The Chiropractic Files

Women Leaping to the Forefront

Article posted on acatoday.org  article suggested

by Michelle Logan Chiropractic Student check out her myspace page  http://www.myspace.com/mishllynne 

As Their Numbers and Opportunities Increase, Female DCs Search for Ways to Balance Family, Practice and More Participation in Chiropractic Leadership

By Angela Kargus, Communications and Public Relations Manager

The chiropractic profession has long been noted for the number of women in its ranks, including both doctors of chiropractic and chiropractic assistants.  From pioneers in chiropractic science such as Mabel Heath Palmer, DC, to modern-day educators and researchers, women have played some of the most influential roles throughout the history and development of the profession.

While recent surveys indicate that the number of female chiropractors hovers around 18 percent—a 5-percent increase from just 10 years earlier—chiropractic colleges report rising numbers of female students entering the classroom, with some schools touting female enrollment percentages as high as 49 percent.

If the trend continues, women chiropractors may have an even greater impact on the future of the profession. Still, striking a balance between career and family remains a challenge for most women—chiropractors or not—as they strive to make their mark.

Female Leaders  

As women already in the field attest, there’s no doubt that opportunities for achievement in the profession are greater than ever before for female chiropractors. And while some in the profession may question whether or not chiropractic leadership represents the diversity that exists in the field, when it comes to women, statistics say the chiropractic profession is par for the course.

According to a review conducted by ACA staff of several national chiropractic organizations—including ACA, FCER, FCLB, CCE and COCSA—approximately 17 percent of all board members combined are women—a higher percentage than most Fortune 500 companies.  According to a 2005 report by Catalyst, an advisory organization working to advance women in business, only 14.7 percent of Fortune 500 board seats are held by women.

“Historically, chiropractic has been a male-dominated profession in terms of leadership roles,” says Kate Rufolo, DC, a board member of the Congress of Chiropractic State Associations (COCSA) and the first woman president of the Pennsylvania Chiropractic Association (PCA).  “However, we’re starting to see a change in the trend, with more women holding leadership positions on boards and committees.”

Alana K. Callender, director of the Palmer Foundation for Chiropractic History and an author on chiropractic history, shares similar sentiments, “In the past, women may not have been on as many boards, held as many offices, or been given due recognition by their fellow doctors, but chiropractic…has never closed the door on women.”

While both women are happy to see the increased involvement of women in local, state and national leadership positions, they agree that an even greater increase in participation by women could only benefit the profession.

“You need the female perspective,” Dr. Rufolo says.  “There’s a different breadth of perspective and expertise—just by being female—that one brings to a board of directors or other leadership position.”

Canadian research shows that boards of directors work differently when diverse perspectives are brought to the boardroom table.  In particular, researchers found a distinct difference in governance patterns, especially in setting an organization’s mission and vision, and in planning and policy-making.  Having more women and people from diverse backgrounds means that companies represent—and better understand—the customers they want to attract, leading to improved competitiveness and productivity.

Another recent American study shows that companies with the highest representation of women on their top management teams performed much better financially than those without—a 35 percent higher return on equity and a 34 percent higher total return to shareholders.

Dr. Rufolo admits that in the beginning her position as the first woman president of PCA was daunting.  “I set the bar higher and looked at myself with more scrutiny than any of my male peers.  From my experience, the good ol’ boys club that everyone throws around isn’t actually there. If anything, from years of hearing about it we simply think it exists,” she says.

Other women agree, including Cynthia Vaughn, DC, from

Austin

,

Texas

, an ACA delegate. “There are ample opportunities for women, and the seemingly large number of men involved in the profession shouldn’t be a deterrent.  With the large number of female students entering the profession, it’s only a matter of time before women gain critical mass.”

Work, Family Balance

Undoubtedly, women today have more opportunities than ever before. Whether as entrepreneurs in their own practices or managers in large corporations, female business leaders are succeeding at an unprecedented pace. The percentage of women-owned businesses is increasing at rates exceeding the national average as more and more women entrepreneurs find access to capital and markets for their goods and ideas.

