Who put the ER in derisory?

This is a time when the author must dust off their soap box, recharge the batteries in their megaphone, and stand up and speak their mind.

I am a FIRM believer in the major medical profession. Plain and simple- there are things that they can do, that we, as chiropractors, cannot: Emergency surgeries, front-end treatment of traumatic accidents, and even celebrating life with the birthing of children. I will start this post off immediately with balance- IF YOU NEED TO GO TO THE EMERGENCY ROOM OR THE DOCOR… GO!!! This article is not steering you away from seeking emergency care when you need it, but rather challenging the medical profession, as a whole, to raise their standards of treatment and come back to the reasons they started practicing in the first place… TO HELP PEOPLE!

I have run into two instances- in the last two weeks alone- that have made me shake my head in disbelief and my blood boil in righteous anger. Both occurrences where with… the E.R…. and not only that… two occurrences… involving THREE different E.R.s in separate parts of the country. I will start with the first…

My D.C. was visiting his family in Texas a couple of weeks ago, and he was having SEVERE pain in his big toe. (May not sound like a big deal… but for a Chiropractor to seek medical treatment… he was in some MAJOR pain). Upon walking in, he was warmly greeted by the front desk and insurance clerks. When he got to triage, the atmosphere changed drastically. His triage nurse was a nurse practitioner, and she seemed already in a mood of indifference. Hardly looking at him, she ran through the standard questions and rapidly entered the information into her computer… until she got to the question of “occupation.”

“Sir, what is your occupation,” she sighed, and continued to stare at the computer screen in front of her.

Nonchalantly, the patient replied, “Oh, I’m a chiropractor.”

Immediately, the muscles in her arms tightened and her eyes narrowed. Without taking her eyes from the computer screen, she replied, “I see…”

WHAT difference does it make what his profession is?! He is YOUR patient now. As if THAT wasn’t enough to make my point, it gets worse.

The chiropractor was escorted to a bed in the E.R. where he waited until the radiology department called for him. He was warmly accepted by the radiologist and well taken care of, and once the films were taken, he was moved back to the E.R. to wait for the attending physician. Shortly after he was back from radiology, to his surprise, it wasn’t a doctor, but rather the nurse practitioner from triage that he next saw.

Not even stepping into the room, she opened the door, leaned her head in, and said, “There were no fractures or breaks in the films. We are treating this as a sprain/strain, and I have prescribed meds for your pain.” She quickly retreated through the door, and pulled it to a close behind her.
SHE DIDN’T EVEN DO AN EXAMINATION! WHA-?! I’m sorry, but chiropractor or not, he was a patient under her care. It is time find whatever beef you have with your patient and grill it up and eat it! After the doctor finished in the E.R., he went back to the radiology department to look at his own films, and the radiologist gave him FAR more insight into what was going on than the N.P. ever did.

We see SEVERAL physicians in our office as patients, and it NEVER occurs to me to treat them with ANY less resources or kindness than our other patients. I am honored that they have chosen to come HERE to seek our advice… Why on earth would I forfeit the chance for a great professional alliance over something as trivial as an elementary prejudice?

The second story I will share with you was NOT based out of prejudice, or at least not in the same vein. A patient was driving his Harley at 65mph one night, and enjoying the familiar feeling of freedom. Life is good. Being an unfamiliar road, he was surprised when the upcoming turn, came in the form of a surface change from asphalt to gravel. In less than ten seconds, his bike was laid on its side, launching him from his seat. Turning two flips in the air, he landed on his left shoulder and side of his helmet, sending him tumbling across the ground.

He was taken to an E.R. for examination. Obvious that he had done damage to his clavicle, they did an M.R.I of the shoulder. The results came back with a positive fracture of the left clavicle. They prescribed pain medicine and sent him home. In disbelief that they didn’t even check his neck, or run tests that would rule out concussion, the family drove to the next E.R. This E.R. did have the wherewithal to do a C.T. scan of his head, but with no swelling of the brain, they sent him home.

I’m sorry, but if a patient comes into your office after having had a motorcycle wreck at 65mph landing him on his shoulder and neck… SHOULDN’T YOU CHECK HIS NECK FOR BREAKS OR FRACTURES?! Two E.R.s, and they BOTH failed to do the seemingly obvious.

We brought him in, did a series of films, and found that his C1 and C2 were so severely rotated that when the patient was asked to close their eyes and look straight, their head was 45 degrees off center. He had a couple of fractured ribs, and a mild concussion. Sheesh… what would have happened if he hadn’t come to us?

