Dreaming of a Future Practice

As I and my fellow classmates roll through the 4th quarter I wonder what kind of practice I am going to have.  Will it be therapy specific, wellness based, medically based, maybe a little of each?  So far, I haven't found a clinic I can refer to that I have visited that sparks a complete interest.  I have visited many and worked at two and in all my experience, I haven't found the right mix of therapy, fitness, and nutrition.  This is either because my idea sucks or it is rarely found in the chiropractic realm.  I know for sure that this idea isn't found in medicine as allopathy is built around the principle of waiting until people get sick to do anything for them.  What can be done to prevent sickness from occurring?  A lot!

The practice I envision will have fitness equipment like treadmills, ellipticals, recumbent bicycles, weights, the full gym set up.  It will be in a semi-private, studio-like atmosphere, so that I can employ personal trainers.  If they, the personal trainers, have their chiropractic assistant license, they can do much of my physical therapy for me, sort of like hiring a few massage therapists to do myofascial release.  I will have a few massage therapists too who will have nice spaces they can rent from me.  The office will be fitness oriented, of course.  Lots of Tour de France memorabilia on the walls and nice furniture for clients waiting for their Tx's.  Eventually, I will expand the fitness end of things into a full membership gym.  It will be high end where a membership will cost at least $75 per month or more.  All of my clients, unless they are already on a fitness plan, will be given a training program to do on their own or in our facility.  Monthly assessments, blood work etc. will be done to assure these people are reaching the wellness end of the health care continuum.  

We will also offer physiological assessments for athletes and eventually will have a controlled lab environment for high-end athletes.  Chiropractic will be used to assure proper biomechanics and the extensive coursework in blood analysis will be used in preventative ways as well as physiological gains for athletes.  There is a lot more we will offer but I haven't learned this yet in school.  For now, this is my vision.  

I can't wait to get this dream underway.  In a way, I am doing this now by going to class or studying.  It is nice to have an idea that can be tweaked here and there as I venture forward in this program.  When it comes time to get the business loan and find office space it will be very exciting!  Having an idea is good because it is giving me motivation to do well in school which is paying off extremely well this quarter.  I know that getting good grades can be used when pursuing business loans etc., so it is imperative I do my best from here on out.  The idea is there, but there is a lot of space between the idea and achieving it. 

All my best 

Outpatient Clinic Experience

Last week I went to the outpatient clinic a couple times to start the battle once again against my stubborn "cycling back".  In the sport of bike racing and riding there is a postural cost you experience after years of training and then quitting suddenly.  Sitting for hours upon hours in Hampton Hall hasn't made things any better.

To combat my aches and pains I made an appointment with an intern at the OPC last week.  Alex, an eleventh quarter student, adjusted me head to toe, or toe to head, rather.  I initially left feeling good but felt my muscles tense even more.  Before I left, I told him the Graston therapy helped significantly last time I was in and he took note.  Last Friday, Alex worked on my stubborn muscles with Graston and I have to tell you, it worked!

The pain from the soft tissue therapy wasn't bad.  He kept it at about a 7 on the pain scale and it turned out to be a good experience overall.  Today, I went mountain biking with Alex and Sadie and didn't feel any pain whatsoever during the ride.  My body was working as it should biomechanically.

In this context, I strongly feel chiropractic is a great benefit to overall health.  Ever since I started riding again, I have been uncomfortable on the bike.  After the manual therapy was applied I quit experiencing pain and was able to ride at about 90% of normal (minus training benefits, of course).  It is neat to have a first hand experience with the therapeutic changes induced by manual medicine.  Alex's treatments allowed me to continue living actively.  Just think, if we somehow match up our chiropractic training to fitness programming we could get people active and keep them active via preventive therapy.  Exciting!

All for now

Chiropractic and Prestige

The definition of prestige is, "refers to a good reputation or high esteem, though in earlier usage, it meant showiness."  

As we are finding out, the chiropractic degree comes with more negative connotation than the serious doctoral student would consider allowable in prestigious terms.  We must fight against many decades of stereotype and mistrust due to a side of chiropractic that defines itself based on pseudoscience and profiteering.  How do we, the serious folk, obtain prestige for our efforts and continue prancing forward in this rigorous but baggage ridden profession?  Does it matter what people think?

As Mamma Spangler always used to say, it doesn't matter what people think, it matters only what you think.  That is all fine and dandy but if you work as hard, if not harder than the traditional medical student, you too would want some recognition.  If you know that your efforts are honest and all that you do and represent to your patients is truly in their best interest, does it matter?  

