer is: It makes money. That's right, increasingly useless (and dangerous) surgeries are being performed purely for profit.

The writers at ChiroACCESS put it this way:

There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients.  There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions.  Spinal stenosis is the most frequent cause for spinal surgery in the elderly.  There has been a slight decrease in these surgeries between 2002 and 2007.  However, there has also been an overall 15 fold increase in the more complex spinal fusions (360 degree spine fusions).  Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that  “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years.  The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…”  There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion.  The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion.  Despite the much higher cost, there is no evidence of superior outcomes and there is greater morbidity associated with the complex fusion.  The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion.

So if anyone suggests to you that you need spinal fusion surgery, first get a proper assessment of your condition by a chiropractic physician.

In some cases, surgery may be required. But the research is clear: Rarely is spinal fusion an appropriate option.

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My Core Principles

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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.

Kids, Don't Try This At Home

As many of my readers and patients know, I am trying to qualify for Paris-Brest-Paris, a 1,200-kilometer endurance ride held every 4 years. Although not a race, it is a timed event, and you have to reach all of the checkpoints by a specified time to avoid being disqualified. Qualifications start this year, as I have to do a full series of endurance rides (called "brevets"): 200k, 300k, 400k and 600k. If I complete all of them successfully, I get to repeat the process next year; and if I complete all of those successfully, I will be able to ride in Paris-Brest-Paris.

So I'm thinking to myself that in a few weeks, I start the brevet series with a nice 200k, and maybe, just maybe, I ought to see if I can do a major chunk of that, like 100 miles. I have been training, though not as diligently as I should.

On Sunday, with no other obligations pending, I took off for a 101-mile loop leaving from Granby CT, going north to Northampton, then looping around through Amherst and Granby MA and eventually back to Granby, CT.

And a beautiful day it was. I passed more cows than you can count, went through beautiful, quaint, New Englandy towns, enjoyed the features of one of my all-time favorite college towns, Amherst, and in general just took pleasure in a fine ride on a beautiful day. The temperature was 72F by 11 a.m. and the few cirrus clouds called it quits by lunchtime.

One of the key tricks to any endurance exercise, whether it is a marathon, a triathlon, or brevet, is managing your fuel and water. You have to constantly plan ahead, because if you wait to drink until you are thirsty, or wait to eat until you are hungry, it is already too late. In addition, the gastrointestinal tract tends to shut down under the stress of endurance exercise, and you may never get hungry. The only way you'll know that you are out of fuel is when your legs turn to lead and your mood plummets.

There are a lot of complex rules governing your body's management of glucose, the basic energy molecule, and there are a lot of nuances to controlling blood sugar levels during exercise. But the general rule of thumb is to have some water every 15 minutes and something to eat every 45.

That's a rule that I generally follow. On Sunday's trip, I also took a longer stop at mile 63 where I had a "deli delight" lunch -- a submarine sandwich, a bag of chips, and some Oreo cookies.

After that, I hopped back on the bike for the final leg of the trip. This was a fun part, because I had finally hit a few hills -- more than rollers, but not what I call a hill around my house. I was gratified to see that, although the legs were paining me a bit, I still had the juice to attack the hills, albeit somewhat anemically.

I was taking the perimeter road around Bradley Airport when I realized, at mile 93, that I had the barest shot of breaking 7 hours for a century. For many cyclists, there's nothing special about a 7-hour century. It's a good pace, that's all. But I'm a slow guy, always have been a slow guy and always will be a slow guy. And among the Berkshires and their foothills, I've never come close to breaking 7 hours.

So...I take a deep breath and put the hammer down. For the next 7 miles, I sprint absolutely as fast as I can. At parts, I know I'm running at my maximum heart rate, because I was getting the tunnel vision and the eyes-rolling-to-the-back-of your head symptoms that have always happened when I'm doing a maximum heart rate measurement.

As I hit the last half mile, I come to a bend. And I look at the clock, and think to myself, "If this is downhill, I've got it made. Uphill, I'm toast."

I round the bend, and there it is: Uphill. So I let out a yell that would tell God Himself to get out of the way, and put absolutely everything I've ever owned into that last half mile. I mean, I ride like Cerebrus' meaner brother was chasing me.

And through my ever-narrowing vision and feeling like I'm about to pass out, I see the clock tick over to 7 hours at the exact same time the odometer clicks to 100.00

It's over. I didn't break 7 hours, but if I realized my opportunity only one hundredth of a mile beforehand, I would have. Still, hitting 7 on the nose is good enough for me. It's still a personal best, and I'm looking at setting a lot of records for myself this summer.

