December 25, 2009 by Avery Jenkins.

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.

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December 15, 2009 by Avery Jenkins.

I had a conversation with a patient the other day, one that I’ve had all too frequently in the past.

The patient, someone with chronic neck pain, had gotten impatient with the length of time it was taking her to heal, and had discontinued care. Now she was back in my office, after visits to the MD, PT, and the radiologist.

“I finally found out what was wrong with my neck,” she said.

“That’s great,” I replied. “What is it?”

“I have arthritis!” she said. “My doctor took x-rays.” She pulls out a manila envelope and hands it too me. “Maybe if I’d known a little sooner, I could have gotten this fixed.”

I left aside for a moment the concept, always a little odd to me, that somehow I wasn’t her doctor. I know, it’s a chiropractic thing.

“Yeah, you probably do,” I said. I ignored the manila envelope. “Doesn’t really make any difference, though.”

“What do you mean?” she said.

“Look, Sarah, you’re 50 years old,” I said. “Of course you have arthritis, everybody does by 50. Arthritis is just a medical term for wear and tear on the joints, and if after 50 years you don’t have any wear and tear, that would be the surprising thing.”

She just looked at me, clearly upset that I didn’t share her enthusiasm for her newfound diagnosis and her (real) doctor’s “discovery.”

“Here’s the thing of it,” I said. “Those of us who treat a lot of this stuff know that there is often very little correlation between what an x-ray or MRI tells us and the pain and symptoms patients experience.

“Heck, studies show us that 30% of the population is walking around with a bulging disk in their lumbar spine, but most of them have no back pain. I’ve seen x-rays that showed massive amounts of ‘arthritis’ and disks that are virtually missing in action, but those findings had absolutely nothing to do with the patient’s pain,” I said.

“That’s why I rarely bother with x-rays or CT scans or MRIs unless I see a red flag when I examine you. In most cases, it’s not worth the radiation exposure or cost, because the ‘arthritis’ isn’t the source of your problem.”

“That’s not what my doctor said,” Sarah replied.

“I know,” I said. “Let me ask you this — what did your other doctor do after he found the arthritis?”

“He prescribed some painkillers for me, and I’ve been going to see the physical therapist.”

“Great,” I said. “How’s it working out?”

“Well, sort of ok,” Sarah said. “The painkillers were giving me a stomach ache, so my doctor put me on a different pill, but they aren’t really much better than Tylenol. The physical therapy really helped at the beginning, but it’s not been doing so much lately.”

“Ok,” I said. “Here’s the thing. The wear and tear you’ve got isn’t really the problem. Chronic pain like yours rarely comes from a single source. It’s usually 2, 3, or 4 things all going on at once. If you don’t tackle all of them at once, you won’t really find a solution.”

From that point, I went on to describe a suggested treatment plan — one that I would have implemented a couple of months ago, had the patient not withdrawn from treatment prematurely.

The problem with this treatment plan is that it requires some lifestyle changes. Regular rigorous exercise, not a few lifts and stretches under the supervision of a mildly bored PT aide. Changes in diet, giving up some favored foods.

These protocols do work for chronic, degenerative conditions. But for so many people, the mental/emotional pain of change — even healthy change — is greater than living with physical pain.

By the time I was finished, I could tell Sarah was still unsatisfied with me and my answers. I understand her reluctance. It is much easier to hang your hat on a simple diagnosis — “I have arthritis” — than it is to tell your friends “I have a metabolic/muscle movement pattern dysfunction with inflammatory overlays.”

Despite my 30 minutes of explanation, Sarah left that day without making any further appointments. I don’t know if I’ll see her again, but it’s likely that if I do, her condition will be that much more farther advanced and more difficult to treat.

Over the years, I’ve had many patients like Sarah. And sometimes they do come back, and often, with committed efforts on both of our parts, we make inroads.

Sometimes, it’s just too late.

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August 19, 2008 by Avery Jenkins.

As you might imagine, the transition from two weeks on two wheels on the shores and islands of Scotland back to Litchfield took a bit more than a soft landing by the KLM pilot, a healthy meal and a sound night’s sleep. And like anyone else returning  to work from a holiday, I was not over-enthused about unlocking the office door on that Monday morning.

Oh, the paperwork! The bills! The inventory!

So  it was with some trepidation on Monday morning that I leaned my mechanical steed into the parking lot, slowed to a stop, and looked around. The first thing that I noticed was that the lawn was neatly manicured and the walk swept clean.

I unlocked the door and walked in. The dark blue carpet of the waiting room was the first thing that jumped out at me.  Usually this carpet is a bit of a mess, receiving a daily coating of dirt, grass clippings, and whatever else patients bring in with them (note to those starting their own businesses: Never, ever, ever use a solid dark color in public areas, never mind how impressive it looks. You will spend either half of your working life or half of your payroll budget keeping the darn thing clean.)

Today, however, it was spotless. I opened the door to the hallway, and was greeted by more clean carpeting, cupboards and countertops neatly wiped down, everything sparkling.

While it was tempting to attribute this to worker fairies who stole in during the night and plied their cleanliness magic, the truth was much more prosaic and important.

During my abscence, my ever-suffering office manager Teresa had taken it upon herself to make a clean sweep of the place and return it to the pristine condition that she knows I prefer.  She even pressed her sons into maintaining the premises outside, and although I understand there was some largesse involved on my part, it still went above and beyond what I could expect from an employee.  And it is true, Teresa is far more than an employee. She is part of what makes the Center a living breathing entity. She’s the first person that patients see and the last to say goodbye to them. To a large extent, my success as a doctor rides on her capable shoulders.

And I probably don’t say this nearly enough. Thank you very much Teresa.

After that brighter-than-expected start, I settled in to the business of being a doctor, which, in primary care, often involves seeing patients. And one after another asked about my trip, and said how glad they were that I had returned.  Slowly, my mind and spirit was dragged back — however unwillingly — from magical Dunedin, and not  only to the business at hand, but a slowly dawning recognition. Or, perhaps, re-recognition.

Over the years, I had begun to forget the magic that I represent to many of my patients, most of whom had unsuccessfully sought relief for their illnesses for months or years before landing on my doorstep. Somehow, I developed the reputation of being the house of last resort, which may be seen by some as a backhanded compliment — “Heck, nothing else works, might as well try Dr. J…” but which I’ve always felt to be an honor.  To some patients, I’m the guy who could fix what nobody else could.

The interesting thing is that, really, I’m just doing what I’m trained to do. Observing, listening, testing, looking for patterns…I just use a different map than most doctors do, and that map gives me landmarks and lesser-known paths that are obscured by the superhighways on other doctors’ maps.

Still, though, I had forgotten what an actual honor it is to be that person in someone’s life. Until, that Monday, when patients started hugging me.

I had timed several therapeutic interventions to launch and proceed through the early phases, where my assistance might be required, before I left for Scotland, and to conclude upon my return so that I could again assist on re-entry, as it were.

Happily, we were successful in all quarters, and my patients’ achievements were manifest. They were so happy and enthused over their success, and I reveled with them. And they thanked me, and to a man or woman, they each hugged me.

And with those hugs, I remembered that beyond the bills, the thieving insurance companies, the  mendacious pharma companies, and the tremendous forces levied against my profession — beyond all of that is the heartfelt thanks of one person to another.

And that, I remembered, is why 20 years ago, I embarked on a radical journey to become a chiropractic physician.

So, to all of my patients, let me say: Thank you. You are doing all the hard work, I’m just here to guide you along the way a little bit.  And thank you for trusting me with your health, and the health of your loved ones.

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