But with this success comes the challenge of striking a balance between professional aspirations and personal responsibilities.  Women tend to play tug-of-war between business needs and spending time with their family, according to a survey conducted by CareerBuilder.com. Although the majority of working mothers say they spend three or more hours with their children after work, 44 percent admit they become preoccupied with work while at home. One-in-four say they bring home work at least one day a week.

“The No. 1 issue for women in practice is balance. How do I have both a great practice and a strong family?” says Janice Hughes, DC, a consultant with The Masters Circle.  In 2003, Dr. Hughes collaborated with fellow

Masters Circle

consultant Elisa Zinberg, DC, to present a custom-designed program to address the unique challenges and opportunities for the female chiropractor.

“The most important thing—for anyone, including moms—is finding what motivates them.  You need to understand your goals, needs and expectations, both at home and at the office,” says Dr. Hughes, explaining that women face intense pressure when trying to balance a high-powered career, marriage and children. “While some women would love more involvement in chiropractic beyond their office, they may realize that taking on an additional professional role isn't a major priority for them at this point in their life."

To achieve a workable balance, many women are blending work and raising kids.  Dr. Vaughn recalls the days when her 8-month-old daughter accompanied her to the office and soon became the clinic mascot. “The key to making home and work balance is different for every family, but it’s not impossible. One of the greatest advantages to owning your own practice is the flexibility,” she says.

Finding Support

For some women, the way to achieve a sense of balance is through membership in a women-specific business networking group, because often the camaraderie goes beyond discussing workplace issues. Women say the appeal to women-only groups is the ability to ask colleagues questions without feeling embarrassed or stupid, and to learn how other women handled difficult situations. Networking also tends to be easier, as women often have things in common already, such as balancing work and family responsibilities.

Sharon Harady, executive director of the Center for Women’s Business Research, a nonprofit group based in

Washington

,

D.C.

, said that successful women network in groups for different reasons. Some look for business leads and help finding employees. Groups specific to women provide those benefits, but also one other benefit that’s hard to find elsewhere: support.

“They are looking for other women with whom they can share experiences and what they’ve learned in a low-risk environment,” Harady said. “That’s the main thing these organizations do. They give you a chance to be with women who have gone through experiences and can help you deal with them, learn from each other and provide connections.”

Aspiring Leaders

For women—or men—who aspire to be leaders in the chiropractic profession, the Women’s Equality Unit, which works to support economic opportunities for women, offers the following suggestions:

·       Seize every opportunity to network. Join professional chiropractic organizations such as the ACA or your respective state association. Attend trade shows and professional conferences. These are excellent learning tools and have the added bonus of enabling you to meet new people.

·       Have the right skills.  Make sure you have as many of the core competencies that boards look for as possible: financial literacy, communications skills, strategic planning, and experience in the decision-making process.

·       Talk about your career aspirations. Let people know what positions or assignments would be of interest to you and why you would be a good match for them.

·       Raise your profile.  Write articles in industry publications, participate in corporate activities and, where possible, attend industry functions.

·       Take on leadership positions.  You know the saying: “Even a journey of a thousand miles begins with a single step.”  If the chance arises, volunteer to sit on a task force or other industry-related board. You gain useful experience as well as the reputation of someone who gets things done. Don’t be afraid to step outside your comfort zone.

·       Identify opportunities. Find out which boards are already looking for women to join them; that way you’ll be pushing at an open door when you put in your application.

·       Believe in yourself. If you can see it, you can have it. Picture yourself in the role to which you aspire.  You must have confidence to get to where you want to go.

·       Persevere.  We are likely to stumble at first. It’s part of the learning process. You may not achieve what you want immediately, but don’t give up. Keep acquiring the skills that will one day take you into that leadership role where you know you belong.

Readers, send us your comments about this article or suggestions for future articles. E-mail the ACA News editor at acanews@acatoday.org. 

