The Chiropractic Files

My Chiropractor is a god

I must say that this is a very interesting site.  I’m not a doctor and I’ve read some of the articles in there.  I’m actually a patient.  About 2 years ago, I had severe migraine headaches and they did all the test for me.  The MRI, Cat Scan and a lot of other tests that I could not even name.

I can’t even begin to mention all the medications that I was on.  If you can name a pill, I took it.  I had a friend that had similar symptoms but was not as severe as my symptoms.  She recommended that I see a chiropractor, but like many of us, I dismissed it.

What made it worse is that I approached my primary care doctor about the idea of seeing a chiropractor and he told me that they were simply witch doctors and that there is no evidence for what they practice.  In one or two words, he told me don’t waste my time and money at the chiropractors.  So a few weeks went by and the migraines were simply unbearable.  So, this was it folks, I was at the end of the road.

I decided that I had nothing to lose, so what the hell, I was already in pain and I didn’t think that anybody can make it any worst.  All the other doctors were thinking that it was all in my head because their fancy tests could not tell them what was wrong with me.

So, I went to this chiropractor and let me say that from the beginning it was the best experience that I had a doctor’s office.  That was the first doctor that I went to, that did not brush me off, and he actually acted as if he cared.  He made me sign a medical release and he got all of my test results from the hospitals, doctors etc……

I was placed on a 40 visit plan, and he told me that I can stop at any point but he did not recommend it.  I read a lot of negative stuff about chiropractors on the internet but I was desperate and I gave it a try.

LET ME TELL YOU, after the 3^rd week of chiropractic adjustment my headaches were better I would say by 70 %,  when I told my primary about it, he told me that it was something called a placebo and that it will come back.  He told me that strokes have been associated with the neck adjustments.  To be honest with you at that point I was feeling so good that I was willing to take a chance.  When I approach my chiropractor about the stroke thing, he told me that I had a better chance of winning the lottery or a better chance of being dead by an aspirin overdose than to stroke out from a neck adjustment.  My chiropractor showed me the research and I read it for myself.

I am now on my 30^th visit and my headaches are about 90% better.  I get some headaches here and there but I mean it’s a HUGE difference.  I would recommend chiropractic care to everybody.  Since then, I put all my trust in my chiropractor.  I see him first before I see my primary.  Some people may think that it’s a stupid choice but this guy is more knowledgeable than all the doctors combined.  All the stupid tests, pain pills for years and only my chiropractor was able to give me relief.

Yup, I read all the nasty articles about chiropractors and it’s a damn shame.  Chiropractors are great.  I guess they have their limitations, but they can really help.  I read all the articles on this site and for those people that’s criticizing chiropractors, I don’t know what to say but not to “ knock it till you try it”.  All I know is that I went through a lot of pain and suffering before I can get relief.  I know what I went through and for somebody to sit there and tell me that chiropractors are quacks, is simply not true.  Well put it this way, if they are quacks then that’s one quackery that I will like to take part in, because they were the only doctors that was able to treat my problem.

I will like to end this by saying.  Thank you doctors of chiropractic.

Sandy Bonase

NSAIDs and COX-2 inhibitors

Andre Broussard, D.C.

NSAIDs and COX-2 inhibitors impede tendon, bone and cartilage repair

NSAIDs are not appropriate for neurogenic pain with no
prostaglandin-mediated inflammation.

/By //Matt Hasson/
ORTHOPAEDICS TODAY INTERNATIONAL 2006; 9:12

*September 2006*

INNSBRUCK, Austria -- Recent biochemical research suggests that NSAIDs
are appropriate for prostaglandin- mediated inflammation, not
"neurogenic inflammation" associated with tendinopathy.

The upshot: COX-2 inhibitors impair tendon and bone healing, two leading
experts said.

Physicians have typically treated patients with tendinopathy but no
inflammation with NSAIDs. However, there are certain chemical and
genetic factors that discourage NSAID use in some patients, said Hakan
Alfredson, MD, of the University of Umea, Sweden.

"In earlier days, the only information we had to rely on was the
information from biopsies," Alfredson said at the 12th ESSKA Congress,
here. "And those biopsies showed us irregular fiber structure, high
concentrations of matrix, vascular ingrowth but no inflammatory cell
traits. But, despite that, we gave these patients tons of NSAIDs. ... We
wanted to use a new method to try to evaluate whether there was any
inflammation in these tendons."

