Dear Don,
Forgive me if I took the liberty to call you by your first name, but I have read all your columns since you took over the editorship of Dynamic Chiropractic from your wonderful Dad, and I feel as though I know you.
An old orthodox jewish gentleman, whose ship went down, was stranded alone on a small island in the middle of the Pacific. Ten years passed before he was spotted by another passing ocean liner. As the captain and a small crew rowed to the island to pick up the stranded oldster, they were surprised to see the tiny island had two synagogues. The captain, on learning that the man had built the synagogues, inquired why he had built two. The old man pointed to one of the houses of worship. "You see," he said with a serious look, "to that synagogue I do not go."Being a full-time practitioner for the past 37 years, I and many others can testify to the incredible profession that we have been both fortunate and honored to be part of. The unfortunate fragmentation of our fellow practitioners into organizations that fortify their individualistic ideas and approaches does not bode well for a profession that is constantly fighting for its place in the sun. Maybe Bertrand Russell had the answer when he wrote: "Few people can be happy unless they hate some other person, nation, or creed." What we have in chiropractic is basically the something that Mr. Russell expressed, except in a more pointed manner.
In any case Don, keep up the wonderful job that you are doing. You apparently have a wonderful insight in seeing the obvious that too often is not seen by most of us. You have certainly been blessed with the astute ability to express your thoughts meaningfully and concisely. May you continue expressing your viewpoint to our profession for many more long years to come.
Most sincerely,
Robert Small, DC
Tel Aviv, Israel
Some Say SEAL Ad "Inappropriate," Others Say, "Why not?"
I noticed in the Dec. 2, 1994 issue of Dynamic Chiropractic a two-page ad by Frank Cucci promoting his "SEAL Team Unarmed Combat Course." Although it seemed out of place in "DC," I thought, "Why not?" After all, it is getting to be a pretty nasty world out there, and martial arts students need years to perfect those fancy wheel kicks popularized by Chuck Norris. Frank teaches basic and effective responses to threats that can be used by the average person rather than by nth degree black belts. Who knows when it might come in handy.
Your readers might be interested to know that the US Navy SEAL team consisted of only 300 enlisted men and officers in the early 1970s. And although it has since grown to almost 3,000, a surprising number of SEALs and UDT (underwater demolition team) have joined the ranks of chiropractic, thus becoming part of another very special team. And for the benefit of those ex-UDT/SEALs and other Navy Special Operators (boat units, etc.), or UDT/SEAL support groups, may I mention that we have resurrected the West Coast Assn. (called the UDT/SEAL Assn.) We operate similar to the East Coast Assn. (Fraternal Order). If your readers' affiliations are West Coast and they want to find their old "swim buddies" (and of course if they want to join the assn.), they can call me at (619) 423-9867 and I'll send them our newsletter and an application for either association. We'd love to hear from them.
Dr. Art Croft
Coronado, California
"... chiropractors start to focus on the soft tissue and forget to adjust!"
Dear Editor:
In reading your November 18, 1994 issue, I read Dr. Hammer's article, "Subluxation-Based DCs Need Soft Tissue." I didn't think about it until last night just before closing when I received a call from a woman who told me her husband had just been to a chiropractor in town for low back after lifting and was now feeling worse. He was at a new job and needed relief, could I do anything. I told her I did not know if I could do anything but I know the other doctor and her husband should come right down.
On questioning the patient told me the other doctor took x-rays, had him move around a bit which hurt, had him lay down and moved his leg which hurt more, put him on an electrical stimulator, did a little massage and sent him home with an appointment for the next day after telling him there was nothing special on the x-rays.
I did some ortho/neuro tests to rule out a disc. Then I did a biomechanical analysis, and adjusted at C1, several thoracics, a lumbar, and the sacrum. The guy was instantly able to move much better and had just a bit of soreness, probably due to residual swelling. I sent him home and told him to come back tonight but take it easy and leave work if it hurt too much.
Tonight, by objective range of motion, ortho/neuro tests, and biomechanical analysis, he was improved over even the condition he was in when he left last night. He was treated and, because he has a fairly large underlying problem, will be back.
I do not think most of the criticisms of soft tissue work are due to the idea of soft tissue work. I think what happens is that chiropractors start to focus on the soft tissue and forget to adjust! Either that or they do not know how to adjust, get lousy results adjusting because they do not know how to find the right things to adjust and fall back on the soft tissue because they do not know what else to do. They should probably be taking motion palpation seminars. At least as a start. (No, I have never been to one. I do standing and sitting full spine films to objectively measure the changes in biomechanics and then adjust.)
Also, Dr. Hammer's second paragraph shows the problem. "The spine does not support the human body." Is the statement along with the whole tent pole-guy wire analogy that is the problem. The spine is in no way analogous to the pole holding up a tent. The spine is a complex lever that acts to support the body. When that lever is misaligned, it can no longer function properly. Then the soft tissues will be pulled out of place and start a circle of problems that lead to fibrosis and spasm. By then you have to work on the soft tissues to loosen them and allow bones to move into a better position.
If Dr. Hammer's concept of a tent pole supporting a tent is the way this profession thinks of the spinal column, it is no wonder we have problems with the perception of chiropractic. I suggest he take some courses in mechanical engineering. The spine, pelvis, legs and feet (and the rest of the body) are the parts of a lever system whose levered forces are transmitted via the soft tissues more as a pulley or bicycle chain transmitting force (gears are circular levers modifying force produced by a power plant) than a rigid pole acted upon by guy wires.
