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.

25 Things You Didn't Know A Chiropractor Could Do #4: Osteoporosis

It appears that the medical community is about to foist yet another quack "cure" for osteoporosis on the women of this country. Prolia, the latest alleged treatment for osteoporosis, is an injectible that was approved by the FDA primarily on the basis of a single study paid for and conducted by the company that developed the drug. Ok, let me repeat that one more time. The FDA has approved a dangerous (we'll get to that in a minute) drug on the basis of research that the developer bought. Not to put too fine a point on it, but government oversight of BP's woebegotten Deepsea Horizon was more stringent than this.

And I haven't even gotten to the good parts yet. Prolia, it turns out, suffers from the same problem as all of the other osteoporosis drugs -- it actually kills bone, rather than create healthy bone. This rather unfortunate tendency is already the subject of multiple lawsuits from women who have been permanently disfigured and disabled by the drugs that were supposed to cure them. Despite the fact that Prolia destroys bone, the FDA has allowed it's release as a treatment for osteoporosis.

Lest I forget, some of the other effects of Prolia include back pain (!), severe calcium deficiency, increased urinary tract infections, increased respiratory infections, increased risk of cancer, eczema, cataracts and joint pain.

I respectfully suggest that if your medical doctor recommends that you receive Prolia injections for your osteoporosis, you should run, not walk, to your nearest chiropractic doctor for osteoporosis treatment that is safe, effective, and inexpensive.

Which brings me to the point of this column. Yes, Virginia, chiropractic doctors do treat osteoporosis, and quite successfully.

Osteoporosis is yet another one of those lifestyle diseases that is most appropriately treated at the source, with changes to habits and diet, using both supplementation and in some cases acupuncture to correct the initial imbalance.

Using these tools, I have been able to reverse bone loss, a reversal which was significant and measurable by laboratory testing.

And it's with the laboratory tests that I begin. Because the cancer-causing radiation tests that medical doctors like to use (they *did* tell you that the bone scan increased your risk of cancer, didn't they?) provide only a snapshot of limited value. They tell you nothing about the health of the bone nor of the rate of calcium loss from the bone, both of which I would consider absolutely fundamental data to have before beginning any treatment.

With labs and physical examination results in hand, I can then put together a treatment plan goes a bit further than "take 1,500 mg of calcium daily" that the medical community substitutes for informed nutritional advice.

With my patient we work on diet, we work on exercise, we work on all of the factors that have led to the bone loss from which they suffer -- and which can lead them out of it.

Drugs? -- Who needs 'em? When it comes to osteoporosis, chiropractic physicians have a far better answer than any other health care provider.

Bicycle Hater: CT license plate 730KMT

I was in a parking lot in Torrington 1-2 weeks ago, and spotted this car. As someone who uses a bicycle for transportation more often than a car, and as someone who teaches others cycling techniques and the value of bicycle use, I am utterly offended. Thus, I am offering a reward to anyone who helps me to identify the owner of this automobile. Espousing violence against others because of their mode of transportation is reprehensible.

If you have information that will identify the owner of this car, email me. I will give $75 to the cycling charity of your choice.

Our Servicemen and Women Deserve Chiropractic Care!

That's the conclusion of Brigadier General Becky Halstead, who herself found relief from fibromyalgia through chiropractic care. The men and women of the military have given us the best of themselves...why should they be denied the best care for many of the illnesses that beset them?

New Edition of DocAltMed Newsletter

I just sent out the latest edition of the DocAltMed newsletter. If you read this blog and you don't get the newsletter, you're missing out. Everybody knows I keep the good stuff for the newsletter.

If you haven't seen it, click here to take a look. Then click here to subscribe.

Are You Integrated?

Those of you who have followed this blog for some time, or who receive my DocAltMed Newsletter, know that I frequently point out the failings, follies, and dangers of mainstream medicine. I don't do it out of vindictiveness or spite, or because mainstream medicine is competition for the traditional medicine that I practice. However, I do feel that there is the need for a voice -- even a small one such as my own -- to counterbalance all of the advertising, marketing, and whitewashing that passes for medical "research" and news coverage. That said, I need to periodically point out that I am not fundamentally anti-medicine (though I am fundamentally anti-stupid and anti-greed). There are medicines that work, and there are times that they are appropriately used. That they are used too often, for the wrong reasons, and with little regard for patient safety is my main beef.

