A study by Legorreta (2004) looked at approximately 1.7 million people for back pain treatment. the outcomes showed, when chiropracticc care was pursued, the cost of treatment was reduced by 28%, hospitalizations were reduced by 41% and back surgery was reduced by 32%, with the cost of medical imaging X-rays, MRI’s, CT’s) being reduced by 37%.

Additionally almost 95% of the patients who received chiropractic care stated they were satisfied with their treatment. It was estimated in Legorreta’s study that if chiropractic were used as the first treatment option for back pain, it could potentially reduce US healthcare costs by more than $28 billion annually.

So why do we till have a blind eye turned on manual therapy and chiropractic?

In 2008, Cook, Cook and Worrell reported  that manual therapy reported that manual therapy  in a hospital based setting significantly reduced both the hospital charges and the lengths of stays in the hospitals.  Wolk, a decade early, revealed that for diagnosis of low back pain, chiropractic had a 20.3% hospitalization rate while medicine had a 52.2% hospitalization rate. The chiropractic care also reduced the disability duration by 51.3%.

In 2007, Sarnat, Winterstein and Cambron stated there was a 60.2% reduction of in-hospital  admissions with a 59% decrease in hospital stays, a 62% reduction in outpatient surgeries and a 85% reduction in pharmaceutical costs.

Ebrall, in an Australian study from 1992 reported that injured workers returned to work 4 times faster with chiropractic care (6.26 days vs 25.56 days) and that these patients had a much lower incidence of chronic low back pain that would require further treatment.

Anyway you look at it, chiropractic is less expensive, gets people back to work more quickly and with less disability.

Every study here implies that chiropractic should be the first line of treatment for low back pain. Imagine how much we could save the American people in terms of the length of time in pain, the side effects from pain medicines, the reduction to disability, the improvement to quality of life, the improvement to job perform, the savings cost wise for health care. All these studies and still . . . business as usual. There is no incentive for conventional medicine to change. In fact it comes with a huge price to hospitals and pharmaceuticals.

Russo, A., Wier, L.M., and Elishauser, A. 2009 September. Hospital utilization amoung near elderly adults age 55-64.

2007 Agency for Healthcare Research and Quality from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb79.jsp

Legorreta, A.P. , 2004. Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine. 164, 1985-1992

Cook,C., Cook, A., Worrell, T (2008), Manual therapy provided by physical therapists in a hospital based setting. JPMT 31(5).

Wolk, S. (1988) An analysis of Florida worker’s compensation medical claims for back related injuries. Journal of the American Chiropractic Association 27(7).

Sarnat, R.L., Winterstein, J., Cambron, J.A. (2007). Clinical utilization and cost outcomes from and integrative medicine independent physician association. An additional 3 yeara update. JPMT 30(4).

Ebrall, P.S. (1992). Mechanical low back pain. A comparison of medical and chiropractic management within the Victorian work care scheme. Chiropractic Journal of Australia 22(2).

Dr Jenny Crosby

Getting patients well from St Peters and St Charles in St Charles County and outlying areas  for 15 years with chiropractic, traditional Chinese medicine, acupuncture, nutrition, food allergy testing, rehabilitative care and more

The participants had all been divided into 4 groups – those with no symptoms 49%; those with mild symptoms that didn’t interfere with work or leisure activities 40.9%; those whith intrusive symptoms that handicap work and leisure activities (these patients needed to use drugs, physical therapy and orthoses for their symptoms) 9.1%; those with severe symptoms (causing the patients to lose their jobs and rely continually on drugs, orthoses and repeated medical consultations) 4.5%.

Between 15.5 and 30 years, neck disability improved in 45.5% of patients, stated the same in 45.5% of patients and worsened in 9.1% of patients.

45.5% of patients were fully recovered at the 30 year mark.

15% of patients had significant symptoms and impairments after 30 years.

Although most patients had reached maximum improvement 2 years after their injury, this study showed that almost 9.1% continued to deteriorate 30 years after the injury.

At two years after injury about 50% of the patients were completely recovered and about 50% had ongoing symptoms. 4.5%  suffered from severe symptoms at the 2 year mark.

Whiplash patients with a disability often develop abnormal pyschological profiles (they get depressed/withdrawn)

For me, what I notice, is that while 50% were asymptomatic at the two year mark, 4.5% had a return of symptoms at the 30 year mark and at the 30 year mark the basic stat to consider is that more than half 59.5% has symptoms. As chiropractors we tell whiplash patients to stay proactive with cervical stretches and periodic spinal adjustments after an injury of this nature. To see 15% with significant symptoms I will continue to suggest this level of proactivity to patients. Remodelled soft tissue needs TLC to keep it happy for life! Interestingly enough – this has been the chiropractic model for a century! Research is now validating what we already know!

