When The Universe Changes

It may be entirely apocryphal, but I was once told that in ancient China, it was the practice to pay your doctor when you are healthy, and your payments would stop when you are sick. This economic model -- the wellness model -- makes far more sense than our current system, in which physicians, including myself, make more money from you being sick than being healthy.

If you look at any other industry, it is apparent that the medical habit of paying for failure is entirely topsy-turvy. Should you pay the airline for not getting you to Hoboken in time for Thanksgiving at Aunt Marcy's? Should you tip the waitress more for bringing cold coffee and yesterday's French fries? Of course not. But when it comes to health care, the sicker you are and the longer you take to get better, the more your doctor makes.

What brought this to mind recently was my daughter's acceptance into college, and the concomitant realization that I was now on the hook for a considerable annual fee to join the august club of College Student Parents. I was bemoaning my fate to a friend who also happens to be a patient. They just looked at me and said:

"You know what your problem is, doc? You get your patients better too fast."

Well now, there's a concept. In what other industry could I possibly be in where I actually hurt myself financially by improving my performance?

The medicopharmaceutical industry has neatly tied up both ends of this ribbon. On the one hand, they create new diseases, find ways of convincing you and your non-chiropractic doctors that you have it (adult ADHD, anyone?), then sell you on a lifetime of pills to fix it. The Great 20th Century Statin Deficiency is another example. Through corrupted research and savvy marketing techniques -- up to and including the use of prostitutes at medical conferences -- the pharmaceutical companies have deluded millions of healthy Americans and their medical doctors into believing that they must take their daily dose of statins to survive. Nothing could be further from the truth, of course, but there's nothing wrong with a healthy revenue stream, is there?

On the other hand, they market drugs as tools of disease prevention, all the time knowing that the nostrums they peddle do little to encourage better health. A perfect example of this are the bisphophonate drugs, such as Fosamax. We now know that bisphonates not only fail to create healthier bone, they also kill the very bone that they are supposed to strengthen.

Long before reaching that fraudulent extreme, however, there is a sound basis for wellness, or preventative care.

Both proper diet (a term I am loathe to use these days, as it has been sorely abused by the media) and exercise are, of course, the foundations of preventative care. But aside from these factors, what should be stirred into the mix of preventative care?

Here's what the research shows us:

• Seniors who receive regular chiropractic manipulation use fewer drugs, have fewer hospital stays, spend less time in rehab, and live healthier lives.
• Pregnant women who recieve regular chiropractic manipulation require fewer ceasarian births.
• It should go without saying -- but in fact, is well supported by the research -- that preventative chiropractic manipulation reduces the risk of suffering from low back pain.

And that's just chiropractic manipulation alone. What about the other services provided by chiropractic physicians?

Acupuncture is one of the therapeutic approaches I use the most for treating people with a variety of existing conditions. But does it make any sense at all to adopt a "preventative acupuncture" strategem?

The research on this topic is surprisingly vacant. While a number of studies have discussed the effectiveness of acupuncture for early intervention in disease processes, this is far from the idea of wellness. A few articles have noted that traditionally, regular acupuncture at certain points has been regarded as beneficial for seniors.

I'm not going to hold my breath waiting for some research to appear, however. Government funding for acupuncture research is only slightly higher than the homeopathic doses grudgingly dispersed for chiropractic manipulation. So how do we decide?

I remember when I posed this question to one of my acupuncture professors: How often should we have a patient return for preventative care?

He didn't break stride. "Of course," he said. "When the universe changes." And then he went on to discuss some observations of the more esoteric uses of Bupleurum.

The answer didn't make sense to me at first, but as I puzzled over it during the following week, I finally realized what he meant. The aim of acupuncture -- indeed, chinese medicine as a whole -- is to put the individual in balance with the environment. Any time that there is a change in the person's environment, they must respond by altering their metabolism and behavior. (This process is known as "homeostasis" in modern biology). Thus, when the universe changes, the individual  can use assistance that acupuncture provides in adapting to the altered environment.

When does the universe change? We need look no further than directly around us to tell. When the fresh green of springtime appears, the universe is changing. When the leaves turn brown and fall from the trees in autumn, the universe is changing. At the height of summer, as the sun ascends to its northernmost latitude above the equator, the universe is changing. And, finally, in the dead of winter when the day's length reaches its nadir, the universe is changing.

The change in seasons does, in fact, affect our health. The fluctuation in communicable diseases, mental health, and the course of some chronic disorders is profoundly affected by the time of the year.

So, from a very practical standpoint, it makes sense to evaluate and adjust your position in the universe as the universe itself changes. And in the absence of more precise clinical data, it is on that concept that I rest my recommendations for preventative -- or should we say adaptive -- acupuncture.

See you when the universe changes!

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Must-Have Android Health Apps, Part II

It should come as no surprise that many of the free apps in the Android market are ineptly named -- after all, these are programmers doing their thing, not marketeers. Expecting a programmer to come up with a sexy title is a little bit like having a chiropractic doctor create a drug name. "Sideffecta" is the first one that comes to my mind, which is probably why SmithKlineBeechamKilla hasn't come around knocking on my door with money in hand.

Which is all a backdoor way to introduce the Center for Alternative Medicine's second winner in the Next-Year-It-Will-Be-Annual Health App Awards: Jefit

I don't know where the name comes from (somebody's android dog, maybe?) but just ignore that. This is the best app a gym rat could ask for.

Maybe a little background is in order. Back in the stone ages, I spent my summers working for the AMC Trail Crew, in the high peaks of the White Mountains. It was intense physical labor, consisting of cutting trees with axes, rolling multi-ton rocks up and down jagged slopes, and carrying ridiculously heavy loads of tools, supplies and food up steep mountain trails. And if you spent your winters as a student of the liberal and hard sciences, as I did, that first week of summer could be a real bear. So I took it upon myself to start keeping in shape during the off season.

Now this was long before gyms became the cheery, chic places they are now. At the university I attended, the weight room was in the corner of the basement of the fieldhouse, and was occupied by two groups -- the football team, and the body-builders. It smelled like stale sweat socks, or worse if somebody's lunch got the better of them in the middle of some squats, had one Nautilus machine and a bevy of free weights, bars and benches. No juice bars, no stereo, no carpeting, just a fan to blow around the stale air.

I knew little about lifting. All I knew is that I needed to be stronger than I ever had been before by the time spring rolled around. While the football squad was less than welcoming, the bodybuilders, who worked out in the odd times that I had available, were a pretty friendly crowd. They took me under their wing, and taught me a lot about lifting, in that time-honored personal transmission of tradecraft that occurred before the internet. And though some of them were assuredly juicing, I was never part of that inner circle in which the "true knowledge" was imparted.

So I learned -- the good techniques as well as the bad -- and gradually developed an addiction to the art of being strong, an addiction which has never really left me. One of the techniques that I learned was that you couldn't evaluate your progress unless you wrote it down. And as you altered your routines to combat your weaknesses, as a general might alter his troop strategy, you were lost unless you had a map of where you had been. After a while, I began keeping a small spiral-bound notebook in my gym bag in which I charted my progress. I still have a few of those notebooks tucked away up in the attic. Last time I looked at one, I could see where the ink had run from my sweat dripping on them, and the thing still smelled like that poorly-ventilated room with a wall of mirrors.

Fast-forward to the next century. I have a dedicated workout room in my house, equipped with weights, which sees heavy use in the winter as my long cycling trips become warm-weather memories. In the corner sits a stool with a 3-ring notebook, pages full of workout information -- weight, sets, reps, rest times -- the unrefined data documenting what is no longer my preparation for a season's high-altitude adventures, but is instead my fight against age and encroaching debility (not to mention my number one prevention strategy against infection, cancer and heart disease).

