docpowers Posted January 1, 2011 Author Share Posted January 1, 2011 I won't say that fractures can't happen. But I doubt if any compression fx took place due to chiro. Probably due to other medical conditions or the drugs given that induce fractures. With chiro as with any profession there will be problems associated. And there are chiropractors and there are chiropractors just like there are doctors of various qualities. If you stopped referring to other medical specialities because of problems that patients had with them then you would no longer refer. We don't want to go there because thousands die each year at the hands of medical doctors either directly or indirectly. But as a chiropractor I still refer to medical doctors if I feel that is there best option knowing that they could be harmed or possibly die. But it should not be a one way street and with many doctors it is not. I don't know what you seen a chiro for but I don't give unrealistic expectations and after a certain amount of time without improvement, I would have either referred you or discharged you. I now realize that I will not be referred to as doctor in the medical arena. I love chiropractic and have saw the many benefits that you have not. But remember I also hear the many patients that say "they just gave me a pain and muscle relaxer that has not worked". But it goes both ways. I will offer an after hours clinic for those that will benefit from chiropractic. I will learn a lot from the medical profession and I will have a lot to give. Diversity will only make me better. Closed minded will isolate one and deprive patients. Link to comment Share on other sites More sharing options...
docpowers Posted January 1, 2011 Author Share Posted January 1, 2011 That is the way I practice also. Need to be more careful with the elderly. I use many different modalities including the activator. Chiropractors relieve nerve interference. Makes sense. Let's all try to see the benefits of various fields. Link to comment Share on other sites More sharing options...
physasst Posted January 1, 2011 Share Posted January 1, 2011 I don't know if I believe the nerve interference bit....but much like acupuncture, if it works for some conditions, particularly pain relief, I am willing to at least keep a skeptical open mind. Again, DATA...DATA...DATA... much like in my role in policy, beliefs or ideologies are useless. In fact, ideologues drive me absolutely crazy, regardless of which ideology. People need to look at life like a computer....less emotion, more reason. Chiropractic may help for musculoskeletal pain...it may not.... I've thought about it at times...On a personal note, I have Crohns, and also have Ankylosing Spondilitis......they came together..in fact, my back pain predated my abdominal problems by about 3 years....I wake up every single morning with back pain. My wife calls me Grandpa, cause I walk hunched over, and groaning for about 3-5 minutes....but a hot shower, and it's better. Still have pain...but eh, life is pain. I mostly just ignore it. EVERY once in a while, on a bad day, I wonder about Chiro. I had a DO do an adjustment once, and it helped for about 24 hours. That was almost more cruel though, cause it was too shortlived. I think I'll just live with the pain. Link to comment Share on other sites More sharing options...
fyrelight74 Posted January 1, 2011 Share Posted January 1, 2011 The MD I work for was a Chiropractor before he went back to school. When I asked why he went to med school, he said he was tired of "not being a real doctor". Basically, he felt bad about having people come back to him 3x per week for several weeks, feeling he really wasn't helping at all. He feels that much of the chiropractor teaching he was taught was quackery. He says that you can show "misalignment" with bad xrays on just about anyone. I believe there is also a disagreement between MDs and Chiros regarding the definition of "subluxation". Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 1, 2011 Moderator Share Posted January 1, 2011 I won't say that fractures can't happen. But I doubt if any compression fx took place due to chiro. Probably due to other medical conditions or the drugs given that induce fractures.. Your joking right? you are telling me the people I have seen who c/o immediate pain after a grade 5 manipulation directly over a vert body that gets worse and worse over time and a compression Fx is seen on CT and MRI was not due to the manipulation??? Yeah sure I believe you..... Sorry to be snide but i just don't understand where you can dictate what I have and have not seen clinically and what my patients have told me. It happens, in fact I have seen chiro treatment releases that specifically list compression fracture as an adverse event. Personally I beleive osteoporois should be an absolute contraindication to grade 5 manipulation instead of relative as I beleive it is listed in text's. Also, every physician, PA, NP, or other medical provider has in some way likely caused injury to a patient either directly or indirectly - I have had the unfortunate opportuinity to put 2 people in the ICU due to my actions - not mistakes, just is bound to happen when you treat a lot of patients - so your statement that cmp fx don't happen due to chiro is wrong. Sorry, just my opinion Link to comment Share on other sites More sharing options...
