Question
Dr. Botnick:

Thank you for replying to my email.

It's been nearly 2 months since I first emailed you regarding my neck problems.  Although you answered my questions, I truly was not happy with some of your answers.  I will go into that later.  However, I still have a couple questions that I forgot to ask you initially.

1. I had a cervical discogram performed on me and it came back positive at 2 levels.  Could you explain how this would affect the prognosis of my neck symptoms and how physical therapy (your recommendations) would help over a chiropractic rehab regimen which my chiropractic performs?

2. How would neck surgery help me get better if I have scar tissue and other issues to deal with for the rest of my life?  Not to mention drug addiction to pain medications!  Many people are shying away from medications and surgery due to their side effects and major complications.  More and more people becoming increasing more aware and are smarter about their health than just dropping on the operating table to be cut open before utilizing conservative treatment first!  Neck and back pain issues are not cosmetic surgical options!  I don't see how pills cure muscle and joint problems.  Pain pills just mask the problem but the problem (injury) remains present!

Answering those 2 questions/comments would be appreciated.  Now I would like to comment on your previous email answers below.

Your answer to one of my questions reads like this:

"Because of the lack of regulation I find that in general patients usually get superior care from qualified medical professionals rather than chiropractors.  However, they may occasionally find bad MDs and good DCs, but the odds are against it."

This comment is very scary, not only for me but the general public.  This is completely false because I've done my homework.  Chiropractic has a national licensing board (National Board of Chiropractic Examiners) and 50 state licensing boards.  A chiropractic doctor cannot sit for any state board without passing the national boards first - right?  Additionally, each chiropractic school has its own post-graduate programs for additional doctor training in specialized areas (ex. Sports, Rehab, Orthopedics, Neurology, etc.).  Isn't this true too?  I ask you Dr. Botnick, what specialty are you certified in?  One can only call themselves an expert if they have qualified and certified training in that field.

Your comment about "superior care from qualified medical professionals" couldn't be farther from the truth.  Did you know that there are over 500,000 people that die from taking medications each year alone!  Did you know there are over 100,000 surgeries performed each year performed on the wrong part of the body!  These are real statistical facts that I found on a governmental website for the public.  There are many other medical statistics that would astound you regarding the perils of medicine, but I don't want to scare anyone.  My chiropractor treats several MD's ( 2 are surgeons) for spinal ailments at his office.  Why do these MD's see my chiropractor (one who I actually met) when according to you, they can go to PT's and surgeons that could help more objectively?  The MD I met is a drug addiction specialist.  His comments were very disturbing.  His job is to get people off pain medication abuse, not illegal drugs.  He also stated that pain medication abuse is in epidemic proportions.  What is your comment on that Dr. Botnick!

A story closer to my heart is that of a neighbor of mine who died 2 years ago on the operating table.  She went in for a routine mastectomy.  The surgeon performed the operation to the wrong breast.  The family states she died due to an allergic reaction to medication given during the surgery - death from allergic reaction to meds (all for the wrong breast)!  That Dr. Botnick is quite scary!  MD's are no more qualified than any other regulated professionals.  They just have bigger pocket books and more lobbying power.  However, more and more people are experiencing great benefits with alternative health care.  You're a chiropractor - you should know this!

My chiropractor has many certificates and many years of post-graduate certified training.  He wanted me to share some with you.  He has a certificate as a sports practitioner (CCSP), spinal trauma (CCST), qualified medical examiner (QME), diplomate chiropractic orthopedics (DABCO) and has at least 5 other certificates that I don't have time to list.  I don't know what all these acronyms mean (I know you do Dr. Botnick) but I do know he is very well trained and a knowledgeable doctor.  Regarding the last 4 paragraphs I touched on, is this what you mean by "lack of regulation" within chiropractic?  Although it may seem that I am defending my chiropractor, this is not why I bring this up.  However, I would defend any qualified professional, MD or DC or DO, etc.  You seem to be a traitor within your own chiropractic profession.  This truly bothers me as a consumer advocate because if I didn't know any better, I wouldn't know who to believe!

Second comment regarding my disc problem.  You stated that I should:

"get an examination by a MD or DO physiatrist and then be referred to a Physical Therapist who had trained in spinal rehabilitation and manipulation.  PTs manipulate just as well as DCs and are more objective."

I already commented above regarding statistical medical perils.  Let me add that I went to 3 different PT's for several weeks while on medication for 2 years and I didn't get better.  In fact, at one point I was in bed for over one week as a result of performing an exercise a PT required of me that the orthopedic MD did not authorize.  This made me worse and I was referred to another PT facility.  I truly realized at that time that PT's were really limited in their scope of practice.  Additionally, the 3 PT's I saw during this period had never performed manipulation on me nor did they ask if I wanted it.

