FIRED ... Again

I was fired again today.  Got my pink slip.  Think I'd be use to it after all these years.  Patient's fire me when I don't meet their expectations, when I fail to give them value for their money, or when I simply can't help them to their satisfaction.  I don't blame them when they fire me.  You see the patient is the boss and I'm their employee.  That's the way it should be.  The patient pays me and in return I provide a service to them.

Unfortunately, in many areas of our health care system the patient is no longer the boss.  They cannot fire the provider even if their expectations are not met, or they do not get the results they desire.  The problem arises from the fact that there is no accountability to the patient because the provider is not paid directly by the patient.  The "value for the money" part of the equation is missing. The provider has no incentive to be accountable to the patient.  As a result the patient has lost the ability to fire the doctor.

You can fire your dentist, you can fire your psychologist, you can fire your optometrist, and yes you can fire your  chiropractor, but if you want to continuing getting medical care you will have a difficult time firing your medical doctor.  That's because your MD is not accountable to you.  He/she is only accountable to the "system".  The system doesn't fire someone for as small a thing as not satisfying the patient.  Patient satisfaction often seems to be a low priority.

Even though I've been fired many, many times,I don't like it any more today than I did when I was first in practice.  But each time I get fired it causes me to evaluate the care I'm providing.  I need to provide service that my patients value and what patients want is constantly evolving.  I know full well that I will not be able to give every person what they desire, but I strive to meet the needs of as many people as I can.  If I can't do it, then I should be fired so the patient can connect with someone who will satisfactorily meet their needs.

Flat Feet

A normal foot has three arches.  When the medial arch weakens, the foot flattens out and is commonly called a flat foot.  The more correct term is that the foot is pronated.  Because the foot is the foundation of the body's posture, when the foot is pronated it results in problems throughout the body.

Without the normal, flexible arches the foot is unable to push off properly when walking.  The result is an abnormal twisting of the foot.  This sets off a chain reaction that stresses the knees, hips, and low back.  The result can be pain and dysfunction in any of these areas.  People with pronated feet also fatigue more easily, they have more problems walking and athletic performance is hampered because it takes more energy when the foot doesn't work properly.

Way back in 1988 researchers, Otman S., et al., studied a number of women with flat feet.  Those that had their feet supported with custom orthotics had improved foot mechanics over the control group.  The researchers looked at more than just foot mechanics.  Very interestingly the ladies with the orthotic corrections consumed less oxygen, had lower blood pressure and lower heart rates both during and after walking!  Their calculated energy consumption was much lower than the women who did not have correction for their pronated feet.

This is a perfect example of how interconnected the body is.  Pronated feet don't just give you sore feet.  They can be the cause of knee, hip or low back pain.  More significantly, they can cause your entire body to work less efficiently.  Loss of stamina and productivity can result.  Quality, custom orthotics can correct the foot's mechanics and help the entire body work much more effectively.

If you read my post "I Don't Have a Foot Fetish" you may recall that I look at the feet in order to determine functional leg length difference.  While looking at the feet I also look for how the patient's shoes are wearing.  There are telltale signs of foot pronation or flat feet.  This can certainly be a complicating factor in not only pain a person may be experiencing but also their overall health.  Supporting the normal arches of the foot can have a huge impact on a person's well being.

Health Care Fads

A medical doctor was being interviewed on Canada AM recently.  One of the points she was making was that people wanting something "natural" for their conditions was a fad.  The hair stood up on the back of my neck for moment.  From my perspective people wanting to look after their health in the least toxic, least invasive way is not any more a fad than people who want a medical approach.  After all natural approaches have been around a lot longer than than the modern approach to medicine has been.

Her comments got me to think about fads in health care.  Indeed, there are many fads in both medicine and natural health care.  Drug commercials a few years ago were all about arthritis medications.  Turn on the TV today and there seems to be non-stop advertising for erectile dysfunction drugs.  When the new wonder drug hits the market, the "performance enhancing" drugs will take a back seat.  Surgeries also go through fads.  When I started practice chymopapain injections where the big thing for spinal disc problems.  I never hear of them anymore.  Arthroscopic knee surgeries are loosing their luster.  Yes we may soon look on them as just another medical fad.

Natural health care has plenty of fads as well.  I can't even begin to enumerate all the products and procedures that I've seen since beginning practice that were the greatest thing and now are virtually unheard of.  There was the berry from South America, the root from South Asia, the extract from the liver of a marine mammal - all promising to cure most of man kind's ills.  Then there were the therapies that promised to reverse degenerative arthritis, alleviate pains instantly, and of course the machines where people would loose weight without doing anything.

I don't have a methodology for evaluating whether something in medicine is a fad, but I have developed a procedure I use to try to spy fads in natural health care.  I think adopting cutting edge procedures is valuable, but I want to keep my eyes open widely when things have only been around for a short period of time.  Fads don't stand the test of time.  I'm  also very cautious of products that are proprietary.   That is to say only one company has the technology to produce a given product.  Having a patent can be a good thing, but creating a monopoly probably isn't, especially when the focus of the company seems to be on putting down similar products rather than the benefits of their product.  The term "secret formula"  can be a red flag (although you can't call KFC a fad with their secret formula).  I also look at who is promoting the product or procedure.  Are there independent people or is everyone closely tied to the company?  What do experts I trust say about the product or procedure?  I really shy away when promotional material consists almost entirely of miracle stories.  Too good to be true is usually too good to be true.  I want to know how thing product or procedure actually produces the claimed results.  Does the process follow logically to the claimed results?

