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American Chiropractic Asssociation President’s letter to the Washington Post on Veterans and Narcotic usage

(copied and pasted from the ACA website)
Letter to The Washington Post
February 24, 2015

Dear Editor,

This letter is in response to your Feb. 18 article on how the new federal rules are making it harder to get narcotic painkillers for veterans who depend on these prescription drugs to treat a wide variety of ailments (“New rules on narcotic painkillers cause grief for veterans and VA”).

The health and well-being of our veterans is of the utmost importance. Given the epidemic of overuse and abuse of prescription pain medications in the United States, veterans need access to non-drug approaches to pain management. In fact, a recent report released by an independent National Institutes of Health (NIH) panel about the need for individualized, patient-centered care to treat and monitor the estimated 100 million Americans living with chronic pain, concluded that widespread opioid use does not provide an effective single approach for the chronic pain patient.

The Joint Commission recently revised its pain management standard to include chiropractic services. Clinical experts in pain management working with the Commission affirmed that treatment strategies may consider both pharmacologic and non-pharmacologic approaches. Services provided by doctors of chiropractic are now included in the standard of care for pain management, effective January 2015.

Although the Department of Veterans’ Affairs (VA) currently provides access to a doctor of chiropractic (DC) at just over 50 major VA treatment facilities within the country, a great number of America’s eligible veterans continue to find it difficult to clinically indicated chiropractic services. As a result of this disparity, a new bipartisan bill, S. 398, “The Chiropractic Care Available to All Veterans Act,” was recently introduced in the U.S. Senate and House of Representatives to integrate the services of chiropractic physicians at all major VA medical facilities over several years and codify chiropractic as a standard benefit for veterans accessing VA care.

Veterans deserve access to the essential services provided by chiropractic physicians, especially since a great number of returning overseas veterans are suffering from musculoskeletal ailments.

Anthony W. Hamm, DC
President, American Chiropractic Association

A fond farewell to an old friend

Friends and Patients who’ll view this blog,

Last week my trusty and faithful friend, confident, and employee, Sharon Etchen, retired from Lehmann Chiropractic Center.  Sharon started work with me on May 7, 1990.  I had barely been a doctor for 6 months.

Sharon initially was a part-time employee that was happy to work full time for my office.  She was there for so many great and happy professional moments for me.  She was tireless as a chiropractic advocate.

Thank you Sharon for all your hard work, timeliness, patience, and loyalty.  I miss seeing you on a daily basis already!  Enjoy your retirement.  You earned it.

Sincerely,

Dr. Steven Lehmann

Thank you for the bottle of wine!

Dear Readers and followers of my blog,

I’ve always wanted to be a chiropractor.  At least from age 4 on.  Prior to that who knows?  By age 15 I was already working in my father’s office.  I was one of his assistants.  I monitored therapies he had applied on his patients and made sure no one got burned or the electrical stimulation wasn’t too strong and painful.

One afternoon my dad had an X-ray on his view box and asked if I saw anything wrong on the film.  I was probably only a sophomore or junior in high school and haven’t had any gross anatomy yet.  I hadn’t learned skeletal anatomy either.  After a minute or 2 of staring at the film I told dad that I thought something was wrong with this patient’s coccyx.  Surprised he asked me to explain more.  I told him I thought the person’s “tail” had a weird angle to the bones.

Dad was really surprised and I remember a feeling of pride was conveyed in his face.  He then told me the patient had fallen on her buttocks and broken her coccyx.  Those small bones of what people know as the tail bone were broken like a finger that looked bent at 90 degrees.  I remember asking him how he would “fix” this person.  He explained to me that she would have to referred to an orthopedist.  The orthopod would have to anesthetize the patient, reach into her rectum and then re set the bones back into place.  It would be too painful to do this in his office without anesthesia.

Fast forward now 35 years.  A week ago I had a patient who called me to say that her son had fallen on his tailbone months ago and still wasn’t well.  She had taken the young teen to see her family medical practitioner who correctly made a referral for an X-ray.  She was requesting for me to get a copy of the report and give my opinion.  The report arrived too late for me to read it to her on Friday evening, but I came back to my office on Saturday morning with this single task in mind.  I read the report as normal and called her to tell her so.  Still not convinced she asked if I would view copies of the films, which is actually a good idea.  I say that, because it was just a year ago that I referred a patient out for an X-ray that the radiologist misread as normal, however upon viewing the DVDs I was of the opinion that a spinal compression fracture was actually present.