This is an issue which came to the fore just the other night, as I was addressing a local MS support group.

Multiple sclerosis (MS), is a chronic, disabling disease which often proceeds in a perplexing course of exacerbation and remission. This characteristic makes it exceedingly difficult for a single doctor, or his patient, to adequately assess whether or not their chosen therapy is working.

As is the case for many chronic, degenerative diseases, mainstream medicine doesn't have very good answers for people with MS. One of the points of my lecture was that alternative medicine offers equally good efficacy, typically at a significantly lower cost and with a greatly reduced risk of painful and dangerous side effects.

At the end of the lecture, one of the attendees asked me if I would be willing to treat someone even if they were taking medications.

My instant response was, "Of course I would!" It wasn't something I have to think twice about.

I frequently manage patients who are taking drugs prescribed by other physicians. They can cause collateral damage in the form of nutritional deficiencies, gastrointestinal dysfunction or organ damage, and I consider it part of my job to respond to those issues, but never would I presume to tell a patient that I could not treat them so long as they were taking a prescription drug.

As good as I am, I don't have all the answers. I never will. The other guys have some pretty good tools, too. But on both sides of the Great Medical Divide, there are doctors who put ideology above practicality, and it is exactly that type of either/or arrogance that has put our health care system in its current sorry state, with the patient often getting the short end of the stick.

Interestingly, after the lecture and the Q&A session, as I was wandering around talking to people, someone else came up to me to tell me that on at least one occasion, she had been told by an acupuncturist that she would have to give up her medications in order to begin acupuncture.

Now that's just wrong. There is no injunction against concurrent forms of treatment with traditional Chinese medicine, and in fact, that's how it is most often practiced these days in Asia, let alone the West.

It's not good science and it's not good protocol. It is just ego. And when ego gets in the way, it is the patient that suffers.

The fact of the matter is that MS is another one of those disorders, like asthma, which is likely best co-treated by both a mainstream physician and an alternative medicine physician such as myself. In this "balance of powers" best-case scenario  -- known as "integrative medicine" -- the patient's more frequent contact would be with myself, with the neurologist called in for periodic review or to help manage severe exacerbations. There is no reason for the exclusion of either discipline, and the patient would benefit greatly.

25 Things You Didn't Know A Chiropractor Could Do, #3: Mental Health

Believe it or not, the treatment of mental health problems constitutes a fair amount of my practice. People who are stuck in the chiropractor = back pain paradigm get all squinty-eyed when you bring this topic up. But the fact of the matter is that every chiropractic physician has had training in the evaluation and treatment of depression, anxiety, and other behavioral issues. It is part of our standard education. It has also been a substantive part of my postgraduate education as well. While the squinty-eyed among us may find this hard to accept, the use of drugs to manage moderate mental health issues is (thankfully) on its way out.

The first death knell in the pharmaceutical paradigm was sounded several years ago, when the American Psychological Association published a groundbreaking article, Listening to Prozac, which found that the effect of the most common type of antidepressant medications such as Prozac were largely due to the placebo effect -- that is, Prozac works only because people believed that the pills would work, because their medical doctor told them so. According to this and subsequent studies, SSRIs -- the class of drug to which Prozac belongs -- are almost next to useless.

With the pharmaceutical option on the ropes, people suffering from anxiety and depression are increasingly looking to their chiropractic physicians for relief.

And, fortunately, we have some answers.

First of all, since chiropractic doctors don't live in the pill-for-every-ill world, we're more comfortable with approaches like talk therapy. I, for one, have a ready list of therapists with a variety of skills and specialties whom I frequently turn to for co-management of these disorders.

