A Big Win for Chiropractic Patients

No matter where you stand on health care reform, the new law is a big win for chiropractic patients. Although the coverage of health care reform reported nary a whisper about chiropractic physicians, the legislation is set to affect chiropractic physicians and their patients in some very profound and positive ways. First and foremost, the law contains anti-discrimination provisions, which will require insurance companies to cover the full scope of chiropractic services. While you, as a patient, may not see, it, insurance companies have set up a number of roadblocks in front of your care. The first one is that most insurance companies will only pay for one, or maybe two, of the many therapies that a chiropractic physician can perform. So if you need more care than a hot pack and a spinal adjustment, you're out of luck. Either your chiropractic doctor provides the service for free (which is what most of us end up doing) or you get charged an additional fee for your chiropractic insurance "benefit."

The second roadblock is that insurance companies have artificially restricted the diagnoses for which chiropractic care is covered. Usually anything outside of purely musculoskeletal conditions is also outside of your insurance "benefit." Do you suffer diabetes, or heart disease, and are seeking alternative care? Sorry, not covered. Are you looking for fertility treatment that has proven more effective than in-vitro fertilization, is safer, and costs far less? Oops, your insurance doesn't cover that. Would you like acupuncture -- a research proven treatment -- for those chronic sinus infections? We're sorry, but your "benefit" doesn't cover that.

In fact, I'll bet you didn't know that your chiropractic physician could treat those conditions. He can, and that's only the surface. Chiropractic doctors are skilled in treating those chronic conditions that are usually very poorly managed by drugs. But you've never been able to get that care because your insurance company refuses to cover it. In some cases, insurance companies have forbidden chiropractic doctors on their plans to even tell patients that they can provide those services.

But all of that ended with the passage of health care reform. Here's what the president of the American Chiropractic Association had to say:

“Regardless of how you feel about this legislation and its overall impact on the nation, it has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against doctors of chiropractic and other providers relative to their participation and coverage in health plans. Such discrimination based on a provider’s license is inappropriate and now must stop,” said ACA President, Rick McMichael, DC.

“While this does not fully level the playing field for doctors of chiropractic in our health care system, this is a highly significant step that has the potential for positive, long-range impact on the profession and the patients we serve. Congress has finally addressed the issue of provider discrimination based on one’s license, and they have said that such discrimination must stop.”

When this law finally goes into effect, that discrimination will stop, allowing you to utilize your chiropractic physician for the full scope of services for which he is qualified.

And that will be a good day for your health, and a great day for the health of this nation. Perhaps then we will begin to turn away from the pill-for-every-ill mentality that has made us one of the unhealthiest of the industrialized nations.

Combating Child Obesity…One Step At A Time.

30% of morning traffic consists of people taking their children to school.

Childhood obesity is skyrocketing.

Coincidence? Not hardly.

I remember the walks to and from school as often being the highlights of my day. When I was younger, it was the source for many an adventure, and as I reached adolescence, an opportunity for romance.

My children have the option of taking a bus, but frequently have chosen to walk. As a result, they have gotten to know shopkeepers in town, in one case leading to an after-school job offer.

It is these simple things that can begin to reverse our nation's downward spiral into disease and drug dependency.

To help your kids begin walking to school, start here.

March Podcast — Brittle Bones and Bad Drugs

The March edition of the Alternative Healthpod is now available. If you are not a subscriber, you can listen to it here, or as always subscribe to it by clicking on this feed. You can also subscribe via iTunes. Show Notes:

Two new studies published last week show that long-term use of oral drugs prescribed to prevent osteoporosis may be associated with unusual fractures of the thigh bone -- in other words, they are weakening the bone they are supposed to strengthen.

The research is not the first to link the drugs, known as bisphosphonates, with fractures. Other research has found that these drugs also increasing the risk bone death in the jaw.

Dr. Melvin Rosenwasser, a professor of orthopedic surgery at Columbia University College of Physicians and Surgeons in New York City, and co-author of the study, said that when bisphosponates are "used beyond a certain point...they may actually be bad."

A second study looked at bone biopsies taken from the thigh bones of 21 women, all past menopause, who had suffered fractures at the site. Nine had not taken the drugs, while 12 had, for an average of 8.5 years.

