August 2008

What you don't know…

by DeDe Van Riper

All too often our society subscribes to the notion that "it'll never happen to me" or "what I don't know can't hurt me." After years of influence from the medical model and concepts such as "medical necessity," more and more chiropractors subscribe to the notion of only adjusting those in pain. Feel pain? Adjustment. Feel fine? No adjustment.

Three years ago my husband David's best friend was diagnosed with stage-four colon cancer -- at the age of 38. For what must have been years, Matt had the same symptoms that most colon cancer patients have: none. He "felt" fine. He "felt" healthy. On Matt's behalf, David and a chiropractor named Brian Lieberman ran the Chicago Marathon to raise money for the Colon Club, a group dedicated to awareness and early detection of colon cancer.

At the beginning of the marathon, David -- who runs with a heart monitor -- noticed that his heart rate was extremely high. But he felt fine. A mile or two into the run, his heart rate had still not settled down. Yet, he felt fine. Finally he decided to slow down enough to allow his heart to recover to a more reasonable level: a pace that was ultimately not much faster than a walk.

Not far into the race, he began to see people dropping out. The first aid tents were overflowing with runners lying on cots and out on the grass. It soon became apparent that what was affecting David was affecting everyone. Finally, when he was about 17 miles into the race, policemen and race officials starting telling everyone to walk… that there was a "medical emergency"… that the race was being cancelled. As it turned out, abnormally high temperatures and humidity combined to wreak havoc on the runners -- and ultimately on the emergency medical resources.

There is a common theme to these situations, Matt and David's. They each were in a situation where they felt fine, yet neither of them was. In David' case, however, he was receiving feedback on his condition. Had he not had the heart rate monitor -- or had he ignored what it was telling him -- there is a good chance that he could have hurt himself. There is tendency to approach things with a business-as-usual mentality. In David's case that might have meant trying to maintain a pace similar to previous marathons. Yet under the new conditions, with the additional stress, that approach might have been disastrous.

What do these situations have to do with chiropractic? The importance of awareness. More specifically, being aware of a problem before it progresses to the point of pain. In each case described here, be it Matt's, David's, or the pain-free chiropractic patient, the technology exists to find problems where a lack of symptoms might indicate otherwise. And awareness is often half the battle.

People are a fairly poor judge of how much stress they are really under.

A study lead by Diane Becker of Johns Hopkins University in Baltimore monitored peoples' response to "mental stress." They found that those people who responded poorly to a controlled mental challenge were six times more likely to have a heart attack or other severe heart event within six years than people who handled the stress more calmly. The interesting -- and frightening -- element to this is that the volunteers for the study usually had no idea if they responded well or poorly to the stress.

In Diane Becker's words, "People's capacity to tell you that they are stressed is worth about nothing. We would see people with hideous responses who say they are fine." In this study, the mental stress reaction was a better indicator of heart risk than factors such as smoking, having high cholesterol or diabetes. Summing up the challenges, she said, "How do you learn to manage something when you don't know you have it?"

Chiropractic is far more than a profession to treat back pain or neck pain. But, without the tools capable of showing the state of a patient's nervous system and how it responds to stress -- and how it responds to chiropractic -- doctors are left to use the absence or presence of pain as the great determiner of care. Today, however, the tools are available to monitor the nervous system providing insights and creating opportunities like never before.

The bottom line is that what you don't know can hurt you. And your patients. There are many problems lurking below the pain threshold. And lack of awareness can have tragic consequences. David's best friend of 38 years passed away in January. One of the runner's in the Chicago Marathon passed away in the middle of the race. And millions of chiropractic patients are treated based on pain without regard to the problems that are caused by stress, even though the technology exists to see them.

The good news for today's chiropractor -- and today's chiropractic patient -- is this: what you do know can help them.

Maybe awareness is more than half the battle.

(DeDe Van Riper has extensive knowledge and experience in the chiropractic field, having worked with Insight Technology, CLA [Chiropractic Leadership Alliance], Now You Know, and other major chiropractic companies. For questions about chiropractic instrumentation, call her at 877-233-0022.)