On Monday I was provided with a CD of the films.  It only took me a moment to see a 90 degree angle between the 1st and 2nd coccygeal bones.  It was probably broken/dislocated.  I called the mom to tell her my findings and that her hunch was probably correct.  My next call was to the radiologist out of Columbus that interpreted the films.  After a short phone call he expressed the need to get a third opinion from one of his colleagues.  Without being definitive he agreed that this coccyx appeared irregular and could be fractured.

I spoke next to the mom.  I told her exactly what was happening and how I thought we should proceed next.  Remembering my father’s experience at age 16 or so I told her that he needed to see an orthopedist and possibly have this straightened.  We discussed an orthopod out of Findlay, OH. that my wife had needed when she broke her wrist.  I have sent this doctor a few other patients.  As a doctor I can sense who really cares and who is also a sharp.  This ortho is one of those kind of doctors.

As a professional courtesy I forwarded a copy of the radiology report, with my notes that I had spoken to the radiologist, to the family practitioner.  The notes also contain the fact that a referral to an orthopod was being made and who.

On Friday of last week I was greeted by the mother of this teenager in my office.  She had brought a lovely bottle of Malbec from Argentina to me as a thank you gift.  Needless to say I was tickled to death.

Thank you for the bottle of wine and thank you dad for the lessons you taught me oh so long ago.

How to Immediately Improve your life- Arianna Huffington

How to Immediately Improve Your Life (Hint: It Starts With Improving the Lives of Others)
Posted: 09/09/2013 6:55 pm

Last week a few HuffPost editors and I were treated to a visit by Bill Drayton and Mary Gordon. Bill Drayton is the founder of Ashoka and a longtime champion of social entrepreneurship, a term that he coined and that has now spread across the world. Mary Gordon is a former kindergarten teacher who founded Roots of Empathy, an organization dedicated to teaching emotional literacy and promoting empathy in children. She was also one of the first Ashoka fellows. Our visit started with talk of the newborn recently welcomed by one of our editors, Gregory Beyer, whereupon Mary presented him with a onesie with “Empathy Teacher” emblazoned on the front. But as Mary — a great empathy teacher herself — told us, it’s a two-way street, and empathy is best nurtured by example. “Love grows brains,” she told us. “We need to show children a picture of love as we raise them.”

And giving not only nurtures empathy; it’s an outgrowth of our innate capacity for empathy. It’s also one of the key components of HuffPost’s Third Metric initiative to redefine success beyond the first two metrics of money and power to include well-being, wisdom, and our ability to wonder and to give — all of which are boosted when we give our time and effort to something other than ourselves.

Philosophers have known this for centuries. “No one can live happily who has regard for himself alone and transforms everything into a question of his own utility,” wrote the first-century Stoic philosopher Seneca in his Moral Letters to Lucilius. And in practically every religious tradition and practice, giving of oneself is a key step on the path to spiritual fulfillment. Or, as Einstein put it, “only a life lived for others is a life worthwhile.”

Since Einstein, scientists have been trying to come up with the “theory of everything,” which would explain our entire physical world by reconciling general relativity with quantum physics. In the study of our emotional world, there’s no analogous theory of everything, but if there were, empathy and giving would be at the center of it. And modern science has overwhelmingly confirmed the wisdom of those early philosophers and religious traditions. Empathy, compassion, and giving — which is simply empathy and compassion in action — are the building blocks of our being. With them we flourish; without them we perish.

In his book The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom, Jonathan Haidt writes that “caring for others is often more beneficial than receiving help. We need to interact and intertwine with others; we need the give and take; we need to belong.”

Science has broken down why this is. A crucial component, a molecule of compassion, is a hormone called “oxytocin,” also known as the “love hormone,” the “love drug,” and the “moral molecule.” And not without reason. It’s released naturally in our bodies during experiences like childbirth, falling in love, and sex. Higher levels of oxytocin are associated with heightened desire and ability to connect socially. Lower levels are associated with conditions like depression and autism.