Further, the spinal column, pelvis, legs, feet and everything else, including the spinal cord, work in a synchronized fashion to support the body by leverage. When something misaligns the leverage effect must be compensated for by increasing the force on the pulleys.
That is why foot or leg adjustments resulting in a better working lever system can reduce the length of the spine sometimes solving headaches while simultaneously reducing spasm in the back and neck. It is why atlas adjustments that improve the carriage of the spine by corrected lever action reduce the stretching of the spinal cord. That takes pressure off the lumbar spinal nerve roots and relieves pressure off the sciatica (by atlas adjustments only) even when the person has a herniated disc proven on MRI. The accompanying reductions in muscle tension in the trapezeus and elsewhere happen instantly, because that much force is no longer needed to support the spine since the lever is working better. What if you do not get those results? You adjusted either the wrong thing or the wrong direction.
These things are not true for every headache or every case of sciatica, but they have happened thousands of times just as other adjustments, seemingly unrelated to the problems at hand, often cured illness or pain in remote areas of the body.
Obviously with the proliferation damage being done by improper adjusting (witness the proliferation of malpractice claims which cannot all the happenstance and greedy patients), much of what we're doing now to analyze and diagnose biomechanical pathologies does not work well enough.
Chiropractors should be doing full spine biomechanical research, analyzing x-rays of patients in several positions so we can identify patterns in remote areas linked to a given illness or musculoskeletal pain. The complaint is not that soft tissue work is never needed, but that an osseous adjustment (maybe not just spinal) almost always is needed and cannot be replaced by soft tissue work.
Sincerely,
Jesse Jutkowitz, DC
Milford, Connecticut
"... most groups need a devil's advocate to shake things up, but please ..."
Dear Editor:
I would like to express my satisfaction with the development of your paper over the past several years. I enjoy reading all the columns you print and found them to be most informative. I have even read Dr. Keating's "Ivory Tower Review." I find his layman's perspective humorous. I would like to address several issues that Dr. Keating brought up in the November 18, 1994 issue of "DC."
In his article, Dr. Keating berated Dr. Sawyer, president of the ACA, for not having a "nonsense detector" in offering chiropractic as a panacea for all the ills of humanity. Also he chastised the ACA for not allowing chiropractic scholars and full-time faculty members from becoming full members of the ACA with voting privileges and the right to hold office.
Wake up Dr. Keating! The ACA represents the practicing chiropractic field practitioner. These are the men and women in the trenches who deal with a variety of patient conditions that's present in the office on a daily basis. Most of these doctors are ethical and responsible practitioners who treat their patients with honesty and to the best of their ability. With no disrespect meant, what would a chiropractic scholar know about managing live patients in pain? I personally would not be comfortable with the idea of having a chiro-scholar as president of a major organization making decisions as to the future of chiropractic.
Most chiropractic patients do not have simple, uncomplicated lower back pain. Most patients that I have treated have real problems that have not been satisfactorily treated by the medical establishment. These patients come to us as a last resort. I thank God every day that I have been able to help many of them.
Experienced chiropractors are aware of their limitations. They are aware of when their treatment plans have reached maximum improvement and when the patient might be better served by another practitioner. However, treatment plans are not based on what the current research community has "proven," but rather on how the individual patient is responding to care.
If an asthmatic patient is being helped by the adjustments, should we not accept the case or discharge the patient because "research" has not proven that adjustments help asthmatics? This view is apparent in your (article).
Clinical observation is the precursor of experimentation. If it were not for the clinician's "private empirical experiences," we would not have anything to research.
I realize that most groups need a devil's advocate (your role), to shake things up, but please, ... inexperienced minds might actually believe it.
Sincerely,
Post script: I do agree with your view that more clinicians should publish their clinical experiences.
Charles A. Sallahian, DC, DABCO
Nanuet, New York
Clinic Sale Scenario
Dear Editor:
I am presently faced with a dispute over the sale of the accounts receivable portion of my entire clinic sale. I'm opening this matter in an attempt to receive objective help from doctors who are familiar with this situation and to inform other colleagues to beware of falling into this scenario themselves.
My sale contract is nearly twenty pages and was finalized by an attorney. The section regarding the sale of receivables states that they are being sold for "50% of the value of all accounts receivable as they appear on the books of the practice as of the date of closing." The attorney assured me that this terminology indicates the two important issues: first, the receivables have and unknown collectibility potential and are therefore being offered at 50% of their book value to protect the purchaser from losses; secondly, being sold "as is" automatically implies that there is no "warranty."
Two years after the sale of the practice, the purchasing doctor completed a line audit of all files and determined that 25% of the total receivables purchased were in fact "dead and collectible" at the date of purchase. He strongly believes that because this certain part of the receivables were uncollectible at the time of purchase, he should now be reimbursed for what he paid for them. My contention is that all receivables accurately reflected services rendered (i.e. there was no misrepresentation of figures) and he had plenty of time to preform "due diligence" and check on their collectibility before he agreed to purchase them. I was led to believe that the way my receivables were sold is fairly standard in our industry. It's like selling a used car: as is, without warranty, and the buyer is free to have it checked out before purchasing. Now it's come back to haunt me two years later.
Surely there must be references to such similar situations that set an objective standard that can be used to help clear up this dispute. Please let me know if you have any advice. And fellow-doctors, if you ever sell your practice, don't rely on an attorney's streamlined way of saying what your intentions are. Meticulously write out every detail of all terms exactly as you want them represented!
Yours Truly,
Michael Koplen, DC
Santa Cruz, California