The Efficiency Trap

When I first started my chiropractic practice, I had a goal of adjusting 1000 patients over the course of a week.  There were other doctors in Hawaii who were hitting this mark and I aspired to be like them.

I have since crossed this goal off my list.  Not because I achieved it.  Not because I dejectedly deem it to be an impossible dream.

I no longer shoot for the 1000 PV/week milestone because I realize that to achieve this goal I would have to become extremely efficient.  My chiropractic practice would need to become a model of efficiency.

Wait a minute.  What's wrong with that?

Well, in a highly efficient chiropractic practice, patients need to flow in and out of the office like clockwork. Patients would need to hop on and off my adjusting table like parts on an assembly line. There's no time to chat.  No time to ask questions.  No time to consider new, original procedures to make healing more effective.  In a sad way, patients almost cease to be people-- just spines to be worked on.

The problem with focusing on efficiency is that it very often diminishes a person's desire and capacity to focus on effectiveness.

When you are constantly thinking about how many possible patients you can cram into your practice's schedule book, it's easy to start to neglect the unique needs of each individual patient.

As each patient gets treated more and more the same way with streamlined policies and techniques with little variation among those adjusted, the efficient practice becomes more like a factory than a clinic of effective healing.

Adjust with Honor

This is my motto for the new year.

As a chiropractor, it is my job to find areas in the spine that are out of alignment and then help restore that subluxation back to proper position and function.

Performing this service with honor means that while I adjust I must try my best to keep my focus sharp, integrity pure, and heart open.

I also realize that my motto extends far beyond the realm of chiropractic.

In all facets of my life, I intend to adjust with honor.

In that, I will be ever-vigilant to discover those areas in my life that are not in alignment with my code-- my principles and values.  And then after diagnosing these misaligned areas of my character, diligently work to correct those flaws.

Origami and Chiropractic

Origami intrigues me.

One night a few months back, I happened to watch on Netflix a PBS documentary, Between the Folds.

While debates ebb and flow on issues of folding technique, symbolism and purpose, this unique film shows how closely art and science are intertwined. The medium of paper folding—a simple blank, uncut square—emerges as a resounding metaphor for the creative potential for transformation in all of us.

What appealed to me the most about this movie was realizing the interesting similarity between origami and chiropractic.

Painting is the fine art of addition-- the application of oils or acrylics onto a canvas.  Medical drug therapy is also about adding: ingesting something from the outside, hoping that the effects of the merging of the drug with the body leads to something good.

Sculpting marble or carving wood is the fine art of subtraction-- the careful removal of unwanted pieces.  Medical surgery is also about subtracting: cutting out something that is damaged and pathological, hoping that the removal of the undesirable part leads to something good.

The art of paper folding simply transforms what is there without adding or subtracting.  The parameters of the spine, like the single square piece of origami paper, are set and constant. The chiropractor, like the origami artist, can only create through controlled application of force and pressure.  Nothing is affixed.  Nothing is combined or connected.  Neither is anything purged.  No cuts.  No rips.

And yet, despite the absence of the art of addition and subtraction, both chiropractic and origami when done correctly with wisdom and dexterity, yield incredible, amazing results.

An elegant paper crane emerges.

An optimal nervous system allows the flow of innate intelligence.

Art, science, and philosophy manifested.

Break Past the Mindset

Note from Dr. Shiraki: The following is a guest post written by Dr. Rodger Niemi, a principled chiropractor from Tacoma, Washington.  He currently adjusts spines at the Renaissance Chiropractic Center.

People are inundated with pharmaceutical marketing on TV, in print and even online.  Our emails are bombarded with messages about cheap deals on various medications.

How do you break past the mindset that everything that ills you can be solved by a pill?  The reality is that the medications may relieve your pain for a time, but inevitably, the pain returns in force.  Many people live day to day popping over-the-counter pain medications like Skittles, unaware of the continued degeneration progressing under these suppressed warning signs.

What if we could get more of these people in to see us to correct their poor posture, their fixated joints, their lost motion?   Even if we could only improve the quality of their daily life by 10 percent, decreasing the amount of medication that they needed on a daily basis-- what a difference that could make in the world today!