Researchers have found that giving people oxytocin can lower their anxiety and mitigate shyness. A study by neuroscientist Paul Zak showed that a squirt of oxytocin to the nose increased the amount of money participants offered each other in an experiment. “The seven deadly sins are still deadly, because they separate us from other people,” said Zak. “They are all about putting ‘me’ first and that is maladaptive for social creatures like us.”

The hormone should not be confused with oxycontin, a highly addictive opiate-based painkiller that has caused thousands of overdose deaths. Oxytocin, the “love hormone,” is in a constant battle with cortisol, the “stress hormone.” Of course, we’ll never completely eliminate stress from our lives, but nurturing our empathy and giving is a sure way to reduce our stress.

But for the greatest positive effect, it’s not just about empathy; it’s about the right kind of empathy. In trying to understand our leaders’ “weirdly detached” reaction to Hurricane Katrina, Daniel Goleman, a journalist and the bestselling author of Emotional Intelligence, describes psychologist Paul Ekman’s breakdown of the three kinds of empathy. First, there’s “cognitive empathy,” which is knowing how someone else feels or what they’re thinking. But simply understanding another’s position doesn’t mean we’ve internalized what they’re feeling. So there’s also “emotional empathy,” in which we actually feel what another person is feeling. This is triggered by so-called “mirror neurons.” But given the amount of suffering we’re so frequently exposed to, it would be too draining to live in a constant state of emotional empathy. “This can make emotional empathy seem futile,” writes Goleman. But there’s the third type, which Ekman designates “compassionate empathy,” in which we know how a person is feeling, we’re feeling their feelings along with them, and we’re moved to act. So compassionate empathy is a skill we can nurture, and one that leads to action.

So this is the kind of empathy we’re fueled by when we’re giving back — though even the term “giving back” is misleading. It implies that service and volunteering are important only in terms of what they do for the community or the recipient. But just as important is what they do for the giver or volunteer. And the science on this is as unambiguous as it is amazing. Essentially, giving back is a miracle drug (with no side effects) for health and well-being.

Indeed, we’re so wired for it that our genes reward us for giving — and punish us when we don’t. Last month Gretchen Reynolds reported on a study by scientists from the University of North Carolina and UCLA that found that participants whose happiness was mostly hedonic (or about consuming) had high levels of biological markers that promote inflammation, which is linked to conditions like diabetes and cancer. Those whose happiness was based on service to others had health profiles showing reduced levels of these markers. Of course, we all experience a mix of both kinds of happiness, but our bodies’ internal system is subtly pushing for us to augment the kind based on giving.

Many other studies show the positive health boost provided by giving. A 2013 study by Dr. Suzanne Richards of the University of Exeter Medical School found that volunteering was connected to lower rates of depression, high reports of well-being, and a significant reduction in mortality risk. And a 2005 Stanford study found that those who volunteer live longer than those who don’t.

The effects of giving back as we age are especially dramatic:

A study from Duke University and the University of Texas at Austin found that seniors who volunteered had significantly lower rates of depression than non-volunteers.
A 2011 Johns Hopkins study found that volunteering seniors were more likely to engage in brain-building activities, which lowers the risk of Alzheimer’s disease. Regaining a sense of purpose among older people who had suffered the loss of their defining roles as parents or wage earners is another advantage of volunteering.
Studies of the effects of giving in the workplace are equally dramatic and show that the way to a more productive business and a healthier, more creative and collaborative workforce is not by continuing our culture’s dangerous devotion to burnout and overwork. For instance, a 2013 study by United Health Group found that employee volunteer programs increased engagement and productivity. The same study showed that:

Over 75 percent of the employees who had volunteered said they felt healthier.
Over 90 percent said their volunteering had put them in a better mood.
Over 75 percent reported experiencing less stress.
Ninety-six percent said that volunteering enriched their sense of purpose in life (which in turn has been found to strengthen our immune function).
Employees who volunteered also reported improved time-management skills and enhanced ability to connect with peers.
Another 2013 study, this one by researchers at the University of Wisconsin, found that employees who give back are more likely to assist their colleagues, more committed to their work and less likely to quit. “Our findings make a simple but profound point about altruism: helping others makes us happier,” says Donald Moynihan, one of the study’s authors. “Altruism is not a form of martyrdom, but operates for many as part of a healthy psychological reward system.”