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

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

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

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

Chiropractic Vs MD: The battle

Hello Doctors.  Below is a perfect example of some of the minds in our profession.  This is debate between a medical doctor and a chiropractic doctor.  I found it on the net and posted it here.  I will email the chiropractor today for permission of this post. The chiropractor's name is Dr. Steven L. Vanden Hoek, D.C. OK READ ON One question I like to ask chiropractors, and one I have never received an answer to, is how organs systems continue to function after transection of the spinal cord due to trauma. They don't seem to understand that many functions of our body do not need the spinal cord intact. Quadraplegics still filter blood with their kidneys. There hearts continue to beat. A chiropractor recently came to Vanderbilt to speak to the 4th year medical students and put up a slide showing how specific subluxations effect specific organs. When will they learn. Clark Bartram | Homepage | 04.09.06 - 3:47 pm | #

Great question - by the way, I am a Doctor of Chiropractic. I appreciate the confusion about my profession, and many claims some of the Doctors make. In response to your question about people with damage to the spinal cord. When a spinal injury occurs, this affects the motor nerves /sensory nerves that allow a person to move muscles and feel sensations. This happens because the damage occurs within the spinal column and signals from the spinal nerves are not properly transmited to and from the brain via the spinal column. Your body has a variety of other pathways for neurologic communication. Your ability to digest food, have bowel movements, breath, or even a heart beat is controlled by the autonomic nervous system - a little diffent than the voluntary motor system. What is also amazing is that both the heart, and the intestines, have additional self stimulating systems. The heart can beat even outside the body, and the intestines can self regulate. Every organ does have a spinal nerve that goes to it, but it isn't the only nerve. The amount of damage you recieve depends on the level of spinal damage, and if any nerves are directly damaged. This is why some people have to use breathing tubes following spinal injury and others don't. The most common sign for emergency surgury associated with a disc bulge is the loss of bladder and bowel function. Yes, you pinch a nerve hard enough and your "organs" don't work properly. But lets get real, very few people actually have a pinched nerve. Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints. Ever bump you head? You rub it to calm down the pain. This is because mechanoreceptors (nerve endings) will calm down the pain receptors (nerve endings). Guess what? A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain. More importantly, if you can keep the joints moving, ie. exercise - the pain will continue to decrease. Same reason your stiff in the morning - lack of joint motion!! In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine. More people have serious complications from taking asprin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor. Transplanted organs - give me a break. You don't think nerve supply is required? You don't have to like chiroprators, lawyers, or mechanics. The truth is that every profession has idiots and liars. That doesn't discredit the whole profession. I spent four years postgraduate, taking the same classes as a medical doctor, reading the same text books, cutting up the same dead bodies in gross anatomy. Give me a little credit. Most chiropractors are to lazy to try to educate their patients - and that is why stupid comments, like the chiropractor you reference, are made. Read my blog if you want a better understanding. http://advancedehealth.blogspot.com Steve Vanden Hoek , D.C. Steven L. Vanden Hoek, D.C. | Homepage | 04.10.06 - 3:23 am | #

"Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints." Really? How is this measured? What studies support this? "A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain." This has as much scientific support as saying that manipulation allows for better flow of life energy from god. "In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine." Where did you get these numbers from. I've heard higher rates. "More people have serious complications from taking asprin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor." Aspirin has a proven mechanism of action whereas chiropractic has theory and conjecture. Your simplistic analogy fails to take into account the potential indirect damage of chiropractic such as delayed medical care for problems that a chiropractor is not trained to detect and may not even think about. This is particularly an issue when chiropractors attempt to treat children. The chiropractic community is very secretive about just how much malpractic goes on. Your cost is lower because people don't sue alternative practitioners like they do MD's. That speaks volumes about the ability of alternative practitioners to connect with their patients, something MD's can stand to learn from. It does not speak to the legitimacy of your profession which is suspect except in the realm of acute lower back pain. Clark Bartram | Homepage | 04.10.06 - 11:51 pm | #

Do you really want a pissing match? I game! Steven L. Vanden Hoek, D.C. | Homepage | 04.12.06 - 1:55 am | #

