^{Dr. Frisch}

Happy New Year!

I hope that all of you had a happy and festive Holiday Season with your family and friends.  Now, however, its time to get back to work!

This month, I am going to bring you some interesting, and also somewhat disturbing information in the health care field, but there will also be some exciting news as well.

The new year reminds me of a plaque that I have hanging in my bathroom at home.  It says "Hello God of second chances and new beginnings, it's me again!"  

As adults, we know that we can't change the past, but learning from our mistakes does influence our future in more ways than you realize.  This newsletter reveals some intriguing material in that regard. 

I wonder if you have ever thought about why I write this newsletter?  Yes it is to inform you of things happening in the office and in the world around you, but there is more to it than just giving you information that you can regurgitate. 

There is a level of understanding and knowledge that you take with you after having read my newsletters.  This knowledge allows 'you to understand you' more clearly.  Some people figured this out long ago, but not everyone has seen the importance of reading my monthly newsletter.  With this issue, I hope to change that!

Please Read On......

For those people who may have been living under rock, there traditionally has been a supposed bias against chiropractic by our 'cousins' in the medical profession. This accusation is not completely unfounded, but it is typically driven by fear, insecurity and unfortunately, economics!

A recent publication of the Occupational Medicine Practice Guidelines proves that a bias still exists against chiropractic and that deceit is still common. In the latest edition, the OMPG uses research extracted from the Work Loss Data Institute, an independent database development company, to determine appropriate guidelines for administering chiropractic care. In California, these guidelines have even been adopted by the legislature for administering worker’s compensation benefits. The problem with the guidelines is that all data is ‘presumed to be correct’.

If the term ‘presumed to be correct’ sounds a little odd to you, that’s good, it stuck out like a sore thumb to me too! Those of you who are patients at my clinic are used to hearing me talk about reproducibility, research outcomes and how the Activator Technique^® eliminates the guesswork involved with treating injuries. Much of the chiropractic profession however is not so lucky. They must still rely on empirical data (…x amount of patients with this condition said that they got better…) to justify that what they do actually works. They do not have an object, reproducible measure to determine success with daily treatment.

This is precisely what allowed the new medical bias to occur. The medical profession took a consensus (survey) of their supposed ‘best and brightest’ minds to determine physical medicine (chiropractic) guidelines. They only consulted with ONE, RETIRED CHIROPRACTOR to gain insight into what would be appropriate guidelines for chiropractic. The rest of the minds involved were medical doctors with no experience, education, or specialty in treating physical injuries. They did not even consult with the American Chiropractic Association or established chiropractic treatment organizations to review their recommendations. If this sounds underhanded to you, then you are smarter than the California legislature!

Their recommendation survey would be akin to asking me to give recommendations for open heart surgery or advice on the appropriate care guidelines for performing a C-section. The Occupational Medicine Practice Guidelines are just that ridiculous! The problem is that we may actually be fighting this type of lunacy in Minnesota in the very near future. The reason for this is that HMO’s began in Minnesota and then spread to the rest of the country. It usually takes very little time for some novel experiment in health care to end up here, usually at the expense of the citizens of Minnesota.

If you weren’t surprised by the article on chiropractic bias by the medical profession then maybe you can relate to a local bias by our own Health and Human Services in the State of Minnesota. A recent publication on allowable services by the Metropolitan Health Plan for the upcoming year of 2005 had a bit of deceit as well.

On Christmas Eve morning, I received an update flier on services that would not be covered for patients on certain State of Minnesota health programs. It is common that needed services like examinations, consultations, therapy, acupuncture, and even x-rays are denied, even though the patient needs and often receives that service (I know that patients like to believe that their doctor is actually paid for performing these services, but that is rarely the case.)

This year, however, there was a slight twist to the typical game of health care. On the bottom of the ‘denied services list’ was the word ACTIVATOR. Someone tried to ‘sneak’ an actual adjusting technique into the list of non-covered therapies. There are dozens of differing adjusting methods in chiropractic with the Activator Technique^® being the second most commonly used, and having the most supporting research data of effectiveness of any technique in the world. This error was intentional. It was an attempt to deny chiropractic services by ‘picking away’ at core elements of traditional care. Others, if they even noticed, would merely say, "Well at least it isn’t my technique that they are picking on." Needless to say, I was slight irritated.