And one that should also be incorporated into how we think about health care. “[I]f you want to live a longer, happier, and healthier life, take all the usual precautions that your doctor recommends,” says Sara Konrath of the University of Michigan, “and then… get out there and share your time with those who need it. That’s the caring cure.”

So given the unmistakable health benefits of empathy and specifically putting empathy into action, how do we strengthen it? And how do we pass it on? Parents put a lot of time into thinking about how to pass on a better material life to their children, but it’s just as important to focus on passing down a rich capacity for compassion. This is especially true in our modern world, in which our deep, hard-wired need to connect with others is beset on all sides by distractions and technology and the lure of ersatz connections.

One 2010 San Diego State University study found a five-fold increase in depression among children since the Great Depression. Another, commissioned by the American Psychological Association, found that millennials were the most stressed demographic in the country last year.

However, the news is not all bleak. John Bridgeland, a leader of the national service movement, believes millennials could “rescue the civic health of our nation after decades of decline.” Recent studies corroborate his sentiments. A 2009 report by the National Conference on Citizenship shows that millennials “lead the way in volunteering,” with 43 percent engaging in service. According to a Harvard Institute of Politics study, the numbers are even higher for college students, with 53 percent saying they had volunteered in the past year, over 40 percent of whom volunteer multiple times per month.

So what can parents do to enhance their children’s sense of empathy? Health journalist Maia Szalavitz and child psychiatrist Bruce Perry are the authors of Born for Love: Why Empathy Is Essential — and Endangered. According to the authors, parents can nurture empathy the same way they help their children start talking. “[E]mpathy is a natural human quality like language — one that relies on specific early experiences to develop properly,” they write. “When these experiences of nurture and human contact are present for children, families, cultures and economies tend to flourish.”

Back in the HuffPost office, during our empathy teach-in, Mary Gordon echoed this point. “We need to show children a picture of love as we raise them,” she said. “Learning is relational, and empathy is constructed, not instructed.” So it’s not enough to tell your children about empathy or to think of how someone else feels. We have to show them. Which means, of course, that we have to do it ourselves. “The baby reflects the emotional state of the parents,” Mary told us. And this makes the positive emotional effects of putting our empathy into action all the more essential.

At one point, one of our editors asked whether the effects of a childhood not rich in empathy could be reversed. Yes, Mary replied, it’s never too late. So the good news is that we can transcend our childhoods, and that any entry point of giving and service can lead to benefits for our well-being — and of course, our community.

That’s good to hear since, as Bill Drayton emphasized to us, empathy is increasingly becoming our primary resource for dealing with the exponential rate of change the world is going through. “The speed at which the future comes upon us — faster and faster — the kaleidoscope of constantly changing contexts,” he told us, “requires the foundational skill of cognitive empathy.”

And the best way to build that internal foundational skill is to reach outward. And compassion and giving don’t have to include getting on a plane to build houses or teach school in a remote part of the world. It may simply involve helping people across town. And it doesn’t just involve giving money. As Laura Arrillaga-Andreessen put it in her book Giving 2.0, it may involve helping “business professionals donate skills in areas such as strategic planning, management, human resources, marketing, design, or IT to nonprofits in need of those skills,” as the Taproot Foundation does.

Technology has made it possible to be in a self-contained, disconnected bubble 24 hours a day, even while walking down the street. Our devices might seem like they’re connecting us, but they’re really disconnecting us from other people, without whom it’s hard to activate our hard-wired need for empathy.

Follow Arianna Huffington on Twitter: www.twitter.com/ariannahuff

Sacro-iliac pain and Chiropractic

I took the following from a chiropractic message board. It is copied and pasted. From one of my colleagues:

Yesterday a male patient in my office mad as a hornet. About 6 months ago, I
told him he had a SI subluxation. Needed Chiro care, no he went to the “EXPERT”
Ortho surgeon. 6 weeks of PT, hip replacement and guess what? Still has sharp
pain at the PSIS!Surgeon says nothing else to do, he needs counseling on how to
live with chronic pain. He also has a script for 2 vicodin pills/24hrs.