1) Symptoms:     fatigue/kidney/heart/lung issues, rash and joint pain (often misdiagnosed as chronic fatigue syndrome, fibromyalgia, or rheumatoid arthritis)

Diagnosis:         Lupus

Tests to confirm: CBC, anti-dsDNA, ANA and lupus erthymatosus cell tests, chest film if symptoms warrant it

2) Symptoms:      tremors in the hands, arms, legs, head; stiff muscles or problems with balance or walking (often misdiagnosed as Alzheimer’s, stroke, stress, traumatic head injury, essential tremor

Diagnosis: Parkinsons

Tests – None

3) Symptoms:      vomiting, abdominal pain and bloating, diarrhea, weight loss, anemia, leg cramps (often misdiagnosed as IBS, Crohn’s disease, cystic fibrosis)

Diagnosis: Celiac Disease

Tests:  Antibody blood tests may be postive in up to 10%, small intestine sample biopsy, genetic (DNA) testing

4) Symptoms: loss of memory or concentration, sore throat, painful lymph nodes in neck or armpits, muscle and joint pain, extreme exhaustion (misdiagnosed as sinus issues, hepatitis, fibromyalgia, lupus, rheumatoid arthritis)

Diagnosis: Chronic fatigue syndrome

Tests – Diagnosis is based on ruling out all above mentioned disorders.

5) Symptoms: anxiety, depression, increased pain sensitivity, incapacitating fatigue (often misdiagnosed as Rheumatoid arthritis, chronic fatigue syndrome)

Diagnosis: Fibromyalgia

Tests: None. Diagnosis is made based on presenting with a history of generalized pain lasting 3 or more months and the presence of at leat 11 tender spots on the body that are extraordinarily sensitive to pain.

Dr Jenny Crosby

Getting St Charles County well for 15 years with chiropractic, traditional Chinese medicine, acupuncture, nutrition, food allergy testing, rehabilitative care and more

“For over 30 years, chiropractic has kept me walking. At 17 I was given a wheelchair opportunity and at 21 my back became very bad again once again affecting my ability to walk. I chose chiropractic both times and for the next 29 years managed my permanent back condition well with chiropractic. Last fall, a new injury compounded by my old issues left me looking at surgery and the likelihood of permanent neurological issues. Once again, chiropractic has kept me out of surgery and over this past year I have regained most of my function and reduced most of the pain . . . . again! My daily activities will continue to be as normal as they can be with chiropractic care.  Maintaining quality of life will keep me a chiropractic patient for life.”

1) Stents for Stable Angina. A stent for stable angina is no better at preventing a heart attack or prolonging survival than lifestyle choices such as exercising and eating healthily to reduce cholesterol according to a 2007 study from the Dept of Veterans Affairs. About 500,000 of these implant procedures occur yearly for stable angina. If your doctor orders a heart catheterization test (keyword here – test), you have the right to ask that they do not stent you while they are performing this test. Instead, try a strict diet and exercise.

2) Spinal fusion. Here the orthopedist fuses two vertebrae together with bone grafts to stop motion and prevent pain. This procedure is often used for spinal stenosis (where the hole for nerve roots or for the spinal cord itself is compromised by bony degeneration. There is no consensus on how to relieve this pain so each doctor has their own preferences. Fusion seems to be the top treatment choice. A study by Deyo reviewed the records of 30,000 Medicare patients who underwent fusion surgery for stenosis of the low back and found the rate of this procedure had increased 1400% from 2000 to 2007. Those having this procedure were three times more likely to have life threatening complications from surgery than those undergoing less invasive procedures. Other studies have suggested that the outcome for fusion surgeries is actually worse than other types of surgeries. Floyd Fowler Jr., PhD., with the Foundation for  Informed Medical Decision Making states “the vertebrae above and below the fusion side have to do a lot more bending and it puts stress on your back.” Alternatives here? Chiropractic, acupuncture, physical therapy, PRP injections and if necessarily medicines, cortisone or pain managment.

