Peanut Butter in the Gas Tank

peanutbuttergastank

People amaze me. Honestly, I am always surprised by many people’s consistent failure to leverage logic in a situation. Here’s an example: A patient had a lumber disc issue three years ago. After seeing several other practitioners, epidural steroid injections and physical therapy all failed to produce desirable results, a friend of the patient suggested he see me. A few properly directed treatments of flexion-distraction and long axis decompression went a long way to quickly dissipate this patient’s disc pain. We were both quite happy with his recovery.

Fast forward to now; three years later. The patient again comes to me with disc pain. When I asked when it began, the patient tells me it started 6 months ago and he went through physical therapy, medications and more injections before returning to me. I was stunned. Chiropractic treatment worked so well for his disc pain in the recent past, why would he not seek my help immediately after a similar flare up?

I equate this form of illogical thinking to putting peanut butter in one’s automobile gas tank. After all, the past hundred times I put gasoline in my car, it ran as it was intended. But this time, I am going to put peanut butter in the tank instead of gasoline hoping for a better result. Huh?

The old adage that people who do what they’ve always done will get what they have always gotten is usually used to illustrate the negative consequences of stagnation. However, if you are satisfied with the results of what you have done in the past, continuing with that same strategy just makes good sense.

 

Brett Kinsler is a chiropractor in Rochester who treats disc injuries in a way that works. If it didn’t work, he would do it a different way. 

Do you do the RHIO?

rhio

Perhaps you’ve heard the term before. Perhaps not. RHIO (ree-yo) stands for Regional Health Information Organization and is a way for multiple providers and health care organizations to share data in a common way. The goal is to facilitate rapid and standardized exchange of patient information. Our office joined the Rochester RHIO which gives us access to the hospitals, laboratories and radiology centers in a 13 county region.

From the first day, our patients noticed the benefit. We were able to quickly obtain lab results that were ordered by another doctor, get imaging results from years back and check on the discharge instructions from a recent emergency department visit. All with minimal interruption to our office workflow. All of these things were obtainable in the past but each required a separate phone call from a staff member and, when a patient couldn’t recall exactly which lab or center performed their test, often multiple calls were needed.

It is easy to see that RHIOs should help in reduction of test duplication, decrease staff hours in tracking down results and providing patients safer care but transferring allergies and medical history to each provider. The organization in the Rochester area has no cost to providers (including chiropractors) but your mileage may vary.

It’s not without it’s weaknesses. Currently, the Rochester RHIO doesn’t have accurate patient insurance information and individual providers cannot upload data. So, if we write a report for a patient from our chiropractic office and discuss the treatments we delivered for a herniated disc, for example, there is no way for us as an individual provider to submit that to the system. Yet. For the moment, we are consumers of the data and not producers. This is a weakness but I imagine it won’t be for long.

If you are a medical doctor or chiropractor in the Rochester, NY area, I strongly urge you to contact our local RHIO (http://www.grrhio.org/) and if you are a practitioner in another part of New York State, you can check this clickable map to see if there is a RHIO you can join in your region: http://www.health.ny.gov/technology/projects/regions/

Wondering if there is a RHIO in your state? Check with the local hospital’s IT or HIM (Health Information Management) department. They should know if there is a current network or one in the planning stages. The transfer of health information across multiple organizations is one of the most important aspects of healthcare and one that benefits providers, patients, hospitals and the communities.

 

Dr. Brett Kinsler is a chiropractor in Rochester, NY and a certified healthcare technology specialist.

Not All Apples Keep the Doctor Away

Those of us in healthcare often can’t help but follow distressing trends. One of these trends indicates that as the nutritional science recommendations for fruits and vegetables increases, Americans inexplicably seem to consume less of these important foods.  It’s like we are a bunch of rebellious teens trying to do the opposite of what our parents tell us. But how bad is it? According to the CDC’s Behavioral Risk Factor Surveillance System (big brother, anyone?), of adults surveyed only 32.5% ate 2 or more fruits a day in 2009 and only 26.3 % ate 3 or more vegetables a day.  Despite millions of dollars spent in marketing, fruit consumption in the US fell by almost 2% from 2000 to 2009 while vegetable consumption remained unchanged.  It should be noted that Idaho was the only state that showed a slight increase in both fruit and vegetable consumption while 10 states (who shall remain nameless) showed a decrease.  So chances are unless you live in Idaho, you are eating no better than you did in 2000 — which was probably not so good to begin with.