The women on the bisphosphonates, researchers found, had 90% "old" bone, meaning that new bone was not being created in the women taking the osteoporosis drugs.

Source: American Academy of Orthopedic Surgeons Annual Meeting, 2010.

If you are taking osteoporosis drugs, or are concerned about your risk of fracture, please contact me immediately at 860-567-5727, or email me at alj@docaltmed.com.

A Father’s Pride, Part II

I usually try to keep things at least moderately professional on this blog, but sometimes the personal part just comes busting through. Like today. This news release just hit the wires:

LITCHFIELD, CT – Sixteen-year-old Shayna Jenkins captured both the silver and the bronze medals in two national indoor archery championships, while simultaneously bringing home dual gold medals in the New England region of these tournaments.

With a score of 1064 out of a possible 1200, Jenkins placed second in the nation in her division at the 41^st National Archery Indoor Nationals. She also took third place nationally in the Junior Olympic Nationals with a score of 533 out of a possible 600. Nationwide, Jenkins was the only competitor in her division to medal in both tournaments.

Jenkins, a junior at Litchfield High School, is no stranger to the podium. In previous years, she has placed both regionally and nationally, as well as winning the Connecticut state archery championship and the Nutmeg State Games.

On the shooting line, Jenkins is known for her cool demeanor under pressure, often shooting off the last of her arrows with only a few seconds left on the shot clock. She is a member of both the New Hartford Junior Olympic Archery Development (JOAD) team and the Harwinton Rod & Gun JOAD team.

Jenkins is now beginning preparations for what she hopes will be an equally successful outdoor competition season.

Happy Feet!

Yesterday's event was a tremendous success! Rebecca from Foot Levelers was booked all day long, and we were able to start bringing relief to a lot of people with foot, knee, and back problems.

Sportsmens of Litchfield also came through in a big way, providing not only discounts at the store for people who came to get their feet scanned, but also some very nice swag for everyone. Water bottles, bags and t-shirts -- many thanks to Jay and Michael at Sportsmens, for being such good sports!

Teresa did her usual fine job of managing things from the front desk, unsnarling bottlenecks and being everywhere for everyone simultaneously.

As for me, one of the things that I really enjoyed about the day was that it brought in some patients whom I haven't seen in a while. It was a real treat to catch up with people, and reminded me once again what it is that I really like about what I do.

Sure, I enjoy the detective work of being a good diagnostician, unraveling the myriad causes of a patient's health problems. And practicing the physical skills required of my profession, manipulating joints, inserting acupuncture needles, or doing hands-on soft tissue work, is a pleasure as well.

But above it all are the relationships I have with my patients: The give and take, hearing my patients' amazing stories, and telling a few of my own.

That, more than anything else, is what I look forward to when I unlock the door to the office every morning.

New Issue of DocAltMed Newsletter Published

I just sent out my latest issue of the DocAltMed newsletter. If you aren't a subscriber, click on this link to read it. If you want to subscribe, just register on this blog or at www.docaltmed.com, and we'll put you on the mailing list.

Show Notes — The Secret Is In The Feet

My new podcast is up, you can download it here, or even better, subscribe to the podcast by clicking on this feed. Or, as usual, you can always go to iTunes and subscribe there. For more information about the March 12 Free Digital Foot Scan, go here.

The laboratory website is www.footlevelers.com.

Research:

Journal of Manipulative and Physiological Therapeutics (JMPT), Volume 23, Issue 3,point prescription 168-174

Effects of orthotic intervention and nine holes of simulated golf on club-head velocity in experienced golfers☆

