Boxing up the Dead

We wrapped up the first year of school by paying our respects to those who donated their bodies to our program with the Circle of Appreciation.  It consisted of about 15 individuals who represented their dissection group through poems, heart felt speeches and humorous essays.  It was nice to finally learn how others got through this challenging first year of graduate school.  Every emotion was present in the room from sadness to pure joy.  Jim, our anatomy professor, shared a touching poem created by a retired anatomy professor who started the circle of appreciation a few years ago, which was approached from the cadaver's perspective.  It was 100% on par with the experiences we all had in lab this past year.

The whole process of dissecting dead bodies is quite brutal and goes against everything we are taught growing up.  You have to come to grips with death and life, for that matter.  We rationalize the situation by joking or convincing ourselves the person "signed up" for this.  In the end, when all the tests have been taken, we stuck them in a cremation box and sent them off to be burned.  

You take a lot more from experiences like this then you expect.  At times you think you are going to fall apart and other times you feel totally disconnected and completely focused on doing a superb dissection.  It is weird to think it is over and humbling to recall the emotional struggle we had to endure through the endless days in anatomy lab.

The next phase of our education is going to be primarily physiology based and next quarter we will get a dose of pathology as well as our first course in evidence-based medicine.  

All for now

The Human Element

What does it mean to be alive?  In the animal kingdom there is a commonality that exists  between species; a beating heart, a sophisticated nervous system, and the need for food, water and shelter.  For some species this is all their life consists of each day.  Their job is to merely survive and the cycle continues until death.  

To be human consists of similar biologic needs but it consists of something unique and special that is found only in our species.  This fundamental difference affords us the ability to make meaning of our existence beyond survival.  We are the only species that can plan out their future and formulate goals to fulfill ambitions in life.   These ambitions go way beyond simple biologic needs.  We are a species that relies heavily on the skills of others in our society for our survival as a whole.  Our efforts in life are not merely for survival but to create a better life for each other. 

The people who donated their bodies for us to learn from were once full of life just like you and I.  They are more than just anatomical structures and teaching tools.  At one point they too were pursuing their dreams and planning for their futures.   They owned homes, worked, contributed to society, had children and perhaps went to college.  In an instant, a mere moment in life, all that they represented suddenly stopped and their ambitions, dreams and unique human qualities remained silent.  All that they did in life continued on thereafter through their immediate friends and family and to some extent us.  One quality each of them possessed in common was the value for education.  Our education. 

We musn’t forget  these people made the decision to donate their bodies for our use in pursuing our life goals.  It was a decision personal to each individual and unique in comparison to all other species.  The human element is a rarity, a gift.  

Our Belief System

I know what I write in this blog is publicly displayed and can be a bit controversial or debatable.  If I over step any boundary in any of these discussions please leave a comment and explain your point.  I encourage any and all opinions.  So, please do not be shy.  :)

Our personal belief system as to what life is and why we are here on planet Earth, spans all kinds of territory from science, religion and the unknown.  The question I ask is, do we have the right to push our belief system on others beyond scientific validity?  Where is the line when it comes to health care?  

I would suggest there is a definite place for a doctor and that is to be the person who uses skills based in science to help those in need of health services.  

What will we be able to do with our skills as Doctor's of Chiropractic?  Many believe the nervous system flow is the most important aspect of our profession and we should keep it free of obstructions because this will allow the body to heal itself.  I need evidence in order to believe in this theory.  Those who push this belief system onto their patients have limited evidence to support them beyond personal experience.  

I truly want to believe this is how it is, that there is greater meaning to the spinal adjustments beyond prevention or treatment of musculoskeletal problems.  Until I see the evidence for subluxation theory, I will focus on what is known by using science to guide my belief system.  Granted, there is a lot that is unknown and could be known if we did the research.  I see nothing wrong with approaching chiropractic from an orthopedic standpoint.  It makes sense to try and prevent people from getting unneeded surgeries.  It really comes down to how we define wellness and whether we are going to believe in an untested theory.  As I have said many times before, wellness cannot be defined as a straight spine.   And that is where the debate in our profession remains strong.

There is so much known in the field of exercise physiology and exercise immunology that puts much of the chronic disease problems of our country on the person with the disease (i.e., genetic pathology aside).  It is our choices in life (i.e., nutrition, fitness etc.) that determines our health, not a straight spine or a magic pill.  There are many people who live a life of wellness without ever seeing a chiropractor for any problem and rarely get ill.  We will look foolish to the academic world and the public if we try to define wellness as a straight spine.  I have seen firsthand how powerful fitness and proper nutrition plays in people's lives.  I have not seen the power of the spinal adjustment.  Maybe with experience my perception will change in regards to subluxation theory.  For now, I remain unconvinced.    