Sure, it can be hard to eat all those fruits and vegetables. Every day.  But there is some good news:  Last year, the relative healthiness of apples was studied in the form of phenolic profiles and antioxidant properties of apple skin extracts. Plant phenols include such beneficial compounds as cinnamic acids, benzoic acids, flavonoids, proanthocyanidins, stilbenes, coumarins, lignans and lignins. These are strong antioxidants and might prevent oxidative damage to DNA, lipids and proteins and therefore reduce the likelihood of developing things like cancer and cardiovascular disease.  So if you eat the right apples, you don’t have to eat as many to get the antioxidant benefits.  In the United States, apples alone account for 22% of our phenolic intake, we would do well to be choosy about those apples.

Which apple should we be eating?  Crabapples ranked highest with approximately 2.5 times the benefit as the lowest ranking apples, the golden nugget and the macintosh.  Also very near the bottom were the gala and the empire.  Firmly in the midrange were the granny smith, honeycrisp, and red delicious.  The top ranking palatable apple was the ……Idared.  Idareds showed twice the benefit as the ‘losers’.  A recent trip to a popular local grocery store revealed not one single solitary Idared in sight.  However, there were plenty of conveniently pre-bagged ‘mini-macs’.  Resist the temptation. Bag yourself a few honeycrisps or granny smiths and you will get nearly fifty percent more benefit for the same amount of apple.  If you are lucky enough to find an Idared, even better. Remember, the study measured the relative amounts in apple skin so making applesauce or juice doesn’t count!  How do ya like them apples?

 

Dr. Michalene Elliott & Dr. Brett Kinsler are apple-loving Rochester NY chiropractors.

New Podcast Episode: Alternative Dentistry

Ellie Phillips, DDS spoke frankly with me about the dental profession and how it can and must adapt from a drill and fill to a systemic and truly preventative model.  She is the author of the book Kiss Your Dentist Goodbye and a most interesting person to listen to.  I assure you, you have never heard a dentist like Dr. Ellie.

Find this episode in the podcast section of iTunes by searching for “On The Other Hand” or go to our podcast site here.

Don’t Confuse Me With the Facts

Food labeling cartoonAs chiropractors, we often get asked about diet and lifestyle in addition to the usual neck and back pain complaints.  In the current word-of-mouse era we live in, patients have access to an unprecedented amount of information only a click away.  Most have done their own research before they bring the subject up in our office.  Sometimes this is helpful.  Other times, it has only served to confuse them.  Some patients choose to follow each and every bit of nutritional news which only serves to drive them crazy.  Today, eggs are bad but coffee is good for you.   Yesterday it sounded like coffee was the Devil’s drink but eggs were the perfect nutritional powerhouse.

So what are they looking for from us?  Google “diabetes”  or “heart disease” and you will get well over ten million hits.  Most likely, after the cereal, shake and snack bar Googlemercials, the next few links will be to popular sources like WebMD.  These have their place but they are supported largely by pharmaceutical ad revenue.  Even if patients found their way to Medline (a source for medical journals) the average person is not used to reading technical and often seemingly contradictory research studies.

What patients are looking for is a way to look out at the endless sea of information and fish out from it the most relevant facts to their own situation.  This should be the role of their health care provider — to assist in this process.  Yet, in many cases, the information from the health care provider does not help in a positive way.

 The cycle goes something like this:

  • patient gets diagnosis (or is told to “lose a few”)
  • patient finds the latest “diet” and follows it
  • patient loses a couple pounds then hits a plateau
  • patient gets frustrated and goes back to old habits
  • this becomes another “diet” that they tried that didn’t work. 

Any diet can work, especially in the short term.  The problem is most are unhealthy and are being used as a temporary fix.  Even diets like the South Beach Diet, which is very effective at weight loss in the beginning, is not an effective long term plan for health when taking into account factors like cancer and heart disease due to too much reliance upon animal protein and complicated “what you can eat when” charts.

Nutritional science can be very technical and complex.  Even if you make it a full time endeavor, keeping up on all the latest research is nearly impossible.  What is a person to do?  First, forget about the current politics of food.  Using only common sense, imagine what a healthy, nutritional meal might look like.  Chances are you imagined a plateful of vegetables.  Maybe there was some meat or fish on the side but the bulk of the plate was filled with plant foods.  Well, let’s start there.  Make your meals (and snacks) look like that imagined ideal meal.  Dramatically reduce (or eliminate if you can) the size of the animal protein (meat, fish, dairy) you have on the plate.  Push it off to the side and fill the rest of the space with several different plant foods.  Add a heap of brown rice or a plain baked or sweet potato.  Then add sauteed spinach, roast carrots, steamed broccoli and/or peas.  See what you did there?  Without even going to night school to get your Masters in Clinical Nutrition, you just put together a perfectly healthy meal.  Just make sure the vast majority of stuff on your plate is unprocessed and plant based.  Still hungry?  Try some whole grain bread with your meal and some fruit for dessert.  Getting started really is that simple.

