RochesterChiros Blog

As an alternative health care provider, sometimes I can’t help but feel like people continue to overlook us until they really want us.

Not an uncommon experience.

Back pain has been the proverbial “thorn in the side” of the modern healthcare system.  The majority of the population experiences it, finding an effective treatment can provide a monstrous challenge for allopathic medicine, and lastly it is a COSTLY problem (estimates start at 10 BILLION.)  How this problem is managed has always presented a challenge for the American health care system.

Before I go off on too many tangents, the reason I bring this up is because the Journal of the American Medical Association (JAMA) recently published an article providing an overview of mechanical low back pain.  The article discussed the problem of back pain including what causes it, but it also promoted the use of conservative treatment for back pain.  Conservative management including chiropractic care!

Now for most people that article may not sound surprising, but many of you may not realize that chiropractors and the American Medical Association haven’t always gotten along. Their relationship started off with a lot of bickering and name calling, and decades later could still only be described as tenuous.

                          No one captures “tenuous” like Bill Watterson.

Over the last few years there has been a lot of improvement, but that underlying tension has stuck around and we generally were not the people your doctor would refer to. So you could imagine our excitement at the notion of being RECOMMENDED as a first step with the treatment of back pain!

Chiropractors (as well as their patients) have known for a long time that we are the go-to doctors for mechanical back pain. The problem has always been that without endorsement from primary care physicians and medical doctors, chiropractors have been considered a last resort when all else fails.  Admittedly, many of us have always experienced a sense of pride with providing someone the secret to fixing their pain after everything else had failed; but just as many of us have wished we could have seen them sooner.  Well, this new acceptance and recommendation could perhaps create that change we’ve been looking for!

The message is simple, back pain is a common problem that usually takes cooperation between many different doctors to correct.  We are glad to finally be part of that schematic in the eyes of fellow health care providers.  Chiropractors are the non-surgical specialists of the musculoskeletal system, and finally we are being seen as such by our colleagues in healthcare.  If you are dealing with back pain there are many places to start, but we are always happy to help you.  –Dr. D

I recently had a new patient encounter that went something like this…

Stressed and in pain patient (SAIPP): “Dr. Daly, I think spinal decompression would be very helpful for my pain but I cannot afford the $3,000 down payment. “

Me: “The WHAT?!?!”

SAIPP: “Well I went to another Chiropractor and they told me they would be happy to help me, but that I needed to sign a contract for treatment and pay up front”

Me:

The face is slightly exaggerated (my eyes aren’t blue), but It’s hard for me to come up with any other initial response.  And seriously, I’ve had A LOT of opportunities to work on it.

The story seems to repeat regularly.  People will hear about a new and exciting therapy for their pain, often including one of the following; chiropractic manipulation, spinal decompression therapy, low level/cold laser, soft tissue mobilization/treatment, traction, etc. The advertisements sound promising, and after they visit the advertising office they find out the treatment costs $3,000 and requires a three time a week treatment plan for 6 months.  They will assume that the $3,000 one-time payment is needed for the treatment, and will go ahead with the expense in hopes of relief.  Many of them are unfamiliar with chiropractic and assume that all chiropractors require the same investment.  Not knowing their options, the SAIPP (read above) will end up buying into an expensive plan that is not covered by their health insurance.  I’ve heard this frequently and I’ve tried to shrug it off, but it is getting ridiculous.

Patients of the world:  do not be swindled.  Spinal decompression, spinal manipulation, cold laser, soft tissue work, and just about everything else doesn’t require months of mandatory treatment and certainly DOES NOT require prepayment!  Our office, (along with many other ethical offices) offer the above treatments as needed or as part of a treatment plan at the standard office fee which is covered by most insurance plans (40-50$ per visit around here).  Why?  Because we do not need to guarantee your return! If we are careful with our diagnosis and utilize the appropriate treatment you should want to come back.  If you were unhappy and didn’t like chiropractic treatment; I’m sorry I couldn’t help you, and I will be happy to refer you to someone who might be able to. There’s no paying in advance for treatment here.

Unfortunately patients who have been duped by his business strategy often have a jaded view of chiropractors, and with good reason. They also have a significant bill that their insurance didn’t pay for, and if the treatment wasn’t helpful they could still be struggling with chronic pain.  After finding out they can receive the same treatment for much less, patients are usually a frustrated combination of happy and angry: “hangry”.  Most people aren’t too happy to pad someone else’s wallet with their own money.