docpowers Posted January 1, 2011 Author Share Posted January 1, 2011 For some things in chiropractic you just have to give it time. Nerve pathways are the slowest to recover. Something like stroke victims are. I'm not trying to compare it to strokes though. If you had some relief after one adjustment then by all means continue for several more treatments and you will probably see great improvement. But after an initial set of adjustments you will most likely have to go every so often for a tune-up because it will probably not be a cure-all for this condition. BTW you have your patients come to see you every so often. I agree that you should have a skeptical open mind. I also do acupuncture and nutrition. The chinese don't even know how it works. Several medical doctors are doing it now. My doctor said he wanted to do it. He don't understand it but he knows it works. Some things work and some don't. Every person and every condition is different. But I do hope you will go back and try the adjustments. You shouldn't have to live with pain if it can be avoided. It's at least worth a try. Link to comment Share on other sites More sharing options...
docpowers Posted January 1, 2011 Author Share Posted January 1, 2011 Please don't think that I am questioning your experience. I know you have seen several patients that have experienced fractures that may be due to manipulation and should have not been manually adjusted in the first place. They should have been adjusted with an low force instrument. A severe osteoporotic patient should never be manually adjusted. I was not questioning the fractures. I was questioning compression fractures. A compression fracture occurs on the long axis of the vertebral column. Adjustments to vertebra are given P to A not cephalad to caudal. Again please don't think I am questioning your knowledge in medicine because you know much more then I in that field. But this is my field. Link to comment Share on other sites More sharing options...
docpowers Posted January 2, 2011 Author Share Posted January 2, 2011 There are many reasons why a person wants to leave their profession. You may not be getting the whole story either. There is a medical doctor here that quit to become a welder. My medical doctor said there was no way his kids were going to become doctors. But for him to say he wanted to become a real doctor is a slap in the face to all who have doctorates and don't prescribe drugs. I guess a psychologist is not a doctor. I do agree that the number of patient visits is usually to many. I see patients 2 times a week for about 3 weeks, then maybe 1 time a week for 2 weeks. Then I suggest once a month and sometimes not even that for a check. Every profession is driven by money and chiropractic is no different. My medical doctor used to see me once every 6 months. Now he wants to see me every 3 months and nothing has changed with my condition. I take just 1 pill for blood pressure and it is good. I may not agree with everything I was taught either, but I can't deny the results. Yes, bad x-rays will show misalignment of the vertebra, probably not the ilium. But what about his hands. Chiropractors can feel a misalignment. I'm sure he is making more money now also. And there will always be a disagreement about subluxation. But as I explained in an earlier post this is how we see it. Your best source about chiropractic is not from a disgruntled chiropractor. I just hope that you will be open minded. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 2, 2011 Share Posted January 2, 2011 How would you compare/contrast chiropractic manipulation with the osteopathic manipulation medicine that is part of what DO's do? I know almost nothing about this and was hoping someone in this thread could explain. Thanks. Link to comment Share on other sites More sharing options...