Dr. Michalene Elliott is a chiropractor in Rochester, NY who has gotten started.

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Could Your PCP Pick You Out Of A Line Up?

DocBaker

I doubt mine could.  Which makes me think about Little House on the Prairie.  Anyone around in the 1970s remembers idyllic Walnut Grove, where Doc Baker took care of everyone and their pets.  He gave advice, dispensed medicines and sent the tough cases to Mancato (the big city).  People ran into him at the general store and he promised to stop on by the next time he was out their way.  To our modern ears, it sounds very quaint until you realize that this is the model of health care that we aspire to and were supposed to get with the onset of HMOs.  Under that model, we were each supposed to have a PCP who would monitor our health, give us lifestyle advice and send us to a specialist if any red flags showed up.  This would be the ‘gatekeeper’ (insurance term) that would be familiar enough with our health history that his or her decision would be one based on a long view of our individual health status.  Unfortunately, this model was managed to death by efficiency experts until it is neither efficient or effective.  The political choices we have before us continue this trend. Until we as patients demand better, the push will be for PCPs to do more with less.  In a recent poll (Investors Daily)  45 % of primary care physicians will consider quitting medicine if the government takes over the health care system.  That is approximately 360,000 doctors that will consider quitting practice.  Clearly, doctors are as frustrated as their patients.  Health care reform, to make any meaningful changes needs to redefine the role of doctor and patient.  The most efficient role the doctor can play is health coach in a proactive way.  That can’t be done in 5-10 minutes once a year. Or with a quick blood test.  Patients that are empowered by their relationship with their doctor will make the most beneficial (and coincidentally, the most cost-effective) changes to their own health.  In that climate, there will be less of a role for bean counters and government pencil pushers.  Let’s not give up the idea of Doc Baker too quickly. 

Dr. Michalene Elliott is a chiropractor in Rochester, NY who doesn’t want to be managed anymore.

What’d Ya Say? Divided By a Common Language.

applesoranges

The importance of using common language when communicating about back pain has been well documented in the medical literature. There are three main areas that lead to difficulties in communication about back pain:

  • patients seeking information from health care professionals can experience difficulties understanding them and the medical literature
  • misunderstandings among health professionals concerning terminology can arise
  • lack of standardized definitions for back pain terms can make comparison of research studies problematic

A study just published in the BMC Musculoskeletal Disorders aimed to explore the meanings and issues surrounding the use of existing medical terms for back pain from the perspective of health care professionals and lay people. Focus groups were used to explore participants’ understanding and samples included general practitioners, chiropractors, osteopaths, physiotherapists, and lay people.

Lay participants understood the majority of the terms explored in the group differently than the health professionals. Some terms were not understood, some misconstrued and some had inadvertent negative connotations or implications. (For example “wear and tear” instead of the harsher term “degeneration” gave implications of wearing away or rotting).   The commonness of misunderstandings, unintended meanings and negative emotional responses to terms used in this study have a number of implications.

Firstly, it must encourage providers to ensure their patients understand what has been explained to them including the contextual and emotional implications. Secondly, patients and providers should have an ongoing dialogue to promote understanding of terms and comminality of language.  Third, this study should be used as a lesson to chiropractors who cling to old, antiquated terminology that we know has differing meanings both intra- and interprofessionally. If other chiropractors cannot agree on a term’s meaning, and other professions cannot agree on that term’s meaning, you can sure as heck bet that your patients have no idea what you are taking about either.

I was recently told that we should take antiquated terms and reframe them so we can continue using them in a different context. To me, this study implies that is not a wise course of action.

 

Brett L. Kinsler, DC is a chiropractor in Rochester, NY who avoids using antiquated terms when he blogs at www.RochesterChiro.wordpress.com

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Up the Nose With a Rubber Hose

balloon_nose

Sinusitis is an inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.  There can be pain and nasal congestion.  Acute sinusitis often follows a cold, but chronic sinusitis can last for extended periods and make people miserable.  More than 30 million Americans suffer from chronic sinusitis, meaning symptoms last longer than two months or regularly recur. Patients repeatedly try antibiotics, decongestants or steroid-containing nasal sprays, but about a quarter are thought to get inadequate relief.  Sometimes, surgery is the best option for chronic sufferers.  Standard surgery involves cutting away bone in the sinus cavity to open the passage way and allow drainage.

This week, a patient asked me about a procedure where they stick a balloon up a patient’s nose and inflate it in order to ‘move the skull bones’ and help with sinus problems.  I thanked him for the idea for a blog article and began to do my research on what I was sure would turn out to be some wacko in a clinic in California (why is it always California?) sticking things up people’s noses and declaring them “Sinus Free!”