David E. Stude, DCa, Jeff Gullickson, DCb

Received 7 April 1999

Abstract

0bjective: This study was an initial investigation evaluating the effects of orthotic intervention on club-head velocity (CHV) among a group of experienced golfers before and after 9 holes of simulated golf. Setting: Northwestern College of Chiropractic, Bloomington, Minnesota. Participants: Twelve experienced golfers were included in the study. Method: CHV was measured with a device used by many Professional Golf Association and Ladies Professional Golf Association teaching professionals before and after wearing orthotics and before and after completing 9 holes of simulated golf. Subjects wore custom-made, flexible orthotics daily for 6 weeks and then were retested with the same objective measurement parameters. Outcome measure: CHV (swing speed in miles per hour) was measured in all subjects before and after wearing custom-fit, flexible orthotics for 6 weeks and before and after completing 9 holes of simulated golf. Results: There was an approximate increase in CHV of between 3 and 5 mph, or a relative increase in CHV by up to 7%, after subjects had worn custom-made, weight-bearing, flexible orthotics daily for 6 weeks. A 5-mph increase in CHV is equivalent to an approximate increase in golf ball travel distance of 15 yards, a significant increase for the tour player for whom small increases in performance can reflect large position changes on the roster board. In addition, the use of these custom ofthoses eliminated the effects of fatigue associated with playing 9 holes of golf (relative to CHV) and therefore may improve the likelihood for more consistent golf performance. Conclusion: The use oftbe custom-fit, flexible orthotics in this study had a positive influence on CHV in experienced golfers. (J Manipulative Physiol Ther 2000;23:168–74)

Sports Med. 1985 Sep-Oct;2(5):334-47.

Running shoes, orthotics, and injuries.

McKenzie DC, Clement DB, Taunton JE.

Running is the most visible expression of the continued interest in regular physical activities. Unfortunately injuries are common, primarily due to overuse, and a number of aetiological factors have been recognised. Of these, training errors can be responsible for up to 60% of injuries. The training surface, a lack of flexibility and strength, the stage of growth and development, poor footwear and abnormal biomechanical features have all been implicated in the development of running injuries. A thorough understanding of the biomechanics of running is a necessary prerequisite for individuals who treat or advise runners. Clinically, the configuration of the longitudinal arch is a valuable method of classifying feet and has direct implications on the development and management of running problems. The runner with excessively pronated feet has features which predispose him/her to injuries that most frequently occur at the medial aspect of the lower extremity: tibial stress syndrome; patellofemoral pain syndrome; and posterior tibialis tendinitis. These problems occur because of excessive motion at the subtalar joint and control of this movement can be made through the selection of appropriate footwear, plus orthotic foot control. The runner with cavus feet often has a rigid foot and concomitant problems of decreased ability to absorb the force of ground contact. These athletes have unique injuries found most commonly on the lateral aspect of the lower extremity: iliotibial band friction syndrome; peroneus tendinitis; stress fractures; trochanteric bursitis; and plantar fasciitis. Appropriate footwear advice and the use of energy-absorbing materials to help dissipate shock will benefit these individuals. Running shoes for the pronated runner should control the excessive motion. The shoes should be board-lasted, straight-lasted, have a stable heel counter, extra medial support, and a wider flare than the shoes for the cavus foot. For these athletes a slip-lasted, curve-lasted shoe with softer ethylene vinyl acetate (EVA) and a narrow flare is appropriate. Orthotic devices are useful in selected runners with demonstrated biomechanical abnormalities that contribute to the injury. Soft orthotics made of a commercial insole laminated with EVA are comfortable, easily adjusted, inexpensive, and more for-giving than the semirigid orthotics which are useful in cases where the soft orthotic does not provide adequate foot control. A review of injury data shows an alarming rise in the incidence of knee pain in runners-from 18% to 50% of injuries in 13 years.

Barefoot Running

A reader brought to my attention the growing trend of barefoot running, given fuel recently by this study:

Foot strike patterns and collision forces in habitually barefoot versus shod runners.

Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y.

Department of Human Evolutionary Biology, 11 Divinity Avenue, Harvard University, Cambridge, Massachusetts 02138, USA. danlieb@fas.harvard.edu

Comment in:

• Nature. 2010 Jan 28;463(7280):433-4.

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

It's an interesting idea, and certainly has its appeal, falling in line with other fitness trends such as functional strength training and the naked warrior concept. I've known people who have been running barefoot since the mid-90s.

But I suspect the faddishness of the trend, and I see some real problems with the research. The first is that it was not until last fall, with the Wolf study, that a decent examination of the consistency of lower extremity kinematics was even performed (to my knowledge, at least). Without that base consistency data, drawing conclusions from a comparison of shod versus barefoot kinematics is perilous. How do we know that the data from the Lieberman study (and others) even falls outside the range of normal variation? The fact is, we do not. So to to make conclusions about technique from such studies is rash.

