Reaching a Diagnosis

Dubious · 11-10-2012, 08:31 PM

Quote:

Originally Posted by Dr. Smith

Documented by whom? Many things have been published, and while rare, vertebro-basilar stroke is only one of the risks associated with chiropractic.

In short, there are at least two sides (and often more) to any/every issue. Reports published by chiropractors tend to support chiropractic; reports by others tend to be more objective, or biased in other directions.

Even the Mayo Clinic, one of the most conservative sites online, which grants:

still cautions:

IMO, both sides should be examined to get a balanced perspective.
risks of chiropractic includes articles by both chiropractic proponents and opponents. Each patient must ultimately decide for themselves if the risks justify the benefits.

Doc

Haldeman's review was balanced; he is a medical doctor, a neurologist out of UC Irvine, California a medical teaching institution with his first degree prior to that being a doctor of chiropractic (he does not practice this as far as I know). His work is still quoted more than most others regarding manipulative adverse events. There are other researchers, i.e. Dr. David Cassidy out of Canada, Rand Corporation, etc. with most coming to the same general conlcusions; that while no procedure is 100% safe, in comparison to surgery and medications, the risk of adverse event from manipulation is minute.

Then there are extremist, on both sides, with the owner of Quackwatch being a psychologist (think he knows much about manual medicine? I don't know, I'm just say'in) and on the other side, the "straights" who are a group within chiropractic who think all disease can be cured by an "adjustment." Both are whacked, in my humble opinion and neither have performed controlled peer-reviewed papers on the subject, at least to my knowlege! And I am not sure I agree with the statement that a paper from a D.C. is biased while a paper from an M.D. is not. Junk science knows no ideological or academic boundries. The power of a paper lies in it's research design, whether it's a clincial trial, review or meta-analysis, controlled or not, blinded or not, intrinsic and extrinsic biases and so forth. So I think you would agree that a series of well constructed research papers whose results consistently are in agreement are probably more reliable than anyone's web page opinion, no matter who owns it!

As far as chiropractors publishing mostly positive literature about itself, I suppose that's sometimes true but you could say that about any organized body of knowlege (Big Pharm). BTW, one of the major contributors to the Quackwatch site was from a group of chiropractors called NACM (National Association of Chiropractic Medicine), who was harder on it's own profession than just about anyone. Right or wrong, they bashed the living he** out of chiropractic.

So in short, I think we agree.....right?!

Dubious · 11-10-2012, 08:58 PM

Quote:

Originally Posted by Dr. Smith

Documented by whom? Many things have been published, and while rare, vertebro-basilar stroke is only one of the risks associated with chiropractic.

In short, there are at least two sides (and often more) to any/every issue. Reports published by chiropractors tend to support chiropractic; reports by others tend to be more objective, or biased in other directions.

Even the Mayo Clinic, one of the most conservative sites online, which grants:

still cautions:

IMO, both sides should be examined to get a balanced perspective.
risks of chiropractic includes articles by both chiropractic proponents and opponents. Each patient must ultimately decide for themselves if the risks justify the benefits.

Doc

Oh...I forgot this one:

Risk of Vertebrobasilar Stroke and Chiropractic Care
Results of a Population-Based Case-Control and Case-Crossover Study
Spine. 2008 Feb 15;33(4 Suppl):S176-83.
by Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ.
(5)

STUDY DESIGN: Population-based, case-control and case-crossover study. OBJECTIVE: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.
SUMMARY OF BACKGROUND DATA: Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke.
METHODS: Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.
RESULTS: There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.
CONCLUSION: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

Embarrasing, I know! Could this mean that people were more likely to suffer a stroke after seeing their PCP than seeing a chiropractor? Wow....really?

Dr. Smith · 11-12-2012, 01:29 PM

Quote:

Originally Posted by Dubious

Junk science knows no ideological or academic boundries. The power of a paper lies in it's research design, whether it's a clincial trial, review or meta-analysis, controlled or not, blinded or not, intrinsic and extrinsic biases and so forth. So I think you would agree that a series of well constructed research papers whose results consistently are in agreement are probably more reliable than anyone's web page opinion, no matter who owns it!
....
So in short, I think we agree.....right?