In vivo microdialysis

"If you use NSAIDs together with proteins, certain NSAIDs virtually
block the protein synthesis in the muscle."
-- Hakan Alfredson, MD

Using in vivo microdialysis to study the biochemical properties of
affected tendons, Alfredson and his colleagues tested 20 patients with
tendinopathy and painful knee function. The control group included 12
patients with normal tendons and no pain. Another arm of the study
focused on six patients with jumper's knee. The control group had six
patients with normal tendons, Alfredson said.

The specialists also assessed patients for prostaglandin E2, which is
"essential for a so-called chemical inflammation," Alfredson said. They
found that prostaglandin E2 levels did not differ between the chronic
painful tendons and the normal, pain-free tendons.

"So, the conclusion from those studies was that there is no
prostaglandin-mediated inflammation inside those tendons," he said.

Studying 1,178 knees, Alfredson's group found that several
pro-inflammatory cell proteins were not regulated in the tissue, again
suggesting no prostaglandin-mediated inflammation in the tendons,
Alfredson said.

"It cannot be justified to treat your patients with NSAIDs with this
background," Alfredson said. "It's also important to remember that
certain NSAIDs have negative effects on muscle protein metabolism. So,
if you use NSAIDs together with proteins, certain NSAIDs virtually block
the protein synthesis in the muscle, so that's another negative factor."

NSAIDs also inhibit tenocytes and, during exercise, decrease blood flow,
Alfredson said. Other factors include heavy vascularity and "neurogenic
inflammation," as opposed to prostaglandin-mediated inflammation.

The benefits of prostaglandins

Norwegian specialist Sigbjørn Dimmen, MD, also noted the value of
prostaglandins, which are "responsible for ensuring balance between bone
resorption and bone formation." Decreased prostaglandin may impair bone
healing, and the COX-2 enzyme is critical for fracture healing, he said.

Dimmen and his group tested how short-term doses of parecoxib, a COX-2
inhibitor, and indomethacin, a COX-1 inhibitor, affect long-bone
fracture healing. The parecoxib and indomethacin groups had lower bone
mineral density than the control group.

Also, mechanical testing showed the parecoxib group and control group
demonstrated significant differences in all properties, Dimmen said.
However, parecoxib proved more detrimental.

"So, our findings with parecoxib had the higher delay in the fracture
healing than indomethacin, with the assumption that the COX-2 enzyme is
responsible for impaired fracture healing," he said.

"Never give NSAIDs for stress fractures or for cartilage damage. NSAIDs
hate chondrocytes."
-- Sigbjørn Dimmen, MD

No prospective, randomized clinical trials or evidence-based
measurements have addressed the effects of NSAIDs and COX-2 inhibitors
on long-bone fractures, Dimmen said. Some data show NSAIDs and COX-2
inhibitors cause no nonunions in acetabular fractures, which "might
indicate that you can't see any negative effects from NSAIDs or COX-2
inhibitors in fractures which normally heal well," Dimmen said.

However, he advised colleagues to avoid NSAIDs or COX-2 inhibitors when
treating stress fractures or even when repairing cartilage.

"We know that prostaglandins are necessary for fracture healing," Dimmen
said. "We know that COX-2 is critically involved in fracture healing in
the first 3 weeks after a fracture. And NSAIDs and COX-2 inhibitors both
impair fracture healing.

"I think one should probably avoid NSAIDs and COX-2 inhibitors in all
shock fractures and also other fractures requiring unimpaired fracture
healing," he added. "Never give NSAIDs for stress fractures or for
cartilage damage. NSAIDs hate chondrocytes."

*For more information: *

* Alfredson H, Dimmen S. Non-steriodal anti-inflammatory drugs
and tissue healing. Mini symposium. Presented at the 12th
ESSKA Congress and 5th World Congress on Sports Trauma. May
24-27, 2006. Innsbruck, Austria.

Article suggested by Dr. Jen MC, DC

In response to the Pediatrician Bartram

It's unfortunate that we have to call this a "battle" between DCs and MDs. It's also unfortunate that people like Clark Bartram do not embrace our chiropractic profession, but that is his opinion and he doesn't represent the whole medical community.

I belong to a family of medical doctors, nurses, and podiatrists and we always engage in wonderful conversations about science and health. My father, who is a general practitioner, now refers many of his patients who have suffered from years of migraines to chiropractors. His patients come back to him thanking him, for had he not referred them to a chiropractor, they might never have gotten better. My father now thanks me for educating him on what chiropractors do.

The point here is that MANY medical doctors really have no idea what we treat and think all we treat is acute low back pain. That is not their fault. In fact we need people like Dr. Bartram to ask these important questions so that we can educate the public.