While the research does show some force reduction at the joints, from that data the researchers are *presuming* a reduction of injury. There are not any studies which actually show a reduction of injury, and it is quite possible that none will be found. Lieberman admits this limitation in his study. What is most probable is that barefoot running may tend to reduce the risk of certain types of injuries, while increasing the risk of others, and as I note below, the benefits are likely to vary widely based on individual biomechanics. There truly is no such thing as a free lunch.

Similarly, performance has not been evaluated. The argument held forth thus far is the "Ethiopian runners do it and they are the best," which is an argument beset with obvious problems, from cardiopulmonary functioning to femorotibial ratios. Until I see some good studies, I am inclined to dismiss barefoot running performance claims.

Interestingly, the kinematics of shoeless running point to the fact that, in all likelihood, the runners who do benefit most from shoeless running are those that are free of foot dysfunction in the first place. Which makes sense.

It is important to note that the foot scans I'm providing are not with the intent to provide a rationale to fit every athlete with orthotics, but more to detect those individuals whose foot dysfunction or pathology tends to increase their risk of injury or hinder their performance. For such individuals, there is absolutely no data to suggest that they would benefit from barefoot running and a wealth of research to suggest that custom orthotics would be beneficial.

I'm not a one-size-fits all kind of doctor, and I may happily recommend seemingly contradictory advice to two different patients with the same (apparent) problem, because I think that any protocol needs to account for the huge individual variability in physiology and biomechanics. It is one of the core ingredients missing in most of mainstream medicine.

So I'm not going to utterly dismiss barefoot running out of hand, because it may have some genuine utility for some people. But the majority of runners, I suspect, will continue to benefit from a well-made shoe and proper foot support.

Free Digital Foot Scan, March 12

I'm very happy to be able to do this. For 15 years, I've been putting my patients into custom orthotics for a variety of reasons, most typically chronic low back or knee pain. I have also used them quite frequently on my athlete patients, as the research has found that custom orthotics can curtail the risk of training injuries.

And in the case of at least one sport -- golf -- there is research that shows that using custom orthotics actually increases performance! Yep, you read it right. Slip these things in your golf cleats and strip a couple of strokes off your game. Can't beat that with a stick (so to speak).

Having made a short story longer, here's the point: I've arranged for the orthotics lab that I've been using for the past 15 years, Foot Levelers, to bring in one of their technicians. She will be spending the day on Friday, March 12, doing digital scans of people's feet to see if you need orthotics. Did I mention that this is free?If it turns out that you do need orthotics and you order them that day, I'll give you 15% off.If you order two pairs, you get 30% off. Sweet.

Here's a linky that takes you to a pretty web page about it.

You can always check out my website to read much of what you've read here, only with more formal wording.And, as always, if you have questions, email me, or call me at (860)567-5727.

Do this. It's free, and it will make you so happy.

It’s Not The Winter Blues, It’s Your Winter Diet!

That's the name of this year's first podcast, and it is up and available now. The feed for all my podcasts is here. And, as promised, here are the show notes:

Br J Community Nurs. 2009 Oct;14(10):422, 424-6. Dietary factors and depression in older people.

Williamson C. British Nutrition Foundation, London. c.williamson@nutrition.org.uk

Depression is one of the most prevalent mental health conditions and can affect people of all ages, but it is becoming more common among the older population with increasing life expectancy. Observational studies have found poor micronutrient status (particularly folate and vitamin B12) to be associated with an increased risk of depression in older people. Supplementation with folic acid has been shown to enhance anti-depressant drug treatment and there is preliminary evidence that supplementation with certain micronutrients may help improve depressive symptoms in older patients. There has also been a lot of interest in the role of long-chain omega-3 fatty acids in depression.

Dietary pattern and depressive symptoms in middle age.

Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK. tasnime.akbaraly@inserm.fr

 BACKGROUND: Studies of diet and depression have focused primarily on individual nutrients. AIMS: To examine the association between dietary patterns and depression using an overall diet approach. METHOD: Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: 'whole food' (heavily loaded by vegetables, fruits and fish) and 'processed food' (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). CONCLUSIONS: In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective. 