docpowers Posted January 2, 2011 Author Share Posted January 2, 2011 An osteopath would be the best to comment on this. I am a chiropractor. Osteopath's manipulate the cervical region pretty much the same way we do. They are more into extremity adjusting then chiro's. But we also have chiro's that specialize it extremities. They will work more with soft tissue before they adjust. And that takes more time where as a chiro will quickly adjust that area. I believe they are more concerned with adjustment to improve blood flow. Chiropractic is concerned with nerve interference. The problem is finding an osteopath who will manipulate also. In my area there are several osteopath's and I only know of one that still does manipulation. Once they get out of school and get busy they quit manipulation. That probably has a lot to do with working for a hospital or group where everything boils down to money. I hope I have answered your question. Of course you know that chiropractors do not prescribe drugs or do surgery and osteopath's do. Maybe an osteopath will post. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 2, 2011 Moderator Share Posted January 2, 2011 I know you have seen several patients that have experienced fractures that may be due to manipulation and should have not been manually adjusted in the first place. A severe osteoporotic patient should never be manually adjusted. I was not questioning the fractures. I was questioning compression fractures. A compression fracture occurs on the long axis of the vertebral column. Adjustments to vertebra are given P to A not cephalad to caudal. Again please don't think I am questioning your knowledge in medicine because you know much more then I in that field. But this is my field. Okay lets once and for all not try to tell me what I did and did not see. BTW I have also worked in t radiology field as Radiology PA and have reviewed literally hundreds if not 1000's of CT, MRI and plain film's. Again, the patient had sudden onset of pain with the manipulation, that pain persisted, they were dx with first a compression fx, then a non healing compression fracture a few of these times and I would be seeing them for a kyphoplasty evaluation. This was atleast 3 patients over a 2 year time frame, then I have seen probably about another 6 or so in my career that have radiographic proven fracture with the same history.... this is not a lark or freek happening -- the chiro's in my area are consistently manipulating these patients and some of them have been their patients (actively being seen every few weeks) FOR YEARS! As for your doc's change to q3 month visits - as we have none of your medical info we can only guess But if you are HTN with an AIC of 6.8, TC 199 and BMI of 33 I would also move you to the q3m f/u as you are very likely going to need further intervention fairly quickly. As well it might be beneficial to have additional visit for me to counsel you on additional lifestyle changes and get you plugged into things like diabetic eduacation, eye exam, foot exams..... and all the stuff that comes with someone newly dx with metabolic syndrome, syndrome x, or whatever the researchers are calling the package of symptoms that drastically elevate you future risk for further metabolic derangement. Or you might be correct in saying he/she just needs more visits...... (but I don't know of to many PCP's out there that are short on patients - atleast in my state there is a pretty real shortage of PCP's) and as for the "it's my field" - I certainly don't profess to know how to do manipulations but I do know and see the negative results of them and as well have a very strong PMR and Ortho background (and radiology in there as well) as many many years of PCP medicine.... enough so that I have (atleast in my local area) not seen the benefit of investment of the patients time and resources into Chiro that does not treat an episodic problem, but instead "keeps them in line". It just seems they want a billable visit - and yes this might happen in the medical world also, but I don't see it in my local PCP world as in my area we are all overworked with patients and the last thing we need is useless follow appointments. Link to comment Share on other sites More sharing options...
discogenic Posted January 3, 2011 Share Posted January 3, 2011 BTW I have also worked in t radiology field as Radiology PA and have reviewed literally hundreds if not 1000's of CT, MRI and plain film's. Do Radiology PAs usually work in Interventional Radiology? Or is there a role in Diagnostic Radiology as well for PAs? Link to comment Share on other sites More sharing options...
discogenic Posted January 3, 2011 Share Posted January 3, 2011 Chiropractic will only work if there is a nerve interference. When there is pressure against a nerve due to a slight misalignment then pain will result... There is a lot more to chiropractic but nerve interference is the major premis. The "bone out of place putting pressure on a nerve" notion is an old model. You mentioned you are 55, so perhaps you went to chiropractic college a while ago, I don't know. But a lot has been learned in recent years, so you'll want to update yourself. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 3, 2011 Moderator Share Posted January 3, 2011 Do Radiology PAs usually work in Interventional Radiology? Or is there a role in Diagnostic Radiology as well for PAs? good question - I would never read films for reimbursement (left that to the doc's but I have heard of PA's doing prelim reads on some films) but instead was responsible for evaluation of patients for kyphoplasty - as one of the parts of my jobs. This commonly entailed seeing patients, reviewing all films, ordering additional films, reviewing all of the data and doing an exam - If I decided a kypho was possible I would have them meet the doc - otherwise just do up a consult and send them back to PCP Link to comment Share on other sites More sharing options...