Christmas Eve morning I drafted two letters, one to the attorney who represents Activator Methods International, and a second to the Office of the Minnesota Attorney General (Remember my internship?). Telephone calls followed. My intent was to make both parties aware of what was happening with MHP and to ask for an investigation. Neither party was aware of what was happening, but I was assured that they would look into it.

I believe that MHP was testing the waters to see what they could get away with. There was an obvious ulterior motive by one or more individuals within the medical, chiropractic or insurance industry to consciously exclude a chiropractic technique. This was a bold and calculated move by which someone would benefit. It is very unsettling to think that ‘one of your own’ may have a hand in this dastardly move.

I may never know exactly who was responsible in this attempt to eliminate the most research-supported branch of chiropractic from Minnesota State services, but I have been assured by the Activator Methods counsel that it won’t happen. Action will be taken! Activator Methods International was responsible for inclusion of the Activator Technique^® in the Federal Medicare Guidelines specifically due to the supporting research. As I write this article I have not heard back from the Attorney General’s Office, but they were just as surprised as I was during our conversation. Since a Federal precedent has been established, any individual attempt to change protocol is highly unlikely. The AG’s office, however, will take a serious look at this issue and they will take action to insure that Minnesota citizens are not being harmed. I should receive their reply within the next several weeks.

The Incredible You

The body is an incredible mechanical and electrical organism.  It allows your heart to beat, blood to flow and even allows growth from an infant to 6'-5" tall!  How does this happen?

We are genetically programmed to be male or female, sound a certain way, and yes, even look like our parents!  It is said that 30% of who we are is directly attributable to our genetic programming.  There are, however, variations that can and do occur for any number of reasons.

First, imagine that your DNA is like the electrical box in your garage or basement.  Each switch controls some aspect of your house.  One may control your appliances, while another the lights in you living room.  The wiring is set and permanent.  You may notice, if you look, that there are several 'empty slots' in the electrical panel.  These blank areas are for future wiring and switches may be inserted as needed.

Your DNA is similar to this, but slightly different.  You have many characteristics, traits and even disease potentials on your DNA that are not active and may never be active.  It can take a set of circumstances to make these trait potentials occur.  Stress, diet, and even environmental triggers may cause specific sites to activate and result in weight gain, bronchial disease and even cancer.  We cannot be sure what will happen under any specific set of circumstances, only our genetic code will know.

Using this premise of body change or disease as a result of mental or physical stressors it can be easy to see why some people fall into the trap of the fatalists.  You know who the fatalists are.  They are the people running around telling you:

•  Don't eat butter, it's bad for you.  

• Second-hand smoke will kill you.

• Chlorine in the water is unhealthy.

• Aluminum in deodorant causes cancer.

There may be a grain of truth to what the fatalist says, but they often don't know what they are talking about or have an ulterior motive to get you to act a certain way.  Sitting next to a disrespectful smoker will not be enough exposure to give you cancer, it is more complicated than that.  Let me give you an example of what I mean.

A recent study published this month (January 2005) in the Journal of Bone and Mineral Metabolism analyzed the impact of aluminum accumulation in the behavior of cortical bone in rats.  This was a unique study in that it discover that when confronted with heavy doses of aluminum, the cortex of bone remodeled itself, under heavy loading, to become stronger, but in a different way than would normally be expected.  Only at toxic levels was the bone unable to recover from exposure. 

What this study really says is that when we are exposed to elements like aluminum, the end result may not be toxicity and injury or disease.  Our bodies do have an underlying, genetic coding to deal with exposure to potentially lethal elements.  Only at true toxic levels does our body fail to recover.

This study proves that the body can recover from exposure without our conscious help, but we should all be aware, and still be careful not to abandon common sense!

Remember, everything in moderation!

Eileen's Corner

2 tablespoons olive oil

2 or 3 cloves garlic, minced

1 can (49 oz.) chicken broth (Italian-flavored or low fat)*

1 can (15 oz.) stewed tomatoes (Italian-flavored)

1 package (10 oz.) frozen chopped spinach, thawed and well drained

1 package(19 oz.) frozen cheese tortellini

Parmesan cheese, grated (optional)

*Be sure to have extra broth, as soup will thicken when it sets.