            Prepayment is a great way to make a buck.  You advertise extensively, make sure patients are desperate and come to you in pain, and corner them into an expensive treatment plan.  It walks the borderline of ethics, but is an ingenious way to make money.  People who are scared and in pain are often willing to spend money for anything that will help!  I’m just not certain who this treatment is benefiting… it doesn’t seem too patient centered to me.

I love what I do. I offer a specialization in healthcare that is sorely needed.  People are often amazed to hear that their back, ankle, elbow, or neck pain can be treated easily without medication or surgery.  But I do not like how some of my colleagues operate. So stop.  Seriously, it makes us all look bad.  If you are in pain and think a chiropractor can help, do some shopping.  You should never be forced to pay absurd amounts of money or get involved with ludicrous treatment plans to find relief.  There are many of us out there who are looking out for our patients, not for our wallets. – Dr. D

I’ve heard this story a lot, especially lately.  I figure it’s a significant enough situation that something needs to be said about it. Let me know if this story rings a bell…

“Dr. Daly, I have a friend who cracks people’s backs for free. Isn’t that the same thing you do? If that works why should I see a Chiropractor?

Sound familiar? If not a question you’ve said aloud, I’m certain you’ve either thought it or had someone ask it in regards to Chiropractors.  In retrospect my biggest mistake was not getting anything signed to get that nickel for every time I have heard it… I need better legal representation…

Good question though right? It doesn’t matter who gets your bone to crack as long as it cracks! What’s the difference?!

Well, some might claim it doesn’t matter.  I however have to play the devil’s advocate and say it matters very much.  As I often do, I will elaborate.

So let’s wrestle this, what’s the big deal with people “cracking” one another’s backs.  I can vividly remember people in middle school, high school, and later college who would boast this ability. They would offer to crack your back, and would do so without any pre-requisite qualifications other than success after a few drinks.  So let’s start this simply; the spine is complicated.

There are numerous moving parts, hundreds of muscles, and let’s not forget the spinal cord with its 62 separate spinal nerves.  Chiropractors have spent over 100 years studying just the spine and how it operates. Chiropractors- Both through history and today have spent their years developing techniques to manipulate the spine (cracking).   We know how to manipulate joints with the appropriate amount of force and in the right direction to both create change and avoid side effects.

Without training and education, there are many possible side effects to trying to manipulate the spine. A short list includes broken ribs, sprains/strains, and without a proper examination any number of more serious side effects- incontinence, paralysis, perhaps even strokes! Non-specific and often aggressive attempts to manipulate the spine may get the crack, but are hardly without risk.  Again, not to toot our own horns, but Chiropractors are doctors who specialize in the treatment of the spine. We know how to examine it for conditions and disease, we know how and when to treat, and most importantly we know when NOT to adjust.

All side effects and nuance aside, the most important issue I have with the good ol’ back crack, is that it is practicing without a license.  “So what? It’s not hurting anyone?” Wrong, first of all it is a criminal offense and a felony in most jurisdictions. Second, going blindly into anything that you have no understanding/experience with is always a bad move. Having the tools for the job isn’t the same as knowing how to do the job.  Adjusting the spine may seem easy- odds are you have a spine, and most people have a hand or two, so it seems pretty straightforward. But If I received a bullet wound (yikes, what was I doing?!), I would prefer to be treated by a trained trauma surgeon over someone on the street with a knife and a set of needle-nose pliers!

So let’s discuss the real world example of what can happen when we do this. So we’ll pretend you offer to crack your friend’s back. He’s been having a rough week and you don’t think he should have to pay for what you can do right at home. You tell him to lie down and you proceed to walk on his back to get it to crack.  Now, Let’s also pretend you don’t exactly have a thorough understanding of the spine and your foot slips and you break a rib. Your friend gets mad about the broken rib (which are generally pretty uncomfortable) and does a not-so-friendly thing and sues you.  You have no license, so right from the start you have have zero defense for what you were doing. Next you have no malpractice/ liability insurance, so whatever he sues you for you will be paying for out of pocket. Suddenly the harmless crack you did ends up being a $200,000 oopsie with a chance for jail time.

            This whole post might sound like a ruthless exaggeration, but I would caution you to talk to a Chiropractor first. We spend a significant amount of time in school learning the ins and outs of working with the spine. We know the good, the bad, and the ugly. Nothing is worse than the “adjustments” performed from first year Chiropractors (not picking on anyone, I was there once).  Limited skill and limited knowledge in anything is going to be trouble, but with regards to healthcare and Chiropractic specifically is often painful. We pay for malpractice because even the best Chiropractor, on his best day, isn’t without the possibility for risk.