Alright Doc - Call me on this if I'm wrong. That is the point of having an open discusion. Please do not be "irritated" by my answers - as I want anyone, not just a doctor to understand what we are talking about. As much as I hate to admit it – most of the support for chiropractic manipulations comes from the medical community and not chiropractic. Unfortunately they are doing most of the research that show the neurological connection between joint manipulation and the benefits the patient experiences. I will kindly address each issue you raise in response to my reply. 1.) "Most people have over fascilitated (irritated) nerves. And not the big spinal nerves you think about, but the microscopic nerve endings found in the surrounding tissue and facet joints." Q: Really? How is this measured? What studies support this? A: The microscopic nerve endings I speak of are nociceptive and mechanoreceptors nerve endings. When a joint has altered kinematics – effusion or swelling (inflammation) is initiated in the area of altered biomechanics. This (inflammation) is a natural response to any proposed injury. Inflammation causes a whole host of reactions. These include increased fluid build up, increased chemicals to the regions, increased blood, etc. This is why when you cut yourself you it swells, gets red and hot, and is more tender. As you know spinal nerves exit the spinal column via the foramen formed by the joints of the spine. If anything – be it a spur, degenerative disc disease, or inflammation and swelling, or a disc herniation encroaches on the nerve directly or indirectly – the nerve will fire. i.e. increased pain, or motor or sensory loss. Basic neurology shows that pressure, even very slight pressure – will cause inflammation of the nerve and increase the firing rate and frequency. You can pump the body with an anti-inflammatory to help the reaction – or you can help improve motion to get rid of the fluid and swelling. Now as you can tell – this doesn’t work when spinal stenosis is present, nor is it as effective with severe disc degeneration or a disc herniation. My study is every neurology, physiology, pathology, and anatomy text book. Look it up – its basic science. Nerve facilitation - I assume you understand the concept of pain and that you understand that inflammation causes pain? This knowledge is the basis for why docs give “anti-inflammatory” medication to patients in pain. That’s why you take ibuprofen. Stop the inflammation, and you decrease the pain. Do I really need a journal article to demonstrate this concept – or will millions of Rx’s for anti-inflammatory meds due the trick. Ever heard of joint effusion – or capsular swelling? Swelling, huh, could this be swelling as in one of the cardinal signs of inflammation – rubor, calor, etc. 2.) "A manipulation of the spinal joints is done to fire those mechanoreceptors to help modulate pain." Q: This has as much scientific support as saying that manipulation allows for better flow of life energy from god. A: Mechanoreceptors modulating pain – scientific proof? You will need three things any 1st year med student will have. 1.) anatomy book 2.) neurology book 3.) physiology book. READ THEM. This isn’t even up for debate. Even the M.D.’s know this - Dr. Mark Sontag – a physiatrist noted “neurological studies show motion tends to block pain impulses to the brain….the more action, the less pain is likely to be felt…” “The perception of pain is dependent upon the balance of activity in large (mechanoreceptor) and small (nociceptive) afferents. John Nolte, The Human Brain, Mosby Year Book, 1993, p. 139. “If large my myelinated fibers (mechanoreceptors) were selectively stimulated, then normal “balance” of activity between large (mechanoreceptors) and small (nociceptive) fibers would be restored and the pain would be relieved.” John Nolte, The Human Brain, Mosby Year Book, 1993, p. 203 It has been shown that in the neck – much neck pain comes from the zygapophysial joints – the very joints chiropractors manipulate. http://www.ncbi.nlm.nih.gov/ entr...l=pubmed_docsum Mechanoreceptor Endings are in human cervical facet joints as per: SPINE volume 19, number 5, pp. 495-501 (March 1, 1994) SPINE 1998;23:168-173 And we also see that these mechanoreceptors provide “afferent input to the central nervous system (CNS); because the endings identified were primarily mechanoreceptive, it follows that the mechanical status … is being monitored at the CNS level.” http:// www.askewchiropractic.com..._adjustment.htm “The transmission of pain signals up the spinal cord can be increased by lack of proprioceptive signals (sensory information to the spinal cord on the movements and positions of muscles); or reduced by greater proprioceptive input. This is Melzack and Wall's "gate" mechanism - the gate is opened to pain (nociceptive signals) by reduced other sensory input.” Bottom line – 1.) mechanoreceptors exist within the joints of the spine. 