It comes down to why you are venturing forward in the first place.  Do you want a title that makes you feel good about yourself because you presently don't feel good about yourself?  Are you looking to be accepted in the public's eye or your counterpart's eye?  What do you stand for?  Is your intention honest?  Why do you want to be a HPC?  Money?  Prestige?

All in all, we want to feel special in this short life and if we don't feel unique we seek ways to fulfill our need in this area, a.k.a., chiropractic or any other health care area.  We are needed as doctors by the needy.  How special does that make you feel when you are needed.  It makes me feel good.  The decision to be in this profession has to stem from something beyond personal identity or prestige.  I think this statement goes beyond chiropractic.

What does this Nation need as far as health care goes?  A good spinal adjustment?  I hope that is not your answer.  A nice pill to subside symptoms?  I hope that isn't your answer either.  The chronic ailments plaguing our society are preventable.  But, our system feeds them pills and spinal adjustments.  It seems obvious that people need behavioral therapy more than anything. People need hand holding for a period of time before they feel confident enough to change or better yet, take responsibility for their actions.  I would rather be the guy who holds their hand through the process of change than the one feeding them pills knowing they will be reliant on those medications for life.  If a person learns lessons on living healthfully, these lessons branch far beyond health.  The positive changes help people succeed at work, school, relationships and recreation.  We have this obligation to our patients.

We have a duty to define what health is and we need to be aware of ways to help people adopt these healthy behaviors.  The current model trains folks to "tell" patients to only come in if you feel sick or hurt.  We as providers will be rewarded for helping the sick or hurt, not to prevent sickness or injury or promote wellness.  Nothing is being done to prevent disease or to foster real personal growth for the public.  If we teach people how to live better lives by living lifestyles we teach, I think the message will be loud.  Patients and people in general need role models.  In the health realm, how many fit medical providers have you met?  You might be thinking, well Nate, you drink beer and occasionally eat breakfast sandwiches from the chiro-cafe.  Well, to be human is to error.  You must weigh the good and the bad and see what is more prevalent.  In my case, I am weighted on the good side of health choices more than bad.  Aristotle was a proponent of moderation.  I try to think about that when I make choices.  If my bad choices during a week outweigh the good, I change my ways a bit and get the good back on par.  Nobody is perfect and if there are perfect people out there, I am sure they aren't happy.

As far as chiropractic and prestige goes, the message I am sending should be clear.  Obtaining a degree isn't prestige, it a piece of paper.  The real prestige comes from teaching and living in accordance to your values for the health of others.  It is that simple.

Thanks for reading

What Do We Stand For?

After a long conversation with my fellow colleague and friend from UWS (University of Western States), formerly WSCC, I have decided there is a need for chiropractic to define itself in the public's eye.  

Some people think chiropractic is all witchcraft and snake oil salesman.  Some believe we cure and prevent back pain.  While others think we are primary care doctors.  What does our profession stand for?  It seems like there are a lot of people who want to be neuromusculoskeletal doctors while others want to go for the conservative primary care approach.  And there are some who want to focus on rehab, fitness and nutrition (like me).  I suppose it is okay for all of these approaches as long as ethical standards are not violated in the process of seeking success.

We, as a profession, have always stood for prevention of disease - even in the good ol' days of subluxation theory.  During the time when these cultish behaviors ran rampant, other cult-like groups manifested in response to religious identification.  Chiropractic was one of the prominent cults during those early years.  However, the theory was never proven to be scientifically valid and today we have moved toward a biomechanical/therapeutic approach.  With that said, there is a huge social movement occurring that is demanding preventative health care reform.  The new national insurance plan is getting tweaked and molded into it's final form and from what I have read, chiropractic is being strongly recommended by many law makers.  

All of this change is so exciting!  To be going into a profession that stands for and has always stood for wellness (in one way or another) is great.  Just think, the new health care plan is supposed to pay about 10% more for reimbursement to qualified doctors.  If chiropractors are added to this reform plan, we'll be sitting pretty nicely.  And being that the Veteran's administration just recently expanded coverage to DC's, I don't see how or why we as a profession wouldn't be added to the reform plan.

There is so much running through my caffeinated brain tonight.  I can't wait to get out there and start helping people change their lives, fix their ailments and keep them off of prescription drugs if possible.  Knowing that our nation is saturated with prescription medications for the most mundane ailments is disturbing and worth standing up against.  A zestful life isn't found in a bottle of prescription drugs.  Particularly, if you can make simple changes that benefit all aspects of life.  Most of us have a choice as to how we live our lives and many choose to live lives full of excess on many levels.  It is primarily due to affluence and lack of immediate repercussions or better yet, the affluence of immediate pleasure!

