Friday, April 10, 2015

Where should I go when I have a concern?

    I often have patients who come in to see a Chiropractor after they have exhausted all other avenues and found no resolution.  While I'm glad that they have come to me, I'm often troubled that it's too late for them to get the maximum effect of what I do.
    Let's examine this. I have a patient come in for, let's say low back pain. They had trouble years ago, and began to treat it with pain pills; common enough solution. After years of this, maybe some steroid shots, possibly a surgery or two, they come in to see me, desperate, at their wits end, they don't know what else to do at this point. I can hopefully help them somewhat, and gladly will, but by now, what I can do has become limited. The problem here is coordination. They never had a plan for how to address the problem and the most invasive options have already been exercised. My contribution is now limited by changes in anatomy and arthritis. Let's take a step back and see what we can do to to make this situation turn out better if it can.
    To begin, most people who develop an issue such as back pain don't expect this particular episode to be the beginning of a long term problem, they just want relief so that they can go back to work. Simplest solution: take some painkillers that they have laying around the house. Here is where the problem starts. Most likely, the problem is not due to a deficiency of pharmaceuticals. If it were that would be great, and the problem would be solved. It rarely is though, because our bodies do not usually require pharmaceuticals to operate properly.  The problem here is in thinking that the pain is the problem. It's not, it's the messenger. If the King gets a messenger from another king stating that he is going to declare war on the first king, simply killing the messenger does not solve the problem, and our smug king will find himself on the gallows, or resting under the guillotine. Problem not solved; addressed...  not solved. So what should our wise king do? It's my opinion that he should address the real threat, the other king, and not simply kill the messenger.  So the pain is our messenger, and we routinely take care of the pain and go on our way. But the other king is still setting up camp outside our castle walls while we blissfully ignore him. Wouldn't it be better to address the problem before it develops and becomes stronger? In the case of musculoskeletal pain this will usually be accomplished by paying a visit to the local Chiropractor. If the problem is not musculoskeletal he will also be able to refer you to the most appropriate caregiver. But what if you would rather go to another type of doctor? Maybe you don't like chiropractors, or you think of them as sort of a last resort? Well that certainly is your right and you can do that if you like, but is it wise?       The point I would like to stress here is that is a most appropriate order of what to do to address a problem and it goes in order of invasiveness. The first choice should be the least invasive, and the last choice will be the most invasive.  The reason for this is simple: the more invasive a procedure is the more other options it cancels out. For example, in most cases, surgery will be the most invasive procedure anyone will pursue for a particular issue. Let's say spinal fusion for low back pain. You had low back pain, you took acetaminophen for years, now you can't stand the pain anymore and you got your back fused. Ok. I hope it worked, because now you have no more options, well almost none, you can still have ablation, which is the burning the nerve and destroying it so that you can't feel anything. Now of course, you don't have that nerve so you don't have use of anything that was driven by that nerve. You can expect muscle wasting and atrophy, total loss of tactile sensing and even paralysis. It may be worth it if the pain was bad enough, but it would be a shame if there were other avenues that could have been explored and weren't. It won't matter now though, because what's done is done. there is no "un-ablation" surgery, it's basically amputation of the nerve.
    So how do you make a wise decision on the appropriate order of treatment?  Well the first thing you have to do is recognize that the pain is not the problem, it's the herald of the problem. Many people will not realize this and refuse to accept this, and for them the pain IS the problem.  They don't care about it any more than that. For those people, there is nothing more that I can do for them and I wish them well as pursue a life of comfort. For the rest of us, we would like to find out what is causing us to have pain, and rectify that, and therefore cure the pain. The most likely culprit, statistically, is biomechanical disfunction. The best thing to do, therefore in my opinion, is to go to a Chiropractor as a portal of entry physician to the health care arena. They will most likely be able to address the problem or refer to Physical Therapy or Allopathic (Medical) care as is appropriate.  If you don't want to go to a Chiropractor for one reason or another, there is still an order of invasiveness as to what's most appropriate. It's pretty much the same for most issues, it follows as such:  Least Invasive:  diet and exercise > Chiropractic > Physical Therapy > medication > surgical modification > ablation/amputation > death :Most Invasive.  The reason I recommend Chiropractic first is that it is the lowest level of invasiveness where your problem will be addressed by a doctor, and most Chiropractors will also be able to address diet and exercise issues as well.  Now, of course I don't recommend going to a Chiropractor first for something like low back pain due to being shot in the back and needing a bullet removed.  Use common sense in determining where you need to step into this model, but remember it is best to step in at the lowest level of invasiveness possible because you can always move up, but you can't always move back. If you still have low back pain after a lumbar fusion, and the fusion was performed in the correct area, there is probably not much a chiropractor can do for you now because he cant move vertebrae once they're screwed together. There is a good chance he could have helped before hand though, even if you weren't told that was an option. Do not rely on medical personnel to make appropriate referrals to chiropractors, many of them have an incomplete understanding of what chiropractic is and certainly of what it can do. They also have no legal or other obligation to refer to a Chiropractor, whereas, Chiropractors do have a legal obligation to refer to medical providers when it's appropriate. That's another reason to go to a chiropractor first, you will get a medical referral if it's appropriate whereas if you go to a medical provider first you will probably not be informed of any Chiropractic options you have, even if they are better or more appropriate.
     So, whether you like Chiropractic or not, the same concerns of invasiveness apply.  I hope that you'll agree with the points I've tried to illuminate here. My one other suggestion would be that for your overall health care you have one main doctor, Chiropractic or Medical, that you trust, that you use to correlate and coordinate all your care so that there can be a logical flow to your care and to avoid confusion and mis-treatment in all your health care issues, and so taht you have one person who has the whole big picture of your care as the health care system we have today can be very fragmented.