Heat oil in a medium soup kettle.  Add garlic and sauté lightly.  Add broth, tomatoes, spinach and tortellini.  Simmer for 20-30 minutes.  Serve with Parmesan cheese on top.

If you are unable to find Italian-flavored broth, you can add Italian seasonings of your choice

You may also find that you have more tortellini and vegetables than broth when you are done eating.  Simply add more broth and refrigerate for the next day.  The 'new broth' will season overnight.

Have a great New Year!

Eileen

The idea that long-term, chronic pain can make a person feel depressed is not a new one. In fact, every person who suffers with chronic pain will say that the pain ‘gets them down’ or that they ‘just don’t have the energy that they used to’. This along with irritability, lack of concentration, and even lapses of memory are associated with a depressed state. Often medication is recommended for chronic pain and it is of some benefit, but it rarely eliminates the pain. If the pain reduces somewhat, however, the individual is usually happy. 

The brain is a large sensory receptor that receives information from the outside world via the nervous system. When signals of physical pain are received, they are diverted so that the brain can continue to receive information. The diversion of pain results in localized muscle spasming and a release of pain reducing endorphins from the brain. We will call this the ‘protective mechanism’ of the body. As I have told patients many times, the brain has a body so that it can go to the store. It doesn’t care if it limps to the store, so long as it can still get there. The body’s healing process is often crude.

What happens if the brain’s pain diversion mechanism fails? This causes the pain to become a primary focus of attention for the brain and an area of the brain called the Limbic System becomes activated. The Limbic System, as you may remember from prior newsletters, functions in memory, emotion, and behavior. The chronic pain sufferer may not feel like their old self because their brain actually changes how it functions! Physical pain has now induced psychological changes.

Another amazing avenue of chronic pain is that depression can actually induce physical pain. This process is actually easier than one might believe.

Activation of the Limbic System (emotion) as a result of true depression induces a release of chemicals, hormones and neurotransmitters that make the brain and body behave in a certain manner. A misfiring of chemicals and neurotransmitters like Serotonin and Norepinephrine (Mood) results in a deregulation of this area of the brain. Mood swings are common, but so is physical joint and muscle pain.

The Depressed Person is often told that their pain is all in their head. This is not true, but it may have actually started there!

Fibromyalgia is a classic example of this type of pain. There is no physical reason for the pain, but brain scans do show an increase of activity in the Limbic System pain centers in those people. It has been proposed that the Fibromyalgia sufferer may have actually developed a sensitivity to physical and mental discomfort.

First, chiropractic works through the nervous system to affect a physical change and homeostasis within the body. This does have an affect on brain function and states of perceived pain. To break the pain cycle is the first step in correcting the imbalance of chronic pain and depression.

Secondly, the pain programs that we use in the clinic directly access the Limbic system to affect a chemical balance between the brain and the body. Altering the improper signals and firing mechanism is much like hitting the ‘control-alt-delete’ sequence on your computer to reset the system. The benefit is significant and immediately noticeable.

When these two forms of therapy are used together, a more successful result is achieved than using either alone.

Something New

Care Cards

Some of you may have already received Care Cards in your statements or picked one up while in the office.  If you have seen them, you may already understand how they work. 

The purpose of Care Cards is for you to share with others!

Over the years I have been asked by patients to give them something that they can give to others so that they can come to my office for an evaluation.  They wanted more than just a generic business card or a solicitation brochure.

I have always been uncomfortable with offering 'free this and free that', like other clinics do because there is always a catch with that approach to attracting patients (The patients know it too!).

The difference with Care Cards is that when you give it to someone, your name and phone number are on the back of the card!  There are two reasons for this:

• When your name and number are on the back of the card, it is a direct gift from you to some else.  It is a personal endorsement from you.

• When someone enters the office with a Care Card and your name and number are on the back, we know who to thank!

 I think that Care Cards will be a wonderful addition to the office.  We will always have extra on hand so don't be afraid to ask if you don't see them!

Take Care and Have a Great First Month of 2005!

Dr. Frisch