I love the scientific approach. (High profit) Beats a dumb non scientific
Chiropractor. (Very little profit in Chiropractic).

Evon Barvinchack, D.C.

Thanks Dr. Barvinchack for this post. I didn’t ask to repost it, but I’m sure you won’t mind.

Steven D. Lehmann D.C.

A question on exercise from a patient

A patient posed this question to me today: Better to go to the chiro after a workout or before?

My answer was this: I would suggest before…….why?

Because joints that are locked are also called inhibited. This joint inhibition also affects muscles by making them weaker and usually tighter (think about it, if you’re tight/contracting muscles you’ll sooner or later experience muscle fatigue. Therefore, weaker muscles are the result of constantly tight muscles.)

So, if you get adjusted beforehand, then the muscles will be stronger, work more efficiently, and actually strengthen more properly.

Of course, then you’ll have muscles that are fatigued from exercise, cause reflexive joint inhibition, and the aforementioned process starts all over again. So you’ll need an adjustment again. That being said, you’ll get yourself to a point where you’ll actually be able to exercise without the need of an adjustment so frequently. Which is where most of us Chiropractors are at and some of our patients.

Many of the elite athletes have gotten to that understanding. They have really come to know their bodies well. They are so in tune with the feedback mechanisms that it’s amazing.

Thank you for reading,

Dr. Steven Lehmann

Cost of back pain (part 2)

Part 2- Back Pain and Costs: As previously mentioned, the costs of back surgeries can run as high as $169,000 for a lumbar fusion and $112,000 for a cervical fusion. In 2010, researchers reviewed the Ohio BWC’s data of 1,450 patients diagnosed with either lumbar disc degeneration, herniation, or radiculopathy. Half of the aforementioned group went through lumbar disc fusion surgery for 2 or more vertebrae. The other half didn’t have surgery even though they had similar diagnoses.

After 2 years post surgical, only 26% of those patients who had surgery had returned to work. The non-surgical group comparatively had a 67% return to work rate. The surgical group (again nearly half of 1,450 patients) had a 36% complication rate with a re operation rate of 27%.

The most eye opening fact was that researchers determined there was a 41% increased use in pain killer usage. And that 76% of patients continued opioid medication use after surgery. A shocking 17 of the post surgical patients actually died during the course of this study!
A review of pain management therapies by R. Norman Harden, MD in the American Pain Management Bulletin states “we practice at a time when unproven experimental, invasive, and expensive procedures are often compensated without question. Many of the surgical and interventional techniques have never been subjected to evidence based inquiry. Oddly, the FDA approves devices and procedures relatively easily … in this context, there has been a proliferation of extremely goofy therapies, which are expensive at best, and downright dangerous at worst.”
Another criticism of epidural steroid injections appeared in the American Pain Society Bulletin by Steven H. Sanders, PhD, who revealed nerve blocks for back pain are not supported by scientific research: “From the current review, we must conclude injections and nerve blocks produce a large amount of money with very little science to support their application.”

Part 3- Back Pain and Costs: Medical Myths

“But my doctor told me I need a back surgery!” I’m sure he did, but did you know that of the nearly 500,000 plus back surgeries performed annually only about 10% were necessary? Dr. Richard Deyo, MD, MPH is quoted as saying, , “It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just six years,” and he mentioned one strong motivation included “financial incentives involving both surgeons and hospitals.”

In 1994, Drs. Cherkin and Deyo performed a study that examined the international rates of spinal surgery with that of the United States. They found that back surgery rates in the USA were nearly 40% higher than that of any other country. They also determined that back surgery rates in the U.S. were 5 times higher than that of England or Scotland (socialized medicine is practiced there). It was apparent to Deyo and Cherkin that the excessive number of neurosurgeons and orthopedic surgeons had a linear on the number of surgeries performed per capita. Basically said, since we have so many surgeons over here, then we can expect each one of them to do more than their share.