And as you might imagine, mental health problems are no mystery to Traditional Chinese Medicine. Interestingly, TCM diagnosis and analysis of these problems is very sophisticated. Though, in the peculiar idiom and allegory of TCM, the diagnoses have some inadvertantly humorous names, such as Plum Pit Qi, Oppressive Ghost Dreams, and my all-time favorite, Running Piglets:

I'm very sorry Mrs. Jones, but you've got a bad case of running piglets!

Humor aside, through the intelligent use of acupuncture and herbs, I have been able to help many people with depression and anxiety disorders.

Another drug-free approach to mental disorders is through nutrition. Nutritional treatment for depression has made great strides since the mid-nineties, when the approach was generally to just throw St. John's Wort at the patient and call it a day.

Today, I am most likely to order a couple of laboratory tests which can tell me a great deal about the physiological origins of the patient's mental complaints. Much can be understood about the neurotransmitters and hormones that affect mood with relatively inexpensive urine and blood tests.

That information takes much of the guesswork out of treatment, and allows me to objectively measure the patient's progress.

Finally, there is the lifestyle counseling that chiropractic physicians revel in. Changing diets, changing exercise, changing habits -- all of these can greatly contribute to mental health.

So, can chiropractors help people with anxiety or depression? Indeed we can, and in this office we do so nearly every day. It is not quackery; it is solid science and clinical decision-making. And, unlike the alternative drugs, the research shows that chiropractic care for mental disorders works.

25 Things You Didn't Know A Chiropractor Could Do, #2: High Blood Pressure

More than a few patients have come to me for assistance in management of their high blood pressure, but these patients are easily outweighed by the patients I have who are already on anti-hypertensive medication -- and are now seeing me because of the side effects. I'm not surprised that few people know that high blood pressure can be managed by alternative means. It's an easy diagnosis to make for the MD, and a given money-maker for pharmaceutical companies. Because, once you get a patient on blood pressure medication, you've got a captive customer for the rest of their life. That's a pretty sweet deal if you're a drug company, but maybe not so hot if you're the guy taking the pill and stuck with the bill. Let's take a look at the common side effects of blood pressure meds:

Electrolyte imbalance, potassium depletion, elevated blood sugar, impotence, insomnia, depression,asthma, bradycardia, cold hands and feet, heart palpitations, swollen ankles, constipation, headaches, dizziness, skin rashes, loss of taste, chronic hacking cough, kidney damage.

And those are just the common side effects. Fully 20% of those taking blood pressure meds report 1 or more of these adverse reactions. The full list of side effects is just too long to get into here.

The problem is that patients are not given the information needed for full informed consent before being given their pills. If diet or lifestyle is mentioned by the diagnosing provider, it is at best a drive-by recommendation, perhaps accompanied by a third-generation copy of the egregiously erroneous Food Pyramid or a recommendation to see a "nutritionist," who will -- guess what -- recommend a diet low in fat and sodium and suggest lots of fruits and vegetables.

There's a whole lot more to controlling blood pressure than that. Most importantly, the side effects of managing blood pressure naturally are all beneficial to the patient, in comparison to drug-based management which creates a whole new set of diseases, which require additional medications to control them. Is anyone surprised?

The Drug Free Alternative

How can a chiropractor help manage blood pressure?

The first step is through spinal manipulation, of course. A study published in the Journal of Human Hypertension in 2007 found that chiropractic manipulation of certain joints in the neck was as effective as two-drug combination therapies in reducing blood pressure. Prior studies in 1991 and 1993, and published in peer-reviewed journals have shown similar effects with chiropractic cervical adjusting.

Lifestyle alteration is step number two. Chiropractors excel at helping patients make healthy lifestyle changes. It is labor intensive, but highly effective. And it involves far more than cutting out the cookies and eating your fruits and veggies. Hard work, but worth it in the end. Side effects of this therapy may include increased energy, improved infectious disease resistance, lower cancer risk and improved looks.

Honestly, would you rather have those side effects, or swollen ankles and impotence? Yeah, that's what I thought.

Herbs and nutritional supplementation can play their role as well. Of course, I have to be careful about statements like this because, while it's ok for Cheerios to claim that a daily bowl will stop you from having heart disease, God forbid that a chiropractic physician suggest that something like Hawthorn extract might reduce blood pressure. The FDA gets all bent out of shape when you start offering alternatives to their clients' cash cows.