I swear I’m not just writing this from a soap box to try to sound better or more capable than anyone else. The point of writing this is to bring home an important point- it’s dangerous to practice without a license.  If you think someone need’s a back adjustment either take them to someone licensed to treat the spine, or tell them to wait a few years for you to get the appropriate education and license to do so.  Questions? Comments? I’d be happy to talk- Dr. D.

No! Not my ears!

“Ear infection? Try treating it with droplets of breast milk placed directly into your child’s ear!”

…  and there you have it….After much deliberation on what witty and clever method I would use to start this post, I realized there was no other way than to just throw it at you.

Dr. Kinsler and Myself came upon that “fascinating” new treatment a few weeks back and it hit us about that hard.  Those of you with an inquisitive rational mind are probably thinking- “uh what? Where on earth did you hear that, and who would say that?”  Trust me when I tell you, those were the exact questions that I had.  I subsequently went on a research journey to figure out where putting breast milk in your child’s ear came from, and if there was any validity to it.

First, as most informed health providers often do, I perused the scientific literature on the topic.  Peer reviewed studies provide the ground work for evidenced based care, and allow us to figure out whether or not a given treatment is useful.  Sadly, this first step proved to be a roadblock.  There is nothing. Again, nothing.  Without evidence this claim exists solely through anecdotes. And anecdotes are just that- individual stories lacking real evidence.  In healthcare stories should not be confused with legitimate and valid science.

So the first and arguably most important aspect of my journey had hit a wall. There was no scientific evidence, but what about the science behind this claim? Surely there is a valid reason it exists! Well… I’m not sure about the “Science” to this one…This mystical home remedy seems to persist through various message boards and online discussions, so I will address some of the claims seen most often.

1^st, Breast milk is full of antibodies and can assist in fighting the infection.

That is true breast milk IS full of antibodies, at least for about a week.  Colostrum is the earliest form of breast milk, which sticks around for the first 2-3 days after birth and is loaded with antibodies.  Transitional milk is the next in line and lasts for about a week,  but by day 10 breast milk composition is mostly water and fat (with some extra micronutrients and vitamins)[1].  So if you were to tell me your 3 day old baby acquired an ear infection and that you dropped your Colostrum directly into the ear canal for the purpose of bringing in antibodies: I would tell you that you are at least making an educated attempt. But if you are using fresh breast milk for your 6 month to 2 year old infant (most common age group to get ear infections), you sure aren’t doing it because of antibodies.

2^nd, Breast milk is naturally antibacterial so drops into the ear will treat the infection.

 If we look at the ear itself, most ear infections (Otitis Media) occur in the middle ear. The middle ear is the area behind the ear drum (tympanic membrane) which transmits sound to the inner ear. The tympanic membrane is impenetrable to fluid, which is why many complicated ear infections require surgical tubes in order to drain the ear of fluid.

Now if we know that the eardrum is impenetrable to fluid, one would have to wonder how or why someone would use ear drops to treat a middle ear infection.  Assuming that the ear infection is indeed bacterial (most aren’t) and that a few drops of breast milk would be enough to have an effect on a bacterial infection (it’s not), there is no way that the breast milk would be able to penetrate the ear drum.

I promise I am not trying to pick on breast milk.  As far as NUTRITION for infants goes, there is nothing better! (you will notice “Nutrition” is capitalized)  And there is in fact an association between breast milk and ear infections… Children who are FED breast milk demonstrate a significant resistance to acquiring ear infections as infants![2] (again, notice “fed” is capitalized).  The added benefits of breast milk could stretch for miles, but they surround feeding with it not dropping it haphazardly. My point is simply that just because something is very effective in your mouth does not mean that it will be effective wherever else you put it!

In order for a treatment to be useful, it should either have physiological logic behind it or evidence to back it up or even better have both- this one has neither.  So would I recommend a new mother put her breast milk into her sick child’s ear? The answer is a resounding no.  Now incase anyone is dealing with a Child who suffers from regular ear infections, here are a few links describing the current treatment guidelines for Otitis Media that you can discuss with your pediatrician.

http://www.sciencebasedmedicine.org/index.php/ear-infections-to-treat-or-not-to-treat/

http://pediatrics.aappublications.org/content/113/5/1451.full#sec-11

Lastly, I want to reiterate; at this point there is no research to back up this claim but if someone should decide to research the topic, we will be sure to keep you all abreast of the situation. -Dr.D

‘Tis the season for family, fun, and sweets! With that, during this season every year the United States goes through over 2 BILLION candy canes[1]!  I know what you’re thinking- that’s A LOT of candy.  It sure is, it adds up to almost 20 billion grams of sugar. While this obviously presents a dental dilemma, Candy canes (Peppermint specifically) may have another side effect: keeping you up at night.