Friday, March 20, 2015

Personal Responsibility. Your health is your problem.

So let's get started.
     I would like for people to address me on this forum, and in turn, I will do my best to address concerns, answer questions, or give my opinion on matters relating to health care.  I will not support any efforts to make this a political page as there are plenty of those already. My main concern is to help people use the healthcare system which we currently have in place to the best possible outcomes.  My goal here is to help people educate themselves on healthcare matters and make wise choices while taking control and responsibility for their own health.
    I'll  start out with this short discussion on health and responsibility.  There are different types of healthcare consumers.  There are those who would prefer to have someone else in control and make their decisions for them, usually a healthcare professional of some sort, and these people generally tend to have an external locus of control.  They do not want the responsibility of making their decisions, and they do not want the work involved in researching and addressing issues on their own. Bless them, and I hope things go well for them, but this page will be of little use to them so i will not address that segment in particular.  There are those people who want to take responsibility for their health because they understand that they need to. No one else will. As for the first group, they are deluding themselves if they think that someone else will regard their health as a primary priority, but they have that right. As to the second group, responsibility for your health is your responsibility, and it is good that you accept it.  Just as an investment broker manages someones assets, your healthcare professional manages your health. But your health is not necessarily the top priority.  An investment broker needs to make money, so does a doctor. An investment broker needs to protect himself from adverse risk, so does a doctor.  An investment broker sells a product or service, so does a doctor. As a result, you may find that your better interests may be deferred to lowering malpractice risk.  Your best interest may come behind profit.  Your best interest may be deferred to the need to keep business "in house".  A doctor or other health care worker will never use your best interest as the primary principle in guiding your healthcare because the risks of today's market dictate that certain measures be taken to protect against fraud and malpractice and to protect the positions of healthcare givers in court.  Therefore, oftentimes, healthcare will be administered from a defensive position.  You may find that you are subjected to extraneous testing, you may find that you have been over medicated or even redundantly medicated, you may be referred out to other specialists unnecessarily in order to cover risk. You may even find that all of these tings are done solely for the sake of profit in some circumstances.  In fact, sometimes the worst thing to be is well insured. If you have excellent coverage, you may find that every possible step is taken to "insure" your safety and proper treatment, but that treatment may not be the best for you, it may be the best to cover the interests of the treating facility. It may also make you a target for profit.

    Now that I've stirred up the hornets, lets take a step back.  I am not trying to scare you or insinuate that you can't trust your healthcare workers in our system. I am only trying to bring things up that need to be taken into consideration.  In truth, by far, most people pursue careers in healthcare with the best intentions.  By far, most people become practitioners because they want to serve others and do good.  The industry is not perfect however. There exists a population of people who make their living by suing for malpractice and accidents and whatever they can get out of the healthcare system.  These actions have led to a robust population of hungry malpractice lawyers who are motivated to find and take advantage of every possible thing they can find. Law school is expensive.  As a result the healthcare industry has had to develop "immune responses" with built in mandatory excesses.  You may not need an MRI with a particular injury, but you'll probably get one. You may be able to treat your high blood pressure with diet alone and no prescription, but you'll probably get one.  The reason these excesses are in place is because previous legal proceedings have established that these are reasonable and prudent measures in general, so in order to defend themselves in court, should the need arise, these things are done in order to establish that "everything possible" was done to assure a good outcome and in good faith. It's a legal recipe.  Sort of like statins for everyone who has had a heart attack, regardless of whether or not they have high cholesterol.  The statins don't protect the patient from another heart attack, they protect the doctor from a lawsuit. Just like the free flow of anti-biotics protects individual caregivers from being charged with not taking prudent measures even while we create masses of "superbugs" that are ever more anti-biotic resistant, leading to more and worse infections than the previously given drugs prevented.

    The point here is not how bad are our system is. The point is that it is prudent to take responsibility for your own health because no one will ever be more invested in your personal welfare than are you.  With information availability as ubiquitous as it is today, there is no reason, other than laziness or fear, not to research your own health concerns and educate yourself on your own personal risks.  If you don't want to, that's fine, that's your right. You won't get the best outcomes.  So here's my point after all this: The most important thing you can do for your own personal health is to take control of it yourself, that's step number one.  If you're still reading at this point, you probably knew that already.      

Wednesday, March 18, 2015

Introduction

Hello. Welcome to my blog. Here is where I will address health concerns people may have and discuss health matters in general and Chiropractic care in particular. I will introduce topics and explain health issues, and answer questions in general.