So I won't make any claims about herbs or supplements reducing blood pressure. But if you want the research, just email me. I would suggest however, that you get together with your chiropractic physician and discuss these options, because clinical experience can reduce the amount of guesswork you would have to do otherwise.

Finally, a few needles can let some of the pressure out as well. Studies such as this one have shown that acupuncture can significantly reduce high blood pressure. Ongoing low-level  treatment may be necessary, but how is that any different from having to take a pill every morning?

Chiropractic physicians can offer their patients several safer, more cost effective alternatives to drugs for managing their blood pressure.

While drugs may in some cases be necessary, I argue that the non-drug alternatives be employed as the first line of defense against high blood pressure. But I'll wager it is rarely, if ever, done.

In fact, I'll put my money where my mouth is. If anyone can submit proof to me that any mainstream medical provider in Connecticut referred a patient to a chiropractic physician for treatment of high blood pressure -- despite the evidence that this should be the preferred approach -- I will give $100 to that person's charity of choice.

Email me, call me, or send the information by carrier pigeon. But I'm not holding my breath.

Beware the Surgeon Selling Spinal Fusion

Spinal fusion, a type of surgery in which the vertebra of the spine are locked together using rods and screws, is a popular surgery promoted by some orthopedists for everything from bulging disks to "weak or unstable" spines (whatever that really means). The trouble is, spinal fusion...umm...doesn't really work better than the alternatives (the safest of which is chiropractic care, by the way). Failure is common and risks are high. So why is it being performed?

Well, according to a study published this month in the Journal of the AMA, the answer is: It makes money. That's right, increasingly useless (and dangerous) surgeries are being performed purely for profit.

The writers at ChiroACCESS put it this way:

There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients.  There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions.  Spinal stenosis is the most frequent cause for spinal surgery in the elderly.  There has been a slight decrease in these surgeries between 2002 and 2007.  However, there has also been an overall 15 fold increase in the more complex spinal fusions (360 degree spine fusions).  Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that  “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years.  The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…”  There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion.  The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion.  Despite the much higher cost, there is no evidence of superior outcomes and there is greater morbidity associated with the complex fusion.  The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion.

So if anyone suggests to you that you need spinal fusion surgery, first get a proper assessment of your condition by a chiropractic physician.

In some cases, surgery may be required. But the research is clear: Rarely is spinal fusion an appropriate option.

My Core Principles

Every organization needs principles. Even the bad organizations, the ones that rob you blind, pick your pocket and leave you bleeding in the alley (think "insurance companies") have a set of guiding principles, however warped and twisted they may be. I've always liked to think of my practice, the Center for Alternative Medicine, as one of the good companies. And for most of its existence, it has only had one stated principle. In organizational management language, its mission statement would go something like this:

The mission of the Center for Alternative Medicine is to provide therapeutic interventions in a health-affirming environment to eliminate disease and dysfunction and enhance the well-being of the residents of Litchfield County and surrounding areas, without regard to race, age, sexual orientation, gender or financial status.

I've always preferred the short version: My job is to make people better using whatever means I have at hand. I'll take on all comers.

But the fact of the matter is, even the plain-language version embodies a number of underlying principles. And it wasn't until I was preparing a speech for the annual meeting of the Connecticut Society of Medical Assistants that, for the first time in 15 years, I sat down and actually elucidated them.

What came out of it was interesting. My 7 Core Principles, I've come to call them. And they truly are the principles that make this doctor, and his practice, tick.

• Primum non nocere.

This is latin, meaning "First, do no harm." It is my job as a doctor to, more than anything else, avoid injuring my patients. This principle is why I became the type of physician that I am. Although the mainstream medical community pays lip service to this principle, you could hardly call it a guiding element of medicine's philosophy. If it were, you would see a lot less blather about rising malpractice rates, and a lot more effort directed toward reducing malpractice. (Did you know that the number one cause of non-traumatic death in the U.S. is medicine? And that's according to published research.)

