Tag Archives: medicine

Headaches – An Informative Post

There are many different types of headaches, but of all the people with headaches out there 90% of them have cervicogenic (tension) headaches.  These are headaches caused by a poorly functioning neck.  These are usually described as tightness, stiffness, or a pressure.

There are other kinds of headaches, migraines for example are periodic, severe, throbbing headaches that usually last more than a few hours, but less than a day.  They can make the sufferer sensitive to light and sound, and cause nausea even vomiting.  Migraines affect women more often than men.  Migraines are commonly heard of and talked about because of their severity, but are much more rare than cervicogenic headaches.

Billions of dollars are spent on headaches each year in the United States.  Headaches are a major cause of lost productivity and time off work.  One of the top reasons for seeking treatment, headaches are big money for drug companies, and big losses to businesses.

People can end up with a headache from stress, a car accident, whiplash, or any kind of trauma.  Headaches can occur a day or even weeks after the initial injury due to the cumulative nature of those kinds of injuries.  Many people think their headaches come on for no reason at all, but if they think back they will remember an accident, increased stress, playing to hard on the weekend, or something a few days ago.

Treatment for headaches traditionally has been over the counter analgesics and NSAIDS, and even stronger medications for more severe symptoms.  These medications can cause serious side effects, and recent studies indicate that we as a country may be over using these to the extent that thousands of people have serious complications every year from these relatively safe drugs.  Many times these pain medications do not work, and can even cause what is termed “analgesic rebound headaches.”

Chiropractic has a great success rate with treating headaches.  It has been found to be better at providing pain relief (with less side effects) and reducing frequency than medication.  Chiropractic addresses the root cause rather than just the symptoms.  When treating your headaches your chiropractor (which could be me if you’re in Utah) should be addressing 3 major things: First reducing the pain, second improving neck function overall, and third proper strengthening of the neck to reduce future risk of re-injury.  While chiropractic is particularly good at resolving cervicogenic headaches it has also been shown to be effective with some types of migraines, and other headaches.

If you are experiencing headaches, don’t reach for that Aspirin bottle.  Reach for the phone and contact your chiropractor.  You will receive better, safer relief, and have less chance of recurrence.

Ankylosing Spondylitis

Ankylosing Spondylitis (AS) is in the category of less common diseases that you may not know that your chiropractor can treat.  Don’t worry, you probably don’t have it.  Recently the topic came up and I promised to create a post to provide some basic information on the topic of AS.

AS RibbonFirst let me cover what it is.  AS is an inflammatory disease and can be classified as a type of arthritis.  It causes pain in joints and bones, particularly in the spine with the most common complaint being the low back.  In the most severe cases it can cause bones to fuse together.  It is much less common than your typical  osteoarthritis and is also harder to diagnose because of the similarity of its symptoms to so many other conditions.  When you walk into a doctor’s office complaining of low back pain, they won’t jump to the conclusion that you have AS.

Your chiropractor can diagnose AS using a combination of your health and family history, blood tests and radiologic tests, but they won’t usually go hunting for this condition.  It is more often found after other things are ruled out or discovered incidentally with X-rays for other conditions.  This is a sexist disease usually affecting men, but that doesn’t mean that women can’t have it.  AS is also not an illness that comes on late in life.  It usually makes its self known before the age of 35.  The cause of AS is unknown still, but is likely genetic, meaning that it runs in families.  As with most diseases whose causes are unknown there is no known cure yet.  There are however treatments.

Most medical treatments for AS focus on management of pain and symptoms, but there are some medications that have been found to slow the progress of the disease.  Your chiropractor should be able to help you manage or reduce your symptoms as well as slow down the progression of the disease without medication.  As always he should also keep in close contact with your other providers that may be treating you, most likely your  rheumatologist, and together they should come up with a plan of action specific to you.

Image by Cienpies Design http://www.cienpies.net

Image by Cienpies Design http://www.cienpies.net

The treatment with the best results for AS is improving your range of motion and flexibility with exercise, diet, and joint mobilization.  You can do much of it on your own at home with guidance from your provider.  Your chiropractor should already be using these tools to treat any low back pain, but they will be even more important if you have AS.  Your chiropractor may or may not adjust your spine depending on your condition, but managing your care does not require manipulation if you don’t want it.

In the past some practitioners would recommend not seeing a chiropractor for AS because possible risks were unknown.  No studies have found increased risk to people with AS when treated with chiropractic manipulation, and recent research indicated benefits even at the late stages of the disease.  While most of the research is focused on finding a cure to AS here’s a link to an excellent case study of improvement with chiropractic management of AS.

