The indomitable and eminently quotable Teddy Roosevelt once declared, "A man who is good enough to shed his blood for the country is good enough to be given a square deal afterwards." Without too much wordsmithing, I could easily substitute "clinician" for "country" and "diagnosis" for "deal" and wind up with: "A man who is good enough to shed his blood for the clinician is good enough to be given a square diagnosis afterwards" or "A physician who is good enough to draw blood from the patient is good enough to give a square deal afterwards."
This is my plea for enabling clinicians - particularly doctors of chiropractic - to perform more intensive and intelligent bloodwork in their diagnostic examinations. Almost two decades ago, when I first considered getting into chiropractic research, already having had extensive experience directing clinical chemistry programs at a Harvard teaching hospital and then at an affiliate of the Mayo Clinic, I was deeply impressed by the curricula in laboratory diagnosis offered by such chiropractic institutions as National and Northwestern. My feeling was that with this exposure, the chiropractic profession was being given the tools to arrive at early and significant diagnoses in their patient examinations - particularly since I had seen poor preparation in this area for hospital staff and actually had designed my own course in clinical chemistry to try to rectify this situation. The reality, unfortunately, is that state regulations involving blood drawing often act as one of several disincentives for chiropractors to put such a powerful diagnostic tool into everyday practice.
The fact remains, however, that if the term subluxation is to be viewed from a progressive, 21st century perspective (as I have suggested in this space previously),5 it is pertinent to consider a variety of early warning signs throughout the body beyond fixations within the spine. These would include abnormal levels of an assortment of analytes within the blood serum that may very well occur subclinically, but that would still qualify as early indications for prompt intervention. The table below is but the smallest sampling of clinical problems that are disclosed with what have become routine determinations in blood serum alone, often automated.
Other analytes that may impress some as being a bit removed from the beaten track, but which are still easily assayed, include aldosterone and homocysteine. Elevated levels of aldosterone may be of significance in that they are associated not only with elevated blood pressure,6 but also vascular inflammation leading to congestive heart failure.7 The situation with homocysteine is far more complex, since elevated levels have been linked to vascular disease,8 cervical artery dissection,9 stroke,10 bone resorption,11 leukoariosis (white matter disease),12 brain natruietic peptide (associated with chronic heart failure),13-14 and hearing loss.15 Finally, interleukin-6 acts as a pro-inflammatory cytokine which is secreted by T-cells and macrophages to stimulate immune responses to trauma. It runs into trouble in that it functions as a key intermediate in the formation and rupture of atherosclerotic deposits along the arterial wall,16-17 eventually leading to cardiovascular events such as myocardial infarctions.
It turns out that there is more than just a casual connection of blood chemistry to chiropractic. Besides just making good sense to inform the patient, knowing about the levels of such analytes as these has resulted in several lines of research that speak loudly to the potential value of spinal manipulation beyond the musculoskeletal system:
What these preliminary data tell us is that there are systemic indicators of metabolic imbalances that are measurable through the assay of blood serum components which cannot be ignored. Several lines of evidence also point to the conclusion that spinal manipulation may lead, at least in the short term, to the suppression of inflammatory intermediates, many of which lead to coronary heart disease26 and the vascular effects which so often and often so erroneously have often been said to be the consequence of cervical manipulation.27-28
Serum blood determinations have much to do with the future of both the practice and research of chiropractic, and as such should be strongly encouraged. The conceptual limitation of spinal manipulation to vertebral fixations without this broader view is, in my opinion, an impediment to the potentials of chiropractic as an integrated approach to health care.
| BLOOD SERUM ANALYTE1 | CLINICAL SIGNIFICANCE | |
| Enzymes [elevations]: | ||
| Acid phosphatase Alanine aminotransferase Aldolase Alkaline phosphatase Amylase Aspartate aminotransferase Creatine kinase Glutamate dehydrogenase N-glutamyl transferase Lactate dehydrogenase Trypsin(ogen) | Carcinoma of prostate Hepatic parenchymal disease Muscle disease Bone and hepatobiliary diseases Pancreatic diseases Myocardial infarction, hepatic parenchymal Diseases, muscle disease Myocardial infarction, muscle diseases Hepatic parenchymal disease Hepatobiliary disease, alcoholism Hepatic parenchymal disease Pancreatic diseases | |
| Proteins: | ||
| IgG elevation IgA elevation IgM elevation Monoclonal Ig's (paraproteins) Alpha-antitrypsin defi ciency Troponin2 C-reactive protein (CRP)3 elevation Interleukin-6 elevation4 | Autoimmune response Skin, gut, respiratory, renal infections Primary viral infections, blood serum infection Neoplasms Congenital defi ciency, neonatal respiratory distress syndrome Myocardial infarction Myocardial infarction risk factor Atherosclerosis intermediate, CRP precursor | |
| Carbohydrates [elevations]: | ||
| Glucose Glycosylated hemoglobin | Diabetes mellitus Diabetes mellitus | |
| Electrolytes: | ||
| Sodium defi ciency Sodium elevation Potassium defi ciency Potassium excess Chloride defi ciency Chloride excess Total carbon dioxide defi ciency Total carbon dioxide elevation | Excessive sweating, prolonged vomiting, severe polyruria, metabolic acidosis Hyperaldosteronism, hyperadrenocorticism (Cushing's syndrome) Alkalosis, primary or secondary aldosteronism, postoperative therapy with potassium-poor Acute or end-stage renal failure Salt-losing nephritis, certain metabolic acidoses, prolonged vomiting Dehydration, renal tubular acidosis, acute renal Renal failure, respiratory alkalosis Metabolic alkalosis, respiratory acidosis |
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