If you are interested in more information about diet and depression, contact me by clicking here.

Thanks for listening, and as always, your feedback and comments are very much appreciated!

Comment of the Week

One of the things I like about being the type of doctor that I am is that patients feel free to speak their mind to me. As happened today, while I was performing trigger point therapy (a highly effective but admittedly somewhat painful technique for some muscle problems), my patient said to me:

Patient: "Doc, that #$%^&! hurts!

Me: "Yeah, I know, sorry about that."

Patient: "That's your bike out front, right?"

Me: "Yeah. Rode it in this morning."

Patient: "Yeah, well, when you're done with me, I'm taking care of it. You're walking home tonight."

Music Therapy in Litchfield

There is some very good news today for parents of special needs children in the Litchfield area. I received an email today from Krizta Moon, a very talented musician, music teacher and musical therapist, which said that she will be offering a music therapy program at the Litchfield community center. If you are unfamiliar with music therapy, it is  "the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program," according to the American Music Therapy Association website.

Anyone who has fallen in love, lost a loved one, grieved or celebrated -- that is, all of us -- knows the power that music has to influence our mood and our minds. Amazing, isn't it, how a few bars from a half-forgotten song bring back to us in 3D living color the gestalt of a period in our lives?

Well, music is capable of far more than that. In the right hands, music therapy can not only help children cope with pain and stress, but also speed their progress in physical therapy programs. Music therapy can reach out and touch the untouchable, engage the unengaged.  In fact, a recent Cochrane Review, largely considered the gold standard of evidence-based medicine, found that "music therapy may help children with autistic spectrum disorder to improve their communicative skills."

Ms. Moon said that she will be having an introductory "meet and greet" session open to everyone on Sat., January 23 at the Litchfield Community Center.

Music therapy sessions are specifically designed around the child's age and developmental abilities, Ms. Moon said. Sessions will be held each Saturday between the hours of 9am-1pm. Each session runs for 45 minutes, starting on February 20th and will conclude on April 10th for a total of 8 sessions. Total cost is $150.00. Sign-up for this event will begin at 10am at the Litchfield Community Center. From 11-11:45, be there to participate in a large group session for parents and special needs children ages 4-18.

"An advantage of music therapy," Ms. Moon's email said, "is that it is an inherently nonthreatening and inviting medium. It offers a child a safe haven from which to explore feelings, behaviors and issues ranging from self-esteem to severe emotional dysregulation. Music therapy techniques can be designed to address more complex issues such as grief, abandonment or deeply conflicted emotions. As a medium, music therapy has enormous range and scope in targeting multiple clinical needs across the gamut of childhood developmental stages. It can set the occasion for a child to establish a meaningful relationship with an adult through musical play and interaction. Music therapy can also facilitate the development of pro-social skills, trust and feelings of positive attachment. Developmentally, almost all children respond to music. This greatly assists in laying a strong foundation for engaging in deeper therapeutic work. A child's natural interest in music is enhanced by the fact that they are occupied in stimulating motor and auditory activities more associated with play or fun than work or therapy. The careful and repetitious orchestration of such multi-sensory experiences, in the context of a skillful and nurturing relationship, has a remarkable range of clinical benefits."

On a personal note, I would just like to add that Krizta Moon has been my daughter's singing teacher for several years. I know whereof I speak when I say that she is an extraordinarily talented, caring and skilled teacher, and I am glad that she has extended her talents into the realm of music therapy. I have no doubt that she will be of great benefit to many children here.

If you would like to attend, please call 860-484-9080 to confirm. You can also contact Ms. Moon via email, at lunazsoul (at) hotmail.com.

Public Agrees With Chiropractic Doctors: No Special Regulation Needed

In a classic set-up, the Hartford Courant published an online poll asking readers if chiropractic patients should be required to sign special consent forms, as I mentioned in a previous post. The poll question was placed directly across from a Rick Green anti-chiropractic screed, in which Mr. Green manages to disclose both an appalling lack of understanding of scientific research as well as feeble rabble-rousing skills in his attempts to mislead the public about this topic.