Until a couple of months ago, when I stumbled onto Jefit in the Android Marketplace (you were beginning to wonder if I was ever going to get around to actually reviewing the application, weren't you?). After looking over many of the purported apps for tracking exercise, none of them come close to doing as good a job as Jefit.

The opening screen allows you to define multiple routines, and assign them to particular days. You can set up a profile with measurements from weight to bicipital circumference. There are a wealth of pre-defined exercises, with visual triggers, and even animated demonstrations. You can also define your own, for those of us who have found, err, novel ways of exercising, or who employ some of the Naked Warrior training techniques which have gained popularity with the rise of the UFC.

You can also add your one rep max data, which will be tracked automatically. After setting up your routines, use is simple. You do the exercise, then use the drop down values on the screen to input weight and rep. Hit the "Save and Time" button, and your data will be logged and the timer set for your next exercise. The input fields default to your last used value, on the assumption (in my case, all-too-frequently correct) that you haven't thrown another plate on for this set. If you are proceeding to another exercise, the timer screen will tell you what it is and how much you lifted last time, so you can set up your equipment during the rest period.

When you've finished your routine, the app tells you "Congratulations" -- always a nice thing to hear, even if it is coming from your smartphone -- and gives you the option of reviewing your log or exiting.

And that's it. Jefit offers a clean, simple interface that doesn't take too much thought when your brain is awash in that pecular combination of enkephalins and Substance P that are the hallmark of a good weight-training session, and your hand is trembling too much to accomplish fine coordination skills. The app will soon have a website to which you can upload your data and track it more thoroughly, in much the same way that my previous winner, Endomondo does.

In any event, it is the perfect next-generation replacement for my old spiral-bound notebooks, and keeps my workouts incredibly productive. What more could an aging gym rat ask for?

A Girl, A Trike and A Disease

Every patient who walks into my exam room receives -- at no extra charge! -- a critical evaluation of their exercise regimen, or lack thereof. At this point, regular exercise has been proven so critical in the prevention and treatment of so many disorders, from depression to cancer to heart disease to the cold and flu, that in my not-very-humble opinion, any primary care doctor who does not investigate, evaluate and manipulate their patient's exercise program is committing malpractice. Yes, it's that important. It's like not taking a patient's blood pressure or pulse. A person's participation in exercise is one of the vital signs of wellness. Frequently, my job is to find exercises that will work within the boundaries set by a patient's existing disorder while at the same time optimizing it to reduce or eliminate the effects of that same disorder.

Among the chronic diseases, one of the most problematic in the exercise prescription department is Multiple Sclerosis (MS). Because of this cruel disease's frequently erratic behavior, coupled with its prediliction for shaving away a small slice of one's competence with each renewed assault, it is hard to find and develop good exercises for my patients suffering from this disease. What was possible last week becomes impossible the next. Problems in balance or sudden weakness can make many standard exercises impossible or dangerous. And the fear of such occurrences can negate even the most committed patient's determination and my craftiest motivation strategies.

Being a recidivist transportation cyclist,  an environmentalist, and a man with a grip on the purse that would make a Scotsman proud, it has rarely come as a surprise to my patients when I suggest cycling as a good all-round exercise. Bicycles are cheap, and every time you ride it to the grocery store, you save money, while at the same time becoming healthier and increasing your longevity. As the great Oregon Congressman Earl Blumenauer once said:

"Let's have a moment of silence for all those Americans who are stuck in traffic on their way to the gym to ride the stationary bicycle."

Cycling would be an excellent activity for my MS patients as well, were it not for the unpredictable and troubling manifestations that could make it downright dangerous.

Which is why I suggest a fun, albeit unusual, alternative: Trikes.

No, these aren't your average 4-year-old's Big Wheel. I'm talking about performance trikes, trikes that have been ridden to the furthest reaches of the Himalayas, in the fastest bicycle races in the world, and on the road. They are trikes that can be ridden every day, as fast or as slow as you want, without concern for the types of crashes that can befall you on a two-wheeler.

For that reason, I think trikes are an excellent source of rich cardiovascular exercise for my patients with MS. And here's how many have taken me up on my suggestion: 0. None. Nada.

Well, all of my patients with MS, and all of you reading this blog who have MS or have friends or relatives who are suffering from the effects of  MS, I want you to take note of this name: Denise Lanier. Denise is a writing professor at Broward College. Her poetry has appeared in Bloomsbury Review, Cake, Luna, Best American Poetry blog, and various anthologies. And she has MS.

In her blog, Wonky Woman on a Bent Trike, Denise writes about her two most powerful tools for fighting this disorder (in addition to her undeniable intelligence and phenomenal willpower): A mobility dog and her trike.

This weekend, after much training, Denise will be riding her trike in the New York City Marathon, as a disabled entrant in this world-famous race, and the first entrant to do it on a tricycle.

But is she doing it for herself? For an MS charity? Certainly not - that would be too self-serving for a woman as generous in spirit as her. Denise has chosen the Leary Firefighters Association as the beneficiary of the dollars she has raised. Go here to read what Denise has to say about the foundation. Then go here and donate.

But more important than any of that, read the words this woman has written, about herself, her MS, and her fight toward health. For anyone with a chronic disorder, she is an inspiration.

And I hope everyone reading this blog (all 6 of you) will join me this weekend in following her progress and cheering her on. In her most recent post, she suggests some ways to do it:

Here’re some ways for you to follow my progress in the marathon on race day, this Sunday, November 7th:

Online Athlete Tracker:  free race-day service, visit ingnycmarathon.org on November 7th

Text Message Athlete Alert:  sign up at ingnycmarathon.org to receive on-demand updates, one-time setup fee of $2.99

Tune In:  NBC4 New York offers live coverage of the entire race; after the race catch the 2-hour highlight special on NBC Sports

Marathon App:  for iPhone, iPod Touch or iPad, download it today!"

Then go out and buy a trike. And ride it.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Must Have Android Health Apps, Part I(a)

This app was not on my original list of must-haves. However, when planning a training ride the other day, I realized that none of the apps I had reviewed for cycling actually had the ability to import a gpx (route or track) file, and instead of recording where you had been, could tell you where to go. Well, ok. I have enough people telling me where to go without really wanting to add to the list. But not infrequently, I will spend some time on a site like ridewithgps.com, or gmap-pedometer.com, creating a "custom" training loop. The varied topography of Litchfield and northwest Connecticut makes it possible to design a route with the amount and type of climbing you want, depending on your climbing goals.

Unfortunately, routing apps don't work very well for creating loops, nor do they take into account your training desires in point-to-point route design. Thus the use of sites like those mentioned above to create the ride of my dreams -- or at least my dreams for that day.

And on those occasions when you are riding on a pre-planned group ride, having your route in your GPS (or in this case, smartphone) saves you from fumbling with cue sheets in the wind, rain, and at busy intersections while you try to figure out which way you are supposed to turn on Reallybighill Road. Or, better yet, prevent you from riding those extra "bonus miles" that you get awarded for veering off course. (My worst day involved 15 bonus miles, but that's another story).

Which is where Must-Have App I(a) fits in. Called OsmAnd, this app allows you to import a .gpx file, either a track or a route, and will give you on-screen or verbal directions as you move down the road.

OsmAnd is free and open source, which means a number of developers are welcome to add their coordinated input to the project. It is also intentionally designed to minimize resource use, both on your phone and in terms of internet access -- a big bonus now that unlimited service plans have gone the way of Vioxx.

Another big bonus is that OsmAnd itself is not only open source, but employs open source maps as well, from the Open Street Maps project. Which means the maps are more accurate, as a larger number of people are available to evaluate the data and make corrections. There is also the OpenCycleMap project which, while currently largely UK-based, holds the promise of creating cycling-specific maps worldwide. OpenCycleMap currently has maps for part of Litchfield County here in Connecticuty. It's an effort worth keeping tabs on, if not actively supporting.