2.) mechanoreceptors affect the CNS 3.) damaged/injured z-joints cause pain 4.) properly functioning z-joints don’t cause pain 5.) get the z-joint moving, and you help control pain 6.) chiropractors restore normal motion to the z-joints thus helping increase joint motion and pain modulation. 3.) "In comment to the stroke issue - the stats show about 1 in 2 million have a cerebrovascular event following manipulation of the neck. You have a greater chance of a stroke from turning your head to quickly while trying to look out your car window then from receiving a manipulation of the spine." Q: Where did you get these numbers from. I've heard higher rates. A: Lets start with this one: (covers the stroke and NSAID issue) http://stroke.ahajournals.org/cg.../full/32/9/ 2207 As shown in their Table 1, the entire argument as to whether spinal manipulation is a significant risk factor appears to hinge on a total of 5 cases over 5 years, or 1 case per year. To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions.11,12 Death rates from lumbar spine operations have been reported to be 300 times higher than those produced by cerebrovascular accidents in spinal manipulation.13,14 For cervical surgeries, recent death rates have been estimated to be 700-fold greater.14 As Rome7 has pointed out, risks for "virtually all" medical procedures ranging from the taking of blood samples15 or use of vitamins or drugs16 are routinely accepted by the public as a matter of course. Then this one: (stroke again) http://www.webmd.com/content/art.../ 1728_80109.htm “As pointed out in Rothwell's study, says Rondberg, the rate of stroke is estimated at 1.3 incidents per one million adjustments given. "Other studies, including one covering a 28-year period reviewing 110 million chiropractic visits, showed conclusively that the risk of stroke from chiropractic adjustments is so small that it's statistically insignificant," he says.” Oh wait, I forgot about this one: (even better – stroke again) http://www.chiroweb.com/archives...s/19/23/ 04.html A paper1 published in the October 2 issue of the Canadian Medical Association Journal (CMAJ) by Scott Haldeman,DC, MD,PhD, Paul Carey, et al. ("Arterial Dissections following Cervical Manipulation: the Chiropractic Experience") reports that the chances of arterial dissection after cervical manipulation is approximately 1 in 5.85 million manipulations. 4.) "More people have serious complications from taking aspirin than from getting an adjustment. Insurance companies understand this - and this is why my malpractice insurance cost are about 1/5 that of a medical doctor." Q: Aspirin has a proven mechanism of action whereas chiropractic has theory and conjecture. Your simplistic analogy fails to take into account the potential indirect damage of chiropractic such as delayed medical care for problems that a chiropractor is not trained to detect and may not even think about. This is particularly an issue when chiropractors attempt to treat children. The chiropractic community is very secretive about just how much malpractic goes on. Your cost is lower because people don't sue alternative practitioners like they do MD's. That speaks volumes about the ability of alternative practitioners to connect with their patients, something MD's can stand to learn from. It does not speak to the legitimacy of your profession which is suspect except in the realm of acute lower back pain. A: Again lets start with this one: (covers the stroke and NSAID issue) http://stroke.ahajournals.org/cg.../full/32/9/ 2207 To put this matter in the proper perspective, one should be forever cognizant of the fact that death rates following cervical manipulation calculate to be anywhere between 1/100 to 1/400 the rates seen in the use of NSAIDs for similar conditions. Then this one: http://www.medpagetoday.com/tbin...x.cfm? tbid=1612 “…the researchers calculated that the national death rate from aspirin or other NSAID-related GI events was approximately 15.3 deaths per 100,000 NSAID and aspirin users. NSAIDs included over-the-counter and prescription drugs. Low-dose aspirin alone accounted for between 8.2% and 12.2% of all GI complications and deaths, the research team reported in the August issue of the American Journal of Gastroenterology. “ Lets look at this one: (malpractice cost) http://tampatrib.com/Business/ MG...GA2EYCO2HD.html “Baycare estimates its average premium for a doctor is $20,000 a year; UCH estimates its average at $20,000 to $25,0 Steven L. Vanden Hoek, D.C. | Homepage | 04.12.06 - 5:03 am | #