3) Hysterectomy. Annually 600,000 women have this procedure. A hysterectomy is critical when the patient has cancer (maybe 60,000 of these surgeries). Most women have this procedure done though for heavy bleeding and for pain caused by uterine fibroids. Complications are HUGE!  There is a 60% likelihood of being incontinent by age 60 and if the ovaries are removed or damaged in the process of performing the hysterectomy, the patient is thrown instantly into menopause, facing a higher risk of heart disease and lung cancer. Alternatives involve uterine artery embolization where there arteries to the fibroid are blocked starving the fibroid or focused ultrasound which shrinks the fibroid with ultrasound waves. Eating 7 to 9 servings of vegatables and using traditional Chinese medicine/acupuncture are also ways to improve these symptoms.

4)  Knee Arthroscopy. A tiny camera is inserted into your knee through a small incision to repair torn or aging cartilage. This procedure works well if the meniscus is torn but is no more successful, than chiropractic, acupuncture and physical therapy in terms of outcome for other issues. It is much better here to start with manual therapy and orthotics/better shoes if necessary, and look at medication and shots to the knee secondly with this type of surgery being the left until you have explored all these options.

5) Gall bladder removal. Again a tiny camera is usually used through little incisions after the abdomen is inflated with air. 60% of those undergoing gall bladder surgeries still have symptoms. There are all the risks mentioned  with stenting, in addition to creating possible GI distress and infection. Once again, modifying diet to remove heavy fats, eliminating ice from beverages (it will cause fats to coagulate in the gut making it harder for the gallbladder to do its job). There are procedures for gall bladder flushes that can be performed under the guidence of a physician if the gall bladder has sludge to it. The pain of a gall bladder attack when dietary choices have been poor can be managed with acupuncture and medicine. Digestive enzymes may be a necessary supplement. Antacids change the pH of the gut making digestion/absorption of nutrient more difficult and should be avoided.

Getting patients well from St Peters and St Charles in St Charles County and outlying areas  for 15 years with chiropractic, traditional Chinese medicine, acupuncture, nutrition, food allergy testing, rehabilitative care and more

This is not just an third world country issue either. Studies suggest up to 70% of the North American population is also Vitamin D deficient.

Vitamin D is not just a vitamin. Researchers have discovered that this incredibly important nutrient acts more like a hormone on our bodies and is literally critical to function on many levels.

Patients with Vitamin D deficiencies are often misdiagnosed with fibromyalgia because of the widespread symptoms of pain and impaired neuromuscular function. In fact, I would suggest that ANY patient with a chronic pain syndrome that is not localized to just one region, be tested for this deficiency.

Vitamin D can become deficient in the body for several reasons. Lack of sunlight, use of sunscreen, more melanin pigmented skin can create this deficiency and in the case of little outdoor time and use of sunscreens/sunblocks, Vitamin D supplementation may become more critical. Certain medications and supplements can also contribute to a Vitamin D deficiency. In particular be aware that if you need to take anti-seizure medicine, glucocorticoids, Rifampin, or St John’s Wort that you should automatically be supplementing with a good Vitamin D source.  While most labs say the blood levels are normal if between 30 to 80 or 30 to 100 nanograms per mL, research currently suggests that 50 to 80 is the optimal range and levels over 150 are possibly toxic.  As we everything, more is not always better so when starting on this fat soluble vitamin it is good to get a blood test on your dose at the 90 day mark to establish if you are in a healthy range. Those who are older, obese, or dark skinned may need a higher dose to reach and maintain a good blood level of this critical nutrient. Higher doses may be required in the winter months. Patients being aggressively supplemented with up to 5000 IU a day should also have their serum calcium and magnesium levels monitored.

There are certain illnesses that will contribute to Vitamin D deficiencies also. Any gastrointestinal malabsorption syndromes such as Crohn’s, Celiac and Whipple’s disease, Sprue,  irritable bowel syndrome, and certain non gastrointestinal issues such as fatty liver, liver disease and cystic fibrosis are illness states that all require automatically testing for and adding (when necessary) a good Vitamin D supplement.

When we get in the sun our skin takes parts of light and converts it to pro-vitamin D. Pro-vitamin D is also obtained from diet and looks exactly the same as the sunlight source. Our body then converts the pro-vitamin D in the liver (this explains why liver issues will impair our ability to have good levels of Vitamin D) to D2. Large amounts of D2 will then circulate in the blood and the kidneys will convert it to D3 with the help of parathyroid hormone and blood calcium and phosphorus. Many patients are prescribed D2 which is not helpful symptomatically. D3 is what is needed for physiological function and the prescription D2 is very large dose and will tax the kidneys badly. In some it may cause kidney damage and it should NOT be prescribed to those with any form of kidney compromise. Over the counter forms of D3 are already in usable form and the kidney is not required to work overtime converting a less user friendly form of D2 to the usable D3.