My point is simply this. To my chiropractors and staff: We offer a valuable service that few people are offering anymore. It is simply- caring. Caring enough to take the time to be thorough. Caring enough to connect with the patient and TRULY listen to what they are saying. Caring enough to treat them as an equal patient, as if it were your own family member that you were treating. The patients are not getting that at every office. Sometimes it can be easy to take our day-to-day routine for granted, but you never know. You could be the highlight of someone’s week, month, or year. Do not underestimate the power of caring.

Look at it as an acronym:

Connect

Ask questions

Relate

Encourage

"I'm strong to the finish, cause I eats me spinach... I mean... phosphorus?"

If I take enough calcium… my bones will be strong! … Right?

WRONG! Well… MOSTLY wrong. Have you ever tried to eat a PB & J sandwich without Jelly? Have you ever tried to watch a 3D movie with only the red side of the glasses? Hahaha… sorry. My point is that there are things that will only work in conjunction with another. That is the case with calcium and phosphorus.

Phosphorus is the unsung hero. It carries with it so many important health benefits, and is more and more proving to be a neglected part of the American diet. Phosphorus not only helps build bone matter, it also aids in transmissions of nerve impulses, gives you stable and plentiful energy, and research shows may even help block cancer. Both calcium and phosphorus are found naturally in dairy products, but most supplements containing calcium and calcium fortified foods/beverages don’t contain phosphorus. This is making it more and more unavailable to the body.

Required by the body for bone and teeth formation, phosphorus makes up more than half of all bone matter. Calcium alone cannot build strong bones and tissues. As new research emerges, it is becoming quite evident that calcium needs phosphorus to maximize its bone-strengthening benefits, and taking several calcium supplements without adequate phosphorus could actually be a waste of money and interfere with phosphorus absorption.

Women who are trying to prevent or treat osteoporosis usually take 1,000-1,500 mg of calcium daily in supplements. However, studies are showing this amount of calcium can bind up to 500 mg of phosphorus, making it unavailable to the body. These women won’t see the full benefits of calcium because the bones are made up of both calcium AND phosphorus, and the normal calcium supplement (calcium carbonate) may actually block most of the phosphorus from being absorbed by the body. The recommended dietary intake of phosphorus set by the FDA is 1000-mg (matching the intake of calcium).

There are so many more uses of phosphorus in the body than just maintaining healthy bones. Having problems with your energy level? Want to have speedier recoveries from injury? Do you have problems focusing on- OH LOOK! A CHICKEN! … haha… What I am getting at, is that phosphorus is the team player. It has shown signs of improving energy levels, speeding up healing, and helping to keep your mind alert and active. Not only that- there have been other studies showing that it can even prevent stunted or slow growth in children and can keep your muscles and heart contracting regularly and smoothly.

I know that this is a LOT of information to take in, but I think that phosphorus has flown under the radar for long enough. It’s time to give credit where credit is due! SO! The next time that you go to your vitamin cabinet and pull out the calcium… make sure to grab his faithful sidekick: Phosphorus.

The Last Straw!!!

DOC! I think I broke my rib! Agh!

How did you manage to do that?

Ow-ow-ow! Don’t touch it! I think I broke it when I sneezed… I put heat on it right after it happened to try to ease the pain, but it just keeps getting worse!

(chuckles and shakes his head) Mr. Smith, you must have lungs like Hercules to break a rib by sneezing… We just took x-rays on you last week, and there was not even the slightest indication of a fracture. Are you SURE that there is nothing else that might have caused this pain? And remind me to talk to you about ice vs. heat later…

Stop poking me! You’re the devil, you know that? I am sure there is nothing else… I’m telling ya… I just sneezed… and POP! There it went!

If you don’t relax, Mr. Smith, it is going to make this even more uncomfortable. Stop squirming. Have you ever… say… fallen? Oooor, been in a car accident?

I’ll relax when you get yer thumb outta my back! YEOW! Well… I fell off of a loadin’ dock about 5 months ago… and got drug by a horse when I was 27… and was in a car accident about 3 ½ years ago… BUT THAT WASN’T my fault! He was in MY lane and I-

Mr. Smith… I think I know what we are dealing with here. Take a deep breath in- this is gonna sting a little- breathe all the way out… I’m gonna give a little push-

OWWW! FOR THE LOVE OF JAMISON AND ALL THINGS HOLY!!! I don’t like you very much right now doc! I… OW! You ARE the devil!