Where Do Chiropractors Fit?

Conservative care means getting the treatment with the least risk first.  Generally you should treat with the most conservative care that will do the job.  When your back hurts you should try resting it for a moment, if that doesn’t work move it around a little, stretch it.  Then you can move up the line to rubbing it.  If your body is unable to relieve the symptoms on it’s own then you should seek more advanced care.

The most conservative place to go to is a chiropractor.  You might think that a massage therapist (LMT) would come first, I am an LMT.  Massage therapists are great at treating conditions, and can recognize contraindications to care, and other conditions, but they are not trained in diagnosis.  You should be seeing an LMT for preventative care.  When an issue arises they should recognize it, if you haven’t already, and refer you to a chiropractor for examination and diagnosis.

The chiropractor may determine that all you need is some massage, and refer you an LMT, or physical therapy, or spinal manipulation, some other or combination of treatments.  He should use the least risky, most conservative treatments at his disposal.

If those treatments fail to resolve the problem then there may be a need for something more invasive.  Again starting with the least risky first your chiropractor and medical doctor should work together to determine the least risky treatment that will allow you to benefit from conservative care.  For example if you can’t relax enough to get an adjustment a muscle relaxant could be beneficial.  Beyond that there is pain medication, manipulation under joint anesthesia, steroid injections for inflammation, etc…

If those efforts are not enough then stronger pain management may be needed in correlation with functional rehabilitation and chiropractic.  In cases such as ALS or multiple sclerosis functional treatments such as chiropractic become more palliative.  It helps with the symptoms, but there is a broader chemical issue going wrong in the body that needs medication to treat, and a medical doctor to oversee.

There are also other issues such as a broken bone fragment or ruptured ligament that may need to be surgically removed or reattached.  In these situations chiropractic should be used following surgical care to make sure function is restored properly.

So, chiropractors, trained in diagnosis and conservative, should be the first physician that you see, and probably be there for your rehabilitation as well.  They should recognize their limitations, know when to refer, and when to provide or request complimentary care.

Chiropractors are initial care providers and case managers for functional or biomechanical issues and primary care physicians for many other issues.

Disturbing News and a Lesson to Learn

Recently in California a man was arrested for more than one reason. He was practicing chiropractic without a license, in so doing he had snapped a mans neck, killing him. This man had set up shop without training. It is not easy to break someones neck and kill them. Especially not on accident. This man got very unlucky. It doesn’t happen like in the movies, but as we can tell from this one incident, training does matter.

Oddly enough he will probably be charged with practicing medicine (not chiropractic) without a license. This topic has bothered me for some time, that of scope of practice. Law makers have always been very careful to limit health care providers scope of practice to that which they are trained. Every provider has a limited scope of practice except one group. Medical doctors have no limitation on their scope of practice. Go ahead, try to find a limit for a medical doctor. Generally definitions of the practice of medicine include:

the diagnosis, treatment, correction, advisement, or prescription in any manner or by any means, methods, or devices, any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary.

This is ridiculous. Medical doctors train for 4 years and then are given leave to do anything. Recently the American Medical Association created the Scope of Practice Partnership not to determine what scope medical doctors should be limited to, but how others should be limited. This has often been referred to as a turf war.

“While nonphysician providers have been, and will continue to be, important elements in the provision of health care, it is important that our patients know and receive the care that only physicians are uniquely qualified to provide,” said Dr. Michael Maves, the AMA’s executive vice president and CEO.

Medical doctors are uniquely qualified. And should be limited to their unique training. I think Scope of Practice limitations are a great idea, and should be set by each professions education. I think that you should be allowed to do what you have been taught to do.

In light of this recent article I think that it is obvious that someone not trained in chiropractic such as a medical doctor should not be allowed to practice it. The same goes for all health care providers. If you want to utilize a treatment method, you should be trained to do so. Schools should recognize the training of other professionals and offer accelerated courses to allow providers to receive additional training.

I guess what I’m saying is: Medical Doctors should have a limited scope of practice.

Do Chiropractors Practice in Hospitals

The full question was Are chiropractors allowed to practice in hospitals or use medical outpatient facilities? I think the real question is, why don’t chiropractors work in hospitals.

The answer is, some chiropractors do practice in hospitals, though they are few and far between. There are none here in Utah were I practice. Chiropractors have in their scope of practice the ability to order lab tests, MRIs, etc… Hospitals and labs across the nation honor this, and will perform medical outpatient procedures for chiropractors.

