A Frank Discussion with Your Medical Doctor

The purpose of this blog post is in no way to belittle or degrade the medical profession. My best friend is a medical doctor and I have several friends whom I admire and respect who are medical doctors. Furthermore, I have many medical doctors who refer patients to me on a consistent basis. No, this article is for those medical doctors who refuse to educate themselves on the benefits of alternative health care. Lately I have had a few medical doctors tell our mutual patients that they should not get adjusted anymore. Every single one of them cited arthritis as the reason why they should discontinue care with me. I hope this article will educate you as a patient of such physicians and maybe even influence some of them to do some research.

First of all, arthritis is a very generic term. Medical doctors routinely use it for any ache or pain in a joint. Most of the time calling it arthritis is technically true but over simplistic. It seems to me like they use it liberally because they do not want to explain what is really going on. Arthritis means is inflammation in a joint. It can be caused by auto-immune conditions like Rheumatoid or Lupus but more often it is caused by wear and tear. This is rarely explained to a patient so I am going to.

When doctors tell you that you have arthritis, most of the time what they are saying is that they can see signs of degeneration on your x-rays. Examples of degeneration are decreased joint space, bone spurs and misalignment. Essentially, instead of seeing nicely aligned joints with smooth edges, they see jagged edges with varying degrees of misalignment. This happens over time. How quickly is determined by how dysfunctional the joint is. The more dysfunctional the quicker it degenerates. Dysfunction of a joint means it is either not moving properly or not moving at all.

In the spine, the vertebrae have discs that can degenerate. Usually, this is associated with a disc herniation or bulge. Degeneration in the spine can lead to stenosis or narrowing of the openings where the nerve roots travel. Spinal degeneration or arthritis can come in varying degrees and complications. I am very aware of the risks involved with adjusting a highly degenerative spine.

Let me repeat that. I am very aware of the risks of adjusting a spine that has arthritis or degeneration! I also know the benefits. For this reason, I am very frustrated with these MD’s who are telling my patients to stop. Do they think I am unaware of my patient’s condition? Do they believe that I have no regard for my patient’s health? To be honest, I don’t believe they consider this, at all. I see fear derived from ignorance.

The truth is that an adjustment of a degenerating joint can be very beneficial. Retraining the joints to move properly can decrease inflammation and increase the nerve flow to that area which will at the very least slow down the degenerating process. Increased function will lead to improvement to the health of the joint. Are there risks? Of course. There are risks to everything. I believe the greatest risk is doing nothing. It is certainly the most predictable risk.

Trusting in your chiropractor to know when to adjust or not is important. Communication is the key! If you have a condition and you are unsure of your chiropractors awareness of it, express your concern. On that same note, avoid taking advice from people who don’t know. They shouldn’t be making recommendations about things of which they are ignorant. That doesn’t seem to be stopping some of them. If you stopped chiropractic care because your MD told you to, but have’t discussed it with your chiropractor, its time to have a frank and open discussion with all the parties involved, OK?

Pillow Talk. (About Actual Pillows, Not the Other Kind)

Ah, the frustration of finding the perfect pillow! Have you found yours, yet? Once you do, your spouse or kid will probably steal it or your dog will chew it up. Or, do you have that pillow that has been perfect for longer than you are willing to admit and it is just moments away from disintegrating in the middle of the night as you blissfully rest? I know how it is. I wish I was writing this article with the perfect solution for everyone. Alas, there is no perfect solution but there are some general guidelines that can help.

First off, finding the right pillow can take time and you may need to invest a little in several different pillows. How much is up to your commitment to a perfect night’s sleep and how important it is for your neck to feel good in the morning.

The most important factor to consider is that you need to keep your head and neck is a neutral position relative to the shoulders. If your head is closer to one should over the other or flexed forward or extended back, you are no longer in a neutral position. This can put a strain on the joints of the neck and cause shortening of one side of the neck muscles and conversely lengthening of the other side. Because we spend so much of our lives sleeping, it is vital that you keep your neck and head in a position that puts little stress on all of the structures.

For side sleepers the biggest issue typically is finding  a pillow thick enough to take up the space between the shoulders and the head. This is especially hard if you have broad shoulders. A firmer pillow is usually your best bet because it will hold its shape all night. Down pillows tend to be fine for the first few hours then compress during the night. I, personally, sleep on a water based pillow that holds it shape really well but is soft enough to be comfortable. It has over a gallon of water in it so it weighs a ton which makes it hard to change the pillow case, but what do you do?