This app does exactly what I wanted it to do. Using ridewithgps, I mapped out a short 20-mile route that would end by taking me past the farm, where I could pick up some milk and eggs on the last few miles and get them home before they spoiled (a route that also, I might add, require me to carry the groceries up a minimum of hills).

Ridewithgps created the .gpx file, which I then downloaded to my Android. I fired up OsmAnd, which on command immediately found my file and created the route. The program worked almost flawlessly, guiding me through  the unfamiliar stretches and turns. The screen updated my location on the map, and an icon in the upper left hand corner told me how far to the next turn and which direction I was headed.

As I noted in the previous review, satellite coverage in my area can safely be graded as somewhere between "less than spectacular" and "I get better satellite coverage in caves." So there were a few spots were the app wasn't quite up to speed on my current position. But it handled the confusion with aplomb, updating itself as soon as it got reacquainted with its satellites. And the constant turn reminder permitted me to estimate the location of the turn, even if the app itself was behind me.

If there are any hiccups in this app, it is only in the installation. It does not automatically create the file folder where you need to place the gpx files, though it does tell you exactly where the folder should be and what it should be named. Similarly, the voice configuration data has to be downloaded separately, from the OsmAnd website. Those sorts of issues are of little consequence, though, compared to the value of the application.

But once those two tasks are accomplished, you're ready to go. This app is not resource intensive, downloading map tiles only as needed and working offline as much as possible; nor did it seem to draw down the battery power any more than any other application using the gps features.

If you are a cyclist or runner that likes to design their own routes, then OsmAnd is the application for you. You can download it from the Android Marketplace or from the website.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

3 Must-Have Android Health Apps, Part I

When the Verizon cellphone account headed for expiration, I decided to (a) look for a better deal, and (b) do some serious upgrading. My old folder did its job and did it well, but had gone a wee bit hinky on me over the past few months,  randomly shutting down, making phone calls on its own, occasionally beeping uncontrollably, and generally acting like a patron of the Pig & Whistle at last call on a Saturday evening. Being a fan of Open Systems software, I was naturally drawn to phones running the Android operating system, and the increasingly large ecosystem of apps surrounding it. So I ended up with a Samsung I897 smartphone. And, of course, immediately began looking at the 1.3 gazillion health and fitness apps for it.

Most of them, unsurprisingly, are less than impressive, and fall into one of several categories. There are the Body Mass Index calculators, calorie counters, weight loss trackers, and celebrity fitness apps. The first group does nothing more than a pencil and paper, hand calculator or a smart digital scale can do; the second group has utility if all you want to do is reduce input, not recalibrate your diet for a healthy intake; and the only appeal of the final group is to assure you that "YES, YOU CAN LOOK LIKE HER," or alternatively, "YES, YOU CAN GET HER," depending on your gender and orientation.

But after slogging my way through the swampland, I found what I consider to be the three Essential Health Apps. They are available for both Android and iPhone platforms, and all three of these applications have the twin advantages of Doing Something Useful and Doing What They Say They Can Do. Neither of these attributes should be taken for granted in the world of applications software.

Two of these apps are for fitness, and the third is for nutrition. All three are free. And if you are engaged in any level of healthy activities, I encourage you to download them and employ them.

The app we will review today is, to my mind, the best reason for getting a smartphone. Health App #1: Endomondo

Endomondo is an application for cyclists, runners, bladers, skiers and walkers. Like all of the other apps in this category, it uses the phone's built-in gps to track your location, and will report your speed, distance traveled, and average speed as well as other assorted data, both visually and verbally. You can look at a screen that resembles the cyclocomputer on your bicycle, or follow your progress on a map. And at user-set times, Endomondo will verbally give you your performance data. All of these are typical of the breed. However, Endomondo goes a notch higher than the competition in several respects.

First of all, Endomondo's use of the gps is far better than any of the other apps in this category that I tried (I tested the top 6.) I live in an area where gps reception is dicey. I've had $500 gps units sit in front of my house for minutes trying to get a fix on its location, only to report failure and retire from the field.

Endomondo, it seems, can variably adjust its filters on the fly to accept weak-signal situations. As soon as I punch the start button, Endomondo is ready to ride, while others -- notably SportsTracker, SportyPal, and CardioTrainer -- took several minutes to acquire a position fix. And My Tracks, allegedly a premier program, never did get a location fix over the course of a 25 mile ride.

Even with the acceptance of lower-level gps signals, Endomondo's accuracy did not notably suffer. In 25 and 30 mile rides, the app was within .05 miles accurate, as compared to a cyclocomputer which had been previously calibrated against a measured 100-mile distance, and the Endomondo distance measurement fell within the range of error of the calibrated device.

In comparison, CardioTrainer gave me an extra 5 miles over a 25-mile distance, something for which I was grateful but hesitant to accept, even though the CardioTrainer error boosted my average speed to the minor diety level.

SportsTracker can occasionally get a fix, and once fixed, would track with admirable accuracy. But before it would let you take off, you had to add a name and description to your ride. And since my rides are usually unremarkable, this feature made little sense. After all, how many times can you type in "milk run"?

SportyPal's interface was unsuitable for low-signal conditions. Until the gps would initialize, it would seize, leaving me sitting in the driveway waiting for the software to get ready. And that's just not an option in my world.

In comparison, I liked Endomondo's no-muss, no-fuss startup. You just picked your activity (surprisingly enough, the list includes "transport cycling" as an option, which pleased me to no end), pressed the "Start" button, then started. Clean and simple.

Endomondo also has the ability to gather heart rate data from a bluetooth-equipped sensor, which it will incorporate into your ride data.

At the end of your activity, you press "Stop," and all of your data is automatically uploaded to your online Endomondo account.

Online, you can look at your history, your maps, graphs of your ride data in a few different formats; but best of all, you can interact with friends. There are activity challenges constantly going on, and if you set up your phone app to do so, you can allow your friends to track you online in real time. Your friends can help you along by sending freeform text messages via endomondo, which are then read to you by the phone's text-to-speech engine. Imagine how much fun it can be, as you struggle up some desperate incline, to hear your best friend cheering you on with such encouraging phrases as "speed it up, lard butt!" or "enjoying your ice cream stop, pal?"

(Such exhortations can be made somewhat more enjoyable, I found, by equipping your phone's text-to-speech engine with a sexy British accent, making your buddy's ribbing much more pleasant.)

Although some may not like them, the social networking features of Endomondo are definitely a selling point for me. Misery always loves company. So that, plus the easy user interface and the weak-signal GPS performance make this my Number 1 health app.

NEXT UP: We take the Android to the gym and let it show its muscle.

Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.

Happy Anniversary

Fifteen years ago this week, I made the very long commute from Ansonia to Kent, and as a freshly-minted doctor, opened my doors to the public. Oh, my...if I had only known what was in store for me.

I had decided to begin practicing in the northwest corner because I knew that somewhere up here was where I wanted to raise my family, and at the recommendation of a doctor who at the time was practicing in New Milford. The good Dr. Hess has since passed away, but when I called him for advice for a place to open a practice, he said, "If I could do it all over again, I would have practiced in Kent."

So there, for better or worse, was where I started. On the largely-abandoned second floor of a building in the center of Kent, above a toy shop, as the "Kent Chiropractic Health Center," a name which to this day floats around the internet, cropping up in the search results from time to time. On that first day, I received a surprise delivery -- a ficus plant from my parents, to wish me good luck. I put it in the reception area.