Does a sneeze cause a "slipped disc" or a “broken rib”?

A “slipped disk” in the low back and a jammed rib is almost always the result of several things. Just like in most chiropractic cases, the problem starts with a simple fall or imbalance that seems harmless enough, and then it continues to build until it becomes symptomatic. We have all heard the proverbial saying about the “straw that broke the camel’s back”… but I think it is a VERY fitting illustration.

Just like the patient above, a simple sneeze can make someone experience sudden back pain that then proceeds to leg pain or pain in the ribs that can mimic a broken bone; in some cases, it can even mimic a heart attack. However, it wasn’t the sneeze that caused the disc to "slip" or the rib to jam, but it does represent the final "straw" in a much more involved process. Some factors that contribute to the pain and symptoms of back injury include dehydration, unusual stress on the spine, and too much weight bearing on a concentrated area of the spine.

The spine works together as a whole, so if there is a mechanical problem in one part of the spine, even as far away from the low back as the neck, it can cause problems in another area of the spine. Imbalances and problems in the pelvis, sacroiliac joints, and low back, as well as restriction in joint motion in the mid-back and neck, can contribute to the process of disc degeneration and eventual injury in the entire body.

A "slipped disc" or jammed rib usually happens when a lot of these and other factors work together and cause disc injury. For example: A middle-aged blue collar worker who stands for long periods of time, suffers from dehydration, has poor posture from weak abdominals, and lack of range of motion from years of repetitive movement, then lifts a heavy piece of equipment and experiences sudden acute low back or rib pain. Or perhaps many months after lifting the piece of furniture, he experiences no pain at all until he sneezes. Bingo. “The last straw”.

SO! Can a sneeze break a bone? TECHNICALLY… yes. BUT! That is only in severe cases of osteoporosis or rare bone disease. By in large… 99.9% of the time, no. A sneeze cannot cause a bone to break.

"Staff" Infection

No, I didn’t spell that wrong. I am talking today about the importance of a good staff in your office. A wise chiropractor once said, “Give me a great doctor and a mediocre staff, and you will have a mediocre practice. However, give me a mediocre doctor and a great staff, and you will have a great practice.”

Whether or not you want to admit it, your staff sets the tone for the type of practice you will have. The patients see and hear from your staff more than they do you. Your staff is the face of your practice. If they are having a bad day, so will your practice. If they are on the top of the world, your practice will thrive.

We have all been to the dentist and seen that staff member at their office. She complains every time she is asked to do something. Especially if it differs from the way they have “always done things in the past since the practice opened 26 years ago.” She hasn’t been at her best since “the accident” 12 years ago, which she reminds everyone of at least three times a day. She starts drama with the other employees and acts like everyone’s mother and boss. It is not a priority to her to work quickly; 60% efficiency is enough. Although, when she is working at 100%, she is nothing to write home to mom about. She barks orders like she owns the place, but you know by her character and work ethic, that is not the case. Yet, each time you go in to see your doctor, there she is- still getting on everyone’s nerves and shooting angry looks at patients across the room.

Now, I know that she has been a familiar face in the office for some time now, has been there with you through thick and thin, and that you are loyal to the core. HOWEVER, the storms she has weathered with you have left her worn out with a bruised ego and a chip on her shoulder. Everyone sees it but you. Sometimes, the powder blue adjusting tables and lavender vinyl traction tables are not the only things that you need to let go of during spring cleaning. This is not heartless! This is a business decision to liberate you and your practice.

Here are some hints that it is time to let her go:

• If you pull up to your office and sigh because her car is not yet in the parking lot… it might be time to let her go.
• If you dread telling her that you are implementing a new office policy and know that she will not only not do it, but give you a laundry list of reasons why it is a bad idea… it might be time to let her go.
• If she doesn’t seem to understand, no matter how many times you tell her, that it is not appropriate to wear cartoon character underwear underneath her white scrub pants… it might be time to let her go.
• If she is out on vacation for a week, and none of the patients ask why she isn’t there… it might be time to let her go.
• If she is out on vacation for a week, and some of the patients make comments like, “Oh good, chiropractic wasn’t the profession for her,” and you have to explain that she IS coming back to the patient’s disappointment… it might be time to let her go.
• If she still doesn’t understand that her foot fungus and trouble with the in-laws over the weekend is not appropriate waiting room conversation… it might be time to let her go.
• If she rescheduled all of your patients one day just because she decided she needed a day off… it might be time to let her go.