What is also wonderful is that many other medical doctors, in addition to my father, DO ACCEPT chiropractic. Just yesterday I had a patient with sciatica down her right leg who was told by her medical doctor to see a chiropractor for her sciatica. I feel a great sense of joy every time I see evidence of the medical and chiropractic profession getting along.

As long as the these two professions together with other health care professions get along can we really reach our common goal, which is to HELP OUR PATIENTS. Folks, this shouldn't be a battle between us, it should be a battle to HELP PEOPLE GET BETTER.

Thank you to Dr. Vanden Hoek for educating those who don't understand chiropractic.

Thank you to Dr. Bartram for asking about our profession. Without questions nothing will ever be answered.

Anna Marie

___________________________________________________________________________________

Dr. Bartram,

How could you possibly say the chiropractor made a fool of himself by giving scientifically-referenced (and in many cases, medical journal references) responses to your emotionally-driven questions? Do you have an equally intelligent rebuttal, or must you resort to name-calling in lieu of a real argument?
Incidentally, my 7-year-old was never vaccinated (I don't tell my patients not to do this either, but I will give them the other side of the story, as will our pediatrician, who supports us not vaccinating), has had one round of antibiotics in his life (the infection came back after the meds, and was then successfully and completely resolved with homeopathy), and has only once been sick for more than 24 hours (the chicken pox--no scratching, thanks to homeopathics and adjustments). I have adjusted him since he was 3 hours old.

I would add that my malpractice is so much lower because the "side effects" of my treatments are improved immunity (as reported to me by my patients, who are thrilled to not have so many colds), better digestion and elimination, and improvement in conditions such as asthma (I don't claim to cure it, but know from clinical and personal experience that regular adjustments drastically reduce the need for rescue inhalers--I've thrown away 2 of my own half-full inhalers because they expired.)

How is it that the chiropractor lost? I think it is your patients who are losing because of your unwillingness to learn.

Tina Warren DC

Part IV boards: Is it that bad?

Hey guys, my name is Jason and I wanted to write my experiences with part IV.  This is not one of those scholarly articles, but just some advice on part IV.  I definitely think that you should prepare for part IV.  You should study as hard as you can and personally, I did my review with NBS and my scores were excellent.  I did better than I expected.

Guys trust me you really have to try to fail this test, not to make it sound easy but if you did some studying, you should be fine.  I have to say thanks to Dr. Clerge for letting me participate in this blog. 

Ok, so when I enter the room, I was nervous, nervous, nervous.  The first room was adjusting and I did very well with that, and once again if you study with NBS you should be fine in that section.  Remember do not thrust, DO NOT THRUST, that’s an automatic failure.   I remember a couple of my friends were freaking out because they heard a cavitation upon positioning the patient, even they did well.

The second room was diagnosis, where they presented you with a case and a booklet and you had to choose some diagnosis that went with the case.  I did very well in that also.  By the 4^th or 5^th room, I was calm and I knew that this would be a breeze.  There are several rooms in part IV.  Some rooms deal with adjusting and others may deal with things like Phys Dx, Performing orthopedic tests, Case history etc……with NBS, you will be ok for that section. Some of the instructors or graders are very nice and some of them will talk to you and make you feel at ease.  On the other hand, there are some jerks that will say absolutely nothing and will do nothing but write.  If you see a lot of writing then that’s not good.

The X-ray portion of part IV is impossible.  Most of the students think that they knew maybe 2 or 3 of the X-rays.  If you fail this test, it’s probably because of the X-ray section.  When I left the X-ray room, I was discouraged because some of these X-rays looked normal and I had to choose a diagnosis.   Personally, I don’t think that there is a way to study for the X-ray section, but study your ass off!!!! You will need it.

Ok, so this is what part IV is all about.  They want to be sure that you can diagnose and that you will not be killing anybody when you get out there.  You should study as hard as you can.  Once again put some effort into it and you will be fine.

If you have any questions, I will try my best to answer it.  I do think that students should start using this site more often, because we can learn valuable information from other students and the successful doctors in this site.