Peppermint while being tasty has an unfortunate side effect of relaxing the gastroesophageal sphincter. This is the little doorway between the stomach and the esophagus which keeps everyone in line. When the doorway relaxes stomach acid leaks into the bottom of the esophagus and causes all sorts of trouble.  This is commonly known as “heart burn” and although it feels like it, the pain is not coming from the heart. That burning is the result of tissue damage because of acid reflux!

                                    [2]

This isn’t to say that no one can enjoy a good ol’ candy cane, just that it should be done in moderation- ESPECIALLY if you already suffer from recurrent heart burn! (Also, please don’t eat 20 billion grams of sugar on your own. That is a whole other conversation entirely.)   Everyone have a safe and fun holiday season!

- Dr.D

Did you ever talk with someone at a party or meeting and realize you didn’t know their name and probably should?  And maybe it’s your third time meeting them and maybe they told you their name the first two times and you forgot it and you certainly can’t ask now because it’s just too late in the game?  For some people I know, this is like podcasts.  I have come to realize that a lot of people have heard about the podcasts and are interested in hearing the interviews we have been doing but simply don’t know how to access them.  And they are embarrassed to admit that they don’t know an iPod from an eyeball and since they didn’t ask sooner, they feel it’s too late to bring it up now.  Fear not, my somewhat technically challenged friend!  If you’d like to listen to some great interviews with important people in chiropractic, alternative medicine and healthcare, here is my brief how-to manual entitled:

How to Listen to the On The Other Hand Podcast

First, let’s look at this misleading word ‘podcast’.  The first mention of the term was in a 2004 Guardian newspaper article as one of several terms for portable listening to audio blogs suggested by Ben Hammersley. The possible names he suggested for this new medium alluded to “pod”  from Apple’s “iPod” digital media player; and “cast” from traditional radio broadcasting. Herein lies one of the primary confusing points for the uninitiated: Podcast is named after Apple’s iPod but in no way does it mean that one must own an iPod (or even any portable digital media player) to hear a podcast.

A podcast is sort of like an on-demand version of internet radio.  And kind of like a DVR or TiVo, you can select what episodes you want to listen to, when and for how long without regard to when they are broadcast.  You can listen on a portable media device (like an iPod or MP3 player) or directly on your computer. You can even listen in your car using a burned CD! There are so many easy ways to listen to podcasts, you just might kick yourself for not doing it sooner.  Here are 5 ways to hear our show:

(1) Direct Player
The episodes for our show, OnTheOtherHand, can be played directly on your computer by going to the hosting website here. Each episode has a little built-in media player. You just click the little play button and listen away!  Super simple!

(2) Download
Once you are on the podcast host website find the episode you want to hear and click “download” at the bottom of each episode description. Then you can save that audio file (it is in MP3 format) and play it at your leisure on your computer — or –

(3) Burn that MP3 to a CD and play it on any CD player  — or –

(4) Copy the MP3 onto any portable digital media player  — or –

(5) Already have iTunes and an iPod? Use the Apple iTunes software which is free and makes it really easy to subscribe to podcasts.  Using iTunes, you can play episodes on your computer, sync them to your iPod and make sure any new episodes are automatically downloaded to your PC. Just go to the iTunes store, and in the search box type OnTheOtherHand. Scroll down until you see the icon for our program and click the subscribe button. You can even use iTunes if you don’t own an iPod — it’s a nice way to organize your music too.

There are literally at least a dozen other ways to listen but one of the above is sure to get you started.  Once you’ve heard an episode, our podcast website has a place for listeners to leave comments about each episode and if you want, to enter into a discussion with other listeners.  You can also rate our podcast on iTunes which is a huge help in boosting our exposure to new listeners.

See? Not so tough, right?

Professor Edzard Ernst, MD, PhD, FRCP, FRCP holds the Laing Chair in Complementary Medicine at the Peninsula Medical School, University of Exeter and is the Editor-in-Chief of two medical journals. He has also been seen as a major public opponent of chiropractic and alternative medicine. He has devoted most of his career to publishing articles that are critical of complementary and alternative medicine….an unbelievable number of papers. Like 1500 or so. He’s been especially critical of chiropractic and, in the opinion of many researchers, has glossed over important research and exaggerated results. To me, what’s most interesting about Ernst is that he claims objectivity and lack of agenda. This podcast asks some tough questions of Prof. Ernst.