In contradistinction, my interventions for the same conditions are far safer and at least as effective, if not more so (fertility treatments, for example. Recent research has found a higher success rate for acupuncture than for the far more risky IVF.)

• Systems Integration

This simply means that I place my focus not on a single system, such as the cardiovascular system, or the pulmonary system, or the digestive system. Instead, I evaluate patients in terms of these systems' interdependence. Or, as the brilliant Buckminster Fuller in his dense eloquence has stated: "Synergy is the only word in our language that means behavior of whole systems unpredicted by the separately observed behaviors of any of the system's separate parts or any subassembly of the system's parts. There is nothing in the chemistry of a toenail that predicts the existence of a human being."

Understanding the whole by examining the interconnectivity of its parts -- the data network, if you will, that allows the brain, heart and stomach to coordinate their activities -- has led me to solutions for patients who have suffered for years and whose well-known specialists proved ineffective. In fact, it was precisely because they were specialists that they could not see the solution.

• Multi-disciplinary Therapeutics

Another way of saying this is that when the only tool you have is a hammer, everything looks like a nail. Any repairman worth his salt will equip himself with an array of tools, of the finest quality possible. A chiropractor who only adjusts has only a hammer; the medical doctor who only dispenses drugs posesses only a wrench.

I've got wrenches, hammers, pliers and a full set of torx drivers, by gum. And I'm not afraid to use 'em.

• Diagnostic Rigor

An accurate and finely-grained diagnosis is the key to success when you are doing alternative medicine. To properly treat my patients, I need to know more than that they simply have a case of sinusitis. I need to know why. I need to know what put that patient in a state that made them susceptible to this bug, and why they responded as they did. With that knowledge in hand, I can then go about fixing the underlying problem. To my mind, this is better than patching it over.

• Relational Equivalency

Ok, I did use some fancy words here, but I could find no others that could capsulate my intended meaning. I have found over the years that the greatest success comes when I work together with my patients to solve a problem. I work often as a mentor, a coach, a teacher. But I advise and recommmend -- never do I dictate. I work as a partner with my patient, and we each shoulder part of the burden.

This type of care cannot happen if a doctor is standing on a pedestal issuing commandments. The feedback and course modifications necessary to any successful outcome is missing in such a relationship.

• Long-term Focus

Many of my patients come to me with problems they have dealt with for two, three, or five years. Rarely am I going to get a resolution in a week or a couple of visits -- though sometimes I have seen it happen. And for all my patients, I am looking not only how their health is now, but how it will be 20 years down the road. Because right now is the time to create the environment for future health.

• Therapeutic Minimalism

Call me lazy if you want, but I prefer to figure out how I can provide the most benefit to my patients with the least intervention. This reduces the patient's costs, and it also refers directly back to principle #1. By minimizing my interventions, I also minimize any risk to the patient.

To me, therapeutic minimalism has a certain aesthetic appeal to it. Occam's Razor proclaims that the simplest answer in science is most often the correct one. And, the most minimal of equations, e=mc², explains nearly an entire universe in four simple symbols.

So that's it. My Core Principles, if you will, the entirety of my practice philosophy. I found that developing and elucidating these core principles to be a valuable process, one that has given me insight into my professional past and a glimpse into its future. I recommend this process for anyone, especially to examine your personal life. You might discover some things about yourself that you thought you didn't know.

Kids, Don't Try This At Home

As many of my readers and patients know, I am trying to qualify for Paris-Brest-Paris, a 1,200-kilometer endurance ride held every 4 years. Although not a race, it is a timed event, and you have to reach all of the checkpoints by a specified time to avoid being disqualified. Qualifications start this year, as I have to do a full series of endurance rides (called "brevets"): 200k, 300k, 400k and 600k. If I complete all of them successfully, I get to repeat the process next year; and if I complete all of those successfully, I will be able to ride in Paris-Brest-Paris.

So I'm thinking to myself that in a few weeks, I start the brevet series with a nice 200k, and maybe, just maybe, I ought to see if I can do a major chunk of that, like 100 miles. I have been training, though not as diligently as I should.