Please, leave your comments if you have any.

All my best,

Nate

 

Chiro-school year one... almost done

It is here.  The final stretch.  Year one is coming to an end and 11 finals are looming.  Yikes!  It is time to get serious about what I don't understand and take steps to etch the material into my long term memory.  The process of getting prepared like this takes a lot of study time and a ton of caffeine (and EtOH at night).  I think the week will fly by and we'll look back and giggle about the nervous tension created by note packets.  Since when did note packets become so scary?

Thinking back to all the academic obstacles created by our first year professors, there is an element of pride that I feel for getting through it all.  Our class is getting to know each other better and we are forming a mutual respect for one another.  Minus those who cheat, of course.  

We are the next generation of chiropractors destined to follow in the footsteps of our predecessors.   Many of us are finding that the public has a negative view of our profession due to a group of religious fanatics known as straight chiropractors.  Their efforts have kept our profession, the ethical side that is, from obtaining a place in modern medicine or placement within the traditional university setting.  I personally want people to respect me as a health care provider.  It is a vigorous path to gain licensure as a DC and due to the past and present folks who lack the ability to practice with ethical, scientifically based ideologies, we future DC's will have to redefine the profession to EVERYONE we come into contact with.  What an awful burden.  Our advice will be questioned by our patients and potential patients because they are skeptical in our training and personal belief systems.  We will fight our pseudo-scientific counterparts during our careers and there will be times when we will want to bail out of the mess.  I often question whether to stay in this and fight.   

Since I started chiropractic school I have been asked for health advice.  Mainly musculoskeletal advice.  I explain things the best I can and suggest they see a chiropractor if I think their problem could be alleviated.  Too often I learn that the person decides not to go because they are afraid of what they are getting into.   Why is there such mistrust in this profession?  We all know the answer to that.  

More than likely I will continue forward in this program and become a chiropractor.  I tell myself it is worth it by looking at what I personally believe people need in their life.  We will have a lot to offer to our patients and clients surpassing many in the health care market.  At times, I wonder if the profession of counseling or psychology has had similar societal woes.  The stigma of going into the "shrink" to get mental health prevents many people from entering this area of health care.  

As a profession, we need to look at what health means, what it consists of.  Perhaps we need to form a different profession altogether.  Branch away from the ACA and ICA and create something that is monitored enough to build trust in society.  Our country needs prevention more than anything else (as far as health goes).  How do we future DC's overcome the negative public perception of chiropractic and also keep the name "chiropractor"?  Should we open chiropractic clinics or should we open gyms with chiropractic displayed as "conservative primary care or conservative orthopedic care"or "non-surgical musculoskeletal orthopedic care".  It is up to us to market our practices based on what we can do as specialists.  Sort of like orthopedic surgeons do (i.e., The Orthopedic Surgery Center of Idaho).  Why not display something like, "The Center for Non-Surgical Musculoskeletal Care". Chiropractic has A LOT of baggage and in my opinion, I feel we should think otherwise as to whether we use the name in the future.  

We are medical students.  How do we gain respect from the public and our medical counterparts in this competitive health care market?  Respect is gained through hard work and ethical values, of which, I believe many students possess in our class.  When we get out and we find that the public doesn't seem to trust us, we will be tempted to buy into the role that people expect us to play, which is straight chiropractic.  It is sort of like a person who has had alcohol problems in the past and is expected to get drunk every time they drink.  Instead of having "a" beer, they consume beer until they get drunk because that is expected of them.  People know they do this, so they use it as an excuse to be a drunk - they have fulfilled a role and it gives them an identity.  Chiropractors have the same problem.  We will be sent out into the world to fulfill a role created by ourselves.  We will be expected to be a certain way when we finish our education at WSCC.  The question then becomes, does the public view chiropractic as we do or as WSCC has been advocating?  Food for thought.

Thanks again for taking the time to read another essay.  

Have a good day

Axis Article Submitted

I thought I would write another article for the next Axis newspaper coming out next week.  It is controversial (as expected) but rightfully so.  Below is what I wrote for the article.  There is a chance the article may not be published due to timing of submission.  If that is the case, at least it is posted here.  Enjoy if you dare... :)

In my last article in the Axis, I vented my frustration toward straight chiropractic without elaborating the true reasons for doing so.  This article will explore the reasoning for having such strong opinions against our dogma stricken colleagues’ approach to wellness.  