(CONTINUED) ---- $25,000. But each insures a large number of physicians in what are considered low-risk specialties, which lowers the average. The cost of the policies generally range from $10,000 to $60,000 - though a few physicians have been given quotes of more than $100,000, Archbell said. “ I paid $1,200 last year for my malpractic – for the whole year – and that was for 1mill/3mill coverage. Sorry I was wrong – it isn’t 1/5th but 1/10th to 1/100th the cost. And bull to not getting sued as much. People can sue for any reason, any time – in fact most the time they know it won’t go to court, but the doc will settle just so his name doesn’t get smeared. Cost are based on pay out – and the more damage you cause – the bigger the pay out. We can’t cause that much damage since we don’t cut on the patient, or rot their liver with powerful drugs. The most we can do is crack a rib, sprain a joint, or exacerbate a current condition. Training: Not trained to detect potential problems? Do you have any idea what are training involves? Per not being trained to detect more complicated problems – is that why I am considered a primary physician – is that why the description of what I can treat and how sasys the following: “…a chiropractic physician(is)licensed to treat human ailments without the use of drugs and without operative surgery.” http://ilga.gov/legislation/ilcs...+Act+of+1987% 2E Now from what I read, this means any – yes any – human ailment. I’m sure you understand that you aren’t legally allowed to treat something you can’t first diagnose. And you can’t diagnose something you haven’t been trained to diagnose. And the training had to come from an approved school – regulated by the government. Look if the government says I can do it – I can. Even if you don’t like it. Even if some of my colleagues choose not to diagnose or treat anything other than a subluxation – which has an ICD-9 code associated with it. Oh that ICD-9 means it is a recognized problem/disease. I guess a subluxation is a disease – at least as much as acid reflux is a disease. Or are only things that can be treated with a drug or knife a true disease? And per future adverse events as the result of a manipulation – give me a break medical mistakes at hospitals cause more serious complications and deaths than all the chiropractic manipulations will ever cause. And if this is such a problem, why are the Physical therapist lobbying congress for the right to give manipulations? Why are Medical doctors taking continuing ed classes to learn how to provide manipulations? Come one – every one wants a piece of our action – b/c it works. I appreciate your willingness to stand up for what you believe is right and wrong. I even agree with your comment that chiropactors haven't proven a great need for children - and the scoliosis screening thing is a scam, a marketing tactic - about the same as those hearing test they give your kids? Honesty - I do appreciate your comments and even your own blog - not bad. Do I treat my own kids – sure. I have three kids – ages 7, 5,4. Guess what – between all three we have had to use one round of antibiotics. I haven’t had one of them sick for more than 24 hours. I feed them good, adjust them, give them food supplements. My son has been in the hospital once – after a bad reaction to a vaccine – guess what, I don’t tell patients not to get vaccinated – that would be practicing medicine. Just like you telling a patient not to get an adjustment is practicing chiropractic. Every profession has to prove itself. Medicine use to use leaches to get the evil spirits out, chiropractors thought they could cure cancer with a spinal manipulation. M.D.’s thought nerves carried air, D.O.’s thought they carried blood, and D.C.’s thought they carried electricity. Guess we got one correct. D.C.’s were doing physical therapy on patients before physical therapist were around. Yeh – we got a lot of quacks out their, but hey, so do you. Feel free to chop up the chiro’s doing crazy stuff , but not the profession – just the person – some of us have our head on straight, and would love to work with you, not against you. Steven L. Vanden Hoek, D.C. Steven L. Vanden Hoek, D.C. | 04.12.06 - 5:28 am | #  Posted by Dr. Clerge