How is it that you state that "PTs manipulate just as well as DCs and are more objective" when that is not their specialty.  That is like going to a general surgeon for spinal surgery.  Yes, they are able to perform surgery as surgeons but they leave that specialized area to orthopedic surgeons (I hope I am correct) to do that procedure.  From my understanding, chiropractors specialize in manipulation of the spine and have done so for over 105 years - am I correct?  Isn't that why over 25 million Americans across the nation see chiropractors each and every year.  And this number continues to grow!  Americans do not see chiropractors for medications or surgery, although chiropractors are licensed to perform physiotherapy.

You also stated that "You may have muscular or bone problems that the chiropractor has completely overlooked.  The physiatrist/PT route I described above is my recommendation."  What bone or muscular problems do you think I have or what are you referring to?  My orthopedic MD stated my x-rays were normal 2 years ago.  My chiropractor stated my recent (4 month old) x-rays were also normal.  What do you mean?  My muscles have been in spasm for over 2 years and was first evaluated by the othopedic MD I went to.  This was also confirmed by my chiropractor who actually did something about it.  You too are a chiropractor and you too have this training - right?  Couldn't you take an x-ray, diagnose my condition and treat my condition as did my chiropractor?  How long have you been in private practice Dr. Botnick?  Were you ever in private practice?

I sensed some resentment in the answers you gave me in my email.  I feel you have bashed your own profession for reasons that remain unclear, maybe for some gain or maybe just anger or frustration held within you.  Nonetheless, there are millions of Americans that love their chiropractor and get fantastic results from their services.  I recently found out that many chiropractors work closely with other MD colleagues on a referral basis - my chiropractor does!

I have never been to a chiropractor prior to my last 4 months.  However, he has changed my life tremendously.  I had severe, debilitating neck pain (9 out of 10) for 2 years while on medications and participated in PT for several weeks.  I was told I needed surgery by this orthopedic MD 6 months after starting treatment with him and that I had no other choice.  Why didn't the orthopedic MD send me to a chiropractor?  I had to take it upon myself to see a chiropractor for the first time in my life and now my pain is manageable (3-4 out of 10).  I am not on pain medications any longer, pain pills that may destroy my liver and kidneys and hinder my longevity of life.  The chiropractic treatments I have experienced have been worth every penny.  I am doing things I haven't done with my family in over 2 years!  Life is good again!

Lastly Dr. Botnick, could you comment on a procedure called Endoscopic Diskectomy.  I hear it's been used for several years now but few surgeons perform this procedure.  I am confused about this surgical procedure because I met a patient at my chiropractor's office that had this procedure done to his neck 2 months ago.  He was in and out of the surgery in one day and back to work within 3 working days.  He felt great for about 4 weeks and then the problems started.  Now he suffers from more pain today (8 out of 10) than before (5 out of 10) the surgery.  He has not received spinal manipulation or PT therapy to his neck since the surgery as his surgeon did not feel it was indicated.  He is now hooked on pain pills again and was not on medications during the chiropractic care before the surgery.  He looked very unhappy when I spoke to him.  Can you please comment on this surgical procedure and how surgery can make people worse and hooked on pain pills.  Thank you.

Again, I do apologize for the lengthy content.  However, I feel these issues are important as there are probably tens or thousands of Americans that suffer from spine related pain as I do and can get pain relief without surgery.

Thanks Again,
Linda
-------------------------
Followup To
Question -
I see that you are an expert in chiropractic misinformation and chiropractic techniques.  Maybe you can help me. I've been drugged up for over 2 year by several MD's and my neck pain has never gotten better. I also had tingling in my arms and hands.  I never even got an MRI done from these medical doctor bo-zo's.

I went to a chiropractor 3 months ago (name witheld).  He is the only one concerned enough to perform an MRI.  He discovered 3 levels of disc herniations and is the only doctor who continues to relieve my symptoms.

Being the expert that you claim to be, I have spent over 2000.00 cash in 3 months and seen this chiro 3 times a week since day one.  He does not accept insurance.  Am I spending too much for care or does it matter if I am getting better after 2 years of hell with medicine?  Are you a chiropractor advocate or a medical doctor advocate?  Have you helped people with 3-4 mm neck disc bulges or sent them to surgery?  Should I continue with the therapy or stop and find someone cheaper and less knowledgable?

Sorry for all the questions.  I am very leary of doctors that claim they are experts.  Most love to shoot off their mouth about theory as they were never successful in private practice.  I am truly interested in what advise you have for me.

Linda
Answer -
I'm really sorry that you are having such a rough time.  There's really no way for me to know if your MDs did a good job in your case-the best thing to do is to get a second opinion from a knowledgeable specialist.  However, I can't see a rationale for taking medication for 2 years given your problem.