If you have not seen a chiropractor, why not?   If you do, have you sent your family and friends to be checked?  Who do you know that needs to be seen?  The need for corrective care is vast,  the need for maintenance is even greater.

Chiropractic and the Correction of Adolescent Scoliosis

I am frequently asked if chiropractic can do anything to correct childhood and adolescent scoliosis.

The short answer is "YES!"

The long answer is best shared with this awesome testimonial letter that I received from a long time patient and friend, Bert Smits (posted with his permission):

In October 2000, when our son Jason was just six years old, he was diagnosed with a malignant brain tumor. He underwent ten hours of surgery to remove the tumor followed by extensive chemotherapy and radiation for the year thereafter. Jason is now thirteen and cancer free. He does however, still have many disabilities due to post surgery and the treatments that he incurred during this period.

While being examined during one of his routine follow ups, which occur about every three months, mild scoliosis was noticed initially to an extent of a 12 degree misalignment. The doctor said that nothing could be done initially, and that we should monitor his condition with a yearly follow up. Over the course of the next two years, his condition worsened, and our conventional doctors could do nothing about this except monitor its progression. We later took him to Shriners Childrens Hospital where they specialize in orthopedic conditions such as treating scoliosis and bone conditions. His x-rays were concerning, showing what now looked to me like severe bending of Jason’s spine. We were informed that his spine had a 24 degree misalignment and was told that at approximately 26 to 40 degrees of curvature, a full body back brace would need to be worn 23 hours a day, 7 days a week. We asked if there were any alternatives and was told that there was no scientific proof that there was any other remedy proven to work.

We asked our chiropractor, Dr. Reed Shiraki, to look at Jason’s x-rays. He told us that he thought he could prevent the worsening of his scoliosis, if not improve his condition with regular chiropractic care and specific daily exercises. My first thought was that it probably wouldn’t work, but that it was also the least intensive procedure, and that it couldn’t hurt. We felt it was worth a try to keep Jason out of a full body brace.

Three months later, when returning to Shriners for his follow up exam, Jason’s x-rays showed remarkable progress. I immediately saw a change in his spinal misalignment, and when his orthopedic surgeon formally measured the amount of curvature, Jason had corrected by 4 degrees to only a 20 degree misalignment, definitely making him a non-candidate for a full body brace. I can only attribute this correction to the regimen prescribed by Dr. Shiraki as Jason’s scoliosis had worsened over time until getting regular chiropractic care.

We continue to follow Dr. Shiraki’s advice and hope to continue to see progress in the correction of Jason’s scoliosis. Thank you, Dr. Reed, for continuing to help Jason. As the family struggles with his disabilities, it’s very comforting to know that what looked like another big hurdle for Jason appears to be resolving.

 Jason and Me

Chronic Pain Solutions

There are two kinds of chronic pain.  One type is the condition described in my previous post.  The original injury has healed, but the brain for some reason continues to perceive pain.

The other type of chronic, lingering pain is due to the original injury not healing completely before that same area is traumatized again.  An example may be a basketball player who sprains his ankle and keeps playing on it week after week without proper rest and rehab.

If I see a patient who suffers chronic pain from consistent re-injury, my job is to help stabilize and align the inflamed area and help modify daily activities for maximum healing potential.

If the patient has chronic pain without a specific, active, acutely injured trauma, I recommend the following:

Chiropractic Adjustments to Remove Nerve Signal Interference

A vertebral subluxation (misalignment) at the area of the backbone near a traumatized area will apply a pressure on the nerve root as it branches from the spinal cord.  This pressure will interfere with the nerve signal flow.  Like a radio not tuned exactly to the proper station, the brain receiving a "pinched" signal may express the nerve transmission as distorted, confused.  This "nerve-static" can be perceived by the brain as a nagging pain seemingly from that injury which has already healed.

Stretching to Harmonize Mind and Body

Stretching the muscle does not just affect the muscle fibers.  As any practitioner of yoga will tell you, stretching the body, when done right can relax the mind and calm the spirit.  Also, tight muscles are not just a by-product of stress but an exacerbating factor that increases stress.  The physical-emotional link of stress is most definitely a chronic pain trigger.  And you do not necessarily need to take up a yoga class to enjoy these benefits.  Fifteen minutes a day of mindful stretching and deep breathing with a relaxed attitude can do much to relieve chronic pain.

