October 2008

The frustration of outcome dichotomy

by DeDe Van Riper

I recently read an article about stress and its affect on the immune system. Even though it wasn't chiropractic research -- nor was it in a chiropractic publication -- many of the concepts were familiar.

The research done by Gregory Miller, PhD and colleagues found that stress effectively created interference in the body's ability to communicate with other areas of the body. They discovered a diminished capacity to "receive" signals. Dr. John H. Krystal, editor of the magazine in question, even commented that in addition to not knowing how stress produces these altered patterns, they don't "know how to account for the resilience of some stressed people exposed to severe sustained stress or the vulnerability of some people to relatively mild stress."

While you might read such ideas in almost any chiropractic publication, this article was published in the August issue of Biological Psychiatry regarding a study of a mechanism through which stress alters immune function. The problems in communication were between cortisol levels and white blood cells, but you'll find something of great interest if you can wade through the discussion of cortisol levels, gene expression, and transcription factors called nuclear factor-kappa B -- they have no idea why people respond so differently to stress.

There are few things more frustrating to a chiropractor than the patient outcome dichotomy: two patients, same analysis, same care, and significantly different results. One is happy and becomes a lifelong patient and a referring machine. The other is anything but happy, possibly ends up worse than prior to beginning care, and quickly joins the ranks of the chiropractic naysayers. Wouldn't it be nice to find a solution to this challenge?

I've worked with instrumentation in the chiropractic profession since the early '90s. Over the years, I've been involved in an evolution of technology and how it's applied in chiropractic. I remember when surface EMG first made strides into the profession as a tool to analyze and educate patients. I saw the advances made in thermography and computerized inclinometry brought on by personal computers. I've seen the introduction of digital x-ray. Yet, as great as each of these tools is in its given area, not one of these will help a doctor see how a patient will respond to stress.

The latest breakthrough in chiropractic instrumentation is not being driven by new technology but by how an existing technology is being applied to chiropractic. The technology I'm talking about is bio and neurofeedback and the breakthrough, a "Stress Response Evaluation (SRE).

An SRE is a neurological exam that will give you tremendous insight into the state of a patient's nervous system. With it you can see how well your patients respond to stress and how quickly they recover from stress. And even though you may still not be able to explain why people respond so differently to stress, you will finally have a chance of knowing up front which patients are likely to respond well to care and which ones may present more of a challenge. And you will be able to measure functional improvement over the course of care, without depending on pain to determine the need for care.

The SRE is performed by monitoring several components of a patient's physiology: EEG, EKG, heart rate variability, respiration, galvanic skin response, EMG, and temperature. The patient is monitored over a brief series of baseline readings, induced stressed, and the following recovery. The information gleaned from this exam can be quite powerful.

The most common question I receive from DCs about the instrumentation is whether or not it fits with his or her technique. The answer is simply that if your primary concern as a chiropractor is the nervous system, there is no better tool for your technique, your practice, or your patients.

Dr. Richard Barwell, the driving force behind this instrument, sums it up by pointing out that although any information can be valuable, taking the results of an exam done with traditional chiropractic instrumentation on a static nervous system and comparing them with the results of an SRE is "like comparing a photograph with a hologram." It may be an accurate depiction of the same subject, but the depth and resolution of information from the SRE is in a completely different league.

Maybe someone should let the immunologists know we are on to something.

(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.)

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An open letter to chiropractors... by D. Fernandez

My son Dylan had approximately 10 ear infections from age three months until he was a year old. Each time a new one occurred, we followed the same routine. His temperature would spike, followed by a trip to the pediatrician, a prescription for antibiotics, and a hope that after 10 days, the infection would clear up. It seemed that just as soon as his ears began to clear, another runny noise would begin, almost inevitably signaling another ear infection.

This continued month after month. The bouts were complicated by Dylan's unpredictable and sometimes severe reactions to various medicines prescribed by a doctor determined, as she put it, to "knock out the infection" once and for all with stronger medications and dosages.

My son's last ear infection was the most serious.

Both of his ears were extremely infected, and this time the antibiotic was useless. The pediatrician adjusted the strength and changed the brand, hoping the new combination would work. Unfortunately, it didn't and after a good month of Dylan's medicine-taking and weekly trips to the pediatrician, she finally suggested we see an ear, nose, and throat specialist to have tubes put in his ear. As a parent, I didn't want to hear that.

Luckily, I happened to vent my frustration to a retired chiropractor. She explained to me how going to a chiropractor might help him. I took her advice, and during a trip visiting family in Florida, my wife and I brought him to a local chiropractor there. After just two adjustments, he was noticeably better.

It's been more than a year since that last ear infection, and, with regular chiropractic adjustments, my son's health has been superb (obviously, he did not get tubes in his ears!).

Yet, as thrilled as we were to finally break this distressing cycle of illness, I was a little displeased.

A football coach of mine had recommended that I visit a chiropractor even though I wasn't in pain. It ended up that I saw a DC regularly from the time I was 15 until age 22. As I became older, I hurt my back multiple times, and, of course, I saw a chiropractor then. In fact, I've seen six chiropractors in three different states.

What got to me was that I'd been going to chiropractors for a period of 20 years and never had one of them properly sat me down to explain all the benefits of chiropractic care -- especially when it came to helping the entire family.

My wife and I had a very allopathic mindset when it came to the health of our children. Our seven-year-old daughter, Brianna, similarly suffered through a spell of frequent ear infections during her toddler years, though they were never as chronic or severe as those our son experienced. Today, largely because of what Dylan went through, we're all regular chiropractic patients.

Dylan, now three, loves visiting his chiropractor, Dr. Cliff Malina, in Decatur, Georgia. As we walk into the office, he makes a bee-line for the adjusting room, climbing on the table, and lying face-down. And, whenever he shows any sign of illness, Dr. Malina's office is the first place I take him.

Brianna, who's been ice skating on a regular basis since the age of three, also sees Dr. Malina. We learned that her pelvis was out of alignment and in dire need of an adjustment. What would have happened if this had gone undetected? How might her health have been affected 10, 20, or 25 years from now?

Doctors of chiropractic, I've shared this personal story because there are hundreds of patients who regularly come through your office who think they know what you do. But they don't. Which leads me to ask, what are you doing to insure your patients are being properly educated on chiropractic care?

(The former owner of two businesses and now Atlantic Region Sales Manager for Brican Systems Corporation, D. Fernandez has honed his ability to acquire new clients and capitalize on repeat business by immersing himself in multiple aspects of marketing and sales over the past 16 years. Besides placing radio ads, he's produced and starred in a TV commercial, acquired 20,000 new members for a website in less than four months, and placed thousands of ads in newspapers and yellow pages. At Brican, specializing in bringing in new patients and increasing patient visit averages, D. has gained extensive experience working with DCs throughout North America. As people today are growing more accustomed to being educated through technology, he offers doctors a wake-up call on how people perceive chiropractic care and illustrates the importance not only of educating patients but transforming their thinking as well. Contact D. Fernandez by calling 800-644-1055 or by e-mail at dfernandez@bricancorp.com)