Kent did turn out to be a wonderful place to start, and I developed good reputation there for treating muscle and joint problems. But my vision of being a chiropractic physician had always been broader than that, and while one might say my concept of a chiropractor as an alternative care primary care physician was forward-looking at the time, it was actually backward-looking. The early history of chiropractic is filled with chiropractors in rural America treating all manner of illness, naturally, using their hands and good food and their hearts to heal patients seeking a more humane form of treatment than the "heroic" medicine in vogue during the 20th century. It was not until the 1980s when chiropractors got painted into the back/neck corner, as mainstream medicine tried to contain the chiropractic threat to its pocketbook.

Only a few years after opening my practice, I returned to school for post-graduate education, while keeping my practice running. Those were busy years, as I hired my first employee, worked all day on Saturdays, and  spent every fourth weekend at the Long Island clinic of the New York Chiropractic College, culminating in passing my board examinations and becoming one of Connecticut's few doctors who were board certified in clinical nutrition.

I also moved my office during that time, so that I was no longer above the toy store, but in what was then Kent's bustling Medical Center building. I shared the building with two MDs and the northern branch office of a radiologist based in Danbury. The ficus plant came with me. With my additional knowledge base and growing clinical experience, I began to expand out more and more from muscle and joint problems into treating people with other health problems.

Kent is one of those small towns which, lacking a diverse employer base, goes through boom-and-bust cycles. When I had opened my practice, Kent was on the cusp of a boom cycle, riding the dot-com wave with a local internet company, Cyberian Outpost.

When the dot-com crash came, Kent suffered a bit. The bustling medical center bustled not quite so much, as the radiologist closed his satellite office, one MD retired and the other moved. For quite a while, I was the sole occupant of the building, which occasionally felt like practicing in a ghost town.

Satellite Office

During that time, I noticed that I could find some office space cheap in Litchfield, and opened a satellite office there. I was in Litchfield two days a week, and Kent the rest of the time.

The Litchfield office surprised me. With little marketing, only word-of-mouth, my practice in Litchfield grew rapidly. I had two rooms -- a consultation room and an exam/treatment room in an office complex otherwise filled with mental health professionals, and it was during that time that I gained a deep understanding and respect for psychologists and clinical social workers. They, too, were drug-free professionals like me, choosing to treat people with mental illness with skill and finesse instead of the blunt tools of psychiatric medications. My association with this group led to my lecture presentation at the 40th annual meeting of the Connecticut Psychological Association.

And, of course, running two offices and lecturing weren't quite enough to keep me happily busy, so I continued with my education. This time, I added to my arsenal by pursuing postgraduate board certification in medical acupuncture, giving me what turned out to be a perfect trifecta in natural medicine -- chiropractic, herbs/nutrition, and acupuncture -- the 1-2-3 punch which has served my patients well ever since.

To reflect the growing cachement area of my practice, I again changed names, this time to "Northwest Chiropractic Health Center." After a few years in Litchfield, and after having moved my family here, I realized that in all likelihood, the future of my practice was going to be in this town. The Litchfield practice continued to grow, and I was increasingly stealing time from Kent to support my patient load in Litchfield. The Kent office's days were numbered, despite my enjoyment of that small, quiet town.

Opportunity struck when, of all things, a local veterinarian decided to move across the street. When I found that this office, on Route 202 only a mile from my house, was for sale, I knew where I wanted to be.

So I took a deep breath and jumped in. Of course, after the purchase, extensive renovations were required. I really didn't think my patients needed kennels, or a place to be hosed down after their treatment here. With much thanks to the now-retired Paul Mattson, who broke every rule in the contractor rulebook by finishing the project in budget and on time, I was ready to move my practice for the fourth -- and presumably final -- time.

That's not to say that there weren't a few hiccups along the way. I learned that any time your contractor calls and says "we need to have a meeting with the plumber," it's going to be an expensive meeting. I also learned that zoning regulations can be as obscure, dated and nonsensical as any New England blue law.

I once again changed corporate names, again for the last time. The change reflected the slow but inevitable transformation in the nature of my practice, as what had once been the Kent Chiropractic Health Center became the Center for Alternative Medicine.

Opening the new Center was an exercise in blindfolded tightrope walking, as I was simultaneously closing the Kent office. Trying to ensure a seamless transition, I closed down operations in Kent on Monday, and with the help of the entire Tuz family, moved everything to Litchfield in the space of two days. I was ready to begin seeing patients -- indeed, had already scheduled them -- except for the small but vitally missing Certificate of Occupancy.

On Wednesday, the Building Inspector came to his final inspection, during which he deemed one of the outlets in one of the treatment rooms too close to the sink. It must be converted to a special GFCI outlet before the CO would be issued.

I called Paul in a panic. His office assured me that this sort of thing happened all of the time, and I was not to worry. Again, it was a testament to Paul's prowess as a general contractor that he had the electrician out on Thursday morning to fix the outlet. The building inspector returned on Friday at 10 a.m., and certified the building. Minutes after he left the building, my first patient arrived.

I had expected to lose some of my patients as a result of the move, and for a time, I did. But over the past few years, more and more of those patients have returned to my care, and I am always glad to see one of my patients from Kent. We swap stories about the old days, and they bring me up to date on the happenings in Kent.

Another milestone was passed shortly after I opened the Center, as I suddenly realized I had begun treating the third generation of a family who had began seeing me in my early days in Kent. The adolescent children I had seen back then had grown to young adulthood and begun families of their own. Realizing that this entire family had depended on me for care through so many changes was enlightening. I was finally beginning to understand the richness and depth that being a family doctor brings. I didn't have to ask these patients about their family health history. I already knew it, and had participated in it.

The Center for Alternative Medicine also brought to fruition one of my long-held goals to bring multiple health disciplines under one roof, as Dave Pavlick, one of New England's experts in EEG neurofeedback moved his offices to the building. Once again, having a mental health professional, especially one of Dave's stature, has added an interesting dimension to my professional alliances.

The thread running through this history has been my patients. The woman with asthma, who was in the midst of an attack and had no inhaler. The man in the middle of a heart attack, who had just left his MD's office after receiving a diagnosis of a cold, and who told me "something just doesn't feel right." The patient with anorexia, whose last visit was less of a discharge than a sad goodbye, as we both knew she had utterly succumbed to this most awful disease. The patient who hugged me and said, "Thank you for giving me my life back."

It is not only those dramatic moments, but also the smaller, simpler ones -- when someone sits up on the adjusting table, rotates their head in directions impossible just minutes before, and says, "thanks a lot, Doc." Or who looks at me after I take the last acupuncture needle out and says, "that feels really good."  It is really those times that keep me coming back to the office morning after morning and staying through the evening hours.

The warp to that woof is the learning. Being a doctor, especially the kind of doctor that I am, means that my education never stops. When I first began practice, nutritional analysis was in its infancy, and we had to rely heavily on questionnaires and history to deduce our patient's problems. Now nutritional doctors have an array of laboratory tests available to reduce the guesswork. And each patient visit, regardless of the problem or whether I have seen them before,  is a 30-minute postgraduate course in health, if I only have the eyes to see and the ears to hear.

With 15 years of experience under my belt, and my first book on its way, I feel that I am poised on the precipice of what will be a second half equally as exciting as the first. I am excited about the new patients that I will see, new associates I will greet, and new challenges that I will meet (so long as they don't involve plumbing).

But most of all, I am thankful. Thankful to have had 15 years to serve my patients to the best of my ability and knowledge, and grateful to have received the trust of so many.

Though my parents have long since passed away, the ficus tree remains with me. It, like all other living things, has gone through periods where it hasn't been so healthy, was dropping leaves and looking barren. But with care and attention, it has always returned to health and continued to thrive. These days, it spends its summer next to the bench and the front door, and winters in the reception room, a reminder to me of that day long ago when a much younger doctor unlocked the door to all that would follow.