No, not entirely, and I would include anecdotal evidence as being unreliable. But since you brought up (not verbatim) well-designed, controlled scientific studies, in the 1987 court decision that forced the AMA's change in position on chiropractic,

Quote:

Judge Getzendanner also went out of her way to make clear what she was not doing:

The plaintiffs [chiropractors] clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study... No such study has ever been done.*** In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence.

http://en.wikipedia.org/wiki/Wilk_v....al_Association

*** I'm still not aware of any such study.

I have done my own homework, and IMO, chiropractic is still pseudo-science/quackery, and I will not allow a chiropractor to come anywhere near my spine or any other part of me.

Doc

Dubious · 11-12-2012, 03:01 PM

Quote:

Originally Posted by Dr. Smith

No, not entirely, and I would include anecdotal evidence as being unreliable. But since you brought up (not verbatim) well-designed, controlled scientific studies, in the 1987 court decision that forced the AMA's change in position on chiropractic,

*** I'm still not aware of any such study.

I have done my own homework, and IMO, chiropractic is still pseudo-science/quackery, and I will not allow a chiropractor to come anywhere near my spine or any other part of me.

Doc

OMG! Really....1987 Wilks v. AMA?

That suit was to get the AMA off of the backs of the chiropractors as they were instituting an illegal boycott of the the profession. It was not to validate efficacy and outcomes of manipulation. That would come later and since then, there has been almost 3 decades of research to that end (you can't find what your not looking for) since that suit ended!

And I hate to tell you but Wilks, a chiropractor, won the suit spurring a plethora of ensuing research (by MD's, PhD's, DC's, etc) validating manipulation and opened up open referals between the two profession that benefited everyone, that once existed before the AMA boycott.

Look Doc, no one is going to force a quackerpractor on you or anyone else and I could certainly tell you about a lot of unbelieveable crazy crap I've seen them do but let's at least be accurate in our degradation and trashing of a profession!

wllwrt4fd · 11-20-2012, 11:05 AM

Indication: Numbness of legs

Technique: MRI lumbar spine with sagittal and axial T1 and T2
weighted images, postcontrast sagittal and axial T1-weighted images.

Contrast: 11 mL Multihance IV.

Findings: Alignment is near-anatomic. Vertebral body and disk
heights relatively preserved. No suspicious focal T1 dark marrow
lesions. Small Schmorl's nodes are noted at some levels for example
superior endplate L3. No significant compromise of the canal or
neural foramina at any level. Distal cord and conus is within normal
limits position T12/L1 and roots of cauda equina appear within normal
limits.

Probable nerve root sheath cyst noted along the extraforaminal S1
nerve root and to a lesser extent S2 nerve roots more proximal, not
uncommonly seen.

No abnormal enhancement cord, cauda equina, or coverings.

Impression: Unremarkable MRI lumbar spine except for probable nerve
root sheath cysts associated with right S1 greater than S2 nerve
roots, not uncommonly seen. No explanation for bilateral lower
extremity numbness.

Dubious · 11-20-2012, 11:53 PM

Quote:

Originally Posted by wllwrt4fd

Indication: Numbness of legs

Technique: MRI lumbar spine with sagittal and axial T1 and T2
weighted images, postcontrast sagittal and axial T1-weighted images.

Contrast: 11 mL Multihance IV.

Findings: Alignment is near-anatomic. Vertebral body and disk
heights relatively preserved. No suspicious focal T1 dark marrow
lesions. Small Schmorl's nodes are noted at some levels for example
superior endplate L3. No significant compromise of the canal or
neural foramina at any level. Distal cord and conus is within normal
limits position T12/L1 and roots of cauda equina appear within normal
limits.

Probable nerve root sheath cyst noted along the extraforaminal S1
nerve root and to a lesser extent S2 nerve roots more proximal, not
uncommonly seen.

No abnormal enhancement cord, cauda equina, or coverings.

Impression: Unremarkable MRI lumbar spine except for probable nerve
root sheath cysts associated with right S1 greater than S2 nerve
roots, not uncommonly seen. No explanation for bilateral lower
extremity numbness.

These are not huge findings but does underscore the necessity to correlate your physical exam findings with your imaging findings or lack thereof.

I assume that all has been exhausted looking for metabolic causes? At this point, if all has been explored, it may be time to go fishing for the outlires. From what I am reading, your issues are more sensory than they are inclusive of motor involvement so less common neurodiagnostic tests like DSSEP's (derma somatasensonsory evoked potentials) do tests the sensory portion of the nervous system and may be worthy of persuing should your profile warrent it. It is possible that your symptoms could be coming from higher up and probably should now be considered but I wouldn't put a lot of stock in that direction...

Good luck!

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