All for now - thanks for reading and go to the ACA and support access to Chiropractic by finding the page that sends a note to law makers in support of our profession.

Food and Disease

I have been on an organic food kick for a while now, minus some meals here and there, and I definitely taste and feel a difference.  After watching Food Inc., I have made some more changes like removing high fructose corn syrup from my diet, eating only organic fruits and vegetables, cutting back meat and consciously choosing the meat I eat.  Granted, there are times when I slip up, as does everyone else who eats this way, but I am trying hard to be a smart consumer.

As we venture through our pathology coursework, I feel like most of the diseases could be and could have been prevented.  There are genetic issues to consider, but I feel strongly that we are products of our environment.  

Take this example - as a kid I was working at my father's auto body shop, smoking cigarettes, drinking beer excessively and eating the crappiest diet you could imagine.  The lifestyle of this workplace advocates these behaviors.  It wasn't until I met my lovely wife Sadie when I finally began making changes.  Some of the changes occurred before I met her but she held my feet to the fire by making me want to be a better person.  The habits I had to quit were difficult, to say the least.  And eventually I found myself racing my bicycle at the elite level.  Now, if I stayed in the negative, suppressing environment the auto body shop advocated, I would not be writing this beautiful essay today.  :)

I feel like we do have a choice in whatever it is we want in life.  Too often I see copouts that prevent people from finding a life worth living with passion.  

As doctors, I think our job is just that, help people gain control of their lives so they can extract all that there is to obtain from this short life on Earth.  And the one thing everyone could have control over is their lifestyle and from making proper choices they could prevent disease in its entirety or at least push it off until the genetic clock decides it is time.  Food for thought.

Thanks for reading

Opinions and Repercussions

The break flew by and now the first week of year two is over.  It is crazy how quick things role once they get momentum.  Before we know it, our first two years will be done.  

We have transitioned out of anatomy into physiology-based coursework.  I am happy for this because anatomy is not my strong point.  The courses include, neurophysiology (taught very well by Dr. Gillette), physiology (taught by Dr. Irving - a new physiology professor), microbiology/immunology/public health (taught by Dr. Burnham), pathology (taught by the amazing professor Dr. Rouhani a naturopathic doctor), radiographic anatomy (taught by Dr. Hoffman), and 5 others associated with clinical topics, evidence based practice, adjustive skills and soft tissue therapies.  All in all, the curriculum looks challenging and refreshing to be launching into clinically oriented coursework.

The first year was quite hard with all the demands on our time.  They kept us really busy rushing around campus - in and out of labs and of course the infamous anatomy lab experience.  Personally speaking, I am really happy anatomy lab is done!  No more smelly scrubs or feelings of dread.  I think the first year was hazing at it's best.  In fact, I am reading a few books on this subject currently that I found in the down town library.  Portland's library is quite extensive and impressive!

Now that we are heading further into our coursework, there is a new found respect that is being given to all of us by our professors.  At times, when a student has a question, they are called on as "doctor".  We get an ego lift from this, of course, because during the first year we were practically smacked around at the leisure of our instructors.  Maybe it is because they know how hard the first year is and their respect for us has grown.  If I was a betting man, I would bet on that notion.

Friday, during our clinical topics course, Dr. Bhalerao asked who was planning on using any "techniques" and which ones.  The class was practically silent with only a few hands that stuck up in the crowd.  Those who did say they were going to use a technique were thinking of such ones as Graston technique, a soft tissue therapy technique that is logically sound, ART which is another therapeutic technique based in science and the use of the Activator tool.  I couldn't tell if he was referring to using the methodology of the technique or just the tool, I will assume he was referring to the tool only.  Regardless, I have decided it isn't my job (anymore) to judge those who choose to use a pseudoscientific technique as it is their choice, not mine.  Besides, I think my constant nagging about the "other side" of chiropractic is getting old, at least for me it is and may be causing more harm than good.  If someone does become a proponent of a technique, I'd like to learn why it is they made this choice, if they want to share, that is.  

Our soft tissue instructor got on his soap box today about banding together as a profession.  He claimed the public views chiropractic weirdly because they don't understand what we do.  That may be true, but I must stick to my opinion in regards to the weirdness they correlate us to falling directly on the theorist's shoulders.  He also said there is a place for subluxation theory as long as it is practiced ethically.  Unfortunately, ethics relies on logic and epistemology and technique systems lack in both areas.  In my opinion, ethics cannot be obtained through systems that lack evidence or legitimate scientific srutinization.  That is all I will say about that, for now.

I thought it was interesting how he gave reference to structure having genetic influence on function.  This means mechanical stress may also have genetic repercussions, good or bad.  It makes sense when thinking of scoliosis or bone spurs forming from poor joint mechanics.  Manual medicine definitely has a place among the sciences.  It is exciting to venture into new territory.