You can get the podcast episode on iTunes by searching the podcast section for “On The Other Hand” or you can just click here.

You can also read the transcript of this episode courtesy of Blue_Wode.

Thanks to this episode’s sponsor: Audible.com, the audiobook company. Get a free audiobook download just by trying their service free for 14 days.

John C. McLachlan is a professor of medical education who wrote an article in the British Medical Journal (BMJ 2010; 341:c6979) called “Integrative medicine and the point of credulity.”  McLachlan proposed that integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking. He worries that failure to detect an obvious hoax is not an encouraging sign.

The author, upon seeing a request for presenters at an integrative medicine conference in Jerusalem, submits a paper posing as an embryologist who discovered a new version of reflexology. He explains that he has identified a homunculus represented in the human body, over the area of the buttocks. The homunculus being inverted, such that the head is represented in the inferior position.  As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping.

He stops short of telling the conference organizers he has discovered a system whereby the head is up the ass and responds to needles.  Funny, right?  Well, after submission of an abstract with some sciency sounding references, the proposal gets accepted for presentation.  The author declines to present and, instead, publishes the correspondence in the BMJ.

Now, I’m all for having a good laugh at the expense of wacko alternative medicine practices but my goal is clear — I want to help clean up the field in order to highlight the people who are actually doing some good, honest, logical research.  I actually have a problem with what Dr. McLachlan has done.  By poking fun from a distance and walking away without letting the conference organizers in on the joke, the author misses a huge opportunity to educate and possibly improve that which he criticizes. It would have been far better if he accepted a slot at the conference and awaited to see if people would point out the errors in his “research” or simply used the platform to show what bad science is.

The only thing that makes him not a 100 percent coward is that he published his story. Someone who asks difficult questions so that when you answer incorrectly you will learn is called a teacher.   To ask difficult questions and then tell your friends how stupid someone is without letting them in on where their error was is called by a different name entirely.

Remember Smith’s article about how parachutes aren’t evidence based? That one is funny and brilliantly illustrates its point. This article, while funny with its head-up-ones-ass ha ha I get it humor, is really only about as funny as watching your kids get their math homework wrong and, instead of helping them, you call all of your friends and laugh at your kids’ ignorance. Nothing was learned. Nothing was improved and we all feel a little bit sick for participating in the joke.

Yes, it was a hoax but science relies on some degree of honesty and trust.  It is impossible for one scientist to be at the apex of all fields and know all that is known from every discipline.  Isn’t that why we have specialists?  Could it be that the scientific committee accepted McLachlan’s proposal simply in order to learn whether or not this revolutionary discovery was plausible or bunk?  Unlikely, but possible.  Today, I would rather lend the benefit of the doubt to the conference organizers rather than the scientific playground bully.

Brett L. Kinsler is a chiropractor in Rochester, NY who writes the RochesterChiro blog and produces the podcast On The Other Hand.

Ellie Phillips, DDS spoke frankly with me about the dental profession and how it can and must adapt from a drill and fill to a systemic and truly preventative model.  She is the author of the book Kiss Your Dentist Goodbye and a most interesting person to listen to.  I assure you, you have never heard a dentist like Dr. Ellie.

Find this episode in the podcast section of iTunes by searching for “On The Other Hand” or go to our podcast site here.

A colleague has a “meter” by which he predicts the current level of doom and gloom facing the chiropractic profession.  Whenever something untoward occurs, he bumps up the “meter” a bit. I think if the meter ever fully registers 100%, the entire profession will explode like the world’s largest bottle of Diet Coke enveloping the world’s biggest Mento.

I am pleased to report that the doom and gloom-o-meter can be reduced a titch. As of today, our podcast “On The Other Hand” has had over 1000 downloads in it’s first two weeks of existence!  There is proof that people are interested in hearing about evidence oriented chiropractic from a scientific perspective.

It’s either that or they want to hear if I sound weird pumped directly into their skull through ear buds.  I’m cool with whichever one it is.  Thanks for listening, downloading and subscribing.  If you are so inclined to rate the podcast and leave us a review on iTunes, that would also be great.

Brett L. Kinsler, DC is a Rochester chiropractor, blogger, podcaster and, with your help, is responsible for lowering the chiropractic doom and gloom meter just a little bit.