December 2003

Appointment with a bonehead

by Dr. Will Tickel

"So, tell me about your past experiences with chiropractic?" I asked the 36‑year old, well‑proportioned schoolteacher suffering from chronic sciatica down his right leg.

Sensing that he was unsure as to where to begin and just how pointed to be in his remarks, I quickly asked, "How many times or how frequently did you seek help from the chiropractor?"

"Every six months or so...," he started to reply."

"For starters," I interrupted, "that's most likely not nearly often enough. I've often seen patients as frequently as every day for two to three weeks and up to a year and a half or more at multiple times per week for conditions that sound like yours."

The patient nodded in agreement.

"What sort of care were you given?," I continued.

He began to answer, "Oh, just your regular chiropractic treatment...," when I interrupted, "Stop there for a moment. We've already established that you were not receiving 'my' regular chiropractic care. So don't say 'your' when describing the care you received elsewhere."

"Okay," said the prospective new patient, in a tone respectfully acknowledging correction. "What he (the chiropractor) did was put me face down on this table, run his hands down my back and press on certain places. Then he'd have me stand up and he'd say, 'Give it some time. If it's not any better come back and see me. Or, if it goes away and then comes back, come see me.'"

It was here that I interjected my own personal testimony about my back problem as a young 27‑year old advertising copywriter.

"You know," I said, placing one hand behind my back and moving it up and down ever so slightly, "I have a scar back here about one and a half inches long, the result of back surgery I had as a younger man. No fusions, mind you, it was done by a neurosurgeon who was more interested in the nerves and spinal cord than the bones and joints," I said, pausing to see if the schoolteacher was remembering what I had taught him earlier about the orthopedist.

He did.

"Anyway, I continued, "I had gone to a chiropractor similar to the one you just described. In fact, some 30 years later I still remember the gesture the chiropractor would use as he saw me out the door with the same instructions as you were given. He'd hold up his two hands before me and spread the fingers as he said, 'Just come back when the need arises.' "

I let that soak in a bit and then went on.

"That's not how we manage patients in our office, strictly based on symptoms. Beyond that, you'll need information as to exercise, do's and don'ts, and input about rehabilitation, most likely."

The schoolteacher was absorbing it all.

"What about x‑rays and examination?" I asked. "Do you recall anything specific that was said about the results of those procedures?"

The teacher replied, "That's an interesting point. He never took any x‑rays or performed an examination that I know of. I always wondered, for this reason, just what he was doing back there when I was face down."

Indeed, I thought to myself.

"That's one thing I was thankful for with the orthopedist," the teacher continued. He had MRIs done so I knew he was coming from an informational standpoint."

TMI? not hardly.

"Too much information," my kids often tell me when the preaching's gotten too long, too involved or too close. "TMI, Dad, " they say.

As is always the case, I was now asking myself where I should start with this guy. how much I could assume, what I could expect him to swallow or listen to.

I took it from the top. "Well, sir," I said, "this coming from a chiropractor may come as a surprise to you, but we're going to need more information. We'll start with the MRI the orthopedist did. We'll request those records. Then, most likely, we'll be doing some conventional x‑rays ourselves. Quite likely, we'll take some views of your neck as well as your low back."

The man was with me, as he nodded his agreement. It was then that I began my basic introduction of spinal anatomy, starting with the origin of the thought of life in the brainstem and progressing down to his leg. "Those x‑rays along with examination findings and your history," I explained, "will enable us to draw some conclusions about what's going on with your nerve system. Because our interest is in the nerve not the bone."

(Will Tickel, D.C. has been in active practice for 24 years. He's a past "Chiropractor of the Year" at Parker and the author of two health‑related books. He can be reached at will tickel@aol.com)