I slow from a gallop to a walk for the remaining 4 miles to the parking lot, and as I make the final turn the wrong way, I realize something might be wrong. I get back to the truck, park the bike, and take stock. My hands are shaking; I feel very dizzy; and I'm slurring my words like Sean O'Malley on St. Patrick's Day.

The problem? My blood sugar had plummeted. I react as fast as I am able, by downing a sugary soda and a concentrated sugar paste. It took a good 15 minutes before I was in control of my faculties again.

In any endurance sport, after the first 60-90 minutes, you have used up all of the energy reserves stored as glycogen in your body. From that point on, as I mentioned earlier, you must constantly add fuel, otherwise you will get into trouble -- as what nearly happened to me.

While I was balancing energy outflow with intake, my nutrition plan did not take into account that impromptu sprint for the last 7 miles. The massive increase in energy use forced my blood sugar levels to dangerously low levels. And, since the body's most energy-consumptive organ is the brain, the symptoms are often neurological -- thus the befuddled direction-finding, the shaking hands, the slurred speech, even while I was able to maintain muscle activity on the bike.

More and more, I am finding that I can help endurance athletes prepare their bodies for the onslaught of their competitive events by working with their diets beforehand so they can achieve their personal best. Just as any athlete needs a coach for their physical training, a nutrition coach is also a necessity.

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

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Chiropractic Winged Angel of HealthIn 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.

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The Spectrum of Being

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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:

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.

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A Big Win for Chiropractic Patients

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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.

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Combating Child Obesity…One Step At A Time.

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30% of morning traffic consists of people taking their children to school.

Childhood obesity is skyrocketing.

Coincidence? Not hardly.

I remember the walks to and from school as often being the highlights of my day. When I was younger, it was the source for many an adventure, and as I reached adolescence, an opportunity for romance.

My children have the option of taking a bus, but frequently have chosen to walk. As a result, they have gotten to know shopkeepers in town, in one case leading to an after-school job offer.

It is these simple things that can begin to reverse our nation's downward spiral into disease and drug dependency.

To help your kids begin walking to school, start here.

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March Podcast — Brittle Bones and Bad Drugs

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Did drugs cause this broken bone?The March edition of the Alternative Healthpod is now available. If you are not a subscriber, you can listen to it here, or as always subscribe to it by clicking on this feed. You can also subscribe via iTunes. Show Notes:

Two new studies published last week show that long-term use of oral drugs prescribed to prevent osteoporosis may be associated with unusual fractures of the thigh bone -- in other words, they are weakening the bone they are supposed to strengthen.

The research is not the first to link the drugs, known as bisphosphonates, with fractures. Other research has found that these drugs also increasing the risk bone death in the jaw.

Dr. Melvin Rosenwasser, a professor of orthopedic surgery at Columbia University College of Physicians and Surgeons in New York City, and co-author of the study, said that when bisphosponates are "used beyond a certain point...they may actually be bad."

A second study looked at bone biopsies taken from the thigh bones of 21 women, all past menopause, who had suffered fractures at the site. Nine had not taken the drugs, while 12 had, for an average of 8.5 years.

The women on the bisphosphonates, researchers found, had 90% "old" bone, meaning that new bone was not being created in the women taking the osteoporosis drugs.

Source: American Academy of Orthopedic Surgeons Annual Meeting, 2010.

If you are taking osteoporosis drugs, or are concerned about your risk of fracture, please contact me immediately at 860-567-5727, or email me at alj@docaltmed.com.

A Father’s Pride, Part II

I usually try to keep things at least moderately professional on this blog, but sometimes the personal part just comes busting through. Like today. This news release just hit the wires:

LITCHFIELD, CT – Sixteen-year-old Shayna Jenkins captured both the silver and the bronze medals in two national indoor archery championships, while simultaneously bringing home dual gold medals in the New England region of these tournaments.

 

With a score of 1064 out of a possible 1200, Jenkins placed second in the nation in her division at the 41st National Archery Indoor Nationals. She also took third place nationally in the Junior Olympic Nationals with a score of 533 out of a possible 600. Nationwide, Jenkins was the only competitor in her division to medal in both tournaments.

 

Jenkins, a junior at Litchfield High School, is no stranger to the podium. In previous years, she has placed both regionally and nationally, as well as winning the Connecticut state archery championship and the Nutmeg State Games.

 

On the shooting line, Jenkins is known for her cool demeanor under pressure, often shooting off the last of her arrows with only a few seconds left on the shot clock. She is a member of both the New Hartford Junior Olympic Archery Development (JOAD) team and the Harwinton Rod & Gun JOAD team.

