Miracles vs. Politics

We as chiropractors have seen numerous cases in which a patient's response to treatment has been nothing short of miraculous. Shortly after graduation, while working as an associate, I had the opportunity to treat a patient whose seven-year-long bout of daily dull headaches came to an end after I rendered her first cervical spine adjustment. With a follow-up cervical adjustment one week later, the hearing in her left ear returned for the first time in seven years.

She had initially presented with low back pain, and when realizing good results, asked if I could do something for her stiff neck. Further examination revealed no counterindications for manipulative therapy, and with each of the two treatments to her cervical spine, a previously unknown condition was alleviated. To the patient, this was nothing short of a miracle, and although I was extremely pleased to see such a dramatic result, I was also shocked to find out from the patient that during my history-taking, she had purposefully left out information, and not answered my questions accurately.

She had suffered from a substantially decreased and "muffled" sense of hearing in her left ear, and daily "two aspirin"-style headaches for the past seven years, after being hit from behind in an auto accident. She had omitted this information from her history because she "didn't think chiropractic could help these conditions." After her accident, her physician treated her with pain medications, and told her these symptoms would probably self-resolve eventually. However, over time, she had become convinced that these problems were permanent and that nothing could be done.

This scenario is nothing new to most of us, but 17 years later, I experienced a situation that is not so commonplace, and for most of us, would be considered a once-in-a-lifetime event.

After 16 years in private practice, I sold my practice due to a series of personal events. Having been a radiologic technologist prior to becoming a chiropractor, I returned to this profession for income purposes. While employed at a local hospital in this capacity, I encountered staff members who were prior patients, and acquaintances who were aware of my also being a chiropractor. I rapidly became the department chiropractor, treating technologists, nurses, and at one point, an emergency room physician. I was frequently questioned about personal conditions and hypothetical scenarios. Some of the radiologists would show me film and ask, "Would you treat a person who looked like this?" I experienced all the negative comments one would expect in this environment, but six months into my position, in July 2004, an event occurred that brought about changes in comments.

Early in that month, a patient was involved in a motor vehicle accident in which he sustained numerous fractures, one being a fractured odontoid process. His odontoid process was sheared off mid-process. The anterior aspect of C1 was thus located posterior and about 0.5 cm inferior to the fracture site, and the fractured segment of the odontoid had traveled along with C1, being held in place by the transverse ligament. The concern for this particular fracture was obviously the possibility of cord damage or impingement. His lateral C-spine X-ray looked like a textbook example of the cervical fractures that cause fatalities or quadriplegia.

One week later, I was called to the intensive care unit to perform cervical spine films on this patient, who miraculously, still had extremity movement, albeit less than ideal. The orthopedist had just placed the patient in a halo device and wanted to check the alignment of his spine in relationship to the head. This orthopedist was familiar with chiropractic, and didn't have the traditional opinion of chiropractors held by most orthopedists. Upon reviewing the films with the orthopedist, I made the joking comment, "What do you think, doc, do you want me to adjust that C1 back into place?" He replied, "Yeah, let's go do it." My follow-up comment had something to do with limits of malpractice, followed by a laugh ... and I walked away.

I then took another look at the lateral film, and even with the memories of classroom lectures telling us to never touch anything that looked like this, I began to believe that the idea was not so far-fetched. I suggested to the ortho that it appeared the transverse ligament might still be intact, and that if the head could be placed in slight traction, it might be possible to contact the posterior arch of C1, and lightly slide it forward away from the cord to reposition the displaced segment. He agreed, indicating that this was what he was trying to do, but needed help, and that since I was a chiropractor and more adept at feeling the vertebrae, I was perfect for the job.

In the ICU, he loosened the halo, applied traction to the patient's head, and as I contacted the posterior aspect of C1 and moved forward, he let up on the traction and tightened the halo. At this point, I took another lateral C-spine view, which confirmed what we had hoped to see: the displaced segment approximating its pre-fracture position almost exactly. In the midst of our jubilation, I overheard one ICU nurse ask another, "I thought he was an X-ray tech; is he a doctor?" The other nurse replied, "He is an X-ray tech, but he's also a chiropractor."

Over the next few days, I noticed two reactions to this event. One reaction was positive comments from staff and physicians; the other was the administration's concern regarding their potential liabilities.

With obvious instability still persisting, the patient was placed in a torso brace that attached to the halo, and approximately six weeks after his accident, although still requiring the halo apparatus for a period of time, he walked out of the hospital. The patient's family thanked me, stating they felt it was a miracle that I happened to be there at that point in time. My feeling was that the miracles here were that this patient actually survived this injury, and that his orthopedist had the faith in the ability of a chiropractor to perform the procedure.

I bring these stories up in an effort to emphasize the importance of educating not only the public, but also the medical community as to the benefits of spinal manipulative care. Far too much time has been spent in political feuding between the two professions - time that could have been used to benefit more patients and create more miraculous stories. I see far too many health professionals practicing politics and greed, and exercising archaic professional prejudice while the primary focus for all health professionals seems to go unconsidered: the welfare of the patient.

Many medical professionals and organizations have come to proclaim the benefits of spinal manipulation; some lobby to include it in their scope of practice, but most continue to profess that chiropractors should not be the ones to provide it. More politics! Why is it so hard to give up the old ways that separate us all, and embrace a new attitude of cooperation for the benefit of us all? Greed, politics, and the fear of change are denying us all the miracles we deserve.

As a final comment, and in making my own political statement, I want to applaud those instrumental in bringing about the addition of chiropractic to the Veterans Administration (VA) care system. As controversial as some may see it, I believe it will make a good first step in bringing care providers together.

Robert McCullough, DC
Atascadero, California