Herniated disks alone aren't necessarily a problem, it depends on your symptoms.  Lots of people have herniations and no pain.  So just because disks are herniated on MRI that doesn't mean that they are the cause of your pain.  However, if you have signs of decreased nerve function specific to that disk along with the herniation it is likely that it is involved.  Another possibility occurs when the hole that the spinal cord passes through is too tight so there is less space for a protruding disk; this is called spinal stenosis.  Sometimes patients have adhesions of the nerve roots that are painful and need to be released either through surgery or special physical therapy techniques.

>Being the expert that you claim to be, I have spent over 2000.00 cash in 3 months and seen this chiro 3 times a week since day one. He does not accept insurance. Am I spending too much for care or does it matter if I am getting better after 2 years of hell with medicine?

If you are getting better that is a good sign.  Spinal manipulation is a good way to help relax and retrain nerve endings in the joints of the spine when necessary.  Sometimes following trauma these nerves can become overactive (aka facilitated) and cause recurring muscle spasms, poor coordination and neck pain.  Spinal manipulation is excellent for breaking this cycle.

However, you need to be aware that many chiropractors are fanatical and try to use spinal manipulation alone for every situation, often inappropriately.  Most have insufficient training in rehabilitation of the spine and diagnosis.  The field is poorly regulated and it's very hard for a patient to know how good a practitioner is.  

Because of these problems I generally recommend that patients get an examination by a MD or DO physiatrist and then be referred to a Physical Therapist who had trained in spinal rehabilitation and manipulation.  PTs manipulate just as well as DCs and are more objective.

>Are you a chiropractor advocate or a medical doctor advocate?

Because of the lack of regulation I find that in general patients usually get superior care from qualified medical professionals rather than chiropractors.  However, they may occasionally find bad MDs and good DCs, but the odds are against it.

>Have you helped people with 3-4 mm neck disc bulges or sent them to surgery? Should I continue with the therapy or stop and find someone cheaper and less knowledgable?

As I said before, it remains in question whether the disk is the problem.  Certainly if manipulation helped it wasn't because it did anything to help the disk.  Manipulation does not help disks.

If you've had three months of manipulation I tend to think that there isn't a reason that your neck would continue to need additional manipulation.  Three times per week for three months sounds like he is treating you too much.  If your neck is still in pain then it would be worthwhile for you to try other treatment options.  You may have muscular or bone problems that the chiropractor has completely overlooked.  The physiatrist/PT route I described above is my recommendation.

>Sorry for all the questions. I am very leary of doctors that claim they are experts. Most love to shoot off their mouth about theory as they were never successful in private practice. I am truly interested in what advise you have for me.

It's good to be careful.  Just make sure the advice you're being given is accurate and not a sales pitch.

ajb


Answer
Dear Linda-

>1. I had a cervical discogram performed on me and it came back positive at 2 levels. Could you explain how this would affect the prognosis of my neck symptoms and how physical therapy (your recommendations) would help over a chiropractic rehab regimen which my chiropractic performs?

That is a test finding not a diagnosis.  I can't comment without a diagnosis because tests for cervical disks depend on the patients symptoms and exam findings also.  If you have been diagnosed accurately and your chiropractor is giving you evidence based spinal rehabilitation then there should be no difference except that the chiropractor will probably use manipulation in addition to the rehabilitation.  The manipulation may make your neck sore by itself which would be uncomfortable.

>2. How would neck surgery help me get better if I have scar tissue and other issues to deal with for the rest of my life? Not to mention drug addiction to pain medications! Many people are shying away from medications and surgery due to their side effects and major complications. More and more people becoming increasing more aware and are smarter about their health than just dropping on the operating table to be cut open before utilizing conservative treatment first! Neck and back pain issues are not cosmetic surgical options! I don't see how pills cure muscle and joint problems. Pain pills just mask the problem but the problem (injury) remains present!

My earlier answer said that if you had a nerve root adhesion then surgery would be indicated to release it since manipulation can't do this.


>"Because of the lack of regulation I find that in general patients usually get superior care from qualified medical professionals rather than chiropractors. However, they may occasionally find bad MDs and good DCs, but the odds are against it."

>This is completely false because I've done my homework. Chiropractic has a national licensing board (National Board of Chiropractic Examiners) and 50 state licensing boards. A chiropractic doctor cannot sit for any state board without passing the national boards first - right?

Yes

>Additionally, each chiropractic school has its own post-graduate programs for additional doctor training in specialized areas (ex. Sports, Rehab, Orthopedics, Neurology, etc.). Isn't this true too?