Bottom line... if they are bringing your office down... its time to let them go.

Disinfect your office!

"Water water everywhere, but not a drop to drink... where am I?"

THE OCEAN!!! Hahaha... This famous childhood riddle is very fitting to my topic today... hydration!

Water makes up nearly 85% of our brain, about 80% of our blood and about 70% of lean muscle. Because our bodies are 1/2 – 4/5 water, then a lack of water - dehydration - could impact our health. If water is such a key component of our bodies, why do most people not consider it necessary to drink it? You would think that common sense would mean “ when you’re thirsty, take a drink. That’s what you need.” However, did you know that in 37% of Americans, the “thirst indicator” is so weakened in their bodies, that it is mistaken for hunger? People are dehydrated and don’t even know it!

Cassie, why are you talking about water? What does THAT have to do with chiropractic?

GLAD YOU ASKED! Let me show you…

In the immortal words of Tin Man: “Oooil caaan… Oh- oil my arms, please – oil my elbows. Oh!”

Water acts as the body’s “oil can”, if you will, to the joints. Since the majority of our body is made up of water, it stands to reason that it also includes our joints, ligaments, and muscles. Think of a prune. A raisin. Both, while once juicy pieces of fruit, are now dehydrated, wrinkled, and tough. Our muscles act in much the same manor. If you are not supplying enough water to your body, your muscles begin to shrivel and tighten. This can cause excruciating pain in the body that no amount of adjusting the spine can cure. Research shows that 8-10 glasses of water a day could significantly ease back and joint pain in 80% of sufferers. Wow!

It is so simple, yet we over look it. We often blame our dehydration symptoms on other things, but let me give you some statistics that might shock you:

• A 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on a computer screen or on a printed page.
• Lack of water is the Number 1 trigger of daytime fatigue.
• One glass of water will shut down midnight hunger pangs for almost 100 percent of the dieters studied in a University of Washington study.
• Even MILD dehydration will slow down one's metabolism as much as 3%.
• Drinking 5 glasses of water daily decreases the risk of colon cancer by 45 percent, it can slash the risk of breast cancer by 79 percent, and one is 50 percent less likely to develop bladder cancer.

I think that it is time to start taking our hydration more seriously. If not, you might find yourself one day to be high and dry…

Hip to be square...

Patellofemoral syndrome, also known as "runner's knee," is a fairly common knee condition that is treated in chiropractic offices. Treatments can consist of many different therapies from taping, mobilization, active stretching, or strengthening programs. Too many times, the treatment focuses mainly on the knee area, but in order to treat this condition most effectively, we have to consider the rest of the body as well. Instead of only focusing on local areas, you must look distal (away) from the site of injury... particularly the hips. That is where the focus of this article will be...

There are so many different causes of patellofemoral syndrome, the most common one being weakness in the leg muscles (i.e. hamstring, quadriceps, or TFL [Tensor Fascia Latae]). Recently, there has been a general shift in focus toward looking at hip muscles and joints, specifically the TFL. By adding strengthening of these muscles, we can not only decrease the pain associated with "runner's knee", but also increase mobility in the body during day-to-day tasks. "Hey Cassie! Tell me how!" Gladly... :)

Initial treatments should consist of mild to moderate stretching of these tight muscles as well as regular adjustments to the lumbar spine (low back). To the patient's tolerance, light exercises can be added into the treatment. Side-lying clam exercises should be initiated to address the TFL and gluteus muscles. The patient should be positioned in a side-lying position with their feet together and knees at 45 degree flexion. Then instruct them to lift the top thigh up and back.

Next, you can progress to weight-bearing exercises involving both limbs, such as squats. Throughout the duration of treatment, hamstring flexibility should be watched. If the length of the hamstring is reduced it can increase pain during these exercises.

The next phase of rehab can include single-leg weight-bearing exercises. These can be in the form of single-limb sit to stand, step-downs, squats, deadlifts, and eventually lunges. Lunges should be done with a long stride instead of a short step. Why? Short step produces more compression on the knee joint. The longer lunge puts more emphasis on the glutes.
*** Side note: When doing treadmill exercise, remember to lengthen your stride in relation to the above mentioned information. ALSO, make sure that the treadmill is not bringing your foot back on the stride. You should be pushing the foot backwards as if you were walking on a stationary surface. Why? Allowing the treadmill to do the work for you will cause over strengthening of the frontal leg muscles, but an overall weakening of the glutes and backs of the legs.