Antioxidant Therapy to Relieve Oxidative Stress

Oxidative stress is a result of free radical damage.  Something we cannot avoid because it is a direct result of our cellular metabolism and its use of oxygen.  It is something that also increases with age.  Also,  poor diet, smoking, alcohol and drugs can accelerate free radical damage.  Oxidative stress has been linked to conditions like arthritis, diabetes, heart disease, and high blood pressure.  The brain that generates chronic pain signals may be doing so because of oxidative stress.  Antioxidants help to control free radicals.  The most powerful antioxidants are the enzymes and molecules, like glutathione, which are already created within us on a cellular level, but there are also nutritional supplements full of antioxidants from plant sources.

Watch this video to discover what I feel is the best antioxidant therapy out there.  (Disclaimer: I do sell this product and own stock in the company that makes this supplement.)

Hydration for Proper Brain Function

Half our body weight in ounces.  That's what we need to drink every day.  A 150 pound man, for example, should drink 75 ounces of water a day.  KG Stiles explains in an online article:

Nerve transmission is heavily dependent upon water. Small waterways, or micro-streams run along the full length of your nerves. These streams float the neurotransmitters along microtubules to the nerve endings.

When your body is dehydrated, nerve transmission is compromised and brain function strongly diminished. Chronic nerve pain can simply be the end result of chronic dehydration.

Exercise Because No Pain, No Gain

Ask any athlete who works out on a regular basis.  Post workout pain is expected.  Not just expected, but sought after on most days.  Aside from the fact that this pain indicates the process of muscle mass building and increasing muscle strength, the workout pain "hardens" a person-- toughens the tissues, focuses the mind and provides a stress outlet.  As the inner-athlete emerges, the person begins to associate pain with progress and fitness.  Pain is no longer the enemy, but becomes in a strange way more of an annoying friend.

It should be said that this workout pain mentioned here is entirely different from the pain that may occur when one unwisely injures him or herself by using incorrect technique or pushing towards inappropriate exercise limits.  And yes there's a fine line...

Chronic Pain: Body Healed but Brain Signals Distorted

Dr. Sean Mackey, an associate professor at Stanford University, was quoted in an article in the February 2008 issue of Best Life entitled "The Psychology of Back Pain".

The standard model of pain-- the same model that is taught in every medical school (and chiropractic school)-- is that you treat the pain by fixing the underlying pathology.  We're now beginning to recognize that you can't talk about chronic pain without talking about its psychological aspects.  It's a condition in which signals from the body are literally distorted by the brain.

In other words, most doctors will try to diagnose the cause of a person's pain, be it perhaps a muscle strain, osteoarthritis, a ligament tear, an inflamed nerve, a subluxated vertebra, etc.  Then after an accurate diagnosis, the appropriate treatment is assigned.  For a medical doctor, the fix may be a drug or a surgical procedure.  For a chiropractor, the fix is more times than not a spinal adjustment.

However, Dr. Mackey claims that this mechanistic approach to pain elimination may not be effective when the pain is chronic.  "Chronic" meaning that even though the injury has healed sufficiently, the pain still persists.  For some reason, the brain still perceives pain from an area of previous trauma that should no longer be generating neuroactive chemicals.  There should no longer be a significant inflammatory response which triggers a pain cascade up along the central nervous system.

Think of it this way: the brain is still getting "phone calls of pain" but the caller on the other end is no longer there dialing. (Cue the Twilight Zone music.)

So what can we do about the chronic pain ghost signals?

I will write up some suggestions in my next post.  Stay tuned.

The Killer Flu and Chiropractic

I took this from the November 2009 newsletter written by Dr. Tedd Koren:

These are statistics from the 1918-1919 killer flu which killed millions under medical care:

• The Palmer School of Chiropractic had one death out of 1,635 cases while Iowa DCs reported 6 deaths out of 4,735 cases.
• MDs (Davenport) lost one patient out of every 15 (6,116 deaths out of 93,590 patients).

[Rhodes WR. The Official History of Chiropractic in Texas. Austin, TX: Texas Chiropractic Association. 1978 andChiropractic statistics. The Chiropractic Research and Review Service. Indianapolis, IN: Burton Shields Press. 1925.]