Good Luck Guys,

Jason

A C A - Vice Admiral Donald Arthur, MD

 

 

 

 

Vice Admiral Donald Arthur, MD, surgeon general of the U.S Navy, talks about his respect for chiropractic and its contributions to the care of severely injured soldiers returning from Iraq and Afghanistan. Well, as you can see not all MDs are against chiropractors.  I believe as long as we all know our limitations, we can co-exist.  There are conditions that should be treated by the chiropractic doctors  and on the other hand some conditions are not biomechanic in nature and should be treated by the Medical doctors. It aches me when ignorant, misinformed health care providers make negative comments about chiropractors.  Unfortunately, my belief is that people reserve the right to express their opinions.  As much as I want to delete some of the recent comments on this site, I will not. Anyway, enjoy the site and let others know.  I hve some great ideas for the future.  Stick around and you will see. Dr. Clerge, DC

What's in a Flu Shot?

Hello All,

I would like to welcome the new doctor to chirofiles.com Below is his information Dr. Dan DeReuter practicing in Dalton, GA., feel free to check out his blog.

Dr. DeReuter will be posting some articles and you may also check out his blog directly. Below is a clip that the doc brought to my attention.

Before you get your next (bird) flu shot, watch this short vid and make sure it's something you really think you need.

A little Chiro Humor!!

Hello once again docs,

Check out this simpsons episode on chiropractic.  It's funny, funny.  We all work hard throughout the day and I want chirofiles to be a place where all chiropractors can come and relax.  While learning from others, we can also use some laughter.  While relaxing we can check out the humor section and lighten our day a little.

Also check out little taylor the future chiropractor

Enjoy the Clip,

Dr. Clerge, DC

Can Medical Doctors do What we do?

Hello all docs,

First let me say thank you to all the doctors that are contributing to chirofiles.com, Once again there may be positive articles while some may be more on the controversial side.  Hey!! this is America, we all have the right to voice our opinion.  Your articles are really appreciated.  Let your colleagues know that this site is in existence.  We have an obligation to inform the new docs, students, the public and other chiropractors.

Check out this clip

Can medical doctors do what chiropractors do?  Hell no, you wouldn't go to the dentist for a knee problem, so why go to a medical doctor for a chiropractic problem.  Below, a few clips for your enjoyment.

Dr Clerge, DC

And you ask yourself is chiropractic safe. Well check it out!!!!!!

They Don't Care About You

I’m writing this article for the benefits of the new docs and students that is not aware of the real world. I know that some chiropractors will probably read these articles and decide not to post. Listen up and listen good, read and learn from the doctors in this site. They have been through it all and they know what they are talking about.

Ok, I will lay it out once and for all.

I’ve been practicing for 20 years and the first 5 years I worked as an associate. The bottom line is that they don’t care about you. Who is they? Well, the chiropractors that you are working for, the insurance companies etc……

The first couple of years of practice the chiropractors that worked for the insurance board reviews were declining my claims. This is when I realize that this is a dog eat dog kind of world. Most chiropractors could care less about their associates. The reason why the majority of chiropractors hire an associate is to make more money. Trust me, you were not hired so that they can lose an extra $50 to $60,000/year.

Let me tell you the problems with the associate position:

1. You will learn absolutely nothing but learning how to adjust. When it comes to the business aspect of it, FORGET ABOUT IT!!! Most chiropractors will not teach you billing, coding ect…..It’s not that they don’t have the time, it’s just that they don’t want to. If you were making a million a year, would you show somebody else how to make a million so that you can have competition.

2. Work, Work and Work. In a busy practice, you will probably be adjusting 3 to 400 patients a week, will probably be screening, will probably be in charge of all ROFs, Exams, X-rays etc……

3. Commission, most of the compensation or commissions plans are crap. For every dollar you will probably get a nickel. Most associates are afraid of opening a practice and you should. Keep in mind that you are swimming with sharks. Managing and running a practice is not an easy task.

Usually in the interview, everything sound nice and they promise you the world. It’s a trap. Make sure that you read, read, READ your contracts. Your employer is not your friend, they are your employer. You need to lay out all the cards on the table from the start. You should agree on what you will and will not do. This is very important, since new tasks are always assigned during the course of your contract.

For those of you currently in an associate position, GOOD LUCK!!! This is not only for chiropractors!!!! I know optometrist, dentist, podiatrist that went through the same thing.

I know most of you are probably saying!!! Well, his on the other side now, why is he writing this? Like I said before, my first 5 years were spent as an associate. Guess What? I was screwed for 5 years. I’ve been in practice for 20 years and I made a promise to myself not to screw any new docs or associates.