On Sunday, with no other obligations pending, I took off for a 101-mile loop leaving from Granby CT, going north to Northampton, then looping around through Amherst and Granby MA and eventually back to Granby, CT.

And a beautiful day it was. I passed more cows than you can count, went through beautiful, quaint, New Englandy towns, enjoyed the features of one of my all-time favorite college towns, Amherst, and in general just took pleasure in a fine ride on a beautiful day. The temperature was 72F by 11 a.m. and the few cirrus clouds called it quits by lunchtime.

One of the key tricks to any endurance exercise, whether it is a marathon, a triathlon, or brevet, is managing your fuel and water. You have to constantly plan ahead, because if you wait to drink until you are thirsty, or wait to eat until you are hungry, it is already too late. In addition, the gastrointestinal tract tends to shut down under the stress of endurance exercise, and you may never get hungry. The only way you'll know that you are out of fuel is when your legs turn to lead and your mood plummets.

There are a lot of complex rules governing your body's management of glucose, the basic energy molecule, and there are a lot of nuances to controlling blood sugar levels during exercise. But the general rule of thumb is to have some water every 15 minutes and something to eat every 45.

That's a rule that I generally follow. On Sunday's trip, I also took a longer stop at mile 63 where I had a "deli delight" lunch -- a submarine sandwich, a bag of chips, and some Oreo cookies.

After that, I hopped back on the bike for the final leg of the trip. This was a fun part, because I had finally hit a few hills -- more than rollers, but not what I call a hill around my house. I was gratified to see that, although the legs were paining me a bit, I still had the juice to attack the hills, albeit somewhat anemically.

I was taking the perimeter road around Bradley Airport when I realized, at mile 93, that I had the barest shot of breaking 7 hours for a century. For many cyclists, there's nothing special about a 7-hour century. It's a good pace, that's all. But I'm a slow guy, always have been a slow guy and always will be a slow guy. And among the Berkshires and their foothills, I've never come close to breaking 7 hours.

So...I take a deep breath and put the hammer down. For the next 7 miles, I sprint absolutely as fast as I can. At parts, I know I'm running at my maximum heart rate, because I was getting the tunnel vision and the eyes-rolling-to-the-back-of your head symptoms that have always happened when I'm doing a maximum heart rate measurement.

As I hit the last half mile, I come to a bend. And I look at the clock, and think to myself, "If this is downhill, I've got it made. Uphill, I'm toast."

I round the bend, and there it is: Uphill. So I let out a yell that would tell God Himself to get out of the way, and put absolutely everything I've ever owned into that last half mile. I mean, I ride like Cerebrus' meaner brother was chasing me.

And through my ever-narrowing vision and feeling like I'm about to pass out, I see the clock tick over to 7 hours at the exact same time the odometer clicks to 100.00

It's over. I didn't break 7 hours, but if I realized my opportunity only one hundredth of a mile beforehand, I would have. Still, hitting 7 on the nose is good enough for me. It's still a personal best, and I'm looking at setting a lot of records for myself this summer.

I slow from a gallop to a walk for the remaining 4 miles to the parking lot, and as I make the final turn the wrong way, I realize something might be wrong. I get back to the truck, park the bike, and take stock. My hands are shaking; I feel very dizzy; and I'm slurring my words like Sean O'Malley on St. Patrick's Day.

The problem? My blood sugar had plummeted. I react as fast as I am able, by downing a sugary soda and a concentrated sugar paste. It took a good 15 minutes before I was in control of my faculties again.

In any endurance sport, after the first 60-90 minutes, you have used up all of the energy reserves stored as glycogen in your body. From that point on, as I mentioned earlier, you must constantly add fuel, otherwise you will get into trouble -- as what nearly happened to me.

While I was balancing energy outflow with intake, my nutrition plan did not take into account that impromptu sprint for the last 7 miles. The massive increase in energy use forced my blood sugar levels to dangerously low levels. And, since the body's most energy-consumptive organ is the brain, the symptoms are often neurological -- thus the befuddled direction-finding, the shaking hands, the slurred speech, even while I was able to maintain muscle activity on the bike.