I wouldn't mind so much about the anti-science bent of his column if Mr. Green was at least able to generate some fire underneath his supporters.

But, alas, he could not even do that. Normally, the placement of a survey as the Courant did in this situation virtually guarantees that the results are skewed in favor of the opinion of the columnist. Not so in this case. Here are the most recent poll results:

I'm sorry, Mr. Green, but it looks like the public has spoken.

And they think you, and the proposed regulation, is wrong.

Cosmo Unveils The Secret Behind Good Health. Maybe.

That fount of modern female wisdom, Cosmopolitan magazine, inadvertently highlighted the fundamental problem with modern healthcare in its recent online article, Hairstyles Men Love. Next to this picture of an undeniably-photogenic Anna Faris:

The article notes that "From an evolutionary perspective, guys subconsciously like hair that looks clean and healthy, like Anna Faris's blond locks. "Hair that's in top condition shows that you have a balanced diet and good health — signs of an ideal mate," says biological anthropologist Helen Fisher PhD."

So far, so good. Sociobiology, or the description of human behavior from a evolutionary perspective, has come a long way since its introduction 40-odd years ago, and is now a widely accepted (if oft-misused) theory. It is quite probable that in matters as fundamental as procreation, we are hard-wired to respond in certain ways just as much as the female Western Tanager will always go for the guy with the big red top.

But then Cosmo blows the lid off of the secret behind looking healthy:

"Work a silicone-based straightening serum through damp hair before blow-drying," Cosmo advises. "Clip locks in 4-6 sections depending on how thick your hair is. Then tackle one at a time with a paddle brush and a blow-dryer equipped with a nozzle pointed straight down. Finish with a light shine spray."

Ok, let me see if I've got this right. The secret to attracting guys, Cosmo says, is to develop that healthy glow, which presumably indicates a fecund future of healthy, bouncing babies to carry the genetic line forward. And the secret to attaining that health is a silicon-based straightening serum?!?

Not a word about the things that I associate with good health, like, maybe, good nutrition, exercise, sanitation -- all that stuff that actually does give a person that healthy glow, instead of simply imitating it.

In the same way, mainstream medicine mistakes appearing healthy for looking healthy. Instead of looking at the person, they look at the numbers:

Cholesterol low?                   Check.

Thyroid hormone normal?     Check.

BMI "normal"?                      Check

All well and good. But the fact of matter is, manipulation of the numbers does very little to change a person's health. You can have a normal body mass index and still be highly prone to cancer and heart disease. You can have normal thyroid hormone levels, yet still have a thyroid that is dysfunctional. And don't even get me going on cholesterol. Cholesterol levels are no indicator of any kind of health whatsoever.

So, by manipulating the numbers, the modern MD thinks they are creating health in their patients. But, like the two ounces of straightening serum, they are only creating the appearance of health.

Reducing your cholesterol level has no effect on your overall lifespan. None. Zero. Zip.

Normalizing your thyroid hormones does not mean your "thyroid" symptoms will go away.

A normal BMI does not mean you are fit.

Just like two ounces of straightening serum will give the appearance of health without the reality, the statin drug or the synthetic hormones will make pretty pictures -- but, in the long run, won't change your health for the better.

Expertise, recognized.

I've just been selected as one of the on-line experts at MDinfo.com. Don't be confused by the name. There are a lot of smart doctors on there handing out good advice.

If I do say so myself.

An Open Letter to the Connecticut Chiropractic Board

I am writing regarding the hearings in Hartford on the requirement for chiropractic physicians to disclose to patients the risk of harm from cervical manipulation.

I am troubled in two ways by the legislation. First, I am concerned that the legislation is based on unsubstantiated fear and rumor rather than established science. Second, I am troubled by the way in which it singles out one medical provider among all others for this invasion into the doctor-patient relationship.

Stroke due to cervical manipulation is an exceedingly rare event. In fact, the most in-depth examination of this topic, a study published in the journal Spine in 2008, concluded that stroke due to chiropractic manipulation may be a non-event. The authors of the study reviewed 10 years worth of hospital records, involving 100 million person-years. Those records revealed no increase in stroke risk with chiropractic.