How do you define health?  Do you think you can become well by going to a chiropractor and getting your back 'cracked' twice a week?  I hope not.  If you do go to a DC, why?  Is it for a problem you are trying to overcome or is it because your DC told you a straight spine would keep you from getting sick?  Hopefully, the answers to the above questions are based on logic and not another person's religious dogma they have poured all over you.  Defining wellness as a straight spine is no different then defining it as the continuous influx of Prozac or Lipitor for optimum health.  If wellness is defined as such, dependency is created for a regular spinal adjustment, just as dependency would occur (and does occur in medicine) for prescription drugs when used as a way or the only way to stamp out disease.  As far as we currently know, spinal adjustments do not prevent ALL disease – like straight DC’s think.  Believing in this subluxation theory, is illogical.  The definition of wellness then boils down to what we are treating or preventing with our adjustments and how we communicate this to our patients. 

If we were to put our scientific glasses on, we'd see it isn't society who determines what they need, it is those who know how to sell an idea that need a paycheck, who determine what society needs.  As new DC's we will be forced to decide whether to approach our role as a primary care physician this way.  Our practices will grow slowly but surely if we do it right and treat patients according to our objective findings.  Some of us will overstep our role in the health care market by manipulating our patients in ways to grow our businesses quickly rather than be true to our patient’s needs.  Some of us will get sued for doing this and some of us will realize our scope and follow the wellness "recipe" known by the academic world.  Many of us will push forcefully, the importance of fitness and many of us will educate our patients about proper nutrition.  These folks are true, caring providers who go against self-centered desires.  In the long run, I truly believe that if you do everything possible to help your patient get better or live well, without selling them on a dogmatic principle you "believe in", your practice will thrive and people will love you immensely for all that you do for them.  

Even if you focus on relieving pain or conservative primary care, you can do it ethically.  The argument I am making is not about what we do when we get out (i.e., wellness versus pain management versus many other approaches) it is how we go about doing it.  Will you convince your patients a straight spine is the answer to disease prevention?  Like it or not, many DC’s manipulate their patients this way everyday. It is inconceivable how a person can sell an idea such as this with absolutely no evidence.  Do you care how the public perceives our profession?  I sure do.  It seems like there is a misunderstanding of what chiropractic is or where it fits in the health care marketplace.  There is a definite level of skepticism amongst the public when chiropractic becomes the topic of discussion.  This problem exists due to straight DC’s who have misinformed the public in the past and present.  We must define chiropractic based on what the public truly needs (i.e., the Healthy People 2010 Initiatives; fitness, nutrition, lifestyle modification, conservative orthopedic care, etc.) to prevent disease without pharmacological or surgical intervention.  Our knowledge is pretty powerful if used appropriately without egocentric greed or dogmatic idiocy. 

Practitioners who try to redefine wellness as a subluxation free spine, are doing so to make money and are deceiving the public.  From a scientific mindset, wellness has only one definition.

 

Thank you for reading.

Hemisection of the Pelvis

In gross lab today we dismembered our cadaver.  Meaning, we removed his leg via a hemisection to be able to view the muscles, organs and neurovascular structures of the perineum.  Many folks didn't like seeing this as it was being carried out.  A lot of frowns and ghostly white-colored faces were present as the hacksaws cut above the iliac crest and straight up the midline of the buttocks and pubic symphysis.  To do this, we had to lay ol' Herby on his side, bring up his top leg as if he was doing the jumping jacks and start sawing.  I wasn't sure how I would react and thought about this prior to class.  It didn't help having only 3 hours of sleep the night prior, but there was nothing I could do about it.  I didn't over analyze the situation. 

Usel and Poytress manned the saw and I held the leg steady.  As they worked up midline, the gap became larger and larger and eventually came to the initial saw incision above the iliac crest.  The leg broke free and there I was holding it in my own two hands.  It was an eerie moment.  I promptly sat it down on the metal dissection table and tried not to watch what happened next.  Usel and Poytress found there to be a significant amount of solid waste in the rectum which clogged the blade's teeth as they sawed.  When the leg was set aside, the rectum was in full view on both sides and completely full of "you know what".  The smell was disgusting and the sight of it unbearable.  I had to take my focus off of what they were doing so I went to the lab bench and went through our final structure list.

I tried very hard today to remember he chose to donate his body to science before he passed.  I kept that in my mind as the saw was slicing and especially when the leg came free and remained balanced in my hands.  

The dissection was very interesting as it uncovered many of the older structures from gross I last fall.  Our new structure list is quite detailed.  There two full pages of new and old anatomical names and we must get them down in the next two weeks.  Time is running out this quarter and there is a TON of work to be done. 

To end, I have to say, I am super excited to only have one more dissection left to complete.  

Good night

AK and it's devoted followers...