More and more, I am finding that I can help endurance athletes prepare their bodies for the onslaught of their competitive events by working with their diets beforehand so they can achieve their personal best. Just as any athlete needs a coach for their physical training, a nutrition coach is also a necessity.

25 Things You Didn't Know a Chiropractor Could Do: #1

In my 15 years of practice, there is a comment that I have heard all-to-frequently from my patients. It is not meant unkindly, nor as a slight, but evidences surprise at my hitherto unbeknownst powers, as if I had just unbuttoned my shirt and unveiled a Superman logo on my chest. This remark is often uttered as I say something that I think is relatively innocuous, like, "Yeah, we should probably do an EKG, just to be sure."

The patient will look at me, with eyebrows raised, and say, "I didn't know you could do that!"

The problem, it seems, is that the majority of the public have been trained to see chiropractors as one-trick ponies. Good for spinal adjustments, but little else.

This distorted image stems largely from the disinformation campaign mounted against the chiropractic profession by the AMA. 100 years of lies takes a while to untangle, especially when the bigotry is backed by a few billion pharmaceutical dollars.

And it is complicated somewhat by state laws, which vary widely. In some states, chiropractic physicians can inject substances and perform minor surgery. In others, they are not allowed to treat anything except the spine.

Throw into the mix the fact that most insurance companies will not reimburse a chiropractic physician for many of these procedures, and you get a large number of chiropractic doctors who will simply will not do them, simply to survive financially. It is difficult to justify spending several thousand dollars on an EKG machine if you'll never get reimbursed for its use.

But the fact of the matter is, chiropractors are trained in how to perform and read EKGs, as well as a number of other things which might surprise you as much as it has my patients.

Which is all a very long-winded way of introducing a new feature here at DocAltMed.

Every other Friday for the next year, I will post yet another example of the many ways your chiropractic doctor can serve you that you may not have heard of. And this week, we'll start with the basics, beginning with:

Your Annual Physical Exam

This, to me, is the real shocker. That people would not realize that they can use their chiropractic physician to do get their physical exam. My physical examination is every bit as complete as that you would receive in a medical doctor's office. Actually, I would argue that it is more complete, because my exams are not only looking for signs of pathology or disease; I am also illuminating areas of nutritional or physiological imbalance. It is those latter factors which are the true harbingers of health problems.

Yes, I listen to the heart and lungs, look into your eyes and ears, and peer intently at your mouth. As you might have guessed by now, we do an EKG, and I order the same blood tests that any other doctor would order.

But when I or another chiropractic physician performs your physical exam, you get two distinct advantages. The first I've already mentioned -- we are trained, as MDs are not, to spot dysfunctions before they become pathologies. The second is that when we do find a problem, you are far less likely to end up on a prescription drug.

In fact, studies have shown that patients who use their chiropractic doctor as their primary care physician end up in better health over the long term. They have fewer hospital days, they need fewer drugs to be healthy, and for older people they maintain physically active later in life.

So when it is time for your next annual physical, think hard about what you want -- better health, more active life -- and who is more likely to be able to give that to you.

The Spectrum of Being

It's very often the first thing we ask about someone. "A baby! How wonderful -- is it a boy or a girl?" Or when we meet someone: "She's a nice-looking girl," or "He's a handsome guy." Gender identification is a core classification that everyone makes, automatically, without consciously thinking about it. Until you are confronted with just how limited that way of thinking is. I have been  fortunate to attend the past few Transgender Lives: Intersection of Health and Law conferences in Farmington CT, and from those conferences, I brought home a single, yet far-reaching fact.

Although we think of the expression of gender as binary, either boy or girl, feminine or masculine, gender is actually a spectrum of human expression in which the elements of masculine and feminine mix and combine over the entire range.

None of us are fully masculine or fully feminine. We are all a combination of gender traits to varying degrees. This mixture of yin (feminine) and yang (masculine) are what the ancient chinese philosophers had in mind in the development of the taijitu:

That small dot of the opposite color within each side represents the simultaneous, mutual existence of opposites within each other. While the taijitu is the reflection of larger universal truths, the characterization of yin and yang as feminine and masculine principles makes the meaning unmistakeable with regard to gender.