Thanks for reading.

Indomitability

I read this word, indomitable, and felt it was worth writing a post about.  What does this weird word mean?  

Impossible to subdue or defeat.

I felt this word was incredibly applicable to the experiences I and all the other DC students are currently undergoing.  What keeps us going?  What is it that drives us to circumnavigate this torturous existence?   Is it merely fortitude or something deeper?  I personally can't answer this for any of you, but I can answer it for myself.

In 2005, I unfortunately got tangled up into an unethical chiropractors web of fraud.  It all started when I decided to open a personal training business tied with a chiropractic office.  Sean Toner, the chiropractor, told me it was okay to operate under his license as long as I used the insurance codes he gave me.  Being a naive personal trainer, I thought this seemed legitimate, so I began building my business under his license.  A year went by and everything seemed fine.  I was billing (with the codes he provided me) for the services I rendered such as: initial consultations, fitness assessments, medical bike fit, and strength training sessions.  Unfortunately, I didn't know he was fraudulently billing my services as chiropractic services such as:  diagnosis codes and x-rays.  He got caught, of course, and I escaped the web by closing my business and pursuing pre-med.  

Still today, I find myself reliving the nightmare of losing my business to a fraudulent DC.  I wonder if others will do the same as Sean did to me.  This is why I am fighting to put an end to the theorist chiropractors out there because Sean was a theorist and he got caught up in making a ton of money.  He affected my life in the extreme sense and 4 other massage therapists who operated their businesses under him (under that same trust as I).  He surrendered his license to practice chiropractic in Arizona and was found guilty of defrauding the insurance company, Blue Cross.  He practices in the midwest under surveillance of the FBI currently.  Go Sean!!

I walked away with an enormous amount of debt (double the amount needed to go to DC school and that is what I intend to pay back).  During the times I was really busy, I had 100 regular clients/patients per month.  My business made about $7,000-9,000 per month at that time.  The lifestyle that followed such a money flow consisted of a 1/4 million dollar town home, a $65,000 Infiniti FX 35 and a lucrative travel budget for my race team (cycling team, like the Tour riders).  It was a dream come true for me.  I was coaching athletes, teaching regular clients a good way to live and following my passion.  It all vanished within a week.  I was left with an enormous monthly outflow that I could not sustain, so I took out a few private student aid loans that skyrocketed my overall school loan debt.  

It took me a year to gain a foothold in the market in Flagstaff Arizona when I opened my business and I anticipate it taking me about the same when I get out of school, so I have no worries.

I know a lack of education was the main culprit for all of the problems that I endured (and continue to endure).  This is why I want chiropractic to change.  I want to see ethics become the norm rather than deception.  

I now understand why many chiropractors choose the traditional route versus the modern path of conservative primary care when they get out of school.  Their debt is huge, their business loans are enormous and their goals are too large.  See, Sean could have done things right if he somehow integrated me into his treatment plan for his patients, but he allowed me and 5 other massage therapists to operate independently.  This was a mistake.  He could have had me build plans for his patients (core stability etc) if he was smart, but he learned he could make more money off of me by having me operate on my own.  Sad for him, he lost his license and paid back Blue Cross over $250,000 (this is all publicly documented if you are interested).

Unfortunately, he is practicing in the midwest somewhere and is most likely doing the same thing as before.  

I wonder sometimes, if some of my classmates will do the same thing as Sean.  I hear men and women saying they plan on making a lot of money etc., etc., and I hope they don't try to grow too fast.  In my opinion, those who think this way should be forced to take an ethics course or two.  The system is set up to force those who don't know shit about business to run businesses, so they rush for the money and screw innocent bystanders.  If we were selling popsicles, that would be another story, but we are selling health care.   

The problem is that there is no real supervision for practicing DC's.  We operate independently and free from critique.  Many times, the stupid DC decides to use a technique system that makes them feel as if they have all the answers.  This is why people like me are suffering to pay their bills!  The selfish needs of weak minded DC's causes a ripple effect that goes beyond what most people can understand.  This is because the expense to the the new DC is huge when they start out and this plays a role in the decision of whether to buy into subluxation theory or not.  Those who buy into this theory are weak minded and lack integrity.  

That is all I have for now. 

Integrating the Organic Movement into Chiropractic

During the two week break I found myself reading a lot about the organic movement or better yet, the green movement.  I have always had an interest in this subject primarily because I believe most disease is caused by our lifestyle choices.  Many books have been written showing an enormous amount of data linking pathology to diet and exercise consumption.  One of which is, Native Nutrition.  Another more recent addition to this collection of disturbing data is Food Inc.

