Dr. Roundy - The Spinal Column

In this issue:

Severe Neck Problems After Unsuccessful Spinal Surgery Helped With Chiropractic
World Health Organization Warns Against 'Just In Case' Antibiotic Use for Anthrax
More People Using Non-Medical Care
Kids Get Psychiatric Drugs Too Often
U.S. House of Representatives Passes Bill to Provide Chiropractic to U.S. Military Veterans
Should Watchful Waiting Be Used More Often for Acute Otitis Media?

Severe Neck Problems After Unsuccessful Spinal Surgery Helped With Chiropractic

In the September 2001 issue of the peer reviewed, "Journal of Manipulative and Physiological Therapeutics" comes a case report study titled, "Chiropractic care of a patient with vertebral subluxations and unsuccessful surgery of the cervical spine". This was a report of a 55-year-old man who had neck pain along with radiating pain down both arms after unsuccessful cervical (neck) spine surgery.

The man's history was similar to many seen in chiropractic offices. While responding to an auto accident during an ice storm, the 55 year old highway patrolman slipped getting out of his car and fell backward, landing on his upper back and neck After a few days he began to experience pain in his neck. Two months later he consulted a medical doctor, who referred him to a neurologist. During the neurological examination, the patient experienced a seizure that eventually led to a diagnosis of a tumor of the adrenal gland. Several weeks later, the patient had surgery to excise the tumor which resulted in temporary relief of the neck pain.

He returned to work, and 6 weeks after surgery he began to experience neck pain again, which he described as “sharp,” along with pain, numbness, and tingling in both arms. His condition worsened for about 6 to 7 months and he was was referred to a neurosurgeon. The patient eventually consented to neck surgery, and an anterior cervical discectomy (disc removal) was performed.

When he returned to the surgeon for a post-surgery check-up and had continuing complaints, he then asked when the surgeon wanted to see him again. The reply was, “I never want to see you again.” This answer was devastating for the patient, and he assumed that he was destined to live with these problems for life.

Approximately 3½ years after surgery, the patient started chiropractic care. The chiropractic care began and after receiving the first set of adjustments, the patient indicated that his ability to raise his left arm had increased by 50% and that his neck pain and arm complaints were also relieved. He was astonished and excited by the results of the care he received. Within 2 weeks of starting care he was able to fully abduct his left arm and to loop his belt to his pants. A year after the onset of chiropractic care, the patient was working on his small ranch performing various odd jobs and has, on occasion, had some problems because of over activity.

This documented and published case is not unfamiliar to chiropractors world wide. The unique aspect of this case is the fact that it was published in a peer reviewed scientific journal. The authors of the study summed this situation up with the following; "This is the first description in the indexed literature of the chiropractic care of a patient with vertebral and sacroiliac subluxations with a history of unsuccessful cervical discectomy of the cervical spine. In our experience, allopathic (medical) practitioners usually do not offer patients the option of chiropractic care before surgery. Perhaps more rarely is chiropractic care considered a viable option in instances of unsuccessful surgical care." It is obvious from this study that chiropractic should have been considered first.

World Health Organization Warns Against 'Just In Case' Antibiotic Use for Anthrax

In a Reuters Health, October 31, 2001 release is a warning from the United Nations' World Health Organization (WHO) against taking antibiotics without any need. In the wake of recent Anthrax reports more people have been taking the popular antibiotic Cipro without any real need for it. The warning is against the blanket use of antibiotics as a defense against anthrax, saying it could do more harm than good.

David Heymann, the head of the WHO communicable diseases program said antibiotics should be prescribed only when there was reasonable cause to think a person had been in contact with anthrax. In an interview at the Geneva-based United Nations agency, Heymann said, "If you are not at risk, you do yourselves and others a disservice by demanding antibiotics". He continued, "The use of antibiotics as 'just in case' protection by people alarmed by reports that anthrax had been found in letters could leave them more susceptible to other unrelated infections.

The problem is that bacteria can become resistant to antibiotics very quickly and can then be passed from one person to another just like a virus. A major WHO concern has been the declining potency of some antibiotics such as penicillin, resulting from widespread overuse. For example, penicillin, can no longer be used against gonorrhea because strains of the sexually transmitted disease have evolved that are immune to the antibiotic.

Heymann concluded, "One has to remember there is a much greater chance of catching pneumonia than of contracting anthrax."

More People Using Non-Medical Care

From the September 4, 2001 issue of the Annals of Internal Medicine comes an article with the long title, "Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey". The survey conducted tests for the usage of what the researchers call "Complementary Medicine." It should be noted that the term Complementary Medicine (also known as "CAM") usually means procedures that, in fact, are not medical procedures. The largest portion of this category of procedures is represented by chiropractic care.

The study did not separate the different Complementary Medicine procedures statistically, but the findings were none the less interesting. Some of the statistics were:

79% of patients surveyed perceived the combination of CAM and conventional care to be superior than either form of care by itself.
Of those that used CAM services and conventional medical services, 70% saw their conventional provider first, 15% saw their CAM provider first.
Of those that used CAM services, 63% to 72% did not disclose that fact regarding at least one type of CAM service to their conventional medical provider.
81% of respondents reported that they had "total" or "a lot of" confidence in their CAM provider, while 77% had the same levels of confidence in their medical providers.