The Applied Kinesiology folks were in town this week to give the students of WSCC a lesson on how they approach health care.  A few students I know went to this meeting and I sadly missed the show.  They reported mixed news as to whether AK fits their personal health care beliefs.  The problem is, many of the students do not have real life experiences in health care to support their belief's.  They buy into whatever the person at the front of the room is selling them without questioning how the "technique" may affect the population as a whole.

If we define wellness as a straight spine and relate all health care problems to an out-of-place vertebra, we are misinforming the public.  If we sell them this idea we are no different then the MD or DO who pushes medication for every problem.  When the patient doesn't get better and continues to live an unhealthy life, they become reliant on YOU for their needs, just like they are reliant on the DO who pushes his/her patients drugs for every whim.  Not saying all MD's or DO's prescribe this liberally.  I am sure you get the drift.

There seems to be a big problem in chiropractic which has to do with whether we should behave as the traditional definition of a doctor, by treating health conditions "conservatively" or whether we fill the gaps medicine has historically failed to close in it's many years of health care monopolization.  Some may argue conservative Tx's are what is missing in our health care system but I am here to say there is much more to the picture.  It is frustrating to me to see students who want to fulfill a doctor's role by buying into profit driven, highly marketed technique systems that help them define what they are doing for their patients.  Granted, we are not seeing patients in the clinic yet, but our initial training in this program allows us to decide whether to buy into a set methodology or create our own based off of personal experience.  Our experience thus far (mine excluded and others too) is limited, in that, it is based in the knowledge obtained from WSCC.  

Should we define health according to another person's definition?  NO!  Should we attend seminars known to be highly controversial at this vulnerable stage of our development?  My answer is, yes!  Yes, you should check these folks out, but only if you have an open mind free of insecurities.  These people seek out insecure, naive students who began this journey without any experience in the health care market prior to DC matriculation.

Health is not just an absence of pain or disease.  Health isn't as simple as some may make it out to be such as the AK fellows.  It isn't a lack of one nutrient as opposed to another.  It isn't reliance on another person for relief or a weekly adjustment.  And is sure as hell isn't about taking advantage of other's health problems by selling them a product, like many of the technique systems advocate!

When I first started as a personal trainer 10 years ago, I had no experience or even a certification I could rely on.  I had to try and sell my services to people who just started at the gym and make them believe they needed me even though I had no real credentials.  I quickly learned my time was running out at the rate I was selling PT packages.  To better myself and gain a foothold on this market, I obtained a nationally ranked certification for personal trainers through the National Academy of Sports Medicine.  Once I had the knowledge from this certification, I was able to use it to sell my product.  I felt more confident in myself because my product, the NASM protocol, was legit.  I relied on this knowledge base for several years and eventually used it to open my own personal training studio in 2004.  

Now, the difference between a chiropractic technique system and the NASM protocol is; 1) common sense 2) scientific reasoning and 3) lack of reliance on subjective data.  The goal has to be higher than relieving pain with our future patients.  Granted, we must get them out of pain but it is our duty to help them PREVENT illness through fitness, proper nutrition and good mental health.  

If we want to help people we have to keep our own selfish interests away from the equation.  Balance the margin with the mission, if you will.  The problem for new DC's is that they will be faced with a huge student loan burden (less than my lofty sum, for sure) and when patients get better quick, how are the bills supposed to get paid?  Keeping the patient for as long as possible to pay bills is a pathetic existence in my opinion.  If you are going to keep your patients in your system, do them a favor and help them find a new level of health beyond a straight spine or lack of symptoms.  

I have thought about this extensively because I worry that when I get done I will be faced with a similar situation.  My only suggestion is to focus on wellness versus acute care.  This way, you retain your patients through services such as nutritional analysis, fitness training and health coaching.  Which from what I understand is all billable as long as it fits the Health People 2010 initiative.  

It seems like those who buy into the technique systems are doing it to define their role.  Many times it is from those who haven't lived a life of wellness.  Shouldn't we be role models to our patients?  Don't you think you would retain a lot more business if the person who's buying your services wants to reach a level of wellness you yourself have obtained?  I'd say this is the key to success in the field of alternative health.  If we hand out supplements or adjustments like the competition hands out pills, we are no different then they are and from doing so, we provide an environment full of codependency.  

A rule good personal trainers live by is to progress clients without reliance.  Meaning, build programs that allow the person to grow and also take responsibility of their health.  There is a way you can help people find optimal health without reliance on a doctor's treatments and also make a financial profit.  That being said, we still must be competent in the health sciences to understand our patients' needs.  Hence, the reason for the extensive education we are currently undergoing.

Thanks for reading