Annual Fear Campaign Set To Begin

The annual Fear Campaign is about to begin, as everybody with a pulse will have it hammered into their heads that if they don't get a flu shot, They Will DIE! Remember the swine flu campaign of last year? It turned out, as I predicted, that the projected swine flu pandemic was vastly overrated, and was primarily a marketing campaign, as opposed to a public health campaign.

Epidemiological research has consistently shown that flu shots are minimally effective and do very little to influence the course or spread of the disease -- as this picture so aptly demonstrates.

Fortunately, 2010 will see the return of the Center's Alternative Flu Clinic. Details to come soon.

Dr. Avery Jenkins is the president of the Center for Alternative Medicine in Litchfield, CT. You can email him at alj@docaltmed.com.

The Map of Human Health

On the surface, it was just another typical moment in a chiropractic physician's office. I was walking down the hall from one treatment room where I had just left a patient with an injured knee, to check on another patient who was receiving care for a painful shoulder. But on that short walk down the hall, I was actually walking the long divide between two health care paradigms. While the patient with shoulder problems was receiving what would normally be considered "standard" treatment -- heat, ultrasound and chiropractic manipulation -- the patient with the bum knee had several acupuncture needles inserted around her knee and ankle.

In one room, the basics of applied physiology were being utilized: Heat was being used to perfuse the injured area with blood, bringing with it oxygen, nutrients, and other supplies for healing, and taking away the detritus of repair. Ultrasound was altering the permeability of the cell membranes, allowing the injured tissues to more readily imbibe the blood's bounty. And joint manipulation was restoring normal physiological shape and function to the ligaments surrounding the joint.

But in the other room, a completely different process was apparently taking place: The normal flow of qi, a nebulous "life energy," was being restored. Excess yang, represented by the heat of inflammation, was being quenched by employing the water principle of the body, as water is always used to put out a fire; meanwhile, meridians controlling the patient's earth energy were used to nurture the damaged tissues.

How do I, as a doctor trained in both eastern and western medicine, reconcile these two utterly divergent approaches? One is so clearly logical and wrapped in the science of the west, while the other explodes with image and allegory, as if the needles tell a parable of health in their placement and actions.

And with increasing frequency, I find that I not only combine these disparate therapies in my practice, but in the treatment of singular patients. Some patients receive both chiropractic and acupuncture. Some are treated with eastern herbs and western physiotherapy. Others are treated with western nutrition and acupuncture.

"Do I contradict myself? Very well then I contradict myself," said the poet Walt Whitman. "I am large, and contain multitudes."

Perhaps the best way of uniting these two approaches to human health which do not speak the same language either literally or figuratively is to apply the principles of scientist and philosopher Alfred Korzybski which can be best summed up by this statement:

The map is not the territory.

Too often, Korzybski argued, we look at a thing and we conceptually "map" it. We assess its shape and weight, its color and texture, and assign those properties to that object, forgetting that it may have other properties of which we are not aware -- or that it may not always have those properties which we have assigned to it.

That's a mouthful, I know. An easier way to understand the concept is to imagine two maps of the same place, for example Ansonia, Connecticut.

One map is a road map.  It clearly shows all the roads in the area, what their names are, and where they go.

The second map is a topographic map. This map does not show the roads so clearly, but it does give us other information that the road map does not. Through the use of contour lines, it shows us the hills and valleys of the terrain, where the swamps are, the steepness of the slopes.

Both maps show us the exact same territory. But they provide us with entirely different types of information.

In the pursuit of understanding, we all too often forget that the theories and hypotheses that we make -- the maps, as it were - are only maps. They are not the territory itself. The map of the human body developed by western medicine is certainly not the only map, nor is it the "true" map. It is merely a map that shows us certain characteristics of that territory. Imagine the arteries and veins as roads, the organs as cities and villages, the nerves as railroad tracks...you get the picture.

The map developed by Traditional Chinese Medicine shows us different features of the human body. Instead of roads and tracks, we see the swamps and the forests, the peaks and the valleys. Entirely different information, but also of great value as I help my patients navigate their way back to health.

Is one more valid than the other? I think it would be the height of arrogance to claim that the western medical map was superior to the eastern. After all, 100 years ago, the eastern map of human functioning was already highly detailed and had been refined for centuries, while western medicine was still scrawling  "here be dragons" on the margins of its crudely-drawn understanding.

I employ both, because I find both to be useful. They help me and my patients reach their destination. And as I continue to proceed along the twin paths of east and west, I find that I can increasingly see one in the other. From the road I see the hills, and from my path in the hills I can hear the hissing of cars on the road. I think -- I hope -- that my patients will be the beneficiaries of this understanding.  As the wise Siddhartha said, "In the sky, there is no distinction of east and west; people create distinctions out of their own minds and then believe them to be true."

Violation of an Oath, a Person, and a Profession: Erin Vaught and Ball Memorial Hospital

At the beginning of every physician's career, there is a moment in which we commit ourselves irrevocably to the wellbeing of our fellow humans. At that moment, when a physician takes his oath of responsibility -- whether it is the Hippocratic Oath of the medical physician or the Chiropractic Oath of the chiropractic physician -- we become responsible to a good far broader than our petty, individual prejudices. From the moment I took my oath to the present day, I have striven to uphold its tenets. Whether it is navigating the thickets of a patient's privacy requirements to ensure that they receive the best care, or challenging health insurers whose policies would require me to commit malpractice, I have always held in mind the obligations of this oath.

So I am understandably sickened when I come across examples of other doctors who not only ignore their moral obligations, but actively violate them to the detriment of their patient. Of course, the Josef Mengele wannabees who conducted the Tuskegee Experiment immediately come to mind.

But not far behind is the as-yet unnamed doctor and his employer, Ball Memorial Hospital, who recently threw a critically ill woman out of their emergency room because she is a transsexual woman. But the expulsion only occurred after several hours during which hospital patient Erin Vaught, vomiting blood and suffering from intractable pain, was subjected to ridicule and derogation at the hands of other hospital employees, being referred to as a "he-she" and being entered into the hospital database as a male, even though her ID card clearly identified her as a female.

Here is part of what happened, in her own words:

They completed my regestration [sic] and I saw that had put "M" as my gender. I pointed out that my ID says female. She looked annoyed and the lady next to her snickered. She told this jock type triage person to take my vitals; he glared at me for a second and turned his head and said, "Remember payback sucks."

You can read her full account here.

Those of you who read my blog regularly know that I have previously written extensively about how transgender people should be treated by doctors, and that I hold in low esteem those who discriminate against people with gender variations.

I fully understand that sometimes people do hurtful things to others out of ignorance. But in this day and age, there is no excuse for any health professional to be unaware of the needs of this demographic. In addition, and quite clearly, the activities of Ball Memorial Hospital and its employees went far beyond those which can be written off as ignorance.

They were words and actions intended to hurt. Intended to humiliate. Designed to violate the very core of the oath that those physicians had taken on the day they became doctors.

I am absolutely appalled, yet at the same time, relieved. I am appalled that the incident even occurred, and even more stunned at the hospital's decidedly pusillanimous response. And I am at the same time relieved that I do not belong to a profession which indulges and condones such bigotry.

Regardless of what unethical behaviors that chiropractic physicians have been accused of over the years, none of it even approaches the level of disregard for patients and their rights which is a standard feature of mainstream medicine. From selling confidential patient data to pharmaceutical companies to denying medical care to black men to watch them die from untreated syphillis, my profession has never come close to the level of depravity demonstrated so often by mainstream medicine.

I hope Ms. Vaught and her family find the courage to sue Ball Memorial Hospital. Though such a suit will likely not touch the individuals who perpetrated the crime, it will be as close as anyone gets to a reprimand.