Back sleepers typically need a fairly thin pillow or no pillow at all depending on the curvature of the upper back. The shape of your neck will largely determine the style of pillow. If you have a good curvature (which is ideal), a pillow that helps maintain the arch can be great. If your neck is unfortunately straight or reversed, then that style of pillow might be very uncomfortable. Some say that using a pillow as a neck orthotic to restore the ideal curvature is a good idea. I could definitely make that argument but sacrificing sleep might not be worth it.

OK, I know the what you are thinking, “I switch from side to back all night.” Let me say it right now, unless you are just the right structure, there is not really a pillow that is dual purpose. Sorry! If you have a pillow thick enough to take up the space between the head and shoulders, it is going to be too thick to sleep on your back and vice versa.  Furthermore, if you are a stomach sleeper, there is no way to keep your head in neutral and still breath unless you have a slot for your mouth and nose.

There you have the basic guidelines. Happy hunting. FYI, just because pillows are expensive doesn’t mean they are going to be a good fit for you. Still, cheap is cheap. The pillows I sell in my office are around $50, if that is useful. Good luck and sweet dreams!

Custom Orthotics from a Chiropractor? For $150? Sign Me Up!

ATTENTION: Unfortunately, we longer provide the service of creating custom orthotics. The equipment we were using broke down and the manufacturer went out of business. We are still looking for a comparable system. Thank you for your understanding. 

At the behest of many of my patients who didn’t know but now do, I offer custom orthotics in my office. I feel compelled, however, to educate you on what a good orthotic is  and how you could benefit from it.

There are 3 different types of orthotics, generally speaking: non-custom, custom casted for the perfect stance, and custom evaluated for the perfect gait.

The first is the non-custom orthotic. These are the Dr. Scholl’s, SuperFeet or the kind from the Good Feet Store. Some can be a very good and beneficial product. Dr. Scholl’s are mostly just a padding to decrease shock absorption. SuperFeet and orthotics from the Good Feet Store are a lot more substantial and can

actually improve the way you walk or stand. The only issue I have with the Good Feet Store is the cost. You are paying custom prices (very expensive in my opinion) for non-custom or semi-custom orthotics. The semi is just because they have a wide selection for the salesperson to fit you as best as possible.

Custom orthotics created to mold the foot into the perfect stance is by far what most podiatrists use. They manipulate the foot and hold it in what is called taler neutral, basically, the ideal position of the foot. Then they make a cast which will be the mold to create the orthotic. Another method is to have you stand on a plaster or foam mold from which they create an orthotic. Typically, the orthotic is made of a hard plastic with no flexibility to keep the foot in the same position.

Either way, this method, in this doctor’s opinion, is outdated and shortsighted. The foot is designed to be flexible. When we walk, the perfect gait is for the heel to strike. Then, the arch flattens out while the foot pronates (flattens inward). Ideally, the flattening of the foot stretches the plantar fascia which creates a taut spring. When the pressure is released, the spring

pushes off  the big toe to the next step. When you put in a piece of hard plastic, you negate the action of the foot. Essentially, you make your foot into a post. You take away the foot’s ability to absorb shock or act as a dynamic player while walking or running. The shock has to be absorbed by something. If the foot cannot absorb shock then it will certainly transfer to the knee, hip, or low back. Plus, it forces those other structures to compensate for the altered mechanics. Who cares if the foot is in a perfect position when you stand still? We are mobile creatures who need to move and function.

The best type of orhtotic and hence, the type I offer in my office, is the kind that corrects the gait. Often times, for various reasons, the foot doesn’t perform the way it should. It makes sense to me to help it work the way it was intended and designed. When we create an orthotic we take into consideration the stance and the gait. We have a digital plate that captures the pressure and the pattern of your stance and your gait. The goal is now to create a flexible and dynamic orthotic that will assist your foot in behaving the way it should.

Not everyone needs orthotics. Every time you add external devices there will be secondary and tertiary reactions. It is difficult to account for all of them. I have had plenty of patients who were wearing orthotics and complaining of all sorts of issues. I told them to take out the inserts and things resolved.  My first course of action when someone asks for an orthotic is to discuss why. Sometimes just adjusting the foot will take care of the foot issue. I also like to look at value. If a patient can resolve their issues with non-custom orthotic for $35, then paying $150 for a  custom pair might not seem worth it. That saying, if you need a custom pair of orthotics, they can be of tremendous benefit and can really preserve not only your foot but your knees, hips, and back, as well.