Who's the Doctor?

Once in a while you will meet a “know it all patient”. It’s usually an educated individual with a science background. I’ve discussed this story with many of the doctors that I know and all of them have experienced a similar situation.

Approximately 2 months ago patient X walked into my office with chief complaint of mid-back pain. Patient X is employed in a health related environment and has some knowledge in human anatomy. The necessary imaging and protocols were followed and the conclusion was sprain/strain to the thoracic region. The diagnosis made sense, since the pain was felt upon lifting a heavy object.

The patient was prescribed the proper stretches/exercises and modalities coupled with the proper adjustment. It all started when patient X noted that the Heat from the heat/stim caused stiffness in the midback. I explained to patient X that heat has more of a sedation/relaxation effect. My first mistake was deciding to stop using heat since it caused patient X some discomfort.

The very next week, X stated that it felt better when she was adjusted P-A instead of A-P and that he/she did not want to be adjusted in the A-P position no longer. Once again I explained the purpose and the specificity of the adjustments; however, I decided that I will only adjust he/she in the P-A position.

The following week X recommended some exercises that must be integrated with her treatment. Now, the confrontation started. I explained to him/her that his/her current exercise is designed for his/her specific condition and that he/she could no longer dictate his/her care. It was a very heated conversation, considering that patient X has an authoritative personality. Unfortunately, patient X is no longer my patient.

This is a very short article. The purpose of this article is to prevent the same situation from happening to you. Do not let your patients dictate their care. We all need to let our patients know that we are the doctor and we should never compromise our decision. My mistake was agreeing with patient X when she initially made the suggestion. Stand firm on your decision. It is best to stop this behavior before it escalates into something that we are not able to handle. 

Dr. Paul

Chiropractic Commercial on NBC: We are Mainstream

Hey Guys,

Let me say thank you for posting your articles.  The responses from the articles so far are excellent.  I spoke with a few of my colleagues and they are loving this site.  Remember the purpose of the site is to educate, inform and inspire.   We accept all articles and we do not edit any of them.  Just follow the rules and "you can speak your mind", we actually encourage it.  Once signed up as a Guest Author, you may write all day long. 

With that said, if you know chiropractors, new graduates and students that can benefit from some of these articles, please let them know about chirofiles.com

Ok,  A new series of chiropractic commercials are scheduled for the year 2007 for a whole year.  This is an  excellent idea for going mainstream. Check out the links to the commercials

the website is  www.chiroontv.com  go check it out.......

Below is the information from the website

1. 3 TV COMMERCIALS. Mpower Media has produced 3 television spots in 35 mm. film, the same level of production of Hollywood and Madison Avenue studios. Every commercial was created with the goal of reaching the specific audience of the Chiropractic market.

2. NBC BROADCAST. Mpower Media has secured airtime nationally with NBC, one of the major TV stations in the country. Mpower will air a minimum of 31 spots a month. The start date of the National Chiropractic Campaign has been set for March 2006, to continue for a whole year until March 2007. One year of getting the chiropractic message across to the American public can get you direct business in your practice.

3. CHIROPRACTORS PARTICIPATION. Thousands of chiropractors nationwide will contribute $300 a month to be a part of this national program. More than 650 chiropractors across the nation are already using these television commercials. Everybody counts. We need your support to make this campaign a national success.

4. THE OBJECTIVE. Mpower Media wants to help the Chiropractic world to bring awareness, credibility and visibility to the Chiropractic profession. The Chiropractic message will be seen in highly watched and credible programs that most Americans watch on regular basis, like NBC News.      

5. THE MARKETING STRATEGY. Each television commercial will be aired nationally for a period of 4 months. Your potential clients will see 3 different spots with the same message, and they’ll remember to call you! Each one of the commercials ends with “Call 1-877-CHIRO-06 to be connected to a chiropractor near you”.

6. YOU GET THE PHONE CALLS. Our state of the art phone routing system connects the calls directly to your office. If more than one chiropractor from one area is involved in the program, the phone calls will be distributed in a round-robin system, so everybody gets the same amount of phone calls.

      7. THE MARKETING STRATEGY. Mpower Media gives an entire print campaign that match the television commercials to every chiropractor involved on the program. Your potential patients watch the characters and the slogans of the commercials and then they get print pieces that reinforce the same message and help them make the connection with the TV campaign.      

8. HOW THE AIRTIME SCHEDULE WORKS The National Chiropractic TV Campaign has started and with 540 million people watching NBC every day, we are reaching 90 million with our television commercials. This historic event has begun. The program starts with the broadcasting of the spots in late night programs, like the re-broadcast of JAY LENO (Monday through Friday) and the Sunday late night re-broadcast of DATELINE NBC. There is a minimum of 31 spots to be aired every month, and that number increases once Mpower Media evaluates the response that the American public has to each time slot. That response determines how many commercials should be aired more during certain times or certain programs. The "Doctor's Only" web site will have every month the changes that are being made to the schedule. At our current pace, you'll be able to see more daytime airings in place of the night time ones. The first spot to be added into the daytime schedule will be in the TODAY SHOW, spots that airs around 9am in most markets, or in the PASSIONS soap opera.

Dr. Nesly Clerge, DC