There will always be fads in health care.  Fads in natural health care are seldom dangerous and generally do provide significant benefits to at least a portion of the people who try the product or procedure.  The greatest draw back is that they can be costly if you don't get results.  On the other hand medical fads can be very dangerous.  Think of the deadly side effects from some of the arthritis medications or the chymopapain injections.  I'll opt for natural health fads over medical fads any day.

I Don't Have a Foot Fetish

New patients in our office sometimes think I have a thing about feet.  I'm always looking at their feet.  The truth is that as I hold their feet I'm comparing the length of their legs.  The relative length of the legs is a very reliable indicator of how the body is functioning.  I use the comprehensive system developed by Activator Methods.

The procedure begins by determining the functional short leg.  A functional short leg is a leg that appears to be shorter than the other one because of muscle imbalance which pull it up.  This is different than an anatomical short leg in which the bones of one leg are actually shorter than in the other leg, usually due to disease or trauma. 

Once the functional short leg is found a specific adjustment is applied to the pelvis to balance the leg length.  After the pelvis is corrected, various joints of the spine and extremities are stressed to see how the functional short leg reacts.  If the leg again shortens, it indicates that the stressed area is subluxated and also how an adjustment needs to be applied to make the best correction.  For a person who has not observed functional short leg checking, this may seem a bit strange.  However,  Activator Methods has 17 published research papers demonstrating the accuracy and reliability of this procedure.  The method has been accepted by independent panels on standards of practice as one of the most accurate assessment methods in the chiropractic profession.


Patients can think what they like when I'm looking at their feet.  The alignment of those feet mean a lot to me!

Mattresses

Getting quality sleep is a very important factor in achieving and maintaining good health.  Patients often ask for advise on purchasing a mattress.  The mattress needs to provide both comfort and support in order to be effective.  There are many good mattresses on the market and comparing them can be difficult when different brands have different features.  A knowledgable sales person is a great asset when trying to make a choice.  Certainly you will want to buy from a story that will give good service.  The cost of a mattress can look formidable but always keep in mind that you will be spending approximately one third of your life on mattresses.  That usually makes the price seem more reasonable.  Most mattresses come on sale regularly.

Consider your individual needs when shopping for a mattress.  Do you share the bed?  Do you have physical challenges, circulation problems, or a bad back?  Are you a large person who needs extra space or firmer support?

Look at the following areas when selecting a mattress:

• Size: A mattress should be large enough to accommodate not only yourself comfortably, but also your spouse if you have one.  Remember that it is normal for people to move and turn in their sleep and you don't want to distrurb one another.
• Support: A good mattress will support the body at all points while keep the spine in the same posture as when standing.  The heavier parts of the body, the hips and shoulders, should sink into the mattress enough to keep the spine in its normal alignment.  Too much or too little support and the spine will be contorted.  This can result in disturbed sleep and morning stiffness.
• Comfort: There should be a cushion on top that embraces the body and the surface should be breathable.  Natural fibres breath the best.  
• Durability: Look for materials that have know lasting quality.  Buy the best mattress you can afford  so you can have years of comfortable sleep.
• Construction: Metal coils provide the best long term support.  The greater the coil count in relation to surface area the more support and durability.  These coils may be concentrated more in the areas where there is more weight.  Connecting coils can reduce motion transfer.
• Warranty: The longer the warranty, usually the higher the quality of the mattress.  Never buy a mattress with less than 10 years warranty.  Keep in mind that the warranty is not necessarily an indication of how long the mattress will last.  It's there to protect you against flaws and defects.

Test the mattress.  Trying laying in all your usual sleep positions.  Make sure your partner is on the mattress at the same time doing the same thing.  Are you both comfortable?  Can you move without disturbing each other?  Sit at the edge of the mattress.  Does it support your weight or does it sag?  Take your time to do a mattress test.  Remember mattresses are a major purchase and can have either a positive or negative impact on your health over the life of the mattress.

When the Pain's Gone

Everyone's excited when pain they've been experiencing goes away.  That's because pain is such a powerful force in our lives.  But the reality is that pain is not a very good indicator of how healthy or unhealthy we are.  When we have a problem pain is usually the last symptom to appear.  It can also be the first thing to disappear when correcting a problem.

Vertebral subluxations in the spine involve muscles, ligaments and nerves.  The inflammatory response to these tissues being injured is usually what produces pain in the spine.  Although irritation on the nerves can also produce pain.  With specific spinal adjustments, the inflammation associated with spinal injuries often subsides very quickly.  The pain goes away.  At this point however the job of rehabilitating the spine is only partly done. 

Muscles, ligaments and nerves take time to heal; often a very long time.  They must also be retrained to do their jobs properly.  Only through the re-establishment of normal joint motion, by spinal adjustments, can the tissues begin to work properly.  Exercise and nutrition are also vital to successful healing.  Until the muscles, ligaments and nerves are fully healed and retrained, they are susceptible to re-injury.

I'm exited for my patients when their pain goes away, because that is usually their goal when they first come to see me.  However, I also know that the job of correcting their spine is only just beginning.  The patient is always in charge of deciding how far they want to take their care.