Yes

>I ask you Dr. Botnick, what specialty are you certified in? One can only call themselves an expert if they have qualified and certified training in that field.

There is no additional certification for general chiropractic other than the NBCE exams and state licenses.

>Your comment about "superior care from qualified medical professionals" couldn't be farther from the truth. Did you know that there are over 500,000 people that die from taking medications each year alone!

You are mistaken that this indicates chiropractic is safer.  Chiropractors treat much easier cases.  Also medical mistakes have nothing to do with chiropractic problems.

>My chiropractor treats several MD's ( 2 are surgeons) for spinal ailments at his office. Why do these MD's see my chiropractor (one who I actually met) when according to you, they can go to PT's and surgeons that could help more objectively?

MDs often don't know much about chiropractic.  Just because these two are going doesn't prove that the treatment is necessary one way or the other.

>The MD I met is a drug addiction specialist. His comments were very disturbing. His job is to get people off pain medication abuse, not illegal drugs. He also stated that pain medication abuse is in epidemic proportions. What is your comment on that Dr. Botnick!

Medication is only one treatment.  When prescribed appropriately it does a lot of good.

>MD's are no more qualified than any other regulated professionals.

This is totally false.  Chiropractic regulation is not science based.  They can and do literally teach anything without evidence.

>My chiropractor has many certificates and many years of post-graduate certified training. He wanted me to share some with you. He has a certificate as a sports practitioner (CCSP), spinal trauma (CCST), qualified medical examiner (QME), diplomate chiropractic orthopedics (DABCO) and has at least 5 other certificates that I don't have time to list. I don't know what all these acronyms mean (I know you do Dr. Botnick) but I do know he is very well trained and a knowledgeable doctor. Regarding the last 4 paragraphs I touched on, is this what you mean by "lack of regulation" within chiropractic?

I mean that in many states chiropractors aren't required or permitted the tests and exams to do as accurate a diagnosis as medical doctors and so put patients at risk by missing diseases and misdiagnosing.

>How is it that you state that "PTs manipulate just as well as DCs and are more objective" when that is not their specialty.

Most of the research done on manipulation is done on PTs.  You don't have to attend a four year DC program to learn it.  You know nothing about chiropractic technique but are lecturing me.

>You also stated that "You may have muscular or bone problems that the chiropractor has completely overlooked. The physiatrist/PT route I described above is my recommendation." What bone or muscular problems do you think I have or what are you referring to?

This is really to involved to get into.  You should ask a physiatrist.

>My orthopedic MD stated my x-rays were normal 2 years ago. My chiropractor stated my recent (4 month old) x-rays were also normal. What do you mean? My muscles have been in spasm for over 2 years and was first evaluated by the othopedic MD I went to. This was also confirmed by my chiropractor who actually did something about it. You too are a chiropractor and you too have this training - right? Couldn't you take an x-ray, diagnose my condition and treat my condition as did my chiropractor?

Not knowing exactly what your DC did I can't comment.

>How long have you been in private practice Dr. Botnick? Were you ever in private practice?

I practiced over a period of two years.

>I have never been to a chiropractor prior to my last 4 months. However, he has changed my life tremendously. I had severe, debilitating neck pain (9 out of 10) for 2 years while on medications and participated in PT for several weeks. I was told I needed surgery by this orthopedic MD 6 months after starting treatment with him and that I had no other choice. Why didn't the orthopedic MD send me to a chiropractor?

You should ask him that.

>I had to take it upon myself to see a chiropractor for the first time in my life and now my pain is manageable (3-4 out of 10). I am not on pain medications any longer, pain pills that may destroy my liver and kidneys and hinder my longevity of life. The chiropractic treatments I have experienced have been worth every penny. I am doing things I haven't done with my family in over 2 years! Life is good again!

In my earlier answer I tried to say that there are a few chiropractors trained to do rehab well but that overall they are hard to find.  Likewise some physical therapists are very good at it while some are terrible.  You have to ask for their qualifications.  

>Lastly Dr. Botnick, could you comment on a procedure called Endoscopic Diskectomy. I hear it's been used for several years now but few surgeons perform this procedure.

This is outside of my expertise since it is a medical procedure.  You'll have to ask your medical doctor.

>Again, I do apologize for the lengthy content. However, I feel these issues are important as there are probably tens or thousands of Americans that suffer from spine related pain as I do and can get pain relief without surgery.

Certainly some people are helped from manipulation however it is a fact that most chiropractors do not diagnose as well as medical doctors and overutilize manipulation harming patients.  I'm glad you seem to be improving however this doesn't mean that the profession does not have problems.

Please read the book 揑nside Chiropractic?and visit www.chirobase.org for some facts that you are not aware of.

Sincerely,
AB