Once infected by a virus, why would a chiropractic patient do better than a medical patient back then?

And today, 90 years later, wouldn't the same hold true?

Localization and Prevention

“Localization: the determination of the points at which functions or pathological conditions originate.” (pg. 207)

                                                      --Lippincott’s New Medical Dictionary

When a patient receives a migraine medication, like RELPAX or Imitrex, has the problem truly been localized?  Nope.  The drug is prescribed to cover up the pain, not to eliminate the cause of the headache.  In fact, in most cases, the exact cause of the migraine is never discovered.

The obvious problem with focusing only on alleviating the symptom instead of going after the cause is that the source of the problem remains ignored.  So why do most patients accept the omission of localization from their doctors?  Simply because the drugs make it feel like things are getting better.  The pain is relieved and without the pain indicator, many are fooled into thinking the source of the symptom has been taken care of... but in reality, the cause of the pathological condition persists.  And often times worsens day by day.

If the migraine is caused by a subluxated atlas, correct that subluxation!

You can take all the prescription medications you want, but no matter how many pills you pop, the drugs will never ever move that misaligned vertebra back into place.

It is interesting that this principle of localization applies to most of the problems we encounter in life-- whether these problems be physical, financial, or even spiritual.  We need to be aware of the root cause of whatever crisis we are in and work to correct that root cause instead of desperately searching for quick fixes to eliminate the pain.

The higher principle of localization is, of course, prevention.  Successful prevention of a painful crisis occurs when we determine a pathological condition way before that problem elicits any suffering.  This is the wisdom behind wellness, wealth and inner peace.

"There is a time in the life of every problem when it is big enough to see, yet small enough to solve."

                                                                                --Mike Leavitt

Recommendations

I make my recommendations and my patients decide to either:

A)  Follow my recommendations exactly

B)  Ignore my recommendations completely

C)  Modify my recommendations into something that "works" for them

I have found that many choose to do "C".

And I am fine with this.  But there are times when...

I may tell my patient that they should start their chiropractic care with three adjustments a week.  However, a patient may decide that they want to get adjusted only once a week instead.  And then two months later, because the pain is still there, they begin to doubt that chiropractic really works.

Or I may recommend that my patient continues regular chiropractic adjustments even after the pain is eliminated, in order to continue with spinal correction and healing and maintenance.  But often times, after attaining relief, the patient disappears... only to give me a call some time later down the road to schedule a quick-fix now that the pain has come back (often coming back with a vengeance).

If I know that the patient knows, I do my very best and try not to say, "I told you so.  You should have listened to me."  Sometimes, I may need to explain again the reasons behind my recommendations.  In as nice a way, as respectful a way, as I can.

It does get frustrating at times.  But I am ultimately fine with it, because:

A)  I recognize and respect the free agency within us all to choose what we feel is best for our own health

B)  I rather adjust a person once than never

C)  For myself, I detest it when someone tries to manipulate me with guilt, money and fear to do what they might think is best for me.  So why would I do this to another?

I know of some very well-respected chiropractors who will absolutely refuse to accept a patient who does not follow their recommendations with exactness.  They will turn him away and shut the door.

I have been taught by the "experts" about the need for a doctor to "draw a line in the sand" and refuse to offer care to anyone who dares to step over the line in disobedience.  If we hold people to a higher standard, they argue, it can only elevate our patients to a place of more excellent health and integrity.

On the other hand, "tough love" arguments aside, individuals are unique.  Circumstances vary.  What works here and now may not apply there and later.  Our recommendations are not laws set in stone, commandments from on high.  They are instead, simply the suggestions of one with a specialized education and applicable experience.

Who am I to resent a person, deny a person, who is not in alignment with the way I see things?

Where is the mercy, understanding, and compassion in denying another because he or she doesn't want to play by my rules?

Rather than kicking people out, my responsibility is to accept where the patient is at and respect their decisions even when they conflict with my recommendations.  Then, I must educate.  Enlighten a person with tact and gentleness to see the worth and benefits in doing things "my way."  Use acceptance and love, and there is a chance they may come around.

Expel that person from the practice, and there is no chance whatsoever!