Otherwise, the same reprisal that was visited upon the Tuskegee doctors will also befall the Ball doctors.

That is, nothing. Nothing at all.

What To Do When The Drugs Don't Work

I'm kicking off this year's fall/winter lecture series with what I think may be one of my best -- and most important -- lectures ever. It will be held at 7 p.m. at the Litchfield Community Center, on September 22. The title of the lecture is What To Do When The Drugs Don't Work, and will discuss the ways that alternative medicine can assist people suffering from chronic illness.

From diabetes to heart disease to osteoporosis, 45% of Americans suffer from one or more chronic diseases. Chronic diseases cause 7 out of every 10 deaths; they significantly impair your quality of life; and they account for 81% of all hospital admissions.

The bad news is that these diseases are poorly managed with drugs, and even when they are, the side effects can make the 'cure' almost as bad as the disease.

But the good news is that many chronic diseases can be prevented or controlled without drugs.

It will be a 90-minute lecture, and at the end, you will learn how to take control of your health and prevent or manage your chronic illness without becoming dependent on medicines. Using research and science-based strategies, Dr. Jenkins will demonstrate why non-drug therapies are more effective, less expensive, and better for your health.

All seminar attendees will receive a workbook which will help them develop a custom health plan that matches their needs. Attendance is free of charge, but registration for the seminar is required. Call 860-567-5727 and ask Teresa to reserve your seat.

Good News For Chiropractic Patients!

For most of the past 100 years, chiropractic physicians and their patients were the only torch-bearers for safe, patient-centered alternative medicine. During the anti-alternative purge of the 20th century, homeopathy was all but wiped out in this country, surviving only on the fringes in Europe for 60 years. Osteopaths, once allied with chiropractors in their unique approach to health, threw in the towel and were co-opted by mainstream medicine; today, the difference between an osteopathic doctor and a medical doctor is indistinguishable except for the initials after the name. Providers of nutritional and herbal medicine such as the Thompsonians and Eclectics were all but exterminated, and by the 1950s, chiropractic was the only profession left that could provide patients with informed, educated, alternative medicine.

Even then, the level of harassment was formidable. The chiropractic doctor who treated me as a child was -- unbeknownst to me -- one of the leading forces in the fight for chiropractic equality. Dr. Reeve, of Dayton Ohio, was jailed no fewer than 6 times for "practicing medicine without a license," during his struggle to obtain licensure for chiropractic doctors.

Slowly, the tide has turned. Chiropractors are the first and only alternative medicine doctors to obtain licensing in all 50 states. And although few people know this, it was at a chiropractic college that acupuncture first found a home in this country, as New York Chiropractic College was the first college in the U.S. to offer training in acupuncture for doctors.

We are, in a way, accepted by medical insurers. But on a very limited basis and at rates that are prejudiced against chiropractic doctors and their patients. So much of what I could offer patients is denied because their insurance companies refuse to pay for procedures which are medically necessary and part of my scope of practice. And even if they were to pay, the reimbursement offered to a chiropractic doctor runs from 10% to 40% of what a medical doctor is paid for the same procedure -- despite our superior skills and training in many procedures.

But that's all about to change.

TheNational Association of Chiropractic Attorneys (NACA) has announced that it has issued a proclamation recognizing “the historic and profoundly positive legal ramifications for the chiropractic profession and the patient community it serves in Section 2706, ‘Non-Discrimination in Health Care,’ recently enacted as part of the federal ‘Patient Protection and Affordable Care Act.’”

The provider non-discrimination provision says that “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law.”

Once in full effect, health insurance companies will no longer be able to deny my patients their right to receive coverage for their acupuncture treatment, their nutritional therapies or the many other medically necessary services which I provide but which insurers routinely reject.

The provision has long been championed by the American Chiropractic Association (ACA) and members of the Chiropractic Summit. It was achieved primarily due to collaboration with Sen. Tom Harkin (D-Iowa) and help from other key players such as Sen. Chris Dodd (D-Conn.). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision. ACA will continue to fight for proper implementation during the regulatory process.

“It is important to recognize this provision as a 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,” said NACA Vice President Mike Schroeder. “While there is still much work to be done in the regulatory process, we are encouraged by the fact that Congress has finally acted to end provider discrimination based on one’s license.”

It is also important to note that Section 2706, and its assurance of non-discrimination in terms of participation and coverage, effectively requires that doctors of chiropractic be allowed to provide any“essential benefit” that is within their scope of practice. This will prove to be a particularly significant victory as the essential benefitspackage under the health care reform law is defined over the next couple of years.

“As significant as Section 2706 is to the chiropractic profession, it is possible to lose ground during the regulatory drafting process,” said NACA President Paul Lambert.

Believe me, the opponents of chiropractic care will work long and hard to keep chiropractic patients out in the cold. In fact, the American Medical Association has already begun attacking the provision, once again fearing the economic competition that chiropractic physicians represent.

To support the work being done to ensure the proper implementation of the provider non-discrimination provision, please add your voice to the thousands demanding full and fair insurance coverage at www.chirovoice.org.

Beyond Avandia: Diabetes Treatment Without Drugs

Even if you don't follow health news closely, it would have been hard to miss the recent headlines as the diabetes drug Avandia went "on trial" before the FDA.

The problem was simple: Avandia tends to kill the people who take it by giving them strokes and heart attacks. So some intelligent people thought it should be taken off the market.

Before all was said and done, it was revealed Avandia's maker GSK had manipulated  risk analysis data, one of the panel's scientists was on the payroll of a GSK competitor, and in the end the FDA figured that killing off some people with diabetes wasn't so bad after all and let Avandia stay on the market.

Missing from the whole discussion was the idea that you don't need Avandia or any other drug to treat type II diabetes!

Type II diabetes is a nutritional and lifestyle disease. The best way of combating any disease, whether it is cancer or the common cold is by addressing it at the source, not by tossing drugs at the symptoms. And the best way of addressing diabetes is by the selective use of foods that help your body naturally regulate your blood sugar, and through exercise routines specifically designed to keep blood sugar levels within a target zone.

Which is how my patients with diabetes improve their health. Of course, I can't say that anything but a drug can cure diabetes, even though the research clearly demonstrates effective diabetic management through exercise and nutrition. I'll leave the quack claims of "cure" to the makers of drugs like Avandia, who are quite willing to sacrifice your health for their profits.

But here's the key fact: It can be more effective, safer, and less expensive to use non-drug therapies to improve the health of people with type II diabetes. And even if you are already taking drugs for diabetes, alternative therapies can still assist your health.

Thus, if you are one of the many thousands of Americans with no health insurance, you have a choice: You can pay a considerable percent of your monthly income on Avandia and its brethren (a one-month supply of Avandia typically costs $170), or you can see me (New patient examination and in-house labs: $150) and I'll help you develop a plan that will allow you to manage your diabetes. You will be in control of the treatment and its costs.

Even if you have insurance that would cover the costs, would you prefer to run the substantially increased risk of death by treating the disorder with drugs? Or would you prefer to take a safer path to better health?

Everybody deserves a choice. The problem is, there aren't many doctors offering one.

I am offering you a choice. A safer, more cost-effective choice. If you want to talk to me about diabetes, click here.

The Power of Touch

While on vacation last week, I had the opportunity (and the need) to do something I rarely do at home: Get a chiropractic adjustment. The need was spurred by a headache subsequent to a 100-mile bike ride that saw me traverse Cape Cod from outermost Provincetown to downtown Hyannis, and back again. It was a pleasant trip, though exceedingly hot. And even though I ride a recumbent bicycle, which is far more comfortable for the neck over long distances than a standard upright, the recumbent in the extremely laid-back configuration can produce significant neck strain over time.