Here are some, of the many possible reasons chiropractors aren’t working in hospitals:

  • Doctors are trying to get out of hospitals. Hospitals tell you how you can practice even more than insurance companies do. They set your income, rather than your earnings being determined by your efforts. They set what you do and how much you will be paid for it, they are a business after all.
  • Politics of the past, medical doctors and chiropractors did not get along well. We are very near the end of that era, but there is still some animosity between the older generation on both sides, and it sometimes will trickle down into the younger doctors. That inhibits some from joining forces.
  • Hospitals don’t really know what to do with chiropractors. They have a structure, and chiropractors don’t fit well into it. Even if we did, they don’t know what we can do, or how to bill for it. It would take some effort to integrate a chiropractor into a medical system, and there aren’t really many models to work from.

Hospitals are always looking to improve patient satisfaction. Chiropractors have the highest patient satisfaction rating in healthcare. A way that we can improve that rating for a hospital is by offering relief and improvement where previously there was none. The two places I would begin is in the Emergency Room, and the Women’s and Children’s department.

The ER sees many cases where people just want to make sure things are not life threatening. The prime example is a car accident. Even if you don’t feel really bad after an accident it is a good idea to get checked out, just in case. When the ER finishes it’s tests and finds nothing broken or bleeding they usually send you away with serious pain killers to cover the pain of your “whiplash”. These are the kind of things that chiropractors deal with all of the time. We can reduce the healing time, and treat the issue without masking it with medication.

The same kind of thing is important for expecting mothers. They visit their OB in the hospital for their back pain. There isn’t much that they can take, medication wise, due to possible effects on the baby. This leaves the doctor with few options. Chiropractic is a proven medication free treatment that can relive the back pain of pregnant patients.

Hospitals can be a great help to chiropractors also. There are many times that chiropractors will find something that needs to be treated, but the pain that the patient is in is too much to allow chiropractic manipulation. Muscle relaxants and pain medication in these situations can allow a chiropractor to perform the needed procedures. Not to mention the many illnesses that chiropractors find that are out of their scope for treatment. Being in a hospital would allow them ready access to the best person for the job.

I think that hospitals incorporating chiropractic would be a great synergistic relationship. I hope that Utah hospitals will soon be open to this kind of opportunity. Things would improve, even if they just set up a working relationship with each other. They don’t have to be in the same building.

So Many Drugs, So Little Time

I read an interesting article at TIME magazine’s website today, and it just came together with some of the other things that I have noticed recently.

My grandmother came and stayed with us about a month ago and I noticed that she had a bag full of medication, probably 10 different prescriptions each day.  I was shocked.  I don’t want to be taking that many pills when I get to be her age.

I was at the pharmacy the other day and observed that THERE ARE A LOT OF DRUGS.  That realization hit me as I stood at the counter to get some medication for my daughter.  As odd as it may be for a chiropractor, I’m not opposed to medication.  I work with medical doctors, and appreciate the amazing things drugs can do.  My family of 5 may fill 2 maybe 3 short term prescriptions per year.

I stood at the pharmacy in disbelief just running the numbers in my mind.  There were thousands of prescriptions waiting to be picked up that one day in this one pharmacy.  There are pharmacies in every grocery store.  I wondered how many drugs this city was taking.

Then came this article showing that over 50% of all Americans are on medications not just short term, but for chronic conditions.  WOW!  What has happened?  I took a look at some research to see.

In the last 50 years medication technology took off.  From 1900-1950 life expectancy increased about 30 years.  From 1950-2000 it increased about 5 years.  In 1950 5% of our GDP was spent on healthcare in 2007 it was 16%.  People are taking less responsibility for their own health, but spending more on it.  Medicine has nearly destroyed infectious disease, but now chronic and degenerative diseases have taken their place.  Perhaps pills have made us lazy, or at least had a hand in it.  We may never overcome our desire for a quick fix with improved medicine.

What did our fore bearers do?  They didn’t have all these drugs yet they still lived good full lives.  Happiness levels haven’t changed as long as they’ve been studied.  I’m not saying we should get rid of drugs.  I am saying that perhaps we shouldn’t use them as much.  That goes for chiropractic as well.  If people just lived better, we wouldn’t be in the shape we’re in.

You know the number one treatment for heart disease is diet and exercise.  Just because you can take a pill or get an adjustment (more info) to lower your blood pressure doesn’t mean you should get lazy.

Just imagine what our society would be like if we lived healthily and utilized healthcare advances.