I purchased the book, Food Inc., at the beginning of the break at Powell's bookstore, which is a documentary style book focused entirely on our nations food supply and its production.  It was eye opening to read about how much of our food is genetically engineered, hormonally enhanced and nutritionally flawed.  My initial belief that lifestyle causes most disease was firmly supported after each and every chapter I read.  It disgusts me to think the poor can only afford the cheapest food which is supplied by the major industrialized farms.  Mass production of food is made quicker, dirtier and cheaper so the parties involved in the process can make the most money they can.  All the while, the workforce involved in this vast game of philanthropy gets to work in horrible conditions and is paid minimally.  To top it off, the disturbing rate at which hormonally enhanced animals grow has been equated to a newborn child growing to be 350 lbs by its second birthday!  Ethically speaking, these animals cannot sustain this growth rate structurally, which leaves them in chronic pain during their short lives.  If we are what we eat, I guess we too are genetically engineered, hormonally enhanced and nutritionally flawed.

The organic/green movement targets all of these issues with industrialized food production by approaching food growth naturally.  No pesticides, growth hormones or antibiotics are used in the production of organic foods, all of which have been linked to health problems in those who consume them.  Many believe the green movement is all about being a hippy or unrealistic but I am not a hippy or unrealistic.  Before the industrial revolution our food supply was completely organic and natural.  And guess what?  The diseases that run rampant in our country today were not the main killers back then.  The way of life these folks lived was much more active than today's society too.  Of course, they had other issues like starvation and infection.  We must try to balance the equation so we don't starve but rid ourselves of disease though proper lifestyle choices.

I have thought a lot about how to integrate my future chiropractic practice into the organic movement.  Out of any health care profession, chiropractic has the potential to really push this concept forward.  As the leading alternative medicine profession, we should adopt the organic/green ideology and integrate ourselves into the abundance of research being produced on this important social change.  If we want to prevent disease we must look beyond merely adjusting people.  

The way in which we choose to practice chiropractic is a personal decision each of us has to make.  In my opinion, these decisions take work and a far greater understanding of what the health of our nation needs than what our personal convictions are.  I know my ideology will change as more time passes in this program, as will many of my colleagues.  I am open to learning and growing.  In my opinion, if we stay unconvinced until evidence proves otherwise, we will set ourselves up to grow into logically sound doctors.   Those who are searching for a quick answer to bite onto so that uncertainty begins to wain, I feel bad for you and only hope you can be strong enough to take the time to search for your OWN answers which are based in science and evidence.   That being said, I know chiropractic palpation skills rely heavily on the individual doing the palpating.  Therefore, there will always be significant difference between each and every chiropractor.  There is still a logical and ethical way to practice even if the actual science of chiropractic is not fully developed.  It seems to me that there is an incredible amount of gray area when it comes to the decision to adjust or not to adjust due to this lack of evidence.  And most of the time science or evidence is left to the individual doing the palpating - not equipment or instruments showing evidence.  I think we can all help people regardless of the evidence as long as we do not convince the patient a "certain" theory is the answer to all their health care needs (I think we all know which theory that is).

If we choose to practice outside the realm of science, we will be looked down upon by the majority of the public and the continued scrutinization of our profession by our medical counterparts will continue.  We need to "buck up" and do the work to be competitive in the healthcare market.  Personally, it disgusts me when our professors say it is okay to believe in magic or high volume/low quality practices.  There shouldn't be a choice as to whether we practice witchcraft or focus entirely on adjusting quickly.  How will we keep enough room in our schedules to be a quality doctor without jeopardizing the real needs of our patients?  I can't answer this currently but I can speculate that this will take an enormous amount of work and practice to become efficient.  I also believe it will take a fair amount of knowledge in Health Psychology and behavior modification interventions.  Of which, we have no scheduled or formal training in this area to speak of in the program.  

Two weeks ago, I took the liberty to go to the public library downtown to find books on how to manifest my worldview as well as integrate psychological teachings into my future practice.  I hobbled away from the library with 5 books to read.  It is my hope that by figuring out how I view the world and by learning how to integrate psychology into my bag of tools, every class I take in chiropractic school will develop my foundation further.  By pursuing this, I have an enormous amount of motivation this quarter to succeed.  

It is my hope through writing about these topics, not only will I formulate my own ideas for the future but also help others do the same - regardless if my opinions rub you the right or wrong way.  I know there are quite a few folks who read my blog that do not "sign up", if you will.  There is nothing wrong with this.  I encourage those who wish to discuss these things further to add a comment at the end of the blog post.

Thanks for reading