In the same publication one month earlier was an article discussing the same subject of CAM. In the conclusion of that article some profound statements were made. "Previously reported analyses of these data showed that more than one third of the U.S. population was currently using CAM therapy in the year of the interview (1997). Subsequent analyses of lifetime use and age at onset showed that 67.6% of respondents had used at least one CAM therapy in their lifetime." The article ended with, "Use of CAM therapies by a large proportion of the study sample is the result of a secular trend that began at least a half century ago. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future.

Kids Get Psychiatric Drugs Too Often

The above headline is from the October 21, 2001 issue of the USA Today newspaper. The opening sentence from the article makes the statement, "Doctors are increasingly prescribing psychiatric drugs such as Ritalin and Prozac to preschoolers, despite questions about safety and effectiveness."

Child psychiatrist Glen Elliott of the University of California Medical School in San Francisco, spoke at the American Academy of Pediatrics meeting in San Francisco and said, "Every pressure I'm aware of is pushing toward more use of these pills in young kids, and the potential for problems is huge." He goes on to explain, "HMOs are encouraging quick diagnoses, working parents often can't be home to enforce structured behavior-improvement programs, and everyone seems to want quick fixes."

The concern about usage of these drugs has been growing following a recent report that showed that Ritalin use more than tripled in preschoolers between 1991 and 1995, and prescriptions for antidepressants doubled in that age group during the same period. Dr. Marsha Rappley, a pediatrician at Michigan State University's College of Human Medicine in East Lansing states that one of the concerns are side effects, which can range from mild to significant. Problems that can occur include headaches, stomach aches, sleep problems and loss of appetite. Additionally there is very little research on safety and effectiveness in kids under 4.

Dr. Elliott worries about the long-term dangers of prescribing drugs such as Prozac to small children. "Antidepressants change how brain chemicals work, and permanent changes might result from kids taking such drugs since we know a lot of brain development is still going on at this young age."

U.S. House of Representatives Passes Bill to Provide Chiropractic to U.S. Military Veterans

This legislative initiative was the product of many years of discussion, negotiations and education and came only after numerous attempts by the chiropractic profession and the Congress to persuade the U.S. Department of Veterans Affairs (DVA) to develop and implement a meaningful chiropractic program on their own. The bill now moves to the U.S. Senate for consideration and action. Some of the highlights of the bill include:

The establishment of on-going, regular chiropractic care as a routine benefit at all DVA facilities.
The establishment of a chiropractic oversight committee to assist in the rapid implementation of full chiropractic availability within the DVA.
A mandatory schedule for deploying in-facility doctors of chiropractic at all DVA medical centers, adding on-site practitioners at 30 sites per year until all locations have in-facility coverage. The first 30 sites are to be identified within sixty days of final passage of the bill.
The securing of “primary care provider status” for DCs so that all eligible veterans can have direct access to chiropractic care without the need for a referral from a medical doctor.
The appointment of a senior doctor of chiropractic to serve as a Director of Chiropractic Services within the DVA. This key individual would be directly responsible to the Secretary for Veterans Affairs and thus able to by-pass a historically hostile and obstructionist medical bureaucracy.
The establishment of an effective program of training and education to inform and orient other providers and beneficiaries as to the important role and availability of chiropractic services within the DVA.

Should Watchful Waiting Be Used More Often for Acute Otitis Media?

Are antibiotics really needed for ear infections? An article from the October 2001 issue of the Archives of Internal Medicine suggests otherwise. According to the article the medical profession is facing a situation where the antibiotics they have relied on in the past are becoming less effective, prompting physicians around the world to consider alternatives. One of the alternatives is ear surgery called myringotomy, an operation where the child is strapped to a papoose board and held down. Myringotomy is an operation in which a small cut is made in the ear drum to relieve pressure caused by pus or fluid in the middle ear. A small tube may then be placed in the cut to allow fluid to drain from the ear and air to pass inside. The tube usually falls out on its own in about a year and the cut heals. While myringotomy is done on both adults and children, it is done most often on children. In fact, it is the most common operation done on children. Myringotomy is not without potential serious complications.

The disturbing part of the report raises the question of effectiveness, "Perhaps the most important question is whether myringotomy is an effective treatment for acute otitis media. The available evidence (1 randomized controlled trial and 1 case series) suggests probably not." The researchers go on to question, "How safe is myringotomy? What other costs are there? The operation's psychological effects of being held down and strapped to a papoose board are not described."

The researcher noted that otitis media is a spontaneously remitting disease. This means that in most cases it clears up by itself. They also noted that other populations have already adopted a watchful-waiting strategy. The result was that nothing catastrophic happened. The Netherlands already has a policy of supportive treatment only and using antibiotics and/or myringotomy for less than 5% of diagnosed cases of acute otitis media. In that country a study showed that more than 90% of nearly 5000 children recovered within a few days.

The option that these researchers are suggesting is "watchful-waiting". They suggest, "Perhaps we need to offer the alternative of watchful waiting more often for acute otitis media, rather than marginally effective antibiotics (which cause bacterial antibiotic resistance) or the fearsome procedure of myringotomy."

Chiropractors have long talked about the benefits of chiropractic care for children with otitis media. One study in 1998 of 401 children showed marked improvement for the children with otitis media who received chiropractic care.

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