Once in the blood serum as D3, this fat soluble vitamin acts as a secosteriod, which is similar in structure to a steriod except certain bonds are made differently. It is most likely this steroidal form enables Vitamin D to function as such an effect way of modulating inflammation and pain in the body.

Vitamin D has now been found to impact a wide variety of tissues and targets more than 2000 human genes or 1/6 of the human genome. virtually every cell in the body has a vitamin D receptor. The brain, prostate, breast and colon tissues and all cells of the immune system require Vitamin D3 to regulate them. It is recognized now that Vitamin D deficiency is a huge factor in determining risk for many cancers including breast, prostate, colorectal and pancreatic cancer.  In addition, deficiency of D3 is associated with coronary artery disease, heart disease, high blood pressure, asthma, insulin production in metabolic syndrome, and Type 2 adult-onset diabetes. Even obesity may, in some researchers opinions, be linked to Vitamin D deficiency (of course we are not letting diet off the hook here.)

Here is a brief summary of issues related to Vitamin D deficiency.

1) Autoimmune disease. Vitamin D deficiency has been linked to a variety of autoimmune diseases  including Type 1 diabetes, Crohn’s, multiple sclerosis, rheumatoid arthritis, Behcets disease, SLE, and Hashimoto’s disease.

2) Psychiatic problems.  Chronic Vitamin D deficiency has been suggested to be involved in Alzheimers, Parkinson’s, dementia, autism, depression and schizophrenia (look to B vitamins with these too as their may be concurrent issues)

3)Common illnesses. Because Vitamin D receptors are on every type of cell involved with the immune system it is not surprising that the deficient in Vitamin D are being found to be more at risk for colds/flu. In addition other common illnesses such as periodontal disease, cardiomyopathy, osteopenia, osteoporosis, osteomalacia, muscle weakness are being associated with this deficiency.

4) Vitamin D is critical for maintaining normal calcium, phosphorus, magnesium levels and for bone metabolism and for assisting with calcium function with muscle contraction and relaxation states, so chronic Vitamin D deficiencies will impact both bone and soft tissues. Fibromyalgia, muscle soreness, muscle weakness, osteopenia, osteoporosis, rickets and even osteoarthritis are being identified as having a higher incidence in those with Vitamin D deficiencies.

5) Endocrine metabolism effects. Low levels of D3 can impact parathyroid hormone and the thyroid gland function resulting in abnormal depositions of calcium in soft tissues.

The Vitamin D council advocates taking 1000 IU of Vitamin D3 per 25 pounds of body fat per day. This dose is safe for all ages, including children. For pregnant or nursing women, up to 4000 IU’s a day is recommended.

Vitamin D is contra-indicated in those with  Vitamin D hypersensitivity, and in those with sarcoidosis, oat cell carcinoma, non-Hodgkins lymphoma and primary hyperparathyroidism.

Dr Jenny Crosby

Getting patients well from St Peters and St Charles in St Charles County and outlying areas  for 15 years with chiropractic, traditional Chinese medicine, acupuncture, nutrition, food allergy testing, rehabilitative care and more

I tell patients regularly that their doctor must correlate a disc bulge on an MRI with the symptoms they are presenting with. Too often the disc bulge is old and is not the reason for their pain. Failed back surgeries happen far too often because a bulge is seen and surgically dealt with and it is old and not the cause of the current symptoms.

If 100 people had spine MRIs from neck to low back, almost 60% of them would have a disc bulge somewhere. The bulge by itself, should not warrant surgery.  Surgeons are geared, generally, to surgery. Getting a second opinion about your pain pattern from a chiropractor, prior to having surgery can never hurt.

Year’s ago the Manga study out of Canada suggested millions a year in health care could be saved by making chiropractors the mandatory portal of entry health care provider for musculoskeletal complaints. A few years later, Kaiser found that patients receiving chiropractic averaged less dollars a year spent on overall health care. This study is suggesting that employers, employees and each states worker’s compensation system would benefit from using chiropractors as portal of entry for musculoskeletal low back pain incurred at work. Ironically, in Missouri, getting employers to authorize chiropractic for these patients is like getting milk from a stone. . .

What will it take before common sense and chiropractic prevail in the musculoskeletal market?