Even if you argue that spinal manipulation can result in injury, it is exceedingly rare. Another study, reviewing 10 years' worth of malpractice claims in Canada, concluded that the risk of stroke following chiropractic treatment could be only 1 in 5.85 million cervical manipulations. Another way of looking at this number is that it would occur only once in a chiropractor's lifetime if he were in practice for 1,430 years. And even then, the study did not find that chiropractic manipulation caused stroke.

Thus, I must ask the question: Will the government require that chiropractic physicians lie to their patients about the risks of chiropractic-induced strokes, when, in fact, the best science available shows that none exists?

Any good doctor, whether chiropractic or medical, cares sufficiently for his patients to inform them of the significant risks and consequences of their chosen course of treatment. This is simply good patient care, respectful of the patient and his rights and the doctor and his responsibilities. And any therapeutic intervention carries with it some degree of risk, although, as in the case of cervical manipulation, it may be extremely small, and the injury typically limited to a pulled muscle.

There is no need whatsoever for the legislature to involve itself in this process and begin the micro-management of the doctor-patient relationship, nor should it single out one single provider for its intrusiveness. The legislature would never even consider mandating that every medical specialty disclose in writing specific but rarely occurring abreactions to their treatment.  Why then would chiropractors be held to a different standard? 

Or, if a 1in 5.85 million risk of injury is sufficient to require specific notification, will the legislators also require an MD to obtain specific written consent every time he tells a patient to take an anti-inflammatory? That is not a low-risk treatment. Anti-inflammatory medications are the 15^th leading cause of death in the country today.

Will the thousands of other procedures conducted by medical doctors with much higher risk of serious injury or death also come under the scrutiny of the legislators?

After all, during the two days in which your hearings were held, 4,296 people died as a direct result of their medical care.

Who provided the informed consent for that?

Very Truly Yours,

Avery L. Jenkins, D.C.

My Christmas Gifts

Probably the best thing about this holiday, in my mind, is that it gives us all the opportunity to be grateful. As a friend of mine recently pointed out, when you spend your time being grateful, you don't have a lot of room in your life for stuff like anger, or fear, or jealousy. It's hard to be grateful and angry simultaneously. Try it. See? Weird, it just can't happen. So I'm feeling really grateful today, as I sit and type this beside a wood stove cranking out the heat and eating a clementine. I'm grateful for the warmth of the stove. The children upstairs still sleeping. The deliciously healthful food made possible by a civilization which, for all of its many faults, gives me the capability to eat an orange in the middle of a cold New England winter. And I'm very grateful to the patient who brought me the fruit.

It is always somewhat surprising to me, when holiday season comes around, and patients bring such wonderful gifts to share with Teresa and me.  Diets be damned, they say, and bake with abandon, creating the most  delicious concoctions enticing me to keep my energy up with a quick midday sugar fix. Or two. Or three. (Hmm. I'm pretty sure I'll be doing the Center's New Decade - New Me weight loss program in lead-by-example format!). I am touched by these gifts, as I know that they signify my importance in their lives. And when I realize that, I am immediately humbled and awed by the trust which my patients place in me.

There were two gifts this year which particularly moved me.

One of my patients, whom I know is no stranger to philanthropy, took her largesse to an entirely new level this year. In honor of me, she said, she gave the gift of a cataract operation (through Seva, a charity devoted to restoring sight and preventing blindness in the developing world)  so that another person might see again. When she told me, it brought tears to my eyes. To be the inspiration for such magnaminity is overwhelming. Thank you, Joan.

Another gift came in the form of an email from a grateful patient whose holiday was brightened by a new addition to the family -- whose presence, she said, was the result of the care which I provided.  I was deeply moved by her thanks as well, and reminded of the joy I experienced many years ago when my first child arrived.

So has it been a good Christmas? You bet! New eyes, new life, tasty treats and fruits and honey. My cup runneth over.

I hope your Christmas has been equally  joyful.

A Common Conversation

I had a conversation with a patient the other day, one that I've had all too frequently in the past. The patient, someone with chronic neck pain, had gotten impatient with the length of time it was taking her to heal, and had discontinued care. Now she was back in my office, after visits to the MD, PT, and the radiologist.