Instead, I got educated on a new alternative to the standard sinus surgery.  Balloon Sinuplasty is compared to angioplasty — you know the procedure where a catheter is fed through an artery and plaques are squeezed to the sides with an inflatable balloon.  With the sinuplasty, the catheter is inserted into the sinus cavity and inflated to open the passageway and promote fluid drainage and pressure reduction.  Inflating the balloon aims to stretch the sinus opening back to its original size or little bigger, thus letting air (and antibiotics) into the sinus.

The research looks promising for this technology and it is most certainly not a novel means of cranial adjusting as I initially suspected.  Whew.  Patients who have the balloon catheter procedure appear to have significant improvement in symptoms two years after surgery.

The best part is that the research generally scores patient symptoms using my favorite clinical instrument:  the SNOT – 20 which I discussed in a previous post.

 

Dr. Kinsler is a chiropractor in Rochester, NY.

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Hands Off That Prostate!

rubberglovedr_3

Quick, go get your March 26, 2009 issue of the New England Journal of Medicine.  I’ll wait…

Got it? Okay, flip to the two articles on prostate cancer screening.  See them?  No?  Okay, perhaps you’ve accidently picked up the Ladies Home Journal.  I know people get confused.  For the last time: 

New England Journal of Medicine = one of the most respected medical journals in the world.

Ladies Home Journal = a magazine (though I swear I was in a seminar not so long ago and the instructor quoted an article from LHJ as if it were peer-reviewed).

That’s okay…cut out the coupon for Birdseye veggies in LHJ while I tell you what the studies say in NEJM. 

Two large clinical trials, one American and one European, assessed whether screening for prostate cancer is effective. Both studies show that screening had little or no effect in reducing prostate cancer deaths. No tiny little studies were these either. 77,000 men in the American study and 182,000 in the European study.

These numbers are huge. I can’t even imagine how someone could manage a clinical trial with that many people. I once tried to organize a Pez dispenser collection and gave up when there were too many to keep track of. 182,000? Actual people? Damn.

So, the American study found no reduction in prostate cancer deaths after all the men had been tracked for seven years and two-thirds had been followed for 10 years.

The Europeans found a modest reduction in deaths after nine years but a high risk of needless treatment given. In fact, half the men diagnosed with prostate cancer would not have had clinical symptoms during their lifetimes. The European research suggests that roughly 50 cases of prostate cancer found through a screening program would need to be treated to prevent a single prostate cancer death.

The amount of unnecessary cancer treatment that has occurred in the name of the PSA prevention is sickening. Certainly these studies are not the final word and you should discuss screenings with your doctor.  And since both studies will continue to follow the men, it remains possible that the United States study will eventually find that screening can reduce the prostate cancer death rate.

I wouldn’t hold my breath.

In the meantime, no one is gonna touch my prostate…unless, you know, I know them really, really well.

Veterans Will Hopefully Get More Chiro Benefits

By Guest Writer Holly McCarthy

female_military

Looks like vets will get expanded veteran’s benefits that will include coverage of chiropractic care. The American Chiropractic Association is thrilled about the bill, which was introduced into the House in 2007 but may actually move along under this Congress.

What’s really cool about the bill is it will require that a chiropractor be on staff at every VA medical facility by 2012. This would amend the existing Veterans Affairs Health Care Programs Enhancement Act of 2001 and ensure vets get the chiropractic care they seek.

This is all just swell until we think about the fact that, currently, there are only 32 out of more than 150 VA medical facilities who actually have a chiropractor on staff. So, getting our military “aligned” (well, at least from a chiropractic perspective) is still next to impossible. It’s frustrating as we think about the numbers of invasive surgeries, procedures and treatments administered to vets every day when chiropractic is noninvasive and considerably more cost effective than many other procedures.

Seems a little short sighted as Wall Street drives the economy deeper into the red as the government looks for ways to scrimp and save. But, we digress.

Oh, and those 32 VA facilities with chiropractors? Well, this lightning-paced change has been in the works for almost eight years now. We all know things do not move quickly in our government but our vets deserve a little more here.

In the end, unless the current bill makes its way through both houses of Congress, making chiropractic care accessible to all veterans will remain a case-by-case benefit, which we can assume will be painfully slow – if expansion to other facilities happens at all.

And, here’s one last thought to chew on as we close. Almost 50% of vets returning from overseas seek treatment for musculoskeletal problems. You know, those ailments chiropractors treat! And, we treat them more effectively and less expensively, to boot. It will be interesting to see what happens in the coming months/years as the number of returning veterans with musculoskeletal problems continues to increase and funding for them continues to decrease.

This post was contributed by Holly McCarthy.  Holly writes on the subject of schools with sports management programs.  She invites your feedback at hollymccarthy12 [at] gmail [dot] com

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