SO! LOOOOONG story short, though the hip joint is one of the most over-looked areas in the treatment and rehabilitation of "runner's knee", by addressing the TFL and hip joint with appropriate stretching, exercises, and adjustments, we can provide a much more effective rehab program.

Stay hip... and stay loose... :)

Manipulation Myth Buster is Striking out against Strokes

"You should never allow a chiropractor to 'crack,' or even touch, your neck, because cervical adjustments are very risky. They lead to strokes, broken bones, or worse!"

If you are in the chiropractic profession, these words hit you in the gut and give you the 'creeps'. The same kind of creepy feeling you can't shake after walking through a spider-web in the dark. Yuck! These thoughts about chiropactic have plagued our profession for years, and I don't know about you, but I am sooo over it!

Chiropractic, in general, is a much safer approach to health care than medical care. It is restorative, preventative, drug free, noninvasive, and has no side affects. This is shown to be true by two considerations. First, chiropractors, by-in-large, are careful, conservative adjusters, and use no more force than is needed to get the proper adjustment. Second, patients who experience chiropractic adjustments not only tolerate them well, but think of them in such a positive and beneficial way, that they often try to "adjust" themselves at home (which we then must gently but MAJORLY discourage). On the contrary, I don't seem to find a large population of people who develop the desire to give themselves injections or surgery at home, no matter how needed the procedure may be. And if this were not evidence enough, lets look at an industry who's wallet is at stake when evaluating these risks... Malpractice Insurance Companies. They openly tell us that, of all the different types of doctors, it is the chiropractor, that has, by far, the lowest-risk practices. In fact, chiropractors enjoy the lowest malpractice insurance rates of ALL the health care disciplines!

We have Hollywood to thank for our irrational fear of the fragility of our necks. How many action movies have you seen that show the apparent ease with which a "ninja warrior" or mafia thug goes around casually, and almost effortlessly, eliminating all those who would dare oppose him with a quick twist of the head. Ha! Give your body and bone structure a liiiiiiittle more credit than that. Food for thought... The average boxer hits with a force of about 800-1,000 lbs across someone's chin. Notice that, in most cases, this does not break the neck. Now, compare that to a chiropractic adjustment which is, at most, 70-80 lbs. God made your body strong... don't underestimate it. :)

Ok... lets think about this rationally. Consider the following ABSOLUTELY TRUE statement: Some people have strokes directly after eating pizza. What was your first reaction to this statement? This question is the first step needed to make a rational assessment of the risks of eating pizza. The second question you want to ask is: How many is people is "some"? If one out of every 1,000 people stroke after eating pizza, then Papa John's Pizza everywhere would be closing down until this epidemic could be stopped. However, if that number was closer to 1 out of every 2-3,000,000 people, the fear level would significantly drop. Everyone knows that there is a risk of choking on a pepperoni, but the love of pizza causes patrons to flock to these restaurants anyway. Why? Because everyone who eats pizza casually accepts the small level of risk in order to enjoy their favorite Italian dish.

Now... lets look at this ABSOLUTELY TRUE statement: Some patients have strokes after receiving a cervical spine adjustment. What was your first reaction to this statement? And again, the next question: How many is some? As people have started looking at the "risk of stroke" statistics a little closer, they are seeing that, as a group, people under regular chiropractic care, appear to have a slightly LOWER risk of stroke than an equivalent group of those not under chiropractic care! WOW!

I will close with this quote from NCMIC (malpractice insurance company) and statistics:

"On analysis, Spinal Manipulative Therapy (SMT) as delivered by chiropractors is one of the most conservative, least invasive and safest of procedures in the provision of heal care services. The risks of SMT pale when compared to known medical risks. Chiropractors, by their training and skill in SMT and special emphasis on the spine, are the best positioned to deliver this mode of health care to the public."

• 99% of strokes occur within the BRAIN
• 1% of strokes occur in the neck

Research is showing that 1 : 5,850,000 chiropractic adjustments MAY cause stroke... here are some relative numbers:

• Being struck by lightening 1 : 700,000
• Drowning in a bathtub 1 : 818,051
• Fatal fall down stairs 1 180,188
• Accidental suffocation in bed 1 : 565,700

I would say this myth is officially... BUSTED!