I was greeted on the morning following my ride, by a classic cervicogenic headache -- that is, a headache caused by the vertebrea in the neck becoming fixed in position. This is the cause of most headaches, which in the popular literature are often referred to as "tension headaches."

I had been needing an adjustment for some time, but like the average bad patient, I kept putting it off. In part, because most other chiropractic physicians work the same hours as myself, and in part because I've just been too busy. Sound familiar?

I was fortunate, however, to find that Dr. Donna Heitzman, in Provincetown, would have a few minutes to see me that afternoon. As Dr. Heitzman, a delightful woman with a puckish sense of humor, treated me, I was reminded of just how powerful the act of simply touching someone can be.

Arguments for the healing power of touch sends skeptics into paroxysms of denial, as healing touch is often so closely associated with fundamentalist religious practices, and the denial of the spiritual aspect of humanity is a fundamental tenet to the skeptic's belief system.

Nonetheless, there is a significant body of research which demonstrates the power of touch. Most recently, researchers found that the quality of objects that people were touching -- heavy vs. light, hard vs. soft, rough vs. smooth -- caused people to form unconscious associations between what they were touching and unrelated experiences. For example, rough objects made social interactions more difficult and hard objects made people more rigid in negotiations.

Massage has been shown to prime the brain for release of oxytocin, commonly known as the "empathy" hormone, making people more capable of bonding with and trusting others.

But touching is even more powerful than that. Touch has been shown to reduce cardiac arrythmias in ER patients, and even have beneficial effects on the red blood cells of comatose patients. Touch also increases one's overall sense of well-being and reduces blood pressure.

Of course, chiropractic adjustments are all about touch, and I am very conscious of the quality of my touch when I am treating patients. Not infrequently, patients will experience an overwhelming emotional response to a chiropractic adjustment. Crying, laughing and sudden relaxation are all common responses to a chiropractic adjustment. Part of it is due to the neurological and biochemical changes which adjustments create, and part of it is simply due to being touched.

Which brings us back to Dr. Heitzman's office. Immediately after being adjusted, my headache disappeared, which is a common response to chiropractic treatment of tension headaches. But more surprising to me was the overwhelming sense of relief I felt. In addition to the emotional relaxation, I felt the muscles of my upper back and shoulders let go of tension that I didn't know they held.

Dr. Heitzman and I spent a few more pleasant minutes talking shop, and then I proceeded to hop on my bike and ride an easy 7 miles back to the house where I was vacationing. A long nap that afternoon ensued, unusual for me.

It was good to be reminded in such a direct, clear way of the powerful treatment that I can offer to my patients. When the "Gee, thanks Doc, that feels a lot better" response becomes commonplace, it is all too easy to forget the powerful sensations lying behind those words, the power of a chiropractic adjustment and the power of a healing, caring touch.

The Business End of Being a Doctor: Telephone Technology

As I do periodically, I reviewed the costs of the practice this spring, and was, frankly, appalled at how much I was spending for a second phone line -- a line which was used primarily for faxes, incoming call rollover, and for me to return patient calls or to call the kids and remind them to clean their rooms. I felt there was probably a better way to spend this money, particularly as there are easier and cheaper ways to provide the same services.

So, step 1 was to move to an internet fax service. For pennies per month, this service provides a dedicated fax number. Incoming faxes such as lab reports are mailed to us as a PDF file, which we can then immediately transfer to the patient's electronic file. No paper, no printing, no muss, no fuss.

Outgoing faxes are simply PDF files emailed to the service which then sends them to the receiving party's fax machine. So, for example, when I make a referral to another physician or to the local lab, I no longer have to print it out and have Teresa schlep it through the fax. Instead, I make the referral through the electronic medical records system, save it as a PDF file, and email it to the service. Takes maybe 15 seconds.

With the need for a fax line obviated, we dumped it. But then another problem became apparent, because I ended up using the single line for making outgoing calls, such as returning calls from patients and the periodic calls to home that are routine in any working parent's day, to make sure the hermit crab got fed and that nobody was doing anything that would result in concussions or uncontrollable bleeding, and to say, yes, I will spend my lunchtime going to the school to drop off the homework you forgot.

Clearly I needed a second line, so I started using Skype for calls to landline and mobile phones. But I've never really been a big fan for several reasons, among them being that Skype uses proprietary protocols. Last year, I converted the entire office from Windows to the Ubuntu (Linux-based) operating system, which I found to be far more effective for our needs. With the most recent upgrade to the Ubuntu 10.04 operating system, my Skype broke completely, insofar as being able to call landlines and mobiles on it. I could  still make Skype-to-Skype calls with no problem, but forget calling the kids or returning patient calls. Skype's tech support was only mildly interested in the problem, and eventually told me to purge the software and reinstall it, and if that didn't work they were washing their hands of the problem.

Needless to say, it didn't work. So I went in search of an alternative, and found Nomado. For a paltry 5 euros per month, I got my own incoming phone number, 500 minutes/month of talk time to almost any phone in the civilized world, automatic call forwarding to my cellphone and voicemail that is emailed to me as .wav files. And all at a price that is almost 50% less than what I had to pay Skype for same.

The voice quality is perfect, better than Skype, and far better coverage for calling Europe, the UK and South American countries. Plus, it uses the SIP protocol -- an open source protocol -- which means I have my choice of PC-based softphones as well as hardware phones to pick from, and I wasn't stuck with the Skype non-functional software and hardware lineup.

I *highly* recommend this service over Skype. Better value, by far.

The Nomado website is a wee bit hinky, especially if you're using Firefox on Linux -- for the signup process, I had to boot up Chrome on a virtual XP machine to get the job done -- but they have online chat tech support that is superb.

So I now have a direct incoming line, with all of the bells and whistles, for about $6 per month.

With the grossly inappropriate reimbursements the insurance companies are dishing out these days, it pays a doctor to stay on top of the technology curve. That way you can reduce costs while maintaining high levels of service.

Published, in the Litchfield County Times

More bicycling than doctoring, but this op-ed piece was recently published by the local newspaper.

Chalk it up to my public health efforts.

How To Reduce Your Risk of Chronic Disease By 78%

What would you say if health scientists had discovered a way to reduce your risk of chronic disease by almost 80 percent? If it were a pill -- one with no side effects -- would you take it? How much would you pay for it? $50/month? $100/month?

In fact, health improvement of this magnitude was one of the goals of the billions of dollars spent on gene therapy research. Billions which were wasted, as I noted in a previous post. Even had genetic manipulation proved successful, you would still have paid through the nose to avail yourself of its solutions.

But because you are one of the five dedicated readers of this blog, I will tell you how to significantly reduce your risk of chronic disease for free.

A 2009 study involving over 23,000 Germans found that taking the following steps reduces your risk of diabetes by 93%, reduces your risk of heart attack by 81%, cuts stroke risk by 50%, and drops your chances of developing cancer by 36%.

Here's how you do it:

• Don't smoke.
• Keep your BMI under 30.
• Exercise 3.5 hours every week.
• Eat a diet rich in vegetables, fruit and grains, and low in meat.

That's it. No gene-manipulating drugs, no daily aspirin, no useless statins, no anti-osteoporosis drugs, none of the other unscientific nonsense daily fostered  on an unsuspecting public as "prevention."

Just "good, clean livin'," as my Ohio ancestors would have described it.

Now, that doesn't mean that even within those guidelines, additional nutritional or other resources might not be necessary, to combat the imbalances created by a frequently-toxic environment and food supply, or the vagaries of communicable diseases. Nor does it mean that you won't need some assistance to put your lifestyle on that healthy path. But once you are there, and the longer you are there, it will get increasingly difficult to knock your health off balance or to knock your lifestyle out of whack. But adhering to those four principles is the foundation for all of the rest.