 

Jenkins is now beginning preparations for what she hopes will be an equally successful outdoor competition season.

 

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Happy Feet!

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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.

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Show Notes — The Secret Is In The Feet

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My new podcast is up, you can download it here, or even better, subscribe to the podcast by clicking on this feed. Or, as usual, you can always go to iTunes and subscribe there. For more information about the March 12 Free Digital Foot Scan, go here.

The laboratory website is www.footlevelers.com.

Research:

Journal of Manipulative and Physiological Therapeutics (JMPT), Volume 23, Issue 3,point prescription 168-174

Effects of orthotic intervention and nine holes of simulated golf on club-head velocity in experienced golfers☆

David E. Stude, DCa, Jeff Gullickson, DCb

Received 7 April 1999

 

Abstract

 

0bjective: This study was an initial investigation evaluating the effects of orthotic intervention on club-head velocity (CHV) among a group of experienced golfers before and after 9 holes of simulated golf. Setting: Northwestern College of Chiropractic, Bloomington, Minnesota. Participants: Twelve experienced golfers were included in the study. Method: CHV was measured with a device used by many Professional Golf Association and Ladies Professional Golf Association teaching professionals before and after wearing orthotics and before and after completing 9 holes of simulated golf. Subjects wore custom-made, flexible orthotics daily for 6 weeks and then were retested with the same objective measurement parameters. Outcome measure: CHV (swing speed in miles per hour) was measured in all subjects before and after wearing custom-fit, flexible orthotics for 6 weeks and before and after completing 9 holes of simulated golf. Results: There was an approximate increase in CHV of between 3 and 5 mph, or a relative increase in CHV by up to 7%, after subjects had worn custom-made, weight-bearing, flexible orthotics daily for 6 weeks. A 5-mph increase in CHV is equivalent to an approximate increase in golf ball travel distance of 15 yards, a significant increase for the tour player for whom small increases in performance can reflect large position changes on the roster board. In addition, the use of these custom ofthoses eliminated the effects of fatigue associated with playing 9 holes of golf (relative to CHV) and therefore may improve the likelihood for more consistent golf performance. Conclusion: The use oftbe custom-fit, flexible orthotics in this study had a positive influence on CHV in experienced golfers. (J Manipulative Physiol Ther 2000;23:168–74)

Sports Med. 1985 Sep-Oct;2(5):334-47.

Running shoes, orthotics, and injuries.

McKenzie DC, Clement DB, Taunton JE.

Running is the most visible expression of the continued interest in regular physical activities. Unfortunately injuries are common, primarily due to overuse, and a number of aetiological factors have been recognised. Of these, training errors can be responsible for up to 60% of injuries. The training surface, a lack of flexibility and strength, the stage of growth and development, poor footwear and abnormal biomechanical features have all been implicated in the development of running injuries. A thorough understanding of the biomechanics of running is a necessary prerequisite for individuals who treat or advise runners. Clinically, the configuration of the longitudinal arch is a valuable method of classifying feet and has direct implications on the development and management of running problems. The runner with excessively pronated feet has features which predispose him/her to injuries that most frequently occur at the medial aspect of the lower extremity: tibial stress syndrome; patellofemoral pain syndrome; and posterior tibialis tendinitis. These problems occur because of excessive motion at the subtalar joint and control of this movement can be made through the selection of appropriate footwear, plus orthotic foot control. The runner with cavus feet often has a rigid foot and concomitant problems of decreased ability to absorb the force of ground contact. These athletes have unique injuries found most commonly on the lateral aspect of the lower extremity: iliotibial band friction syndrome; peroneus tendinitis; stress fractures; trochanteric bursitis; and plantar fasciitis. Appropriate footwear advice and the use of energy-absorbing materials to help dissipate shock will benefit these individuals. Running shoes for the pronated runner should control the excessive motion. The shoes should be board-lasted, straight-lasted, have a stable heel counter, extra medial support, and a wider flare than the shoes for the cavus foot. For these athletes a slip-lasted, curve-lasted shoe with softer ethylene vinyl acetate (EVA) and a narrow flare is appropriate. Orthotic devices are useful in selected runners with demonstrated biomechanical abnormalities that contribute to the injury. Soft orthotics made of a commercial insole laminated with EVA are comfortable, easily adjusted, inexpensive, and more for-giving than the semirigid orthotics which are useful in cases where the soft orthotic does not provide adequate foot control. A review of injury data shows an alarming rise in the incidence of knee pain in runners-from 18% to 50% of injuries in 13 years.