But you’re going to tell me that an MRI or a CT scan revealed this large herniation. I’m sure it did, but did you know that a repeatable study employing an MRI on 100 and a 1,000 pain free patients, who never had back pain, revealed 30% of these people had bulging or herniated discs, but were pain free! It’s not surprising that in areas of the world (and of course the US) where MRIs and CT scans are in high numbers that they also have a high correlation of back surgeries.

I personally have seen patients with lumbar strains, facet syndromes, arthritis anteriorly and posteriorly, and mild stenosis who also had positive MRIs for disc herniations of bulges, but their source of pain wasn’t from a disc herniation. And when I treated their cause they responded. The med docs aren’t alone. I too have seen MRIs with large disc lesions that I referred out to surgeons only to hear the patient be told to return to my care for a few more weeks of conservative treatment and ultimately they didn’t need surgery. Or the patients who refused surgery after being referred out who later became symptom free.

The problem isn’t just the abundance of surgeons or imaging facilities, the problem is that doctors are often not treating the biomechanical causes of patients’ back pain. Even covering up the pain with narcotics, steroids, and injections isn’t treating the true cause of their pain. All too often doctors rely on radiographic findings rather than a good history and examination. Many of my patients tell me that their exam was lacking, the doctor never touched them, or worse yet they were examined by a non-physician (nurse or physical therapist). My question is how do you determine which structures are actually at fault or injured if you don’t examine the patient fully.

Continued-

“But my medical doctor doesn’t believe in Chiropractic and wants to send me to a surgeon.”

First off, we’re a profession, not a therapy. Chiropractic is a profession. What we do is adjust or manipulate and more. Many of my colleagues perform acupuncture, taping, rehab., nutritional and diet counseling, sports medicine, neurology, imaging interpretation, mid-wifery, pediatrics, applied kinesiology, reflexology, and much more. You don’t just clap your hands and believe in us. How unscientific is that comment?

The Costs of Back Pain (part 1)

Back pain and costs: On the top ten list of diseases in America, low back pain is listed as #8. According to Forbes it costs us $40 billion annually. Low back pain sent over 3 million people to the hospital emergency rooms in 2008 at a cost of $9.5 billion. Low back pain ranked as the 9th most expensive condition treated in U.S. hospitals that year.

In spite of the overwhelming research and the new wave of data that proves much of the current medical/allopathic treatments are ineffective and costly; the medical establishment across the US has failed to read or heed the data and research. They continue to prescribe opiates, epidural steroid injections, and radical surgeries despite the warnings of their peers.

The costs of back surgery are staggering and are among the most expensive. Not including costs such as hospitalizations, imaging, drugs & medications, iatrogenic injuries, and other associated costs; the base costs are listed below:
 Anterior cervical fusion: $44,000
 Cervical fusion: $19,850
 Decompression back surgery: $24,000
 Lumbar laminectomy: $18,000
 Lumbar spinal fusion: $34,500

Dr. Richard Deyo, MD, MPH found that when combined with surgical costs, MRIs, rehab, and disability, spine surgery costs approach $100,000. And the direct costs for lumbar spinal fusion may reach as high as $169,000. A cervical Fusion can cost as high as $112,000.

In 1998 a research study was published in the Annals of Internal Medicine by Dr. Paul G. Shekelle, an internist with the West L.A. Veterans Affairs Medical Center and the UCLA’s RAND corp. He found that chiropractic manipulation was effective for over 46% of the people it was administered to. The research also found that 29% of the study group had chiropractic inappropriately used as a treatment, which means only 25% of appropriately selected patients failed to respond to chiropractic care.

In 24 years of practice as a chiropractic physician I would say that an 85 % success/failure rate is about what my patients and I have experienced. So the aforementioned study isn’t as accurate as real life practice would suggest. I have also learned which cases are going to respond to chiropractic and which ones don’t. So a 29% rate for inappropriate usage of chiropractic as a treatment is also higher than I experience in real life practice. No disrespect to Dr. Skekelle intended.

Lastly, Dr. Shekelle opined of his study, “instead of thinking of chiropractic as an alternative or some kind of therapy separate from other care, we really should consider it equivalent.” He went on to say, “our study basically provides the first systematic look at the quality of chiropractic care.” I believe he was pleasantly impressed with what he saw.