discogenic Posted January 3, 2011 Share Posted January 3, 2011 good question - I would never read films for reimbursement (left that to the doc's but I have heard of PA's doing prelim reads on some films) but instead was responsible for evaluation of patients for kyphoplasty - as one of the parts of my jobs. This commonly entailed seeing patients, reviewing all films, ordering additional films, reviewing all of the data and doing an exam - If I decided a kypho was possible I would have them meet the doc - otherwise just do up a consult and send them back to PCP Has insurance reimbursement for vertebro/kyphoplasty tightened over the last year? I know some studies were published recently that weren't very favorable to that procedure, even though I have several patients who have benefitted from it. Just curious. And as a PA, do you do any IR procedures, or is it mostly evaluating the patients to determine their candidacy for a particular procedure? Link to comment Share on other sites More sharing options...
docpowers Posted January 3, 2011 Author Share Posted January 3, 2011 I did not say you did not see compression fractures. Apparently you have extensive experience in x-rays. I said in my earlier post that it is very difficult to cause a compression fracture with a P to A force. Compression fracture usually are along the long axis of the vertebra column. I have had several patients that had compression fractures before adjustments but not after. Those patients should not be manually adjusted. But they can be low force instrument adjusted. Your patient could have been aggravated by the adjustment. But like I said they should have not been manually adjusted. There are mediocre chiropractors just like there are mediocre medical doctors. You are only seeing one side. There are over 200,000 adjustments done every day. Please don't write us all off over a few. Gosh, if we were to not go to medical doctors for all the mistakes or wrong judgements I've seen, then we would not being going at all. I used to be a Respiratory Therapist. There will always be a disagreement between chiro and medicine. I sometimes feel that I am the only one who can agree that we need both professions equally working together. But I know of group practices that have chiro doc's and medical doc's working together. The Veterans hospitals are now hiring chiro's. Let' work together and agree to disagree on some things. But don't exclude chiro completely. Chiropractic has been around since 1895 and is licensed by all 50 states and believe me they would not give a license if it was not beneficial. Virginia chiropractors are licensed through the board of medicine and only 1 chiropractor is on the board. I know you have concerns with chiropractic and I'm not going to convince you otherwise. But that does not negate the fact that it is a viable profession. I see it all the time. But if I didn't have any chiropractic experience maybe I would see it the same way you do. As far as me going to the MD every 3 months, Nothing has changed with my labs or medical condition to justify that. I talked with a MD who said he was dissatisfied with his group practice and left because of the pressure to order more tests to pay for there equipment. It happens. I'm glad your practice is not that way. Link to comment Share on other sites More sharing options...
docpowers Posted January 3, 2011 Author Share Posted January 3, 2011 I have seen to much to doubt it. But I do not make wild claims about all sorts of cures either. I could tell you story after story but it would be useless if one is dead set against it. Please prove to me that nerve interference doesn't cause weakness or pain. Link to comment Share on other sites More sharing options...
cinntsp Posted January 4, 2011 Share Posted January 4, 2011 2) Chemicals- by chemicals I mean the foods we consume. Most of the foods contain preservatives or other chemicals (and I know our superior FDA always say it is not harmful due to the small amounts -I just saw the Doctors show where the host doctor said he couldn't understand why the FDA allows food coloring because it causes cancer). chemicals can be in our atmosphere or in the prescription drugs or otc drugs. 3)Emotional stress - I see alot of this today. Now, when the last 2 of these situations occur, the muscles and ligaments surrounding the spine will spasm and cause the vertebra to pull to the side of least resistance thus causing a subluxation. Not to be rude, but I can only hope for any future patients that you do not take that pseudoscientific mentality with you to PA school. Where is the data? :rolleyes: Link to comment Share on other sites More sharing options...