Post Script: Don’t let the price fool you. I could easily charge $300-600 for these orthotics (everyone else does). These are made by the same types of labs that do work for every doctor who works with orthotics. I keep my prices low because if people need them I want them to be able to afford them. Do I make much money from them? No. For now I am going to keep them at $150. I actually dropped them down from $200 because I switched to a direct lab and they only charge me around $100 per pair. If you want some, act quickly because the time it takes to gather the information is substantial and I will probably go back up to $200 again, soon (which is still a bargain).

Your Chiropractor As Your Primary Care Doctor?

The concept of having a primary care physician is to control the cost of patients seeing a specialist directly. Under the primary care model, patients see their family doctor who treats or refers to a specialist. This frees up more expensive specialists from seeing patients directly who may or may not be a candidate for the specialist. All said, even though it does cut costs for insurance and patients, the concept can also help direct a patient to proper and appropriate care. In this way, managed care has it right in theory if maybe not exactly for the right reasons. 
Proper care is predicated upon a primary care doctor being a competent differential diagnostician who can manage the overall case especially if multiple specialists are involved. Unfortunately, the way it stands, most primary care physicians are either not very good at differential diagnosis or they just don’t have the time to do it right. Part of the problem, whether they like it or not, is that they are inundated with too many patients. Too many patients creates an environment of hasty visits and poor communication. In addition, there is pressure from the insurance companies to be more efficient and to save costs often at the expense of proper diagnostic protocols. 
Here is where chiropractors can come in. Chiropractors have learned the art of differential diagnosis, pathology, etc. just as much as our medical colleagues. In addition, chiropractors have more training in musculoskeletal diagnosis, radiology, and nutrition. In my practice, I spend a good amount of time during the initial visit discovering any and all health concerns and what is functioning well with a holistic outlook. In short, most chiropractors if they were interested would make excellent primary care doctors. 
There are some major advantages to using some chiropractors as primary care doctors (not all chiros are interested and some see diagnosing as a dirty word). First, we have a shortage of primary care doctors which really limits access to care (I wonder how much worse it will get if go to socialized medicine). Opening it up to chiropractors could significantly ease the burden. 
Second, chiropractors tend to build stronger relationships with their patients. Chiropractors tend to see patients much more than just when their patients are sick enough to go in. In addition, we put an emphasis on building relationships because we have to in order to grow our practices
Third, chiropractors are actually concerned about patients’ health and not just their sickness. Sure most people come in because of a problem but what is the underlying cause and what else can be prevented? You don’t know unless you ask and in my office, at least, we make it a point to comb through your entire history and do a full exam. 
Fourth, although we cannot prescribe medication, our ability to conservatively treat patients in a cost effective manner is second to no other health profession.  
Just like in anything cooperation is the key. There are still specialized MD’s who will not accept a referral from a chiropractor and, there are chiropractors who act like diagnosing is an evil art form invented by the medical community. Both are part of the reason that chiropractic still struggles with a legitimate identity (another post, altogether). 
I think my patients who know me well use me as their primary care doctor. Usually, the switch happens when they have something come up and they go to their MD. They then casually bring it up to me. I take the time to diagnose and educate and then point them in the right direction for proper care. Sounds like a win win to me. What do you think? 

What’s In a Name?

So, I am sitting at my desk on a rainy morning anticipating the morning rush. I have a new patient in the hyperbaric oxygen chamber and the patient I had scheduled at this time to receive her report of finding called in to postpone due to the flu.

In my suddenly open schedule I determined to start a blog. But, what do I name it? I had a blog before but the name was not only too long but apparently too obscure. Nobody got it. To add insult to injury had a glitch where I couldn’t edit or add pictures. But, in the name of persistence and an outlet for my ideas on health I have tried again.

This time the name I came up with is “Optimal Health.” I use this phrase quite often through the day. I believe the pursuit of optimal health should be one of our top priorities. God gave us these bodies, shouldn’t we take care of them as best as we can?

This name also gives me an opportunity to discuss many aspects of health and health care. By the way, I am open to any suggestions for topics that I can research.

Here it goes!