Financially, I’m OK and all my associates are OK. I do not hide anything from my associates, I lay it all on the table. I tell them what I’m making and what they will be making. I tell them from the start that they are not hired because I wanted to lose money, so yes they will be working. I teach them how to bill, code and they have an option to leave and start their own practice if they so wish. The funny thing is that most of them don’t want to after learning all the stress of running a practice. I treat all of them as if they were partners and they are compensated well, well, well. For Example my first year associate is making $78,000/year plus commission. His first year straight out of school, he earned $102,000/year. This is more than any new MD, Dentist, Optometrist etc….. How many associates can you honestly say that’s making that kind of money. Don’t let it fool you Dr. Chuck work his ass off also.

Out of all the associates that I’ve had, only one ended up leaving for family issues. I have 4 associates working for me and they are all happy.

My advice is to be careful, it’s not a kind world out there.

I will be glad to answer any question. Feel free to post any questions, I will be happy to answer them.

Dr. Simmins

Pay-For-Performance

Ever heard of "Pay-For-Performance" healthcare?

It sounds like a great idea at first. The idea is that a doctor or hospital would get reimbursed for following a set of guidelines that could ensure statistically the best care for the given condition. Who is doing it? Mostly HMO plans. And here is the kicker, more than 50% of HMOs are doing it. To be honest, I am not sure if I like it or not. My frustration is that I feel the few will be ignored for the many. That some will suffer because they don't respond to treatments that others respond to. Most of you know I root for the underdog. I constantly treat the person who falls through the cracks of standard care. I treat those that are the few who don't respond the way everyone else thinks they should. As such I am mad that more and more people will fall into this category as they are shoved through a flow chart of protocols rather than the doctor being required to investigate. I am also glad because this means more people for me to treat. But this isn't really what I want.

A recent article noted:

"More than half of the nation's HMOs used pay-for-performance programs in their contracts with doctors and hospitals in 2005, according to a new study supported by HHS' Agency for Healthcare Research and Quality. More specifically, the study, which was published in the November 2 issue of the New England Journal of Medicine, found that nearly 90 percent of those included these arrangements as part of their physician compensation and more than one-third of HMOs with these programs included them in their hospital contracts. "
http://www.medicalnewstoday.com/medicalnews.php?newsid=55682&nfid=nl


What does this Mean for you?
This means that when your doctor sees you, they will get paid more if they follow a flow chart of what most people respond well to. This is good in that is helps motivate your doctor to give you the care most people respond best with, but on the flip side, it also means your doctor is getting trained consciously and subconsciously to think about your care in terms of the dollar. Now don't get me wrong, your doctor won't give you care just because of the dollar value associated, but what it does is create a pattern in your doctors behavior. It trains the doctor to always follow a certain pattern of diagnosis and treatment. When you're doctor gets in this groove, it is hard to get out of the groove. Doctors tend to create habits and follow them, they have to, they don't have a lot of time to spend with you. For the average patient, this is a blessing. But what if you aren't average. This can often result in a delay in the correct diagnosis or treatment. The problem isn't the idea, but the possible result.


As a society we are moving into a grey zone. I remember having the conversation as a youngster that went like this. "If you could save one thousand people, but had to kill one to do it, would you?" Twenty years ago most people would say "No way!". Nowadays most the people I ask say "It depends?" What? But more and more we know the true answer. We practice it and make it law. We say that destroying embryos for research to help bring cures to people is worth it. We say that sending troops to Iraq to prevent an attack on America is worth it. I am not bringing judgment on either of these statements. We all know that freedom isn't free. We all know that sacrifice is required in life. But where do we draw the line, is the line getting thicker or thinner.

What does this last comment have in regards to pay-for-performance?
This is the connection. When we look at people and health care through a statistic, we stop seeing them as individuals with unique needs. We de-humanize people and put them into categories. When this happens, the role of a doctor from being a teacher, investigator, and mediator will be changed to that of a technician. The doctor of today is slowly pushed into treating patients based on their insurance and statistical relevance. Doctors are scared, frustrated, and not sure what to do. They have seen this happen with the drug companies telling people what they want, and as a result M.D.s and D.O.s have become the mediator of therapies based on symptoms. Soon they will be more restricted into the mediator for the insurance company and the drug company.

Will more people get better d/t standards of care. Yes. Will everyone, no. What I predict is that we will just shift who isn't getting better.

Solution: Make your doctors work for you, not the insurance company. HOW? Get yourself a healthcare savings plan. This way you are covered for serious injuries and illnesses, but you pay for the care you get with your own pretaxed dollar. This puts health and healthcare back into your hands. Now your doctor is only responsible to you - not the insurance company. In addition to getting better care, you will save money, and build up savings in your healthcare account.

Live long if you're healthy! Live well, if you aren't! ~sv