docpowers Posted January 4, 2011 Author Share Posted January 4, 2011 I know your not trying to be rude. It's just that many don't have the advantage that I have concerning natural approaches. I wonder why it is that many medical doctors are accepting acupuncture without understanding how it works. They have referred patients to me. I have a PA that refers patients for acupuncture. I realize I will have to try to keep my mouth shut in PA school because it will be like jumping in with the Lions. I just want to get the good stuff that is in medicine. But there are many medical doctors that practice natural approaches. (Andrew Weil MD). I won't be able to practice like them due to limitations but I will incorporate as much natural approaches as I can. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 4, 2011 Moderator Share Posted January 4, 2011 Has insurance reimbursement for vertebro/kyphoplasty tightened over the last year? I know some studies were published recently that weren't very favorable to that procedure, even though I have several patients who have benefitted from it. Just curious. And as a PA, do you do any IR procedures, or is it mostly evaluating the patients to determine their candidacy for a particular procedure? - Right when those studies came out I left the field - loved it but could not stand a career full of days in the fluoro lab = I was almost 100% procedural based and loved it - basically ran the special suite as my own - great field but to much radiation for me (I was a little neurotic about it but still had the highest badge readings as I was in the lab every day - the doc's rotate through every 2-3 weeks) The other reason I moved on was the lack of Dx thought - I have found the only practioners that really get the time and patients to mentally think about a differential and work ups is the primary care fields. As a sub specialist everyone I was seeing had been seen by numerous other physicians before me and the possibility of a new Dx or doing a work up was pretty much not there - mostly procedures, very little dx thought. Link to comment Share on other sites More sharing options...
discogenic Posted January 5, 2011 Share Posted January 5, 2011 I have seen to much to doubt it. But I do not make wild claims about all sorts of cures either. I could tell you story after story but it would be useless if one is dead set against it. Please prove to me that nerve interference doesn't cause weakness or pain. That depends on what you mean by nerve interference. Of course nerve compression, for example from a disc herniation, could cause weakness. And nerve irritation, for example from noxious inflammatory chemicals, could cause pain. But I got the impression you were saying that chiropractic works because a bone jumps out of place, presses on a nerve, and the chiropractor puts that bone back where it belongs, relieves the nerve pinching, and all is well. Is that what you mean? Link to comment Share on other sites More sharing options...
docpowers Posted January 5, 2011 Author Share Posted January 5, 2011 If that bone puts enough pressure against that nerve to cause pain then it is going to cause those symptoms. I see it every day. When I adjust sometimes the pain goes away instantly and sometimes it decreases and thats why we have to adjust a few more times if it goes back out again. If it stays in place then they may still have some pain because as you know that the nerves recover very slowly. But he pain will be much less. Not only chiro's do this but Osteopath's do if you can find who wants to take the time. Link to comment Share on other sites More sharing options...
discogenic Posted January 5, 2011 Share Posted January 5, 2011 If that bone puts enough pressure against that nerve to cause pain then it is going to cause those symptoms. I see it every day. When I adjust sometimes the pain goes away instantly and sometimes it decreases and thats why we have to adjust a few more times if it goes back out again. If it stays in place then they may still have some pain because as you know that the nerves recover very slowly. But he pain will be much less. Not only chiro's do this but Osteopath's do if you can find who wants to take the time. When I said yours is an old model, I didn't mean chiropractic adjustments don't work. I meant the understanding of the mechanism behind why/how they work is where your model is outdated. Adjustments work; but they don't work by unpinching nerves being squeezed upon by a bone out of place (the old 'garden hose' theory). Where'd you go to chiropractic school and when? (Don't take offense. Just curious.) Link to comment Share on other sites More sharing options...
docpowers Posted January 5, 2011 Author Share Posted January 5, 2011 Nerves are not pinched directly. They are pressured by the tissue that surrounds the nerve by the subluxation or misalignment. Sherman college. 2004 Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 6, 2011 Moderator Share Posted January 6, 2011 Sherman college. 2004 so just to be clear - you are 55, have been a chiro for only 6 years, can't agree with other chiro's on the new-v-old cause of pain and now are looking at becoming a PA? where you medical before being a chiro or are you new to the medical field? Link to comment Share on other sites More sharing options...
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