"I finally found out what was wrong with my neck," she said.

"That's great," I replied. "What is it?"

"I have arthritis!" she said. "My doctor took x-rays." She pulls out a manila envelope and hands it too me. "Maybe if I'd known a little sooner, I could have gotten this fixed."

I left aside for a moment the concept, always a little odd to me, that somehow I wasn't her doctor. I know, it's a chiropractic thing.

"Yeah, you probably do," I said. I ignored the manila envelope. "Doesn't really make any difference, though."

"What do you mean?" she said.

"Look, Sarah, you're 50 years old," I said. "Of course you have arthritis, everybody does by 50. Arthritis is just a medical term for wear and tear on the joints, and if after 50 years you don't have any wear and tear, that would be the surprising thing."

She just looked at me, clearly upset that I didn't share her enthusiasm for her newfound diagnosis and her (real) doctor's "discovery."

"Here's the thing of it," I said. "Those of us who treat a lot of this stuff know that there is often very little correlation between what an x-ray or MRI tells us and the pain and symptoms patients experience.

"Heck, studies show us that 30% of the population is walking around with a bulging disk in their lumbar spine, but most of them have no back pain. I've seen x-rays that showed massive amounts of 'arthritis' and disks that are virtually missing in action, but those findings had absolutely nothing to do with the patient's pain," I said.

"That's why I rarely bother with x-rays or CT scans or MRIs unless I see a red flag when I examine you. In most cases, it's not worth the radiation exposure or cost, because the 'arthritis' isn't the source of your problem."

"That's not what my doctor said," Sarah replied.

"I know," I said. "Let me ask you this -- what did your other doctor do after he found the arthritis?"

"He prescribed some painkillers for me, and I've been going to see the physical therapist."

"Great," I said. "How's it working out?"

"Well, sort of ok," Sarah said. "The painkillers were giving me a stomach ache, so my doctor put me on a different pill, but they aren't really much better than Tylenol. The physical therapy really helped at the beginning, but it's not been doing so much lately."

"Ok," I said. "Here's the thing. The wear and tear you've got isn't really the problem. Chronic pain like yours rarely comes from a single source. It's usually 2, 3, or 4 things all going on at once. If you don't tackle all of them at once, you won't really find a solution."

From that point, I went on to describe a suggested treatment plan -- one that I would have implemented a couple of months ago, had the patient not withdrawn from treatment prematurely.

The problem with this treatment plan is that it requires some lifestyle changes. Regular rigorous exercise, not a few lifts and stretches under the supervision of a mildly bored PT aide. Changes in diet, giving up some favored foods.

These protocols do work for chronic, degenerative conditions. But for so many people, the mental/emotional pain of change -- even healthy change -- is greater than living with physical pain.

By the time I was finished, I could tell Sarah was still unsatisfied with me and my answers. I understand her reluctance. It is much easier to hang your hat on a simple diagnosis -- "I have arthritis" -- than it is to tell your friends "I have a metabolic/muscle movement pattern dysfunction with inflammatory overlays."

Despite my 30 minutes of explanation, Sarah left that day without making any further appointments. I don't know if I'll see her again, but it's likely that if I do, her condition will be that much more farther advanced and more difficult to treat.

Over the years, I've had many patients like Sarah. And sometimes they do come back, and often, with committed efforts on both of our parts, we make inroads.

Sometimes, it's just too late.

Help Save the Insurance Companies

When I saw this, I didn't know whether to laugh or cry. I settled for laughter. It didn't hurt as much.

Protect Insurance Companies PSA from Will Ferrell

Bigger, Badder, Scarier!!!

Coming on the heels of revelations that the CDC cooked the books to make the H1N1 (formerly known as Swine) virus look far more dangerous than it was, comes the latest  scare tactic to get people to stick those needles in their arms: The H5N1 Virus! Omigod! It must be 5 times as deadly as the H1N1!!!!

Scientists have already detected the virus in poultry in Indonesia, Egypt, Thailand and Vietnam, and warn that it is only a few mutations away from posing a threat to human life!!!

Good grief. More and more these days, what passes for public health in this country resembles a poorly-plotted zombie movie.