The individual intermixture of gender is also embodied in the work of the psychologist Carl Jung, who developed the concept of anima and animus, representing the female aspect within the male psyche and the male aspect within the female.

The idea that we, psychologically, embody both genders has long been accepted. But that the blending of gender would be reflected physiologically and neurologically is a concept that has fought an uphill battle to, first of all, be recognized, and secondly, to be regarded not as a psychological or moral pathology but as a normal variant.

Transgenderism is the umbrella term for the expression of gender identity that differs from the strict male/female dichotomy recognized as normal by society. Transgender people range from those who enjoy dressing as, and behaving as, a person of different gender than their birth gender; to transsexual people who, with the assistance of hormones and surgery, change their entire appearance to live their lives as a different gender; to people who are born with the physiology of both genders and choose not to identify as strictly male or female.

Because it is so basic to our patterns of classification, gender expression outside of the norm can be quite disturbing to many people. Transgender characteristics are usually lumped together with sexuality, although sexual orientation is entirely different and unrelated to gender expression.  Transgender people, like everyone else, may be straight, gay, both, or uninterested. Unfortunately, transgender people are considered by some to be morally corrupt, or predators disguising themselves to gain intimate access to the opposite gender (this is the laughable -- and indefensible -- argument used by some in Connecticut to restrict restroom access by transsexual people).

And, though once thought of as a psychological disorder, research is making it evident that transsexual people do not suffer from some sort of behavioral aberration. More and more it becomes obvious that transsexualism is the result of neurological and hormonal activity and development in the womb. Studies of the brains of male-to-female transsexuals show that their brains are much more similar to the gender they identify with (female) than the gender they were born as (male).

Unfortunately, that research goes unrecognized at many doctors' offices, where both doctor and staff have little understanding of this segment of their patient population, and transgender people may be subjected to anything from embarassment at the hands of thoughtless and poorly-trained staff to outright discrimination because of their gender preferences.

Like most doctors, I received absolutely no education on the requirements of treating transgender people, either from a clinical standpoint or from a practical standpoint. But once I became aware of my ignorance, I undertook to rectify it. From talking to people, to reading, to attending the Transgender Lives conferences, I learned.

Much of it boils down to simple things that I already know and try to practice. Things like respecting my patients. Accepting what they bring to me as people and understanding their needs and goals for their care. Recognizing people's boundaries, and not transgressing them without permission and without good reason.

That last sentence bears a little more explanation. For obvious reasons, both personal and social, a patient may not be comfortable revealing to me their gender history, though clues may be evident in the general health history with which they provide me. But the more important question is whether gender is pertinent to the problem at hand.

And, frequently, it is not. For example, most musculoskeletal issues are gender-neutral, and whether or not my  patient is a transgender person is simply not important. Why make someone uncomfortable by delving into aspects of their life that they would rather not reveal? Being a doctor gives me great latitude to explore another person's privacy in the search for clues to the nature of their problem, but that license must be used with discretion.

Much of being a transgender-friendly practice also boils down to attending to simple things that are easily overlooked. For example, the patient whose legal name on their insurance card is Jennifer Smith would rather be addressed as David. Or that gender isn't as simple as circling the M or the F on the intake form.

So I don't use M or F on the form anymore. Instead there is a blank line for the patient to provide the gender information which most suits them.  And in addition to the Last Name and First Name entries, I have a Preferred Name entry, so that we know that Jennifer should be addressed as David, the name he prefers.

These and other alterations are subtle changes, unlikely to even be noticed except by those to whom they are directed. But for that very reason they are important.

I hope that other doctors, particularly those who provide alternative medicine services, take it upon themselves to enhance their practices in this manner. It is not difficult and the rewards can be significant.

I will unfortunately not be able to attend the Transgender Lives conference this year. It will be the first time in several years that I will miss it. But I am grateful for what the conference, and my patients, have taught me.

The Economics of Pharmaceutical Research

I'm starting to get a little worried that, with this post, two out of the last three posts involve comics. I really do read other things than the comics section of the local newspaper. Honest.