That, of course is where my profession comes in. If you can't say yes to each of those four guidelines, I or one of my colleagues is likely to have the tools to help you get there. In fact, I can rather comfortably say that chiropractic physicians are the health care professionals best equipped for the prevention of chronic disease.

It was the great American inventor, Thomas Edison, who once said:

"The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease."

I think I know which profession represents Edison's ideal doctor. And we're here right now.

Board Decision: Chiropractic Does Not Cause Stroke

From the American Chiropractic Association: In a comprehensive and detailed ruling published on June 11, the Connecticut State Board of Chiropractic Examiners confirmed that Connecticut’s chiropractic physicians are taking the proper steps to inform and protect their patients. Through its ruling, the Board reaffirmed that the informed consent process practiced by the state’s doctors of chiropractic is the standard of care for the profession.

The announcement caps a process that began more than a year ago when the Connecticut Chiropractic Association asked the Board to issue a declaratory ruling on whether the current standard of informed consent is sufficient or whether, as opponents demanded, it should specifically include the possibility of a stroke or cervical artery dissection as a possible side effect of cervical manipulation/adjustment.

The Board’s decision follows four days of testimony in January in which an extensive range of evidence was presented. In making its determination and declaratory ruling, the Board cited the most comprehensive scientific study to date on the subject, by J. David Cassidy, DC, PhD, DrMedSc, et al. The Cassidy study is considered the definitive research on the subject. The abstract and complete paper can be found at PubMed Central.

In issuing its final judgment on the matter, the Board wrote: “After a careful and thorough review of all the testimony and documentary evidence admitted at the hearing, the Board concludes that there is sufficient evidence to establish that a stroke or a cervical arterial dissection is NOT a risk or side effect of a joint mobilization, manipulation or adjustment of the cervical spine.”

Look Mikey, We Found A Gene!

The New York Times today reported on the utter failure for medical research to find anything useful to do with the human genome. A full 10 years after the human genome map was completed (and the rush to patent your body parts began), the promised treatments for cancer, Alzheimers and other diseases have yet to materialize. Companies purporting to develop cures based on genetic manipulation have become little more than serial failures. That wasn't what everyone was sold 10 years ago when, as the Times reports, "Francis Collins, then the director of the genome agency at the National Institutes of Health, said that genetic diagnosis of diseases would be accomplished in 10 years and that treatments would start to roll out perhaps five years after that."

"Over the longer term, perhaps in another 15 or 20 years, you will see a complete transformation in therapeutic medicine," Collins said, according to the Times.

Uh-huh. This is exactly the type of bloviation from which the medical community suffers which I noted in my last post.

The problem here is not so much a lack of effort or funding -- billions of dollars have been poured into this research -- but a basic lack of understanding of the role of genes in human health. Which shouldn't be surprising, given that mainstream medicine has not yet even figured out the real cause of something as simple as heartburn, despite the evidence in front of it. (If you want to find out the causes -- and a simple treatment -- for heartburn, you'll have to click here and subscribe to my newsletter.)

Several years ago, I took some interest in the low-cost DNA tests that were just beginning to be offered. Always one to look for a better way to gather the data I need to treat patients, DNA testing seemed to be just the thing. It would -- I thought -- help me to tailor my nutritional therapies for patients.

It wasn't long until I realized that the tests were virtually useless. The tests told me nothing about a patient that I couldn't surmise -- more accurately and at less cost -- by conducting a thorough history and doing a proper examination. Interestingly, a research study looking at risk factors for heart disease came to the same conclusion.

The trouble is that the mere existence of a gene does not mean that the gene is active. Genes get turned on and off all of the time -- in fact, that's what most cells do for a living, turn a gene on, produce a couple of proteins or other necessary items, and turn it back off.

Genes can be turned on by a variety of things -- environment, drugs, and even -- hold onto your hat, Annie -- food! Yup, nutrients cause genes to do all kinds of things. In fact, you could quite safely argue that when I recommend supplements to patients, I am conducting a form of gene therapy. (And you thought chiropractic wasn't cutting edge!)

Add this genetic plasticity to the fact that (except in rare conditions that we've been aware of for half a century), there exists no one-to-one correlation between a gene and a disease (as well as the fact that genes can play multiple roles in different processes), and you arrive at the rather obvious conclusion that this approach doesn't really seem like a good idea.

Even if you were able to develop a drug that could manipulate genes on such a massive scale, the odds are that it would have enough side effects to kill a horse, limiting its utility.

So 10 years after the gun went off, all of the horses are returning to the gate, sweaty, tired and without their riders. The promise of gene therapy has turned out like all days at the track -- noisy, hot, and after watching everybody run  around in circles for a long time, you go home poorer than you left.

Do Chiropractors...?

Here's a fun little exercise for rainy days. Go to Google, type in the beginning of a search, and see what Google's autocomplete feature suggests. It gives you a sense of what people are asking about, in a more granular way than looking at Google's overall search trends. And as any good quantum scientist can tell you, the question you ask gives as much information as the answer does. Thus, it was with some concern that I looked at the autocomplete results when I typed in a search phrase starting "Do chiropractors...." Here's what came up:

This screenshot, more than anything, is a testament to the success of the smear campaign conducted for nearly 100 years by the AMA and its cohorts. And even after the Federal Court ordered the AMA to stop defaming chiropractic physicians, the smear campaign continued in the form of fringe groups with funding of uncertain provenance.

So even now, after millions of clinical successes and thousands of studies demonstrating the value of chiropractic services for the treatment of myriad disorders, we are faced with these questions, which I will address one by one. First, to the perennial, AMA-disinformation induced question: Do chiropractors work?

The efficacy of spinal manipulation has been demonstrated for a variety of musculoskeletal and non-musculoskeletal disorders. The efficacy of nutritional treatments and herbs for another gazillion disorders is also well-established, and it should go without saying that a chiropractic physician is far more equipped to deliver science-based nutrition than any other type of physician. Finally, when you couple that training with the increasing number of chiropractic physicians with advanced training in acupuncture, it is clear that chiropractic physicians are health care's most powerful triple threat against illness.

In short: Yes, chiropractors work. And quite effectively, I might add. Do chiropractors really help?

See the preceeding question. I'm just dumbfounded that this question continues to be asked.

Do chiropractors go to medical school?

Nope. But don't let that confuse you. Chiropractic school requires the same number of hours as medical school, and we study many of the same subjects during the first two years: Anatomy, physiology, pathology, endocrinology, etc. It is during the latter two years where the differences come more into play, as the students of each discipline begin to focus on the practical aspects of their professional tasks: Medical students to drugs and surgery, and chiropractic students to adjusting and nutrition. Do chiropractors prescribe medication?

Not currently, although the chiropractic physicians in one state are currently changing their scope of practice to incorporate prescriptions.

For the most part, however, chiropractic doctors really don't see the need for drugs, or have the interest in using them. My single biggest advantage over an MD is that I don't use drugs, a fact which brings more patients to my door than anything else.

Do chiropractors help?

Yes, we do. But whether a chiropractic physician can help you is something only you can decide in consultation with the chiropractic physician him- or herself.

But during my 15 years of practice, I have had many patients come to me and with hugs or tears in their eyes, thank me for changing their lives.

In all honesty, it wasn't me. It was the patients themselves that changed their lives. I just helped them along the path, that's all.

And, I suppose if you are looking for the clearest difference between medical doctors and chiropractic doctors, it is that one simple thing. While medicine and big pharma bluster and brag about their "new miracle cures" and "medical advances," and put themselves on the pedestal rightly belonging to the patient, chiropractic doctors recognize where cures really come from -- and are much humbler of our role in the process.